TKR Second Opinion Questions

[GordieO]

I'm so very thankful for the above posts about icing and elevation. Why didn't my surgeon and the two P/T clinics I've used since my surgery explain this very important component of recovery? Today I get a second opinion about my lack of ROM progress (particularly extension) over the last 7 months. What's interesting is the fact, due in large part to this forum, that I totally stopped P/T and almost all home exercises, and concentrated solely on reducing the swelling in my knee and left leg and the associated pain in my knee. I did maintain some very light stretching. I use the Lounge Doctor cushion and two ice packs 4 times a day for 45 minutes. I began this new phase of my recovery a week ago today. As of this morning, I can actually see the beginning shape of an actual knee on my leg!!!! And I'm also walking better (with a cane) to the point where I can begin concentrating on stepping heel-to-toe with each step. I still experience pain, but not nearly as bad as a week ago. Starting Saturday I plan on stepping up my stretching a bit, including light use of a recumbent bike. I can't tell you how much my attitude has changed. I can see slight progress beginning, and it's something I haven't haven't experienced in over 7 months! My thanks to each member of the bonesmart.org staff for tolerating my bumbling ineptitude in trying to respond to your so very valuable reply posts. I'm actually looking forward to resuming an exercise regimen again. The most important factor is that I WILL CONTROL THE AMOUNT OF PAIN THAT IS INFLICTED ON THIS 85-YEAR-OLD BODY!!

 

[sistersinhim]

Why didn't my surgeon and the two P/T clinics I've used since my surgery explain this very important component of recovery?

That is why Bonesmart is here! With tens of thousands of joint replacement patients' experiences, we have learned what is the best way for most members to recover from these very traumatic surgeries.

Starting Saturday I plan on stepping up my stretching a bit, including light use of a recumbent bike.

Don't mess up and do too much. You have improved so much lately from your change in recovery, and you don't want to have a setback.

 

[Jamie]

@GordieO …. Posts like yours are what we truly LOVE to hear. You get a Gold Star, my friend, for becoming an advocate for yourself, trying something different, and now seeing the positive results. Your new approach to your recovery sounds perfect for you. The key for everyone is to listen to their body’s messages. Not everyone heals in the same way….our bodies are all unique. If a person pays attention, they will know what is working and what is making things worse.

I’m so happy to hear that you see a good path ahead. Keep up the great work and you’ll soon be one of our success stories!

I wish I had an explanation for why many in the medical community still believe there is just one approach to recovery from joint replacement surgery. BoneSmart has recommended a more gentle approach to recovery and therapy since its beginning because we saw the positive results people had with that approach. And interestingly enough, even some of the surgeons we work with on a regular basis, who in the past were recommending aggressive and early therapy, have now switched to gentle bends and stretches and giving your joint time to heal before anything too aggressive. While it is true that some people do okay with a more aggressive approach, most of the people we’ve come in contact with do better with a more gentle program that helps keep swelling and pain at a minimum. Thanks for letting us know this worked for you!

 

[benne68]

As of this morning, I can actually see the beginning shape of an actual knee on my leg!!!! And I'm also walking better (with a cane) to the point where I can begin concentrating on stepping heel-to-toe with each step.

I can't tell you how much my attitude has changed. I can see slight progress beginning, and it's something I haven't haven't experienced in over 7 months!

So wonderful to read this! Thank you for sharing.

 

[Layla]

Best Wishes, GordieO!
Sounds like things are looking up for you. That is such good news!
My 86 yr old dad just had his knee replaced about 8 weeks ago.
I hope you will continue to share your progress with us so we're able to support you along the way.
Have a great weekend!
@GordieO

 

[GordieO]

@Jamie

I got my second opinion from another ortho surgeon last Thurs. It was just more unremarkable news. He told me straight out that he did not recommend revision surgery. I asked if there was any further imaging that would shed more light on the scar tissue/adhesion/swelling situation, he said no, because the main swelling is in the back of the leg joint beneath the knee and that it was not feasible to try arthroscopy in that area of the knee. So, surgically, I have no other options. He claims that exercise is the only course of action available to me. I told him that Oxy and Tramadol didn't help previously with pain that hindered how I could exercise, he said I should try Dillaudid. I don't really think there's any prescription that will help with sharp nerve pain, and I'm a heart patient so I can't take NSAIDs. When I explained that I was taking some time away from exercising and not doing anything that would cause pain, he gave me one of those eyes rolling up into his head looks. When I told him about bonesmart.org and the overwhelming belief that "no pain, no gain" is actually a hinderance to progress, he rolled his eyes up again. So, I'm at the crossroads once again. How much longer to backpedal on exercising before I start light exercising again because my pain level has eased somewhat but is still a factor. Any words of wisdom you can offer would be appreciated.

 

[Jamie]

Your surgeon’s eye rolling is a typical result we see, sadly. I’m sorry you got that. My best advice is to try and follow what your body is signaling. Nothing good or bad in your recovery is going to happen overnight (unless you were to have some type of traumatic injury). Read your body’s reactions to what you’re doing. If things are going pretty well, do some increases in activity or exercise. If you begin to feel some pain or swelling afterwards, scale back for a few days and try again. Normally your body will give you a “gut feeling” that it’s ready to do a little more.

With the surgery and two MUAs, your body and particularly your knee, has had a lot to trauma in a short period of time. Things may go slower for you because of this. On the one hand, your doctor is probably correct that this is something you will need to use exercise to cure. Don’t ever hesitate to get the help of a good physical therapist at any time during this process. Your GP can write orders for therapy, so you may want to deal with that doctor and not the eye rollers.

 

[GordieO]

Thank you for sharing your thoughts and for suggesting that my primary doctor could write a P/T prescription. I didn't realize that was an option. Is it too far out there to think that I should have little or no pain before beginning light exercises? I'm concerned because I don't want to start exercising again before my pain is really under control, yet I feel that waiting too long might make starting up after a lengthy delay more difficult.

 

[mendogal]

There's a real difference between having a normal post-exercise muscle ache the day after PT (= ok) and having knee pain and swelling the day after PT so you basically "lose a day" (= too much).

 

[Jamie]

A good therapist should be able to work with a situation where there is some current pain. Just be sure you discuss in detail where the pain is, when it occurs, and what can be done to make it a little better. For example, if you have muscle tightness or a soft tissue problem, it may be hurting but would respond to trigger point therapy or some massage. If you tried to wait until all the pain was gone, you would not be successful. These types of issues tend not to resolve without the help of someone who understands muscles and the problems associated with them. Just be sure that whatever therapist you select is trained in gait analysis and trigger point therapy.

 

[WFD]

suggesting that my primary doctor could write a P/T prescription. I didn't realize that was an option.

I've done this. It's a great option. Your primary care doctor often is more open-minded and less judgemental about things like this.

 

[GordieO]

Many worthwhile comments; my thanks to each of you. I have a follow-up appt. with my second opinion surgeon in 6 weeks. I'll start tomorrow to test where I'm at with pain-after-exercise, and a bit of walking without the cane. I have my prayers to rely on and fingers crossed for a luck wish!