TKR Rock Hard Frustration

[KaMcC]

TKR - March 18-
PT twice a week. Good flex 95+ with extensive warm up. Recently frustrated by knee that goes rock hard with full weight. Not always in the same location. Feels like super tight wide rubber bands above the cap and below and sometimes running across the cap. Sends pain down in to the shin, calf, and up the thigh at times. Over the weekend felt like a hard knot behind the knee with labor pain-like waves of tightness. Would be ok for a minute, begin to tighten and then get really hard and tight and then release to start again. Hate the fact that my progress and mobility seems to be going the wrong way. PT has to spend time massaging and loosening the knee to get anything done. Almost regretting the surgery. Have read in the other threads this has happened to others.

 

[Falcon]

I experienced the same tightness you described. I am now 60+ days post surgery, and with PT 2X a week, this condition has finally passed. I was delighted that my range of motion was now 125, but I still have some shin pain to deal with. Don't give up...stay the PT course...You will get through the wicket. I am 11 years your senior.

 

[Layla]

Hello and Welcome to BoneSmart. Thanks for joining us. Please don’t get discouraged. Hip and Knee replacement recoveries can take a full year. So it’s still pretty early into the process for you at not even two months post op.

Sends pain down in to the shin, calf, and up the thigh at times. Over the weekend felt like a hard knot behind the knee with labor pain-like waves of tightness. Would be ok for a minute, begin to tighten and then get really hard and tight and then release to start again.

This explanation sounds like spasms. Wondering if you agree? Have you tried backing off from PT at all to see if you notice any difference? May be something to consider…

I will leave our Recovery Guidelines as you may still find some of the information beneficial. I hope you obtain relief soon and continue to update your progress here.
Please share which knee was replaced so we can add that information to the signature we’ve created for you. Thank you in advance!

Knee Recovery: The Guidelines

As you begin healing, please keep in mind that each recovery is unique. While the BoneSmart philosophy successfully works for many, there will be exceptions. Between the recommendations found here, your surgeon's recovery protocol and any physical therapy you may engage in, the key is to find what works best for you.


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
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
6. Access these pages on the website
Oral And Intravenous Pain Medications
Wound Care In Hospital


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.

 

[KaMcC]

What can you tell me about manipulation after TKR?

 

[Jockette]

Hi @KaMcC I moved your post above out of the Monthly thread as that thread is reserved for surgery date information. We prefer all other discussion to take place in recovery threads.

Manipulation Under Anesthesia (MUA) is a surgical procedure in which the doctor forcefully bends your knee to release adhesions which are preventing your bend from increasing. The force they use is enough that you need to be under anesthesia for them to do it.

Why are you asking? Has anyone on your medical team mentioned it?

Good flex 95+ with extensive warm up.

Many surgeons won’t recommend MUA once you’ve passed 90. You are still early in recovery, in this year long healing process, so it really is a bit early to be thinking MUA. Adhesions are actually rare, and very often the “problem” is swelling. Also, we all regain our ROM in different timeframes, and there is no “window of opportunity.”

Myth busting: "window of opportunity" in TKR

This "six week window of opportunity" surgeons often speak about is little more than a myth. It presupposes that all patients have the ability to create adhesions which is far from the truth. It also ignores the simple fact that in the first 3-4 weeks after surgery, swelling reactive to the...

bonesmart.org

Over the weekend felt like a hard knot behind the knee with labor pain-like waves of tightness. Would be ok for a minute, begin to tighten and then get really hard and tight and then release to start again.

As Layla mentioned, this could be spams. In addition to spasms, it could be swelling.

How much time to you spend icing and elevating?

What is your daily activity level, and what do you do at PT? It’s possible you are doing more than your new knee is healed enough to do.

 

[Claire56]

I had very similar symptoms. It was blamed on poor extension- I was at 10 degrees of bend. I was told that it was as if I was doing shallow lunges and it was causing my leg to spasm. The recommendation was to work on extension which I did. It took about 1 1/2 weeks but it appears to have worked. I am still doing extension exercises roughly every 2 hours during the day. My leg is not straight yet but it is better. I have not had any spasms for 3 weeks.

I also agree that backing off some of the PT might be good especially if it is triggering the spasms.

 

[KaMcC]

Thanks for the responses. Pain is now so bad when walking or standing and the tightness sometimes collapses my knee. Saw surgeon last week, MUA tomorrow. I think it is more spasms than scar tissue but stuck at about 95-100 flex. MUA will be almost 8 weeks exactly from surgery. My extension is good, it seems to be the minute I put full weight it goes into tightening so I can't walk normally. All of this just started two weeks ago and I was doing 1/2 mile without any problems. I guess if the tightness returns, it won't have been scar tissue and I understand there is more PT a week following MUA. Kinda regretting having the TKR.