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Bilateral TKR Stiffness in knees<

mld02860

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Hello, I'm new to this group. I had BTKR on July 21, 2017. I was young and fit and my doctor agreed BTKR would work for me. I immediately started PT and worked hard to get ROM and full extension back. After 8 weeks, my surgeon decided to do Manipulation Under Anesthesia because I still couldn't get my ROM & extension. I started PT the day after my MUA. I continued to be stiff after the MUA. I was going to PT, doing PT every day on my own (I'm a Type A personality) and using the pool 6 days/week. After 6 months, my surgeon suggested that he do knee revision to take out the scars in my knees, which is what's causing the stiffness. He scheduled this for April (9 months after my BTKR). I got 2 additional opinions from other Orthopedics and they both stated that I should wait a year before any additional surgeries be done. I am leaning toward these recommendations.

Does anyone have any input? I'm just not used to be less than 100%. I appreciate your help!
 

AThom10731

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Wow, I am certainly not an expert here but this sounds like you are doing too much and need more rest and ice until the soft tissues have healed vs jumping back into surgery. I will let the admins address this. So very sorry for your issues and you are very wise to get additional opinions and wise to come to this forum. These folks have been such great resources of information.


Sent from my iPhone using Tapatalk
 

Pumpkln

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@mid02860 ,
Welcome to BoneSmart, glad you joined us!
Sounds like too much has been done to your knee, suspect PT was pushing and shoving for ROM. All the pushing and shoving can cause swelling and inflammation, blocking your ROM.
There is nothing we can do to rush this year long+ recovery, but we can set it back by doing too much, too soon.

Suggest you stop all formal exercise and start Resting, Icing, Elevating, and Medicating on schedule as prescribed. Listen to your knees, if swelling, pain, or inflammation increase, they are letting you know you did too much.
It is time to give your poor knees a chance to heal, they have been through a major surgery, brutal PT, and an exercise program.

IMO, I would postpone the surgery to remove scar tissue, and give your knees half a chance to heal.

Here are the recovery guidelines, the articles are short and will not take long to read.
Give the guidelines a week or two to turn your knees around.

Knee Recovery: The 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
5. At week 4 and after you should follow this

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.
 

Josephine

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I immediately started PT and worked hard to get ROM and full extension back. After 8 weeks, my surgeon decided to do Manipulation Under Anesthesia because I still couldn't get my ROM & extension. I started PT the day after my MUA. I continued to be stiff after the MUA.
The times I hear this on here. And it's so bad and wrong! Before I say anymore, I'd really like to offer you some structured advice but in order to do that, I also need to ask you some questions. Are you willing for me to do that?
 

sistersinhim

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Many of us never took formal PT or did exercises. I am one of them. I had 11 knee surgeries, 2 of them kneecap removals and 1 tkr. Even after those I never took PT. But, I didn't just sit around and do nothing. I took care of myself, my house and yard as my knee allowed me to do. As I healed, I did more. But, my knee was always in control! This was enough therapy for me and would be for any tkr patient. All the awful pain of PT is so unnecessary.

All you have to do is use it in your daily living! Your knee knows how to rehab itself and doesn't need anyone telling it how. Just use it and it will come back like new! You have to be patient, though, it doesn't happen quickly! ADL,(activities of daily living), going to the bathroom, brushing your teeth and bathing, fixing a light meal, getting something to drink and or a snack, those kinds of things will be all the exercise your knee needs. If you just use it daily in your living, you will have a quicker and less painful recovery. We know what works, we've been there!
 
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mld02860

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Thank you all for your help and responses. My Surgeon tried to convince me that my lack of ROM is that I have a "mental block" in my head keeping me from additional movement. Although he's a great surgeon, I've lost confidence in him doing MUA at 8 weeks post op and recommending scar revision surgery 9 months after my BTKR. It helps knowing that my mentality, "No Pain, No Gain" is incorrect and I should take it easy on my poor knees. I have been going to an incredible massage therapists who's showed me how my quads, hamstrings, and the muscles and ligaments were all tight. That certainly didn't help with my ROM. And honestly, I don't have pain in my knees...just discomfort that they're still bent and my ROM isn't all there. I think I need to take a deep breath and give my body a break...although I do like the pool and the soft exercises that I've been doing that make me feel great. Thanks again for all your support.
 

SusieShoes

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If massage therapy is helping you relax, chances are good it will help. Your early focus on PT and trying so hard might have aggravated your knees and interfered with getting back your flexion. Extension often comes later no matter what, because straightening requires those tough hamstring tendons to stretch and stretching takes time.

That you have no pain is great! I had BTKR about two months ahead of you, and I too have no pain. My flexion is good and my extension came back to straight at about five months. I followed the BoneSmart method of only gentle PT and let my knees just do their healing thing (with the help of lots of walking).

It can take up to a year to fully recover from TKR, and to get back full ROM. Here is one member, Bertschb's, record of his ROM over the full year of his recovery.

~~~~~~~~~

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.

~~~~~~~~~~~
 

Josephine

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Here y'go then!

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 forget to factor in other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness).

2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?

3. how swollen is your leg compared to these?
ai63.tinypic.com_eta39s.jpg


4. what is your ROM - that's flexion (bend) and extension (straightness)

5. are you icing your knee at all? If so, how often and for how long?

6. are you elevating your leg. If so how often and for how long?

7. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and

8. are you doing any exercises at home? If so what and how often?
This is the most crucial question so please help me by using the format I have left as an example
(which means please make a list and not an essay!)

Exercises done at home
- how many sessions you do each day
- enter exercise by name then number of repetitions of each
etc., etc.

Anything done at PT
- how many times a week
- enter exercise by name then number of repetitions of each
etc., etc.
 

DebM

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I am thinking a lot of your ‘stiffness’ may be due to swelling from overdoing it. I am 13 months out from BTKR and find I still get some swelling after a big day at work (driving a manual car all day) and am certainly quite stiff as well compared other ‘normal’ days of housework, shopping etc.
 

Roy Gardiner

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You don't need hard work. Imagine 'working hard' to recover a broken leg or a sprained muscle; you can't, and walking on a broken leg or exercising a sprained muscle are counter-productive, obviously. It's much the same with TKR, you have damage needing healing, not unfitness needing training.

All you need is to help retain mobility (not fitness or strength) until healing is complete. This is done with gentle stretching exercises, without pain.

Using an exercise bike for mobility exercises can help.
  • Set the bike to zero resistance
  • Set the saddle low enough so that a single rotation is a challenge; difficult but not painful. When a rotation becomes easy right from the start, lower the saddle a max of 1cm.
  • Gently turn the pedals, through discomfort but without pain.
  • Continue until the knee is 'warmed up' and the rotation is now easy, or for 2 minutes, whichever is the shorter time.
  • Repeat several/many times a day, but don't go mad. Diminishing returns will apply; my guess is that half a dozen reps would be enough
  • Do not pedal fast or for more than 2 minutes, this is a stretching exercise, not training.
  • And if you get any pain or swelling in the 24 hours after doing this, cut it down until you don't
Here is a bit more chat and some pix http://bonesmart.org/forum/threads/rom-and-extension-stretches.13159/page-3#post-423701
and how healing and training are different http://bonesmart.org/forum/threads/post-operative-exercise-–-the-bonesmart-view.25463
 
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mld02860

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HI Josephine,

Here are my answers to your questions above:

1. My pain level is low...around 1-3. I only put in a 3 when I have trouble sleeping because I can't get comfortable. I'm told not to put a pillow under my knees (that's been my favorite position for years). So I end up sleeping sideways with the pillow in between my knees. And a 3 when there's still stiffness and I can't get ROM or full extension.

2. I take no pain meds. maybe once every 2 weeks I might take some Tylenol.

3. My legs are not really swollen.

4. Right knee - 95 degrees, left knee - 85-90, extension - 15

5. I am not icing. I'm 7 months post surgery. Should I still be icing it?

6. No, not really.

7. I do typical housework, cooking and shopping. I also walk my dog 3/day (about ¼- ½ mile at a time) See my note below.

8. Exercises done at home

I go to the pool about 4 times/week
I do water classes that focus on stretching and slight cardio (but not much really)
I use the pool because it makes me feel good

Here are my additional stretches in the pool:
quad stretches for 5 seconds; 10 times
calf stretches; 10 times
knee kick backs; 20 times
light squats to bend my knees; 10 times

I haven't gone to PT since December
I sort of stopped doing any tough PT since I've been reading these posts and suggestions

I will go to the gym to do these exercises about 2 times/week:
there's a machine that bends my knees while I"m sitting down (think of a stair stepper but seated) I'll do that for about 5-8 minutes.
TRX knee bends; 10 times
walking on the tread mill - about 10 minutes

I just don't know if I'm still doing too much or not enough.

Thank you for your help!
 

Josephine

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1. My pain level is low...around 1-3. I only put in a 3 when I have trouble sleeping because I can't get comfortable. I'm told not to put a pillow under my knees (that's been my favorite position for years). So I end up sleeping sideways with the pillow in between my knees. And a 3 when there's still stiffness and I can't get ROM or full extension.
Well you're 7 months out. I think it's time you resumed your normal things, don't you?
2. I take no pain meds. maybe once every 2 weeks I might take some Tylenol.
Okay
4. Right knee - 95 degrees, left knee - 85-90, extension - 15
okay
7. I do typical housework, cooking and shopping. I also walk my dog 3/day (about ¼- ½ mile at a time) See my note below.
Good

I go to the pool about 4 times/week
I do water classes that focus on stretching and slight cardio (but not much really)
I use the pool because it makes me feel good

Here are my additional stretches in the pool:
quad stretches for 5 seconds; 10 times
calf stretches; 10 times
knee kick backs; 20 times
light squats to bend my knees; 10 times
I will go to the gym to do these exercises about 2 times/week:
there's a machine that bends my knees while I"m sitting down (think of a stair stepper but seated) I'll do that for about 5-8 minutes.
TRX knee bends; 10 times
walking on the tread mill - about 10 minutes
My only question here is WHY? You're 7 months out. Who ever told you that you had to keep on doing these exercises for ever?!!
I haven't gone to PT since December
I sort of stopped doing any tough PT since I've been reading these posts and suggestions
Good! But it would be even better if you'd said you'd stopped doing PT at altogether!
 
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mld02860

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Josephine, again, I really appreciate your commentary and support with my challenges. The Orthopedics and the Physical therapists instilled in me from the start to keep myself moving and do the aggressive PT. It appears I've been over-doing it. I've let myself relax more and I'll keep you posted with my progress.
 

SusieShoes

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Oh my. I've been putting a nice pillow under my knees when I'm on my back in bed for... months! Still do it when my knees tell me they'd like the pillow. For what it's worth, I don't think my recovery has suffered at all from that pillow. It's amazing all the conflicting advice about TKR recovery.

Please keep us posted about your progress. If you listen to your knees and stay mobile in ways that keep your knees happy, you should be seeing more ROM return and have a less stressful recovery. :friends:
 

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