TKR ROM #'s by week - examples please?

[Eehamm]

I am 2wks past TKR and feeling very confused about ROM info. I hear some folks talk about a window of opportunity that 'closes', scaring me about losing ROM availability forever, but then others talking about it continuing to improve with work over the first year or two. I have seen one post on this site where someone listed their numbers from week 1 to week 26. I'm curious if others tracked their numbers and might be willing to list what they got to by each week#.

I have struggled to get to the 90 they wanted in week 1 and 2, but am trying.

Week 1 - 60
Beginning of Week 2 - 80
Later in Week 2 - 82

I'm not too worried as I am progressing, but I would love to see what others have gotten if they kept track and by when. I know every body is different and every set of ROM #'s will be different, but I find the examples really helpful if folks are willing to share.

 

[MSuki]

If you have a lot of swelling you will likely have limited ROM until the swelling goes down. But since you are just barely getting started it is way too early to worry or even know how you are going to be doing. Give it some time. I don’t have weekly numbers but I have heard other people talking about their PT having a 6 week goal, which in many cases is not realistic. I have never even heard of a 2 week goal for ROM.

 

[Layla]

Hello and Welcome to BoneSmart and recovery. Thanks for joining us!
Please share the exact date of your surgery and identify which knee was replaced so we're able to create a signature for you.

There is no Window of Opportunity - Window of Opportunity so please let go of that notion and concentrate on healing at this early date. While your range of motion is currently limited, it will naturally increase as the swelling subsides and the pain eases. Give it time.
I will leave our recovery Guidelines. Please read through them and let us know if you have any questions.
Best Wishes on the journey!

KNEE RECOVERY 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.

If you want to use something to assist with healing and scar management, BoneSmart recommends hypochlorous solution. Members in the US can purchase ACTIVE Antimicrobial Hydrogel through BoneSmart at a discount. Similar products should be available in the UK and other countries.

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
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?

Nutrition is of paramount importance. Available here are dietary tips, nutrition basics and additional food supplements. These articles are both general advice on food and specific guidelines aimed at people both pre- and post-surgery.

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.

 

[mendogal]

You're doing fine! My ortho team was united : in terms of activity during the early weeks "Less is Better." 90 degrees was their 6 week goal - and goals are aspirational, not commandments!!!

Also my ortho never measured or asked for my range of motion! He just wanted to see me move and hear how I was doing.

I'll be back with more info in a moment!

 

[mendogal]

Some of our members have shared charts of their progress regaining flexion. As you can see, for each, it returned slowly but surely.

Campervan’s ROM history
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

Bertschb’s ROM history
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

 

[Eehamm]

Some of our members have shared charts of their progress regaining flexion. As you can see, for each, it returned slowly but surely.

Campervan’s ROM history
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

Bertschb’s ROM history
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

Thanks, Mendogal. I figured folks would respond by telling me I'm doing fine. I do trust that. But thanks so much for the list of numbers.... I like the examples, as they do help. Even if the numbers vary from folks who got it 'slowly' to those who got it 'quickly'. I'm not comparing to myself as much as just finding comfort in seeing the actual variations. It really helps get the idea into my bones that all bodies are different, but progress over time is possible.

Thank you, thank you, thank you for those two sets of info.

 

[Eehamm]

Hello and Welcome to BoneSmart and recovery. Thanks for joining us!
Please share the exact date of your surgery and identify which knee was replaced so we're able to create a signature for you.

Date of surgery was 2/19/24 for right TKR. I am quite young, only 47, but was severe bone on bone for a couple years before i finally couldn't stand it anymore and went through with this replacement. My right knee had already been reconstructed twice before (ACLs - one with patellar graft and one with cadaver).

 

[mendogal]

Oh my you're very welcome!!!

 

[Layla]

You may also appreciate an update a current member, JusticeRider, shared awhile back in regard to ROM.

JusticeRiders post -
"I just want to add, for all those coming along, a note on ROM. I want to share this because nearly all of us have a tremendous amount pressure put on us to increase our ROM by certain deadlines, or else.

Mine has been extremely slow coming. First I had to wait out the swelling, which in my case took more than 5 months. Yes, months. At that point I began to see real progress. It has continued to this day. I have seen improvement in the last 2 weeks. It’s still going. A this point I think the limiting factor is tight muscles, ligaments, and tendons from 3 yrs of very limited ROM and actually about 25 yrs of somewhat limited ROM. Those tissues are slowly stretching.

I have had to be willing to let my flexion improve at a glacial pace, be very patient, and tune out the dire warnings of my surgeon, PA, previous PT, and some well meaning acquaintances. I refused painful PT and refused a MUA. I have absolutely no regrets. I know my body, and I believe those things would have caused a domino effect of swelling and pain that may have derailed my recovery long term and even possibly have torn soft tissue, etc. I now know I have the added challenges of hypermobility and an immune condition that causes an inflammatory reaction. I think a MUA would have been very harmful to me.

Instead of forcing it, I have relied on weekly massage and using my stationary bike as a stretching aid every single day. I have been very active, but I have ramped up really, really gradually. I have not measured my flexion, because honestly I feel almost a PTSD type of reaction around it. All I care about is function and what I can do. My knee is very functional now, and still improving. I love my new knee. I’m glad I let it heal on its own timeline even though it was so much longer than everyone (most of all me!) would have liked."

 

[Layla]

@Eehamm
Here is one more account to read for good measure.

VolLady's post -
"I want to tell everyone that has went though TKR that it is a long journey to heal. I am going this spring to have my other knee replaced.

Please do not get discouraged and I know you will because I did with my first one and cried more than I had in a life time. Scared mostly.... Surgeons will not tell you everything that you will experience during your healing. It took me 7 months actually to feel more normal but not 100%.

For the ROM I only got to 112 at 4 months and still cannot bend it all the way back to reach 130. But I can drive, sit at a table, put my shoes and clothes on great without a ROM of 130 or 120. There is no swelling at all at 8 months but I still have some stiffness at times but I deal with it and walk. I also still ride my bike with no trouble.

I am telling everyone this because your body will heal without PT and pushing your limit beyond to the point there is more swelling and pain. I have decided when I have my other knee fixed this spring, that I will do my own PT since I have all the equipment and items that they use anyway.

I had a MUA at almost 6 wks., and regretted it from day one. Simply because it did not help me anymore with my ROM but it did set me back on healing. The swelling was awful. I will not have another MUA even if my ROM was 95 at the time.

I will go in with open eyes on this other knee comparing on what I went though with the first one. So, with all that said, I wish everyone a happy healing and let your body decide with healing than someone trying to push you until you scream with pain. Also don't worry about the ROM, it will come -- it might take a year or more, but it will come. I am 67 years old and I don't expect to get past 120, but I do what I want to do at 67. Oh! and I can even bend down with the knee need to kneel on it..... Best wishes everyone!"

 

[kiwicurls]

Welcome @Eehamm !
You’re doing great! Just follow the Bonesmart way and all will be well. How do I know? Two years ago I had the first tkr and last week the other knee was done. I had a really good recovery by just taking it easy and never letting a physio push me. I intend to do the same this time. Bonesmart is excellent and the staff are full of great advice. Anything I can do to help, just ask.

 

[selketine]

I feel plagued by the ROM monster at times - the info is confusing. Also if you have 2 different people measuring you they can get different numbers (in case someone else's number is lower and you're thinking your knee bend is the same or better).

I'm kinda bummed because I asked her to check the measurements to compare with 2 weeks ago and it's about a 5 degree improvement in both straight and flex. Not quite straight although 5 degrees straighter (feels straight to me!) and my flex is only 90 - she had measured me at 85 about 2 weeks ago.

I wrote that (above) exactly one month after my surgery. So at 2 weeks I was 85 and 4 weeks was 90. I wasn't measured again until last Friday (March 1st) - so about 3 weeks later at 7 weeks - and she got 105 and I can straighten my leg fully. I'm at 8 weeks today. I could really tell my knee loosened up with bend around week 6.

I also think my pre-surgery bend was around 105-110. I need both knees done and my TKR knee is already very close in ROM to my bad left knee. Hopefully I will get a better bend than I had before surgery. My knee still feels tight and weird - but not painful so much.

I also read somewhere - and I don't know if it is true - but the surgeon can choose to make the knee more tight or loose depending on some of the hardware they use. Tighter means harder to bend but more stable - loose means easier to bend but the knee can give out more easily. This was a post elsewhere about a skier who asked for a "tight" knee cause he wanted to ski again - and another person complaining that her knee gave out too much and was told it was "loose" which explained her quick attainment of a great ROM after surgery but problems later. No idea if this is true but it's made me wonder about people who get a 130 ROM in the week after surgery.

 

[Eehamm]

@selketine thanks for your story and your numbers. That's interesting about tight versus loose and with my engineering and physics backgrounds, I can totally imagine the hardware itself and how it is installed could very well play a part. Thanks for sharing.

 

[Eehamm]

@Layla thanks for the additional posts. While this is my first TKR, it is my 7th knee surgery in total. I am very much never going to allow manipulation. They did it once for a previous surgery to get me straight and it was one of the worst moments of my life. With all my surgeries, doctors have always been surprised at my ROM i ultimately achieved with all of them. I know myself and I work at these things religiously... BUT NOT in opposition of what my body is telling me. I love gentle stretching and watching my flexibly improve. So I work it for both the joints and muscles. It does sound like ROM prior to surgery also has some impact, so that leaves me feeling more optimistic. I already have -1, but will have patience with the bend. Bottom line though, no one is manipulating this knee. It's mine. I do want to recover as much ROM is possible, though. Got a lot of years left at 47 and likely will need a revision before I'm done on this planet because of my age. I will keep at it gently.

 

[benne68]

Bottom line though, no one is manipulating this knee. It's mine.

Good for you! You are absolutely right. It's YOUR knee and YOUR recovery and you don't need to make anyone else happy!

By the way, there is so much focus on ROM numbers, but it's not the number, it's the function that matters. I found this information helpful when I was recovering from my first TKR

These degrees of flexion are 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

 

[Eehamm]

@benne68 thanks so much for your response and encouragement. I have seen that post before, and I will say, with all respect, the words are a bit contradictory. As you clearly show with the list of numbers at the bottom of your post, ROM IS related to functionality. I am not looking at the numbers gratuitously for just the number itself or to even please PTs or the surgeon. More ROM means more functionality. That's what I'm ultimately after.

 

[benne68]

Sorry, @Eehamm, I see what you mean and guess I wasn't clear in making my point.

Yes, ROM and function are intertwined, but what I was trying to say is that we don't need 135 degrees of flexion in order to function well. Too many PTs push us to achieve THEIR goals, rather than ours.

I was fortunate to have a therapist who only measured me twice -- at our first session and at our last. He was more interested in how the knee was functioning doing those activities of daily living.

 

[Eehamm]

@benne68 no worries at all. I totally hear what you are speaking too. Luckily I'm super flexible and can tie my shoes with a straight leg. Haha
But yes, there definitely IS a difference between orienting just towards some random numbers vs orienting towards functionality.... but yes definitely intertwined. I just know that with more ROM, moving around is easier than with less ROM.

Sounds like you had a PT that oriented in the same way you did and was a good fit. I like my PT but it does seem like many of them focus on #s a lot. I bet it somehow gets taken as how successful the surgeon is without acknowledging the other things like functionality and quality of life for the patient.

 

[Jockette]

Here’s another example of ROM improvement:

This is what one of our members, TortiTabby, experienced:

(Just so you know, ADL means Activities of Daily Living.)

“Just an update for those who are apprehensive about gaining ROM:
It has now been 26 weeks and all I do is ADL and this is what my ROM has done:
3.5 wks: 75
6 wks: 85
7 wks: 90
10.5 wks: 95
14 wks: 100
17 wks: 105
20 weeks: 110
26 weeks (where I am today): 120!!!
I did it! My goal of 120! No "pushing through pain", no PT after the first 3 visits, and most importantly to me: No MUA! My surgeon who said I would never get beyond 85 ROM without pushing through pain was wrong, wrong, wrong. I'm excited to see if it gets even better. “

 

[Eehamm]

@Jockette thanks for this additional example! Much appreciated!