TKR TKR Progress

[lovetocookandsew]

IMHO, stopping formal PT was a good choice. If possible, ice and elevate more than just in the evenings. Also realize, you are still early in your recovery, and your knee is going to fuss a lot with too much activity, so when it does, backing off on the activity that made it swell or become painful is a good thing to do. Try the activity again at a later date and see if your knee is ready yet.

Your flex will get better over time as the swelling you can see, and the swelling inside that you can't see, dissipates. The time frame for that is different for everyone, but generally many people begin to feel better somewhere around three months. Your knee will still be healing after that as it takes, on average, a year or so to recover, but right now you're at almost 8 weeks out of around 52.

I've never had my ROM measured as I measure my recovery by what I can do, not by a number. As you look back at your recovery, you'll begin to see over time that you're able to do more and more, and think about your knee less and less. That's the natural progression of this recovery; doing more and hurting less as time passes.

 

[Odieodell]

IMHO, stopping formal PT was a good choice.

I was wondering if I should also back off of the home PT exercises as well that exert a bending force on the knee (ie. squats, bike peddling). My knee is often very sore after PT, so it does make me wonder how much it has been really helping me. However, I don’t want to lose the 95 degree bend that I do have, so I’m sort of hesitant to backoff. Thoughts?

 

[lovetocookandsew]

I don't think squats this early in your recovery are a good idea; bike peddling depends on how you're doing it. If you're spending a long time each day, and/or going fast, it's probably not a good idea. Or, if you're actually riding your bike outdoors already, that may not be the best idea so soon. But, if you're gently peddling on a stationary bike, and for short periods, and your knee doesn't object, peddling is probably okay. If you get pain, swelling and/or stiffness in your knee, that's your knee telling you it's not ready for that activity yet. Back off it, and revisit it at a later time when you think your knee may be ready. As long as you keep walking as much as your knee tolerates, plus doing normal daily activities, you shouldn't lose any bend, and you'll probably find you gain it as your knee settles down and heals.

 

[Jockette]

However, I don’t want to lose the 95 degree bend that I do have, so I’m sort of hesitant to backoff. Thoughts?

You’re not going to lose ROM if you back off exercises that cause pain, which increase swelling, which decreases ROM.

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.

 

[Odieodell]

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.

@Jockette I’m finally starting to believe this. At around 4 weeks my knee was feeling so darn good, but that’s when PT started getting more aggressive with the exercises and pushing my knee. Afterwards my knee was always so swollen and my gains in ROM stopped for 4 weeks. I thought I wasn’t doing enough, so I pushed harder.

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.

Starting today, I’m going to start applying this theory. I’m going to let the healing happen and let my daily life activities be my PT rather than those exercises that hurt.

I initially saw a surgeon who never prescribes PT after surgery and I thought that he wasn’t good because of that, which is one of the reasons I didn’t pick him to do my knee. My friend who had him for hip surgery said this surgeon wants you to heal and doesn’t want PT causing his patients pain. Little did I know.

I wish I had found this forum before I had my knee replaced, but better late than never. I dodged an MUA because of this group.

 

[Odieodell]

Today, I’m one week out of not doing anymore PT and trusting healing and daily activities. I do believe the swelling has gone down some from not doing PT, yet I can still feel internal swelling. I don’t believe I’ve gained any ROM, but it’s only been a week.
The most notable pain I sometimes experience is behind my knee. I’m wondering if this could be due to the possibility of a Baker’s Cyst. I was told several years ago I had one behind this knee, but it hasn’t bothered me in years. I often felt pain behind the knee when I was doing PT. Trying to bend it beyond 95 degrees is still painful, so I’m not pushing it.

I’m hopeful I will see improvement in a month. On a good note, I have absolutely no pain walking.

This coming Thursday will be 9 weeks post-op.

Stay tuned!

 

[kneeper]

Pain behind the knee is pretty normal. I'm glad to hear that the knee seems to be settling down a bit now that you've backed off of strenuous things like squats. You won't see instant results, but when you're not continually reaggravating it with intense exercise, you should see some improvements in the swelling over the weeks.

I found simple heel slides on and off during the day, short walks and general daily activities (so long as I didn't overdo) to seem to do the trick--in between lots of icing and elevating. Lots of experimentation to figure out what qualifies as overdoing, from day to day though.

 

[Odieodell]

So this evening I received a call from either my doctor’s office or the medical equipment company asking me again if I want the knee brace machine. I’m guessing she is referring to a CPM machine. She said they recommend using it two hours a day to improve range of motion. Apparently, you can adjust the tension. She went on and on how much it would help me and, of course, how my insurance would cover it. She said they would ship it to me and I could try it for 30 days and return it if I didn’t like it. It seemed like a hard sales pitch. I told her I wanted to think about it, but she said she needed to close her books tonight and needed to know this evening, so I declined.

Has anyone ever felt these were helpful? Should I have not declined? To me it sounded like more PT.

 

[lovetocookandsew]

Most doctors no longer prescribe these; it seems they really don't make a difference in your overall recovery. I had one in 2014 after my TKR, but didn't use one in subsequent surgeries. I found it didn't help at all; it was often painful and also stressful to remember to use. I would not have used it again if it had been offered-normal walking helped more and you don't have to strap your leg in and let a machine move your knee for you.

I suspect this was just a sales pitch-it sounds like they need to try to amp up their business, at least with these CPMs anyway. Good job on not falling for it!

 

[InkedMarie]

My physical therapist told me that he has seen injuries from people using them at home and not lining things up properly.

I was a nursing assistant on the ortho floor of a hospital back in the 90’s. Every TKR patient had them in the hospital but I don’t recall hearing of anyone taking them home. I believe they did go to rehab for ones who needed rehab.

I‘m very happy my doctor doesn’t use them.

Marie

 

[WFD]

I used one and found it very useful, so much so that I bought my own on eBay.

I agree with the comment made that you need someone experienced to help you set it up so it is right for your body proportions.

The research seems to show that they are useful for people with arthrofibrosis (like me) but in the long run provide no net gain for regular patients.

They also consume many hours out of your day.

SOP according to my first surgeon was to use it only for the first three weeks, so if you were going to do it, you could fit it into the 30 day guarantee period.

 

[Odieodell]

Tomorrow will be two weeks since I stopped going to PT and stopped doing all forms of PT exercise at home. I am approaching 10 weeks post-op this Thursday. I feel like I may be starting to feel less resistance in my knee bend. Walking down our basement stairs has definitely felt a wee bit easier. My knee overall feels great. No pain walking or golfing. I played 18 holes for 3 consecutive days, so to say I’m happy is an understatement. The pain I was having behind the knee also feels like it is subsiding. I haven’t felt the need to ice my knee in weeks.

I am feeling what could be a few incision adhesions. Nothing horrible or painful. I keep massaging and rolling and pinching the skin. Is there anything else I should be doing for this?

 

[Jockette]

I keep massaging and rolling and pinching the skin.

Just leave it alone and let it heal. A lot of times in this recovery, Time, is the answer. There isn’t always something to do to make it better.

 

[sistersinhim]

Time is your friend in this recovery. Slow and easy wins it!

 

[Odieodell]

Just leave it alone and let it heal. A lot of times in this recovery, Time, is the answer.

@Jockette you seem to believe the adhesions will resolve in time. I was thinking a little bit like the doctor that the less time they have to firmly set the better my chances would be to loosen them. I don’t believe mine are significant enough to warrant the MUA the surgeon wanted to do, yet I’m not sure ignoring them since my ROM isn’t changing much is wise either.
Are you certain that the small adhesions will resolve themselves as my ROM gradually returns?

 

[Jockette]

There is a big difference between “adhesions” and “ scar tissue.”

MUA (Manipulation under Anaesthetic) and adhesions

First let me first put your mind at rest - this is quite probably nothing to do with not having done enough PT or been 'good enough' in following orders. Here is my standard mini-lecture on the subject so read and absorb ... All the structures in the body, muscles, tendons, ligaments, even gut...

bonesmart.org

I do believe a true adhesion will need help.

You said you are feeling what could be a few incision adhesions.

I believe that thick parts of the knee incision, which is normal scar tissue at less than 3 months post op, will heal nicely, all by themselves. I don’t believe that this area gets adhesions.

I think that pinching the area is only going to irritate it further. I could never have done that to my sore knee.

 

[WFD]

If you wait, and it turns out you need an MUA because of scar tissue, you can opt for an arthroscopic lysis of adhesions combined with an MUA. This can be done at any time. When I had this done, my surgeon wanted me to wait until at least 6 months after my revision so the inflammation and swelling would have a chance to settle down. People sometimes have this done years after their TKR.

This allows you to wait and see if it will resolve on its own, and not be forced into an MUA early on.

 

[sistersinhim]

Be careful messing around your incision scar. You have many layers of soft tissues that are healing under that scar. That's why we say it takes as much as a year to heal from this surgery. You don't want to pull apart any tissues that are knitting together inside causing more trauma, pain, and swelling. That will probably cause a decrease in your bend.

Just think of what is happening on the inside of your knee. Closing stitches. Look at all these layers of stitches you have.

 

[Odieodell]

I believe that thick parts of the knee incision, which is normal scar tissue at less than 3 months post op, will heal nicely, all by themselves. I don’t believe that this area gets adhesions.

@Jockette my incision has healed up very nicely. No thick scarring and it doesn’t hurt in any way. The skin on my non-surgical knee moves freely when rubbed. Portions of my incision skin also moves freely when rubbed, but not all. The lower portion of the incision is where I sometimes feel a little pull or pinch when I rub it. I don’t feel the incision is inhibiting my ROM, so do you think what I am describing is just a little scar tissue?

 

[Jockette]

so do you think what I am describing is just a little scar tissue?

I do. You are still relatively early in this year long recovery.

My knee overall feels great. No pain walking or golfing. I played 18 holes for 3 consecutive days, so to say I’m happy is an understatement. The pain I was having behind the knee also feels like it is subsiding. I haven’t felt the need to ice my knee in weeks.

You are doing very well for so early in recovery. Concentrate on this and let Time and Nature take care of the rest.