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Bilateral TKR Slow recovery

You do not have to exercise the knee for it to come back normally.

I agree!

Regaining our ROM does not require forceful bending or painful exercises. That is counterproductive.

Regaining our ROM is more about Time than repetitions of a list of exercises.

Time to recover.
Time for pain and swelling to settle.
Time to heal.

Our range of motion is right there all along just waiting for that to happen so it can show itself.

In the general run of things, it doesn't need to be fought for, worked hard for or worried about. It will happen. Normal activity is the key to success.
 
It just frustrates me when I read comments from others who have had marvelous recoveries.
I felt the same way. It was very hard for me mentally, as I was struggling along with swelling and limited ROM, to read about others at my stage out there living their lives and doing so much more. I often just had to stop reading those posts when I was down. If you would like to read about a long, hard recovery, feel free to check out my thread. It’s very long! But it might make you feel better about where you are at.

I am just over a year post op now, and yesterday I hiked 6 miles with 2300 ft of elevation gain. It was awesome! But at your stage in my recovery, I was in a terrible state, and so far behind others. You are doing far better than I was, so take heart!

Our knees choose their timelines and as hard as we try to control that, the knees always win. Wishing you patience and fortitude, PVCT.
 
I am now 4 months post BTKR and struggling with ROM. I was prescribed anti inflammatory meds that had severe side effects so I stopped taking them. However, my ROM is still at 90 and my surgeon suggests that MUA might be needed for both knees when I see him next month. At that stage I will be 5 months post-surgery.

Has anyone else had similar problems and any suggestions will be most welcome. I am hoping that my daily stretching and cycling will result in getting past 90 in the next month but I am not confident about this as my knees are both quite swollen making bending very difficult and painful.

Is it likely that my ROM will increase in time or am I likely to be stuck at 90 and possibly might require revision surgery?
 
I have no experience of knee replacement but the thread from @JusticeRider is well worth reading as regards frustration and ROM worries. Best wishes for your continuing recovery, as others have said 4m is still early in the joint replacement journey.
 
@PVCT Far too early to be talking about MUA. I can never understand why surgeons are so impatient regarding ROM. You never lose ROM. It is just hindered by inflammation.

Are you icing your knees? Ice will reduce the swelling that is limiting your ROM. Gentle stretches and your cycling will indeed help you increase ROM. But there is no timeframe for this.

A couple of our members recorded their progress gaining ROM. Sounds like your current range is in line with what they experienced. As you can see, it can take one year or longer. And Campervan's example shows ROM continues to improve years later.

Here is betrtschb's record of how his flexion developed over time:
I'm 12 months out from my surgery and have some advice based on my experience:
1- Stop going to PT (all it will do is make your knee swell and reduce ROM)
2- Don't worry about your ROM
3- Be patient - VERY patient!!!

Here is my ROM history (more or less):
1 month - 60 degrees
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
I spent waaaaay too much time worrying about ROM. I thought I'd be riding my bike a couple months after surgery but it took SIX months! Looking back on my surgery, if I knew then what I know now, I wouldn't have wasted my time with PT and I wouldn't have worried about ROM.


And I have another record, from Campervan - she discovered that her flexion had increased even at 6 years post-op:
"I had a slow recovery. Here's my flex measurements at various points:
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
125 - 1 yr 8 months
128 – 6 years "
 
knees are both quite swollen making bending very difficult and painful.
The real question is why are you still this swollen at 4 months? While swelling can, and does, continue for months, what you describe could indicate more than that. Maybe ask for some bloodwork to make sure all is well.

You need to spend more time resting and elevating to get this swelling down. Very swollen knees do not bend. An MUA will only irritate knees that are already quite swollen. It is the swelling that is preventing your knees from bending better.

What are your activities on a daily basis? Too much activity (meaning more than your particular knees can handle) with healing knees can maintain swelling.

I had a very rough first year ROM-wise, but my ROM increased a lot in my second year as my whole leg continued to relax and heal.
 
Here is the post I believe, Newhip_Pol may be referring to in regard to JusticeRider.
Hopefully these accounts from other members bring you some peace of mind in regard to ROM.

Justice Rider's 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."
 
I am hoping that my daily stretching and cycling will result in getting past 90 in the next month but I am not confident about this as my knees are both quite swollen making bending very difficult and painful.
This is obviously not working for you. Why not stop all cycling and stretching and concentrate on getting the pain and swelling down? The best way to do that is to ice and elevate the whole time you are sitting or lying down. When the swelling goes down, your bend will naturally improve. Swelling is keeping your knee from bending more and an MUA will only increase that swelling, decreasing the bend. Stop your extra knee activities for the next month and you'll see improvements. Doing your gentle daily activities along with icing and elevating is all your knee needs to recover its ROM.
 
I am now 4 months post BTKR and struggling with ROM [....] However, my ROM is still at 90 and my surgeon suggests that MUA might be needed for both knees when I see him next month. At that stage I will be 5 months post-surgery.
If the problem is scar tissue (as opposed to stubborn swelling) one thing to consider is an arthroscopic lysis of adhesions followed by (if necessary) an MUA while the incisions are open. The MUA is used only if there is scar tissue that the surgeon cannot get at with his instruments. This kind of surgery involves less trauma than a standard closed MUA, and allows the surgeon to drain any bleeding before closing the incisions.

I had this surgery (I develop huge amounts of scar tissue) and it would have been successful if not for the undetected infection that was in place since the previous revision.

Not every orthopedic surgeon can do this - you might have to seek out an arthroscopic specialist, as I did.
 
Hi @PVCT! I’m so sorry to hear you are stressed and worried about ROM. I can relate and sympathize with what you’re going through. As @Newhip_Pol and @Layla mentioned, I too struggled with flexion and was told by my surgeon I would never gain more ROM without a MUA and I would be stuck where I was at at forever. I was swollen and miserable and scared.

I absolutely believe the first order of business is getting the swelling down. Swelling inhibits bend, and until you can resolve the swelling you may not see much improvement in your bend. But there is no time limit to get that bend back. For me, it wasn’t until my swelling finally started to settle down around 5-6 months out that I began to see progress. That progress has been very slow, but it has continued into the present. I am a few days short of 14 months and improvement hasn’t stopped. I have more flexion than I did a month ago. I am far, far beyond where I was at 5 months, and I am riding horses, hiking, backpacking, and working on my farm.

There is no window of opportunity to increase ROM. Work first on your swelling…rest, ice, elevation, regular walking, and GENTLE bending stretches. Then your flexion will be able to improve. Patience is the hardest part. But that and believing in your body’s wisdom and resilience will get you there. Best of luck @PVCT
 
Had MUA 4 months ago because my ROM was stuck at 90. Still have knee and hip pain especially after cycling with saddle at maximum height. I am only just beyond 90 and my surgeon wants to do another MUA. I am naturally reluctant because the last MUA did not appear to help significantly and my pain level was very high after the MUA. Anyone else have similar issues? I would appreciate comments and advice.
 
So sorry you still have pain and poor flexion.
I would be asking my surgeon why he thinks a second MUA would help if the first one didn't work.
Is the knee still swollen? I haven't had any experience of MUA myself but I know the feeling is here that it resets the healing process back to the date of the MUA. So effectively you are at 4 months in your recovery process. Could you be doing too much or not resting enough to allow the knee to settle down?
I wonder if it might be time to think of a second opinion rather than put your knee through another potentially painful procedure?
 
Thanks to those who responded - makes me feel that there is hope on the horizon. EalingGran I have taken your advice and booked a second opinion next month if my condition does not improve. I find it difficult where to draw the line between doing too much exercise and too little. I guess the trial and error way is the only way forward. I am now keeping a daily log of exercises and the outcomes the next day.
 
I am hoping that my daily stretching and cycling will result in getting past 90 in the next month but I am not confident about this as my knees are both quite swollen making bending very difficult and painful.
You wrote the above on October 3, 2023. Knees that are quite swollen are very hard to bend.

Had MUA 4 months ago because my ROM was stuck at 90. Still have knee and hip pain especially after cycling with saddle at maximum height. I am only just beyond 90
You wrote this today. Has your swelling gone down significantly yet, since October? If not, you may indeed be doing too much to promote better ROM. While movement is good for our healing, too much can keep us swollen and yes, it can be a fine line. How long/how far do you cycle?

I had a difficult first year with my ROM, but I did have a lot of improvement all around, in my second year, as my whole leg continued to relax and heal from the surgery.
 
Thanks for the info Jockette. I am encouraged by your recovery in the second year. I do not cycle on the roads - I have an exercise bike at home and I do 2/3 short stints after warming up slowly. MUA date was 20 November 2023. Swelling has not gone down significantly since my post in October.
 
As a cyclist myself and scheduled for my second TKR within 3 months I understand your frustration. After reading most of the thread I would say a couple of things. How much ROM did you have before the surgery? I only had 115 and 9 weeks out I am at 106 and believe I will be at 110 by April 25 and my next surgery. Also athletes that have the mind set of getting and staying in good physical shape, myself especially, tend to think pushing beyond comfort is the way to regain fitness. In this case with the amount of trauma inflicted during the procedure the last thing we should be doing is pushing into serious pain. Soft tissue takes time to heal and you will have a much better experience if you just patiently allow your body to recover. Repeated painful stretching and manipulation just delays the entire process and may even cause more scar tissue to appear. Look we are all different and comparing to others will just cause more anxiety. Overwhelmingly these procedures work quite well with marked improvement in your everyday life.
Hang in there.
 
Thanks for your comments Jtmav. I had very good flexion in both knees prior to surgery - probably 125 - 130 and got to 90 within 2 months after surgery. However, I have been stuck in the 90 -95 range since then and the MUA merely resulted in more swelling and pain - probably because I pushed myself too hard on the exercise bike in the weeks after MUA on the understanding that one only gets back approximately 50% of the ROM achieved by the surgeon during the MUA. The pictures taken during the MUA show that I got to about 130.
 
Surgeon now says that spacers in both knees are too large and need to be replaced by smaller spacers. Has anyone else had similar issues and, if so, I would be grateful to hear any comments that might be useful to me before I commit to the surgery. Specifically I am keen to know how long the recovery process is likely to be and the rate of success that this type of surgery has been with others who have undergone similar surgery. The plan is to do one knee at a time and, based upon the success of the surgery, then the second knee will be done after I have recovered. Sadly it sounds like it is likely to be a long recovery process.
 

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