PKR Slow, steady recovery....challenging gains in ROM

[kneeper]

My first knee stayed warm for a long time, but it got there. 10 weeks is still pretty early in the big scheme of things, so if the tight band is getting better I'd imagine it will continue to do so over the next couple of months.

 

[maui]

@kneeper...how long did it start warm...do you remember?

 

[Clipless]

I've been keeping a log, so I'll throw some numbers at you: I'm approaching 4 months out and have had intermittent pain, heat, swelling and stiffness up to as recently as two weeks ago. At nine weeks post op I suffered some kind of mini-setback that dropped my ROM from 4/100° to 8/95°. A week later (10 weeks) I improved to 0/100°. I felt I was making good progress, then at 13 weeks post I did it again- inflamed/swollen and my ROM dropped to 4/90°. Less than a week after that, however, the swelling went down and OS eyeballed me at 0/110°!

Yesterday after a short little bike ride I crashed on the couch without icing and promptly fell asleep. My son tells me I kept whimpering, "oww my knee, my knee, my knee!". But today it feels great- go figure.

Due to the recent rough episode the OS gave me another couple weeks off work, for which I am grateful. The PA says I've been breaking scar tissue on my own, which causes temporary inflammation. After every swollen episode resolves I seem to gain ROM. I still have a long ways to go, but I believe I'll get there eventually.

If you and your OS mutually decide that MUA is the best plan, don't sweat it- it might be just the help you need.

 

[numbzee]

Sorry you are having trouble with your ROM. I was afraid my surgeon was going to suggest one when I went to see him at 7 weeks. I was only at 74 degrees with a lot of help at PT and it was painful. Well here Iam at 14 weeks and I am up to 114 degrees! my doctor was so pleased he discharged me and said to continue what I have been doing and come back at my one year postoperative. He did suggested massage therapy and riding an exercise bike and keep stretching. Well back when I was at 74 degrees I decided to buy the exercise band that they use at my PT and use it at home everyday around the clock usually every two hours to stretch and flex an I truly believe along with elevating and using ice helped me to get yo where Iam today. I hope this may help you.

 

[kneeper]

I'd say it stayed warm for a few months, but progressively less so. my second knee cooled off sooner.

 

[Wrangler]

Hi @maui - thinking of you. I hope that you are doing well in your recovery!

 

[maui]

Hello. I haven't posted in awhile. I am now 14 weeks post op. Did not end up needing an MUA (as of yet) because my ROM keeps improving. I was measured last week at 104° by my PT. My healing is just so slow. Can anyone relate or speak to the reasons that I feel a rubber band feeling in my knee? ( It's whereabouts changes daily moving from the sides of my knee to the top of my knee....) Also, it feels like the ROM that I've gained from about 92 to 104 degrees has to be stretched out....and even when it is stretched out....all i have to do is walk for awhile and the tightness returns. Does this seem to sound like anyone's experience? Also, I'm having a tough time regaining my quad stength. One side of my quad is stengthening while the other is not. This causes my knee cap to track weird and pop. It doesn't hurt...just is a horribly weid, unsteady feeling. Hopefully that goes away soon when the strength returns. Hope you all are doing well in your recoveries. Take care and any notes of similiar stories would be appreciated. Sometimes I still feel like I'm the only one that is taking so long to recover. I'm learning this is all in God's time.

 

[Clipless]

Hi @maui , it's great to hear from you! It's funny- I was just thinking, "Ohh I am having the slowest KR recovery everrrr." then I logged on to Bonesmart and saw that you feel kind of the same way.

Just so you don't feel so alone in your slow recovery, I am 19 weeks out (19!!!) and I still get significant swelling when on my feet a lot (e.g. at work). Whenever that happens (every time I work) my knee stiffens, I lose ROM, my quad refuses to cooperate, and my lower back spasms. Last night my co-workers were so sweet- they insisted on taking care of my patients for half an hour so I could elevate & ice. It helped!

My ROM was last measured at 0/110 by my OS's PA last month. Flex might or might not be slightly better now, unfortunately I can't tell because it takes days to recover after each shift worked... and I'm already back to work by then.

I also would like to know if my experience is within the range of "normal". I asked the PA last visit, and his response was that I need to "work really hard" on my exercises.... Are you kidding me?!?!

Last night one of my patients' visitors (a very sweet lady) showed me her 7 months post op TKR knee. Not only was there no swelling at all, I could barely see the incision scar. Yes, she's a little further along in her recovery, but I don't expect my knee to look THAT good for many more months.

I've tried with and without thigh-high support hose at work, and wearing them seems better. Without them my TKR leg swells nearly to the ankle.

At this point I'm assuming my body is just having an exceptionally robust inflammatory response to the surgery vs.scarier thoughts of infection or rejection. Unfortunately I can't take NSAID's so all I can really do is elevate and ice whenever possible, and try to wait it out.

Thank you for keeping us posted on your recovery. I'm super glad to hear of your flexion gains! Can you ride an exercise bike now? Hopefully everything will sort itself out soon.

 

[kneeper]

It can take more months for that tight band feeling to completely go away, but it should gradually be reducing now.
YOu're right about the scar, @Clipless I'd be worried about mine still being pinkish purple if I didn't know scars take a long time to fade for me. I was worried about the first knee scar taking a long time but it eventually turned to just a pale line. It takes what it takes and is very individual.

 

[Pumpkin]

I feel a rubber band feeling in my knee?

This is a common experience, it goes away over time. Here is a link to an article in the library.
"Tight band" feeling across the front of my knee
Thanks for checking in, sounds like you are doing great with your ROM increasing slowly but surely.

 

[Jamie]

I agree that what you are experiencing is totally normal. You are actually still early in this recovery process and you can expect a full recovery to take up to a year or more. Of course, as you're finding, there is a lot you can do now with your new knee....it's not like you shouldn't be testing your limits a bit. But most people say they don't feel the knee really begins to feel "right" until at least 6 months.

If your quads are not equalizing in strength, you might ask for some sessions with a therapist to learn exercises for strengthening. It would be okay to start some basic ones as long as you don't get pain or swelling from them.

 

[maui]

Hello....just wanted the valued opinion of those that have tred the path before me.......
I am 21 weeks post op RPKR. This whole thing has been a huge ROM struggle for me. However, I have continually made progress and am currently at 110 degrees and 120 with a push. All along my OS has told me that a long as I'm making progress he would not intervene. I went to my regularly scheduled apt this week to find my OS had been called into surgery and that i would be seeing his PA. She took one look at my knee and recommended i have an arthroscopic open manipulation to remove scar tissue and get my leg moving. Don't get me wrong...its kind of a relief . I'm sorta over this leg not bending and I'm starting to feel like I've done everything i can possibly do...it's time to get this process over with.
Herein lies my question....
Has anyone had this done at my stage of this process and what was the outcome?? I am torn...don't know if by having this procedure i would be quitting this race with the finish line in sight or getting a sudden burst of energy to finish strong.

 

[Pumpkin]

I would first see your OS for his opinion, before deciding anything. I am surprised the PA made this suggestion with out first consulting with the OS.
MUA would make sense at this point in your recovery if that is what you and your surgeon decide is best for you.
Others have had arthroscopic scar tissue removal but were much further along in their recoveries.
I am going to tag @Josephine for you.

 

[Josephine]

am currently at 110 degrees and 120 with a push. I'm sorta over this leg not bending. PA.... took one look at my knee and recommended I have an arthroscopic open manipulation to remove scar tissue

ER, scuse me? You're at a 100 and think your leg is not bending? That your PT can get it to 120 'with a push' clearly says you do NOT have any scar tissue!

I'm going to ask you some questions and 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 compare this with the bone-on-bone pain you had before surgery!

) Also don't forget to include other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness

2. are you still taking any pain medications, if so what and how much are you taking (in mg please) and how often?

3. are you still icing, if so how often and for how long?

4. are you still elevating your leg, how often and for how long? Do you have much swelling?

5. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and if you work, what kind of work is it and how many hours a week do you do?

6. what kind of PT exercises and exercises at home are you doing? How much and how often? (and detailed details would be appreciated, please! **Reps, sets and sessions** and all that)

** If you're not familiar with this, it goes like so:
1 lift of your leg = 1 rep (repetition)
5 reps and then a brief rest = 1 set
5 sets and finishing = 1 session.

 

[maui]

Thanks Josephine,
If it's not adhesions or swelling..why won't my leg bend? I think i do have scar tissue because I've heard it pop several times.

1. I am a 1 on the pain scale. Zero most days.
2. 7.5 mg of meloxicam...but weening it off
3. Rarely but doctor says i am not swollen anymore
4. Not elevating....not swollen
5. Honestly, i don't have a regular routine. I have two kids that are in school but outside of that i do the cleaning and everything else that goes on with raising a family
6. I ride the bike 30 minute OR walk 1 mile every day. I see my pt once a week for stretching strengthening and Graston. I see my chiropractor once a week for stretching, laser treatments, and Graston.
I do walk slides several times a day and leg raises. 3 sets of 20 ankle weighted with 4 lbs.

Thanks for talking the time....i do appreciate your input.

 

[Josephine]

I think i do have scar tissue because I've heard it pop several times.

Contrary to popular opinion, this does not infer adhesions!

doctor says i am not swollen any more

Good, okay.

I ride the bike 30 minute OR walk 1 mile every day. I see my pt once a week for stretching strengthening and Graston. I see my chiropractor once a week for stretching, laser treatments, and Graston.

What laser treatments?
And this also means you are having two sessions of Graston a week? I don't think that's wise. I really don't think you need it at all as I doubt you have any adhesions.

I do walk slides several times a day and leg raises. 3 sets of 20 ankle weighted with 4lbs.

May I ask why you are still doing exercises at 5 months out? Your problem is doing things like this, especially the weighted stuff. I think you should quit all this and allow your leg to get better on its own. Truly! Walking within normal life activity limits is all you need. You already have really good ROM and still have plenty of time to get it even better. This can continue for as long as a year. You're in too much of a hurry and trying to beat your poor knee into submission! It doesn't work like that. And don't forget - with all due respect to your two therapists - you are a source of income to them so they are not about to tell you don't really need them any more!

As you can see in my signature, I have had two knee replacements and with both I got excellent ROM quite quickly. My 'secret' was that I did NO exercising whatsoever! That's right - none at all. You should try it. You might be very surprised with the results but they won't come quickly. Your knee has a lot to recover from and I'm not referring to the surgery!

 

[Spencieca]

I agree and would wait to talk to the OS...I had an MUA at 7 weeks, my ROM was only 75, 80 when REALLY pushed! I am at 8 weeks now and ROM is 90-95. I talked to my OS about the exact same thing you are talking about..he said he has only done 1 person with the scope removal with MUA and he said it didn't do much so he doesn't recommend it...but honestly, 100-120 is awesome! My OS said he would be VERY happy if I get to 110-115...hang in there...

 

[Josephine]

I do walk slides

Did you mean wall slides here? I've Googles 'walk' slides and got some very funny results! Assuming this be the case, then this is truly a serious part of your problem along with the weights. They are so punishing on the knee.

 

[maui]

Yes...wall slides....I'm doing them laying on the floor....is that easier on the knee?. I have felt for so long that they are helping increase the stretch.

 

[Spencieca]

Yes...wall slides....I'm doing them laying on the floor....is that easier on the knee?. I have felt for so long that they are helping increase the stretch.

I do wall slides also and they are a GREAT stretch and help with my ROM..I lay on the floor and do them as well, and I do them at the PT 3x's a week....