Having knee replacement: how to prepare and questions about PT

@debbraw, @jillypooh : I read this ancient post/question while browsing for another subject. Anyway, for what it’s worth at this point in time: I had right TKR in Sept. 2018. Pretty decent recovery, nothing out of the ordinary, except it took months for me to get full extension. Flex was easy. PT basically forbade me from walking until leg was at 0 to prevent hip issues. Fast forward: I did lots of swimming, some recumbent biking, not too much walking for exercise. Suspended indoor pool membership end of May, transitioned to lots of walking. Hip bursitis! On and off. PT exercises did not help. Cortisone shot did, some. Mid July suddenly problems with gait. Could not take a full stride with my left (good!) leg. Legs measured, TKR leg is about 1/3” longer than the other. Not sure if it was like that before, but never had problems, so it MIGHT have been result of surgery. Working with orthotic inserts now, big improvement. I did have to do 2 weeks of specific exercises to make sure it’s not a muscle imbalance or tendon issue before being fitted for orthotics, but repeat measurement after those 2 weeks still showed the same leg length difference.

@artscaping : I’ll try to be concise. The hip bursitis (repeated episodes), as well as the gait problems were supposedly caused by differences in leg length. At least, that’s the only thing that was likely to produce those symptoms without any other factors. Whether the TKR was the cause of the length difference, or whether I have had uneven legs all my life, and it was simply aggravated by the surgery, nobody knows. The actual length difference is “only” 1/3”, but that can still cause a lot of trouble. My PT said that I may eventually get used to living with the discrepancy, but because I had already gone through 2 episodes of hip bursitis, as well that I have a decade long history of sciatica, he strongly advised custom orthotics to prevent further episodes. I use them when I’m very active and on my feet a lot, but still go barefoot or wear sandals part of the day. Or, for example, when I do yard work, where because of the terrain my legs would anyway never be level respective to each other, I don’t use the orthotics either.
Other than judicious use of the inserts, I do a 10 minute set of leg/back exercises to keep my sciatica in check (every day, 5 years running now), I walk 2 miles 5 to 6 days a week, and most days do 30 squats or 20 bridges, or both, or something similar, and do roughly 1 to 2 hours of yard work per day. Just turned 70 recently, and in generally decent shape (both health-wise, and weight-wise.... proud to be 37-29-37!!!!!) = Not my social security # 🙂...

@ellerbracke Thanks for the explanation. I might buy the TKR being the cause because with your physical fitness program you would have been in trouble a long time ago if there had been unevenness. I wonder if you can just “stretch” the good leg.

This is quite amazing. I also do sciatica prevention at least 5 days a week. My personal trainer showed me just two exercises the Pigeon and a twist. I owe her a lot. PT and surgeon never mentioned any preventive body work. And I am green with envy about your 2 miles walking. That used to be me before neuropathy. With weekly MFR I am back to 1 mile.

But my dear....you bring home the prize.....37-29-37. That is fantastic and an acknowledgement to your fitness choices and perhaps your food choices. Congratulations! Celebrate! Chris

I am supposed to wear them most of the time that I’m actively moving. They work with “closed” shoes, like running/walking shoes, I suppose with boots, later in the season. I’m cheating some, though. I wear the orthotics when I walk for exercise, of course, or when I know that I’ll be on my feet a lot, as in extended shopping runs. However, living in nice, steamy, hot SC, I still wear sandal-type shoes for short errands, for style, for vanity, for ventilation! I have already seen a marked improvement even with the limited use of the orthotic inserts, so as long as I don’t hurt, I’ll play it by ear how many hours each day I use them. One pair only, so far. Still waiting on the invoice! Perhaps I’ll spring for a second pair, depending on the financial pain. Until then I’ll move them around between different shoes as necessary.

I did not have any indication. I worked from home and did a lot of sitting but I don't know if that mattered. I stood up to take a break one day and my leg hurt as if I had stepped in a small hole and twisted it badly. I thought it would pass but ended up going the doc who sent me immediately to the ER for tests. There were actually two clots. One ran from. My ankle to just under my butt and the other from the back of my knee up further. I was in the hospital for week. I am on a blood thinner all the time

I love they electric ice pad I used. I was able to do recovery with no narcotics.