Can you do TOO MUCH after Total Knee Replacement Surgery? Physical Therapy, Pain and Swelling 

I'm at 3 weeks post-op Rt TKR. At 90+ degrees flexion and ~ 4 degrees short of full extension. We are taking a slow walk, with the cane, around the block most days. I did Pre-op PT for 4 weeks. I didn't even know that was a thing. I recommend it HIGHLY! I have to say that my wife has been a KEY to my staying on track. I'm at PT twice a week and doing the work at home 3 times a day. (Twice on PT days) Everyone is going to be different. Having a routine has been key. I use the R.I.C.E. method and recommend it highly. Rest (Sleep 8 hrs+). Ice (20" every hour). Compression (Wear those T.E.D. Hose!). and Elevation. If I'm sitting, I'm elevating my leg. Knee at or above the heart level. I have a timer always set at 40 minutes to remind me to get up and move around a bit. Having said all of that, I woke up yesterday with an empty tank. So. I got up anyway, but chilled out, and took an "easy" day. Today has been fine. I feel confident I'll have a very good outcome. You can too! 😊

Eight weeks after my TKR I can achieve 120 degrees w pain level 7-8 (out of 10). Until last week, 120 ROM was only possible with pain level 10+. I work on it 3x per day and my wife helps by pushing the knee to the 120 deg limit & I made a device that helps me measure the angle. Anyone contemplating this procedure should recognize u may endure unrelenting, unending pain that sends spikes thru the leg in the middle of the night when u r trying to sleep. The knee regime will consume your life, 100% of your attention and focus will be to get range of motion back so listening to cheerleaders like Rosen doesn't fully help the patient understand what may be ahead. One of the nurses said it best, after the first 2 days u will feel like u were hit by a truck. Nurses seem to be very honest. I have achieved 120 deg ROM, but the price in pain was extraordinary and I will NOT do the other knee which is just as arthritic as the "fixed" knee. If u overdo it, you will know because the dull pain and the spikes will increase big time. Had I changed my exercise routine to a recumbent bike I could have avoided this horrific event in life. OXY was helpful but the side effects were drowsiness, nausea, insomnia and weight loss. Glad to be off of OXY but the weight loss helped the non repaired knee. I use ICY Hot w Lidocaine for the constant, dull pain, and Pure Magnesium Oil to arrest the electrical spikes which I assume come from nerves that were cut during the procedure and have yet to heal.

Everyone is different, until you have a TKR you do not know how painful this procedure can be. “Pushing past the pain” is one of the worst phrases I’ve ever heard and my excellent Consultant and physio team in the UK are horrified when they hear it. Talking about people at the top % or bottom % is counterproductive too, hard enough being in pain without being labelled. Damage can be done and coming back from that is even harder. Listening to your own body helps, it’s telling you something. I’m now 6 weeks and doing absolutely fine, but not “killing myself in pain” my OA pain is completely away and I am gently working my way through day by day. As my surgeon says only 20% of healing has occurred at this stage, this is a marathon not a sprint, steady progress is best and ignore the eejits who want to turn all things into a league. 🥰🏴󠁧󠁢󠁳󠁣󠁴󠁿🇬🇧

100% spot on! At two months post op I was riding my bike 5 miles and felt it more in my non-surgical knee (it gets replaced in late-May) than my surgical knee. At 2 weeks I was at 100 degrees and at 4 weeks 125. At 6 weeks I was doing gentle squats at the gym. The PA and surgeon were thrilled but I worked really hard at PT. I’d come home and ice my knee. No pain, no gain and never thought I was doing too much. Had a great PT team too. Now that I know what to expect and how to achieve an excellent outcome, it will be easy to recover and rehab the left knee. Oh…I’m also 69 years young with a very positive attitude which helps enormously too. BTW…your book is excellent. You and my surgeon are of kindred mindsets.

70 year old woman that is 1 week post op. Found your vids. Today I was in a slump thinking I had made the worst mistake of my life. I needed this motivation. I'm at 90° and looking for more exercises than the 3 exercises I was sent home with and putting in a call to my doctor about pt. Thank you for your inspiring words.

7 months PO. I shoveled and was pushing w too many steps and hurt my knee and all the muscles started freaking out. Surgeons office said use the cane for a bit ….. finally the muscles are better

My husband had TKR Nov 14. He wakes up and knee feels fine. He does his therapy and he says it feels like a vice is squeezing his knee. He rides the bike and has done his therapy faithfully. He told his surgeon and he didn’t act concerned

My first TKR I went home with only 78 degrees of flexibility. I hit the panic button and exercised that knee ! Throughout the day and the night as I couldn't sleep. I pushed myself to the limit of pain. I ended up at 8 weeks with 130 degrees and that knee is fantastic. Pain is your friend at this stage. Don't ignore it but push through as much as you can. Take frequent rests. I found myself holding the knee and sending loving thoughts. Second TKR started off better, 90 degrees the next day ! But I developed a bleed when the antibiotic needle was taken out so spent 3-4 days trussed up and immobile till it stopped. I ended up with only 125 degrees and a less happy knee. This emphasises the need to exercise from day 1, and that pain is your friend. Thanks Adam and good luck everyone !

Hi, I live in the UK, and finally, I'm set to have a full knee replacement in just under a month now, and I just wanted to say that out of all of the videos I've watched over the last 12 months (and I've watched plenty) since I finally got in to the queue for the op, your style and presentation has been the most useful, and every question I've been thinking about you've covered in your vlogs, and in your book. So many thanks for all your work producing these very informative videos, they've been a great help in preparing for the new knee, I feel I know what to expect and what I need to do to make a success out of the procedure. Thank you. 👋

I developed patellar tendonitis about 3 months after my first knee replacement. This was not a result of PT, but of doing too much at the gym and other activities. I'm now about 5 weeks post-op on my second knee. I am better now at distinguishing pain that is helpful, and when it's time to back off a bit. I had another therapist suggest PT should be uncomfortable, but not super painful. Finding the 'sweet spot' of productive discomfort can be hard at first.

TKR in July of 2023. 100° flexion 2 days after surgery! At 5 weeks after surgery, and I now have 135° flexion.

At 8 weeks out, I remain very compromised, stiff and swollen, though there has been progress. hard to remain optimistic but these vids are helpful. Wish the med community advocated Pre Hab more vigorously - I got myself involved 4 weeks out, but don’t think I accomplished much. So now feel the strain of “catching up”. PT aggravates the knee so I try to measure 2 45 minute sessions daily w little tweaks at the kitchen counter or in a chair. Hate the meds so am confronted w that dilemma. Asked my surgeon about cupping and am glad he approved…biggest flexi on improvement to date since I began cupping the knee and thigh as part of PT. There is a huge opportunity for someone to seize the knowledge market encompassing the best modalities available for a focused approach to recovery… there is a wealth of talented caregivers out there! Thanks for your insights - inspiring!

My original TKR was in February of this year, 2023 and I was doing fine; then I fell, broke the implant which in turn went up my knee and broke my femur. I then had a TKR near the end of March and the rest is history. I'm on the mend, 3-4;more weeks of PT then in October back to the doc. I enjoy PT but will be glad to get back to my chair aerobics class and do PT in my own. 😊 Thanks for good info!

It really does make a difference!

I had bilateral total knee replacement 9/14/22. At 66 had a lot of pain before surgery for years so standing with no pain is such a relief. Done with physical therapy at 6 weeks and surgeon released me until my anniversary. But had 125-130 range of motion at 3-4 weeks with mild discomfort. Never pushed myself, just listened to the therapists. They were all great. Get both knees done at same time if needed don’t wait. It’s better and recovery is done and over with.

Great information Dr .

Brilliant, very good advice!

Thank you very interesting!

I’m thankful for your videos!!! I had TKR and and based on my range of motion in the two week follow up and PT, I’m “way ahead of schedule”. I’m 61 and am very active and at 2 weeks got rid of my walker, 3 weeks have climbed the NRG stadium steps for the Houston Rodeo, slow danced with my wife at the Zac Brown Band concert, worked training roping horses in the round pen and doing pasture maintenance on our tractor. My pain has been controlled with pain meds, but I’ve weaned myself off of them and only take partial doses at night to help get a decent amount of sleep. I’m icing my knee for an hour five times a day and at night to control swelling using a cuff and cooler pump system.

I really appreciate your frank and honest videos. I’m six weeks into a TKR which was complicated by the need to remove lots of scar tissue from previous surgeries 20 years ago, after the knee was pinned and plated back together after being crushed in a car accident. I’m 46, so really need my knee to get super strong and last many years. It now fully straightens and have 108 degrees bend, which is now better than pre op. Your videos really give me a boost to keep pushing which the exercises.