TKR Which exercises to continue pre MUA?

[Focuspositively]

add 1 of each of the exercises to my LTKR (6 days post op) and 5 of each of the exercises to my RTKR (13 weeks post op).

I found that the day after doing this both of my legs were more swollen and painful so I stopped doing them. Back to the basics yesterday (short walks in kitchen & dining area a few times, quad sets and ankle pumps) plus elevating, icing and resting. Woke up with my legs less swollen and less painful. Noticed small seeping of blood from wound on sheets. Felt a little woozy after shower so less strong. Had to lie down and rest before attempting the stairs down to the living room couch. Not attempting to add any more exercises today. Reading everyone’s comments here on this forum so encouraging so I’m not stressing.

 

[Layla]

It is helpful to read comments from those that are healing right along with you, in real time, as well as those that have already recovered from joint replacement. We're happy you joined us!

Glad you're taking cues from your body! Thankfully doing so eased the swelling overnight.

Those first showers, while feeling wonderful can be exhausting. I always caution members to have someone within earshot. You pretty much need to get in, wash, and get out. Not too hot of a shower either. I recall feeling drained just as you mentioned after the first couple of showers. Take those rests and breaks as you need them, your body is recovering form the controlled trauma of major surgery, so give yourself the TLC you deserve and you'll have an easier recovery. Happy Friday!
@Focuspositively

 

[Focuspositively]

add 1 of each of the exercises to my LTKR (6 days post op) and 5 of each of the exercises to my RTKR (13 weeks post op).

I wanted to update you on my plan from a week ago: to my surprise, I found this too much so stopped doing them the day after. Since then, I’ve only done the walks, quad sets and ankle pumps. My legs are happier with less swelling and pain. I do get extra stretching doing the stairs to my bedroom at night and then down in the morning to the main level and getting up and down off the couch. It’s harder this time because I don’t have one good strong leg, having had the MUA on the TKR done in August. I see my Surgeon tomorrow for my 2 week post op. Do you have any suggestions as to what I could ask him while I’m there? His nurse will also remove the staples.

The next day, I’m scheduled for my first PT appointment at the hospital clinic. I’m nervous about it. I don’t want to repeat overworking my knees like I did after the first surgery. I may tell them I’m only available once a week to help overdoing it.

 

[Jockette]

Since then, I’ve only done the walks, quad sets and ankle pumps. My legs are happier with less swelling and pain. I do get extra stretching doing the stairs to my bedroom at night and then down in the morning to the main level and getting up and down off the couch.

This is excellent and all you need to be doing.

I may tell them I’m only available once a week to help overdoing it.

I think this is also excellent. Remember, it’s your recovery, so stay in charge and only do what you think you should. So many times, less is more!

 

[Layla]

My legs are happier with less swelling and pain.

Good for you taking cues from your body! Glad you're feeling better for it!

I see my Surgeon tomorrow for my 2 week post op. Do you have any suggestions as to what I could ask him while I’m there?

What does he want for Christmas?
Just kidding!

How about discussing your feelings on pain management and whether your expectations are realistic, or not.
How much pain / swelling is typical at two weeks post op.
Adjustments in meds as a topic, if it pertains.
Share your ROM progress. You can ask for goals, but theirs aren't always realistic...personal opinion.
What activities does he feel are safe, if you have any in mind, name them. What to avoid and for how long.
When you can drive.
When should you return.

The next day, I’m scheduled for my first PT appointment at the hospital clinic. I’m nervous about it. I don’t want to repeat overworking my knees like I did after the first surgery. I may tell them I’m only available once a week to help overdoing it

Remember who deals with the pain of a too aggressive session afterwards...not the PT, so have the courage to say STOP, or NO, whenever you are uncomfortable.

Best Wishes for your post op tomorrow. Please stop by and tell us all about it!

 

[Focuspositively]

Thank you again for all your encouragement and support.

He had recommended the use of a JAS brace at my 6 week post op for my first knee (right) to help get my ROM. I still have it. I didn’t find it helped me as I had shooting pains in my knee joint without stretching it at all. I think it was just the weight of it on the leg that caused the pains. I used it a few times - kept it on for the recommended 30 min, tightening it every 5 min but didn’t get to a flex that was anywhere near where I could flex my knee without the brace on. When he asks about whether I’ve used it again, I’ll tell him no as my knee swelled up 3 hours after the MUA and have been doing other types of PT instead. I don’t want to try using it again as I’m afraid of having the pain return.

 

[Focuspositively]

Dec 4: Had my 2 week postop with Surgeon and got the staples removed.
ROM 98 left knee 95 right knee measured by eyeball by Surgeon. He didn’t bring up my use of the JAS brace so I’m just returning it.

Dec 5: started physio. Physiotherapist set me up with weekly sessions. She agreed not to push me through pain. She gave me 6 exercises to do at home. I did them twice a day. ROM was 69 left and 78 right (active no pushing)

Dec 11 (3 weeks postop tomorrow) PT measured me after doing exercises on a recumbent bike and an exercise using straps sitting on a bench: 80 left and 88 right. PT doesn’t think I’ll increase my ROM on right knee much more. That’s the knee that the Surgeon performed the MUA on. I think she was feeling me out and didn’t want to raise my expectations. I told her that I just wanted it functional and that I believe I’ll get increased ROM yet as I’ve heard some have continued to get increased ROM even after 2 years. I’ve repeated that I won’t push exercises through pain and she’s agreed not to do that. I told her that I believe it’s the swelling that is preventing the increased ROM but she doesn’t feel that I have more than the usual amount of swelling than others at this timeframe and doesn’t feel that swelling prevents ROM. She feels patients have to work their knee through swelling. She didn’t give me extra exercises to do but asked me to raise my right foot to a higher step on one of the quad exercises and raise my left foot by a few inches to increase the stretch in my quads. She said walking wouldn’t increase my ROM rather it only increases my strength. I woke up due to pain around 5:40 am the next day and took Advil because I had already taken tylonol at 4:40 am and it wasn’t time for hydromorphone yet. Probably due to having had a physio session yesterday.

I’m almost tapered off my hydromorphone now (taking it 2 times a day today and tomorrow, then dropping down to once a day for a few days). I’m taking Tylenol every 4 hours and will add Advil once I’m finished the Hydromorphone unless I can get a renewal to my prescription of Celebrex from my Surgeon.

Question: My large toes are going painfully numb and cold from elevating with icing. is this a lack of circulation? I bought an electric heating pad to put on my feet while icing but my ankles and toes are reacting in pain to the heat. I’ve layered a blanket under the heating pad but it hasn’t helped. I had been using an hot water bottle but it was hard to hold it on my feet so switched to the heating pad. Anyone else who’s experienced this have any recommendations?

 

[Jockette]

My large toes are going painfully numb and cold from elevating with icing. is this a lack of circulation?

Do they do that when you elevate and don’t ice? Maybe try some ankle pumps while you’re icing, for circulation.

I disagree with your PT. Many members increase their ROM without doing any exercises. Walking around will give your knee the gentle mobility it needs and will increase ROM over time, as your swelling goes down and as you heal. I don’t believe you need 6 exercises, twice a day, at this early stage of recovery.

Regaining our ROM does not require forceful bending or painful exercises. That is counterproductive.

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.

 

[mendogal]

Please excuse my eye rolling and (sigh)...
Swelling absolutely interferes with range of motion! What an odd thing for a PT to disagree with.
And practicing proper heel to toe walking absolutely increases range of motion by gently promoting flexion and extension of ALL the muscles and tendons that support the knee.

Re your feet: some of our members have various reasons why the amount of icing we recommend is simply Too Much for them (cold intolerance, circulation issues, sensory issues).

If you can add more layers of fabric to help turn Cold to Cool, that's a good place to start. And try elevating not so high and/or for not as long.

You don't want numbness! @Focuspositively

 

[benne68]

I told her that I believe it’s the swelling that is preventing the increased ROM but she doesn’t feel that I have more than the usual amount of swelling than others at this timeframe and doesn’t feel that swelling prevents ROM. She feels patients have to work their knee through swelling.

She said walking wouldn’t increase my ROM rather it only increases my strength.

She needs to go back to school for some basic education if she doesn't understand that (1) inflammation blocks flexion, (2) different people swell differently, (3) forcing the bend increases the swelling, and (4) walking requires flexion, so it will naturally increase your bend!

Unfortunately, not all PTs are educated in joint recovery and think they can approach therapy the same way they would for a sport injury. It doesn't work.

Stand your ground on this. It is your body and your recovery -- not hers.

 

[Focuspositively]

Thank you @benne68 @mendogal @Jockette for all your advice and support. The exercises the PT gave me aren’t painful - just stretching. Do you still think six is still too many? I figured that if my knees were more painful or swollen after 24 hours I’d hold back and rest before trying them again. I didn’t react after doing them last week. I just reacted after doing the exercises at the physiotherapy clinic yesterday.

Before I was diagnosed with OA and found out that I needed TKRs, we started planning a 13 day European cruise. The plan is to leave 5 months post op. Do you think I’ll manage?

I was trying to find out whether people were still needing to use raised toilet seats or support bars to lower and get off a toilet seat at 5 months. I imagine I’ll run into a lot of washrooms without accommodations on the trip. Any advice?

 

[EalingGran]

Before I was diagnosed with OA and found out that I needed TKRs, we started planning a 13 day European cruise. The plan is to leave 5 months post op. Do you think I’ll manage?

I would say it is a bit borderline. Some people might be OK but others would find it too much. I managed a shortish flight and family trip at about 6 months. Before that I would have found managing the airport/ standing in queues/ hauling luggage etc a problem. Boats can also be unsteady although riverboats obviously don't rock like sea ships can- but you still have to be pretty steady on your feet to manage gangplanks. I also struggled with sleep after my PKR and it was several months before I could contemplate
enjoying sleeping in a different bed

 

[benne68]

Before I was diagnosed with OA and found out that I needed TKRs, we started planning a 13 day European cruise. The plan is to leave 5 months post op. Do you think I’ll manage?

I was trying to find out whether people were still needing to use raised toilet seats or support bars to lower and get off a toilet seat at 5 months. I imagine I’ll run into a lot of washrooms without accommodations on the trip. Any advice?

First, a reminder that we are all different and we all recover at different rates!

That said, I went on an African safari exactly six months after my left TKR. We had 14-hour flights each way, miles of walking through airports, and lots of climbing in and out of safari vehicles. My six-month old knee did okay, but I did experience some pain, stiffness and swelling. I needed NSAIDs at bedtime and had to ice and elevate many afternoons.

At five months post-op, you won't need to worry about raised toilet seats or support bars, but -- depending upon the amount of walking you do, you will still find that your knee will swell and stiffen and you may end up in the overdid it club. But, with a lot of pre-planning and taking advantage of every break you can, the trip is doable.

Here are some things that will help you get off to a better start:

* Pack light. One medium size bag you can check and a carry-on. Choose a bag with good, sturdy wheels.

* Pack your pain medications and an ice pack in your carry-on bag so you can use them on the plane. Also pack/carry a cane or walking stick so you have an assistive device if you need it.

* When booking your airline tickets, ask for handicapped assistance: a wheelchair and a porter to wheel you and your bag. You just sit. The porter will check your bag in and take you to the gate. You'll board first and can take the wheelchair all the way down the ramp if needed. The same when you disembark.

* Try to book an aisle seat so you can stretch out into the aisle if needed. (Even better, book a lie-flat business class seat so you can elevate your legs during the flight.)

* If possible, book a direct flight so you don't have to change planes. Otherwise you'll need wheelchair assistance at every airport where you must change to another airplane.


A big advantages of a cruise is that you don't have to worry about moving from hotel to hotel, the restaurant is only steps away and -- if you are having a tough day, you can decide to skip the excursion and spend the day onboard.

* Once you arrive onboard the ship, give yourself a chance to put your feet. If you are uncomfortable, ask for ice for your icebag.

* If you feel at all unsteady, carry your cane/walking stick. In addition to providing support, it is a signal to others to give you space -- especially helpful in crowded places!

 

[Jockette]

I was trying to find out whether people were still needing to use raised toilet seats or support bars to lower and get off a toilet seat at 5 months. I imagine I’ll run into a lot of washrooms without accommodations on the trip.

As said, we are all different. I had a major setback, at 4 months post op, due to spending a weekend at a friend’s house with a low toilet and nothing to help ne get up from it. In my case, it took a month to recover and start to improve again. But, also, in my case, it had been years since I lived with a low/regular height one. The combination was very bad for me.

 

[Layla]

Best Wishes for a safe trip and fantastic time. Please consider posting an update in the interest of others upon your return letting us know how navigating the airport and the flight was, also sharing any tips you found useful on the cruise.

Check with your doctor for approval before flying.
On the flight -
Wear compression socks to prevent a potential blood clot.
Get up and walk every 30 minutes or so.
Stay hydrated by drinking water and avoiding alcohol and coffee.
Stretch and flex your muscles often while seated. Do calf squeezes and ankle pumps
Check on a bulkhead seat if there are no available isle seats and first class is not an option.

Raised toilet seats - at five months post op, most no longer need a raised toilet seat. However there are always exceptions, so no shame if you're still feeling the need for a bit longer than that. If you can comfortably bend your knee, it's unlikely you'll need one. If you feel steady when sitting down and standing up, you probably don't need the extra height. If at that point you're still regaining strength and balance, you may need one. Fingers crossed, you're comfortable without it by the time you're ready to travel.

I hope you have a lovely holiday season and a blessed 2025!
@Focuspositively

 

[Focuspositively]

Would you recommend that I buy or rent a recumbent bike to help my recovery? I used it at physio for 5 minutes last week and loved it. I’m only going to Physio once a week. Will using one at home help me heal faster? I already have an elliptical but haven’t tried it yet as I heard that it’s too much for a TKR. I hated the upright bike I used at physio after my RTKR Aug 27, 2024. It caused me too much pain. I don’t want to do too much exercise to aggravate swelling and stiffness in my knees (LTKR Nov. 21,2024 and MUA on RTKR) but I want to be strong enough to be able to go on our European cruise in 19 weeks. I’m cautious about how much exercise to do because I did too much after my first knee and really appreciate what I’m learning from Bonesmart on not overdoing it.

 

[Focuspositively]

Is there a type of magnesium that you’d recommend to help with sleeping?

 

[Layla]

I use and prefer Glycinate as its gentle in the intestinal tract.
Magnesium Glycinate supports the following:
Bone health
Healthy blood sugar
Cardiovascular health
Muscle relaxation and nerves
Promotes healthy sleep (falling asleep and staying asleep)

An article on Magnesium -
https://bonesmart.org/forum/threads/magnesium-is-a-star.20301/

 

[mendogal]

Would you recommend that I buy or rent a recumbent bike to help my recovery? I used it at physio for 5 minutes last week and loved it. I’m only going to Physio once a week. Will using one at home help me heal faster? I already have an elliptical but haven’t tried it yet as I heard that it’s too much for a TKR. I hated the upright bike I used at physio after my RTKR Aug 27, 2024. It caused me too much pain. I don’t want to do too much exercise to aggravate swelling and stiffness in my knees (LTKR Nov. 21,2024 and MUA on RTKR) but I want to be strong enough to be able to go on our European cruise in 19 weeks. I’m cautious about how much exercise to do because I did too much after my first knee and really appreciate what I’m learning from Bonesmart on not overdoing it.

You can't "heal faster." On a cellular level, there's a standardized physiological process that can't be shortcut.
It can be fostered through rest, good nutrition (including ample protein divided throughout the day), and slow increases in activity that don't aggravate the tissues that need to heal.
It can be hampered by the opposite, especially by overworking the knee.
You can't safely focus on strengthening muscles until their tendons heal after 12 weeks.
The bike, in this early phase of recovery, is meant to be used sparingly and slowly to gently promote your range of motion.

 

[Focuspositively]

I love this feedback. I’m afraid of rushing in and overdoing it but need the reassurance that I’m doing enough. I was wiped yesterday which was the day after my second physio session, so I did my stretches only once yesterday. I usually do them twice a day. I had more pain than usual last night. Woke up every 4 hours in pain. Could be reacting to the physio or the fact that I’m tapering off the hydromorphone or combination thereof. I took a 400 mg Advil to help with the pain. Today, I feel better though. I’ve done one set of my stretches this morning. If I feel good this afternoon I’ll do the second set. I’ll put off the decision to pursue the bike another few weeks and see how I’m progressing. My surgeon renewed my prescription for Celebrex so that’ll help manage my pain and swelling now that I’m almost finished the hydromorphone. The magnesium will help also. Thx! @mendogal @Layla