Exercise BEFORE TKR

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Robin and Jan have both mentioned that leg muscles can be weak before TKR so need to be built up after.  Some say weights are a good idea and some say not.  My own view is that since obesity raises the chance of wearing out knee joints early, then squats with weights do too, and I've read studies about deep squats frequently done, being a reason for knees wearing out BUT I do appreciate that legs have got to be strong to support those knees.  My hospital gave me exercises to do BEFORE the TKR to strengthen legs.  As Robin said, many people don't lead an active lifestyle before TKR because pain has limited them, so there is a weakness and it does sound a very good idea to reduce that weakness before the op.  I'm wondering if this is what helped me so much - as well as the hospital exercises I'd been doing the exercise bike for years, so legs were pretty strong at the time of the op.  Are all other hospitals stressing this point, or is pre-op condition something that gets neglected?

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  • Posted

    My operated knee got rapidly bad in the year before my TKR. In the 2 years prior to that had hydotherapyvand physio as could ni longer use my road bike it was help. Muscles got weak so quickly. So did the physio religiously even though it felt much feeble than what I was use too it helped a bit. However once surgeon listed me knee in such a bad way surgeon suggested pool and joined Aquatone stuggled to get in pool but it really really helped build up quads a bit pre ip. I am cinvinced this helped me post op. I k ow others like Chico dont agree but I do.

    At pre up was given lots of stuff to do and I did it. I do think it's variable what people are given but I'm very happy with my treatment Chris

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    • Posted

      That's good Jan.  It can be such a struggle to motivate yourself with exercise before the op, but I started the bike initially because I knew I was getting so unfit, and then we got the treadmill and so on but people used to ask me how I managed to do it with the arthritis.  Yes, for me it DID make it more painful - no doubt about it, but I felt it had to be done.  I know some sites say it relieves pain, but it truly didn't for me.  BUT I do think it made me so much stronger for the op and it DID help after.  I'll always remember when I went back for my six week check and the physio (keep in mind that was the only physio I saw after leaving hospital too!) told me to stick my leg out straight and he tried pressing it down and was really surprised how strong it was.  So was I, to be honest.  I didn't know they were going to even do that LOL!  I'm so glad you were given pre-op exercises too!  I wonder if that is general then?

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  • Posted

    You don't have to do deep squats and you can use light weight. I think some people on here were more athletic before their op these are the gymnsters who build up to 10lb weights post op.Even 3lbs will help or resistance bands. I don't go beyond 6lbs. Get advise from your physio

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    • Posted

      What physio LOL! ???????  Where??????:-) LOL!  Not one in sight here LOL!

      I think I'll just stick with a few squats just going down a little way because I reckon that's what stairs would do.  I KNOW I'm neurotic about not wanting to wear my knee out prematurely, and I do appreciate we need the strength, but I think I can get that via the bike without putting the weight on the joint:-))))  I used to do squats with 144 lb!:-))))

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  • Posted

    My hospital gave me 8 exercises to do before the surgery. I had weakness for about 2 weeks but I have forced myself to walk and the weakness is almost gone.
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    • Posted

      Excellent - thanks for this Valerie.  So far it's looking as though more had exercises instructed before their op then:-)))))  That has to be good!  Glad you're feeling stronger too!

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  • Posted

    I went into my TKR blind, I did not want to chicken out by overthinking it. In hindsight, I should have at least read up a tiny bit. But, one of the first things I thought after the procedure, on my way home via two commercial flights, was that I should have built up my muscles before the procedure. I've had a few physical therapy sessions a couple years prior to the TKR recommendation, and my physical therapist always stressed the importance of strong glutes being the key to easing most of our bodies troubles, especially knee troubles.

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    • Posted

      Do you think it was more difficult because you hadn't built up the muscles Lynn?  Did your hospital not give you exercises to do just before, or mention it?  I think you've done what we've all done though.  I read up a lot on it before I had my op but STILL feel as though I fumbled through and learned all sorts of things after it!

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    • Posted

      I do think it was more difficult for the first two weeks post op because I hadn't built up muscle, I never felt so much the weight of my whole body on my not-in-shape left glute as I did those first two weeks anyways. After that time period, though, as I began really walking with my weight on my repaired knee, things felt easier. I'm 7 1/2 weeks post op, feeling better & better every day! I am still working on my Range Of Motion, no PT in our rural town, so I am a little behind. If I haven't gained more bend in the next month, the surgeons will discuss manipulation if I want the full ROM, or they said I can leave it at the less bend if I'm okay with that. I, and my family agrees, want the fuller range so I've been trying each day to really stretch and bend.

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    • Posted

      Ah - I'm sorry to hear that Lynn.  It does make me think it's important that hospitals tell patients to build up some muscle before the op then.  Also, what possibly makes a difference, even though the other knee might have severe arthritis, is that it's possibly a better support for the operated knee if muscles are built up a bit.  Keep working on the range of motion - my surgeon said it improves for two years!  I don't know how much - what sort of a curve it is.  I IMAGINE the faster improvement is in the first two or three months, but don't actually KNOW that.  But keep at it and you may well get there without manipulation.  Good luck:-)))

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    • Posted

      I forhot to mention, I was a 90 degrees at my first follow-up (7 weeks post op), but since then, I do think my husband has been able to get a little more bend just by helping me with stretches & bends. I have read others mention many months (and possibly years) to make those ROM gains and I will keep this in one before the manipulation decision is necessary. One tricky issue I've had, since a few months BEFORE my knee replacement, is a groin /hip strain that's really been disabling (it's a shocking pain in my groin/hip with certain movements). I am a (up til 2 years ago anyway) 44 year old active person, so it's been very frustrating to feel so laid up (two thumbs down).

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    • Posted

      Oh my - that strain has GOT to have affected you!!!  I can SO imagine dealing with that as well as the physio!  I don't know if it might help anyone, but in the first few days after the op when the physio was telling us to slide our foot along the bed to raise the knee, I found myself helping it with the hands under the thigh.  I didn't really give this any thought, and don't even know if it was a good thing to do, but will ask when the next knee is done - I sort of did it automatically really!  It certainly helped though and I wonder if that got me off to a flying start!  But I will ask with the next one!

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  • Posted

    "I've read studies about deep squats frequently done, being a reason for knees wearing out...".  We need to find a study on the effect of deep squats on ARTIFICIAL knees.  Can't compare the two.  Apples and oranges.  I doubt there's any data since so many people do a TKR later in life and are less likely, with a more limited ROM, to do the kind of deep (+140 bend?) athletic squats the study may be referring to.  Plus the weight on the bar has to be a factor too.  I personally don't see any of us squatting 300 pounds (136 kg) or getting to +140 intentionally.

    Also, everything my daughter recommends for leg/glute/core strengthening on my lengthy Exercise Post was meant to be done at a gym on the gym machines.  Don't know how many of them can be done with free weights alone without some kind of apparatus.  The at-home bands were also mentioned as an alternative to those who can't get to an actual gym.  This is all done to take the pressure off the joint and put it back on the supporting muscles where it belongs thereby extending the life of the replacement.  

    Hmmm...  Now I myself wonder if the last part of that statement itself is really true since I have no data to support it.  Need to find some but that will probably have to come from manufacturer testing information as they're the only ones who test the device to point of failure.  Wonder what they found?  Does longevity vary by manufacturer?  Interesting...

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    • Posted

      Sorry should have said - one of the studies I referred to was done in Korea and was on artificial knees.  The conclusion was that deep squats where people squatted down to prepare or eat meals etc. wore the knees out so prematurely that it defeated the object of doing them in some cases. 

      What I'm struggling with is I don't understand why obese people, who are used to carrying around a lot of extra weight, wear their knees out much faster than slimmer people.  Yes, I can see that some obese people won't be as active as some slimmer people, so might have less muscle but some slim people aren't active for various reasons and some obese are so I can't see how that can be generalised.  But if carrying extra weight on the body damages knees, then why doesn't bending with weights.  The weight is still going on the knees and it's not muscle in the artificial knee - it's the polythene stuff or whatever it is that wears.

      This is one study I just came across about deep squatting and TKR - called

      VOL. 89-B, No. 11, NOVEMBER 2007

      1457

      High incidence of loosening of the femoral

      component in legacy posterior stabilised-flex

      total knee replacement

       But it's not the one I found the other day.  I think it might refer to that one though.  This also mentions the danger of too much of a bend, something that some of us looser limbed people are going to have to watch.

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