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.
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!
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.
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.'
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!
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!
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!
Interesting. I have lost ROM post surgery and am waiting on seeing surgeon as there must be a problem causing this. You need extension as well as flexion for "normal" everyday activity. I could not do a lot of things before surgery, but always had good bend, leg would not bend due to a persistant Baker's cyst. Now it is the opposite way round, ironically.
I guess from the above it means doing those thing unaided as I can do quite a lot with poor ROM, although it is not easy. I have osteoarthritis more generally so that is a barrier as well.
I wonder how others have fared with poor ROM - most people have much better than I ever have so far. Even with manipulation not everyone gets to the targets. I used to do yoga and a lot of walking - it does not look likely anytime soon.
PS meant leg "would not straighten"
I can't remember where I read it, but I think it was saying that it was fairly common to lose some ROM after surgery, and not just straight after, but over a couple of years, with some people if the movement wasn't repeated often enough. The whole thing seems incredibly complicated to understand. I found some very good sites but by the time I'd finished reading I was utterly confused LOL! I do remember it saying on a couple of articles that those who had a very good ROM before tended to lose a tiny bit and those who had a poor ROM tended to gain more, which was actually the opposite of what I'd expected. Also, re manipulation, it gave percentages gained and how those gains went over a year or so, but I can't remember what site it was on, but you could google it if you want to find it. The ROM seems to vary with different aspects - surgeon, replacement knee, tissues around it, scar tissue, obesity, and how much the person pushes it, bend before, and probably some issues I've forgotten! But I hope you can get what you need for good quality of life!
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...
Everyone gets dry obsessed with Rom. Mine was slow coming after the op - I'm now 24 weeks and it's between 95/100 and I'm very happy with it. When you are able to do what you need to there's a lot to be said for that. Happy healing.
I wish I could have heard your French doctor!!! Love accents!! Ooh la la! Getting a little off the subject! Sorry!😆😆😆
Agree!!!
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!
We do tend to obsess on rom. But honestly I am happy to be able to do what I like to do, (or at least when no2 is done!) which is walking & gardening. Which is why I seldom measure.
Let's not forget that extension is as important as bending. I was told by my physio after arthroscopy, that it is very important to straighten the leg as without you will always limp.
Marilyn
XX
I agree. My straight is prett right on thankfully!
I believe a lot of the ROM for anyone is what they want to do. I was operated on Nov. 14, 2016 and now only have a 95 ROM. Of course, I would like it to be more, but I think what I want to do for the rest of my life, the 95 will work. I am 69 years old.
I was always bemused before this surgery by everyone talking about ROM. Mine is mainly an issue since my knee is so stiff the physio cannot even get it to budge much.
The knee seems very flat and not hard and the skin is tight when not bending even, so I suspect there is some contraction and scarring. It has been like this since a few days post op and was extremely painful as the meds did not touch it early on. I have lipoedema of my legs so that may be a reason as it can cause excess swelling and scar tissue apparently.
But I will update when we know what the surgeon thinks. It is sooo confusing, the more you read up on all this. Most ppl seem to recover ROM in due course and a few suffer prolonged stiffness and pain. Maybe as they make more scar tissue or have arthrofibrosis.
No-one ever cared about about my ROM all the years before surgery when I could hardly walk, now it is all about it! My husband got almost full ROM back after a terrible knee injury some years ago. Physio did not succeed, they tried to force it and there was great trauma but still no movement. He declined an op but it healed pretty well with time just exercising at home. Not a TKR I know but he is at least sympathetic to my situation!
They need to rule out anything up with the implant etc and maybe will suggest a MUA (shudder) - I'm just frustrated that I cannot sort this myself. Thanks for all your info, you have really been delving deep.
The "standard" is 0 degrees straight and +120 bent. I started at -14 / +84. Ten weeks of PT got it to -1 / +123...I'm now 0 / +133. The zero is very important to prevent limping for the rest of your life. My doc told me not to expect anything better than 140 but some people have done better than that. If you can sit back and have your butt touch your heels, that's 161...I don't think that's possible with a metal knee. I'm happy where I am.
Caution: The measurement is VERY relative. Ten PTs can come up with 10 different results...all similar but different. There is no absolute measurement as they just kind of "eyeball" the angle.