TKR What I did on my summer vacation

[kneeper]

Congrats on the good x-ray! I would start slowly and work up to 100 reps. You don't want to throw yourself into tendinitis. (I speak from experience of what can happen doing too much too fast.)

 

[birdwatchr]

@kneeper haha, I think I learned that on saturday! Got an email to do squats a new way, only tried 10, and pretty much could not walk saturday or sunday! What I don't understand is how they atrophied when I've been using them big time, and just read online that it's a well known fact that you do well for 6 months, then start slipping backwards after that due to atrophy. Another thing doctors don't tell you??? Trying to get all kinds of exercises I can do. Can't do those squats anymore for sure!

 

[Celle]

just read online that it's a well known fact that you do well for 6 months, then start slipping backwards after that due to atrophy. Another thing doctors don't tell you???

I don't know where you read that, - please will you cite a source? - but it hasn't been our experience here on BoneSmart. It doesn't sound likely to me.
I think what happens is that recovery slows down, - but slip backwards? No way! You should continue to progress, although more slowly.

Squats are always hard on a new knee. Start gently, with half-squats.

 

[sistersinhim]

I certainly haven't been sliding backwards after 6 months. I continued to get better. I am stronger and have better ROM today than I did at 6 months. Please tell us where you found that article. I'd like to read it, too. As far as your muscles being atrophied, I sure don't understand how that could happen. I'm going to google it.

 

[KarriB]

I only got better at 6 months, swimming laps and riding a bike. Unfortunately, I didn't do a lot of walking.

 

[Jaycey]

He wants me to do exercises 100 times a day.

As others have said - this will get you nowhere except in pain and lack of mobility. Start very slowly!

 

[birdwatchr]

So no one has any suggestions or ideas why muscles would atrophy even though you are using them? I don't get it. I've been using the steps at work some, and this is one exercise they say to do for stregthening (online). I've been walking about 20 minutes every day. I've been stretching almost every day. I take breaks and get up and move at least once every hour. So how did my muscles get atrophied?

 

[Celle]

So no one has any suggestions or ideas why muscles would atrophy even though you are using them?

I can think of no reasonable explanation at all as to why your muscles would atrophy at 6 months, and frankly I don't believe they do. There is no logical explanation and I just hope that your surgeon was joking when he told you that.

I can believe that you found doing squats hard, but that's because you haven't been doing them and your muscles are a bit out of condition. That is completely different from saying they have atrophied.
Any time you ask your muscles to do an unaccustomed activity, they are going to protest at first, until they get used to doing that thing.

 

[birdwatchr]

@Celle This doctor actually does not joke around. And why would any doctor tell a patient their muscles have atrophied (if they haven't) or joke about something that serious? Also, I am a year out from surgery, not six months. The squats were not hard to do; they just made my inner thighs sore. When I asked about doing them that way, I was told not to, and they showed me how I should be doing them. The issue here is not the exercising, which I've been doing all year, but why would/do muscles atrophy when you are using them? If I had not been using them, I could understand. If I had just been being a couch potato, I could understand. But I haven't! And I don't understand.

 

[kneeper]

I have no clue. Do your muscles feel weaker?
Many of our muscles get a bit atrophied as our knees go bad in the years before surgery. Could the surgeon be referring to general atrophy, not new weakness?

 

[birdwatchr]

@kneeper
Well, they don't feel weaker to me, but he never mentioned atrophy before, and he compared it with my other knee. So I don't know. Didn't get to question it, but he did show me my xray and said my other knee is fine, meaning he did not anticipate it needing surgery.

When I delivered something upstairs today on a chair with wheels, I sat in it and pushed myself backwards down the hall to the elevator. Everyone was laughing saying they wished they had a picture, but I thought it would be a good exercise for a quad. So I guess I'll just have to come up with my own exercises and hope for the best. I don't want to become an invalid, especially after going through all this.

 

[Celle]

The issue here is not the exercising, which I've been doing all year, but why would/do muscles atrophy when you are using them? If I had not been using them, I could understand.

So I guess I'll just have to come up with my own exercises and hope for the best. I don't want to become an invalid, especially after going through all this.

I'm sorry I got your recovery period wrong.

However, joking or serious, your surgeon has obviously told you something you believed and it is worrying you.
I have no idea where he got this strange idea from. I have never heard of it. It defies logic, and I don't believe he is right.

Since it is worrying you, can I suggest that you ask him again, and also ask for references to scientific studies that prove what he said? I would be very interested to learn of them, so please share the references with us.

I have searched online. There are several clinical studies of quadriceps atrophy after a knee replacement, all of which only followed patients up to 6 months after surgery. They all indicate that quads recovery has occurred by 6 months. However, I could find no reliable studies that continued after 6 months.

The only mention of muscle atrophy after 6 months that I could find is here
https://totalkneereplacementrecovery.net/preventing_muscle_loss_thigh_after_knee_replacement/
This is in a commercial site which seems to be promoting the use of amino acid therapy post-operatively. It mentions a study, but lacks any valid links to that study.
The front page says this:

Research demonstrates that functional recovery peaks at 6 months after a knee replacement and that from then on, there is an acceleration of functional decline due to thigh weakness that outpaces normal aging and is not attributable to a lack of range of motion or pain.
In other words, we normally lose muscle mass as a result of aging but a knee replacement can exacerbate and accelerate the problem.​

I am suspicious of any claim that "research demonstrates" unless that claim is backed up by a valid reference to a study done by qualified people and published in medical literature.

Nothing I have read on that site convinces me that muscle atrophy after 6 months is a generalised problem. Nor does it give sufficient evidence for your surgeon's statement.

Since you are leading an active life, I really don't think you need to worry. I don't think there is any prospect of your becoming an invalid.

 

[birdwatchr]

@Celle
Thank you for clearing that up. I was at a loss. I know they said my hands had atrophied due to pinched nerves, but again, I still use them, although they do feel swollen and tight. But my leg doesn't feel like that.

I am very glad that he doesn't think my other leg will need surgery, but I think I will see my original knee doctor for that one, cause I do have some pain with it. It's just not near as much pain as this leg has been. When I mentioned that the pain on surgery leg seemed to be getting worse and sending me backwards, he said it was the atrophy causing it. However, the bend in it is 135 to 140, so it seems pretty good. I will try to get more answers.

 

[Celle]

I hope I was able to reassure you, @birdwatchr .

Just keep using your knee as if it was the one you were born with. I'm sure you're going to be OK.

 

[birdwatchr]

@Celle
I've made an appointment with my doctor who treats my back and neck. He usually spends a little more time with me and has shown concern over my legs. I'll ask his opinion about signs of atrophy as it will be easier to get in to see him, and I think he'll answer questions better. When both legs have similar pains, I can't blame it on surgery. I also feel I need a second opinion now. In the meantime.... onward I go!

 

[sistersinhim]

It sounds like to me your surgeon just made up something to explain why you are having pain. I am so glad you're seeing another doctor. I bet he'll agree with us. It doesn't make sense that you are active on muscles that have 'atrophied'. Your knee is not that much ahead of mine, and I will still have some pain at times, too. But, no one has ever said my muscles had atrophied! You deserve truthful answers.

 

[kneeper]

It does seem that often when they can't pin down what's causing a pain they say you need to exercise more.

 

[sistersinhim]

It does seem that often when they can't pin down what's causing a pain they say you need to exercise more.

Shoot, and that more exercising could be the very thing that's causing the pain!

 

[birdwatchr]

Update: I had my June 28th appointment moved up to today. This doctor doesn't seem to think my knee/muscles look much different than the other one, but did suggest exercises to strengthen them both. He did not think another mri would be helpful, and will wait until I tell him the pain is worse before trying any epidural shots in my back. I can go back in a few months for piece of mind, or email him any concerns. So that is what I'll do. Meanwhile, knee still hurts more than it did a few months ago, but I still walk much better. Probably a wait and see thing.

 

[KarriB]

I can tell you my TKR hurt for quite a while, especially while walking. My leg was extremely weak before surgery and I think it took over a year before those muscles began working really well.