TKR How much have your quads recovered?'

willib

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On Sept 11 I had my right TKR and on Nov 30 I am having my Left TKR.

I have read numerous articles that indicate significant quad atrophy and strength loss, that may not ever recover. Articles indicate recovery to about 50-55% strength after 1 month and 80-85% after 1 year.

Have any of you tried to quantify your quad strength before and after? I'm not sure how to do it reasonably accurately. Before the first TKR I was still able to cycle hard and have a history of my performance on Strava. But cycling speed is a combination of fitness and strength so it is not a direct measure of quads.

Pre-TKR conventional weight lifting like squats were difficult. Since I am right before my second TKR, I'm trying to use a leg press machine to measure strength, however, the left knee hurts before the quads are fully loaded, so it's probably not a good measure. Looking for ideas.
 
Before I give you an answer, I'd really like to offer you some structured advice but in order to do that, I also need to ask you some questions. Are you willing for me to do that?
 
Sure. Happy to answer questions.
 
Oh, jolly good! Here y'go then!

It would be very helpful if you would answer each one individually - numbered as I have done - in as much detail as you can then I'll come back as see where you are ....

1. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine. And don't forget to factor in other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness).

2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?

3. how swollen is your leg compared to these?
ai63.tinypic.com_eta39s.jpg


4. what is your ROM - that's flexion (bend) and extension (straightness)

5. are you icing your knee at all? If so, how often and for how long?

6. are you elevating your leg. If so how often and for how long?

7. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and

8. are you doing any exercises at home? If so what and how often?
This is the most crucial question so please help me by using the format I have left as an example
(which means please make a list and not an essay!)

Exercises done at home
- how many sessions you do each day
- enter exercise by name then number of repetitions of each
etc., etc.

Anything done at PT
- how many times a week
- enter exercise by name then number of repetitions of each
etc., etc.
 
@Josephine ,
Below are my answers. The quick summary is that my recovery has been substantially better than I had ever expected, which is why I pushed to schedule my 2nd TKR as quickly as I could schedule it. I realize that I am quite fortunate. We are now 9 weeks after the RTKR and 11 days to LTKR. Going into the first TKR I was fit. I typically worked out 5 days a week. With a few Advil I could cycle hard for hours, and the week before the first TKR I had set a few personal best times and was within 15% of my max cycling power numbers. While cycling was fine, within 30 minutes of walking, knees would start to swell, going up stairs was ok, going down was awkward and bit painful. My goal and hope is to exceed my pre-TKR fitness and cycling power numbers and be able to walk all day, go up and down stairs like most people.

Now the questions (I just turned 60, 6' 0, 205 pounds).

1. Pain on the right knee - essentially zero, left knee: zero sitting around, swells up walking, doesn't like going down stairs.

2. Pain meds - stopped Oxycodone at week 4, Weeks 2-4 was taking Ocycodone 5 mg 3 times per day, before bed, around 2 AM, and early afternoon. Now I take 2-3 advils before workouts, mostly for left knee.

3. Swelling - slight to almost zero. Right leg quads are slightly smaller than left, even though I am right leg dominant.

4. ROM right: 125 and zero. I got to those numbers around week 2-3 and they haven't changed much since. Left (pre-surgery): 120 and 5

5. Stopped icing after about week 5 or 6 except for after heavy workout. Haven't iced in a few weeks.

6. Elevating - not anymore

7. Activity level - high, back to full time work (engineering desk job)

8.Exercises - workout 5-6 times per week. Typical this week.

Elliptical or exercise bike - 20-30 minutes.
I was able to use the bike after 1 week, just moving legs around with no load. I started elliptical at about week 4. Definitely more challenging that bike.​
Leg press machine - 3 sets of 10 each leg. Right (with new knee) is about 20% stronger than left primarily because left knee doesn't appreciate heavier loads.
Bench squats - 2-3 sets of 10 with 70-80 pounds (was over 100 pounds before any TKR).
Could barely get off bench at week 3 or 4.​
Wall squats with ball - 2 sets of 10
Planks
upper body weights
Variety of stretching/knee flexion exercises.
Working on kneeling and trying to sit back towards heels. Feels weird, but kneeling doesn't hurt when on a good thick pad.
Balance exercises on floor and Bosu ball

I also ride my road bike outside on weekends, except now the weather is getting uglier. Slowly at week 3 and have been getting back closer to my pre TKR pace in the last 3 weeks. Typically 60-90 minutes, 17 to 25 miles.
Have done a few hikes, 1- 2 hours, used trekking poles.

PT - just stopped this week. Similar to what I do at home. Occasionally they added something like a fireman weight carry or walking with an elastic band around ankles.
Things that are still hard:

Going down stairs is still difficult to do smoothly. The new knee is better than old knee. Hopefully that will be addressed in two week. :)
Balance needs improvement.
 
I am finding that my quad has been slow to recover. I work on it regularly at 6 mos post surgery and it is definitely a lot weaker. I was quite fit prior to surgery - spin class 2 x week plus road biking a couple days and lots of hiking. I am only about 60% of my pre-surgery resistance on the bike in spin class and I notice the lack of quad strength in the various leg strengthening exercises I do. Sounds like you are doing a lot at this point in recovery.
 
Yes, trying very hard to regain as much strength as possible before TKR #2. Was able to get to 90 pound squats yesterday which is getting closer to where I was pre-RTKR. My legs are sore from lifting, but knees are still ok. :) I'm cautiously optimistic that I will as lucky with #2 as I was with #1. However, I am also aware of stories on this forum where people have greatly different experiences between the two TKR.
 
1. Pain on the right knee - essentially zero, left knee: zero sitting around, swells up walking, doesn't like going down stairs.
I'm not surprised at 10 weeks! Most people find it takes around 16 weeks and often longer.

Will, I'm not going to spend the next hour creating an advice post for you as you will clearly not be receptive to it. Besides which, you seem to be doing okay anyway!

I'll just leave you this to read which will precis all I have to say anyway. BoneSmart philosophy for sensible post op therapy
 
Josephine
Thanks for the response and the link. I can easily imagine how this could be a horrible experience with PT causing pain. I guess I have been fortunate on several fronts. My PT told me not to take pain meds before PT because he wanted to make sure that he never pushed too hard and could give him feedback. At no time did he ever force anything and constantly asked how it felt. I pushed things myself because I wasn't experiencing any negative issues.

I found that my workouts were not causing any swelling or pain so I felt comfortable stepping up the intensity. I had concerns preTKR that I would have trouble maintaining fitness if I couldn't do sufficiently intense cardio, but I found cycling, both stationary and road, to be essentially pain free so I was able to get good cardio workouts starting at about 3 to 4 weeks.

I guess that I have digressed from my original question which was have people been able to recover full quad strength? While recovery is proceeding well it seems that quad strength is hard to fully regain.

Sent from my SM-G935V using Tapatalk
 
Full quad strength will come back, but it takes time. Remember that it takes as long as a full year for complete recovery from a knee replacement. Nothing happens fast!
 
have people been able to recover full quad strength?
Yes. Once healing was complete I could ride more smoothly than before, because my knees tracked straight. Then able to train as hard or harder than before. There is no doubt I'm riding better now at 65 than I was at 58 but pre-BTKR.

Strength is of course hard to regain, because one has to doss about doing nothing for so long. Put another way, one has to implement a structured recovery programme that precludes force going through the recovering knee.

Seriously, its essential to allow healing to complete before going hard in training. The knees are your guide (as you have said); if they swell or go stiff after doing X, then either cut X out or cut it down until the knee doesn't react. It's easy to overdo things, but your recovery won't be affected by underdoing (your fitness might, but that can be rebuilt).

Here's our general recovery stuff:

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. Here is a week-by-week guide for 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?

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 original reason for posting was based on articles like those below. The articles state that even after 1 year, quadricep weakness persists, and walking and stair climbing performance is less than people who have not had a TKR. What I'm interested in finding out is if anyone has made a specific effort to quantify their quad strength loss and what they have done to counter any weaknesses. I realize that this is an issue that goes beyond basic recovery. Obviously the more important initial goal is to achieve normal mobility and pain free living. However, I am also interested to see if one can achieve the same level of capabilities/performance as those that who have not had TKR or at least match their own pre-TKR strengths.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1167681/
Early Quadriceps Strength Loss After Total Knee Arthroplasty
The Contributions of Muscle Atrophy and Failure of Voluntary Muscle Activation
Ryan L Mizner, MPT, PhD, Stephanie C Petterson, MPT, Jennifer E Stevens, MPT, PhD, Krista Vandenborne, PT, PhD,and Lynn Snyder-Mackler, PT, ScD​

or

Quadriceps and Hamstrings Muscle Dysfunction after Total Knee Arthroplasty
 
All I can say is (a) I wouldn't trade back to pre-surgery pain for a king's ransom (b) I walk and cycle better than pre-surgery. I am probably no worse now than I was 10 years ago (and 55-65 is pretty significant!). I can train as hard as I like on the bike, my knees have no impact on it.

This is just my own experience.
 
Well, I can tell you that my RTKR is much stronger than my left natural (that needs replaced). My RTKR is the leg I depend on and it’s the one that climbs the stairs. I did have RTKR pain while walking for a few years, but it’s because I was afraid to use it and didn’t use it the way I should. Once I slowly began a walking regimen that built my stamina and the muscles around the TKR I can now walk steadily for 2-3 miles, painfree. Standing also is no longer a problem. I also ride 8 miles a day with no pain. Walking has helped me more than any PT I did and I had a lot of PT. The key is start slowly and build slowly.
 
I was never a fitness-focused person, but I’ve always had strong legs. My PT guy even remarked on my strong quads on first visit. Lifting my legs into and out of bed by myself was never a problem, not even a little, and I transitioned easily to walking, swimming, and more recently to some strength exercises with a personal trainer. We just did some leg presses to establish a baseline and she said my leg strength is surprisingly good, novice level or something, and we’re not going to push for more now because, quite frankly, it’s good enough for what I do. I’m working more on my upper body (if anything, my recovery has shown how woeful that is!).

The point is, not everyone ends up losing quad strength after surgery. Immediately after surgery, yes. Everyone will lose some because recovery is less active, but after the knees heal people can get that strength back. My legs are way stronger now than they were back in May when I had the surgery. Walking and swimming have really built them back up. I’m not doing weights and squats or machines because I don’t want to chance possible negative effects in my prostheses. I’m happy with walking, stairs, and swimming.

I think once your knees are healed you can work out a program with a PT that will get you to your quad strength goals.
 
My doctor told me at my one year checkup my quads were atrophied. But I still walk better, do dance/stretching exercises, walk up and down stairs some, etc and don't think they necessarily look atrophied. One knee is replaced; the other is not, so they pretty much look the same to me. Plus I was reassured here that as long as I'm using my legs, I'm fine. I do still have pain, and no, I can't do leaps and bounds anymore, and my legs will not run up the stairs. But I can get up them and I use that as a strengthening exercise a couple times a week. At my 2 year check up I will ask doctor about the atrophy and take it from there depending on what he says. Plus, I think the aging process has something to do with atrophy too, along with some medical conditions like pinched nerves. And I really couldn't find a whole lot on atrophied muscles after tkr on the internet. So it's on the back burner, so to speak, until I have problems with it.
 
In my humble opinion I think you may be striving for too much too soon.

My quads are much stronger now (two and three years post TKR) than they were at one year post. Complete TKR recovery was a two year process for me. The improvements from year one to two were subtle but noticeable.
 
Last edited:
I have continued to research the issue of quad loss and rehabilitation. I made contact with someone at http://www.ucdenver.edu/academics/c...earch/researchfacilitieslabs/Pages/MPLab.aspx

They sent me some papers to read. I haven't had a chance to digest them yet. One point seems to be that most research has been in becoming pain free and good ROM such as the good advice on this forum However there is much less info on muscle atrophy and strength loss. There are experiments with electrical stimulation and more intense resistance training. With younger people getting Tka they have greater expectations and the question is how to get there.

Hopefully I'll learn something in the next 6 days before my second TKR. ☺️ Actually I'm sure I'll have plenty of time to read since the next 3 to 4 weeks will be trying to get pain free and decent rom.
 
However there is much less info on muscle atrophy and strength loss. There are experiments with electrical stimulation and more intense resistance training. With younger people getting Tka they have greater expectations and the question is how to get there.
Everyone who has a knee replacement experiences muscle atrophy afterwards. It's part of the deal.
Your muscles gradually regain strength as recovery progresses.

At first, you need to rest your leg until the surgery trauma is healed enough, before you start strength training. We usually recommend not starting any strength training until 3 months post-op. That applies whether you are 18 or 80, because your tissues take the same amount of time to heal, regardless of age or prior fitness.

Bear in mind that complete recovery can take as long as a full year. There's nothing you can do to speed up that process. We have had quite a few younger, fit people who have experienced worry and frustration because they aren't recovering faster. Unfortunately, regardless of your age, this recovery takes time and patience.
Healing: how long does it take?

Please don't consider that older people don't have the same wish to regain full fitness and function. We're not all rocking chair grannies!
I have travelled around the world more than once, by plane, ship, bus and car, since having my knees replaced. I manage my own luggage and don't need help anywhere. I walk without a cane, I play with my grandchildren and I'm pretty active for my age.
 

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