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TKR Post surgery - Finally!

Sometimes a setback can take longer to recover from than we expect, especially in the early months. We have all been there, done that! :flwrysmile:
 
I'm sorry, BarabooProud. It sounds like you're still in the ODIC (Over Did It Club) but making your way toward the exit. :wink: Keep resting and chillin':ice:and feel better soon!

BarabooProud said:
This recovery is definitely not a linear progression!!
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You have that right!
[Bonesmart.org] Post surgery - Finally!

May each day be better than the one before.
 
Hi all,

I need to be reminded that if my flexion is 109 and my extension is 2, it's fine. I'm going to PT and doing exercises at home, but I'm not gaining much lately. I'll be at 7 weeks tomorrow. My physical therapist isn't worried, so it's more myself that is wanting more progress, I guess. :bored:
 
BarabooProud said:
My physical therapist isn't worried,
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Your therapist is right! At less than 2 months post-op, there is still lots of internal swelling in that knee (even if it doesn't show on the outside). As the inflammation gradually dissipates, your ROM will increase all on its own.

Don't push for it -- that's counterproductive because it will increase the swelling.

My surgeon likes to say: The most important muscle to exercise in this recovery is the Patience Muscle!
 
benne68 said:
The most important muscle to exercise in this recovery is the Patience Muscle!
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Boy, that's the truth!! I'm getting impatient! I know I'm making progress - sleep is getting better and better, I'm able to stand longer without pain, I don't need to ice quite as much, etc. But, I would love better flexion!!
 
Remember that this is that changes and improvements will come over the next YEAR. You’ll be functional long before that, but there are still small successes that come with more time. Stay focused on listening to your body’s signals that will tell you when you can challenge yourself a little more and when those times come that you’ve overdone it and you need to scale back a bit. Your therapist is right on target.
 
BarabooProud said:
need to be reminded that if my flexion is 109 and my extension is 2, it's fine
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I honestly don't know what my flexion was at 7 weeks because no one measured me or troubled me about it. It probably was about your level and it increased gradually back to just a few degrees less than my unoperated side over the first year to 18 months. I was pretty hypermobile and I now have 150 degrees. The only thing I can't do is sit fully back in child's pose or a standing quad stretch.
If you follow BoneSmart advice and just do lots of gentle movements/ stretches but don't force your knee or hurt it ( which will cause inflammation) you will recover to your natural level. The best predictor of post TKR/ PKR ROM is your pre-op level. If you have been stiff for years then the muscles will have contracted and the higher degrees of flexion may not be possible. Even so gradual stretching, without pain, using say pilates may recover some flexion.
The other thing is that it appears the obsession with ROM seems to be more common in some parts of the US and less so in most of the UK. Function is more important than flexion. There may be a trade off between stability/ strength and high flexion. I was hypermobile but not particularly strong. There are people here with much less flexion than me who can snow board or ski which I wouldn't have had the muscle strength for, even when younger.
 
When I elevate and ice, how long should I make sure to keep my leg up? I guess I have a bit of swelling lately. Probably not taking it easy enough. I thought I saw on here that it takes at least 45 min of ice and elevation to positively impact the swelling?
 
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That is correct about the time. You need 45-60 minutes for each icing and elevating session for it to be effective. But it can be longer if you like.

This is vastly different from the guidance you may receive of 20 minutes of ice and at least 20 minutes off. This schedule is more appropriate for an injury recovery than recovery from joint replacement.
 
For the first few months, I iced and elevated the whole time I was sitting or laying down. This kept my knee nice and cool, and the pain and swelling down. You can not over ice as long as you have a cloth between your leg and the ice source. To me, it worked better lowering pain and swelling than pain meds did.
 
BarabooProud said:
When I elevate and ice, how long should I make sure to keep my leg up? I guess I have a bit of swelling lately. Probably not taking it easy enough. I thought I saw on here that it takes at least 45 min of ice and elevation to positively impact the swelling?
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Icing for up to twenty minutes only is what most of us have heard or been advised to do following an injury. Following joint replacement, ice is a critical part of pain management and should be used not only on the joint, but any surrounding areas of discomfort for as often and as long as you're comfortable doing so, always placing fabric between your skin and the ice source. Icing helps bring relief from the soft tissue trauma and internal swelling. Icing is a great natural pain reliever and best of all, it's free. While some care providers do put a maximum time on icing, others suggest you ice as often as you see fit.

Icing after therapy, exercises, or prolonged activity that challenge ROM and endurance should help ease any discomfort, or preventively keep pain at bay. You may find relief through icing for weeks to months post op.

:ice::thumb:
 
I’m still icing and elevating at 7 weeks PO rtkr. I have a patch on the high outside of the right knee that swells and is painful! It’s a more recent swelling area.
 
Went to my post op with the surgeon today. Since my flexion is at 104, he said I have one month to increase that flexion or he will want me to have an MUA. I'm just over 7 weeks right now. Thoughts? I'm very anxious about this news, but I knew it was coming.
 
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No one can make you have an MUA. It's your decision.
Do you have a PT you trust?
I would ask their view as well about how you are moving and doing more generally.
If I felt I was improving and gradually getting stronger, having less pain and moving better then I would be reluctant to jeopardise that by a further procedure.
What was your ROM before surgery?
That is one of the best predictors of longer term post op ROM.
MUA rates do vary enormously from country to country- yet outcomes are pretty similar in places that do very few.
 
Please try not to worry about this threat made by your surgeon. You are the one who chooses whether to have an MUA or not. He can recommend it and hopefully explain in detail why he believes it is a needed option (not just “it will give you better flexion”….but the why behind a statement like that), but you make the decision.

You are less than 2 months out. You have adequate flexion for this point in recovery. A lot of surgeons won’t even do MUAs after 100 degrees is reached. As long as you are making some progress, no matter how slow, you are still moving forward. It’s quite likely there is still internal swelling in your knee that you cannot see or feel. The knee compartment is very compact and it doesn’t take much fluid to inhibit your flexion.

If you are hearing that you won’t gain any more ROM past a certain date in your recovery, please consider that we have many, many BoneSmarties who continue to gain flexion for a year or more. There is no “window of opportunity.”

See how you are doing in a month, listen to what he has to say at your next appointment, and then make a decision to have an MUA or work on the flexion on your own. Continue with exercises that will stretch and challenge your knee. But don’t do them to excess. This is not a case where more is better.
 
Thanks for that advice, ladies. I feel a bit better now. I have no idea what my flexion was before surgery, but it was better than now since I could bike comfortably and now I lift my hip slightly and it's uncomfortable. Honestly, that's the level of flexion I'd like to get at - being able to bike and go down stairs comfortably. Beyond that, I don't really care. I'm very functional in other aspects. My physical therapist has said in the past that she didn't think it was scar tissue build up. She will have me sit on a bench and gently push until I tell her to stop due to pain. She says there's some "give" when I tell her to stop. She says she could keep going, but my pain is what is stopping her. She thinks it's my muscles not wanting me to go further, not scar tissue, as that would feel like a hard stop, in her experience. Not sure what to think. The surgeon says I should push through pain. I don't know how I feel about that. But, my flexion has not made the gains I have wanted. I guess tomorrow I'll have more information since I have a PT appointment and haven't been there since last Wednesday. I'm taking a 3 week online knee bending course through succeedcourses.com with PT, Dr. Samantha Smith. She has you do exercises 3 times a day. I'm pretty much doing that since some of the exercises are what my PT has given me. I'm in the 2nd week of the course and I'm curious if I've made any gains since my PT last week.

Update: I clarified with the nurse something I forgot to ask the surgeon. What would be the minimum flexion the surgeon would want for me to avoid manipulation. He responded that if I make progress, even if it's a little bit, he wouldn't move forward with the manipulation. Only if I make no progress or regress. Makes me feel a bit better!
 
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BarabooProud said:
My physical therapist has said in the past that she didn't think it was scar tissue build up. She will have me sit on a bench and gently push until I tell her to stop due to pain. She says there's some "give" when I tell her to stop. She says she could keep going, but my pain is what is stopping her.
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She sounds great and I would listen to her views. She is sensible and not pushing you to pain unlike some PTs.
I would also say that going downstairs comfortably is one of the last things to come and isn't just dependent on ROM.
I had pretty amazing ROM ( 130 degrees from fairly early on and now 150 degrees- due to a combination of previous hypermobility and a very mobile partial implant. But I couldn't do stairs comfortably for well over 6 months.
Things like muscle strength and ligament/ soft tissue recovery affect stairs. It's not just ROM
 
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