TKR Unsure about my progress.

KMLknee

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I had a right TKR on May 27th 2020. I am now just over 7 weeks post op. I am 53 and in good health. I have now had 2 weeks of home PT right after surgery (6 visits) and outpatient PT 3 times a week for the last 5 weeks(15 visits) for a total of 21 with at least 5 more to go.
I am still having problems getting full extension. I can passively get to 2 degrees and the therapist can assist me to 1 degree. My flexion is at 118 passively and 121 with assistance. I am still limping and it's driving me insane. I walk around the house without a cane but use it when I go to the grocery or outdoor walks. I still occasionally have a buckle of the knee without warning, and I'm scared of another fall. I fell the day of surgery due to nerve block and having it done outpatient.
I guess my question is if the limping and buckling are normal at this stage? I am frustrated with my progress even though my therapist says I'm doing well. I'm still having some mild swelling and warmth at my knee (icing several times a day). I'm still waking up in pain several times a night. Is all of this normal? Is my ROM or lack there of normal at 7 weeks post op or am I being too hard on myself?
I have to have the left knee done as well in a few months due to bone on bone arthritis. I'm starting to rethink that and not do it at all, even though it hurts almost as much as my operative knee. Any reassurance or advice would be much appreciated. Thank you.
 

Sara61

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@KMLknee
:welome: to BoneSmart, you already have a very good extension and range of movement at this early stage in your recovery.
The pain is coming from too much exercise. Try reducing your level of activities and use plenty of ice and elevate as much as you can.

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.
 
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Jaycey

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Still early days @KMLknee ! Ice for 45-60 minutes several times per day. And I agree with Sara61 - ease off all that exercise and any forcing the knee. It's counterproductive. There is no timeline for this recovery. That ROM will continue to improve but it needs time.
 
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KMLknee

KMLknee

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Thank you to all who have responded. I appreciate your insight. I'm assuming that this is now my recovery thread. I will continue to document my progress. I have physical therapy on Tuesday and I am choosing to give myself a break this weekend. I'm only going to walk the dog, move to maintain progress and rest, ice and elevate. I'm guessing this is ok as long as I don't go backward. Again thank you for your help.
 

Jockette

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I'm guessing this is ok as long as I don't go backward.
There will be times that it will appear that you are going backward, and that is par for the course, in this recovery. It’s not that you are going backwood, it will just mean you did more than your knee wanted at the time and it responded with increased swelling, which by default, will reduce ROM. Don’t worry about it when this happens, it will be temporary. Just go back to resting, icing and elevating, to “get back on course.”
 

Jaycey

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I'm assuming that this is now my recovery thread. I will continue to document my progress.
Yes, this is your recovery thread. Post all your updates and questions here. We are with you all the way!
 

sistersinhim

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I'm guessing this is ok as long as I don't go backward.
You will go backward if you do too much and inflame and anger your knee. It will have to recover from what was done before it can get back to where you were before you did the thing your knee reacted negatively to. You are much better off just doing gentle movements that don't cause extra pain and swelling.

There might even be times where you can't trace back your knee's anger to something you did. I think that sometimes we move the wrong way during the night and not realize it until the next day. Just realize there will be up and down times of recovery. The best you can do is learn your knee and what it can and can't do without pain.
 

Celle

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Hi @KMLknee
It sounds to me as if your PT therapists have told you that you have a limited amount of time in which ti gain Range of Motion (ROM). That's not true, although they were probably taught that. It's a myth that should have died long ago.

With an active flexion of 118 and extension at 2, you are already well ahead of the game. It's only the active numbers that count, the ones you get by using your own muscles. The passive numbers are just theoretical, so don't let your therapist push or pull on your leg. Doing that could be bad for it, and it causes pain as well.

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

Also, 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 knee has the potential to achieve good ROM right from the start, but it's prevented from doing so by swelling and pain. As it heals and the swelling goes down, your ROM (both flexion and extension) will gradually increase, as you use your knee during your activities of daily living.

You won't lose the ROM you've gained already.
.
 

Summer2020

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In my book that kind of ROM at 7 weeks is awesome!!
 
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KMLknee

KMLknee

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Hello all. I went to therapy today and spent almost the entire visit crying. Not that I was being tortured but because I cannot get full extention in my knee and it seems to be even less than it was last week. I basically did what you all advise in the forum. I took the weekend off. I still exercised but only twice a day instead of 3 and only did 10 reps trying to give myself a break. I still walked the dog, went to the grocery, church and drove several times.

Ok so back to today. Apparently the muscle at the inside of my quad just isn't "firing" according to the therapist. The director who has her P.H.D. in physical therapy worked with me as well. They stretched, pulled, did a special concentrated form of electrical stimulation and had me do rapid small movement sitting leg extensions to "wake it up". All to no avail except that I feel like a failure and I am sitting with it elevated on 2 pillows and constant ice for the last 2 hours.

I thought I had been making progress since I have been sitting with my ankle on a roll with space under my knee and allowing gravity to "pull" the knee straight for as long as I can stand it at a time. About 5-6 minutes. I even add a 5 lb weight at least once or twice a day. They have now given me a wedge for my left shoe to raise it, so that they are even. They say that when I walk the right knee can't fully extend because the left leg is a tad shorter due to lack of joint space that will be corrected when I have the left one done in a few months. This doesn't allow the right leg to extend. I hope this helps.

I'm so tired of limping. I'm so tired of being stuck. I know I'm preaching to the choir right now but I just need to get it out. Tomorrow is week 8 and I know that isn't really that long. But to me it feels like an eternity. What if it never straightens out? Can it freeze like this? Will they have to manipulate it under anesthesia? These are the questions that lurk in the back of my mind and cause me serious anxiety. Thanks for listening. My husband is supportive but just doesn't really understand.
 
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Pumpkln

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Apparently the muscle at the inside of my quad just isn't "firing" according to the therapist
For your VMO (Vastus Medialis Oblique), while sitting straighten your knee while allowing your foot and leg to rotate to the outside. Hold for 5 to 10 seconds do 2 -3x a couple of times a day. This position will facilitate contraction of your VMO.

To promote knee extension, try walking with a heel to toe gait.
walking heel toe.jpg

Extension: how to estimate it and ways to improve it
Can it freeze like this?
As your knee heals, and swelling and inflammation go down, your ROM will be there as it has been all along.

I took the weekend off. I still exercised but only twice a day instead of 3 and only did 10 reps trying to give myself a break. I still walked the dog, went to the grocery, church and drove several times.
When you take a few days off, that means a total break from your home exercises, the rest of your activities are OK as long as you do not do them all in one day.

Sounds like you had a real work out today and will need to Rest, Ice, Elevate, and Medicate as indicated. Recommend you skip your home exercises tomorrow.
 

Jockette

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I’m so sorry that you are so worried. :console2:You truly are going to be ok, but it’s going to take time.

You don’t have to try so hard, and there’s no rush to get your leg straight. Mine wasn’t straight at 8 weeks either. It will come as you heal and your swelling goes down.
I am still having problems getting full extension. I can passively get to 2 degrees
This is so close to straight I’m really surprised your PTs are literally pushing for more. It may have been less today because you are working too hard on it, especially putting a weight on it. There is absolutely no need to do that, it will cause pain and more swelling and just upset the leg. And increased swelling will reduce ROM.

This recovery takes an average of 52 weeks/one year. At 8 weeks you still have lots of time to improve, and you will, but you need to slow down and treat your knee more gently.

Don’t get caught up in the pressure some PTs can put on their patients. Each of our knees are on their own healing time frame, not your PTs timeframe, or your surgeon’s, or even yours.

Allow your knee the privilege of sorting itself out. It will, in time.


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.
 
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KMLknee

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Thank you Pumpkln. I guess I really didn't take a day off. Ooops. I want to really take it easy tomorrow but at the same time I feel like like somehow they will know that I was lazy when I go back on Thursday . I do walk heel toe at least I always have so that muscle memory is there. I concentrate to do so as I walk now. When I stand and try to distribute my weight through both legs, I can feel that I am not able to put weight completely through my right heel. I will try the exercise for my VOM that you suggested.
I will keep you posted. Thanks again
 

Jockette

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I want to really take it easy tomorrow but at the same time I feel like like somehow they will know that I was lazy
It honestly doesn’t matter what they think, this is your recovery, not theirs. And lazy isn’t what it’s called. And it’s not “doing nothing.” It’s giving your knee the best circumstance in which to heal, and don’t let them convince you otherwise.
 

sistersinhim

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Apparently the muscle at the inside of my quad just isn't "firing" according to the therapist.
That's baloney. If your quad wasn't firing you wouldn't be able to walk or lift your leg at all.
I basically did what you all advise in the forum. I took the weekend off. I still exercised but only twice a day instead of 3 and only did 10 reps trying to give myself a break. I still walked the dog, went to the grocery, church and drove several times.
That is not resting at all. It's more than anyone at eight weeks should be doing. No wonder you didn't see any improvement. When we say rest, we mean from all activities except just walking around the house taking care of your daily needs. You need to do this for several weeks not just a weekend. Your swelling will go down and your extension will improve, though I don't understand why you are upset. Most people don't see 2 degrees until 4 or 5 months.
I even add a 5 lb weight at least once or twice a day.
This is a huge no no. This inflames the knee and causes more swelling. That swelling is what's keeping your ROM from being perfect.
I want to really take it easy tomorrow but at the same time I feel like somehow they will know that I was lazy when I go back on Thursday.
Your PT has no idea how to rehab a joint replacement. They are keeping you stressed out over nothing, I believe to keep you coming back so they can be paid. Who is the employer? You are. You are paying them, either out of pocket and/or through insurance. They have to listen and please you.

If I were you I'd take at least two to three weeks off of PT and do nothing but normal daily activities. You won't backslide, you will improve.

My extension was slower coming in than my bend was. The best way I improved mine was to walk with a long stride, heel to toe. This helps to stretch out those huge muscles and tendons in the back of the knee. It doesn't happen in a few days. It takes weeks or even months to stretch those. I didn't sweat it. I just went about my daily living and thought nothing about bend or extension. Chill out and enjoy the improvements you have already made.
 
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KMLknee

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Thank you for your kind words of encouragement. I think my biggest problem is myself. I keep reading on various web sites that people are expected to have complete extension on the first day or at least the first week. ( Clearly unrealistic) My therapist is really sweet and she keeps saying " your passive ROM is there. You are at 0° with assistance. It takes time. Everybody heals differently. Stop stressing, you improve every week". It's actually me pushing her to find a solution to make it extend fully.
I just want to be walking without a limp and a cane. I am an over achiever by nature. I don't think I expected it to be this hard because I'm younger. I guess I didn't really take into account that I have been in pain and struggling for 10 years and I have been compensating and babying my right knee for a long time. I had a cartilage transplant 10 years ago that was unsuccessful and probably haven't had 0° extension in a while. I only have 2 more PT visits approved and will probably stop there. I know what the exercises are and I think you all are right. If I just do normal activity I will get better faster than pushing and straining my muscles. They just need more time to heal. I don't have adhesions and likely won't develop them at this stage. I just need to cut myself some slack like everyone is telling me. I have stopped torturing myself between PT visits so my muscles have some time to repair. Hell even bodybuilders know that you can't train the same muscles every day.
The therapy office is a part of my surgeons office and he said he was happy with my progress 2 weeks ago. I see him again in 2 weeks. We'll see what he says then. I will say that the limp is better with the heel lift in my shoe for the left leg. It makes some sense that if that leg is shorter due to decreased joint space that it would keep my right knee from extending fully. I'll try to relax and just let it do what it's going to do. Thank you again. I'm so glad I found this group. You all have helped relieve some if my anxiety and it's good to hear that I'm not as far behind the curve as I seem to think I am.
 

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I listened to the advice above......and my life, knee, mood, EVERYTHING!!! Is better for it.

i figured that PTs have to justify the billing to insurance by showing you have improved with their help. I think that’s crock now. They kept me in agony until I went five days without them touching me. It was the biggest load off my shoulders, knee whatever.....I have ever experienced.

do yourself a favor.....quit PT. I’m not sure I should say that. But I’m not a professional and it did wonders for me.
 

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@KMLknee ... I just wanted to say that it’s normal to worry about your progress. Even though my surgeon was very candid about the recovery being a long, slow process, I thought I’d be different. For the first 8 weeks post op, I was always worried that I was falling behind, especially because my surgery was right before my state’s lockdown. I didn’t have my first official PT session until 10 weeks post op, when medical visits were allowed again with restrictions. I had six sessions, all very gentle (no pain) and encouraging. Now at 4.5 months after my surgery, I’m doing really well. My ROM continues to improve and other than some occasional stiffness and minor discomfort, my knee feels strong. You’ll get there, too. The advice from Bonesmart was so helpful in relieving my concerns!
 

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