Limited ROM after total knee replacement.

Posted by Ozziegee @ozziegee, Jul 7, 2017

Hi, I seem to be stuck around 90 degree ROM following tkr surgery 20 weeks ago. I went to PT for two months and have been doing post op stretches and exercises daily. I’ve had constant swelling ever since the surgery and recovery has been very slow because of it. I’ve also had several prior surgeries on the same knee so figure scar tissue is at least a big part of the problem. I was wondering what options are available to me without doing a MUA? Any thoughts or suggestions?

I see you mentioned stretches. My PT tells me not to do stretches and bending on the same day. And to get the angle it takes bending exercises. I use a squat where I hold on to a bar or something and keep shoulders above knees and point my butt out as far as I can. I just got to One 10 today and I was 1053 days ago. I was 90 about two weeks ago. Surgery was five weeks ago. I think fear of bending my knee holds me back on the bending. PT tells me not to worry about it, but my brain imagines the mechanical part breaking out of my bone. I know that won’t happen but I have to learn to trust it.

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@softwaredev

I see you mentioned stretches. My PT tells me not to do stretches and bending on the same day. And to get the angle it takes bending exercises. I use a squat where I hold on to a bar or something and keep shoulders above knees and point my butt out as far as I can. I just got to One 10 today and I was 1053 days ago. I was 90 about two weeks ago. Surgery was five weeks ago. I think fear of bending my knee holds me back on the bending. PT tells me not to worry about it, but my brain imagines the mechanical part breaking out of my bone. I know that won’t happen but I have to learn to trust it.

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Hi @softwaredev – I totally understand your fear of bending. I had a TKR in April 2017 and at 5 weeks, I don't think I could have bent like that. By 12 weeks I had total extension and 125 degrees bending. Was your surgery 5 weeks ago a TKR? It sounds like you are doing well!

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@softwaredev

I see you mentioned stretches. My PT tells me not to do stretches and bending on the same day. And to get the angle it takes bending exercises. I use a squat where I hold on to a bar or something and keep shoulders above knees and point my butt out as far as I can. I just got to One 10 today and I was 1053 days ago. I was 90 about two weeks ago. Surgery was five weeks ago. I think fear of bending my knee holds me back on the bending. PT tells me not to worry about it, but my brain imagines the mechanical part breaking out of my bone. I know that won’t happen but I have to learn to trust it.

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@softwaredev How is the knee coming along? Have you gotten beyond 90 in your flexes?
My ortho was very insistent on moving forward slowly, without aggressive PT, and it worked pretty well for me overall, although I did not get to 120° flex, the minimum desired.
Have you gotten over the fear that the new knee will break out of your bones?
JK

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I am a 67 yr old male and had right TKR surgery on 10/18/18, with P/T 2x per week through mid January 2019 (with daily exercises at home which continue). My problem is that the knee remains stiff with limited ROM (90 degees) and unable to straighten my leg, (approx. 11-14 degrees from straight). Occasionally I have some discomfort, but it's mostly the result of the stiffness, so pain is not the primary issue…stiffness and limited ROM is the problem. The stiffness has been since surgery and the ROM seems to have plateaued at about 6 weeks post op. Since than it's like the movie Groundhog Day…every day the knee is the same stiffness (or a little more) as the day before no matter what I do. Because of this, I had MUA on 12/11/18, which really did not help at all, other than to have pain/soreness for a week or so afterwards, and followed this with 2 weeks of aggressive P/T. My surgeon said he was able to get full ROM of the knee under anesthesia. However, when I'm not under, there has been no change in ROM. About two weeks ago I saw the surgeon and he said it could be arthrofibrosis which may require additional surgery, but he wanted me to keep exercising and working the knee for a while and he didn't yet want to consider the additional surgery. I've kept up the exercises, in addition to using a stationary bike and treadmill at the gym several times per week. Nothing I do seems to lessen the stiffness. On the contrary, everything I do seems to result is stiffness, stiffness and more stiffness. Even icing the knee. I plan to keep on exercising the knee, but it sure does get angry at me after working it out. It feels like something is wrapped around my knee joint tightly so that I can only bend or straighten it so far. Reading the various posts here makes me realize there are many people with the same or similar problem. I've also read (and heard from some others) that they do something accidentally that makes the knee pop and get freed up. Any suggestions on attacking this problem? I really don't want more surgery on the same knee, but I also would like more, not necessarily 100% full, ROM. Also, surgery to remove scar tissue/fibroids can be arthroscopically or open the knee up. The latter really scares me, but I can't go on forever like this. In addition, my left knee is also bone on bone and needs to be replaced, but after this experience, I can't even think about that. I've read that because I had this experience with one knee does not necessarily mean that the other knee will have the same problems post op. Any helpful input would be appreciated.

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I went to PT twice after my first replacement. I quit because they were putting heat on the knee and they hand you off to kids that don’t know what they are doing.Candidly,I think there is a lot of rip-off in PT because of the exponential increase in business from baby boomers. What I did was to go back to my yoga practice and stationary bike,seat high and spin…no pressure. It took me a year to get over my surgery. My wife had surgery and was back to work in a week…men are wimps! I have had two knee replacements and a hip at Mayo and no prescriptions was giving for PT. My wife has two hips and two knees and no PT prescribed. Mayo did give us a list of illustrated exercises and said most important just move. Be compassionate with yourself, a knee replacement is a tough operation. I also recommend do not let your doctor operate on you again! If you can get into Mayo go! Mayo doctors are paid on salary,they have no need or incentive to operate. My first problem knee I went to two orthropedic doctors in my home town, Both told me,we need to operate ASAP! I went to Mayo and Dr. Pagno told me,you need to do nothing immediately and delay until you knew it was absolutely needed. I push the operation out 5 more years…this is important because the prosthesis may fail with time so you want to die before that happens. It doesn’t cost anymore to go to Mayo,just travel and lodging.If you go to their site, Mayo Rochester, Minnesota there is information on their site. My first knee doesn’t completely straight out but I don’t how it compares to yours.I can do everything I want to do,except run; but I do Zumba 5 times a week…I’m 72. I know each person’s genetics and situation is different. I suggest you find the PBS film on Mayo to have a better understanding of why it’s the worlds greatest medical facility.I also suggest you go to U.S. News and World for a list of hospitals ranked by excellency in a variety fields.You may find a top rank orthopedic hospital close to you.You can also research top doctors by speciality. Unfortunately most doctors are motivated by money…it’s the human condition and much money is being made by orthopedic doctors…aging of baby boomers.My opinion is you are overworking your knee…I would quit PT and use the stationary bike and just move as best you can.Most important be compassionate with your self…healing takes time.You can’t push through to speed it up! Elevate your legs…legs up the wall ( check net, YouTube on how),ice and use Tylenol for pain…I’m so sorry for the pain and suffering you are going through. Again be compassionate with your self… that saying no pain no gain,that doesn’t apply to knee replacement…time, patience and understanding that you will eventually get better is what it takes. Peace!

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@billyro7

I am a 67 yr old male and had right TKR surgery on 10/18/18, with P/T 2x per week through mid January 2019 (with daily exercises at home which continue). My problem is that the knee remains stiff with limited ROM (90 degees) and unable to straighten my leg, (approx. 11-14 degrees from straight). Occasionally I have some discomfort, but it's mostly the result of the stiffness, so pain is not the primary issue…stiffness and limited ROM is the problem. The stiffness has been since surgery and the ROM seems to have plateaued at about 6 weeks post op. Since than it's like the movie Groundhog Day…every day the knee is the same stiffness (or a little more) as the day before no matter what I do. Because of this, I had MUA on 12/11/18, which really did not help at all, other than to have pain/soreness for a week or so afterwards, and followed this with 2 weeks of aggressive P/T. My surgeon said he was able to get full ROM of the knee under anesthesia. However, when I'm not under, there has been no change in ROM. About two weeks ago I saw the surgeon and he said it could be arthrofibrosis which may require additional surgery, but he wanted me to keep exercising and working the knee for a while and he didn't yet want to consider the additional surgery. I've kept up the exercises, in addition to using a stationary bike and treadmill at the gym several times per week. Nothing I do seems to lessen the stiffness. On the contrary, everything I do seems to result is stiffness, stiffness and more stiffness. Even icing the knee. I plan to keep on exercising the knee, but it sure does get angry at me after working it out. It feels like something is wrapped around my knee joint tightly so that I can only bend or straighten it so far. Reading the various posts here makes me realize there are many people with the same or similar problem. I've also read (and heard from some others) that they do something accidentally that makes the knee pop and get freed up. Any suggestions on attacking this problem? I really don't want more surgery on the same knee, but I also would like more, not necessarily 100% full, ROM. Also, surgery to remove scar tissue/fibroids can be arthroscopically or open the knee up. The latter really scares me, but I can't go on forever like this. In addition, my left knee is also bone on bone and needs to be replaced, but after this experience, I can't even think about that. I've read that because I had this experience with one knee does not necessarily mean that the other knee will have the same problems post op. Any helpful input would be appreciated.

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@billyro7 Hi Billy. Your knee sounds painful. I had a TKR in October 2017, my second, and was in a lot of pain initially but the pain lifted at around 6 weeks.
The stationary bike is one of the two exercises my ortho recommends most highly. The other is water jogging – minimal impact. According to him, the treadmill does not help with knees, although it is good cardio.

My flex is not as good as I would like it so I may have a very surgery, lysis, to improve it. If that is what your doctor is suggesting it is not major, it is OP and pretty simple I believe. Most doctors say you can improve your ROM for up to at least a year so if you keep at it you do have plenty of time still. It is important to keep at it though.
Some physical therapists are much better than others. I had a great one for in-home PT while I was home-bound. Then I went to outpatient PT and had one I had used in the past for other problems but he did not do very well with PT for my knee. I only went to him for a short time. If one is not helping you should change, get some recommendations from other people who have had TKRs.

My doctor, like the doctors at Mayo and at probably all major medical centers, works for the hospital, he is not in private practice, so I don't think he would recommend it for personal monetary gain, although I am sure doctors are expected to bring in a certain amount of revenue no matter what hospital they are attached to. It simply is not ethical to do that, whether the doctor is in private practice or part of a hospital staff though.
The suggestion to find a hospital close to you that is highly rated for orthopedics is a good one. I live about 55 miles from Boston so I have a number of excellent hospitals to choose from.
Keep us up to date on your progress, I hope it will improve.
JK

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@jenerprise Good info. My second knee is not here but I have no idea what knee my first one was. I should find that out.
JK

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This isn’t the absolute total of all knee replacement recalls. After every knee replacement, the hospital staff will attach a number of stickers containing the serial number, size and other details of the implants used in the surgery, to your discharge summary. You can thus verify it. The FDA keeps track of all recalls. You can write to them and tell them you have concerns and would like any and all data (recall history etc of the company and the implants used ) and they will will reply with the answers or where to look for the info. Dice@fda.hhs.gov

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@contentandwell

@billyro7 Hi Billy. Your knee sounds painful. I had a TKR in October 2017, my second, and was in a lot of pain initially but the pain lifted at around 6 weeks.
The stationary bike is one of the two exercises my ortho recommends most highly. The other is water jogging – minimal impact. According to him, the treadmill does not help with knees, although it is good cardio.

My flex is not as good as I would like it so I may have a very surgery, lysis, to improve it. If that is what your doctor is suggesting it is not major, it is OP and pretty simple I believe. Most doctors say you can improve your ROM for up to at least a year so if you keep at it you do have plenty of time still. It is important to keep at it though.
Some physical therapists are much better than others. I had a great one for in-home PT while I was home-bound. Then I went to outpatient PT and had one I had used in the past for other problems but he did not do very well with PT for my knee. I only went to him for a short time. If one is not helping you should change, get some recommendations from other people who have had TKRs.

My doctor, like the doctors at Mayo and at probably all major medical centers, works for the hospital, he is not in private practice, so I don't think he would recommend it for personal monetary gain, although I am sure doctors are expected to bring in a certain amount of revenue no matter what hospital they are attached to. It simply is not ethical to do that, whether the doctor is in private practice or part of a hospital staff though.
The suggestion to find a hospital close to you that is highly rated for orthopedics is a good one. I live about 55 miles from Boston so I have a number of excellent hospitals to choose from.
Keep us up to date on your progress, I hope it will improve.
JK

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@contentandwell : You have mentioned before that you were not happy with one of your PT people. I am not sure what “most” physical therapists do/are supposed to do for TKR rehab. I had worked with my PT before for other issues, and basically he told me what exercises to do, adapting some in order not to trigger my Sciatica. I did the exercises, reported back to him, got another set, and so on. I think I saw him roughly every 7 to 10 days for about 10 weeks, and that was that. Only twice did he very gently stretch and bend my knee to ascertain ROM. Some posts have mentioned doing PT with supervision 2 to 3 times a week, for quite some time. What would be the advantage of that? Do some therapists provide hands-on help with the knee? Thankfully, my knee rehab is done, although I’m still doing daily stretches and strength excercises. I am also currently “enjoying” some more PT exercises to take care of some tendonitis/bursitis in my hip. No big deal, though.

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@ellerbracke

@contentandwell : You have mentioned before that you were not happy with one of your PT people. I am not sure what “most” physical therapists do/are supposed to do for TKR rehab. I had worked with my PT before for other issues, and basically he told me what exercises to do, adapting some in order not to trigger my Sciatica. I did the exercises, reported back to him, got another set, and so on. I think I saw him roughly every 7 to 10 days for about 10 weeks, and that was that. Only twice did he very gently stretch and bend my knee to ascertain ROM. Some posts have mentioned doing PT with supervision 2 to 3 times a week, for quite some time. What would be the advantage of that? Do some therapists provide hands-on help with the knee? Thankfully, my knee rehab is done, although I’m still doing daily stretches and strength excercises. I am also currently “enjoying” some more PT exercises to take care of some tendonitis/bursitis in my hip. No big deal, though.

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@ellerbracke My ortho doctor has quite different ideas than most, and his success rate is huge. He advises "gentle PT". The in-home physical therapist had worked with his patients before and seen the successes so was happy to abide by that. The outpatient PT had no idea what to do with me, he was pretty much useless.
JK

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@contentandwell

@ellerbracke My ortho doctor has quite different ideas than most, and his success rate is huge. He advises "gentle PT". The in-home physical therapist had worked with his patients before and seen the successes so was happy to abide by that. The outpatient PT had no idea what to do with me, he was pretty much useless.
JK

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Well, retroactively (in case there’s knee # 2 in the future), that is basically what I was asking regarding PT. My therapist instructed – meaning showed me exactly what to do, so I would do it correctly, – and then left it up to me how hard and how often I can/want to do it. Sounds close to “gentle” PT?

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@ellerbracke

@contentandwell : You have mentioned before that you were not happy with one of your PT people. I am not sure what “most” physical therapists do/are supposed to do for TKR rehab. I had worked with my PT before for other issues, and basically he told me what exercises to do, adapting some in order not to trigger my Sciatica. I did the exercises, reported back to him, got another set, and so on. I think I saw him roughly every 7 to 10 days for about 10 weeks, and that was that. Only twice did he very gently stretch and bend my knee to ascertain ROM. Some posts have mentioned doing PT with supervision 2 to 3 times a week, for quite some time. What would be the advantage of that? Do some therapists provide hands-on help with the knee? Thankfully, my knee rehab is done, although I’m still doing daily stretches and strength excercises. I am also currently “enjoying” some more PT exercises to take care of some tendonitis/bursitis in my hip. No big deal, though.

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@ellerbracke – My doctor ordered in-home PT 3 times a week until I was able to drive, then outpatient twice a week for 6 to 8 weeks. I'm doing this with my left TKR now (surgery 1/29) and I did it with my right TKR (done in April 2017). I thought that the PT was one of the key factors in my successful recovery. My therapists give me the exercises, watch me do them, correct my form when needed, and walk with me when we do outside walks. It's kind of like having a personal trainer. I definitely push myself harder when I'm with the therapist vs. the days I'm on my own. I may be especially fortunate to have GREAT therapists, but both of them have anticipated when I could do more, encouraged me to try harder AND reigned me in when I tried to do too much. Last week, I was at 3 weeks post-surgery and I had full knee extension and 128 degrees flexion. My outpatient physical therapist says we are going to work on balance and functional skills along with maintaining the ROM – and getting up to 130 degrees where I was before the surgery. Bottom line is that I would not have been where I am without these caring and skilled physical therapists.

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Congratulations! I'm sure a lot of your positive outcome was due to your perseverance as well!

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@ellerbracke

Well, retroactively (in case there’s knee # 2 in the future), that is basically what I was asking regarding PT. My therapist instructed – meaning showed me exactly what to do, so I would do it correctly, – and then left it up to me how hard and how often I can/want to do it. Sounds close to “gentle” PT?

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@ellerbracke If you want to progress you need to exercise the knee frequently, preferably daily. I think what my ortho had in mind was to not push it to the point of excruciating pain. When I had my first TKR, the PT I went to would bend my knee until I very literally screamed. I ended up hurting so much the next day that I couldn't exercise my knee at all. From what I have heard, this is not uncommon. You definitely need to work the knee and to do it pretty much daily. My ortho is opposed to is doing it to the point of extreme pain. He actually thinks patients can do as well with recumbent bikes, moving the seat closer and closer as you increase the bend in your knee, and also water jogging! He is totally, completely opposed to the equipment where you put your feet on a platform and it pushes your legs toward your body — I forget the name of it. He is also opposed to icing the knee! According to him, ice prevents the blood from circulating to the wounded area, and the blood is healing. I think it was six weeks at which he was OK with ice. I know he sounds unorthodox but he is very successful and there are literally people from all over the country who go to him.
JK

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