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?

@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 that’s interesting about the difference in leg lengths. I had heard a long time ago that pretty much everyone does have a small difference, I know I have. If I don’t have seamstresses to pin both legs of my pants they look uneven. I’m glad that since your difference was a problem that it’s been addressed, and hope that the orthotics help.

@anncgrl That’s unusual about a blood clot after so long I would think. I’m glad that it’s better now. I too am very happy with both of my TKRs. My only problem is not being able to really kneel.
JK

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@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

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@ellerbracke

@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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PS; How legs got measured…. PT did it, since he was suspicious that may be cause of gait problems. He had measured legs toward end of post-surgery rehab, but at that point I did not have full extension, so they came out even. Now they did not.

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@artscaping

@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

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Chris: before I got measured for orthotics, my PT had me do extensive stretching of the good leg, and scrunching of the TKR leg. Lots of reps. some involving holding those stretches for 30 seconds, 10 times, each, twice a day. No change, so that’s when he admitted that it can’t be exercised away.

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@ellerbracke Well that’s not the path we wanted. Reminds me of gals who didn’t meet the height requirement for the cabin attendant positions with airlines. They had to be able to reach the overhead compartments. They would stretch themselves in anticipation of the physical hoping to add some inches. Have a lovely evening. Chris

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@ellerbracke

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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@ellerbracke – That's very interesting. I know what you mean about summer in the South. I live in FL. It would hurt my feelings to wear closed shoes 24/7. However, as fall/winter approaches, it probably will get a little easier to wear them more. And I'm impressed that you've seen a difference already. Keep us posted as you move forward. OK?

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@anncgrl

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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@anncgrl – You are so fortunate that you went ahead and had the doctor check instead of thinking it would go away. Is your ankle swelling due to the blood clot?

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Start immediately! With a good PT. Ask around, and set up your schedule Before you have surgery. Have someone help you to bend your knee several times per day, starting day of surgery. (Passive motion). Otherwise it will stiffen up and it's tough to get flexion. To get your muscles working again, stand up, hold onto something sturdy, and move your leg forward, back, and to the side several times to exercise. No one told me this before my first surgery!

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@dawn_giacabazi

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

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What is an electric ice pad? Never heard of one!

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Start strengthening exercises NOW. Get a list from your doctor. Find a GOOD physical therapist now (ask around) and schedule for 6 or 7 days post surgery. My doctor insisted on me starting immediately, like that. I just got home yesterday from my second knee replacement. Glad I only have two legs! Moving is easier this time, because my therapist told me how to prepare. I'm still very swollen and can't bend much, but that will pass. Good luck with everything. A good therapist is essential to recovery.

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@zackat google the words " ice therapy machine knee " Tip – if you have the cooler type, use frozen water bottles instead of ice cubes to keep the circulating water cold.

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Hi all – I'm having a revision to a TKR what was done in July 2018. Dh will be working from home during the early part of my recovery. During my original recovery, I remember having in-home PT for just a few weeks. If I can't drive for 6 weeks, how am I going to get to outpatient PT? My area centers aren't open late enough for dh to get home in time to drive me. All area friends work. I have a stationary bike and am good about doing exercises at home…

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@babette

Hi all – I'm having a revision to a TKR what was done in July 2018. Dh will be working from home during the early part of my recovery. During my original recovery, I remember having in-home PT for just a few weeks. If I can't drive for 6 weeks, how am I going to get to outpatient PT? My area centers aren't open late enough for dh to get home in time to drive me. All area friends work. I have a stationary bike and am good about doing exercises at home…

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I lived on Uber and Lyft. Choose a place close by, which was relatively inexpensive to get there. Hated the feeling of having depend on friends and family all the time. Give me some sense of independence. Couldn’t get in the backseat though – not enough leg room..

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Yes, I thought of Uber and Lyft, but I have a fear of my outside stairs – about 10. I know this is mostly psychological as I've never had a fall or slip on the stairs. The only time the fear is legitimate is when they are icy. And we're headed into that season!

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@babette

Hi all – I'm having a revision to a TKR what was done in July 2018. Dh will be working from home during the early part of my recovery. During my original recovery, I remember having in-home PT for just a few weeks. If I can't drive for 6 weeks, how am I going to get to outpatient PT? My area centers aren't open late enough for dh to get home in time to drive me. All area friends work. I have a stationary bike and am good about doing exercises at home…

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@babette If you are on Medicare and can’t get out you shouldn’t have a problem. I know I had in-house PT for about a month and then it was my choice to drop it because I didn’t want to be “home bound” anymore.
JK

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