Bilateral TKR 7wks post op

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I also think you are trying to do way too much at this stage of recovery.
Yes---this is a case where you are thinking "I should be here by this time in recovery."

What you are really thinking is "I want to be here by this time in recovery."

What is actually happening is this---you knee is telling you,"No matter where you think you are, no matter where you would like to be, you are only here, and I (the knee) will determine how fast you recovery."

This is your time to relax and let others take care of the chores. Your job is healing and you interfere with that if you try to do too much.
Again, a big "YES"!!! It is time to take a few steps back and reduce your activity level---and let the knee heal.

The happier the knee, the better and easier (not necessarily faster) the recovery.
 
@KTF , I see that Josephine answered your questions (better than I could!). The thing with keeping your legs straight all the time is the strain it puts on the backs of your knees - at least I find it very painful. I do put my feet on a stool in front of a chair when I'm sitting for short periods of time as it is an aid in extension. But if I'm lying in bed, I usually keep a slight bend...not putting anything under the knees, just not trying to keep them rigid. My extension if fine.

I will use stairs for flexion exercises - foot on step and bend knee forward - but can't imagine doing that going down. I am pretty chipper...if not satisfied with my flexion. But I wholeheartedly agree with the philosophy of recovery and I read and re-read the articles Josephine left for you.

Keep the faith! It will get better!!!
 
@KTF, I was so surprised to read the description you gave of the problem you are having in your right knee. It matches me exactly! Describing it as an electrical shock through your body is very accurate - I was having trouble describing it and said it was like a rubber band tightening up, and then hurting very badly when it finally snaps. Mine is in my right knee, as well. My OS as well as the 3 physical therapists who rotate with me don't seem to be concerned. But it is very painful, and keeps me from progressing as well as I should because I am always anticipating (and dreading) the "snap". I am almost 12 weeks out, and currently battling with the Dr. to get adequate pain control. They started about a month ago already, telling me I should be able to do with less as time goes by. I find I can make it through the day if I take 2 vicodin 3 times during the 24 hours. But they don't want me to do that anymore -- my last refill was 15 tablets and is supposed to last me for a week. Tramodol and Meloxicam don't work on me for some reason. Their last suggestion is to take 2 Tylenol 3 times a day! How are you managing your pain levels? I would be happy to switch to any other type of meds that would work. And how are you handling the pain in the right knee?
 
@chandler, I just saw this message. I somehow missed this whole thread and @Josephine's thoughtful answers. I'm not good at getting around in this forum. Wow Chandler, you have that same pain I do?!?! I'm in my 9th week and that pain is not changing. I just do everything I can to not aggravate it. I am hoping that by 12 weeks some healing would take place. I missed whether you did one or two knees.? My left knee is a champ! The RoM is about 125 and while it still hurts and swells, I can see the light at the end of the tunnel. My right knee is stuck somewhere around 100-103 and frequently feels like less. I don't like doing the measurement on that one because of my fear of the shocking pain. It is hard to not go to fear a lot with this one. The doc saw me have this and did not get excited. One pT says push, most say DoN'T! I see an osteopath who says avoid the pain, thinks a tendon or something seems to be wrapping a nerve or perhaps there was a nick in the nerve (eeeek) . He says let it heal for 6 months and then we can address it. I stay with that thought and try to stay positive.

I noticed that everyone seemed to remark that I'm doing too much. That is odd for me to hear as I feel like I really am not. I understand how subjective this is and how it is difficult to describe, however, I will heed the advice and pay closer attention to my activity.
Chandler, I'm sorry your docs are not more empathetic about your pain. I'm using norco (10mg) and Tylenol. I'm careful to add up how much I take thru the day to not exceed around 3000 mgs Tylenol. I take 2 norco at bedtime and 625 mg Tylenol around 8 am. I take 2-3 more norco during the day with Tylenol depending on my activity. 15 for a whole week is ridiculous!

What is your ROM on your painful knee?
KTF
 
@KTF, so glad you are still here! I thought I lost you! lol Actually, I went to see my surgeon today, as that pain "we" have is so hard to deal with. As luck would have it, as soon as he sat down and put his finger on the spot that catches and finally clicks, it did it like clockwork! I was so sure that I would try to describe it and never have it happen while I was in his office. At least he knew it wasn't all in my head! He took x-rays just to make sure that something wasn't floating around in there, and said he thought it was just soft tissues that are forming and trying to figure out where they will end up. He ordered a full prescription of pain meds (hydrocodone 10-325s) for me without any hesitation, and said to just take as needed for another several weeks. It at least made me feel relieved that I won't have to fight the pain without any help other than Aleve or Tylenol!

As far as ROM, it is 124 on the right knee (where the "catch" is) and just under 120 on the left. My physical therapists seem pretty content with the motion and straightening, and we are working on strengthening the muscles. Thursday, one of the therapists asked if I had ever had dry needling. It sent chills right through me, cause I have a real needle phobia. But he was really encouraging about the helpfulness of it, so we tried it. Really wasn't bad at all, and I felt a bit of relief in the area that catches. But it certainly hasn't eliminated the problem. And I'm not sure if I'll want to do it again when I go in next week.

What, if anything, does your Dr. suggest you do to try to get beyond it?
 
@chandler , Hi! You are doing so well with your ROM! I think this is called ROM Envy! And I believe you are only about 3 weeks further along than I am. My rt leg feels stuck at about 100 or so and it is very depressing and makes it hard to enjoy the success of the left leg. Well, maybe the next couple of weeks will make a difference. I've only been told to do some stretches and massaging by the PT, the surgeon didn't give me any suggestions other than patience.
What exactly is the dry needling ... acupuncture or something else? And would anyone want you needling near the knees? I thought infection was what we fear most!! But I'd try anything!
Thanks for your reply! I enjoy this forum. I just need to figure it out a little better.
Edit: I just looked up dry needling...I would so be open to this...I'll check it out.
 
I must say I am very concerned about the duration of icing this site advocates. I have asked several Drs (OS) and Physical therapists and all agree No more than 20 min on and an hour to defrost between. Otherwise negative things happen.........
Just ask your own Dr before leaving ice on indefinitely or going over 20 min......Please ask your P.T. and Dr



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And let us all remember not to push to the numbers.......I am so guilty of this trap , then I get too much swelling and set back. My Dr said she wants me to be more concerned with swelling than P.T. at 8 wks.....food for thought.


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I must say I am very concerned about the duration of icing this site advocates. I have asked several Drs (OS) and Physical therapists and all agree No more than 20 min on and an hour to defrost between. Otherwise negative things happen.........
Just ask your own Dr before leaving ice on indefinitely or going over 20 min......Please ask your P.T. and Dr



Sent from my iPad using BoneSmart Forum


@Josephine @Jamie
Any comment?
 
I noticed that everyone seemed to remark that I'm doing too much. That is odd for me to hear as I feel like I really am not.
I agree with everyone, sorry :)

Josephine and 'everyone' has explained why, here's my extra tuppence worth.

If you do something and it causes a bit of swelling, then do it again before the swelling has gone down, you are progressively worsening your knee. This is a vicious circle. This is why the mantra contains

- If you won't die if it's not done, don't do it;

All you need to do is gentle mobility stretches, to the point of discomfort not pain. The rest of the time sit and watch TV. Really.

You don't need to exercise to heal, exercise is for when you are healed to make you fitter.
My right knee ... I don't like doing the measurement on that one because of my fear of the shocking pain.
Then don't do it.

Mantra again

- If it hurts, don't do it




If you think that I am shouting at you, I apologise; you are obviously only trying to do your best.

The correct way is so counter-intuitive and counter-culture (Jane Fonda 'no pain no gain' is simply 100% wrong for TKR recovery) that we sound like we're telling you off. We're not, we've been there is all.
 
I am over six months post tkr. Icing was the thing that helped me the most. My OS had his patients ice all night with ice machine which I did for 7 weeks. In the daytime I iced as much as I could - slowly tapering off. I believe my recovery was so good because the icing reduced my swelling tremendously. So I have to agree with the BS mantra that says ice ice ice! And definately dont do anything that hurts! I felt fortunate my surgeon had the same philosophy as this site. Take care!!
 
@Jozilla, @KTF, so good to read your experiences. @Roy Gardiner too! I now know that I need to start icing again. I have to admit that I have been lax in it because I have really felt things were progressed far enough that I wasn't having swelling any longer. But obviously, the snapping pain I/we are having could be irritated or enhanced because of swollen tissue deep inside the joint.

Today, I get my 2 cooling machines out and seriously work on icing. KTF, I have been pretty active for the past several weeks. I do most of the housework (just my husband, myself, and our yellow lab, Casey). I do have help in once every 2 weeks to do bathrooms, total vacuuming, etc. I have been doing limited gardening - not up and down squatting, but planting and arranging lots of pots, placing plants in prepared holes in the ground, watering, etc. It feels good to do things like this, until the dreaded "snap"! I often feel that if it just has to do it once, get it over with! But sometimes it does it every 5 - 10 steps. That is when it wears on me. And I am able to drive with no problems - grocery shopping and regular recreational shopping as well. No marathon shopping sessions as of yet though - lol. I am able to bike - just a little stiff in the very beginning. Yesterday, I did almost 2 miles on our blacktop road. It felt really good to be out and feeling a little more "normal". No problems during or after that.

I'd have to say my problems are pain on the sides of both knees when getting up from seated position, and the snapping band on my right knee. KTF, your ROM will likely come along with time. Mine seemed to be pretty slow, but steady.

The dry needling may be similar to acupuncture. The therapist said it is intended to fire up muscles that don't seem to be responding to exercise. I think he worked on 2 areas, but I have to admit I just laid face down and tried not to think about anything relating to needles! My surgeon wasn't quite sold on the idea and said he only would OK it as long as they didn't go anywhere near the joint itself. So I'm not too sure if I'll have it done again. My next appointment is Wednesday, so we'll see what the next several days bring.

So, after getting 3 1/2 hours of sleep so far (that seems to be my longest lately), I have taken 2 hydrocodones and plan to go back and try for another couple hours before starting my day. Ice will play a part in it, and hopefully that, along with positive thinking, will produce a good weekend. I like your idea of no longer treating myself as an invalid. I'm not saying we need to pretend it didn't happen, but I am ready to be able to do things without having to really think how I'm going to take the next step! Let's get on with life, right?!
 
I so agree with you - let's get on with life! Have a great weekend!
 
Nice to wake up to dialogue. @chandler oh how I wish I could get on a bike. Need more rom on my right to do more than easy recumbent. With regard to the subject of swelling .... I don't think that being up and around for one hour or three hours changing the amt of swelling. I am most stiff and swollen when I wake up and before I go to bed. Activity, my version of moderate, tires me out but doesn't seem to increase swelling beyond that which seems to be a norm. Fat knees and the lumps on the outside of the knees varies. This is so subjective that it is hard to discuss with typing words, but I love the input.
My icing includes first thing in the a.m., then once or twice more in the morning and afternoon, depending on schedule, and again before bed. Usually 3 to 5 times a day, 20 to 40 minutes, or just as long as I lay here, sometimes sleeping.
Here's a question.... Does anyone have theories as to WHY their joints give out, besides the usual answer of arthritis?
Here's mine... I've been an upholsterer for over 30 years, in my home, which allowed me to be able to raise my kids and do the usual struggle, but on my time. My shop is small and besides all the schlepping of heavy pieces, odd positions of stretching fabric, I could never walk more than a couple of steps in any direction without having to pivot. One of the things I've heard about preserving these new knees is to avoid pivoting. Got me thinking. It is not about the blame game or anything, it is just about learning and change. I think my days in that small shop doing that work are over....however, I will do something out there with some rearrangement. I make floor cushions, meditation zafus, like in my picture, however it will be sometime before I can sit on my own work....hahaha.
What are some of the changes people are making as you go through this amazing and difficult experience?
 
I must say I am very concerned about the duration of icing this site advocates. I have asked several Drs (OS) and Physical therapists and all agree No more than 20 min on and an hour to defrost between. Otherwise negative things happen.........
Just ask your own Dr before leaving ice on indefinitely or going over 20 min.

The 20-minute rule is something you will frequently hear in the US (not so much in other countries) and I think it stems from the potential for problems IF a person doesn't provide a buffer between the ice source and your skin. If you don't do this and just place an ice pack directly on the skin, you do risk damage to your skin....the same as frostbite if you're in the cold too long.

In some cases ice packs or gel packs come with a thin terry or polyester fleece cover that is meant to provide a barrier, but it really is not enough. If you read the BoneSmart advice, it is to use a kitchen towel to wrap the ice source. It is thicker, with air pockets that help insulate your skin from damaging cold. When you do this, you can ice for as long as you want with no ill effects. In fact, it is advisable to do this for pain control, particularly after a knee replacement. This is the only thing that works for some people - especially during the night when you are inactive and your knee tends to stiffen up. The stiffening is from swelling.

The same is true when one uses a cooling device like Polar Care. The water flowing through the pad is chilled and cools the knee. It is somewhat less cold usually than actual ice or a gel pack, so it can be that a thinner towel or cloth will work fine as the barrier. But, these devices are made to be used for lengthy periods.

I don't know why doctors and therapists are not aware of this. It's probably the same reason so many of them don't understand the need for proper pain management during recovery. They do the surgery or see the patient for brief periods, but unless they have had a joint replacement, they don't really know the recovery end of it.

Of course everyone must do what they feel is right for themselves. But I can say with certainty that icing correctly as much as possible works. It worked for both my knees. It has worked for everyone here on the forum who has done it. We've not had one single case where someone reported skin damage or problems from icing.
 
As time has gone by and my knees are less "hot," I find I can only tolerate shorter periods of icing than I did in the beginning. It just starts to get uncomfortable and I get so chilled. Of course it makes a difference what you are using - actual ice or gel packs which don't get as cold.
 
I must say I am very concerned about the duration of icing this site advocates. I have asked several Drs (OS) and Physical therapists and all agree No more than 20 min on and an hour to defrost between. Otherwise negative things happen.........
"defrost"? Why, are they thinking you have to put your leg in the freezer? What nonsense! Correct icing involves use of a protective covering between icepack and skin. It's rather more a cold pack than icing. After a while, as the 'heat' of the ice pack disseminates, one can removed the cloth and apply the pack directly to the skin. But one should NEVER apply a frech ice pack directly on to the skin. I think this is the misunderstanding these people have.
As time has gone by and my knees are less "hot," I find I can only tolerate shorter periods of icing than I did in the beginning.
That's because you are clearly not using the correct form of protection on your skin. Icing should never hurt or burn. Not eva!
 
I see an osteopath who says avoid the pain, thinks a tendon or something seems to be wrapping a nerve or perhaps there was a nick in the nerve (eeeek)
No such thing! What tosh!
I noticed that everyone seemed to remark that I'm doing too much. That is odd for me to hear as I feel like I really am not. I understand how subjective this is and how it is difficult to describe, however, I will heed the advice and pay closer attention to my activity.

Okay, here are some questions and it would be very helpful if you would answer each one individually 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. And don't compare this with the bone-on-bone pain you had before surgery!
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)


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

3. how often are you icing your hip and for how long?

4. are you elevating your leg, how often and for how long?

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

6. what kind of PT/exercises are you doing? How much and how often? (and detailed details would be appreciated, please! Reps, sets and session and all that)
 
@KTF here is your thread, for your questions and concerns.
How is your recovery coming along? Josephine can best help you when you answer the above questions.
 
@KTF, I've been wondering how you are coming along with the problematic right knee? I find I still have that darn "snap" (or "shock" as you describe it). The Drs and therapists can hear it and feel it. My therapists have been doing deep tissue massage on the area where it is happening, and I think they are doing some good. It sounds like it is probably scar tissue, and they are trying to break it up. One session, they used a metal tool and moved it somewhat like a rolling pin over the area. With a lot of pressure! I think it is probably helping, cause the snaps don't come quite as often as they did before. I know you'll agree...we'll be so happy to get back to normal, right?
Hang in there....
 
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