TKR Week 20 update...all good and getting better

[robhunt3]

Hi all, thanks for all your support over the last couple of weeks Suzette, sistersinhim, kneeper, Snoosie, Jamie, KarriB[, Josephine, Jockette, SusieShoes, and everyone else.

Here is my 6 week report.

I have been continuing to rest and ice, but am doing more day by day. I am pretty much pain free other than at night, when I get some aches. I am off all pain meds (again), but sometimes take a couple of paracetamol if needed.

I've been walking a bit further and have been out and about more, and as might be expected this has both helped and hindered. For the most part I would say it helps.

There hasn't been a huge change in my flexion. Some days I think it's a bit better at around 95 or 100, and then other days it seems it isn't and is at or slightly less than 90. Swelling and stiffness is up and down, and know that affects progress. Extension is still good at around 0.

I feel like I am waiting for a 'Eureka moment' where it will just give way a bit and suddenly bend more than it has been!

Today I had my 6 week checkup with Mr Allen my OS, who was very happy with everything other than the stiffness as he called it (bend as I would call it), which was about 90. He wants to see me again at 12 weeks to see this has improved, and said I need to push it a bit harder to get more flexion. He did say that pre-operatively my knee was a bit of a mess, so it will perhaps be harder to get full a fuller flexion because my muscles and ligaments were used to a lesser bend (pre-op my bend was 120, and approx 135 before my accident in Nov). I'll be working on this over the next 6 weeks, but I know it may take longer - we will see, but I want to avoid an MUA.

I can now drive (yippee) and will be returning to work next week, just into the office in London a couple of days a week on the train and working at home the rest of the time, aiming to gradually get back to full time in the office. I know that's not really conducive to resting the knee, but it is what it is and I'll be glad to get back to some sort of normality.

I'm also going to start down the gym again now I can drive, just to start getting my body moving gain, and to help with my fitness and mobility. I've missed it, and I know how weak I have become from doing virtually nothing for 6 weeks!

Thank you to everyone that has helped me through the ups and downs of days 0 thru 42. It has certainly been a rollercoaster, and I know I'm only a short way through the ride.

And finally, here is what I call my double A knee...the new straight Attune knee and my old wonky Arthritic one...

 

[KarriB]

Not sure if I said this before, but my flexion was 109 around 4-5 months post op. Six-seven months later it was 120 and continued to improve. Don’t work too hard, you don’t want to go backward.

 

[Jockette]

Personally I think your body is weak more because you are only 6 weeks out from major surgery, not because you’ve “sat around” for 6 weeks.

Most of your body’s energy is going towards healing that major assault that happened in that major surgery. There’s not much left over for other things yet. As you heal your strength will improve.

Patience.

 

[SusieShoes]

Why, that’s a handsome new knee! I’m glad it’s treating you well and will join the chorus of saying to not overdo things trying to push for better ROM. That said, if you’re sensible at the gym and listen to your knee, scaling back on any exercise that leaves it painful... that could work for you. You will be doing something you enjoy and find satisfaction in actively directing your rehab.

At this early stage (six weeks is still early and three months is when most can safely return to strength work) you should still avoid weights, like ankle weights, or machines like leg presses. Using a bike is better exercise for a young TKR and you can gradually build up the resistance. Just want to keep you safe, friend!

Your work schedule sounds sensible to me. It’s early, yes, but only two days a week and the rest from home is a good way to test the waters. Hope taking the train is not too much for you and things go smoothly at the office. It would be good if you can take an elevation and icing break once or twice during the day, if possible. It has to feel good to be getting back to your usual routines.

 

[robhunt3]

No matter how hard I try @KarriB, I can't help but think I'm not far enough along the ROM road. I expect I'd be thinking the same if it was 115 now instead of 90-100. I'm a fool to myself I know, but it's not helped by those healthcare professionals that are constantly telling me I should be doing better.

I agree with you @Jockette, it has knocked me for six - just walking round town locally I have felt drained of energy, but I also feel like I've really done so little while I've been recovering (compared to normal at least).

It is quite a good looking new knee @SusieShoes , and I hope it stays that way! I went to the gym today and did a few minutes on the recumbent bike and my normal spin bike, no resistance just turning them over. This is my first time back on a bike since before my surgery but I managed to get full rotations on both and did about 5 minutes on each. I found it uncomfortable at the top of the flexion for the first few rotations, but not painful. It has definitely helped loosen my knee - I didn't expect to be able to get a full rotation at all, so I'm very happy I managed it.

I then walked for 1 mile on 'The Curve' running machine at a slow pace. This was also good as its concave curved track encourages me to walk with a better gait, a fuller stride and proper extension.

I finished off the gym session with some upper body weights using the various machines, no stress on my knee at all, and then went into the Jacuzzi for a bit more of a stretch in the warm water.

Overall I think this has helped. My knee is more swollen than usual this evening, but I would expect that given the slight increase in activity - I've spent the rest of the day elevating and icing. Hoping it will be back down to normal size by morning.

 

[Celle]

No matter how hard I try @KarriB, I can't help but think I'm not far enough along the ROM road. I expect I'd be thinking the same if it was 115 now instead of 90-100. I'm a fool to myself I know, but it's not helped by those healthcare professionals that are constantly telling me I should be doing better.

I wish we could counter all these people telling you that you should be further ahead!
It's only 2 and a half months since you had your TKR and complete recovery does take a full year, no matter how young or fit you were before the surgery. A TKR knee on a 20-year-old takes just as long to recover as a TKR on an 80-year old. It's a matter of how long various internal structures take to recover, and you can't influence that.

You've probably heard it from us before, but I'm going to say it again:
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

Here are a couple of other people's records of how their ROM progressed - thank you, bertschb and Campervan:

I'm 12 months out from my surgery and have some advice based on my experience:
1- Stop going to PT (all it will do is make your knee swell and reduce ROM)
2- Don't worry about your ROM
3- Be patient - VERY patient!!!

Here is my ROM history (more or less):
1 month - 60 degrees
2 months - 80 degrees
3 months - 85 degrees
4 months - 90 degrees
5 months - 90 degrees
6 months - 110 degrees
7 months - 120 degrees
8 months - 125 degrees
9 months - 130 degrees
10 months - 135 degrees
11 months - 140 degrees
12 months - 140 degrees

I spent waaaaay too much time worrying about ROM. I thought I'd be riding my bike a couple months after surgery but it took SIX months! Looking back on my surgery, if I knew then what I know now, I wouldn't have wasted my time with PT and I wouldn't have worried about ROM.

As you can see, Campervan's flexion continued to improve for a long time.

"I had a slow recovery. Here's my flex measurements at various points:
92 - 8 weeks post op
105 - 10 weeks
107 - 5 months
110 - 6 months
112 - 7 months
116 - 9 months
119 - 11 months
118 - 1 yr
120 - 1yr 2 months
125 - 1 yr 8 months"

 

[KarriB]

As you can tell from Celle’s post above, everyone recovers at their own rate and nothing can hurry it along. However there’s a lot you can do to slow it down. Biking at 0 resistance was beneficial to my ROM that’s for sure. It took a few weeks of rocking the pedals back/forth before I got a full rotation, but once that happened I rode 10 minutes every other day and by 5 months post op I rode 20 minutes a day. It really loosened up my knee.

At not even 2 months post op you’re doing great. My OS advised I take 3 months of work and I needed every day of those 3 months due to swelling as well as energy drain.

 

[Suzette]

Hi

I too felt frustrated at 6 weeks. But mine was from pain. My flexion was good except when the knee swelled. So I had pain worries whereas you have flexion worries. We all seem to have one thing or another to be fed up with around this time, including getting right down in the dumps because of it.

It's good you rotated the pedals. So your flexion must be getting better to be able to do that. It will come honestly

I had 11 weeks off work. Mainly due to not being able to control that throb and also due to being so tired, not helped by lack of sleep at night. I really couldn't have coped going back earlier. So you are doing well managing now.

The first week back was hard and I kept getting stiff, but things are much better now and I am nearly normal !!

Keep positive have patience and rest. It will happen in the end.

 

[robhunt3]

Frustration and impatience sum it up for me @Suzette, but I'm slowly getting better at dealing with it - and hearing everyone else's experiences helps greatly with that because I then know what's happening to me is normal - so thank you! It sounds like you did it exactly right though, and now you're back to normal which is fantastic to hear, and some motivation for all of us to see that there is light at the end of the tunnel.

I do overthink things, but I should remind myself about how quickly those 'things' fade away! In a few weeks I will have forgotten about this and will be worrying about something else no doubt.

I returned to work yesterday, and it was great to be back. No problems getting there or home on the train, I did a full day and wasn't too tired but my knee and lower leg were pretty swollen last night after sitting in an office chair with my leg down for most of the day. I did get up and walk around regularly, but didn't take time to elevate it. After elevating and icing last night it is back to its normal lightly swollen size this morning. I'm in again Wednesday so will try to put it up for a bit if I can.

I am walking normally and at a normal pace most of the time so ordinarily nobody would know I have a recovering knee. The doctor advised I take my walking stick to work with me as a sign to others to steer clear, get a seat on the train etc. but it's amazing how many people completely ignore it! I suspect the sight of me walking briskly along with a walking stick makes people think I am some sort of disability claiming cheat! Having said that, going down stairs is still quite a slow affair so it is plain for everyone to see then at least.

My bend is gradually improving, largely dependent on the state of my swelling at any one time, but I think I'm back at around 100 flexion now - maybe slightly more when I'm on the exercise bike trying rotations (but that does push it to the uncomfortable range, so I only do a few minutes). I'm sure it will improve so I feel lot more positive about it.

Thanks again @Suzette, @KarriB, @Celle and everyone else for your advice and incredible support, it has been invaluable for me...

 

[SusieShoes]

What a truly excellent report, Rob! You're... what? Six weeks out? Your flexion for this point is really good. And you are doing more than most and handling it well. It's good that your knee settled down quickly after your work day. It's naturally going to react to being asked to do so much more, but that it settles down overnight is a good sign that what you're doing is not TOO much. It would be grand if you could stay at home and off your knee for another several weeks, but that's your situation and it's working out well, in huge part because you're being sensible.

The bike is a perfect rehab exercise. My aged mother rehabbed both of her TKRs on a stationary bike. She did so well she now sits on her heels. Not sure I'll ever do that again.

Can you arrange an ottoman at work? Borrow one from your boss? Have one shipped in from Amazon? It would be a good investment and afterward you could use it as a side table or donate it to a needy co-worker. Every workplace should have an Office Ottoman to pass around. If you can find a way to work icing/chilling into your office routine, even better.

Stairs get faster later. For me they were slow at first (and I did them early), then they became easy (but still slow), and only in the last couple months have they become easy and normal speed. Not fast yet. I try to run up the stairs but it's a bit of an effort to speed up. Running down, though, is okay. But we get there, you know. It all comes back in time.

 

[KarriB]

We are all definitely different! I could not have returned to teaching at 6 weeks!

Some members have used a trash can to elevate at work while sitting at a desk and I took ice packs to work with me. While I was too busy teaching to ice at work I did ice while driving home by just sticking the ice pack up my trousers.

 

[Suzette]

Hi @robhunt3

How are things going. Have you noticed that when back at work the weeks disappear really quickly and before you know we are nearly into April!!

My knee really does ache a lot since going back. I am now week 14 plus weeks. I have had a lot if lateral and medial pain lately which now wakes me up at night. I also walk about a lot so may be I also need to elevate at work too.

I hope all is ok with you and your knee

 

[robhunt3]

Hi @Suzette, everything is going reasonably well at the moment thanks. Time does fly! I'm at 8 weeks now and have been back at work for two weeks, 3 days in the office and the remainder at home each week. Starting next week I'll be in the office 4 days a week.

I know exactly how you feel about the aching, my knee has been playing up a lot too, especially overnight (which seems to be common) so I've been quite tired most days as a result. I hope yours settles down soon and you manage to get some proper rest, I'm sure it will. How is everything else going? Are you gradually getting better at doing things, stairs, walking etc? I'm OK going up stairs, but it's slow coming down and I sort of have to limp my way through it because it seem like I'm at the limit of my ROM doing it, but I can't be really as I bend it much more when I'm doing other things. It was the same with my previous surgeries, it soon improves.

I think being back at work has helped more than hindered by getting my knee moving more, although I haven't really been able to elevate it while I'm at work - you should try if you can. Most evenings my knee is moderately swollen (and my lower leg too), but usually recovers by the morning to lightly swollen.

The joint itself is still swollen internally and this is limiting my flexion still to about 110 at best at the moment. My extension is at about 5 now. So going back to work has improved my flexion, but at the expense of my extension which was near to 0. I know I need to forget about it, it's improving gradually so I should be happy. I'm at the gym a few days a week too which helps with that, but it's still such a slow process - I really want to be doing stuff again!

You're doing really well though, before we know it we'll be back to relative normality and wondering what all the fuss was about! It's good that as humans we have a tendency to forget all the bad stuff. Suits me!

 

[Suzette]

Hi

I found getting back to work got my brain going and out of the depression I felt was setting in.

I have been able to go up and down stairs for a while now but am pretty sure it only occured, by accident, when my flexion was about 115. Until then I didnt even realise how the knees bend and the angle it bends to, when going down stairs!! I do now ..there were a few occasions when my leg got stuck on the stair due to the lack of bend !

Lately though my knee feels a bit stiffer going down so there must be some swelling going in there .

Walking is ok with no pain other than those twinges on my lateral side. I think my problem is, if it doesn't hurt walking and standing, it's ok. I now seem to be paying the price for that, but I then forget and over do it again!

Your flexion is coming on well now. Thats great news

Hopefully the extension will re appear again too. It must be to do with swelling.

I think we are all doing great....but we have been on a huge learning curve!

 

[Jockette]

Hopefully the extension will re appear again too. It must be to do with swelling.

I love how you chose the word “re appear “ because that’s exactly it. Your ROM is right there from the start just waiting for pain and swelling to go down and healing to happen.

And we know it takes a long time.

 

[robhunt3]

So I'm now just over 9 weeks in and as frustrated as ever by the slow pace of progress, although I'm becoming used to it.

Highlights over the last couple of weeks:

• I'm working in the office 4 days a week, and 1 at home. No real issues other than swelling of an evening, to be expected and recovers to near normal by morning
• I've been going to the gym a bit more
• I'm now doing 20 minutes on the Watt Bike with a little resistance (it still takes a few minutes to loosen my knee up)
• Doing 2 miles fast paced walking on the Curve each time
• Going upstairs a bit quicker
• Going downstairs one step per leg, albeit tentatively. I can feel my Lateral Collateral Ligament or maybe my ITB stretching to extreme when I'm doing this, which may have something to do with my reduced ROM perhaps?

And lowlights:

• My self assessed maximum flexion ROM of 110 turned out to be 105 when the physio measured it, although I think it has been better than that at times. I've been a little disappointed by that, but it's still better than 90 barely a few weeks ago.
• Extension is back to near 0 after focusing a bit more on straightening as well as bending
• I'm still struggling to get a decent night's sleep. Obviously sleeping just makes my leg stick in one position, then when I move it the aches wake me up.
• I get occasional pain on the medial inner side of the joint, which is similar to the sort of pain I used to have with my osteoarthritic joint, but this is usually only momentary - of course, being the overthinker that I am, I take this to mean all sorts of bad stuff (loose TKR, infection etc) - I'm pretty sure it's not.

So I'm still frustrated and a bit worried by the slow ROM, but I hope I'm past the point where the OS might still talk about MUA. I see him in just under 3 weeks at the 3 month point, but hopefully it will improve further by then.

I am going to try sports massage this week to see if that makes a difference to my muscle/ligaments and frees the joint up a bit, although it feels more like the joint itself is preventing movement at the moment (unless it is that LCL or ITB I mentioned perhaps?). The masseur has experience of improving ROM in TKR patients, so I'm hopeful. I've also been trying to find a local Graston Technique practitioner, but I'll try the massage first - I expect it will be similar.

I'm also going to go back to taking Paracetamol regularly. I've been off it a while, but maybe it will help with the aches that make the knee stiff at certain points during the day and overnight. Does anyone have any opinions as to whether I should take it when I actually have aches/pains as opposed to regularly to help avoid the onset of it?

 

[Celle]

Your ROM will continue to improve slowly, Rob, as long as you don't let your knee get angry by doing too much.

You did go back to work a bit early, so on the days you work don't do any other exercises. Your knee gets plenty of use on work days. Give it lot of rest, ice and elevation when you get home.

 

[SusieShoes]

Massage helps many and it feels got d, so that’s a win no matter what. I found it good for relaxing my knees and still do it on my own sometimes, especially when Lefty decides to be a little sore. Like this Easter when I was on my feet far more than usual. Massaging the “sore spot” eases it.

Do take it easy. That advice is hard to follow, I know, but you will hear it a lot because it’s really good advice!

 

[robhunt3]

Week 10 update - still stuck at 100-105 maximum flexion :-(

I've had a couple of sports massage sessions this week which focused on myofascial release, and definitely helped loosen the skin around my joint - after the first session my bend felt significantly better in terms of it being less tight, but it doesn't seem to have had any material affect on my flexion.

My bend still seems to feel restricted as if the mechanics of the joint itself will not move much further.

I've had a busy week at work and at home, and been at the gym a few times, now doing 25mins on the bike at a time which generally feels OK and helps it feel less stiff.

My knee is still moderately swollen at the end of each day, but is back to a reasonable state each morning. I have some aches and some pains which come and go from time to time, but generally not very much.

I'm doing more hamstring and quad and calf stretching as the masseur did a fair bit of work on my right hamstring which she said was very tight. I'm having some more sessions this week and am hopeful it will help longer term.

So I'm still frustrated that the bend is a bit stuck, but I'll just have to accept that for now. I see the doc in a week and half at 11.5 weeks, I'm sure he'll talk about MUA given I've only progressed about 15 degrees in 6 weeks, but I'm not keen to go down that route at all.

Has anyone else had their new knee feel like it won't move past a certain point (almost as if it is the mechanics of the new knee joint is stopping it), but have found that it eventually improves?

I feel almost as if the joint is too tight, maybe the plastic spacer is too big to allow a bend? I doubt it, just overthinking as always. It's probably more to do with tight muscles/ligaments and swelling. I just wish I knew what I could do to make a difference, even a small one - there must be something!

Yours,
Frustrated and impatient TKR patient

 

[Jockette]

My knee is still moderately swollen at the end of each day, but is back to a reasonable state each morning.

This is why you can’t bend as well as you’d like. You’re only 10 weeks post op in a 52 week on average recovery.

So I'm still frustrated that the bend is a bit stuck, but I'll just have to accept that for now.

Yes, you just have to accept that for now. Where you are now is not where you will end up.

Has anyone else had their new knee feel like it won't move past a certain point (almost as if it is the mechanics of the new knee joint is stopping it), but have found that it eventually improves?

Most of us have and I definitely did. At one year post op my bend is still improving, just like Bonesmart said it would.

I thought I was way behind many others but we all have different time frames for healing. I’m sure most of us felt that way.

Relax, get on with your life (like you’re doing). You still have a long way to go with lots of healing to do. You will definitely improve!

Do I still think about my knee just about every minute? Yes!! But it’s better than it was. Yours will be, too!