TKR Should I be able to lift my leg??

[Merlin803]

I am so glad that I have found this forum! I had TKR 1 week ago today and feel like there is information that I am not getting from my PT or Dr.

I have had 4 PT sessions and through the first three, I kept trying to ask the PT if I was where I should be or if I should be concerned about anything and everything seemed ok. The 4th trip the PT said he was concerned that I still can't lift my leg.

Specifically- I can't lay on my back and lift up either my whole leg or if I put a ball under my knee, I can't lift from just my knee down.

Because of this, I went in and seen my DR. yesterday and he took a look at it and took x-rays and said it looked fine and "I just need to do it".

I can do all the other stretches/exercises but this one but I really just can't lift my leg (extreme pain on my kneecap area and it just doesn't want to move).

Does anyone have any experience with this specific issue?

 

[WFD]

I couldn't do that at one week either. The pain levels in the thigh (caused by the tourniquet) and the knee (caused by the surgery itself) caused my body to 'guard' the injuries by refusing to let me do it.

This is very very common and it surprises me to hear your doctor tell you to 'just do it'. That sounds really clueless.

By the two week point I was able to do it with some difficulty and now at three weeks it is easy.

What you are experiencing is all perfectly normal. The only abnormality is your doctor's attitude.

You just need to heal some more.

 

[sistersinhim]

@Merlin803, welcome to BoneSmart. You have come to the right place to get answers to your questions. Not being able to lift your leg at 1 week out is not unusual at all. It will come and one day you'll realize that all of a sudden you can lift it!

Each person is different as is their recovery. Most find that the Bonesmart approach works best for them, but others find that a more aggressive therapy helps them more. It's your recovery and your choice on how you recover. As you read more on other members' recovery threads, you’ll get a better perspective of what to expect. The following are our basic guidelines and should help get you started.

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.

KNEE RECOVERY 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
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.

Try out our great new opportunity to improve your gait. It's OneStep. It's free and you will find it to be a huge help to you. Click here: OneStep

 

[Shansea]

Lifting my leg was painful for me for the first month. I would use a strap to get in and out of bed and needed the strap to lift my leg onto the elevation pillow. I am 10 weeks out and the leg is lifting much easier. Hang in there!

 

[Merlin803]

Thank you so much! I was believing that there was something really wrong. It is hard enough to sleep but having this additional worry was just piling on.

I look forward to reading though the forum and gaining more knowledge.

 

[mystikfairy61]

I had surgery Monday and also had my first knee 9 years ago. I remember the first one well. It felt like I had a log for a leg. I too had the pain around the knee that seemed to make it resist me trying to lift it. I am day 3 on this new knee and having some of the exact things going on now as I did then. I am using a leg lifter I bought to help me get my leg on and off the bed as well as my raised pillow. This like everything else comes about. I try to follow the Bonesmart mantra about anything I am dealing with like this. Don't worry about it, it will come.

 

[mendogal]

I want to add something... The exercise of trying to raise the lower leg with a ball under the knee? The PTs call that a short arc quad. And it's not a range of motion exercise. It's a strengthening exercise.
My ortho surgeon (and others I know of hereabouts) wouldn't ever clear me for strengthening so soon after surgery. The first couple of weeks it's ankle pumps, gentle heel slides, some quad sets, erring on the side of prudence. No strength training until 6 - 8 weeks to avoid really damaging the muscles.
May I respectfully suggest you decline anything like that or that causes pain? It can seriously set you back.

 

[Merlin803]

I want to add something... The exercise of trying to raise the lower leg with a ball under the knee? The PTs call that a short arc quad. And it's not a range of motion exercise. It's a strengthening exercise.
My ortho surgeon (and others I know of hereabouts) wouldn't ever clear me for strengthening so soon after surgery. The first couple of weeks it's ankle pumps, gentle heel slides, some quad sets, erring on the side of prudence. No strength training until 6 - 8 weeks to avoid really damaging the muscles.
May I respectfully suggest you decline anything like that or that causes pain? It can seriously set you back.

Thank you for that input.

It's tough because I don't know any better than to try to do what I am asked because on one hand your told "it's going to hurt but it's important that you do these things and it will then get easier the more you do it".

So, while I have always thought I had a high pain threshold, I am thinking that everyone is able to easily do these things so I just need to try to suffer through them.

I am no longer going to try to do those specific ones (I can't anyways, and it feels like my kneecap is going to explode when I try).

 

[WFD]

The PTs call that a short arc quad. And it's not a range of motion exercise. It's a strengthening exercise.

My PT hasd me do these solely to activate the quad and get it connected to my brain and working again, and it seemed to do that well.

Done for a reasonable number of repetitions, as long as it is not stressful or painful, I found it to be useful.

 

[mendogal]

My PT hasd me do these solely to activate the quad and get it connected to my brain and working again, and it seemed to do that well.

Done for a reasonable number of repetitions, as long as it is not stressful or painful, I found it to be useful.

Interesting variations in practice, which given what we read here isn't surprising. Not a judgement, just an observation.
For me, quad sets immediately post op as tolerated very effectively activated the quads without stress; having the short arc quads added after the 6 weeks mark for me it would have been way too much earlier.

 

[JusticeRider]

I just have to say, it boggles my mind how poorly many of our medical professionals prepare us for this recovery and how many things they for some reason don’t tell us. I also couldn’t raise my leg at first and was alarmed and terrified that something was wrong. No one at any point warned me that this could happen or assured me that it was very common and nothing to worry about. My PT said, ‘you just have to keep trying’ and implied I wasn’t working hard enough. I didn’t understand why my leg was not obeying my brain and thought maybe it was nerve damage or worse. Come to find out on BoneSmart that this happens to many, many people and resolves on its own with just a little time. Why don’t the surgeons/PA’s/PT’s just TELL us this stuff? Imagine how much stress we’d avoid…!

 

[Merlin803]

I just have to say, it boggles my mind how poorly many of our medical professionals prepare us for this recovery and how many things they for some reason don’t tell us. I also couldn’t raise my leg at first and was alarmed and terrified that something was wrong. No one at any point warned me that this could happen or assured me that it was very common and nothing to worry about. My PT said, ‘you just have to keep trying’ and implied I wasn’t working hard enough. I didn’t understand why my leg was not obeying my brain and thought maybe it was nerve damage or worse. Come to find out on BoneSmart that this happens to many, many people and resolves on its own with just a little time. Why don’t the surgeons/PA’s/PT’s just TELL us this stuff? Imagine how much stress we’d avoid…!

Exactly, I was feeling the same.

I did have another PT visit today and it was pretty productive! I don't know why he didn't think about the last time but we did some simple stretches and movements to get my quad moving, because it basically was not contracting AT ALL. Once we did that and I then could focus on contracting and using the quad, it started to "listen" and work with my knee.

I can pretty easily lift my leg standing and did get a little movement even when laying down afterwards but did not push it beyond minor pain (basically just to see if my quad would contract if I started the leg lifting process).

I think now that I can focus on the quad muscle that I should be able to move forward (and not stress about having something like nerve damage.....).

I am glad I found a group that has firsthand experiences to share!

 

[mendogal]

Any time you are feeling like a specific muscle isn't firing well, try gently touching it with a few fingers throughout the activity of trying to activate it. I was taught this many years ago by a myofascial therapist and have found it invaluable.

 

[Layla]

Happy One Month Anniversary, Merlin
How are you doing? We'd love to hear about the progress you're making.
Hope to hear from you soon.
@Merlin803

 

[Merlin803]

Just an update - it's been a few weeks and my quad muscle came along where I can lift my leg and do what I need to for PT.

I have in fact been walking for a couple of weeks with no assistance and even bowled on Saturday (slowly and cautiously...).

I have my last scheduled week of PT next week and my follow up appointment with my Dr. a week from Friday.

My only concern is I am only about at 90 degrees of bend right now. Is only 1 month of PT considered pretty normal?

 

[sistersinhim]

90 degrees at 1 month is a very good bend. Most OSs look for 90 degrees at 6 weeks and you are 2 weeks ahead of that!

Is only 1 month of PT considered pretty normal?

It varies. Some take PT for many months and others take no PT at all. The outcome for all is the same.

 

[Jockette]

and even bowled on Saturday (slowly and cautiously...).

I was in a bowling league when I had my surgery, so I know what you’re going through. I waited 3 months before I started back and by that time it was summer and the league games had ended, so I had time to go back gradually, for when the season started again in September.

 

[Merlin803]

90 degrees at 1 month is a very good bend. Most OSs look for 90 degrees at 6 weeks and you are 2 weeks ahead of that!

Is only 1 month of PT considered pretty normal?

It varies. Some take PT for many months and others take no PT at all. The outcome for all is the same.

Ok, I won't feel too bad about the bending then, thanks!

 

[Merlin803]

and even bowled on Saturday (slowly and cautiously...).

I was in a bowling league when I had my surgery, so I know what you’re going through. I waited 3 months before I started back and by that time it was summer and the league games had ended, so I had time to go back gradually, for when the season started again in September.

Yeah, I didn't really know what to expect until I tried.

The first several throws were mostly making sure I wasn't going to fall over and make a spectacle of myself, lol.

Once I was sure that I was pretty stable and my balance was going to be ok, I was able to do a semi-normal approach and it actually helped loosen up my quad muscle.

 

[Axx72]

Sounds like you are doing great! Bowling at this stage is a major achievement I'd think