The Reality of PT after a TKR

Unless someone has different information, I don't know of any other way of breaking down the post-op scar tissue except through PT or an MUA.  Yes, the Physical Therapy is right out of The Inquisition (I swore my therapist wore a dungeon master's cowl and had an Iron Maiden covered up with a sheet in the corner...), is extremely painful (some people take meds an hour before a session but then can't drive there), and is full of successes, setbacks and plateaus.  I went from -14 / +84 in 10 weeks @ 2x/week to -1 / +123 (the goal is 0 / +120).  I got stuck at -4 for weeks...frustrating.  But I did a lot of heel slides and squats at home too.  I started my PT 3-4 weeks post-op...wait longer and the scar tissue has had more time to build up.  Haven't heard of anyone starting sooner...anyone out there who did that?

With the MUA, you're unconscious and the docs get out whatever scar tissue they can in an attempt to give you better ROM.  The downside is that you're now dealing with another operation, open incision and post-op pain.  Personally, I'd work like hell to avoid that.  In my opinion, MUA is a last resort for people who have not had any success with PT.

This is simple: No way you'll get your ROM back by doing nothing but rest, ice and elevation at home.  Not a chance.  This takes physical manipulation by a PT to break down the scar tissue so you can walk again without a cane or a limp for the rest of your life.  Even the people who have reported great ROM numbers within a month of surgery still did the work to get it.  Maybe there's even that one in a million patient whose DNA does not allow scar tissue to form.  Who knows?  For the rest of us, it's hard and painful work...but worth it.

I did ask my PT about people in their eighties...what goals do you have for them?  He told me that 0 / +120 is not likely to be achieved by the very elderly so they focus on enough ROM and strength to get a person out of bed, to the bathroom and kitchen, and out to a car.  Pretty much self-care basics.  Different age...different standard of success.

For a PT session, they will warm you up on a bike...might take a week or two to get one full pedal rotation.  Patience...it will come.  Then there's more leg work of various types.  I loved sitting on a rolling stool and using the bad leg to push and pull me around.  Always a fun one.

Down the road, they will try and make you climb a single stair, bad leg first to engage the dead quad muscle.  No holding on to a rail, no bouncing on the good leg to pop you up there.  This is VERY hard.  Could not do it without using the rail for many weeks.  Even after PT and 6-12 months of recovery, stairs are still very difficult because of the lack of leg strength.  Only serious gym time and lots of leg presses will do that.  At home, get a set of exercise bands and do them every day!  At 14+ months, I can do two steps at a time alternate legs with no railing.  Lots of work went into that (plus residual leg strength from 45 years of hockey...so I cheated...).  Be patient.

Now for the exciting denouement.  The PT lays you on your back, puts your heel up on a block of wood and pushes down on your knee...maybe 6-10 times, each one harder than the last.  Fun, right?  Remember the chest-waxing scene from The Forty-Year-Old Virgin with Steve Carrell yelling "Kelly Clarkson!!!.....Richard Nixon!!!"?  Yeah, something like that.  Then he lays you on your stomach with your knees just on the edge of the table.  That's it...just let the knee hang...and hang...and hang.  Gravity may be a law but it's also a b**ch!!!  For fun, he'll add a 2-pound ankle weight to the bad leg.  Weeping and gnashing of teeth...biblical-level pain.  Be prepared...

But it's what must be done to give you your life back!!!!!!!!

I'm at about 15 months and most of the time I don't even know the knee is fake.  I have to be very conscious of it nonetheless.  The only way to get "here" is to go through "there".

Good luck everyone.  There is a light at the end of the tunnel and it's NOT an oncoming train.  Please add your experiences...

"You gotta go through hell before you get to heaven." - Steve Miller, Jet Airliner

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