TKR PT Failure

[Shea]

This is my first post on this forum. My left total knee replacement was done on January 25, 2024. I have been pretty much following the PT exercises and going to PT 3 times a week. The dr pt bent my knee back every session in hopes of increasing my flexion and rom, plus some other machines bonesmart does not recommend. I had been reading this forum, and had very mixed thoughts on allowing them to cause me so much pain..

The end result was I lost a whole lot of function, including being able to get out a chair, other than the one that lifts me up. I apparently tighten my whole body when my knee is getting worked on and that triggered two bad shoulders and my other knee.

The PTs became kind of angry at me and insinuated that I was not doing my exercises. I think I got kicked out of PT and quit at the same time. Their only suggestion was an MUA, which I’m not interested in doing.

So now I’m trying pool exercises and something called FELDENKRAIS where their motto is, if it hurts, don’t do it. I feel like my main goal now is to decrease the swelling in both knees and see what kind of flexion I can achieve when the swelling and pain decreases.

I have been very frustrated with my progress but literally it got so bad I felt like I had no other choice other than to try something else. Bonesmart makes sense to me. It feels good not to hurt so badly all day every day.

 

[benne68]

Welcome to BoneSmart, @Shea. I'm so sorry that you went through such a terrible experience with PT, but -- if you read through other's stories here, you'll see that, sadly, it is not uncommon.

I will leave you our Recovery Guidelines. Each article is short but very informative. Following these guidelines will help you have a less painful recovery.

Just keep in mind we are all different, as are the approaches to this recovery and rehab. The key is, “Find what works for you.“ Your doctors, PTs and BoneSmart are available to help, but you are the final judge as to the recovery approach you choose.

KNEE RECOVERY GUIDELINES

1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now, they are almost certainly temporary.

If you want to use something to assist with healing and scar management, BoneSmart recommends hypochlorous solution. Members in the US can purchase ACTIVE Antimicrobial Hydrogel through BoneSmart at a discount. Similar products should be available in the UK and other countries.

2. Control discomfort:
rest
elevate
ice
take your pain meds by prescription schedule (not when pain starts!)
don't overwork.
3. Do what you want to do BUT
a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you
b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.
4. PT or exercise can be useful BUT take note of these
the BoneSmart view on exercise
BoneSmart philosophy for sensible post op therapy
5. At week 4 and after you should follow this
Activity progression for TKRs
The Recovery articles:
The importance of managing pain after a TKR and the pain chart
Swollen and stiff knee: what causes it?
Energy drain for TKRs
Elevation is the key
Ice to control pain and swelling
Heel slides and how to do them properly
Chart representation of TKR recovery
Healing: how long does it take?

Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

There are also some cautionary articles here
Myth busting: no pain, no gain
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds

Good nutrition is very important during recovery:
Dietary Tips for Recovery
Nutrition Basics

We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery. While members may create as many threads as they like in a majority of BoneSmart's forums, we ask that each member have only one recovery thread. This policy makes it easier to go back and review history before providing advice.

 

[benne68]

I feel like my main goal now is to decrease the swelling in both knees and see what kind of flexion I can achieve when the swelling and pain decreases.

That's a very good goal. Be sure to ice and elevate as much as possible, as described in the articles that I shared above. The combination of icing and elevating are the best way to reduce inflammation and pain. (FYI: I still have occasional swelling for which I ice and elevate and my surgery was December 15.)

I think you will find that as the swelling goes down, your bend will improve on its own.

 

[mendogal]

Oh my goodness, you've not been having a good recovery. I'm sorry!

Feldenkreis is a very good mindful movement discipline that might help you and surely won't hurt you.

A lot of our members swear by pool therapy. They often mention that because we feel weightless in water it's easy to overdo it - because water is so much more dense than air. So do it within whatever time limit doesn't increase your pain or swelling that evening.

Many of our members have had setbacks in PT and went on to slowly regain good range of motion.

The "window of opportunity" is a myth. Here's why.

Some of our members have shared charts of their progress regaining flexion. As you can see, for each, it returned slowly but surely.

Campervan’s ROM history
92 - 8 weeks post op
105 - 10 weeks
107 - 5 months
110 - 6 months
112 - 7 months
116 - 9 months
119 - 11 months
118 - 1 yr
120 - 1yr 2 months

Bertschb’s ROM history
2 months - 80 degrees
3 months - 85 degrees
4 months - 90 degrees
5 months - 90 degrees
6 months - 110 degrees
7 months - 120 degrees
8 months - 125 degrees
9 months - 130 degrees
10 months - 135 degrees
11 months - 140 degrees
12 months - 140 degrees

 

[Shea]

Thank you, both of your answers are very reassuring. I love being in the pool and stuck to 15 minutes today. Hopefully that won’t stir anything up.

 

[mendogal]

Hang in there! We are here for your concerns and small milestones and just plain venting!

 

[EalingGran]

Feldenkreis is a very good mindful movement discipline that might help you and surely won't hurt you.

Agree with @mendogal. I have done this in the past and the mindful movement will help with posture and balancing after surgery.

 

[Shea]

It’s been about 10 days since my last post. My apologies for letting this get as long as it is but I guess I needed to talk.

I’ve seen improvement since ending physical therapy, but not as much as I’d hoped to be honest. It looks like that’s a common theme along with struggling with finding a balance for doing too much and paying for it mightily for days afterwards.

Exercise seems to be out of the question right now, but since I live alone, I get plenty of daily living activity movement. I finally learned to get help when I need to carry something even a little heavy or stand around for any length of time. Etc.

I think my biggest struggle is being disabled in all my limbs, particularly my right shoulder, which will need surgery soon. It was limping along until I needed it to compensate for my surgical knee. My shoulder has given me a lot more grief than my knee to be honest, which is saying something. After that’s complete I’ll get surgery for my other knee.

I still need to study every chair carefully before I sit in it because I’m not gonna get out of most of them. Toilets without risers also carry a particular fear cause I’m not getting off of them either. Obviously that limits my social possibilities.

My main reason for posting is I found an excellent knee ice wrap that works better than all the other ones taking up space in my freezer. Is anyone else having trouble finding their food underneath all the ice wraps?

https://www.amazon.com/dp/B079JX3J4W?ref=ppx_yo2ov_dt_b_product_details&th=1

It’s the Vive knee ice wrap and it’s available on Amazon. The wrap stays on pretty well, ices both the front and back, hugs my knee tightly and stays cold longer than my vinyl wraps. It has made it a lot easier to ice as many times as I do a day. I can really tell the difference the next day when I ice up a lot the previous day. Before stopping PT, my knee was like a plumped up sausage about to burst at the incision line. It definitely feels more soft and pliable now.

I know it’s a repeat to mention how helpful this group is. It’s hard to fight upstream when the rest of the medical profession and my friends are stunned and concerned I’m not following mainstream ideas. They firmly believe what they’ve been told, I’ll be disabled and chairbound for the rest of my life because I am too lazy to do the exercises. My friends are more forgiving of course but scared for me.

I find it pretty scary myself, but I honestly had no choice. My PT was a bend past the point of pain manipulator, and it was all way too much. Additionally, I tighten up my entire body when I am in severe pain, so that got everything fired up. My PT said I am not a relaxer. I do feel like I’m on the right road now. Thanks folks. It’s nice to have a place to vent one needed too.

 

[mendogal]

I'm sorry your shoulder is hampering your ability to be more mobile on transfers.

At about 10 weeks out you're still really early in recovery, with lots of key little milestones to achieve. It's good you see the swelling improving and THANK YOU for describing the ice wrap you found!

Have you been able to continue going to the pool? I'm curious how that's working out.

 

[Shea]

@mendogal thanks for asking about the pool. Nope, I did 15 minutes of very safe movements and regretted it for days afterwards. I loved it though, it’s so good to talk to strangers again, smile

 

[mendogal]

You'll get back there - even if just for eight minutes of movement and ten of chatting!!!!

 

[Layla]

Glad to read you're making progress, Shea!
Thanks for sharing the Vive Knee Ice Wrap, I'm going to check it out online and add it to a list we have going of useful recovery articles. I wish you well as you continue to heal!
@Shea

 

[Jockette]

It’s hard to fight upstream when the rest of the medical profession and my friends are stunned and concerned I’m not following mainstream ideas. They firmly believe what they been told, I’ll be disabled and chairbound for the rest of my life because I am too lazy to do the exercises. My friends are more forgiving of course but scared for me.

I know how you feel! Almost everyone I see in person believes this. It’s so hard to convince them that painful PT is not necessary, but they believe it is. I gave up trying to convince them.

 

[Shea]

@Jockette

I‘d hope your good results would be enough. A very good friend and I are deliberately not discussing this. Her daughter and son-in-law are PT doctors and she is a firm convert.

I think time will be on our side with this, the UK already has a very different approach to PT...Gentle exercises at first until healing has taken place. I think I read on here that Mayo was coming around too.

 

[EalingGran]

think time will be on our side with this, the UK already has a very different approach to PT...Gentle exercises at first until healing

I think you are right that here in the UK most physios are a bit more laid back and not as preoccupied with ROM. I never had formal physio apart from a few sessions in hospital and my surgeon was fine with that. I just used private pilates lessons and was never ever asked to exercise to or past pain. My recovery apart from some complications due to an overstretched ligament, was great- and I have almost full (150+) flexion now.

 

[ladyj]

I am on my second knee replacement and with both had no problems with bending my knee back fully, right from day one.
Not gloating, but why is this?

 

[Shea]

@EalingGran that’s really remarkable, I didn’t know knees went back that far. I bought myself one of those flexion measuring devices but only used it once since physical therapy ended. It hurt to bend my knee back as far as I could so the heck with it. You folks have unleashed a new me, wild and free.

I only got to 103° flexion even after sessions of my PT doctor tormenting it. I’ll be happy when I can get my socks on easily and I’m already fitting my leg into my car better.

I’m not sure I have an OS anymore since I blew off the appt. to schedule an MUA. Guess I’ll find out in October when I schedule my second knee for a January surgery. I’d love to be able to show him that torture isn’t necessary and that my leg goes all the way back without it.

I do wonder why so many people respond well to physical therapy and some like me don’t. And I’m also curious about Lady J’s question. I did wait a long long time for the replacement surgery, 15 years plus with the assistance cortisone shots for 10 years.

 

[Jockette]

I do wonder why so many people respond well to physical therapy and some like me don’t. And I’m also curious about Lady J’s question. I did wait a long long time for the replacement surgery, 15 years plus with the assistance cortisone shots for 10 years.

I feel I had my PKR too early, before I was bone on bone, and I didn’t handle some of my PT’s protocol well at all, so I think it’s just a matter of individual bodies, and different PT protocols. Waiting too long to get our knee replaced can make recovery a bit more difficult, but not always.

 

[mendogal]

I am on my second knee replacement and with both had no problems with bending my knee back fully, right from day one.
Not gloating, but why is this?

I don't know if this applies to you, but most of my body has joint laxity.
It's not to the degree you would call me "double jointed" nor have I ever dislocated a joint (except for chronically slightly subluxed thumbs). But while it has given me more flexibility, it has also made me susceptible to injury from overstretching - which I didn't find out until taking up martial arts at age 41!
I have assumed this laxity is why my flexion was near normal right after both knee replacements. The main inhibitor was the normal swelling behind my knees post op.

 

[Shea]

@mendogal , hmmm, good thinking. It makes sense. I kept telling my PTs about the swelling behind the knee but it was like I was talking in Greek.