TKR TKR Pre-op questions

[Jockette]

. I am worried about getting a good PT.

You have plenty of time now to search and interview the PT you choose for your TKR recovery. And, they are not all created equally.

the ones I do know of seem aggressive which makes me nervous because I want to keep the swelling under control.

After a TKR you do not want anything aggressive. Your knee will be wounded from the surgery, not lazy or unfit, and it doesn’t need hard work, it needs to be treated gently, especially in the beginning, so it can heal.

Look for a PT who will use modalities to help reduce your swelling. One who will be encouraging that this recovery will take time, but you will improve as you heal.

You don’t want one who will tell you “we’ll get that knee to bend.” You don’t want to allow anyone to bend your knee for you, or push it “farther” as that will increase your pain and swelling. You don’t want one who will talk about a “window of opportunity.

Myth busting: "window of opportunity" in TKR

This "six week window of opportunity" surgeons often speak about is little more than a myth. It presupposes that all patients have the ability to create adhesions which is far from the truth. It also ignores the simple fact that in the first 3-4 weeks after surgery, swelling reactive to the...

bonesmart.org

Regaining our ROM is more about Time than repetitions of a list of exercises.

Time to recover.
Time for pain and swelling to settle.
Time to heal.

Our range of motion is right there all
along just waiting for that to happen so it can show itself.

In the general run of things, it doesn't need to be fought for, worked hard for or worried about. It will happen. Normal activity is the key to success.

 

[winedunce]

I am wondering what ROM people get when they are full recovered. I have heard that we can't kneel on our knees any longer after TKR. I'm wondering if that is because of risk of breaking the knee cap? I do a lot of yoga where we are on hands and knees and am wondering if that will no longer be possible. Also, I'm curious about whether I'll ever be able to sit back on my knees ever again. My range of motion has come back incredibly from previous surgeries. Fortunately, I have had phenom PTs who were very gentle and it was all about range of motion (even when I was non-weight bearing in some recoveries). Super gentle sliding the foot on a towel or doing wall slides is a big one where you lay on your back and your surgical leg (heel) rests on the foot of the healthy leg and your healthy leg guides your surgical leg up and down the wall from straight to bent as far as is comfortable. No force. It sounds like the Bonesmart way is very similar to that. Get the range of motion back first and then build strength once you are healed from the traumatic surgery.

 

[Jockette]

Some of our members are able to kneel and others not. I haven’t even tried and I don’t plan to, it’s not important to me.

Do a search for the word yoga, I’m sure we’ve had TKR members get back to that, but I don’t specifically remember who. You may or may not be able to get back to that, you’ll just have to see how it goes.

 

[pamsknees]

@Jockette - great suggestion about interviewing pt! What sore of questions should I ask?

 

[Jockette]

@Jockette - great suggestion about interviewing pt! What sore of questions should I ask?

1. Do you believe in a window of opportunity to regain ROM? (The answer should be no.)

2. Will you bend my knee for me, to bend it more than I am able myself? (The answer should be no.)

3. Will using weight, bands or gym machines be part of the rehab you want me to do? (The answer should be no.)

Here’s some information about post op PT:

BoneSmart philosophy for sensible post op therapy

You will have noticed there is a significant opinion here about the potential hazards of PT. You may feel that your therapists are experts and know what you should be doing. However, over the last several years I've been here, I have observed that the more intensive the regimen of exercising...

bonesmart.org

 

[loneshark64]

[/QUOTE]
What kind of PT do they have you doing right now?
[/QUOTE]
They massage a little, make sure everything’s OK, then stretch a bit. A series of exercises, light squats, part of the way around on an exercise bike, swing it side to side a little bit, etc Nothing too horrible. Gives my guidance on my gait, how to use the cane (I got graduated from walker to cane yesterday! Every man’s dream!!)

I am going three times a week. Yesterday was a week after my surgery and I had a different therapist and he pushed a little more, but I also tried harder myself, and I was sore afterwards but I am fine this morning. I just did laps around my dining room table for a half an hour and it felt pretty good.

He measured ROM at 93 and full extension and said that is very good after a week, so I was happy to get that feedback.

 

[Jockette]

What you do want to do in recovery/rehab is gentle movements for mobility. Gentle stretches. Walking may not seem like it will bend your knee much, but it does an excellent job of moving the knee joint. Start out with short walks and increase time and length very gradually.

Always listen to your knee. If anything causes extra pain and swelling, that is telling you that you did too much for your knee at that particular time. Back off and let your knee recover and try that activity again at a later date.

 

[LD of Michigan]

On point advice Jockette. 3# made me think about my PT scene. We are starting to use gym machines which at the cost I am paying (out of pocket) seems to be a waste! I have an active gym membership and was given the ok to resume with care.

So outside of the stretches and useful manipulation I think my PT series is nearly done once I complete my original prescribed cycle... I will inquire per my progress. Thank you.

3. Will using weight, bands or gym machines be part of the rehab you want me to do? (The answer should be no.)

 

[LD of Michigan]

I wonder too winedunce... My surgeon said it might feel uncomfortable. Some say impossible, others suggest a pad like those gardening pads. I leaned in a bit on my knee to change my bedding. It was a bit painful but that was a relatively soft surface. I guess I'll be keeping my grabber around for a while...

I am wondering what ROM people get when they are full recovered. I have heard that we can't kneel on our knees any longer after TKR. I'm wondering if that is because of risk of breaking the knee cap?