Knee Replacement Recovery Time

[tonka97]

I had a full knee replacement this past August 29. ...

I was (of course!) expecting to do better than I am.

I tell my patients to allow 6 months for the TKR to feel satisfactory, and 9-12 months to feel 'normal'.

Suggest taking care of yourself for 6 months...lots of swimming, low impact type exercises, stationary bicycling, and continue moderate to light range of motion exercises.

Try to stay at a light weight for your body type. Your joints will love you!

The pool environment is fraught with dangers to a person with a joint replacement, especially when heavy items are being manipulated by students. Why not wait for 6 months and then resume teaching?

Go easier on yourself with expectations. Your range of motion is excellent this close to surgery. If you overdo stretching and exercising, you have a risk of significant set-backs due to increased edema and scar tissue formation.

Make sure that you provide transverse friction massage to the surgical scar, to reduce pain and to assist maturation.

Your range of motion will continue to improve as the edema resolves. Stretching the hamstrings before surgery would have had minimal impact on extension after surgery. Just make sure that you gently stretch the knee into extension...a good technique is to place your heel on an ottoman while you are sitting, and let gravity extend the knee as you relax.

Total joint replacements are truly miracles!

 

[boulderjohn]

I am continuing to supply updates so that future people doing a search will encounter what is essentially a journal that will help them know what to expect. I am now 8 weeks out from surgery.

The CW class I had scheduled was canceled for lack of enrollments, so I did not have to make any decisions there.

I continue to make good progress. My unforced flexion is 128º, and my extension is not quite as good at 4º. I can walk very well right now, and I think I could have done the class if I had had to. It might not have been a good idea, though, as was suggested above by Tonka97.

My doctor told me not to try to play golf, except for chipping and putting, until ten weeks. This past weekend I played with friends, "chipping" with long irons from the ladies' tees to start each hole. I used a cart and a handicapped flag to get close to the greens, and I had no trouble at all. In fact, I had far less swelling the next day than I had that morning, and the swelling continues to be fairly minimal now.

 

[DocVikingo]

Hi boulderjohn,

Sounds like it's going very well, indeed.

Please let us know how you are doing in another month (12 week update).

Thanks,

DocVikingo

 

[redrover]

Aloha,I’m very glad you are posting. I need a new knee, bad. I’m encouraged hearing how it is working for you. What knee do you have?
Sure am hoping the total joint replacementing is whipping along with new and improved as it was when I was in the thick of things some years ago (one of my docs had his own Total Knee.) I’d also like to hear how it goes with any TK diver.

I got to this point via several reconstructions (ACL) among other things and getting the full flex and extend was an ordeal each time despite having a very high pain tolerance. I’m sooo not wanting to do it again but unfortunately am bone on bone now.

I’ve been protecting this knee for years and diving has been my athletic endeavor salvation. When I boat dive I think crew tend to look at my wrinkles and assume I’m feeble (or scared) – it’s just deliberate and absolute controlled steps and motions.

Tonka97, what about not able to do what you suggest to prep? I’m a good weight and shape (except for the knee) but haven’t been able to bike or run for years. Work is physical, stairs and hills are a killer. Very pleased to hear your take on the hamstring thing, I’ve been worried about that, any other suggestions or advice?

Any one have thoughts re: travel far for surgery? I’d really like to go back to the mainland (they were fixing other surgeons mistakes half the time) but can’t really swing a long stay financially. Is it reasonable to return home (6hr flight) when discharged? I trust the local docs to follow up, it’s the artistry and experience, are total joint not do total joint, and having the knack I’m worried about.
Mahalo!

 

[tonka97]

My unforced flexion is 128º, and my extension is not quite as good at 4º. I can walk very well right now...

Your flexion is excellent; you really don't need much more than that for all of your functional activities.

Spend most of your 'knee specific' exercise time on extension. The best way to improve range of motion is by ACTIVE exercises that gently and repetitively encourage the tight tissue to remodel.

Example: Sitting with your operated leg (knee) extended, support your heel on an ottoman, then actively extend your knee, 30-40 times, holding for a count of 10. This helps to: develop the necessary muscle strength (especially vastus medialis), neuro-motor coordination, and will stimulate re-modelling of knee musculature to gain range of motion, without tissue damage.

or:
Standing: periodically extend your operated knee, holding for a count of 10 seconds. Standing gives your knee the opportunity to exercise in a weight bearing, facilitated position. We are "wired" to extend knees when standing, and this exercise facilitates the effectiveness of extension.

You will want to continue to avoid rotatory and overly flexed positions of your knee (greater than say 125 degrees flexion). Avoid the 'full squat' position that has damaged a lot of knees. (ask any baseball catcher).

When a client needs to work at ground level, I suggest the 'half kneeling position' with knees flexed to 90 degrees, with weight bearing upon non-operated knee or to use a low 'gardener's chair.'

Is your body weight optimal? As we walk, trot, and run, the reactive forces acting upon our knees are multiples of our body weight. Running will increase the forces 3x or so. A lighter weight will protect all of your joints.

 

[tonka97]

........
Tonka97, what about not able to do what you suggest to prep? I’m a good weight and shape (except for the knee) but haven’t been able to bike or run for years. Work is physical, stairs and hills are a killer. Very pleased to hear your take on the hamstring thing, I’ve been worried about that, any other suggestions or advice?

Any one have thoughts re: travel far for surgery? I’d really like to go back to the mainland (they were fixing other surgeons mistakes half the time) but can’t really swing a long stay financially. Is it reasonable to return home (6hr flight) when discharged? I trust the local docs to follow up, it’s the artistry and experience, are total joint not do total joint, and having the knack I’m worried about.
Mahalo!

Total knee replacements have been perfected; very few fail with moderate activity levels. 20 years ago, the cement was a challenge with occasional failures, but failures are quite rare today. Obesity is going to shorten the expected life of a replacement as would significant osteoporosis.

Before the surgery I would stay active with low-impact exercises....elliptical trainer, water aerobics, gentle stretches. I would want to optimize my cardio-pulmonary conditioning anticipating a few months of de-conditioning following surgery.

Make sure your home is compatible with guarded ambulation....railings, throw rugs rolled up, no cords in walkway, non-skid shower floor. Get an ice bag at the pharmacy...the type that looks like a hot water bottle, but with a neck big enough for ice cubes added to water. The cooling packs they will give you at the hospital are pretty pathetic.

Following surgery EXPECT 6 months to 'feel OK', and 9-12 months to feel normal (which is much better than pre-surgery)

I usually discharge my patients when they get 110 degrees of flexion, and full extension. They continue to progress from there with normal activities and assigned exercises.

Re: traveling far for surgery....Yep, it's worth it to have your TKR performed by an orthopedic surgeon who has replaced hundreds of knees with an excellent reputation.

 

[DocVikingo]

I tell my patients to allow 6 months for the TKR to feel satisfactory, and 9-12 months to feel 'normal'. Why not wait for 6 months and then resume teaching?

Update from BoulderJohn dated 02/21/08:

"Hi Docv,

Thanks for asking.

I was cleared for diving long ago. I had a checkup in the beginning of December, and they told me I could do whatever I wanted within their normally prescribed limits, depending upon how ready I felt for each activity. I can even ski moderate slopes if I want to, although I have not done so. (I was once an expert skier.)

I went back to instructing pool sessions before that (with their permission), with only moderate discomfort. I was in the pool for an OW class the last two nights, and it felt perfectly fine. I have twice walked 9 holes of golf, carrying my clubs each time, with no problem.'

Surgery was Aug 29; medical release to scuba was early Dec. That would be ~3 mos.

Regards,

DocVikingo