TKR Eciulla's recovery thread<<

[Eciulla]

Thank you Jockette!!

 

[Jockette]

Yes, I responded that I would be happy to answer all questions!

@Josephine

 

[Josephine]

Here y'go then!

It would be very helpful if you would answer each one individually - numbered as I have done - in as much detail as you can then I'll come back as see where you are ....

1. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine. And don't forget to factor in other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness).

2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?

3. how swollen is your leg compared to these?

4. what is your ROM - that's flexion (bend) and extension (straightness)

5. are you icing your knee at all? If so, how often and for how long?

6. are you elevating your leg. If so how often and for how long?

7. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and

8. are you doing any exercises at home? If so what and how often?
This is the most crucial question so please help me by using the format I have left as an example
(which means please make a list and not an essay!)

Exercises done at home
- how many sessions you do each day
- enter exercise by name then number of repetitions of each
etc., etc.

Anything done at PT
- how many times a week
- enter exercise by name then number of repetitions of each
etc., etc.

 

[Eciulla]

Hi Josephine, thanks for taking the time.

1) pain level 3

2) oxcycodone 10mg every 4 hours. Have not taken any for 10 days. Also prescribed flexaril 10mg
3 times per day. 1 or 2 per day for quad stiffness

3) moderate swelling

4) rom 130 extension 0

5) icing 1 or 2 times per day after exercise or walking . 30 minutes

6) elevate while icing

7) activity level good. Try to walk a few times a week. I dust, do laundry, cook dinners ,make bed

8) I exercise at home 5 days per week , one time per day
Quad contraction 10x 3
Glute contractions 10 x3
Heel slides 10 x3
Straight leg raises 10 x3
Leg raises with roll under knee 10 x3
Bent leg raises at edge of bed 10 x3
Marching in place 10 x3
Bent leg kick back 10 x3

Out patient pt 2 times per week

10 minute warm up on eliptical, seated or 10 minute warm up on bike
Heel slides 2 x 15
Balance board 5x 20 seconds
Balance on foam one foot 5 x 20 seconds
Leg slide machine 2 x 15 little weight
Tens and ice 30 minutes

I try to walk a few days a week about 40 minutes = 2 miles

 

[Josephine]

1) pain level 3

Pretty good for 9 weeks!

2) oxcycodone 10mg every 4 hours. Have not taken any for 10 days. Also prescribed flexaril 10mg 3 times per day. 1 or 2 per day for quad stiffness

If you noticed in my notes, I said there are other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness. Thus you do't really need Felxaril, you need a pain med, maybe even just Tylenol 1,000mg 3-4 times a day. I'm sure you will find it much more effective.

3) moderate swelling

I also said that swelling was a form of pain so did you factor in to your pain score?

4) rom 130 extension 0

You knoe, ROM means range of motion and includes BOTH flexion and extension, not just flexion! So your ROM is 130/0! Jolly good!

5) icing 1 or 2 times per day after exercise or walking . 30 minutes

You actually accomplish little or nothing in 20 minutes. Ice for at least 40-60mins and more than 4 times a day.

6) elevate while icing

Good

7) activity level good. Try to walk a few times a week. I dust, do laundry, cook dinners, make bed

Good.

I exercise at home 5 days per week , one time per day
Quad contraction 10x 3
Glute contractions 10 x3
Heel slides 10 x3
Straight leg raises 10 x3
Leg raises with roll under knee 10 x3
Bent leg raises at edge of bed 10 x3
Marching in place 10 x3
Bent leg kick back 10 x3
Out patient pt 2 times per week
10 minute warm up on eliptical, seated or 10 minute warm up on bike
Heel slides 2 x 15
Balance board 5x 20 seconds
Balance on foam one foot 5 x 20 seconds
Leg slide machine 2 x 15 little weight
Tens and ice 30 minutes
I try to walk a few days a week about 40 minutes = 2 miles

Walking is fine but all those exercises! Gee wiz! You've already got superb ROM so you don't need any of these any more! And if you quit them all - yes including the PT sessions! - you will find your pain and swelling gets to 0 pretty quickly! Walking is all you need now so stick with that in moderation !

The exercises I have made bold are the worst ones and I can promise you that if you continue doing them, your pain, swelling and stiffness will just get worse and worse.

 

[Eciulla]

Hi Josephine! thank you so much for your very detailed response.
In response to the pain level, yes that included the swelling and stiffness.
I will try Tylenol for pain today.
thank you for the clarification on ROM.
PT said last week she thought this coming week would be my last two sessions.
I will for sure ice longer and more than just 2 times per day.
Do you think the 2 miles is too much?
Also I have 3 levels in my home so I am up and down the stairs a lot.Some days more than others.
Thanks for heads up on the bad exercises. I will remove them along with the others.
Should I continue to do some stretching exercises?
Scheduled for knee #2 January 9th 2019. Gluten for punishment!!

 

[Josephine]

Do you think the 2 miles is too much? Also I have 3 levels in my home so I am up and down the stairs a lot.

I think that with all those stairs, you don't need to walk 2 miles a day!

Should I continue to do some stretching exercises?

Give me a 'for instance'

 

[Laurenkate]

@Eciulla - you're doing the right thing to just get the other one replaced in January. Much better to do it sooner rather than later - and then you're on the road to recovery without worrying about when to schedule the next one.

 

[Eciulla]

Josephine, stretching such as heel slide, laying on back, raise surgical leg with help of belt and lower to opposite side, sit up with back to couch and with belt slightly raise surgical side for good stretch.

LaurenKate, agree better sooner than later. Did you find that your first TKR was able to support second surgery?

 

[Laurenkate]

@Eciulla - yes, absolutely. My situation is a little different. 2/3 of my left leg went numb before my replacement and that recovery was very different from my second tkr. I will never be unaware of my left leg, knee, and ankle because of the numbness but I'm beginning to realize that in another few months, I probably won't think about my right knee at all except when it swells. You're further along than I am on range of motion - good for you!

 

[Josephine]

Josephine, stretching such as heel slide, laying on back, raise surgical leg with help of belt and lower to opposite side, sit up with back to couch and with belt slightly raise surgical side for good stretch.

heel slide - I suggest not
laying on back, raise surgical leg with help of belt and lower to opposite side: Straight leg raise - no!
sit up with back to couch and with belt slightly raise surgical side for good stretch: No!

 

[Eciulla]

hi, 10+ weeks post op. felt great the last week. walking, doing chores around the house, grocery shopping. saw the OS on Thursday said everything looked good. took xrays,kneecap is lined up well. He examined my knee, rom and extension. He really pushed, pulled and pushed on top of knee to see the extension I guess. yesterday afternoon,
( two days after my appt with him) I started having terrible pain in the back of knee, my knee feels weak and am stiffer than I have been. The only thing that I an think of, was Friday morning, 1:30am I woke with a start and sort of got out of bed in a hurry. I remember that my knee said "ouch" but can't imagine I could have done any harm? any thoughts? Took two oxcy this morning, haven't take any pain meds for 3 weeks .

 

[Jockette]

I think it was that examination your surgeon did.

I don’t understand why the surgeons can’t just ask you how you’re doing and assess from that. My surgeon liked to push my knee to a painful place to measure ROM. I finally refused to let him do that at my 7 month check up. You walk in feeling decent and come out hurting.

 

[Eciulla]

and I gave him the PT's progress notes that said rom 132 and extension 0. Yeah, so now I am two steps backwards. Jeeze!!

 

[Jockette]

At my last 2 appointments I did not get up on the table, I stayed in the chair. I had more control over what he could do if I was in the chair. One becomes very vulnerable on the table.

He was ok with that the first time, at my 7 month check, but he was a bit annoyed when I did it again at my one year check.

Other members report that their surgeons don’t do that, so it all comes down to their opinion. By my one year check I no longer cared what he thought. I never felt like he encouraged me, the check up was all about new X-rays and ROM measurements.

And your ROM is awesome!

 

[Eciulla]

Hi Josephine, Looking to you for support this week.

Saw the OS last Wednesday he released me said everything looked fine, no infection, ROM good, leg was straight.

The past many days I have increased discomfort and my knee feels rather weak. I did mention that to him. He said keep working on the quads. I also feel as though my knee is hyper extended.

Having more pain when getting out of a chair if I don't use the arms. Of course still numb, perfectly normal. Still swollen and tight. Released from PT 1 week ago. He also took xrays. Everything did look really good and lined up perfectly.

Your thoughts?

 

[Jockette]

I will tag @Josephine for you.

 

[Eciulla]

Thanks Jockette!

 

[Josephine]

The past many days I have increased discomfort.
Having more pain when getting out of a chair

Perhaps you would show where these pains are?

 

[Eciulla]

I would say LF3D and LF4D, right over the left kneecap. Not painful enough to take any pain meds. No pain in back of knee, no fever. Still slight to moderate swelling. Difficulty getting up from the chair with no hands