TKR Quads and ROM

[Roy Gardiner]

I forget how @Roy Gardiner stated it...

When you are icing and elevating and watching telly you are not 'dossing around' you are 'engaging a carefully considered proactively designed heuristically programmed dynamically structured recovery programme'.

 

[Bfan]

I'm at the beginning of my seventh week. I try not to overdo it. I've told my PT to be more gentle and he has but still tries to bend to get a number. With effort I can get to 115 and that's it. My extension has always been good. Just recently my pain seems to have gotten worse. Particularly after sleeping. Is it common to go backwards on the pain and swelling? (It's really depressing) I know ice and elevation is the preferred method but has anyone had success with inflammation and swelling using heat? Thanks so much everyone.

 

[mendogal]

Hi there! A few reassurances...

It's likely not going backwards; a normal recovery resembles a weird roller coaster more than a straight line upward. On my first TKA, I went through a period during weeks 8-12 where out of nowhere the knee would be too painful to lift off the bed after four hours. Talking 9/10 pain. I had to use my hands and other foot to raise it and swing it. The first steps were awful. By the time I hobbled to the bathroom it was subsiding to 3/10. It wasn't like that any other times but overnight. I just kept up with my walking and ROM. At 12 weeks it literally disappeared overnight!

Generally we ascribe overall increase in pain and swelling to increased activity - too much, too fast - that is aggravating the new, still traumatized joint.

PT bending the joint to get a better number is doing you a disservice. They are overdoing it just for temporary gain, which vanishes as soon as your knee swells up in response to this "treatment" - I saw this effect repeatedly until I stopped allowing it!

Your current ROM is both functional and appropriate for your weeks out. It's FINE!
Here's a very helpful article on our knees' range of motion.

Something I found especially helpful in it is the degrees of flexion required for the following activities:
- 65° to walk,
- 70° to lift an object from the floor,
- 85° for stair climbing,
- 95° for comfortable sitting and standing
- 105° for tying shoelaces.


Heat doesn't reduce inflammation. Inflammation IS heat. Heat is great for chronic pain or muscle aches, but not for post op or post injury swelling and pain. Ice applied for 45 minutes or more reduces swelling and also helps relieve pain. It's safe as long as there's fabric between you and the cold source.

 

[benne68]

Just recently my pain seems to have gotten worse.

That's probably a signal from your knee that you are doing too much. The pain and swelling don't happen immediately while we are doing an activity -- they generally hit later, often in the evening when we are in bed trying to sleep.

While I think your flexion is very good for just 7 weeks out, remember that inflammation restricts flexion, so until you get that internal swelling down it will be hard to get more bend in your knee.

I agree with mendogal. Ice and elevate as much as you can. And back off the PT exercises for a week to let the knee recover. I'll be you'll see a big improvement if you do!

 

[sistersinhim]

I've told my PT to be more gentle and he has but still tries to bend to get a number.

You are his boss, not the other way around. When you say, "NO!" stick to it. If he/she still tries to force your knee tell them you will have them arrested for abuse because that is what it is when you say no, and they don't listen. Being pushed past what your knee is healed enough to do is harmful to your recovery. You don't want that.

 

[Layla]

Is it common to go backwards on the pain and swelling?

Hang in there, it will get better!

 

[sistersinhim]

Is it common to go backwards on the pain and swelling?

Oh yes, that's why we call it a rollercoaster ride, because it's up and down. Remember it's a year-long recovery and along the way there will be lots of dips, but it will be worth it in the long run! I know, I've been where you are!

 

[Bfan]

Had TKR Jan 3. In a week from now my family wants me to go to LA Art fair at The Convention Center. Walk from parking, then several hours walking through art fair. I know everyone one is different but does that seem like I'm asking too much to take that on?

 

[benne68]

does that seem like I'm asking too much to take that on

It really all depends upon how much walking and standing you can do now without pain and suffering.

Can you walk for a mile without difficulty? Can you stand for an hour (or more) without pain? Perhaps you should give it a try in your own neighborhood as a test run. If you can't manage it, tell them to go without you.

If you decide to go, be sure to carry a cane. It will be a signal to others in the crowd not to bump into you.

 

[LittleBit]

@Bfan - It does seem like a lot. I'm at 9 weeks and wouldn't attempt it. You know how you feel. What other activities are you currently doing, and how are they affecting pain and swelling?

 

[Jockette]

Had TKR Jan 3. In a week from now my family wants me to go to LA Art fair at The Convention Center. Walk from parking, then several hours walking through art fair. I know everyone one is different but does that seem like I'm asking too much to take that on?

I wouldn’t go, unless maybe I had a wheelchair option, but even then, unless it has an option for elevating your leg, I would have found sitting with my foot down for any length of time painful.

 

[sistersinhim]

I think you'd end up being miserable. Your knee is awfully young to try this. I know I wouldn't.

 

[Layla]

If you're able to get dropped off and picked up at the door, take elevators instead of stairs and make use of rest areas if you become tired, I think it's a possibility. I'd want my family to understand the plan ahead of time so no one, including you, feels pressure if you have to sit out part of the visit in a comfortable rest area. I also think, benne68's idea of a trial run in the neighborhood may indicate whether you'll be able to handle navigating the event. Good luck if you go! If you do, let us know how it went.
@Bfan

 

[mendogal]

(checking notes) at 2 months I could comfortably walk 1/2 mile. Upping it to 3/4 mile was awfully overdoing it and I stayed at 1/2 mile for a good couple of weeks before trying it again.
And every 1/2 mile walk was followed by rest, ice, and elevation.

 

[Bfan]

I'm in the middle of my 7th week post op. I've been able to walk up stairs, although not in an easy breezy way. When I slow motion walking down I get a sharp pain on the outside of my knee. Are there any exercises or stretches that can help.. or will it just happen one day when I'm not thinking about it?

 

[mendogal]

At your stage of recovery I wouldn't work at it... you're just as likely to aggravate things. Going down stairs tends to come later than going up. That's because, from a muscle coordination and strength perspective, it's really complex!
Maybe give it a try a couple of times a week and, yep, I bet one day everything will be ready!

 

[benne68]

I'm about three weeks ahead of you, @Bfan, and could not descend stairs normally without pain when I was at 7 weeks either.

My physical therapist had me practice stepping down on a low (3-inch step) until that was comfortable, then raised it to 5-inches and finally to regular step height. At home, I practiced using thick books!

Keep moving that knee, but don't force anything. If it hurts, back off.

Be patient!

 

[Bfan]

Hi All. LTKR Jan. 3. Around 8 weeks post op. Been making some gains. Still dealing with pain, stiffness and ROM of around 115. I do have a question. Most of my pain is in a very specific spot. Left side of knee, near the bottom. Sometimes there is visible knot. This one spot is keeping me from progressing. I had arthroscopic surgery 15 years ago and this could have been a place where they went in. Anyone else have this? It seems that I could do much more but this area is the source of most of my pain and stiffness. Thank you.

 

[benne68]

Hi @Bfan. What you are describing is not uncommon. I am 3 weeks ahead of you and also still deal with stiffness and soreness. TKR recovery is a journey that requires patience! Remember that, at 8 weeks, you are only 2 months into a year-long recovery.

Your flexion of 115 is actually good for8 weeks post op and it will continue improve slowly over the weeks and months to come. Many of us gain ROM well into our second year -- I know that I did with my first knee replacement in 2021.

Most of my pain is in a very specific spot. Left side of knee, near the bottom. Sometimes there is visible knot.

I had something similar with my first knee. My physical therapist showed me how to massage the area around the incision and recommended I do it daily. If you are still in PT, you could ask your therapist to show you how.

 

[kenn t]

The days following the complete knee replacement operation need to be painful to get rid of new forming scar tissue. Just keep in mind there are a limited number of days needed, it is not forever.