TKR 9 weeks - so far so good!<

[ferddword]

Hello everyone! Although I just recently created a profile and this is my 1st post or comment, I've been an avid reader since week 2 of my recovery.

First and foremost, thank you for this site! I truly appreciate all the folks contributing and sharing their experiences and knowledge. It's been such a great resource as I work thru recovery. Very much appreciate everyone!

RTKR on 11/7. Competitive impact sports (basketball, softball, long distance running) for many years even after OS told me to stop caused a slight valgum deformity. All went well and now after years at looking at a crooked leg, its now straight! OS, hospital, and staff have been really great. Only thing is they didn't tell me to ice as much as I have learned thru this site. Been religiously doing that since week 2. Went home after just 1 night.

Following the mantras and went to PT week 3 to get exercises. I was at 0 and 100. Go twice a week, but do them everyday. Mainly walking and doing things around house to get my workout in.

I do have a few questions/concerns (I've tried searching for the answers, but haven't found anything that was exactly specific):

1) I have the tight band feeling mainly at night, not too bad, but curious if I should still do exercises when I'm feeling it. Its a bit less in the morning.

2) Operated leg feels a bit longer. I've read that it should go away as the swelling continues to go down. But, anyone else experienced this and what was ultimate outcome?

3) Skin around incision is really dry. I know not to put any lotion on the incision, but how about around it?

4) Knee feels definitely foreign still, but kneecap feels exceptionally hard. Maybe nerves are still reconnecting thats causing that sensation?

5) Done with aspirin and celebrex and only take Norco twice a day. Gabepentin once a day have a few days left. Should I start taking alleve or ibuprofen to keep swelling down?

Thank you in advance!


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[Josephine]

Hi ferddwrod and welcome to BoneSmart! Sounds like you're not doing at all badly for 4½ weeks out! I'll try and address your questions.

1) I have the tight band feeling mainly at night, not too bad, but curious if I should still do exercises when I'm feeling it. Its a bit less in the morning.

There are two causes of the 'tight band' syndrome. Both are related to pain. One is this "Tight band" feeling across the front of my knee but the other is that it is caused by exercises! So stop the exercises! ALL of them!

2) Operated leg feels a bit longer. I've read that it should go away as the swelling continues to go down. But, anyone else experienced this and what was ultimate outcome? Had a slight valgum deformity

Well, it's either valgus or varus. There's no such thing as valgum! But which ever deformity you had, it does give you the sensation of a loss of leg length. But no doubt you had this deformity for some years and so became accustomed to it. But now it's straightened out and back to normal, the immediate result was that your body perceived this as being longer when it was, in fact, just restored to normality!

3) Skin around incision is really dry. I know not to put any lotion on the incision, but how about around it?

Around it is okay but not on the wound.

5) Done with aspirin and celebrex and only take Norco twice a day. Gabepentin once a day have a few days left. Should I start taking alleve or ibuprofen to keep swelling down?

No! Elevating and icing and adequate pain meds are the key to this.

4) Knee feels definitely foreign still, but kneecap feels exceptionally hard. Maybe nerves are still reconnecting that's causing that sensation?

It's probably swelling which can be quite hard sometimes but I very much doubt you are in any way aware of the implants - I'm not and I have two! - but the surrounding tissues if swollen can be very hard. And since swelling is a form of pain, I will be bound to ask you a few questions and here they are!

It would be very helpful if you would answer each one individually - numbered as I have done - in as much detail as you can then I'll come back as see where you are ....

1. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine)

2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?

3. how swollen is your leg compared to these?

4. what is your ROM - that's flexion (bend) and extension (straightness)

5. are you icing your knee at all? If so, how often and for how long?

6. are you elevating your leg. If so how often and for how long?

7. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and

8. what kind of PT exercises and exercises at home are you doing? How much and how often?
This is the most crucial question so please help me by using the format I have left as an example
(which means please make a list and not an essay!)

Exercises done at home and how many sessions you do each day
enter exercise by name then number of repetitions of each
etc., etc.

At PT (how many times a week)
enter exercise by name then number of repetitions of each
etc., etc.

 

[Josephine]

Oh yes - and I need to leave you these as well! Sorry to bombard you this soon but you must know how this forum works by now!

First is the reading - everybody gets a free copy of the recovery reading!

Here are the BoneSmart mantras ....
- rest, elevate, ice and take your pain meds by the clock
- if it hurts, don't do it and don't allow anyone - especially a physiotherapist - to do it to you
- if your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again
- if you won't die if it's not done, don't do it
- never stand when you can sit, never sit when you can lie down, never stay awake when you can go to sleep!
- be active as much as you need to be but not more than is necessary, meaning so much that you end up being in pain, exhausted or desperate to sit down or lay down!

Next is a FAQ (Frequently Asked Questions) thread.

And here are some very crucial articles
BoneSmart philosophy for sensible post op therapy

The importance of managing pain after a TKR and the pain chart
Swollen and stiff knee: what causes it?
Energy drain for TKRs

Myth busting: no pain, no gain
Activity progression for TKRs
Heel slides and how to do them

Extension: how to estimate it and ways to improve it
Elevation is the key
Ice to control pain and swelling

Healing: how long does it take?
Chart representation of TKR recovery
Myth busting: the "window of opportunity" in TKR

Myth busting: on getting addicted to pain meds
Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

 

[FlaGranny]

Mine feel hard too, but it is because I can actually feel them and see them now. I have had swollen knees for so long that I forgot I had kneecaps.

 

[ferddword]

Thanks, Josephine - you are awesome, such a wealth of information. You've been my voice and source of advice for last few weeks!

Tight band - I have read your post regarding this before, but since it wasn't too tight, was wondering if working out would be ok. I'll stop as soon as I feel them coming on. I feel it mainly on left side.

LOL...it was valgus. I'm a little worried though that it may be slightly longer because my left knee has a slight bend also. Not near as much but still there. I'm pretty sure I'll need it a TKR at some point down the road.

Ok on the lotion and on not taking alleve or ibuprofen.

To your questions:
1. I'm mostly at 1. Not really painful. Just tightness.
2. Originally Celebrex and Aspirin - 2x/day, Gabepentin 1/day. Norco 1 every hours.
3. Moderate
4. At week 3 at PT was at 0 and 100. Haven't been back but feel like its better now.
5. Yes, mainly in afternoons after being active during most part of day. Around 40 minutes. Also before I sleep for same.
6. Yes, I follow the pics on the site for proper elevation. Elevate same time as icing.
7. Walk half a mile twice a day walking dog. I have a couple small businesses so visit office and store. Nothing too strenuous. A bit of light shopping. Driving since end of week 3. Tooling around in garage.
8. All exercises twice a day: Laying heel slides 1 set of 10 reps. Quad sets/leg raises 2 sets of 10 reps. Side leg raises 2 sets of 10 reps. Laying hamstring stretch 1 set of 3. Sitting knee flex 2 sets of 10.

But I actually have been listening to your philosophy of doing less PT in hopes of gaining more.

I feel like its going slowly but steadily so happy about that. Looking forward to getting back out on the golf course soon!

And thank you for the mantras and articles. I think I've read them all at least 6 times previously...all excellent.

Thanks again.


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[ferddword]

Josephine - so with regards to the tight band, do you think I should cut down or even stop PT exercises until that feeling completely goes away or subsides substantially? Will "normal" activity like walking, housework, light shopping, etc suffice? Skip knee focused exercises, but I'm worried the lack of activity will negatively affect me.


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[BBCG]

Hi Ferddword and welcome.... I'm glad you've been following ideas here since week 2; I didn't find this forum until I was about at week 3 in dire straits! But, I've had some of the same issues, so thought I'd chime in...
1...Tight Band at Top of Knee: When my knee was about 5 weeks from surgery, someone on this forum mentioned a pain cream they were prescribed, and I investigated it here in Oregon, and found a "compounding" pharmacy that would make it for me, once I got my OS to prescribe it. So, I called the PA there, explained why I wanted it (tight band at top of knee and tight quads, etc.) and they did authorize it. I've been using it daily and once the wound had closed firmly, it was okay to use it on the scar according to my OS, so I've done so since then. I'm not experiencing the tight band any more (at just about 5 months), and only use the pain cream once a day, usually before bed to aid pain-free sleep.
2...Skin dry: My skin initially was dry, but once I began using the pain cream, that problem vanished...
3...Leg Feels Longer: I, too, have a nice straight leg now...plus the other one that's bent (valgus deformity)! So, indeed, my new knee leg felt "longer" at first, but I've gotten accustomed to it, now, and if I stand with bare feet, I can sense that difference, but it's not affected my gait, my recovery, or much else. I work on walking more normally now, with foot straight instead of turned out, I'm strengthening both, and my not-yet-operated leg is actually happier than it used to be, since my new leg is pulling its weight now. My latest "test" was helping carry a heavy concrete/aggregate bench top to a customer's car without any dire results, so that was cool.
Indeed, as you'll hear so often, time is on your side, and these small victories happen over and over, smaller then bigger, as you recover. I, too, had to reign in PT enthusiasm for bending and forcing, and doing so worked well for me, as I continued to go for about 3.5 months...
Hang in there, as time really makes a big difference. I feel that at 4 months, my progress in bending and straightening really took a jump forward!

 

[ferddword]

Thanks so much BBCG! I'll research that cream. The tight band feeling seems to be dissipating ever so slightly each day, but its more pronounced at night - maybe due to activity throughout the day. Its not painful and doesn't hinder my sleep. Glad to hear a fellow Valgus sufferer not having issues. I too will need to get my other knee done at some point. Wow! At 5 months you carried something that heavy?! Thats real encouraging. Happy to hear your recovery is going along nicely! I see and feel mine is progressing pretty good as well and hope it continues in that direction. Thanks again!


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[ferddword]

Should I wait till the tight band feeling goes away completely before I do any knee focused exercises?


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[FlaGranny]

That's up to you, but remember - do not do anything that is painful or that causes you pain after the fact, that night or the next day, or in any way makes your knee worse. You will know if you should or shouldn't do something. I am at almost 3 months for my newest knee and I'm going to try next week to return to the gym. We'll see how it goes. If it hurts I won't do it. If I'm sore afterwards I won't do it. I "knew" I wasn't ready until just recently and now I'm itching to try.

 

[newlybionic]

That tight pain feeling plus the fact that you describe your knee as having a moderate amount of swelling indicates to me that you need to elevate amount c ice more frequently than you are doing now. I know it's hard to try to give your knee more time to heal but you are only 1 month ought from surgery. You need to ice amount cod elevate more frequently than 2 times a day. You won't lose range of motion by cutting back a little on what you are doing.
http://bonesmart.org/forum/threads/activity-progression-for-tkrs.14334/
Look at the link above to see what you apshoukd be doing at each stage of recovery.

 

[ferddword]

Appreciate it @FlaGranny & @newlybionic! All makes sense. Just tough to sit (or lay) around. So used to be active...cabin fever sets in much more quickly it seems this past week. I need to accept to relax and chill! More is less I guess!


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[Josephine]

Thanks, Josephine - you are awesome, such a wealth of information. You've been my voice and source of advice for last few weeks!
And thank you for the mantras and articles. I think I've read them all at least 6 times previously...all excellent.
But I actually have been listening to your philosophy of doing less PT in hopes of gaining more.

Why thank you, kind sir! A girl can use a nice bit of flattery from time to time! I'm pleased you've found them so useful.

so with regards to the tight band, do you think I should cut down or even stop PT exercises until that feeling completely goes away or subsides substantially? Will "normal" activity like walking, housework, light shopping, etc suffice? Skip knee focused exercises, but I'm worried the lack of activity will negatively affect me.

You've pre-empted my replies to your answers! The fact is that you can safely cut out ALL exercises and the only result will be entirely positive, I promise. The trouble is that PTs are so hopelessly imprinted on the 'no pain, no gain' and that you have to 'work hard' for ROM, it's become legend. But I can promise you too that this is all myth and there is no truth in it whatsoever.
You might like to read these
Myth busting: the "window of opportunity" in TKR
Myth busting: the "window of opportunity" JBJS
Myth busting: no pain, no gain

1. I'm mostly at 1. Not really painful. Just tightness.

Well, tightness is a form of pain! Don't forget that!

2. Originally Celebrex and Aspirin - 2x/day, Gabepentin 1/day. Norco 1 every hours.

Aspirin is just for anti-coagulant therapy. If your pain is only at a 1, why are you taking Celebrex and Gabapentin? If you need any pain meds at all, a couple of Tylenol 3-4 times a day will be much more effective.

3. Moderate

Swelling is also a form of pain, you know. So stiffness, tightness and swelling - I'd say you would be better off using the Tylenol.

4. At week 3 at PT was at 0 and 100. Haven't been back but feel like its better now.

Jolly good!

5. Yes, mainly in afternoons after being active during most part of day. Around 40 minutes. Also before I sleep for same.
6. Yes, I follow the pics on the site for proper elevation. Elevate same time as icing.

You accomplish little or nothing in that period of time. Ice for at least 60mins and more than 4 times a day.

7. Walk half a mile twice a day walking dog. I have a couple small businesses so visit office and store. Nothing too strenuous. A bit of light shopping. Driving since end of week 3. Tooling around in garage.

5 weeks out - sounds okay to me!

I'll give you my ideas about this anyway
My comments in bold
All exercises twice a day - I'd say once a day is plenty and none at all at the weekends!
laying heel slides 1 set of 10 reps - heel slides are easy to do badly and this is badly! Read this Heel slides and how to do them properly.
sitting knee flex 2 sets of 10 - this is a second knee flexion exercise - never mind you already have excellent ROM so really don't need to do any of them any more!
quad sets/leg raises 2 sets of 10 reps - too much, too intense sessions. Besides which, once you can do SLRs you don't need to do them any more! Honestly!
side leg raises 2 sets of 10 reps - these are not appropriate for knees
laying hamstring stretch 1 set of 3 - these are okay IF you ave hamstring pain

But you're going to stop all these anyway, aren't you? So it's all irrelevant anyway! But you could read this to confirm your decision: It's not the exercising that gets you your ROM, it's time. Time to recover, time for swelling and pain to settle and time to heal. One thing that seems to be missing from all the PT's protocols is that all your ROM is there right from the start, just waiting for all that to happen so it can show itself. In the general run of things, it doesn't need to be fought for, worked hard for or worried about. It will happen. Exercise as in strength training is counter-productive and does more harm than good. Normal activity is the key to success.

I feel like its going slowly but steadily so happy about that. Looking forward to getting back out on the golf course soon!

It will improve a bit faster when you stop but it might not do that for a week or two. But do remember that your ROM is 100/0 already which isn't half bad for just shy of 5 weeks! You'll be impressing yourself no-end by week 12!

 

[sistersinhim]

You are really doing well for just a month out! All you have to do is to follow the BS way and you will continue to do fine. Quitting PT was a smart move. You're already there with your ROM and will continue to get better every day. You will have ups and downs for months. I still do and I'm 6 months out. But, my downs are so much better than they used to be. And yours will be, too!

 

[ferddword]

Thanks again, @Josephine! And thank you, @sistersinhim! I will follow the advice and forego the PT exercises and just let time and day to day activities serve as my "exercises." I actually cancelled my PT sessions earlier today after I read your replies. Just feels weird to go against everything I've read and everyone I've talked to before getting surgery that said "just make sure you closely follow your PTs instructions!" I'll ramp up my icing. It does swell a bit more at end of day after being active throughout the day. My knee feels "normal" and a part of me in the morning, but as day progresses swells so starts to feel clunky and I start to limp a bit. I barely iced this weekend...ugh. I'll hold off on Tylenol unless I feel discomfort/pain. Ok, last time, you sure I should stop going to PT? No pain, more gain!


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[ferddword]

Anyone see any issues that I cover my incision with gauze even though its closed, no seepage, most of the steri strips have come off, and half of the scabs are gone? I don't tape the gauze completely down, it still breathes. In my mind I'm giving it a bit of protection. Am I risking anything by going overboard?


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[Celle]

What are you trying to protect your wound from? You say it's closed and scabs have formed. It should be OK if you leave it open. It's sensible to cover it if you feel that your clothes are rubbing on it, but otherwise, I'd leave it uncovered.

And, yes, stop the PT. even though your skin incision is closed, healing is still going on under the surface. Your knee needs time and gentle treatment, so that it can continue to heal.

 

[sistersinhim]

Oh yeah, you can stop pt and just use your knee in your daily life. I've done it 11 times with both knees and know it works. As you start to feel better, you'll automatically use it more, thus you're doing your own pt. And you're doing it the safest way for your knee!

 

[ferddword]

Thanks @Celle & @sistersinhim. I'll follow the BS philosophy. Crazy that our surgeons(and their teams) can successfully perform this incredible surgery but advise improperly on PT?!


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[sistersinhim]

I have my own thoughts about these two professional teams. I believe that most OS haven't kept up with the latest PT methods for a tkr and were trained years ago on the old way. And as long as the therapists keep you coming to them, they are making money. I believe that's a motive for many of them. These are just my own opinion and I have no facts to back it up! But, if you had a broken leg, would you start therapy a day or two after breaking it? Well, your knee has 2 broken bones in it that have to heal, not to mention all the tissues inside. That takes time.