Latest / The Total Knee Success Podcast: Your Essential Resource for Navigating Total Knee Replacement / Episode 92: The Last 10% After Knee Replacement (When You Finally Start Thinking About Your Life Again)

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Episode 92: The Last 10% After Knee Replacement (When You Finally Start Thinking About Your Life Again) · The Total Knee Success Podcast: Your Essential Resource for Navigating Total Knee Replacement

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  The last 10 % may also represent a goal that's
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  never been clearly defined. I want my knee to
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  feel normal. Sounds straightforward, but normal
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  can refer to several different things. It might
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  mean walking without a limp, getting up from
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  the floor, kneeling at a church service, playing
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  18 holes of golf, managing a full travel day
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  or a full work day, or simply reaching the evening
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  without thinking about your knee joint. Are you
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  ready to get back to what you love after knee
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  replacement? The Total Knee Success Podcast is
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  your trusted guide with practical tips, evidence
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  -based strategies, and no fluff. It's not personal
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  medical advice, just solid education to help
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  you manage pain, regain mobility, and get back
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  to living the life you love. Let's dive in. Welcome
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  back to the Total Knee Success Podcast. I'm Michelle.
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  Have you ever caught yourself saying, I'm about
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  90 % better, but struggled to explain what the
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  last 10 % actually is? You may be walking independently,
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  driving, shopping, traveling, and participating
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  in most of your normal routine, yet your knee
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  may still feel stiff when you first stand up.
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  Stairs may require more attention than you expected,
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  or walking may not feel completely automatic.
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  At the end of this episode, you'll have a clearer
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  way to understand what may still be improving
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  what may simply feel different, and when an unfinished
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  feeling deserves another conversation with your
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  healthcare team. I hear versions of this all
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  the time from people who are several months or
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  even a year or more past knee replacement. Some
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  say they're 85 % better, others say 95%. The
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  exact number changes, but the experience, it
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  seems to be similar. They know life is easier
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  than it was before surgery, yet their knee has
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  not completely faded into the background yet.
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  That remaining percentage can become surprisingly
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  distracting. Once the major pain has improved
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  and basic independence has returned, smaller
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  limitations become easier to notice. Early on,
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  getting in and out of bed or walking to the bathroom
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  may have been the day's major accomplishment.
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  Later, the standard changes. Now you notice that
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  you still use the railing on stairs, hesitate
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  before stepping onto uneven ground, or feel tired
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  after an afternoon that would not have seemed
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  demanding years ago. Nothing necessarily went
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  wrong. You may simply be seeing the difference
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  between having less pain and having fully restored
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  physical capacity. One reason people might feel
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  stuck at 90 % is that they compare today's knee
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  with the knee they had before arthritis even
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  entered the picture. They remember hiking without
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  thinking about every step, kneeling in the garden
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  for an afternoon or spending an entire day on
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  their feet without paying attention to either
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  knee. That memory can become the benchmark even
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  when it reflects how they moved 20 or 30 years
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  ago. But what about the final year before surgery?
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  How far could you comfortably walk? Were you
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  turning down trips because you were concerned
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  about keeping up? Did you pause before climbing
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  stairs? Were you planning errands around how
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  long your knee would tolerate being on your feet?
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  Arthritis usually changes life gradually. You
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  walk a little less. Choose a closer parking space.
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  Stop taking a certain staircase or let someone
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  else carry the laundry. Each adjustment is small
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  and it's small enough to seem reasonable. But
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  over time, those adjustments become your normal
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  routine. Once surgery reduces the arthritic pain,
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  it can be easier to remember the distant past
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  than the limitations you were living with immediately
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  before the operation. Another reason the last
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  10 % can feel elusive is the expectation that
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  your artificial knee will eventually become indistinguishable
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  from the knee you were born with. A knee replacement
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  can become comfortable, dependable, and highly
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  functional. It can allow you to return to activities
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  that severe arthritis has taken away. But it
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  does remain a reconstructed joint surrounded
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  by muscles, tendons, nerves, skin, and other
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  tissues that have been through both years of
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  arthritis and a major surgery. Some people do,
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  however, return to feeling like their knee replacement
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  is their natural knee. though this doesn't happen
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  to every single person. You may occasionally
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  notice pressure at the front of your knee, a
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  patch of numbness beside the incision, clicking
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  from the components, stiffness after sitting
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  or an unusual sensation when kneeling. Some people
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  notice their knee joint after a long day or a
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  sudden increase in activity. Awareness of your
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  knee does not automatically indicate damage,
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  loosening, or failure. A helpful question isn't
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  usually simply, do I ever notice my knee? It's
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  often, how often does my knee interrupt my life?
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  Three months ago, you may have thought about
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  it with every step. Today, perhaps you notice
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  it when you first stand, then forget about it
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  while talking with a friend or walking through
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  a store. You may go several hours before it crosses
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  your mind again. And that's meaningful progress,
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  even though your knee has not become completely
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  invisible. Research supports the idea that improvement
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  after knee replacement is not captured by one
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  simple percentage. Self -reported function often
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  improves substantially during the first three
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  to six months. Performance -based measures, including
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  walking speed and other physical tasks, can follow
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  different and more variable courses. People may
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  report feeling much better while still demonstrating
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  limitations when a task becomes faster, longer,
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  steeper, or more demanding. That difference helps
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  explain why you may be pleased with the surgery
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  and still feel like it's unfinished. Pain relief,
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  daily function, strength, endurance, movement
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  quality, and confidence do not always improve
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  at the same rate. Consider walking on stairs.
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  You may be able to climb them using a normal
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  alternating pattern, but still depend heavily
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  on the railing. Going down may remain slower
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  or less controlled than going up. And that final
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  portion is often less about the new joint itself
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  and more about the strength and control required
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  to lower your body safely onto the next step.
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  The quadriceps muscle at the front of your thigh
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  has to control that descent. Your hip muscles
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  contribute as well. If those muscles are still
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  weaker than they were before arthritis, you may
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  find yourself using the railing, shifting your
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  weight to the other leg, turning slightly sideways,
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  or dropping more quickly onto the lower step.
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  The task gets completed, but it doesn't feel
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  natural yet. Walking can create a similar experience.
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  You may be able to walk through the grocery store,
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  but tired during a full day of sightseeing. You
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  may move comfortably on a smooth sidewalk but
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  become cautious on grass, gravel, or a crowded
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  path. You may walk well when concentrating and
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  notice an old limb when you're tired or distracted.
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  Those are not necessarily signs that anything's
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  really gone wrong. They may show that ordinary
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  walking has returned before the higher levels
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  of strength, endurance, balance, and automatic
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  movement needed for more complex situations.
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  If walking still feels awkward, uneven, tiring,
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  or unlike your old pattern, I wrote a concise
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  book called Walking Like Yourself Again After
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  Knee Replacement. It explains why walking can
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  continue to feel different and how people gradually
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  rebuild smoother, more confident walking for
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  everyday life. The link is in the show notes
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  if you'd like to check it out. There's also a
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  difference between capacity and participation.
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  Capacity is what you can do under controlled
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  conditions. Participation is what you actually
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  do in daily life. You may be able to walk for
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  20 minutes when you set aside the time, wear
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  the right shoes, and choose a level route. But
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  perhaps your normal day still contains long periods
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  of sitting. You may be capable of climbing stairs,
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  but continue to avoid them out of habit. You
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  may have enough strength to rise from a chair
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  without your hands, yet still push from the armrest
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  because the pattern became familiar. Surgery
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  can change what your joint allows. It does not
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  automatically rebuild every activity that disappeared
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  during the years before surgery. Returning to
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  those activities usually requires repeated exposure.
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  Your body needs opportunities to use this new
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  capacity in your ordinary life. That does not
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  require turning every day into a test. It may
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  involve choosing the stairs once while the elevator
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  is also available, walking a little farther through
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  the store. standing during part of a conversation
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  or carrying a light bag when that's appropriate
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  for you. The goal is not usually to choose exhaustion.
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  It's to reconnect physical ability with the life
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  that you want the ability to support. The last
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  10 % may also represent a goal that's never been
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  clearly defined. I want my knee to feel normal.
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  Sounds straightforward, but normal can refer
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  to several different things. It might mean walking
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  without a limp, getting up from the floor. kneeling
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  at a church service, playing 18 holes of golf,
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  managing a full travel day or a full work day,
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  or simply reaching the evening without thinking
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  about your knee joint. Until the goal becomes
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  specific, it may be difficult to know whether
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  the missing piece is strength, mobility, balance,
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  endurance, skill, confidence, or an expectation
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  that no implant could realistically meet. Suppose
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  someone says, I'm 90 % better, but I still can't
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  get off the floor. That's a specific functional
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  problem. It can be assessed. A physical therapist
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  can look at your knee motion, leg strength, hand
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  support, balance, and the sequence being used
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  to move from the floor to standing. The person
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  may need a safer strategy, more hip and thigh
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  strength, or practice using a stable surface.
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  If that's the case, you might want to check out
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  one of the future episodes where I'll talk about
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  transferring to the floor and getting back up
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  again. Another person may say, I'm 90 % better,
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  but I still notice my knee when the weather changes.
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  If daily function is good and no concerning symptoms
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  are present, that occasional awareness may not
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  require a new rehabilitation goal. It may be
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  part of living with your new prosthetic joint.
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  The percentage sounds the same, but the situation
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  is very different. This is why chasing a perfect
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  score can become frustrating. Every time one
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  limitation improves, Your attention may move
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  to the next smallest difference. First, you want
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  to walk without a cane. Then you want to walk
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  without thinking. Then you want to walk farther,
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  faster, on hills, and through an entire day.
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  Progress creates new expectations, which is often
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  a good sign. But it can also make the finish
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  line keep on moving. There's nothing wrong with
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  continuing the pursuit of meaningful goals. The
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  key is to decide whether the goal improves your
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  life or simply proves that your knee is perfect.
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  A useful way to judge progress might be to look
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  across several areas. Think about what you can
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  do, how much effort it requires, how you feel
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  afterward and how often your knee changes your
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  plans. You may discover that an activity is possible,
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  but still inefficient. You may find that the
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  activity feels good, but your endurance is limited.
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  Or you may realize that you're physically capable,
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  but you've not attempted it because you're unsure
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  what is safe. Those distinctions guide the next
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  step far better than an overall percentage. They
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  can also help you decide when another professional
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  assessment is worthwhile. If you've reached a
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  genuine functional plateau, a physical therapist
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  can compare your operated leg with the other
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  side, observe your walking and stair mechanics,
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  measure strength and motion, and identify whether
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  your current program still matches your goals.
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  Rehabilitation after knee replacement should
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  be individualized. Someone returning to a demanding
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  job, caring for a spouse, hiking on uneven terrain,
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  or trying to get safely onto the floor may need
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  different training than someone whose primary
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  goals are household mobility and comfortable
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  community walking. The exercises should really
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  serve the destination. You may also need to reconsider
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  dosage. A program that was appropriate six weeks
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  after surgery may no longer provide enough challenge
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  at six months. Ten easy repetitions of an exercise
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  can remain useful for movement practice, but
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  they may not be sufficient to build the strength
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  required for stairs, hills, carrying, or rising
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  from a low seat. Strength training should still
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  be progressed carefully and in line with your
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  surgeon's and physical therapist's guidance.
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  Yet, careful does not have to mean permanently
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  easy. Muscles adapt when the tasks gradually
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  ask more of them. That may involve added resistance,
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  slower lowering, greater range, additional repetitions,
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  or a more demanding functional variation. Walking
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  deserves that same thoughtful progression. Adding
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  a large amount all at once can leave your knee
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  irritated and make it difficult to know what
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  caused the response. Gradual increases provide
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  information. You can observe how your knee responds
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  during the activity, later that day and the following
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  morning. A temporary increase in stiffness or
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  muscle fatigue after a new challenge is different
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  from rapidly increasing pain, major swelling,
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  new instability, or a loss of function that continues.
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  Those changes deserve attention rather than being
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  dismissed as the last 10%. Persistent or worsening
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  symptoms should not be explained away with encouragement.
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  Contact your surgeon or another qualified clinician
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  if you develop increasing pain. Warmth, redness,
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  drainage, fever, new calf pain, Shortness of
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  breath, a sudden loss of motion, repeated giving
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  way or a major change in your ability to bear
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  weight. A knee that has been doing well and then
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  changes substantially also deserves medical review.
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  For people with ongoing pain months after surgery,
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  the goal is not to assume that more exercise
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  will solve everything. Persistent pain can have
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  several contributors, and a structured evaluation
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  is appropriate. If you feel a bit conflicted
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  about your pain because it changes from day to
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  day, I wrote a concise book called Making Sense
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  of Pain After Knee Replacement. It offers a clear
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  way to understand what you're feeling and prepare
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  for more useful conversations with your healthcare
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  team. Check out that link in the show notes if
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  that's something interesting to you. Most people
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  are not describing severe or escalating pain
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  when they talk about the last 10%. They're describing
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  smaller gaps between functional and feeling fully
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  effortless. Effortless movement often returns
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  later because it depends on repetition. When
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  you have practiced a task enough times, your
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  attention no longer needs to supervise every
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  detail. You stop thinking about where to place
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  your foot, how much to bend your knee, or whether
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  your leg will support you. The task becomes familiar
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  again. You may notice it first in brief moments.
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  You walk across the kitchen without monitoring
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  each step. You stand from a chair while continuing
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  a conversation. You reach the bottom of the staircase
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  and realize you didn't think about every step.
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  These moments are easy to overlook because the
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  achievement is the absence of attention. If you
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  tend to focus on what's still missing, consider
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  keeping a simply monthly record rather than grading
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  your knee every day. Note a few activities that
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  are relevant to your life such as walking duration,
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  stair use, getting up out of a chair, shopping,
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  gardening, travel or sleep. Monthly comparisons
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  can reveal changes. that disappear inside the
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  ups and downs of individual days. You can also
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  ask someone close to you what they've noticed.
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  They may see that you're walking farther, accepting
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  invitations you used to decline, standing through
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  a social event, or joining activities that arthritis
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  had gradually removed from your life. They're
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  often looking at the whole picture, while you
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  might be focused on one stiff knee morning or
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  one difficult staircase. If you enjoy having
• 15:44
  practical knee replacement education and research
• 15:46
  updates collected in one place, you can join
• 15:48
  the Total Knee Success insider newsletter. I
• 15:51
  share additional education there to help you
• 15:54
  make informed decisions and keep your goals connected
• 15:56
  to daily life. When you describe yourself as
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  90 % better, pause before deciding that the remaining
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  10 % is one single problem. Give it a name. Is
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  it stair control, walking endurance, kneeling
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  strength, balance, a patch of numbness? occasional
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  stiffness in your knee, concern about damaging
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  the implant, or the wish that your knee would
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  feel exactly as it did decades ago. Once you
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  name it, you can decide whether it needs training,
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  practice, reassurance, medical assessment, or
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  acceptance of a sensation that does not limit
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  you. The last 10 % is not always one more exercise,
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  one more degree of motion, or one more milestone.
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  Sometimes your strength continues to grow. Sometimes
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  a task becomes easier through repetition. and
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  sometimes the remaining sensation stays present,
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  but stops influencing what you choose to do.
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  One day, perhaps without planning it, you may
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  finish an entire afternoon and realize that you've
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  hardly thought about your knee. It didn't disappear
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  or become the knee that you had at 25. It simply
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  carried you throughout the day and without asking
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  to be the center of your attention. For many
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  people, that's what the last 10 % eventually
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  looks like. In episode 93, we're going to focus
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  on one activity that often remains inside that
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  final percentage, and that's kneeling. We'll
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  look at why kneeling can feel painful, pressurized,
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  numb, or frightening after knee replacement,
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  what the research says about the ability to regain
• 17:22
  it, and how graded practice may be used with
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  the approval of your surgeon and rehab team.
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  Thanks for joining me. I'm Michelle, and this
• 17:30
  has been the Total Knee Success Podcast. This
• 17:37
  podcast is for educational purposes only. Discover
• 17:40
  more at TotalMeSuccess .com and be sure to subscribe
• 17:44
  and share because every step forward takes you
• 17:47
  closer to living the life you love.