Bilateral TKR Stiffness

[Tired2007]

I’m not a physical therapist but I was insistent that I was going to go to PT. I’m three weeks post-op today. I’m running into the challenge of excelling at the “ROM” markers with as excessive swelling I have from bleeding into both legs during surgery. And I had to inform my PTA yesterday that I’m just not ready to spring out of a low chair without any holding on. My ORtho said he’s happy if people are hitting 85-90 by 6 weeks. So I don’t know that you’re that far off from what they might expect. One thing that I have found to help me with my moderate swelling (and after PT I really feel it in my thighs!) is compression stockings. It’s made a world of difference for me especially at night/in the morning.

 

[Josephine]

I am still confused about how much to push myself as surgeon and other specialists all say I won't get ROM without it. But I am suffering very much and at almost 7 weeks no where 90.

Well if you would answer my questions in post #15, then I can answer all your other questions and give you my advice.

 

[Yerdua]

I am still learning how to work this site.. I can't find post 15, sorry

 

[Josephine]

It's here https://bonesmart.org/forum/threads/rom-issues.46897/#post-1147031

 

[sistersinhim]

Because of them I have gotten into the 70's in 2 weeks from 50's.

You probably would have had even better bend if you hadn't had PT. This infant knee needs to heal before subjecting it to PT. Just your daily activities are enough to rehab your knee.

There's still plenty of time for you to continue to improve. Recovery from a knee replacement takes as long as a full year, sometimes even longer. It's a marathon, not a sprint, so you're in for the long haul.

There's no need to rush to get ROM (Range of Motion) because it can continue to improve for a year, or even much longer, after a knee replacement. There isn't any deadline you have to meet:
Myth busting: the "window of opportunity" in TKR
We even have one member who found out by chance that her ROM had improved at 3 years post-op.

From now on, though, it's a matter of letting your knee make progress on its own. You can't speed that up by working at it. In fact, working too hard could actually slow down its progress. Just keep using your knee in your normal daily activities. Even PT isn't really necessary any longer.
It's not exercising that gets you your ROM - it's time. Time to recover, time for swelling and pain to settle, and time to heal. Your ROM is there right from the start, just waiting for all that to happen, so it can show itself.

Here are a few articles that may help you:
TKR: work “smarter” and not “harder”
Knee recovery - Lose the Work Ethic!!
TKRs and our fast food society
Life in the slow lane

 

[kneeper]

I have to agree with sistersinhim. Even with a good PT it is easy to overdo. I tried to be very compliant with my first PT who had me do things that caused me what I learned was unnecessary pain. With my 2nd knee, I listened to my knee more. There were times I just said "that's enough for today" when she encouraged me to do a bit more. She was willing to listen. They don't know unless you tell them.
Also that PT told me point blank that if I was hurting (more than the typical recovery achy-ness) for more than an hour after a session I had done too much and should go easier the next time. My sessions were about 1/2 hour. My recovery was much smoother with less pain and a good result.

Ultimately the knee is the boss.

 

[Yerdua]

I am 7½ weeks out from bilateral TKR. My extension has not been a problem but getting ROM has been a nightmare for me.

I am in R knee 84, L knee 75. I know this is way behind but at 4 weeks I was in the 50's! I just did 30 heel slides with the rope on each and pain is now keeping as usual from sleeping. Thank God I found bonesmart as my lack of ROM had me so depressed and doctor threatening MUA. I do 90 minutes PT, 3 times a week and also exercise at home.

Because of all of the wonderful advice from here I stopped killing myself everyday and iced and elevated more. But I pray to get what is needed without MUA and my pain (I do walk around a lot) is draining me. I fly for a wedding to Bermuda May 8th and I am so worried about the pain and how to handle it in airport, airplane etc. Sitting and standing is the worst!

I am happy but so jealous of all of you who got the ROM! I hope one day it will be me. I waited 8 painful years before being ready to do surgery. I am 59 (just turned 59) so does waiting so long cause my issues with ROM?

 

[mlwreader]

Hi @Yerdua Well here we are again!

It is my understanding that ROM issues are often the result of overdoing PT and exercises, which then causes the knee to swell, which then interferes with ROM. I am not a medical person, but from what I've read, you might be doing more activities than are good for you at this point. It might be a good idea to back off from some of it and concentrate on icing and elevating for a while and see what happens.

Also, from what I've read on bonesmart, your numbers are not terrible at 7 weeks out. Another thought is with a bilateral replacement, which I had as well, your body is working twice as hard to repair what was done to your knee. So the energy diverted to healing the knees is double what happens with a single TKR. This causes a tremendous energy drain on your body, and you need lots of rest and good solid protein to make up for it.

It is also my understanding that age has little to do with how fast the knee recovers from the surgery. It just takes time and it is overall a full year's recovery process.

I was unable to do much PT after my bilateral knee replacement. I did it at skilled nursing, but after I got home, I had issues with my stitches, an infection, then the stitches broke open for a while (not all of them, but a few). My doctor told me to stop the PT until they healed. That forced me to rest, didn't know I was doing the best thing for the knees, but it just happened that way. My ROM was good early on, not due to any exercising or anything I did - it just happened that way. I have a theory that each of us has certain post-suregey issues, usually a combination of an issue and otherwise pretty good recovery. The luck of the draw sometimes gives some of us ALOT of issues at once, and that just doesn't seem fair.

For me, the excellent ROM was counterbalanced by the infection and subsequent abscesses on my knees, then allergies to the suture material and also to the bandaids adhesive that I had to keep on the incision FOR WEEKS!!!!!

Anyway, I am sure you will get some good input from others on this site. My doctor was not a hardliner for PT in any event.

 

[SusieShoes]

I waited 8 painful years before being ready to do surgery. I am 59 (just turned 59) so does waiting so long cause my issues with ROM?

I also waited a long time before finally surrendering to my pain and getting the surgery. It was 10 years for my left knee (the worst one) and 8 years from when my knee specialist told me my right knee was also bone on bone. By the time I saw my surgeon, he looked at the x-rays and asked, "How are you walking?"

I had BTKR just like you. The fact I waited a long time to have surgery doesn't appear to have affected my ROM. It's quite good and I got it back rather quickly compared to many. What I do have as a result of having waited too long is that my left knee took longer to become pain-free than my right knee. It was quite damaged, so needed more work.

Ninety minutes of PT three times a week, plus exercises at home strike me as too much activity for not yet two months out from surgery. Your knee is still healing and I suspect your exercises are setting it back. At that stage, all I did was maybe forty minutes at PT twice a week (and I refused most of the exercises there... no leg presses, no straps, no weights, no wobble foam) and walking maybe a around the block. No exercises at home. And I cut out the PT altogether at two months.

The key to gaining flexion (bend) is to reduce swelling. If your exercises are leading to increased swelling in your knees, that's what is holding back your knee from getting to those ROM numbers you want to see.

 

[Yerdua]

Thanks ladies for the great advice. I am still shocked that NO ONE, surgeon, nurses etc., told me to elevate! I only learned after finding bonesmart. I have been listening to all of you and am resting more but I have to work. Even though I have home office I have to get up a lot due to work.

I am sorry to hear mlwreader about your complications. I am grateful I only have the one, bad ROM but it is so frustrating . My PT team are great. They don't push and have told me to stop doing so much exercising at home. I am frustrated as I hear and read so many having great ROM right away or so fast.

My left knee is definitely the "badder" girl! I am scared of always having pain as I have heard and read so many still having pain years later. My husband did his right knee 6 years ago and even though no complications, full ROM etc., he is still not happy and has yet to get his other knee done. I pray this doesn't happen to me. My left has always been the worst.

I am exhausted from this whole ordeal!

 

[Jockette]

I am exhausted from this whole ordeal!

I agree, this recovery can be an exhausting ordeal. I felt mine was.

 

[Roy Gardiner]

Yurdua's doctor said 'you can't overdo exercising'

Exactly and precisely WRONG. You can't UNDERDO exercise.

pain is now keeping as usual from sleeping

Remember

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.​

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.

 

[Celle]

Here are Josephine's questions again, since you don't seem to have found them. Do try to answer them as fully as possible. at the moment, it seems that you are doing far too much exercise.

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?

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.

 

[robhunt3]

Hi @Yerdua, I've spent the last 6 weeks worried about my ROM which seemed to be stuck, but finally listened to the heaps of good advice on here and decided to stop worrying about it, forget about it and as if by magic, at week 10, 11 and 12 everything is settling and things have improved. Less aches, less pain, more motion.

So don't overdo it, it really doesn't help it just hinders, and if you can, don't worry either. In a few weeks you'll see progress, it'll happen just like everyone else says it will. It took me a while to believe that, but really it is true.

All the best!

 

[Josephine]

but I have to work

Wait a minute there! You're working AND doing exercises? You do need to answer my questions so I can give you very specific advice.

 

[Yerdua]

Josephine I just don't know all the technical names of the exercises as I gave them all nicknames to make me laugh. I can promise my pts are great, not overdoing it and I stopped killing myself everyday with exercises. I ice and elevate a lot. Now the icing sometimes actually hurts. My swelling is way down

It is the tightness and pain after walking 5 or more minutes that gets to me. R knee is now 86, L stuck at 75 for a week but it will go eventually. My extension is almost 0. Scar almost not visible!

I only do quad presses, on bicycle can't do rotation yet but close, heel slides with rope, leg lifts, pulling legs back sitting on their table with the rope. Bicycle and leg pulls 5 minutes each 30 on each leg of others.

They then massage and work on my knee.

I apologize very much for not being as organized as you and feel badly as I know you are trying to help me. Between how bad this was and is for me, lack of sleep etc., I just can't seem to focus and answer you properly.

Please know normally I am an intelligent person but right now I just can't seem to answer you properly. Please forgive me. I truly appreciate you and your advice.

Right now 4am and my left knee is screaming at me. I know for now I need easy ways to handle this so again your response was amazing but I just can't respond in the same way.

Frustrating for you and I feel bad, sorry. I am always open for your advice. Doing the best I can with how I am right now

Thank you for understanding.

 

[Roy Gardiner]

Looks to me like you're doing way too much, and it's training, too, which is not what you need. I'd stop doing anything that puts force through your knees.

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 a static bike.

• Set the bike to zero resistance
• Set the saddle as high as possible and rock the pedals back and forth as far as you can with discomfort but no pain
• 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
• 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 and how 'healing' and 'training' are different

 

[Yerdua]

Thanks. That is what I do. I rock back and forth to feel the stretch. No more till pain!
My swelling is minimal unless i stand or walk too much .
Thanks again for the information .

 

[HappyCatTX]

After 7 weeks from TKR my current flexion is close to 120, but the extension part is around 12. This is an improvement since 3 weeks ago when I started PT it was around 25. Pain level is currently around 0. Any suggestions to continue improving ROM extension?

 

[Yerdua]

My surgeon showed my husband and I how to get it. Put your leg as straight as you can and have a partner push down on your knee to help it get closer. He did it rather forcibly on me but my extension is 3 so I only have a bit more on the right knee to go. Hope this helps. I wish I had your rom! I am 86 r knee , 75 L after 7.5 weeks . Good luck