TKR So happy Surgery is behind me!

[trinket]

I was prescribed Amoxicillin 500mg x 4 for a recent podiatry procedure. I needed to have a toenail excision on a severely ingrown toenail. My OS didn't want to take a chance that it could get infected and travel to my knee. He has also indicated I will need to take antibiotics whenever I have a future dental procedure. I know there are many different thoughts on this, but I will err on the safe side and take the antibiotics. The last thing I want is to take any chance on infection in my knee.

 

[Bridgy]

Thanks! I can see your side too. I’m usually an err on the side of caution person. Maybe I’ll take antibiotics for a couple of years. I trust my GP so will get her opinion in June before the next dental visit.

 

[Bridgy]

Thanks @JusticeRider! I hope you see improvements everyday too. I like to read what you have to say also since we had our surgeries around the same time. Very grateful for the input of all of the bonesmart members!

 

[Darkang]

@trinket
I had a big discussion about future dental visits and what I needed to know to protect my knee in the future. It is interesting to see the different opinions the OS have!! A bit confusing. He said, a cleaning is nothing worry about. Nor is a filling, but if I was having a crown or a procedure that was more invasive, than antibiotics would be necessary. I'm a farm kid, so I was also concerned about 'what if' I get a nasty cut in the barn etc. Again, he said, don't worry about it. SO confusing!!!

 

[Whoodee]

Yes, I would like a clear answer on this as well.

 

[Bridgy]

So sad to report that at almost 9 months, my flexion has worsened. I think when I left PT in December, 2022 they were able, with pain, to get it to 110. Even though I have tried my best to continue flexion exercises since then and workout regularly, my current flexion is not quite 90.
I’m not in pain anymore when I walk and can get to 10,000 steps over a days time with little trouble.
I have continued difficulty going downstairs and will never be able to ride a bike.
I’m starting PT again on Tuesday to see if there’s anything I can do at this point.
Unfortunately in my case more flexion did not come with more time. I wish I would have known how hard I needed to work to keep what I had from PT in December.
Even though I appreciate the support I received here since my surgery, I no longer believe, at least in my case, in the advice given.

 

[JusticeRider]

@Bridgy I remember you, you had your surgery a month after me. It makes me so sad to see you are struggling with range of motion and feel hopeless about getting it back. I sincerely hope that is not the case. Please don’t give up. I am just ahead of you at almost 10 months and have seen significant progress in the last month. It is still not too late for you I am praying you will see more improvement. Hopefully your new PT is a good one and can help.

One thing that was invaluable to me was getting a shorter pair of crank arms for my stationary bike. This reduces the circumference of the rotation needed to get the pedals all the way around. So you can pedal even with less flexion. If I hadn’t had those, I wouldn’t have been able to pedal earlier on. And that has been my number one most important stretching exercise for my knee. You can get them for a regular bike too. Please don’t give up on riding your bike You deserve to do the things you love!

I am wishing you the very best, Bridgy. I will be thinking of you and praying for a bigger and brighter future than you can see from here.

 

[Jamie]

@Bridgy I’m so sorry you’re still facing some challenges with your knee. Although the guidance we provide here on BoneSmart generally works for most people, we always stress that each person’s recovery is unique. So it is possible that you will still see some gains to your flexion, it just may take longer for you to get there. We do see people making gains even a couple of years after surgery.

You are wise to enroll in therapy again to see if that helps. Also, I hope you take JusticeRider’s suggestion regarding the crank arm length on your bicycle. This particular exercise (riding a stationary or actual bike) is such a good way to get gentle movement on soft tissues that need work.

One other suggestion….if you haven’t talked with your surgeon about your flexion, that would be a good idea. If you feel a a “hard stop” when you bend your knee, it is possible that some adhesions are preventing you from moving any further. Although not a frequent occurrence, adhesions like this do happen in some cases.

Please let us know how things go. We care about you and your progress in recovery. One really great point is that your knee joint itself seems to be doing great as shown by the fact that you are able to get 10,000 steps in a day. That is wonderful!

 

[Bridgy]

Thank you both for your support. I too hope that my new PT will help. I do have a floor bike pedaler that I use most mornings. It takes awhile each morning but I am able to get a full rotation. I joined a small gym across the street so I can use their recumbent bike. I’ve also tried using the upright stationary one there and can get the pedals around if I move the seat way up. Thanks for the tip about the crank arms.
My surgeon offered a one time chance for a MUA at no later than 3 months or maybe even less as I recall. I really thought my ROM would improve at that time and declined. I was also using advice from here and my PT that cited more problems after MUA.
I’m not sure how to tell between scar tissue vs adhesions. All I do know is that it is very painful to bend beyond my limit.
I will keep fighting the good fight and try to focus on the fact that I can walk way better now.

 

[Rain Dancer]

So sorry to hear that you are having trouble with flexion. Limited flexion can be caused by issues other than adhesions, such as inflammation, and you won’t truly know what is causing your limited flexion unless you have diagnostic testing, such as a dynamic ultrasound or CT scan. (X-rays cannot detect soft tissue issues.)

My flexion was stuck for 17 months because the implant was catching and fraying the popliteus tendon. I still struggle with chronic inflammation since the surgery to release the popliteus. I take supplements such as quercetin and Japanese knotweed to help. I also try to avoid sugar and gluten.

An easy test for whether the popliteus is being impinged is to lie on your side with the operated knee on top. If that position causes pain, you may have a popliteus issue.

There is still hope, even if you have adhesions. A surgeon can perform arthroscopic surgery to remove the adhesions. This may have to be done by a sports medicine surgeon who is used to this type of clean up procedure. While not always successful, it is worth exploring.

The important thing is to not give up and pursue answers, even though you must be terribly frustrated and depressed about your limited flexion. I hope that you get relief soon.

 

[Bridgy]

Thank you rain dancer. I don’t like my surgeon mostly because early on he blamed my poor ROM on my inability to handle pain. He said it bent just fine in the OR.
Because I can now walk without pain and sleep without pain, I can’t imagine going back to surgery for any reason. That said, I do have to wonder what’s going on in my new, stiff knee.

 

[JusticeRider]

he blamed my poor ROM on my inability to handle pain.

I sure hope you don’t believe that! The truth is, plenty of people do all the exercises and suffer all kinds of pain and do everything the surgeon tells them to do and still have issues with ROM. Some then have a MUA and gain some only to lose it again. (And some have long term pain after that too.) That doesn’t mean it’s their fault. Nobody wants to have limited ROM! I’m sure you did your best and sometimes we just get dealt a bad hand.

I’m glad mine is coming along, but it has been slow for sure. Like you mentioned, I thought worst case if I can at least not have that horrible pain I had before surgery, it will still be worth something! I haven’t measured my ROM at all but I’m sure my surgeon would not be satisfied with it. I don’t care because I am not in pain and can do the things I want to do, and it’s still continuing to improve. If I never touch my heel to my bum again, I’ll live.

Keep moving that knee and don’t give up on more improvement in the months to come. I believe you will be able to go down stairs again and ride your bike and so many other things you want to do. It might take you 18 months or even 2 years but keep your eye on the prize

I do want to add: if your ROM continues to decrease instead, I do think you should get checked out by a surgeon (maybe a different one from the one who did your surgery) in case something else is going on in there. Just my 2 cents I’m rooting for you Bridgy!!

 

[EalingGran]

Keep moving that knee and don’t give up on more improvement in the months to come. I believe you will be able to go down stairs again

Agree with JusticeRider. I do a 20 minute leg pilates session most days ( free on YouTube Katja pilates- glutes). It has really helped strengthen and keep flexible my leg. I am still seeing improvement at over 7 months. I can now go downstairs ok although it still gets a bit sore and stiff by evening.

 

[Bridgy]

Thank you both for your encouragement. JusticeRider your words brought a tear to my eye. It’s all very emotional esp. when you feel judged by your inability to progress.

I went to the new PT today and I like her plan to work slowly to gain a degree at a time. She said if there is no gain that she will refer me to an orthopedic surgeon for evaluation to see if something could be wrong.
For now she said my TKR quad is super strong and I could work on strengthening my hamstrings to balance that. She thinks I could be doing too much and is encouraging me to forget about my knee sometimes and have one rest day a week. I have a few gentle exercises that she gave me to start with 4x/wk. I felt very validated by her so that’s a great start.

EalingGran I will checkout the YouTube Pilates - thanks!

 

[EalingGran]

For now she said my TKR quad is super strong and I could work on strengthening my hamstrings to balance that

Your PT seems good and really helpful. I wonder if it's possible that if you just work one set of muscles and not the surrounding ones that could contribute to stiffness??

 

[JusticeRider]

I agree with @EalingGran your new PT sounds great! I bet she’ll be a big help and encouragement to you. I’m so glad you found a good one.

It’s all very emotional esp. when you feel judged by your inability to progress.

I agree! It’s mentally harrowing. Any surgery is hard but this one… I’ve had 3 other surgeries and helped my husband through 2, and NEVER has there been the threatening and shaming and pressure and judgement like I’ve had with this one. And so many of us share the same story. The medical community needs to change this. It’s bad for people’s mental health, and just cruel.

My neighbor was telling me how her surgeon was shaming her in an appointment for not having good ROM. He blamed her and said, ‘you need to stop being a baby and toughen up!’ She was almost in tears and very angry and she said she told him ‘I’m a normal person. I’m not a battle hardened soldier!’ Good for her, right? She did get her full ROM back, though it took her 2 years. She messaged him a picture of her sun bathing with her knees up at 120 degrees
I love her!

 

[Bridgy]

Now at 11 months and winding down on another (3 months) try at PT. I did see a small increase of flexion at the beginning - maybe to 96 or 98. They are running out of ideas. I mentioned that I am a little looser after PT for 20 minutes or so. The new plan is for me to do 4 bending exercises 5-8x/day. They are not super painful and I only do 4 of each but the thought is this could be another route to gaining more permanent flexibility. Their current theory is that my body reacted after surgery with a strong inflammatory response causing scar tissue. In their opinion I still have a window of 7 months or so to make some gains. My knee is still a little swollen and a little warm. They want me to keep focusing on building strength even if the ROM doesn’t improve. Also I have started kneeling on a folded yoga mat in my exercise class so I can do a few push ups, fire hydrants and bird dog. It feels ok and I’m happy I can do most exercises the same as anyone else.
Surgeon appt in one month.

 

[EalingGran]

It feels ok and I’m happy I can do most exercises the same as anyone else.

At the end of the day, function is more important than numbers. If you can do the stuff you need to without pain then that is more important than ROM.
I always had great ROM but it is only in the last couple of months that my residual pain has settled and I can walk downstairs normally.

 

[sistersinhim]

I still have a window of 7 months or so to make some gains. My knee is still a little swollen and a little warm. They want me to keep focusing on building strength even if the ROM doesn’t improve.

There is no window of opportunity for gaining bend in this recovery. People even gain it in their second and third years as their knee settles down. Your knee is still swollen, meaning it isn't completely healed yet and is inflamed. An inflamed joint should be rested, not worked. You are just keeping it inflamed by all that you are doing to it. Also, your strength will improve as your healing progresses.

I suggest you stop all exercises and PT and just let your poor knee calm down. Ice and elevate to get the heat and swelling down. Doing less will allow it to bend better after the swelling goes down. You can't bend a swollen knee very well!

 

[kneeper]

My first knee would get a little warm for about 6 months, iirc, but not that long.

I think the way I continued to gain a few degrees over the first year was by just using the knee in daily activities--and maybe a few heel slides.

It really sounds like you're doing fine. All this extra PT could be actually be counterproductive and keep the knee inflamed.