TKR Last visit

[Reader525]

I had my TLKR on July 7th. I am absolutely miserable. My physical therapist had me bending all the way to 140 degrees on Day 6. I am an extremely limber woman and bending was not my problem before surgery. I had perfectly normal measures. My problem was bone on bone with a bone spur that shattered. The pain medication has me so nauseated that I want to cry and definitely not eat. Unfortunately after Day 6's PT I had to up my pain medication to the max, and I'm queasier than ever. I am terrified to go back to PT on Monday. I tried taking Promethazine for the nausea but I felt even more drugged. I honestly don't know what to do. Any advice? As of today, I have stopped all Hydrocodone as of 22 hours ago due to the nausea.

 

[Atkinson8]

140 degrees? Day 6? That seems not right. I've worked for 6 weeks (sometimes painful) with PT to finally get to 120 --- with help. Listen to those hear who know - But I think that's unrealistic and could hurt you going forward. Limber prior to surgery almost doesn't matter in the affected knee; it's like we're starting all over again (almost). I'd perhaps put off the PT, or change the person helping you out.
Truly.

 

[Jockette]

@Reader525 Hi and Welcome to Bonesmart!

You are not getting appropriate physical therapy for your newly replaced knee. Physical therapy should not be painful, and it should not increase your swelling. Doing so is counterproductive. I suggest you talk to your PT and request modalities that will help address your swelling, and don’t allow them to bend your knee for you. At all. It is not necessary and will do more harm than good. If your PT doesn’t agree, get up and leave, and find another office with a more update, gentle approach.

I will leave you our Recovery Guidelines. Each article is short but very informative. Following these guidelines will help you have a less painful recovery.

Just keep in mind all people are different, as are the approaches to this recovery and rehab. The key is, “Find what works for you.“ Your doctors, PTs and BoneSmart are available to help, but you are the final judge as to the recovery approach you choose.

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 to these pages on the website

​

Oral And Intravenous Pain Medications​

Wound Closure​

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 the 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 the member’s history before providing advice, so please post any updates or questions you have right here in this thread.

 

[Freestyle]

Welcome @Reader525! You certainly came to the right place. That PT session sounds like torture, not healing. You shouldn't have to live in fear of physio...

 

[Reader525]

I know I'm being foolish but I'm a little worried about telling someone who works at my surgeon's office in physical therapy that I know better than she does. Then I'll be labeled "non-compliant"! Do you think it's typical of therapists to push so hard? I had a knee arthroscopic last summer and the therapist never pushed like this. I haven't been able to do anything since Wednesday except ice and rest. Wednesday night after PT, I was up all night. I am SO glad I found all of you!

 

[Celle]

I know I'm being foolish but I'm a little worried about telling someone who works at my surgeon's office in physical therapy that I know better than she does.

Just remember that it's your body and your knee and you are the only one who has the right to say what happens to it.

No means No in terms of treatment of your knee, just as much as it does in any other aspect of your life.
Saying no to therapy - am I allowed to?

 

[Reader525]

Very interesting. I think I probably give Healthcare workers too much authority. Do you think I should message my orthopedic surgeon and tell him what happened, or deal with it one on one with the therapist.

 

[Mimi55]

My experience TKR April 29 , I could barely walk for 2 days after my knee was pushed at 8 weeks to get 130 . Swelling and pain - PT did once more same result, so I asked no more . At 13 weeks it is progressing with regular exercises and activity . It is 125 plus some now I’m sure . I was always looking forward to PT to help until they did that . I continued on without that push deal and had positive experience . Just say no .

 

[Reader525]

Did you continue doing PT that wasn't as forceful? Leg Raises? Were you put on a stationary bike? On Day 6 I was put on bike for 10 minutes. I was told it's good to push through the pain. How is your walk, do you bend your leg when you walk, or so you limp at all. All of this information is wonderful to read.

 

[Freestyle]

Very interesting. I think I probably give Healthcare workers too much authority. Do you think I should message my orthopedic surgeon and tell him what happened, or deal with it one on one with the therapist.

I would talk to the PT first. I had a rough patch with my PT and talking things out made the whole difference. If the PT refuses to listen, I would switch PTs.

 

[Mimi55]

I continued just without the knee push with a wide rubber band wrap, quashing it too! I did the bike 10 minutes from the 3 or 4 th visit I think , slide board , lifts etc. then ended last couple weeks with some weights on ankles leg lifts , stair lunges, I walk very well , still some weakness if I get up too fast . Any activity still wears me out later , ice , rest often . Hope you get some relief . The whole thing was so confusing until like 6-7 weeks !!

 

[Mar]

When I had my stitches out I told them my PT was too aggressive and I wanted a more gentle approach. My leg was really swelling and painful. So I left where I was at found someone who just massages my leg and does lymphatic drainage. I would call around and find someone who does lymphatic drainage. This way your still doing PT but nothing aggressive. The rarely bend my knee and if so very gently. You all ready have range of motion. I’m so sorry you are going through this! My old TKR is 120 and there isn’t anything I can’t do for my age anyway, almost 70. Praying you can find someone gentle who will work to reduce your swelling and get your pain under control.

 

[Jockette]

I know I'm being foolish but I'm a little worried about telling someone who works at my surgeon's office in physical therapy that I know better than she does.

I felt the same way, when I started my recovery. After a lot of bad PT, I now know that I know what’s best for my own knee. I have learned a lot in my 4 years on this forum!

Do you think I should message my orthopedic surgeon and tell him what happened, or deal with it one on one with the therapist.

I would just deal with this yourself. Too often our surgeons agree with the PT protocol, mine did.

On Day 6 I was put on bike for 10 minutes

Personally I think day 6 is way too early to be on a bike. I was 3.5 weeks, and that was too early! (for me)

I was told it's good to push through the pain.

It is wrong to push through pain in this recovery. The surgery caused a lot of trauma to your whole leg, and pain is a sign you are doing more than your healing knee is ready for. As @Roy Gardiner recently said, “Pain works for training, where you damage muscles and they recover stronger. We don't think this philosophy works for recovery.” I fail to understand why the PTs don’t know, or care, about this.

 

[Roy Gardiner]

I was told it's good to push through the pain

I know I'm being foolish but I'm a little worried about telling someone who works at my surgeon's office in physical therapy that I know better than she does.

No need. Ask them exactly why they believe that pushing through pain is good, and to explain to you the difference, if any, between 'training' and 'recovery'. Any athletics coach could.

Then I'll be labeled "non-compliant"!

This is a family forum. You must imagine my words in reaction to this.

On Day 6 I was put on bike for 10 minutes.

Too much. That is training, not recovery. Using a bike to gain ROM is pretty simple:

• Set the bike to zero resistance
• Set the saddle low enough so that a single rotation is a challenge; difficult but not painful. When a rotation becomes easy right from the start, lower the saddle a max of 1cm.
• Gently turn the pedals, through discomfort but without pain.
• Continue until the knee is 'warmed up' and the rotation is now easy, or for 2 minutes, whichever is the shorter time.
• Repeat several/many times a day, but don't go mad. Diminishing returns will apply; my guess is that half a dozen reps would be enough
• Do not pedal fast or for more than 2 minutes, this is a stretching exercise, not training.
• And if you get any pain or swelling in the 24 hours after doing this, cut it down until you don't

Here is a bit more chat and some pix and how 'healing' and 'training' are different

 

[Reader525]

All of you have been wonderful, I feel like I'm being heard. Perhaps you can help me with my approach to the pain medication. I have not taken any for 36 hours because I thought it was causing my really problematic nausea, but I'm not sure that's what it's free om. I'm very sensitive to anesthesia and think maybe I'm still recovering from that. Do I take the Hydrocodone as needed, or as I've seen on here, regularly. I truly hate the way it makes me feel. And then there's the ever-present nausea and weird taste in my mouth...do I take the Promethazine, in spite of feeling in a haze from it. Please help!

 

[Jo Wo]

I am nearly 3.5 weeks out and just slowly pedalled my recumbent for five minutes. I felt a good stretch, not a painful one in the area that always feels tight at the max flexion of my knee. immediately I am icing and elevating after that.

a week ago when I tried, I developed painful hamstring tendons, but there was no pain this time, I had to back off a bit from all exercise to get it to calm down.

 

[Reader525]

I wonder why they push so much. It seems you know your body and are doing all the right things especially by waiting another week to do the recumbent bike. Seems our bodies know when to back off. At 3 1/2 weeks, do you still feel the same level of pain you felt the first two weeks or so?

 

[Sisterpat]

Welcome, Reader and sorry you were put through that torture! PT mean well and it is what most of them were taught. But it’s too old school and not proven to be beneficial today. Gentle stretching is all you need right now, along with ice and elevation. If they label you “non-compliant” who cares? It doesn’t make you non-compliant!
Say NO, or look for a different PT who will respect your wishes.
As for the nausea, let you surgeon know and ask about medication for nausea. Also, are you taking your pills with food? That sometimes helps. Keep us posted. Be strong - it’s YOUR knee.

 

[Lark]

I am at 12 weeks TKR and I still get nausea from time to time. I am also very sensitive to anesthesia. Fresh ginger, ginger ale that has ginger in it and ginger snaps with real ginger All help. I also got a prescription for nausea.
It was probably week seven before the insistent nausea started to let up and become more occasional. I drank more ginger ale that first 8 weeks than I had in the last two years of any soda.
Any type of exertion in those first few weeks would cause extreme nausea also. It was very frustrating as I rarely experienced nausea in my pre-TKR life.

 

[Reader525]

Today is the first morning I have less nausea which I attribute to not taking any hydrocodone. I dread using it again but I'm sure I'll have to when I see the physical therapist on Monday. I had some fruit and a few pretzels before I took my morning Celebrex and aspirin, and I think it helped to cushion my stomach.
I really am drawn to the idea of the "gentle stretching" you mentioned.
I know this sounds extreme, but I wonder if a knowledgeable person could do her exercises at her own pace at home, involving stretching and leg raises and bends, and not go to a physical therapist. I had a meniscus repair last summer and was very diligent about doing my 25 minutes of PT every day. I know what to do. I just worry that my PT will dismiss my idea. Also the surgeon would probably be appalled.