Will I have full range of motion after RTKR?

[kneesrus]

Good question Kneeper. Actually, the OS should be the first to realize it is going to take longer to obtain functional ROM of the knee joint. This population may achieve 105 to 115degs of flexion and 5 to 7deg of extension. The PT does need to take a good history on the knee and tailor the treatment plan to be realistic. This is were experience pays off and the PT does not get too aggressive and make the tissues inflamed. There are a few manual mobilization techniques that help achieve ROM. The manual techniques need to be perform no more than twice a week. More is not better.
David

 

[2boxers]

@kneesrus I will see the PT sometime after my pre-op physical and before my surgery. This is all so new to me, what is considered normal flexion and extension? What are the manual mobilization techniques that will help achieve ROM?
Thanks so much for all your help.

 

[tiredwife]

@2boxers I don't think there is really isn't anything that says a person should be at this ROM at this time. Scanning through the threads you will see that everyone is heals at their own pace. From what I understand the closer to 0 for extension the more stability. The flex is needed to be able to walk stairs normally. At 6 week my husband's extension was 3 and his flex was 117 and he is doing really well. There are people that don't hit 110 for months. It really varies. They should give you an exercise list at the hospital, gentle exercises that will help. I think ROM for good knee are around 0 extension and 135 flex, but I'm not sure. I'm sure someone will come along that can answer you better.

 

[kneesrus]

"Normal ROM" would be what Tiredwife posted, 0deg extension and 135deg flexion. As we age those numbers change even with a healthy knee. If you are having difficulty getting your knee back to a functional ROM, your therapist can perform joint mobilization to the knee. This is a gentle technique to stretch the tissues that surround the knee joint. They are called: anterior glide and posterior glide of the tibia. Now this technique is again, more is not better. I may do it just once a week on a patient.
Another mobilization technique is to move the knee cap side to side. You don't want the knee cap to get stuck in the joint.
The most success I have with TKRs, is to encourage the patient to re-engage in life. Life is therapy. Just keep things in moderation.
Best of luck,
David

 

[Josephine]

When I asked the OS ( that I was going to use as my surgeon ) if he could straighten my leg out during surgery, he said he could do it but I would have to give up some stability.

I have never heard of reducing stability in order to achieve full ROM

Well it isn't done deliberately but if he adjusts things to be less tight so you can get a fully straight leg, then in normal usage, at some positions, it's going to be slack. That's what he meant. These are things you cannot predict and all in all, it really depends upon how stiff your knee is now and, more importantly, why

what is considered normal flexion and extension?

You can see it all explained in this article ROM (range of motion) information

 

[Daystar]

@2boxers I have the same problem, only I haven't been able to straighten my knee for around 10 years. I can no longer stand up straight when I walk because of this, so I am expecting it will be a lot of work to get back to anything normal. My OS told me yesterday that he will have my leg at 0 degrees on the table, which I guess is worth something. But the backs of my legs have always been very tight, even when I was a kid. I have never been able to touch my toes. I'm hoping for at least an improvement.

 

[kneeper]

Be sure to mention that to your PT.

 

[NetballKnees]

@2boxers ... thought I would come and say 'hi' as we share a surgery date. I am having my second TKR - this time on my right knee. It has been 10 months since my LTKR and my ROM is only 80-85 at best, but I do have full extension. Some reason, or most if I am honest I guess, would be because I have such big legs. I am obese, but carry all my weight from the hips down. I have small boobs and a waist and when I lose weight, my waist is the first thing that gets smaller. So I guess my calves must be touching my hamstrings as well and then a full-stop!!!.

I think you will maybe need a bit more patience than someone who hasn't had a bent knee for so long, but I believe life will be so much better for you. One thing I do know is that with the LTKR while it pains occasionally (mainly behind the knee and medial cruciate) and is still swollen and numb, it is so much stronger. Even if the right follows exactly the same path with the ROM, at least, hopefully I will eventually be able to walk without a limp for the first time in ages.

I will talk to you again before our surgery date, but wish you all the best with pre-op preparations. Hugs .. Ellen

 

[Florida 1]

The only thing I can really add to this is how I'm living now, 1 1/2 years later. I don't know my numbers, but I do know that I don't have that awful pain I had prior to my surgeries. Some days my knees get swollen if I'm on my feet for long stretches without much movement or sitting down. It's a bit noticeable, but doesn't affect my movement, etc.

I can't really say what I can and can't do because I'm finding that a lot of what I thought I can't do was carried over from before my TKRs. In essence, a lot of what I'm limited by is actually mental, not physical. I was helping my brother move a slightly heavy dresser. The way that I was holding it was near the bottom. When he started to set it down, I yelled "NO! I can't squat....." as I squatted almost to the floor and set it down as gently as could be.

I'm back to working in the construction industry which I never thought I'd be able to again. I rarely even think about my knees as I go about my daily activities unless I have to get on the floor. I still can't/don't like to kneel. I haven't decided if it actually hurts or the feeling of it just grosses me out. That is the only time that I can think of that I'm cognizant of my TKR. Otherwise, I'm moving like I did more than 10 years ago.

From what I've learned from my own experience, I wouldn't stress so much about the numbers. I had some extension problems with RTKR that I didn't with LTKR, though my ROM was better. I did aqua therapy (which felt very nice on those tissues that felt so abused) and out patient after the second to improve. In hindsight, I think it was the simple stretching exercises that I learned to do at home that truly made the difference.

Best of luck to you!

 

[2boxers]

@NetballKnees… Glad to know I have a surgery date buddy Although I understand that everyone is different, it will be reassuring to be able to talk to someone who is at the same point of recovery as I am. Just as you, I am hopeful that I will eventually lose this limp that I have, not to mention the pain I get behind the knee. Because of the pain behind my knee, I can only sleep on my back if I elevate my knee with several pillows, and because of my limp I have developed bursitis in my right hip. It has come to the point that if I go for a 30 -40 minute drive into town I am so terribly stiff when I try to get out of the car. So, it is time to do this, and I am so glad to have this forum to come to for advice and encouragement.

@Florida 1…Wow, you are encouraging…going back to the construction industry and squatting almost to the floor!! I hope I will have as good a result as you. While I am hopeful for an improved ROM and extension, I know I may never get the perfect numbers since my knee has been bent for so long. Although at this point anything is an improvement, and as you said, the main thing is no more pain.

 

[2boxers]

Well, 4 more days till my RTKR. I have been giving our house a very thorough house cleaning, done the laundry and ironing, have stocked up the freezer with home made meals, plus cleaned the goat house & the chicken coop. Needless to say my knee is really bothering me. I will be so glad to have this over and done with and eventually be able to do my normal daily chores without being in pain.

I am, however, a bit concerned about the nausea associated with pain meds. My OS will be prescribing Norco 10 mg 1-2 every 4 hours, Celebrex 200 mg 1x daily, and Vistaril 25 mg 1-2 every 4 -6 hours. The Norco does make me very nauseous, so I was wondering if anyone else has had the Vistaril, and does it work well to prevent this?

Thanks

 

[bottomshollow]

I can see, @2boxers, that you've got all your ducks in a row for this surgery. I can't tell you a thing about Vistaril, but I'm sure there's someone who will come along and give you the lowdown. Only thing I've ever had was Phenergan when morphine made me nauseous---so no more morphine for me.

If Norco makes you nauseous, can't you get your OS to prescribe something else? Just a thought. But I'm sure you'll get what you need for this.

In case I should not get back to you before Thursday for a very successful surgery.

Take care and keep us posted. We care.

 

[tiredwife]

@2boxers I know several people have nausea issues with narcotics, they say it helps to eat something before you take the meds, and there are anti nausea meds that do work to help stop the nausea. My hubby is lucky that it doesn't bother him. I believe some use ginger to help.

 

[NetballKnees]

@2boxers I get very mixed up with time differences, so I hope your op is tomorrow and not today. Just wanted to wish you all the very best for a problem free op and problem free recovery. I will be thinking of you and the others having their knee op on the 21st.
Hugs ... Ellen

 

[2boxers]

@NetballKnees, thank you, wishing you the best also. We can do this!

 

[Jozilla]

Good luck! Hope all goes well and you have an uneventful recovery! Post when you can!

 

[kneesrus]

Hi Kneeper, you are exactly correct, PT's have to realize the time element when trying to regain ROM. This does not mean you have to be more aggressive. They have to be patient and perform mobilization techniques and explain to the patient they will get there, but it is going to take time.
I have been using a new technique to achieve full extension call Dry Needling. You can google it and learn more about the technique. It is painless and I am getting very good results on knees that are way over due for a new knee. Ask your PT if they are certified to perform the technique.
David