TKR TKR Progress

[Odieodell]

I had my TKR surgery done on 3/30/2022. Prior to surgery, I diligently did strength training for 4 months. Pre-surgery my extension was -30 and my flexion was 120 degrees.

The first week was rough, but by the end of that week, I was using a cane. Incision staples were removed 11 days later by the RN. My flexion was only at about 68 degrees and she didn't feel it was good enough and recommended some mechanical brace. I continued doing PT and ROM gains have been slow. When the PT from the hospital called about the mechanical brace around the third week, I refused it as I felt I was doing well enough. She mentioned I may need MUA if I didn't use that brace.

At three weeks my flexion was at about 80 and extension was at -18 and I was walking 80% of the time without a cane. At four weeks, with a little aggressive help from PT, my flexion hit 95 and my extension is still only -15. The joint itself doesn't hurt and the swelling is significantly less, but the surrounding tissue/ligaments are sore and tight. I don't mind pushing myself a bit as I want to be able to get active again as quickly as possible.

Honestly, I was hoping to be golfing at the 6-week mark. I don't see my surgeon until around the 7-week mark on May 19. I had a Conformis custom knee replacement and the recovery time is supposed to be quicker. I read that many patients are golfing after 6 weeks. I have been out chipping and putting and actually took a couple of swings with a low-lofted iron and I was fine with that about a week ago. I don't think I can hurt the joint itself and if I feel well enough to do it I'm tempted to start playing a little bit and build up to playing 9 holes. However, I don't want to upset the surgeon since I won't see him for a while. Would you recommend I wait to play until I see him or trust myself? I'm also a little concerned he may push MUA if my ROM doesn't improve much before then, but honestly, I will probably decline it. Would I be wrong in refusing that if he mentions it at 7 weeks?

 

[FourCats]

You’re only a month out from what is at least a year long recovery. Personally I think you’re doing too much. Your focus at this point should be on allowing the knee to heal by icing and elevating. Pushing it will likely cause setbacks and you’ll find yourself frustrated and impatient. Don’t compare yourself to the stories of others; every knee is different, even on the same person.

 

[benne68]

Hello @Odieodell and welcome to BoneSmart!

Please let us whether you TKR was your right or left knee so we can create a signature for you.

Pushing yourself is counterproductive because inflammation keeps you from bending your knee. If your leg is "sore and tight", it is telling you that you are doing too much for so early in this year-long recovery.

I will leave you our detailed recovery information below.

 

[Claire56]

In my humble opinion, if whatever you want to do doesn't make your knee hurt or swell, go for it. I'm a little puzzled about the brace since a lot of the exercises are for increasing bend and I would think a brace would hinder that.

As far as damaging the prosthetic goes, I understand it is pretty hard to do that.

Are you using an exercise bike or peddler? My surgeon feels it is pretty important to use one. I think it was a big help in increasing my ROM.

 

[benne68]

@Odieodell

Following are the BoneSmart Guidelines for recovery from a TKR. Based on your initial post, it sounds like you are doing much too much for so early in your recovery.

We've all heard those unbelievable stories of people who play golf, climb a mountain or run marathon (just joking) within 4, 6 or 8 weeks post TKR. If you spend some time looking at the many recovery stories on the forum, however, you will see that -- for most of us -- this is a long, slow recovery.

Don't hesitate to ask questions! There are lots of folk here who will be happy to share their experiences.


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 Care In Hospital


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.

 

[Odieodell]

It was my left knee that I had replaced.

 

[sistersinhim]

When the PT from the hospital called about the mechanical brace around the third week, I refused it as I felt I was doing well enough. She mentioned I may need MUA if I didn't use that brace.

I can't imagine why the hospital wanted you to wear a brace. To threaten you with a MUA at one month out is ridiculous. Your knee has had no time to heal yet. Forcing it to bend when it's so young would only cause more trauma, inflammation, swelling, and pain.

The joint itself doesn't hurt and the swelling is significantly less, but the surrounding tissue/ligaments are sore and tight. I don't mind pushing myself a bit as I want to be able to get active again as quickly as possible.

It's impossible for the joint to hurt, it's artificial. The soft tissues are sore and tight because you are overworking them. That slows down healing. Your number one concern should be to heal. The best way to heal is with gentle movements, not forced bending or straightening.

I'm also a little concerned he may push MUA if my ROM doesn't improve much before then, but honestly, I will probably decline it. Would I be wrong in refusing that if he mentions it at 7 weeks?

It is your knee and your doctor works for you, not the other way around. You have the say so about whether or not you get a MUA. And no, it would not be wrong to say no to one. You are doing well for one month out. To have a MUA when you don't need it will only cause a huge setback. It is definitely not worth it.

 

[Odieodell]

Are you using an exercise bike or peddler? My surgeon feels it is pretty important to use one. I think it was a big help in increasing my ROM.

I finally got full rotation forward at therapy. Backwards rotation came first. I have a recumbent exercise bike at home, but can’t make the full rotation on mine yet. So for now, I just push forward and back, trying to improve ROM.

 

[FCBayern]

I'm also a little concerned he may push MUA if my ROM doesn't improve much before then, but honestly, I will probably decline it. Would I be wrong in refusing that if he mentions it at 7 weeks?

You would be completely right to tell him no, or even no! You are seeing improvements in ROM so it's not adhesions preventing your ROM so an MUA would only put you back to day one of recovery. I agree that you are doing too much and the swelling that results from too much activity is limiting your ROM. In this recovery you need to really listen to your knee, if what you did during the day causes additional pain or swelling that night or the next day you have done more than your knee was ready for. Less is often more in this recovery. It sounds like your surgeon only gave you the "miraculous" knee recoveries, playing golf at 6 weeks. This is a 12-18 month recovery and you can't do much to speed it up, but pushing too hard can certainly slow your recovery. You might be able to play golf now, but I guarantee you'll pay a big price for it.

 

[Susie-Q]

I don't know who told you that you could golf again at 6 weeks, that might be one person in a million who could do that. Certainly not what the majority of us could ever do.

Here is a chart that shows how long it takes for various parts of the body to heal. This is a year-long recovery and while I don't think golfing will take a year to get back to, I would wait at least 3 months for those bones to fully heal. Ease back into things slowly and listen to your body. If it hurts, swells, feels stiff after an activity, you've done too much. Go back to resting, icing and elevating for a few days and try again when things settle down.

 

[Odieodell]

Another quick question. My incision seems to be healing nicely, but it is super sensitive. I’m guessing the nerve endings are growing back. I don’t have any numbness that I’ve heard of other people talk about. How much longer does this last and is there anything I can do to reduce the sensitivity?

 

[sistersinhim]

My incision seems to be healing nicely, but it is super sensitive.

This is a common complaint. My doctor suggested rubbing different fabrics over my incision to desensitize it. It takes a while, but the incision will calm down after a while.

 

[bertschb]

So for now, I just push forward and back, trying to improve ROM.

I've had both my knees replaced and I learned after my first TKR that nothing I did through PT would improve ROM. In fact, the more I tried to improve ROM, the worse it got because it just created more swelling. I'm an avid mountain biker and it took six months before I could make a full rotation on my bike with my left knee and seven months with my right knee.

The recovery period for TKR for many people is veeeeeeery long. Regaining ROM can take a very long time. Here is how long it took with my left knee:

Don't let anybody talk you into an MUA because of a lack of ROM. Your ROM will improve on it's own. The harder you work to improve your ROM, the longer it will take.

 

[Odieodell]

The recovery period for TKR for many people is veeeeeeery long. Regaining ROM can take a very long time. Here is how long it took with my left knee:

Don't let anybody talk you into an MUA because of a lack of ROM. Your ROM will improve on it's own. The harder you work to improve your ROM, the longer it will take.

I have gained about 5 degrees each week from PT. At 4 weeks, my flexion was 95 degrees. I had pretty much made up my mind I wouldn’t let the surgeon do a MUA on my knee. Your comment and timeline further encourages me that it will continue to get better on my own after I finish my PT. The swelling of my knee is down considerably which is why I believe I am currently making gains.

 

[Jockette]

My ROM continued to improve in my second, and even in my third year. It made me kind of mad that the medical team causes us so much stress about it in the early weeks.

 

[bertschb]

It made me kind of mad that the medical team causes us so much stress about it in the early weeks.

Yes, there is a lot of misinformation in the medical field about TKR recovery and PT. I tried PT with my first TKR and the guy said I would need an MUA because my ROM was so poor. I know this isn't the experience that everybody has but my PT actually caused more swelling which slowed my recovery. I skipped PT for my second TKR and it has healed just fine by itself.

If you push things too quickly, you will likely cause swelling which will reduce ROM. Your knee can't flex if it's swollen!

 

[Jockette]

I know this isn't the experience that everybody has but my PT actually caused more swelling which slowed my recovery.

This is the experience for a lot of us. It happened to me, too. I don’t understand why the PTs don’t understand it.

 

[ski_bum]

Another quick question. My incision seems to be healing nicely, but it is super sensitive. I’m guessing the nerve endings are growing back. I don’t have any numbness that I’ve heard of other people talk about. How much longer does this last and is there anything I can do to reduce the sensitivity?

Golf you twist you knees. Be careful you don't cause IT Band issues. I missed a step twisting my leg and now my second IT Band is angry.

 

[Odieodell]

Yesterday, I hit the 5-week post-op mark. I had PT today and this was the first week I had no gains in my range of motion (ROM). I must admit, I’m a little disappointed, but not discouraged. I haven’t had to take any pain medication in weeks. Walking and being up on my leg doesn’t really bother me. Swelling only occurs when I push a bit bending during any PT exercises. I have done some chipping and putting on the golf course. Yesterday, I also hit some easy swings with my irons from the par threes and my knee felt fine with it.

I’m still having a horrible time falling asleep or sleeping well once I do drift off which is a bit frustrating. Prior to surgery, I always slept well. My knee really only hurts when I bend it, which may be what is causing me to wakeup. I do use pillows to help me sleep.

I see my surgeon for the first time on May 19, so it will be interesting to see where my ROM will be by then and what he will have to say. I have no intentions of letting him do MUA.

 

[Jockette]

Sometimes our ROM will plateau for a bit. It will continue to improve as you heal. Mine continued to improve well into my second year, and even a bit more in my third. There is no “window.”