TKR TKR - 8 Weeks - Losing Range of Motion

[Kneebie]

Hi,

Thank you for all this helpful information; what a great resource!

I am 61 years old and had TKR on my right knee on September 15, 2020. The surgery went well. The only unusual thing was that I was not prescribed Celebrex anti-inflammatory which my surgeon likes to prescribe, since I have had ulcers in the past. Otherwise, very standard.

2 Weeks after surgery: I was doing way too much PT and having a lot of pain, and then I found this website! So I backed way off to just minimal stretching twice a day, once a week PT, with stretching that I was comfortable with. That helped a lot. I closely followed the protocol of lots of ice, elevation, rest.

5 weeks after surgery: Things were going along pretty well. I had stopped using my cane; was walking one to two times a day for 20 min, and I was doing minimal tasks around the house. I still had moderate swelling many days, not necessarily tied to my having done anything different, but overall, the pain was mild to moderate. My range of motion was 0 degrees and 108 degrees. I apparently overdid it one day walking around to do some shopping and light chores and using the exercise bike for 15 min with no resistance. The next day it was very swollen and I had severe pain on the outside of the knee joint whenever I bore weight on the leg. I backed way off, called the Physician's Assistant, who said it sounded like tendinitis and told me to take it easy and to freeze whole cups of ice and do ice-massages. This did seem to help.

6.5 weeks after surgery: I was still icing, not doing any exercise, not taking walks, and was back to using a cane, just doing daily activities, and it was much less painful. I saw the doc for a 6-week check up and he said that I am having inflammation issues, that these are not uncommon, possibly related to my not being able to be on an anti-inflammatory after surgery? Anyway, he wanted to see me again in 3 weeks. Regarding PT, he wants me doing the bike, with no resistance. I was not able to do the bike without pain, so I have not been doing it or any PT. With this total slacking off (only daily activities, minor housekeeping), and lots of ice/elevation/rest the swelling and pain did get quite a bit better.....

8 weeks after surgery: It has been 8 weeks now, and while the pain and swelling are indeed better, I have lost SO much range of motion! Currently it is about 87 degrees. I use the cane most of the time, and I feel like I have backslid so far. If I try my stretching exercises at all, there is pinching, sharp pain at the outside front of knee joint, and swelling.

My questions: Is it ok that I reached 108 degrees by week 5, but then by week 8 I am back to 87 degrees? Should I just keep resting mostly to keep pain and swelling down, and trust that the ROM will return when the swelling finally goes down? (As I read over and over on this forum!) Or should I try the stretching a little every day even if it triggers the inflammation/swelling/pain...so that I don't continue to lose ROM...?

Thank you!!!

 

[Kiwigal]

Hi @Kneebie - I did very similar to you...went shopping as well as lots of exercise and then my knee told me to lay off. It made it's point very clearly! same as you pain, swelling and also unable to walk easily. Mine was internal stretching/rebleed of scar tissue...so said surgeon anyway. Had to lay off exercise and walking but only do stationary bike. Been 5 weeks since that shopping day (the new dress was not worth it....lol). It's taken a while to settle down again and still not back to what I had been doing but want you to know it does come right. Surgeon told me would take another couple of weeks so 7-8 in total. Lots of icing is key I've found. Good luck...hang in there

 

[Pumpkln]

@Kneebie
Welcome to BoneSmart, glad you joined us!

I apparently overdid it one day walking around to do some shopping and light chores and using the exercise bike for 15 min with no resistance. The next day it was very swollen and I had severe pain on the outside of the knee joint whenever I bore weight on the leg.

Sounds like you may have ITB (ilio-tibial band) issues and treatments
Take it easy on the Exercycle, in some people, cycling can flare up the ITB.
Glad you have backed off your other activities.

I have lost SO much range of motion! Currently it is about 87 degrees.

You may want to try these two gentle exercises for ROM.
Heel slides and how to do them and Extension: how to estimate it and ways to improve it .

Or should I try the stretching a little every day even if it triggers the inflammation/swelling/pain...so that I don't continue to lose ROM...?

The only stretching you should do is stretching that does not trigger inflammation/swelling/pain. Give the two activities I left for you a try, be very very gentle, do 1-2 reps 1-2 x a day.

Right now ice and elevation are your best friend.

 

[Pumpkln]

Here is your copy of the Knee Recovery Guidelines, the articles are short and will not take long to read.

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

​

the BoneSmart view on exercise​

BoneSmart philosophy for sensible post op therapy​

5. At week 4 and after you should follow this

​

Activity progression for TKRs​

6. Access these pages on the website

​

Oral And Intravenous Pain Medications​

Wound Closure​

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.

 

[Kneebie]

Thank you so much!

You are absolutely right... I forgot to include that the doc said that it seems like IT Band is flaring up. After reading the helpful link on IT Band issues and rereading the other links, I have a few follow up questions:

Do IT Band issues usually resolve with rest and IT Band stretching and icing?

Should I continue to rest it, given that stretching like heel slides does seem to cause generalized pain/swelling-up of the knee? It seems to love the resting ...and it seems to also love the cane (picking up some of my weight with my arm seems to prevent pain, even though I only weigh 110). But at some point, I need to go back to walking with weight on it, and doing at least heel slides, right? If I just keep resting it to avoid the swelling/pain, I am going to lose more and more ROM, right?

I am going to see if I can do some of the IT stretches very gently and get the IT compression wrap and give that a go...along wit the icing, elevation. Any other advice?

Thank you SO much.

 

[Pumpkln]

If I just keep resting it to avoid the swelling/pain, I am going to lose more and more ROM, right?

it is more likely, as the swelling goes down your ROM will reveal itself.

It seems to love the resting

Respect what your knee is telling you, right now rest is best.

 

[Kneebie]

An update, in case it helps anyone else... and a question;

8-9 weeks after surgery: I followed your advice, rested almost exclusively, as even the gentlest heel slides were causing swelling. Stiffness and swelling was still really bad; the reduced range of motion remained unimproved, at 87...but the IT band issues have almost completely resolved. Yay.

Saw my Doc. He was concerned and said we had to get the joint moving. He did two sort of unexpected and sudden flexings on my knee...one where he kind of pulled and pushed my knee, rocking it, (while I was sitting and it was bent almost to 90 degrees). Kind of ninja, where I did not expect it and couldn't guard against it. Each of them hurt significantly, but very short-term and the pain subsided fast. By the time I left the office, it was perceptibly looser. I also asked him to recommend the best PT person he knew to help me with range of motion, super gently. He made a recommendation for one. He also talked me into trying Celebrex for 2 weeks to counteract the inflammation. I agreed after talking to my GI doc.

10-11 Weeks after Surgery: I started PT again but only the mildest stretching, and rocking partial revolutions on the bike. This PT is about 50 times better than the previous inexperienced PT. I am making very slow progress, have gotten to 104 degrees flexion. The Celebrex does seem to have reduced the pain, but it has not reduced the swelling. I am also taking turmeric (with pepper), 2 capsules per day, as it is also supposed to be very anti-inflammatory.

Question: I am 11 weeks out from surgery, with ROM of 0 and 104 degrees. I still have moderate swelling pretty much all the time. I cannot reduce the swelling through complete rest for days...or by my faithful icing and elevating which I do for 3-4 full hours per day. I am only walking 20 min per day and doing gentlest heel slides. It seems like the swelling doesn't fluctuate or improve anymore. It neither flares up, not gets better. Is this inflammation and swelling normal for some people, even 3 months out from surgery?

Thank you!

 

[Pumpkln]

. It neither flares up, not gets better. Is this inflammation and swelling normal for some people, even 3 months out from surgery?

Some of us have swelling for months, for you it is normal. Seems you are slowly but surely improving, and have an experienced PT.
This is a year long+ recovery, and is just going to take time and patience.
Where are you in recovery?? (TKR)

 

[NFenske]

Depending some will always have some form of swelling some minimal. While I am not a good example considering the amount of surgeries I have had, I have always had some swelling and depending on activity meaning if I over do it an increase. After my 6th replacement my surgeon told me once you get to 95 degrees you can do just about everything you need to do. One thing you should not do is compare your ROM to others, really who cares your not them and they are not you. We all heal differently. As many surgeries as I have had on left knee and even considering I will be having another end of Dec my ROM is 132 however as far as extension I am at -10. Just cannot straighten no matter how hard I try.
Recovery takes time and lots of patience your doing fine keep it up!!

 

[Kneebie]

Thank you both! I appreciate the feedback that this is just normal for me...and to just hang in there. NFenske, good luck with your knee. Sounds frustrating to not be able to straighten fully, but that is sure an impressive flexion degree. And what a positive attitude, too. Good luck getting ready for your next surgery.

 

[Bikeknit]

I had 2 knees replaced 3 months apart. The first knee was definately still swollen at 11 weeks though it reduced shortly afterward but still a little swollen at times at 5 months. The other knee is at 9 weeks and was less swollen from the very beginning. The newer knee also got better flexion faster. Same surgeon, same body, different reactions. Hang in there. Sounds like you are making progress.

 

[Kneebie]

Thank you, Bikeknit. That is a very helpful Tale of Two Knees.... I hope your second knee is continuing to make easier progress for you... I have just accepted the swelling and found that I am still making flexing progress despite it... All in good time!

 

[Margie013]

Hi Kneebie. I hope things continue to improve over the next weeks. It really is a slow journey and takes some adjustment of activity during rehab compared to pre-op exercise. I've also overdone my activity and had to pull back on it. I just wanted to suggest that you talk to your doctor about taking turmeric with Celebrex. I have taken it for years, and I know there can be interactions with other drugs.
Take care and hang in there.