TKR Right TKR - post surgery knee flexion

SheShe

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Hello everyone, I’m a 61 yo female, with right knee TKR on Jan 10, 2022. That means I’m in my 6th week of recovery. I’m scheduled to do the left knee in April. We have to do it this soon because I’ll be losing my insurance in July. My worries are about my knee flexion in the operated knee. I go to PT twice a week still, and they work me so hard, and insist that I do the same at home. My knee flexion was at 113 last week, but this week it was only 105. That was with me pulling it with a band until I had tears in my eyes. All the time they are saying “pull harder!!” I’m so frustrated at losing range over the past week. They keep telling me if I don’t work harder I’ll end up getting a “manipulation” under anesthesia, and will need therapy five days a week after that. This will also interfere with my ability to get the left knee done while I still have insurance. I’m so frustrated over my recovery. Not to mention that I still have so much pain that I rarely sleep more that five hours a night. I’m taking Gabapentin at night, ibuprofen during the day. On the bright side, I’m walking without a walker or cane, and I’m able to drive short distances now. But I’m still so worried about the flexion issue, and the threat of scar tissue building up, which is what they say will happen if I don’t work the bending harder. Any advice?
 
Hi and Welcome!

I am so sorry your PT is causing you so much physical pain and emotional stress. They are wrong, and are giving you inappropriate “therapy.”

Your ROM number dropped because all that forcing it to bend has created more swelling, and the more swollen a knee is, the less it bends. (Doesn’t that make sense?)

And, by the way, 105-113 at 6 weeks is fine, and even really good, so please stop worrying about your ROM.

Please stop forcing it and don’t let your PT push it either. Not working hard enough does not make a MUA (manipulation) necessary, and they are wrong to threaten you with that. IF a manipulation becomes necessary (and more often than not, it is not necessary) it is designed to help you, not punish you, which is sometimes what it seems they make you feel. Manipulations are designed to address adhesions, which are rare. Most cases of a “low” ROM are due to swelling, not adhesions.

Regaining our ROM is more about Time than repetitions of a list of exercises.

Time to recover.
Time for pain and swelling to settle.
Time to heal.

Our range of motion is right there all
along just waiting for that to happen so it can show itself.

In the general run of things, it doesn't need to be fought for, worked hard for or worried about. It will happen. Normal activity is the key to success.
 
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 all people are 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: 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
ice
take your pain meds by prescription schedule (not when pain starts!)​

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

6. Access to these pages on the website

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 the 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 the member’s history before providing advice, so please post any updates or questions you have right here in this thread.
 
I go to PT twice a week still, and they work me so hard, and insist that I do the same at home
But I’m still so worried about the flexion issue, and the threat of scar tissue building up, which is what they say will happen if I don’t work the bending harder. Any advice?

The BoneSmart view is that it's overdoing exercise that causes damage. Imagine exercising hard in recovery for a broken leg or a sprained muscle; counter-productive, obviously, and would worsen the damage. It's much the same with TKR, you have damage needing healing, not unfitness needing training.

All you need is to help retain mobility (not fitness or strength) until healing is complete. This is done with gentle stretching exercises, without pain.

Here is a longer explanation of the training/healing differences https://bonesmart.org/forum/threads/post-operative-exercise-–-the-bonesmart-view.25463/

Here are some ROM and extension stretches (there are loads, these are just examples) https://bonesmart.org/forum/threads/rom-and-extension-stretches.13159/
 
Find another PT immediately! Interview them and ask what their approach is. Our knees need gentle movements and never to extreme pain. 113 at your timeline is terrific. With my right knee I never did formal PT, just exercises I learned with 1st knee at my pace. If exercise caused me swelling or pain I backed off and tried again, gently, when it felt better. I'm doing the same with my revision now. My numbers are good, as yours will be with time and a gentle approach. I did the agressive PT the first time around and was in pain for months!
 
Hi @SheShe , sorry to hear the challenges you're having. The April deadline doesn't help any, unfortunately, as it adds another dimension of pressure and worry.

Here's a thought based on observations from my own ongoing recovery (at the risk of stating the obvious) - the more swollen my leg is, the more difficult it is to get a decent bend ... conversely, the less swollen my leg is, the easier it is to get a deeper bend.

My go to swelling-reduction routine has been to - laying on a yoga mat on the floor (or on the bed), I raise my leg straight up and while the leg is up, I massage the leg from ankle to the calf to the back of the knee to hamstring - squeezing as hard as I can, kneading and squeezing as I pull downward. I do that around 5 minutes - hard massaging downward - with the leg straight up. Then, I let gravity bend the knee and when the knee comes to a stop (in my case, it'd settle in a pain/discomfort-free bend), I'd pull gently against the knee to get a little extra bend and then hold that position for a minute or so, then raise the leg again straight up in the air ... and repeat the massage, gravity bend routine for a couple of cycles. I found this routine to be very helpful and hopefully if you try it you will as well.

Best of luck on your recovery. And, easier said than done but - try to flush out negative worrisome thoughts as much as possible. Hang in there!
 
Hi @SheShe It makes me so angry when PTs bully TKR patients into trying to force ROM. As the others have said, it's not only painful, it's counter productive!

Your flexion is great for just six weeks out. I was about at the same flexion at the point in my rehab, and my surgeon was quite pleased with it. It took me three months to get to 120 (which is the goal all the PTs seem to set) and I did not need an MUA!

Those ROM numbers are really pretty arbitrary. Rather than focusing on the numbers, think about what you are able to do -- for example, you no longer need an assistive device! That is great progress!

Don't let the bullies get you down. We're here for you!
 
Get your swelling down and your numbers will naturally improve. Can you easily bend a water hose that is full of water with the nozzle closed? Nope. Open up the nozzle and let the water run out and it'll roll right up. Your knee is the same way. Get that fluid out and the ROM gets better. If you aggressively try and get it to bend when it's not ready to go that far it becomes more inflamed and swollen...counterproductive. Easy movements=better ROM!
 
Hello everyone, I’m a 61 yo female, with right knee TKR on Jan 10, 2022. That means I’m in my 6th week of recovery. I’m scheduled to do the left knee in April. We have to do it this soon because I’ll be losing my insurance in July. My worries are about my knee flexion in the operated knee. I go to PT twice a week still, and they work me so hard, and insist that I do the same at home. My knee flexion was at 113 last week, but this week it was only 105. That was with me pulling it with a band until I had tears in my eyes. All the time they are saying “pull harder!!” I’m so frustrated at losing range over the past week. They keep telling me if I don’t work harder I’ll end up getting a “manipulation” under anesthesia, and will need therapy five days a week after that. This will also interfere with my ability to get the left knee done while I still have insurance. I’m so frustrated over my recovery. Not to mention that I still have so much pain that I rarely sleep more that five hours a night. I’m taking Gabapentin at night, ibuprofen during the day. On the bright side, I’m walking without a walker or cane, and I’m able to drive short distances now. But I’m still so worried about the flexion issue, and the threat of scar tissue building up, which is what they say will happen if I don’t work the bending harder. Any advice?
What the? Hope you are doing better in the past few weeks. I had my TKR same day and definitely wasn’t at 113 2 weeks ago. I’m still 108-111 this week and feel the pain and swelling getting better every week. ❤️‍ sending you healing thoughts.
 
@SheShe, I hope by now you have come back here to read the supportive feedback you got! I also had a similar experience after my first TKR, until I found Bonesmart and began to understand that I was allowing the PTs to make my knee worse, not better. Please know we send our support and hope to hear you are improving!
 

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