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Things I learned from my first TKR

Discussion in 'Knee Replacement Pre-Op Area' started by redbedhead, May 7, 2012.

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  1. redbedhead

    redbedhead Member

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    Having had 2 hips and 1 knee replaced in the last 6 months, I have learned hips are MUCH easier to recover from than Knees.


    Here is what I learned about knee recovery that is DIfferent from Hip recovery:
    • Keep a close eye on your breakthrough pain pills and how many you have left.
      • DO NOT LET YOURSELF RUN OUT!
        • IF your pharmacy is like mine, it can take 24 hours to fill a narcotic prescription (Because of the extra security daylight pharnacy robberies in town have caused)
    • DO YOUR PT EXERCISES
      • at least 2 times a day when you are not scheduled to see the therapist!!!!!
      • and 1 other time when you are to see the therapist.
        • IT is amazing how fast it will stiffen up on you if you don't keep up with the stretches!
      • Ask your in home therapist to write them all down for you (Along with directions) so you don't forget anything.
        • also remember to have them update the notes whenever they add exercises to you
      • Try to push yourself to bend your knee a little bit more every time you do the exercises,
        • you should feel a stretch but not hurt
      • be sure to take a pain pill at least 20 minutes before the Therapist is supposed to come (or you are doing your exercises on your own), so that it will be working and you will be able to do what you need to do.
    • ICE often!
      • Use ice for at least 20 minutes after each time you do exercises
      • ice for at least 20 minutes after each time you use the CPM machine
      • Ice for at least 20 minutes anytime you are just sitting and vegg'ing out
      • Ice everytime you take a pain pill
    • Elevate your leg as much as possible throughout the day, to help keep swelling down.
    • USE THE CPM if it is prescribed.
      • Besure to take a pain pill at least 20 minutes before you start the CPM so that it will be in effect and you can relax while the machine moves you.
      • The CPM makes your knee go from straight to bent (up to 120 degrees, but usually starts at 90 degrees). It helps to get back ROM faster and keep scar tissue from forming too thickly.
      • If your doctor prescribed a CPM unit USE IT!!!
        • I was prescribed it 2-3 times a day for a minimun of 6 hours a day
        • My knee felt a LOT better everytime I finished using it.
      • Start with a lower setting for the flexion angle for 5 minutes as a warm up then move it to the new top setting for the day
      • Remember to increase the flexion angle as you can tolerate it, the goal is to get the CPM up to 120 degrees for at least 1 hour a time, for a full week.
        • I was able to turn it up 5 degrees a day, and for the last week I have been able to handle 120 for 2-3 hours at a time
        • DO NOT Turn it up so high that it hurts!
          • IF it hurts TURN IT DOWN!
    • Transition from the walker to the cane as soon as you can carefully.
      • walkers promote a bent over gait which can be hard to get rid of
      • be sure to have the Therapist watch you walk with the cane to make sure you are safe
    Anyone else have helpful hints to add?
     
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  2. Josephine

    Josephine NURSE DIRECTOR, BONESMART Administrator

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    Good post only I would argue the bit about the CPM as most surgeons (over here anyway) don't use them for the very reason that they are 'passive'.
     
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  3. redbedhead

    redbedhead Member

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    Yeah the passive versus active can be a sticking point for some. I think (in my totally biased personal experience, and knowing next to nothing about Anatomy and Physiology; I am a trained although unemployed kindergarten teacher) that it is getting movement that matters more than if that movement is active or passive. My In home Physical Therapist told me, "if you can get to 120 passively, then we know that it is totally possible to get the strength back and be able to get to 120 actively eventually."

    I am not sure if she is right or not but I feel like I have much better ROM because of using the CPM than I would have if I had not used it.

    I know that before surgery I only had active flexion of 89 degrees in this knee. The first time I had in home PT after surgery (6 days post op), we measured active Flexion at 68, and last Friday (The last day of in home PT, and 16 days post op) I had active flexion at 113.

    I also know that when my knee feels really stiff (from the weather, the normal up and down of healing, or whatever), If I use the CPM as high as I can stand it for at least 1 hour, it is not nearly as stiff feeling, holds my weight better when I walk, and makes it easier to do my home exercises. Maybe it stretches out those muscles? Not Sure!

    I do understand that this is my personal experience and may not reflect others experiences. But why not use every tool you are provided with to get better as fast as you can? Of course if your doctor does not prescribe CPM, then you dont have that tool in your toolbox anyway.
     
  4. BigGene

    BigGene Sr Bonesmartie

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    My vote is for the exercise bike. Does the same thing as the machine but I was in control of both the flex and my muscles.

    Just my bias.
     
  5. bottomshollow

    bottomshollow Moderator

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    Just want to be sure that folks understand that a CPM is not a necessary piece of equipment for TKR threapy and recovery.

    Some of us never even see a CPM machine or hear anything about them. I only knew the device existed through my reading and research. My OS never mentioned it, and no one else on the ortho hall at my hospital who had TKR was using one. The rehab center I went to after surgery did not use them either.

    So for us it means manual stretching and bending and using the bike. Which gets the job done, and that's the main thing.
     
  6. Bluegrove

    Bluegrove Junior Member

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    Bottomshollow, do you think I should buy an exercise bike or can I use the ones at the gym I belong to? Would I need to use the bike before I am able to drive myself to the gym following surgery RTKR on May 14. Thanks!
     
  7. Roy Gardiner

    Roy Gardiner Forum Advisor

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    RedBedHead, the only thing I'd take issue with is taking pain pills before PT or using the CPM. You correctly emphasise that neither of these things should hurt, but taking a pain pill suppresses pain and therefore allows one to overdo things.

    Bluegrove, an exercise bike could be an expensive white elephant if you just intend to use it for recovery. Stretching exercises will do just as well. But if you fancy a bike for long term exercise, go for it, bikes are good for knees, natural or bionic.
     
  8. BigGene

    BigGene Sr Bonesmartie

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    RedBedHead, Most Physical therapy centers have excercise bikes.
     
  9. bottomshollow

    bottomshollow Moderator

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    Bluegrove-

    The only advantage of owning your own stationary bike is having it available to you at all times. My OS did not feel I needed out patient PT and did not give me a script for it--so I used my bike at home along with the stretching and bending exercises I did with the inhome PTs.

    I purchased a recumbent because I have a problem with the seats and the height adjustment on an upright bike. I am only 5'. I did, however, have to drill another hole to get the recumbent in the correct position for me to pedal properly.

    I find it is really nice to hop on for 5 or 10 minutes here and there throughout the day to keep the stiffness away. And it comes in handy when the weather is bad and you can't get outside to walk.

    Bikes come in many different price ranges---I shopped the internet and found one for around $150.00 which I am very happy with. And I assume it's possible to find one for less on e-bay. Getting a bike for yourself depends on how much you think you'd use it in the long run and if you feel you can afford it. It's nice but not an absolute necessity.
     
  10. kneeper

    kneeper Forum Advisor

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    My doc prescribed a cpm. I think it was good for keeping the knee moving. It does not replace your active heel slides, etc though.

    I'd say if your doc prescribes it, use it, but don't think it will magically "cure" you. (Not what redbedhead was suggesting at all) If not you can still do fine doing exercises on your own.

    Personally, I kind of thought there was a psychological benefit as I saw I could gradually set the machine to more bend.
     
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