TKR Dear Diary, Surgery Complete

[mendogal]

The thing you call "quad strengthening" are what most of us know as "quad sets." Their purpose in the early post op weeks isn't building strength.
It's to "wake up" the quads; that is get them activated and firing effectively across their length and breadth. It takes weeks just to do that! They are an incredibly effective exercise because they also help develop range of motion and increase circulation, while if done in moderation they don't hurt or add to swelling.
I never counted out reps or sets of quad sets. Whenever I was relaxing in the recliner I'd just randomly do a bunch (half dozen to a dozen?) throughout the day.

I agree with @Jockette that repetitions/sets of any form of squats is not appropriate until way later. Getting on and off toilet, chair, bed, etc once at a time instills the capacity. At your stage of healing the repetitions overwork traumatized skin, muscles, and tendons and will set you back.

 

[Layla]

You've already read this, but please do reconsider the squats, SnowHare, as they can cause generalized tendinitis particularly in quads, glutes and hamstrings. You don't need that.
I hope today is a good day!
@SnowHare

 

[SnowHare]

I just started the squats yesterday - more like a half inch dip. I won't continue.

Thx

 

[WFD]

They are an incredibly effective exercise

My favorite too. I also found them pretty effective in improving my extension, although my extension deficit wasn't very bad compared to many.

 

[sistersinhim]

My thoughts are with you. You are blessed to have children that will lend a helping hand. I'd say to just ignore your husband and do everything you can yourself. Many of us recovered alone. It can be done. I had a neighbor come over the first week to clean out the kitties' litter boxes, and stay as I showered. Many called to see if I was OK, but that was about it.

It sounds like you have already been taking care of yourself. Every time you do something, that is PT and exercising. It's natural movement exercises and are even better for you than repetitive exercises. I think you are doing great! Who needs that husband anyway!

 

[SnowHare]

@mednogal

Here's the list of exercises I am expected to do:

1. Armchair pushups
2. Ankle pumps
3. Core stability - pushing your tummy into the bed
4. Simple thigh squeeze - toes to nose, tighten muscles in thigh and push back of knee to bed
5. Harder thigh squeeze - roll under knee, straighten leg. Do not push into roll
6. Knee straightening - toes to nose, small roll under ankle, push knee to bed
7. Knee slides on bed
8. Sitting knee slides in chair
9. Sitting knee leg staightening
10.Standing knee bends - hold onto counter, slowly lift heel to buttocks
11.Standing leg lift - hold onto counter, lift leg as if going up a step
12. Mini knee bends - hold onto counter, weight on heels, slowly bend knees

 

[mendogal]

Number 4 is quad sets. Yay!

Number 5 sounds like a short arc quad - it's too early for that strengthening exercise.
Number 6 - does this mean literally push with your hands? Without the hand pushing, just with the small roll under the ankle, it's a good variation on quad sets.
Number 10 - we tend to have swelling behind the knee post op that is in a small tight space; personally I found this movement very quickly aggravated the painful swelling and offered no advantage over Number 8, seated heel slides, which are a wonderful and safe range of motion exercise if done without pushing past mild discomfort into pain.
Number 11 and 12 are basic activity of daily living movements that in my experience doing reps of really overtax the joint and muscles if started this early post op.

I and many other members have found we get better results day by day plus overall across time if we 1) are very selective about which exercises we do and 2) instead of doing a lot of reps and the prescribed number of sets, spread the exercises out across the entire day, doing a few reps more often - it's more like how we do normal activities and results in less swelling, less pain.

I want to add: This is what works for many of us. We also completely understand that some people follow a more intensive regimen, enjoy it, and reap benefits from it. As long as PT isn't manipulating your knee or causing pain, we totally support each member's priorities and the approach they use in managing their recovery.

 

[SnowHare]

@mendogal

Thanks for your review.

Actually, after number 5 is another exercise I don't do, which are leg lifts. The booklet says not to do them until you can do simple thigh lifts.

Number 6 - no hands involved.

I am supposed to do the exercises 4 x per day, with reps of 3 - 5. Right now I don't seem to have a lot of swelling. I compared my knees in the mirror, and they seem pretty much the same size, at least from the front. I get random pain here and there for short periods of time. Sometimes a change of position helps

I have commenced cutting back the Oxy by 25%. So far there has been no change in pain. This time around, it's so much less painful, as I take lots of painkillers of different types, some at different times of day. The longest I go is at night. I wake up at night to pee, but I'm not in any pain, not like the last time. I think I'm ready to go downstairs for lunch and supper.

 

[mendogal]

It sounds like you have been given a much more sane regimen than the ones we see here in the USA (several times daily do three sets of 10 or 12 reps each of every exercise - so that's 30 - 36 reps each time!) - that's great!

Use your own good judgement and let your knee's reaction guide you.

Oh going downstairs for a couple of meals daily will be a great milestone! Let us know how it goes.

 

[SnowHare]

Dear Diary,

Ouch ouch ouch.

I might have overdone things today. Went up and down the stairs twice today. The worst thing I did was sit at the supper table for too long. The guidelines say not to sit for more than 30 minutes at a time. Sitting now with my legs elevated, and my leg complains if I try to straighten it. It will be better in the morning.

Reading other people's posts, I realize how lucky I am. I have not much swelling. This time around, it's been a cake walk so far. Son came tonight and said I look so much better than the recovery of the first TKR. I certainly feel a whole lot better, even with the leg pain tonight.

Looking forward to Monday, when the staples come out.

 

[mendogal]

Oh no, I totally sympathize! I couldn't sit up in a chair more than 6 minutes at a time the first few weeks with my second knee.

Yep, you know the drill.... ice and elevate and tomorrow's another day!!!!

 

[Layla]

Sounds like you're doing really well. Good luck with the staple removal tomorrow.
I hope you have a great week!
@SnowHare

 

[SnowHare]

Dear Diary,

Staple removal today! Went quite well, although there seems to be some scabbing that the nurse just wanted to leave. I'm now steri stripped, and I will continue to use steri strips for the next week. The nurse gave me a handful of steri strips to take home, then decided to give me a whole bunch more. There is concern about the pain in my calf. I will be going first thing tomorrow for an ultrasound. Still bruising, but not an undue amount of swelling.

My heel to bum measurement is about 100 degrees. The physiotherapist seemed pleased. I go for my first outpatient physio assessment on Wednesday. The physiotherapy itself is done in group classes.

My new knee compared to my my 5 year old knee.

 

[mendogal]

Knee looks good, range of motion is great!

Please be super careful in getting group physio - there's a ton of peer pressure to go along even if the leader is pushing folks past their current capacity into pain.

At two weeks post op gentle stretching and moving is all that's safe. With your excellent flexion, nobody should be physically bending your knee nor pushing it down to straighten it.

And it's way too early to challenge muscles to get stronger when they haven't healed. Even minor athletic strains and sprains need 6 - 8 weeks to heal, and our replacement surgery is way more traumatic than that!

 

[SnowHare]

@mendogal

I probably won't be starting physio right away. The physiotherapy clinic just wants me in this week to review the Bone and Joint Clinic's requirements and how I am doing. I'm in no hurry to start. The B&J Clinic's physiotherapist said that I will be doing the phase 1 exercises for another month, so it's unlikely I will start the group classes for another month anyway. This is government funded, so things tend to take a bit more time.

The B&J physiotherapist said I am moving very, very well. He wants me to take things slowly, gently, consistently, and to move as much as I can. This recovery is like night and day, compared to my 2019 knee replacement. No pressing down on my leg this go 'round. Everything is quite gentle. Last time, I was in the hospital for two nights. There was no exercise done, and I think that made a big, negative difference. Gentle stretching the day after surgery really helped.

I was talking to a friend who had her knee replacement in February. Everyone here goes through the B&J Clinic. She had a different surgeon, who had a different pain protocol and expectations. You get assigned a surgeon, when you are first assessed. Because I was a previous patient, I had the surgeon who did my first knee replacement. Evidently, he is trying to move with the times, as he has changed how his patients go through the process.

Just trying to be kind to myself and not fall into the hurry up and wait mindset. More, all in good time.

 

[benne68]

...physiotherapist said I am moving very, very well. He wants me to take things slowly, gently, consistently, and to move as much as I can. This recovery is like night and day, compared to my 2019 knee replacement. No pressing down on my leg this go 'round. Everything is quite gentle

This is great. Slow and steady wins this race.

Glad you are noticing the difference already.

 

[SnowHare]

I went to my physiotherapy assessment appointment on Wednesday. Here are my historical results up to and including Wednesday.

pre-surgery: flexion = 100
extension = -25

surgery April 1: flexion = 88
extension = -16

April 15: flexion = 100
extension = -25

April 17: flexion = 113

The physiotherapist was very impressed with the flexion number. She says, however, that I need to work on my extension. It's within the realm of what is normal at this juncture. All exercises to remain gentle.

I am now allowed to walk around my bedroom, but I must use one crutch to move around the rest of the house and use two crutches outside the house. It's not quite the right weather for outside walking - snow again yesterday, but I'm looking forward to my first 10 minute walks outside. I thought I would take my phone and set the timer for 5 minutes, then turn around and go home.

I am totally blown away at how much better the recovery is going with this knee replacement than the last one.

I've started reducing the Oxy. Not sure how things will go once I stop taking the Pregabalin at night time. My goal is to get to just the Acetominiphen and the morning ASA. I get spells of not nice pain, but gentle massage seems to help.

 

[mendogal]

Very good!!!!!
I did just that with my phone timer when setting out for walks. And was strict about turning around and going home!

 

[benne68]

She says, however, that I need to work on my extension. It's within the realm of what is normal at this juncture. All exercises to remain gentle.

Many of us have found that extension improves more slowly than flexion -- especially when it was limited prior to the surgery. I found self-massage helpful in relaxing the muscles in my leg. You might ask your physiotherapist to teach you some techniques at your next session.

Your flexion is amazing for less than 3 weeks post-op. Glad to read that you are finding your second TKR recovery easier than the first. I had the same experience. I think some of it was just knowing what to expect -- and knowing it does get better.

Wishing you an easy recovery.

 

[Freyagirl]

You are in recovery mode and doing well. Lower your standards of housekeeping because you can’t and your caregiver won’t keep it up. Just take really good care of yourself and enjoy the extras from your kids. There’s plenty time in the next months to catch up with chores. Sounds like you are doing well mostly on your own. Good going!