TKR Range of Motion

chookgate

So, I had my last physio session today, and at the end they measured my knee bend at 124 degrees. Obviously very happy with that, but the physio said that was the most I would get, and I shouldn't push for more as the knee implant has a maximum range of 120 degrees (not that she knows which implant was used!), and if I do get more bend I might not be able to get my knee fully straight.

Has anyone else had this sort of advice about maximum ROM? My problem is I don't want to stop doing the bending exercises because I don't want to lose the ROM I've got, but the physio has worried me that I might do damage if I keep them up.

I intend to ask my consultant when I see him next, but that's not due til May!

stickywicket

Speaking as one who has never had much over 90 degrees out of any of my TKRs and also never felt I was missing out on anything, why is it so important to keep pushing it? It seems to me that, as long as you keep up a basic maintenance regime, all should be well. You can do that without straining for 124.

chookgate

That's just it, I haven't particularly been straining, I've just been doing the exercises I was given, and the bend has gradually been increasing. Now I'm scared to do them, in case it increases too much! I don't want to lose the bend through not doing the exercises, because it has only just in the last week or so become comfortable to cycle.

stickywicket

I'd be concentrating on the phrase 'don't push for more' is assuming it's OK to do them gently and, if you lose a bit of movement, that's presumably OK. If you're cycling regularly that has to play a big part in keeping your knees OK. If you're really concerned about it, could you ring up and ask for a quick word with her?

babytiger

Hi you sound like your giving good maintenance with cycling and 124 is pretty good also, this is from someone that didn't get past 70 with my knee but as Sticky says if you want advice give them a call.
Eileen

Helenbothknees

I asked about this before I got my TKR, and was told the knee was designed to bend all the way back, but most people couldn't do that. Both mine bend right back, ie I can stand on one leg and touch my buttocks with the other foot, with no strain at all. No-one has ever suggested that this is bad. One physio did tell me not to sit right back on my heels, but another said if I could do that with no pain it was just fine....go figure! Of course, I may have a differently designed TKR than you; I don't know, but that's my experiences.

blueknees

My ROM stopped at approx. 100 for ages. I was doing lots of exercises and just kept getting real pains and swelling. I needed ice after every session.

My consultant told me it wouldn't get any better but should keep up the exercise bike and swimming.

I don't do much exercise any more and don't get the painful swelling and my knee seems to be bending more now.

I think all that exercise was not good for me, may be the same for others, so don't keep pushing just be patient.

chookgate

Helenbothknees wrote:

I asked about this before I got my TKR, and was told the knee was designed to bend all the way back, but most people couldn't do that. Both mine bend right back, ie I can stand on one leg and touch my buttocks with the other foot, with no strain at all. No-one has ever suggested that this is bad. One physio did tell me not to sit right back on my heels, but another said if I could do that with no pain it was just fine....go figure! Of course, I may have a differently designed TKR than you; I don't know, but that's my experiences.

This is interesting, and why I need to speak to my consultant, but it seems a trivial thing to phone him (well his secretary anyway) about. I don't want to phone the physios to ask again, because they said, only today, "do not sit back on your heels, you will break the joint". I believe the physios have no idea what my TKR is designed to do, they don't know which implant was used - the consultant told me he had used "female implants" and the physio hadn't heard of them. I just wish I'd remembered to ask about ROM when I had my 6 week check. I am encourage that you have such full movement, so just keeping up what I've been doing shouldn't hurt me (or my TKRs)

elainebadknee

Hi

Well as one who is now 14weeks post TKR and the last time they measured my bend it was 97%. I dont know where else to get it measured as that was with the physio at the end of December 2012...I am doing my exercises as given to me on sheet of paper and with the board and the doughnut but when I get up from a chair I am finding my ligament on the lateral side very painful....I was also back at gym on wednesday and tried to cycle - ouchers!!! Since then had to come home early yesterday as my knee was hrting lots and both my bursitis in hips was aching like hell...
Id be happy wtih the degree you've got now and woud just say if its not cuasing you any pain keep doing as you are doing...The exercise surely cant harm can it...

Elainexx

chookgate wrote:

So, I had my last physio session today, and at the end they measured my knee bend at 124 degrees. Obviously very happy with that, but the physio said that was the most I would get, and I shouldn't push for more as the knee implant has a maximum range of 120 degrees (not that she knows which implant was used!), and if I do get more bend I might not be able to get my knee fully straight.

Has anyone else had this sort of advice about maximum ROM? My problem is I don't want to stop doing the bending exercises because I don't want to lose the ROM I've got, but the physio has worried me that I might do damage if I keep them up.

I intend to ask my consultant when I see him next, but that's not due til May!

maria09

Hi.
I don't think it matters which prosthesis you have
the range of movement is 90 to 120 there are many reasons why they don't want you to push it too far
If you damage your prosthesis you may need further operations to correct this
physics are normally very good and knowledgable
There is a very slight chance a knee replacement could dislocate in 20 some years as a nurse on an orthopaedic ward I've only come across one that had dislocated
Your consultant should be able to tell you or if you don't want to ring him you could contact orthopaedic clinic they may be able to help
take care
Maria

maria09

maria09 wrote:

Hi.
I don't think it matters which prosthesis you have
the range of movement is 90 to 120 there are many reasons why they don't want you to push it too far
If you damage your prosthesis you may need further operations to correct this
physics are normally very good and knowledgable
There is a very slight chance a knee replacement could dislocate in 20 some years as a nurse on an orthopaedic ward I've only come across one that had dislocated
Your consultant should be able to tell you or if you don't want to ring him you could contact orthopaedic clinic they may be able to help
take care
Maria

I must add it was many many years ago
Don't want to worry you all and dislocation is rare
Especially as technology has advanced since then

Helenbothknees

I was definitely told by my consultant that theoretically a full range of movement is possible, and that was only seven months ago. I was also told by a one physio that sitting right back on your heels caused twisting, which was a problem (contradicted by another physio, as I said). I can't quite do that anyway, but I can get fairly close with no pain. I figure exercise which causes no strain or pain can't do any harm, can it?

barbara12

Im with SW dont overdo things, I know that the physios can make you work hard...this is for your own good....but you must also listen to there expertise...hopefully your consulatant can help when you see him x

stickywicket

I think it's very important that all of us TKR and THR people bear in mind that our implants are probably different and different bits of us have been shaved off to get them in and we are all, anatomically and medically different to start off with.

For those reasons I think it's vital that we each listen carefully to our own (i)surgeons (ii)physios and (iii)bodies rather than comparing ourselves with others. There are such things as 'female TKRs'.

blueknees

I didn't know you could "break the joint"?

I have pictures of my X-rays and my TKR is two main separate pieces of Cobalt, not joined together so cannot break apart.

I don't try to sit back on my heels as I couldn't do that before the op so don't see why I should try now.

Various Physio's have told me that rest is a very important part of the recovery so maybe we all need a few days off from the exercise to give the body a chance to recover

stickywicket

blueknees wrote:

I have pictures of my X-rays and my TKR is two main separate pieces of Cobalt, not joined together so cannot break apart.

I'm fairly sure they can't break apart but, depending on what they're made of, each half can split or bits break off.

Helenbothknees

I asked all the professionals if I could carry on doing yoga, and no-one even said to be careful with some asanas or pushing it or anything similar. The only thing they were against was high impact exercise, like running. I never heard that the new knee could break, and believe me, I asked everyone everything I could think of.

elnafinn

My humble opinion is having had both knees done two years apart that we are all different and consultants/physios say different things too. I was told by my wonderful consultant I would not get more than 90 degree bend and I would not be able to kneel. I told him that I had a good knee bend and could kneel and he smiled and said he was very happy for me. My knee bend is more than 90 degrees, more like 120 degrees and I love to kneel - actually after a spinal op recently it is the most comfortable way for me to look inside a cupboard for something and I love to wash the kitchen floor on my knees Mad or what?

My way of thinking is that if you are careful and go steady that is the way to progress post op and if your body feels comfortable with what you are doing why not carry on. Keep up the good work too from then on. Exercise is good for you .

Elna x

elainebadknee

There is no way on earth I would ever be able to stand on one leg and hold foot in hand...I just want the pain away from my later ligaments to heal and then I will be happy.....Everyone is different but as long as we get about our lives in a reasonably happy comfortable way surely thats the best outcome?

Elainexx

lizzieuk1

This is def a question for the surgeon involved, he/she will know exactly which implant is involved and precisely what it is capable of mechanically, don't feel bad calling them its not a trivial question and the consultants I've come across would much rather you asked than risk damaging yourself or the implant.

chookgate

elainebadknee wrote:

There is no way on earth I would ever be able to stand on one leg and hold foot in hand

Me neither - I couldn't do that when I was "young and fit" before my knees started bothering me! To be honest I'm surprised I'm able to bend my knees as much as I can, everyone told be before hand the amount of bend would depend on how much you could do before surgery - and that was very little at all!

blueknees wrote:

Various Physio's have told me that rest is a very important part of the recovery so maybe we all need a few days off from the exercise to give the body a chance to recover

Yes, they've told me that too, but I have also been told that it is important to keep doing the exercises religiously to prevent scar tissue forming, as scar tissue can restrict the ROM. One question I keep forgetting to ask is how long after the surgery is it safe to say scar tissue will no longer form?
As for kneeling, it's years since I was able to, so post TKRs I haven't even attempted it! Maybe I'll give it a go in a few more weeks ...

lzzieuk1 wrote:

This is def a question for the surgeon involved, he/she will know exactly which implant is involved and precisely what it is capable of mechanically, don't feel bad calling them its not a trivial question and the consultants I've come across would much rather you asked than risk damaging yourself or the implant.

I probably will end up ringing them to set my mind at rest, or at least get the facts as they apply to me.

It has been interesting and enlightening to hear about other peoples experiences though, and the conflicting information we all get from different sources.