TKR Slow recovery from TKR

[benne68]

I'm so sorry your PT tried to frighten you with this ridiculous story, @westiemom.

I've been through two TKR recoveries with Medicare+a Medicare Supplement and can assure you that there is no such "rule." I would fire this PT practice and find a different one if this is how the operate. You should never feel threatened to perform.

It is YOUR knee and YOUR recovery. Not your PT's and not even your surgeon's. You have every right to say "No" to painful forced movements.

 

[mendogal]

I understand @westiemom - I'm in a rural area with limited medical care specialties and staffing.

90 degrees in 4 weeks is simply not an achievable goal for many of our members, who nonetheless go on to have superb recoveries with fully functional knees.

I only went once a week, with my first knee, and was firm with limits. With the second, I went even fewer times as I'd learned what to do and not do! It sounds like they want to rush you through in as few weeks as possible, even at the cost of your own healing.

 

[Layla]

I can tell I am doing better. I am doing so many more things at home - just daily living stuff - that I never imagined I could do when I first got home from the hospital. Even my dogs know I feel better; they're not as clingy as they were in the first few weeks

Wonderful! This IS progress.
Have a great weekend!

 

[westiemom]

I've been doing my at home exercises with help from DH. He watches to make sure I'm doing them like they showed me at PT. I am just NOT getting that extra flexion. DH said he thinks I have gone backwards and my flexion is not as good as it was. DH is very honest; he tells me like it is, so I believe him. I can also see that my bend is not as straight as last week.

I could just sit and cry about this. I really am trying so hard to do better, but my knee just does.not.want.to.bend. Should I be checking with my OS about the MUA yet? I am so discouraged that it's hard to have the motivation to even try the exercises. I just did the heel slides for several minutes and can't see that my knee has loosened up at all.

i Just don't know how to proceed at this point. I'm discouraged, sad, mad, sorry for myself - you name it, I'm feeling it.

Thanks for letting me vent in a safe spot. Everyone I know is so encouraging, saying I can do it; everyone can do it. Just try harder. I'm at my breaking point here.

 

[mendogal]

@westiemom
Please give your baby knee a rest.

It's certainly true that a very small proportion of knee replacement patients develop scar tissue quickly enough to benefit from an MUA.

However for the overwhelming majority of us, the lack or loss of flexion during the initial weeks is the result of increased swelling. Motivation to do more exercise only leads to more swelling, leading to less flexion.

Icing, while elevating "toes above nose," for at least 45 minutes at a time will help prevent rebound swelling.

This is an excellent article on Adhesions and MUAs.

The "window of opportunity" is a myth. Here's why.

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

 

[WFD]

@westiemom , you are at 84° at about 5 weeks, right? Many surgeons expect to see 90° at six weeks, so you are doing OK.

If you do opt for an MUA, most surgeons want to do them in the first three months, so you have time. I suggest backing off your exercises and focusing on ice, elevation, and easy motion. Try that for a week or two and see if it helps. If your RoM is being limited by swelling, hard exercises are not going to help.

Your limited range of motion is most likely caused by swelling not scar tissue. I make scar tissue like no one's business ("the worst I've ever seen" according to one of my surgeons), and even for me it wasn't a problem until two months or more.

On the three month MUA limit, I know Bonesmart disagrees, but all my surgeons adhere to that rule. One surgeon told me that one of his patients suffered a broken femur during an attempt at an MUA, so you can understand where their caution comes from.

You can also get an arthroscopic lysis of adhesions with an MUA at any time. I had one done about six months after my revision - the surgeon insisted on waiting that long so the inflammation would die down.

Good luck, and try relaxing a bit.

 

[benne68]

Everyone I know is so encouraging, saying I can do it; everyone can do it. Just try harder.

No! You don't need to try harder. Whoever is giving you this bad advice doesn't understand this recovery.

ROM comes with time -- not with pushing -- and you are only one month post-op. Your knee needs more time for the internal swelling to go down and for the soft tissues to recover from the surgical trauma.

I know it's hard, but try to ignore all those voices telling you to try harder. Listen to your body. Cut back on the exercise. Ice and elevate. You WILL regain your ranger of motion if you just give it time.

 

[Jockette]

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

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

“At my six week appointment this is what my OS wrote in my visit summary: "She reads an online website called Bone Smart which states to not push through pain following knee replacement. If she were to follow this direction, she will have to learn to live with a knee that only reaches to 85 degrees of flexion. I believe this website is very misleading."

It has now been 20 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 (where I am today): 110
I am so thrilled it keeps improving and improving and I know now that I will get to my goal of 120 (or even better, dare I say!)


And,

“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. “

 

[Layla]

It is totally understandable that you're concerned about your progress. I am sorry you're so stressed. Please take a deep breath and relax. Many members have felt the same at this stage. It is normal to still be working on ROM at only one month post TKR.

As you've read, this recovery takes a full year for most and even longer for some. ROM improves well beyond these early weeks. MUA is generally considered only when your ROM is severely limited.

I understand it's difficult, but try not to stress about numbers right now. Do some gentle stretching and strengthening exercises daily, gradually increasing activity as pain tolerance allows. Know that progress in not linear, there are ups and downs...good days and bad days.

Soft tissues are healing and pushing too much will likely only increase swelling and the resulting stiffness.
There are many threads here of those that had slow starts. Refer back to JusticeRider and VolLady's posts in your thread, Posts 18 and 19 as examples. Take the pressure of by focusing on realistic goals and timelines.
You will get there! I hope you sleep well tonight and have a good week!
@westiemom

 

[westiemom]

I had PT yesterday and it was actually a good session. I had discomfort after, but not actual pain. He did not measure my ROM; he said they will only measure it once a week. So thankful as I hate hearing that number. I did make a mistake and didn't take pain med to sleep since it was only bad "discomfort", not pain on a level of 7. Didn't sleep good and throbbed all night. Won't make that mistake again.

I'm just telling anyone who asks me that I'm progressing and the doctor was happy at my last checkup. I'm basically just sluffing everyone off so they don't say anything more.

 

[benne68]

I'm just telling anyone who asks me that I'm progressing and the doctor was happy at my last checkup.

That's the perfect answer! After my first TKR, I would tell people "Surgeon says I am on schedule for me."

The "opinions" of others -- whether they've been though this recovery or not -- are not relevant.
It's your knee and your recovery. Do what is right for you. We are here to support your journey!

 

[westiemom]

Well, Friday I had my PT and I have actually regressed. The best I could get to was 78 degrees (or maybe it was 71 - I was too upset to remember correctly). I have an appointment with the surgeon on 1/15, but she wants me to try to get in sooner to discuss my regression. She is going to message the doctor to tell him herself, since she doesn't think I will contact the doctor myself.

I honestly don't know what to do now. She did suggest a CPM or CMP - a constant bending machine thing that I lay and it just bends my knee and I can keep dialing it up to get a better flexion. Of course, there's the standard MUA to talk about too. I have not called my surgeon yet as I want some decisions in my head before I go to see him. Of course, week before Christmas presents its own problems too.

I am so depressed. I haven't even discussed this with DH as I have been trying to come to terms with it myself. The PT thinks it is scar tissue that is built up and I will either never get better flexion or possibly keep regressing?

Part of me just wants to quit both PT and not go back to the OS and just see what happens in my own time. One of the problems with the MUA is because of my heart problem, they have to do my surgeries at the hospital not the bone building with a cardiologist on call. This means I get thrown into the surgery recovery floor where the nurses hardly speak english (I couldn't even understand what pills they were giving me last time) and no pain meds because of my heart. Trust me, no one wants to have surgery and then no pain pills. It was pure torture. DH brought a vicodan from home for me to take to endure the one hour drive home.

I am just sick at heart and ready to give up. Does anyone know of anyone who regressed and then went on to do better or should I resign myself to being with a walker or cane the rest of my life?

I am so sorry to be so depressing; I know this forum is supposed to be for helping others and giving encouragement and I can't do either.

 

[Jockette]

should I resign myself to being with a walker or cane the rest of my life?

It is far too early for such a dire acceptance that you will never improve. This is a year long recveory and you are only one month into it.

One of the problems with the MUA is because of my heart problem

Wow, that seems like quite a risk. All for a number than can improve, in time. And, no pain medication?

Part of me just wants to quit both PT and not go back to the OS and just see what happens in my own time.

Only you can make this decision, but what do you have to lose by this option, other than the stress all this is causing you. You can always go back to PT at a later date.

Back when I was recovering, I was always so stressed about my upcoming appointments with my surgeon, as he was a fan of bending patients knees as far as he could until he was happy (or happy enough) with the number. I dreaded the pain that caused. Someone suggested to me that I just cancel the appointment. Oh my, I couldn’t do that, he was the surgeon, and I couldn’t go against him. Fast forward almost 8 years, and reading many posts here on Bonesmart about different members recovery experiences, and if the same thing happens to me in the future, I will cancel appointments with any surgeon who treats me like that, in a heartbeat! That stress was unnecessary and did me more harm than good.

Our surgeons and PTs are only human, and have their individual opinions about recovery. That’s all it is, opinions. Your opinion is the most important of all. Do what is best for your body and your mental outlook.

 

[Jockette]

Lose the Work Ethic While You Are Recovering!

Lose the Work Ethic!!! Article by Referee54 (Tim) Many of us have a tremendous work ethic---and for several reasons. I can still remember, to this day, my father saying to me on the morning of my first day on a “real job”, “Give them nine hours of work in an eight hour day.” I believe that...

bonesmart.org

 

[Jockette]

TKR: Where are you in recovery?

How many of you have been in a shopping mall or an amusement park and have seen a map that says, “You are here.” It tells you where you are so you can locate what you have to do in order to get to where you want to be. Well, here is more realistic chart of the “You are here” for a TKR. Too...

bonesmart.org

 

[Jockette]

TKRs and our fast food society

Many of us here in the US of A are rather used to getting things fairly quickly. We have adopted a "fast food mentality" to almost everything---not only restaurants, but also oil changes, banking, dentistry, grocery shopping, etc to name a few. Almost all of us, however, have to understand...

bonesmart.org

 

[Jockette]

What You Should Not Expect To Do After a TKR

Written by Tim (referee54) Many of you have written that you are prepared "to work really hard in PT/rehab after your TKR or your BTKR." You have to remember that this is not an athletic-type injury; it is true that many of us have had some type of arthroscopic athletic surgical repair done to...

bonesmart.org

 

[mendogal]

@westiemom

I am so sorry to be so depressing; I know this forum is supposed to be for helping others and giving encouragement and I can't do either.

You aren't here to be inspirational, you're here to receive support!!!! Those 3 AM terrors and those hard decisions? Yep we're here for you!

You truly are facing a hard decision, though I don't think you need to act on it today or next week.

Many people referred for MUAs in the USA don't seem to need them. I say this because (1) they are referred faster than adhesions normally form and because (2) overall success rates for TKRs are the same regardless of them and because (3) success rates are similar in countries that don't rush their knee patients into MUAs. So there's a very real cultural USA mindset that wants fast results by any means at our disposal.

There certainly are humans who have a tendency to form adhesions - whether it's after abdominal or orthopedic surgery, their bodies respond by going into overdrive to produce them. Fortunately most of us don't.

I want to reassure you that whatever you decide, for or against a MUA, we will 100% support your decision and be here before and after offering unconditional support.

 

[Layla]

Hi westiemom,
It is natural to feel discouraged after a setback. This is just a moment in your year long recovery journey though, not your final outcome. This journey is filled with ups and downs and unfortunately setbacks are normal. You're still healing in these early weeks. You've been through a lot and your body is adjusting after the trauma of surgery. This will continue for months to come, so breathe easy. Try not to lose sight of the progress you've made, no matter how small. You are stronger than you realize, remember that. You will continue to make progress.

I don't understand the PT telling you she will contact your surgeon because she doesn't trust that you will. Does she not understand that you are taking your recovery seriously?

Hopefully you're actively engaging in low impact activities like walking and gentle stretching for example which can help maintain and potentially improve your ROM. I know you understand the importance of icing and elevation also to reduce swelling which can hinder our range of motion. Then there's water therapy which many enjoy.

Feel free to vent here. We understand. You don't need to worry about supporting and encouraging others when you're feeling down, we will do that. You're welcome to stop by anytime for comfort, support and encouragement, we'll be here for you no matter what you decide! Don't lose faith in yourself, or the journey. You can do this!
@westiemom

 

[Jockette]

Does anyone know of anyone who regressed and then went on to do better

I did. At 4 months post op I had a setback to that severely damaged my healing soft tissue and I could hardly bend my knee. I would have thought that couldn’t happen at “the advanced healing stage of 4 months!” I had gone away for the weekend to visit friends and I tried to keep up with them as if I’d never had surgery. Between multiple times a day up and down stairs, and their lower height toilets, I struggled all weekend.

It took me a month the begin to improve and then my son got married in a town 90 minutes away from my home. It was a total of a 3 day weekend, multiple trips back and forth and little time to rest, ice and elevate. Once again my ROM was very poor. Once again it took a month to begin to improve, but my ROM was poor the rest of my first year.

BUT, I had a lot of improvement all through my second year, in all ways, as my whole leg continued to relax and heal, proving there is no “window of opportunity.”

My flexion at best was 84 when the PT hurt me and I was swollen like a beachball. A week and half later and I'm at 78.

A week and a half is not enough time to recover from such an injury.

With PT causing you this much pain and swelling, what is actually happening is they are re-injuring your knee which is preventing any progress. This is inappropriate PT. Not all PTs do this, which proves it’s just their opinion of rehab. I suggest you take a step back from PT for a few weeks, spend more time icing and elevating, and resting, (longer walks at the mall can wait) and let your knee, and your emotions, settle down. Then, when you are feeling much better, find another PT office with a more update, gentler approach to rehab. You do not have to stay with this office, there are many PT offices.