Having knee replacement: how to prepare and questions about PT

Posted by ronnie3716 @ronnie3716, May 1, 2016

I’m having knee replacement (L) on June 20th.
Any suggestions on how to get ready for it?
How soon does physical therapy start after one gets home?

I want to echo what others have said—5 weeks is early and many things seem positive for you like a great ROM! I stopped PT at about 10 weeks when my OS gave me the green light to return to Pilates. I meet with my instructor (who in a prior life was a PT but became frustrated with the system—too many patients, too little time, and a growing belief she wasn’t able to truly help people) twice a week and for those 50 minute sessions I have her undivided attention. Every session is tailored to my knee on that day. I was at 107/0 when I resumed Pilates and now I’m at about 112/0. Extension never an issue but flexion coming back slowly but steadily. I no longer use a cane but if I’m on my feet a lot, and knee stiffens, I fall back into pre-surgery “limp.” I use Exerstrider poles and walk on our high school track so I can focus on my gait. Hopefully this gives you and others a chuckle since you mention a 5K: about three weeks ago it took my 9.5 minutes to walk a 1/4 mile lap. Today it was ONLY 9 minutes. But I do not have knee pain and at almost 15 weeks post-op I am grateful that I’ve experienced steady gains in flexion, strength, and a return to walking, biking (stationary bike), and swimming (my preferred sport). Keep fighting the good fight and be as patient as possible with your new knee!

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@coffeecraz

5 weeks so far seems like eternity, especially when used to being at work – need that reminder that it's still early in recovery, and I have more improvements to see. I'm talking with the physical therapist next week, I need to be able to handle the pain on the stretches, and I need to know and be able to trust they will stop when I can't take more.
The cane – for balance, never had perfect balance – I use a cane, or need one before the TKR, but at three weeks transitioned from walker to cane (re: balance), so far PT watches me walk without and says keep it. Focused more on gait at the last session, mechanics of walking – it definitely did not come back naturally so far. Wish there was a video that showed the ABC's of walking. I've been going to the local track where there is a flat, straight area with railing to practice and focus on gait – before doing slow laps.

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Oh @coffeecraz – It IS hard. I can just feel what you are going through. Trust that everything you are doing is having a positive impact on your recovery. Keep it up. Will you let me know what the surgeon says when you see him/her in August?

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@coffeecraz You are putting a lot of pressure on yourself, but sometimes that strong motivation is the key to success. Just be very careful that you don’t overdo it. Overdoing it could set you back rather than move you forward.
That’s good that you are seeing the therapist, maybe he or she can advise you if you are expecting more than can be accomplished.
JK

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Just saw this. I hope you started PT as soon as you got home from hospital. I found that I wasn't given enough info, despite the class and the booklet they gave me!

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The better shape you are in BEFORE the operation, the easier will be your recovery. Get a list or picture of the post-op exercises and do as many of them as you possibly can. Naturally you should not hurt yourself or torture yourself, just do everything you gently can. This, and have a good attitude. Make up your mind that you will recover quickly, it helps.

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@nightwatchrenband

The better shape you are in BEFORE the operation, the easier will be your recovery. Get a list or picture of the post-op exercises and do as many of them as you possibly can. Naturally you should not hurt yourself or torture yourself, just do everything you gently can. This, and have a good attitude. Make up your mind that you will recover quickly, it helps.

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@nightwatchrenband I agree totally. I worked hard at getting in shape beforehand and the recovery was much easier. By the time i had my TKR I was actually in considerably less pain because I had strengthened the supporting muscles.
JK

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Totally agree with @contentandwell & @nightwatchrenband – You will be well rewarded for all of the effort you put into "pre-hab" as my orthopedic surgeon calls it!

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I had a total right knee replacement several years ago with no trouble during recovery or physical therapy. I followed the instructions of my doctor and e rested a great deal in the beginning especially. The little machine with the ice in it (don't know the name) was a huge blessing, Physical therapy was not a cakewalk. but I got through it and I don't have any residual pains in my knee to date. I did, however, develop a rather large blood clot in that leg about a year later…maybe a little bit less…and have had some problems with that with ankle swelling on a daily basis, several follow-ups to check for another clot based on symptms. I have read that blood clots can be one side effect of knee surgery. I have not had that confirmed. Today my knee is as agile and useful as my left knee! There is no way I could have functioned with the knee as it was prior to surgery. The surgery has been a blessing.

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@debbraw

Hi @jillypooh – Welcome to Connect! There are a lot of great people here who are helpful and caring in sharing their experience. I'm going to say that 3 or 4 months is still a little early in the healing process. I think you will continue to gain extension and flexion as you exercise. For me, I continued to improve for months. I hope you will too.

I agree with @contentandwell JK that I haven't heard of that particular outcome in a TKR, however, there was a discussion about changes is leg length due to a hip replacement. You might check out this link:
https://connect.mayoclinic.org/discussion/does-any-one-know-if-you-have-a-hip-replacement-1-leg/?pg=1#comment-31704
As you will see there there is an NIH study mentioned that addresses the issue of "limb discrepancy:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4094096/
I'm curious about how you determined that there was a difference in length? I know when I had my TKR and was working on leg extension it would have been really painful to try to measure my leg length. Also curious as to what your physical therapist says? Does he/she have any advice? Please keep us posted as to what the doctor says when you get in touch with him. Wishing you the best.

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@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.

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Wow @anncgrl – sounds like a textbook recovery except for that blood clot. It must have been so discouraging to get that news. I just had a knee replacement it January and like you, I didn't have any serious recovery problems, but that is scary about the blood clot developing one year post op. I'm curious about what caused you to have the doctor look at it and discover the bloodclot. Was it the swelling? Were there any outside factors like a long plane trip or anything?

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@ellerbracke

@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.

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Wow @ellerbracke – That is great information on difference in leg length. Thanks for sharing. It would not have occurred to me to have that checked. It was good that they did that kind of thorough assessment for orthotics. I don't have any experience with that. Can you wear them with any shoes or do you have to have one for each pair?

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@debbraw

Wow @ellerbracke – That is great information on difference in leg length. Thanks for sharing. It would not have occurred to me to have that checked. It was good that they did that kind of thorough assessment for orthotics. I don't have any experience with that. Can you wear them with any shoes or do you have to have one for each pair?

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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.

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@debbraw

Wow @anncgrl – sounds like a textbook recovery except for that blood clot. It must have been so discouraging to get that news. I just had a knee replacement it January and like you, I didn't have any serious recovery problems, but that is scary about the blood clot developing one year post op. I'm curious about what caused you to have the doctor look at it and discover the bloodclot. Was it the swelling? Were there any outside factors like a long plane trip or anything?

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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

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@ellerbracke

@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.

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@ellerbracke Good afternoon……I am interested in your finding that the TKR knee has caused an uneven gait and pain in the left leg. That is very concerning. I have had bone spurs and arthritis in the right "good" leg. Tried the cortisone injections and it took a few weeks for them to work. You can only have 1 or 2 per year so I decided to just keep walking and enduring. Sometimes you just reach a point when enough is enough. What have you done in addition to orthotics? What do you do in the summer with sandals? Does heat or cold help? Why is the TKR leg longer? How did you measure it? Any clue?

As I relate to this, I also realize that my reverse shoulder has left me with a right arm that is 2" longer than the good one. My surgeon told me to expect that and so I never gave it much thought. It is a problem because I cannot eat with my right hand. Nor can I do anything that requires coordination. You should see my push ups…..LOL. The one positive outcome. I became ambidextrous for most tasks so I can use the non-surgical arm.

Please share with me as your story evolves. And be content and at peace today. Chris

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@artscaping

@ellerbracke Good afternoon……I am interested in your finding that the TKR knee has caused an uneven gait and pain in the left leg. That is very concerning. I have had bone spurs and arthritis in the right "good" leg. Tried the cortisone injections and it took a few weeks for them to work. You can only have 1 or 2 per year so I decided to just keep walking and enduring. Sometimes you just reach a point when enough is enough. What have you done in addition to orthotics? What do you do in the summer with sandals? Does heat or cold help? Why is the TKR leg longer? How did you measure it? Any clue?

As I relate to this, I also realize that my reverse shoulder has left me with a right arm that is 2" longer than the good one. My surgeon told me to expect that and so I never gave it much thought. It is a problem because I cannot eat with my right hand. Nor can I do anything that requires coordination. You should see my push ups…..LOL. The one positive outcome. I became ambidextrous for most tasks so I can use the non-surgical arm.

Please share with me as your story evolves. And be content and at peace today. Chris

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@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 # 🙂…

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