TKR LTKR RECOVERY

[suge671]

Greetings,

I am 11 days removed from my second TKR in (2) years, this most recent being my (L) knee. My previous procedure was conducted almost exactly 2 years to the day from this past week or so. Thought I should give a little bit of background to help assist any future responders.

I am almost 41 years old and an active law enforcement/military member with (prior to treatment), history of college athletics and multiple deployments to the Middle East....basically my knees (and entire body) have seen a lot of action and have been subjected to some major damage.

I am towards the end of my career and as such finally decided to get my medical affairs in order and actually “take a break.”

Both of my procedures have been conducted by the same orthopedic team at Walter Reed National Military Medical Center - I LOVE THEM ALL.

Unfortunately I could not say the same for my initial (outpatient) physical therapy providers (who I will not list out of courtesy/respect to others who may have a different opinion/experience), assigned to me after my 2018 TKR. I did not have the best experience nor was I provided the beat care, which resulted in them essentially getting “fired” by my ortho team and I having to undergo a manipulation around 10 weeks post-op since (at that point) I had barely 70 degrees for ROM. I WAS STIFF...

The good news was I was reassigned to another outpatient PT after the manipulation which resulted in me attaining somewhere between 115-120 ROM.

Fast forward to this past procedure (July 23, 2020). I am on day 11 as I write this post and I am able to get around (I don’t call it walking because my ROM is still pretty stiff) the house without any assistance from crutches, cane, walker. I also tried/succeeded walking from one end of my block to the other on day 6 (without any of the aforementioned assistance), BUT that was a huge mistake as I felt it afterwards and maybe regressed a little As a result...

I have some PTSD from the previous experience, specifically with my initial PT and how much unnecessary pain I was subjected to as a result of them wasting the crucial first 4 weeks or so not giving me the assistance/guidance I needed to ensure I wouldn’t end up STIFF-LEGGED.

This past Friday, I measured a 65 (bent knee) ROM and a 2 on straight leg (forgot what they call it). I know everyone heals differently and each situation has different variables, I just get anxiety reading how folks are way past where I am at this juncture, let alone where I was at 2 years ago. I do the exercises at home and ice (I need to ice more that I do for sure...). I don’t elevate my leg/knee as much as I should, so I need work there...pain management is not my biggest concern, moreso getting my ROM where it needs to be.

I have been told throughout my years of (athletic/law enforcement) activity, that I am a “big” guy with some tight muscles. I am currently 6”3 and weight about 300 lbs.

Any suggestions or comments would be appreciated...I’m looking for encouragement or feedback on some accessories I could purchase to assist my recovery.

Thanks,
Mike

 

[Roy Gardiner]

to BoneSmart. 1st the general reading:

Knee Recovery: The Guidelines

1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now, they are almost certainly temporary

2. Control discomfort:

rest​

elevate​

ice​

take your pain meds by prescription schedule (not when pain starts!)​

don't overwork.​

3. Do what you want to do BUT

a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you​

b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.​

4. PT or exercise can be useful BUT take note of these

the BoneSmart view on exercise​

BoneSmart philosophy for sensible post op therapy​

5. At week 4 and after you should follow this

Activity progression for TKRs​

6. Access these pages on the website

Oral And Intravenous Pain Medications​

Wound Care In Hospital​

The Recovery articles:

The importance of managing pain after a TKR and the pain chart​

Swollen and stiff knee: what causes it?​

Energy drain for TKRs​

Elevation is the key​

Ice to control pain and swelling​

Heel slides and how to do them properly​

Chart representation of TKR recovery​

Healing: how long does it take?​

Post op blues is a reality - be prepared for it​

Sleep deprivation is pretty much inevitable - but what causes it?​

There are also some cautionary articles here

Myth busting: no pain, no gain​

Myth busting: the "window of opportunity" in TKR​

Myth busting: on getting addicted to pain meds​

We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery.

While members may create as many threads as they like in a majority of BoneSmart's forums, we ask that each member have only one recovery thread. This policy makes it easier to go back and review history before providing advice.

 

[Roy Gardiner]

I also tried/succeeded walking from one end of my block to the other on day 6 (without any of the aforementioned assistance), BUT that was a huge mistake

It was, well recognised. Overdoing things is easy, but it's not really possible to underdo them. Relax, take it easy.

I have some PTSD from the previous experience, specifically with my initial PT and how much unnecessary pain I was subjected to as a result of them wasting the crucial first 4 weeks or so

Yes, pain is unnecessary - in fact, counterproductive - in recovery.

The BoneSmart view is that there is no such thing as a crucial time period. Your soft tissue has been traumatised and needs only gentle stretching to recover, which can continue for months.

, I just get anxiety reading how folks are way past where I am at this juncture,

I guess from your background you're a pretty competitive guy, right? But this isn't a competition. Well, maybe - let me try this you now need to be World Champion at doing 'not very much' (please restate that using two military-style words...) and not having any pain. When you are icing and elevating and watching telly you are not 'dossing around' you are 'engaging a carefully considered proactively designed heuristically programmed dynamically structured recovery programme'. Stated as a joke, but it's not.

I am currently 6”3 and weight about 300 lbs.

I'm sure you know yourself, weight loss would be good. But your knees will recover whatever weight you are, if you don't overload them.

 

[Dizzy]

...and thank you for your service! One day at a time...one step at a time!

 

[Celle]

Hello @suge671 - and

Roy is right. Take it easy and let your knee heal itself.
At this early stage of recovery, walking, in moderation, is all the exercise it needs.

There's no need to rush to get ROM (Range of Motion) because it can continue to improve for a year, or even much longer, after a knee replacement. There isn't any deadline you have to meet:
Myth busting: the "window of opportunity" in TKR

It's not exercising that gets you your ROM - it's time. Time to recover, time for swelling and pain to settle, and time to heal.

Try not to compare your recovery to anyone else's. No one else has your knee and no one else had the exact same amount of work done during surgery as your knee did.
Your knee is following its own agenda for recovery. It knows what it's doing.

 

[leejaa]

I will add to the chorus of take it easy and give it time for your body and knee to recover. I will add that elevation and ice is your biggest friend in this endeavor. Icing and elevation gets the swelling to go down or stay down so you can do more be it flexion/extension or walking without too much stiffness. Also, please consider using some sort of walking aid as you say your are still stiff. Being able to do something does not always mean it is the best thing to do. I could walk or is it limp or is it shuffle but used the walker for in case and to practice proper gait with heel/toe heel/toe being repeated out loud or in my head. There is no time line for recovery that must be met.

 

[Jockette]

My ROM continued to improve after my first year, and after my second year, so it’s true that there’s no “window of opportunity.”