TKR Review after 1 year

dcweather

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Had my second TKR on May 8th and I think recovery going reasonably well. On here and elsewhere I get conflicting comments regarding ROM. There seem to be some almost "boasting" about their achievements and telling others they will get there and implying they may not be doing the exercises. My surgeon and physios (this and previous TKR) don't seem to expect any particular value and imply it will be different depending on previous state of knee and age. I cannot get past 95 degrees but straight is almost there. I had less rom than that for may years pre-op so I suspect I may not get much more? I do wish people would quote their ROM pre-op because I have a feeling that should be the target with anything more a bonus. What do others think and has anybody with a long history of little rom got big improvements?
Dave
 
No straightforward answer Dave. ROM was a big problem for me last time and I ended up having a MUA. However, that worked and all was gradually well. The presentation was very specific though: no progress beyond 60 and gradual reduction from that. It was just plain stuck. No pain or excessive swelling. The OS said this tendency to adhesion was genetic. Nothing I could do but I didn't know that at the time so worried a lot. I followed the BS mantra but it didn't help in my case.
It's early days yet for my latest TKR but already it seems better. I can bend it to a reasonable extent despite swelling. The PT says that my underlying muscles are in good shape and moving more smoothly than last time. I had a different surgeon who seems to have used a different approach. ROM is not being used as a measure here. Practical use is. That seems fine to me. That said, having read my medical notes the OS did say that he'd be ready to do another MUA if necessary. Fingers crossed its not!
 
Hi @dcweather and :welome: Try not to get too focused on ROM. A lot of people don’t know their pre-op ROM. I didn’t. I knew my knees didn’t bend as well as they should, and I knew the left one didn’t go straight, but I had no clue what my ROM numbers were. It never occurred to me to ask. I know what they are not, but not then.

For what it’s worth, my ROM is much better now than it was before surgery. I can tell because my knees both bend better than before and are straighter than before. Just don’t have pre-op numbers to chart.

Feel free to ask questions and share any of your thoughts or concerns. We’ve all had TKR and know what you’re going through!

Here’s some reading we give to new members in recovery. The links lead to short articles about TKR recovery and you might find some answers there.

Knee Recovery: The 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
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
5. At week 4 and after you should follow this

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


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.
 
My OS said pre-op ROM is a good predictor of post op ROM but many people do better than that. I was maybe 110 going in to surgery (with many years like that) and I'm at least 115 last time my doc eyeballed it. For me the main things are: 1) I don't have the old pain 2) I can do more than I could before tkr--pretty much what I want to do

So you may gain more bend over the next several months, but it sounds like you're on a positive track regardless.
 
I cannot get past 95 degrees... I had less rom than that for may years pre-op so I suspect I may not get much more? I do wish people would quote their ROM pre-op because I have a feeling that should be the target with anything more a bonus.
Your soft tissues have adapted over the years to your bad knee. Bone spurs and other nasties have restricted movement. Post-op these impediments are gone (which is why some, myself included, feel wibbly-wobbly). All (all, he says!!) that is needed is to engage a programme of progressive, gentle stretching exercises, and ROM can go wherever you want.

You're right, it is a bonus as work is needed! But some of that comes in everyday life, just sitting and walking and stuff.
 
Not sure what my Rom was pre op but if I had to guess it was probably 100 or so. I have been told by OS and pt that its not a race to get Rom..My last 3 measurements have varied due but nothing has been said that its an issue. I'm 8 weeks post op.
 
My OS said pre-op ROM is a good predictor of post op ROM but many people do better than that.
I agree with kneeper.

It may be possible for the muscles and tendons that had shrunk prior to surgery to continue to stretch , gradually increasing your ROM. That will need to happen slowly, though.
That's OK, because there's no need to rush to get ROM (Range of Motion). It can continue to improve for a year, or even much longer, after a knee replacement. There isn't any deadline you have to meet:
Myth busting: the "window of opportunity" in TKR

Here are a couple of examples from people whose ROM was slow to develop:

This is what Campervan wrote about the slow development of her ROM. (Thank you, @Campervan ) As you can see, her flexion continued to improve for a long time - look what had happened by 6 years post-op!.

"I had a slow recovery. Here's my flex measurements at various points:
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
125 - 1 yr 8 months
128 – 6 years "


And here's an example from bertschb:
I'm 12 months out from my surgery and have some advice based on my experience:
1- Stop going to PT (all it will do is make your knee swell and reduce ROM)
2- Don't worry about your ROM
3- Be patient - VERY patient!!!

Here is my ROM history (more or less):
1 month - 60 degrees
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

I spent waaaaay too much time worrying about ROM. I thought I'd be riding my bike a couple months after surgery but it took SIX months! Looking back on my surgery, if I knew then what I know now, I wouldn't have wasted my time with PT and I wouldn't have worried about ROM.
 
On here and elsewhere I get conflicting comments regarding ROM. There seem to be some almost "boasting" about their achievements and telling others they will get there and implying they may not be doing the exercises.
You won't read that from any of the staff advisors here! We know that each knee and each recovery is different. It's not exercising that gets ROM, it's time. Time for the swelling to go down and for healing to happen. Swelling is what inhibits ROM, not lack of exercising.
 
You won't read that from any of the staff advisors here! We know that each knee and each recovery is different. It's not exercising that gets ROM, it's time. Time for the swelling to go down and for healing to happen. Swelling is what inhibits ROM, not lack of exercising.
Indeed. Only certain individuals on another well known forum although generally empathy is quite good there as well!
Also, perhaps it is no coincidence with my last TKR after I had to spend 8 days in hospital at 10 weeks post op with a nasty gall bladder issue, it felt looser and a bit more flexible. I had been unable to do any exercises and lost over a stone in weight! :)
 
Last edited:
Thanks to everyone and the useful replies so far which I agree with. I am basing this to some extent on my first knee which was a very gradual degradation from having cartilages removed at age 30. SO a long osteoarthritic de-generation of almost 40 years ending in bone spurs, extreme bandiness, bent knees and low ROM. Probably 10- 85 deg pre-op. Luckily most of the pain till near the end was during standing , walking etc and was recoverable after 24 hrs- till the next time. So two years in my new knee is great. I can walk well, am pain free but I never managed to get the ROM past 90 (so far!) which does make stairs and getting out of chairs tricky. I don't really see how that will improve (although MUA never been offered) as any amount of stretching and forcing will not increase it.
The second one has been more painful for first three weeks but now Rom is better than pre-op at about 95 degrees so I hope to get more.
But the caveat for me is still that everyone will be different. Some will have had more deformity, some for longer and so muscles, tendon and ligament damage before and caused by op will vary. This is why I don't agree with people suggesting what others should be able to achieve. The goal is "the best you can do" I think.
Apologies for writing so much but all info in either direction is therapeutic.
 
I agree with the advice already given. At PT we began measuring success on functionality gained rather than ROM and let that take care of itself, which it has done.
The day I “graduated” from PT one of the therapists sat down and shared something very profound to me “There are people in this room right now whose ROM you envy. Those same people in this room right now envy the functionality and strength you have regained.” There are many paths to succeed in this journey. Ultimately your knee chooses the path and timeline you take.
 
Every person is different and every knee is different. I had both done at the same time. The left was in worse condition going in than the right (more pain, less bend, unable to lift me on stairs, and it couldn’t go straight), and so no surprise it was the “less good” knee coming out.

My right knee healed like a champ. It had excellent flexion early on, went straight, and had very little pain. At six weeks it had no pain. If my right knee were my only TKR experience I would be telling people TKR is a miracle surgery with quick results. My left knee, though... it took months longer to bend as much or go straight, though it eventually did both. It also hurt for much longer. It’s flexion, while now very good indeed, is still a little less than the right knee. Not a problem. It’s just as strong, just as capable, and most importantly, free of pain! But it took that full year of recovery for Lefty to get to the same place as Righty.

No one can force their knee(s) into a good recovery. All we can do is set up the best situation for recovering, and letting nature do the work. That does mean moving the knee as it is able, but not trying to get it to do things it cannot yet do. Do nothing to injure it while it is healing. To me your approach sounds very sensible, @dcweather. :SUNsmile:
 
I suspect I will never really get to the bottom of why I have difficulty bending the knees. I've read lots of accounts which include lots of horror stories. I enjoyed reading Josephine's account as well. Taking everything into account it would appear that on balance I have suffered less pain and needed less pain killers than most after the first three weeks. Considering how smoothly everything goes with me I've never had a clear explanation as to why I don't get the bend as other aspects seem above average at each stage but I still think it's because very few mention how it was and for how long before the op. From what I can tell I have one of the best surgeons in my area so when I see him next week I'll ask him again!
Dave
 
You're really fairly early in the recovery process. Slow and steady. I found I gained a bit over 6 months to a year as seen in just the ease in doing things increased.
One example, at 12 weeks sitting on a high stool I had to struggle to get my feet on the rungs. Then I noticed one day about 6 months in that I could do it with no problem. I think just using the knee in daily activities had simply gotten me there naturally.
 
Well I am now at three months in my recovery. It has gone more or less as I thought it would/should. (I had another 2 years ago so have some sort of bench mark) After the first three weeks of higher than before pain levels the pain more or less subsided into various dull aches and twinges dependent on what I had been doing but no pain at rest. ROM has been a struggle as documented elsewhere and has stuck at about 100 deg flexion although straight is good enough, both better than other knee. But now after quite a lot of effort nothing much is changing. If anything it has got a bit stiffer and is still a bit swollen and looks bigger than the other knee. I am walking quite well however.
There is a tendency I find after the pain goes to maybe try and do more than you really should. I've finished physiotherapy but still exercise and have started going to the gym to do some of them like the leg press and a couple of other quad type machines they have.
The question is do I exercise more or rest more. ?
 
Neither. Just live your life and go about your business in the usual way. You'll discover one day that you haven't even thought about your knee and that your ROM has mysteriously improved massively. Good luck!
 
You are doing a lot for 3 months. Gym machines are not recommended this early.
But now after quite a lot of effort nothing much is changing. If anything it has got a bit stiffer and is still a bit swollen and looks bigger than the other knee
This proves you are doing more than your knee is ready for. You are only 1/4 the way through the healing process.

Contrary to popular opinion this recovery does not require a lot of effort. Take it easy on the exercises and allow your knee the privilege of sorting itself out. (One of my favorite quotes from Josephine!)
 
Every recovery and everyone is different. But I did too much after my first tkr (left leg) and my leg was swollen for a year afterwards. Since I've been forced to rest and ice with the most recent tkr, the swelling in my left leg is down & hasn't bothered me nearly as much as in the past.
 

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