What ROM is needed

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After my surgeon telling me today that I don't need to worry about ROM at all now, I still wasn't sure what ROM would achieve the best.  One article I read said to get up and down in a bath 'normally' you needed 135.  But I just found a useful bit in the 'orthopaedics and trauma journal' online - scopic ROM in a PS knee is an average of 115° and a maximum of 145°. This functional range is adequate ... ROM after knee replacement.  - That seems a fairly good guide!  It went on to say in climbing stairs and rising from a chair (guess that depends on height of chair though!) 95 degrees are needed.

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  • Posted

    Just googling more about flexion - so many articles say different things!  This was another:

    Postoperative knee flexion is an important indicator of

    success in total knee arthoplasty (TKA). Satisfactory

    flexion is required for various activities of daily

    living: 67º is required for the swing phase of gait, 83º

    for climbing up stairs, 90º for descending stairs, and

    93º for rising up from a chair.

    1,2

    In North America and

    Europe, 110º or 115º flexion are considered adequate

    for the lifestyle of seniors.

    Some articles SEEM to imply that 135 is about the maximum bend.  I don't know how this varies from replacement knee to knee though! 

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    • Posted

      Ah - carrying on this subject - something in the same journal as the first post on this says 'Deep knee flexion is thought to have a deleterious effect on the survival of the replacement knee possibly sacrificing the goal of surgery.  But they are talking about getting acurate information on people who are bending to 130 or 140 every day, in Korea.'

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  • Posted

    I am completely hung up on rom. I bought a goinometer and measure all the time. I range from 95 to 100 and I'm 12 weeks out. I walk well and my straight leg is 0 so guess it's all good. My doctor says I'm still swollen and won't reach the good rom until the swelling goes down. He said not to worry just keep working on it.

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    • Posted

      From what I've been reading Duckfan, that doesn't sound anything to worry about at all, and your doctor is right!  I'm not measuring much these days - have gone to measuring every four or five days or so - I seem to have been around the 135 for a couple of weeks or so now, but talking to the surgeon today he thinks I can relax  now and not worry about it.  I'm just going to make sure I'm getting my foot to the same point on the chair from time to time, to make sure I'm maintaining the bend, I think.  But they do expect the ROM to improve as swelling goes down, over two years post op!  To be honest, I think the surgeons are far less hung up about ROM than some physios, although the physios at my hospital aren't.  I wonder if a lot of anxiety is caused where it needn't be!  I'm chilled out about it now LOL!

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    • Posted

      Thank Goodness Duckfan. I'm right there with you! 15 weeks out. ROM 95-100..

      Still get the mild swelling daily and stiff band feeling. Although that is getting better. Still working hard at home on exercise...

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    • Posted

      Duckfan, we're in almost the identical situation. I also bought the stupid goinometer and range 95-100 depending on the day. During my last therapy session (thank goodness!) the therapist "yanked" me to 107 degrees to show "that it's there". I'm 12 weeks out, walk well and straight measurement is fine at 0. I have the same problem, I'm always swollen, it's just a question as to what degree of swollen. Bad, very bad or extra extra bad. I see my surgeon tomorrow.

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    • Posted

      Yep swollen everyday. I just went to acupuncture and he treated the area. I'll see if that helps. I feel so stupid carrying that goinometer around "maybe it will bent better here, maybe there,maybe after a shower, maybe before."

      I'm encouraged by reading your post. Thznks😄👍

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    • Posted

      Yes, I will let you know.  He said that my left quad muscle is not firing and had some words explaining all of it that I can't remember.  He used what he called a magic pen on the scar that has a positive and negative charge.  He said that the scar blocks the flow. I'm not to excited about the east/west chi or whatever but I do believe in acupuncture.  Guess it works if you believe in it.  I will let you know.  

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    • Posted

      Oh Duckfan - are you really serious?  I'm SO sorry you've got so hung up on this!  I know it's easy for me to talk, but I think if I were you I'd be going back to concentrating on being able to do what you need to do for ordinary life, rather than the numbers!  It's making me wonder if this is WHY my hospital gave us the leaflet with the man sitting on the chair with the leg at angles so he could hold the stick up and it was several inches in front of the knee first, and then he could push the foot back so the stick was against the knee and against the front of the foot, and still upright - that's what they wanted you to achieve before going back at 6 weeks.  My surgeon said the 120 was what they wanted people to get to in two years!  I think this more relaxed attitude puts a whole different light on it and people don't feel as though they're letting everyone down if they haven't achieved 'numbers' despite doing their best!  Just MAYBE pushing it too hard brings EXTRA swelling and pain and defeats the object.  If you look online though, at studies that have been done post TKR there is quite a high percentage who don't reach the number that some physios want.  Look it up and it might reassure you.  Those of us who get high numbers aren't 'succeeding'  and others 'failing' - we're all just doing our best and I think to a great extent, it is what it is!  It's like IQ - you've got what you've got to a great extent!

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    • Posted

      Hi Duckfan, just read your post on acupuncture. It has been verified that acupuncture is excellent for relieving chronic pain. The NHS even has Acupuncturists now. Wow!! For years they commented badly on 'alternative therapies' but are now embracing some!!

      I had Acupuncture on my back in 2001, all my GP could offer was physio, which was useless! The Acupuncture worked really really well! I knew it would as after the first session I felt quite light headed & I often went home with a needle still in the top of my head to bring the energy back up into my head!!

      Enjoy & appreciate Acupuncture it really works!

      Marilyn

      XX

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    • Posted

      Hi. It's been two days since the acupuncture and I think it helped. Less stiff, better bend. I went shopping yesterday and walked and walked. My hip flexors were tight but no knee pain. I'm encouraged.

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  • Posted

    I agree with the 115 to 145 thinking. And, apparently my orth surgeon does too. I'm 16 weeks post bilateral TKR and I'm about 115 in both knees give or take. Before surgery for years I was no where near even 130. I believe right before surgery I was maybe 108ish. I'm soon to be 65. I can walk fine, getting in and out of tub getting easier as well as going up and down steps. Going up and down steps isn't smooth but it will get better; gotta keep doing exercises. As my orthopedic doctor says "it's all relative". If I was 30 years old or a little older and a runner, etc he would and I would expect more bend. But as long as I don't go backwards, keep being active as I am accustomed to, I should be good. I was never a runner or big time athlete; just a walker. For me I know this whole process can take up to a year and there's a good possibility I can improve my bend but what will be will be! I say don't stress over your bend when you hear someone is better than you! We're all different!

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    • Posted

      Yes, you do have to get things in perspective!:-)))  I'm worried about pushing the bend too much now in case it loosens the cement!  I don't think the amount of bend I've got would do that but I'm going for maintenance now rather than increasing it.  My surgeon didn't express any concern that I was overdoing it though, just that I didn't need to keep pushing it and had achieved all I needed to, or rather way MORE than I needed to.  He's French and I wish I could explain his exclamation at the bend LOL!

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    • Posted

      You'll have to use your imagination when he found out what my bend was - sort of 'tphew' (yes, the t was at the start of it) as he sort of waved the air in surprise LOL!  Then the aneasthetist was lovely - WOW!  He was Polish.  But there were so many laughs with all of the different departments!  It was a fun day!

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