TKR ROM issues

[sistersinhim]

Your rehab and recovery are certainly not normal for the majority of TKR patients. If most of us had tried this we'd be in agony for weeks.

 

[skiforever]

Your rehab and recovery are certainly not normal for the majority of TKR patients. If most of us had tried this we'd be in agony for weeks.

My recovery for this knee is extremely slow compared to my first knee and the two my husband had done. Some friends also had easy recoveries, but I do know two TKR people who had difficult recoveries, all through the same surgeon. At first I thought it was how the surgery was done. Although that has to be a big factor, I think the condition of the legs going into surgery makes a difference. If you can do squats and interval work before surgery, recovery is probably going to be much easier. If the knee surgery does not radically change the configuration of the knee, recovery will be quicker. The two who had difficult recoveries using our surgeon had radical changes in the leg positioning and were fine after one and two years.

 

[sistersinhim]

Not all of us were or are able to do squats before our TKRs. I agree that the shape of the legs going in has a lot to do with the recovery afterward. But, most of us have had a TKR because our knees were so painful the surrounding soft tissues were not strengthened but weakened. That's why no two recoveries are the same, even on the same person.

 

[WFD]

If you can do squats and interval work before surgery, recovery is probably going to be much easier.

Three months before my first TKR, at a bodyweight of 160lbs, I back squatted 275lbs for 5 reps, below parallel, and was in great shape from kayak racing. I've since had a horrible experience with five surgeries over three years, and I'm still recovering.

Unfortunately, being in great shape beforehand doesn't guarantee a great result. There are also a lot of sedentary folks who eventually have a full recovery with great results. My sedentary aunt, at 78 years old, had a bilateral and was back at a desk job, part time, after six weeks. Go figure.

I think there is a lot of luck and randomness involved that you can't predict. Look at all the people who've had both legs done, and one went great and the other poorly, like my uncle, who ended up with a lot of scar tissue in one knee but not the other.

 

[Jaycey]

 

[Jamie]

WFD has it right. No one can predict a recovery - good or bad. There are so many factors and each joint is its own thing. That is why we will consistently tell people to listen to their body when they begin recovery. If you try a more aggressive approach and end up with pain or swelling, your body is telling you it's not ready for that level of activity just yet. Same if you get pain and swelling with less activity. It's a balance of pushing just enough at any given time to challenge your new joint and the surrounding muscles and soft tissue but not to the point they are sore and irritated during the activity or up to 24 hours later.

@skiforever ... I'm glad you are doing so well. As long as you pay attention to your body's signals with whatever activity you're doing, you should be just fine.

 

[skiforever]

I did not see my surgeon for my 3 month checkup, just his PA, but he called me the next day and answered all my questions. Very cool! He also sent a follow-up email saying:

"Can do whatever you tolerate! No restrictions.
Do what is comfortable, and even if it gets sore, as long as it goes away, then no worries.
It should loosen up and get stronger with time."

The "window of opportunity" is now closed, but he still thinks I will gain ROM (not so good now). He did not say what happens if I do not recover from what I do. I guess I get to worry about it!

Today I rode my bike 25 miles, with 1500 feet of climbing - so nice to have electric assist. It was a lot of pedaling and my legs are throbbing. Tylenol might be needed to sleep. Onward!

 

[sistersinhim]

The "window of opportunity" is now closed

Not true. It never closes. We have members who have gained bend even into their 3, 4, and 5 years. The "window of opportunity" is a myth.

 

[skiforever]

Ok Three months before my first TKR, at a bodyweight of 160lbs, I back squatted 275lbs for 5 reps, below parallel, and was in great shape from kayak racing. I've since had a horrible experience with five surgeries over three years, and I'm still recovering.

Sorry you are having so much trouble. Good luck completing the rest of your recovery.

Of course there is nothing guaranteed to work. I will give up on the squat theory. But the surgeon does matter.

Many people do just fine despite lifestyles that might cause one to think they might have trouble. Many do so well they never need the help of bonesmart.

 

[skiforever]

The "window of opportunity" is now closed

Not true. It never closes. We have members who have gained bend even into their 3, 4, and 5 years. The "window of opportunity" is a myth.

The "window of opportunity" refers to the time soon after surgery that gaining ROM is quicker. As time goes by after surgery gaining ROM is slower. I am still working on my first knee, almost 4 years after surgery. It is slow but not impossible.

I thought it was very interesting that my surgeon indicated that my ROM can improve. He pushes very hard for early ROM gains. For my second knee early ROM work was just too painful and debilitating in those early days.

 

[Jamie]

You’ll find that most people who are talking about the “window of opportunity” are not referring to a time where ROM improves more rapidly. In fact, you can have both surgeons and therapists who will insist that you must regain all your ROM within a specified period of time or it is lost forever. This is why we counter people who use that term, as ROM can be gained for quite some time after surgery. Even if ROM comes more slowly, it’s regained at your body’s own speed. You cannot force it or you risk overdoing things. So it’s best not to worry about when a certain number is reached. We encourage folks to slowly increase activity over time for the best result. It is a good thing that your surgeon recognizes that ROM can increase over an extended period. By not pushing so hard immediately after surgery with this knee you may find your overall recovery goes a bit better.

 

[skiforever]

There are so many unknowns in this recovery process it is very hard. I can do a lot of things with my knee being perfectly happy, but when I do a tiny bit of ROM activity it complains vigorously, and has from day one after surgery.

I think this thread could be renamed "Trouble Gaining ROM". There has been almost no interest in gaining strength, which surprised me. The ROM issue has troubled me for the whole recovery time.

 

[skiforever]

Strength building is so hard. I keep increasing distances and difficulty of hikes, bike rides, and Scuba diving. My leg with the new knee may get a little achy but that is always gone the next day. Rarely does the knee have anything to say. At day's end I am very tired and often go to bed before 10 pm and sleep until nearly 8 am. The process of getting stronger is extremely slow, but I keep working at it.

 

[skiforever]

Today I am 4 months from surgery. I can do most activities though my strength and stamina are still deficient. My ROM, range of motion, is the same as it has been for the past 3 months, about 8 to about 105. When I try to gain ROM I am down for days and cannot do my regular activities, such as walking the dog, water sports, and e-biking. It is hard to get into the driver's seat of the car and hard to get over the top pedaling a bike.

 

[Layla]

Happy Four Month Anniversary!
Give it all more time, I think your strength and stamina will improve along with your ROM. You're only four months into a recovery that can last a full year for some, even longer for others. I hope you have a good week!
@skiforever

 

[skiforever]

Thanks, Layla. It is great to be able to do lots of things. I do not like down days, but I often wonder if I should sacrifice a few days to work on ROM.

 

[skiforever]

I am coming up on 5 months post TKR and my ROM (range of motion) is still not happening, actually getting worse. Many people say theirs is improving but details on how they make that happen are missing. I need help with ROM. Maybe my thread could be renamed "Need help with ROM".

 

[EalingGran]

Many people say theirs is improving but details on how they make that happen are missing. I

I used pilates to gradually stretch and strengthen my knee and I have great ROM (0 extension and 150+ flexion).
My teacher has loads of free classes on YouTube- Google Katja pilates. Or find a good private teacher and work slowly on bend. I think some people who do a lot of exercise have large but very tight muscles which don't help with bend. It is important I think to look at forms of exercise that emphasise movement as well as strength.
For extension the best exercises are gradually increasing your stride in walking ( using the heel/ toe walking shown in pictures on this site) or lying on your tummy on a bed with your lower leg hanging over the edge to stretch it out.

 

[Jaycey]

Sounds like you need to stop all that forcing the knee and do what EalingGran suggests. Gentle stretches and increasing your stride is all that is really needed.

Here is the illustration of heel/toe walking:

This involves striking the ground with your heel first, then rolling through your heel to your toe, and pushing out of the step with your toe.

It takes a concentrated effort, but I believe you'll notice a difference. Give it a try.

 

[skiforever]

Thanks EalingGran and Jaycey.

I do not push it at all because I read on this site that all one needs is ADL. Also it hurts in a prolonged way to do any ROM work.

My limited ROM work is a seated stretch for the hamstrings to help extension and a short time on the bike to help flexion. I am making no progress. My ROM is about the same as it was at two weeks post-op, about 8-105.

I do walk and I think that is how I walk. How can I tell?

Are there other thoughts on gaining ROM, especially when it makes the whole leg hurt for a long time afterward?