TKR Day 11 post op concern with Therapy'

GiantsNY

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I’m very happy to stumble across this site. You guys are great! I have a concern with going to outpatient therapy already. My surgery date was April 24th. I was in hospital for special surgery for 32 hours. I had total left knee replacement. I’m happy with the outcome as the pain is manageable with meds and I can get around better than I expected. I had an in home therapist come to my home who has given me many ROM and some strength excersises which I have been doing every day. He tells me I am progressing very well as I can walk without a cane. I am very sore and swollen as to be expected. He recommended that I start out patient and I have my first appointment tomorrow. Going threw some posts on this site it sounds kind of aggressive and the last thing I want is a setback. Today is my best day and I feel it’s related to the fact that I cut out a lot of the excersises yesterday and just iced and elevated all day. I know out patient will push me hard so I’m just concerned. Any advice would be appreciated.

My numbers are 5 degrees when I straighten and 95 on the bend.
My knee was replaced due to football injury when I was 19 and 3 surgeries later developed into bone on bone. I’m 50 . Thanks again
 
Giants, I have had 2 knee replacements, and I do follow a PT regimen, which I believe works for me. I am 5 days ahead of you , do exercises 3 times every day , but I am always in total control of how I do them.

I am an old jock and exercise has been a major part of my life. It makes me feel good, so I need to take an active approach to my recovery that includes PT.
 
Hi and Welcome to Bonesmart!

Softtail is correct, you control the PT session, not the therapist. It can be a hard lesson to learn if you don’t know that ahead of time. (I didn’t)

Right now your knee needs gentle movements, not lots of exercises. Bonesmart doesn’t recommend any strength exercises until 3-6 months post op. Your leg right now is surgically wounded, not lazy or unfit.

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.

Especially read the ones on post op exercises and therapy.

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
5. At week 4 and after you should follow this
6. Access to these pages on the website

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.
 
Thanks for the reply! I’ve been training my whole life just got nervous reading some of the posts that suggest less is more and that you need time. I don’t have a lot of time since I have to get back to work. We are doing the same exercises. He has me putting on a 5 pound bag of rice which is helping with getting straight. Makes sense to set the tone once I go to therapy.

Let me ask you since this is #2 for you. What is a realistic goal of getting back on a truck and working . I have a route business so I’m in and out of a truck all day carrying product to stores.

Best of luck to you brother
 
I don’t have a lot of time since I have to get back to work.
There is nothing you can do to change the healing timeframe of your body.
He has me putting on a 5 pound bag of rice which is helping with getting straight.
This may seem to be helping now but it’s a very poor practice and can cause harm if you continue.

I am going to tag @Josephine
our forum administrator and nurse director to address your concerns.
 
Giants, wow! I am retired but living in the finger lakes in upstate NY I needed something to do so I drive a wine tour Trolley on weekends. With my left knee I was back in Trolley at start of week 4. With right ,will wait to week 5.

Won’t kid you , everyone’s recovery is different, but driving a route, carrying packages, up and down out of truck will put some stress on that knee, and probably gonna be fairly sore till about 8 to 10 weeks out. Some take considerably longer. I would actually lie down and elevate my leg and ice a bit for week 4 and 5 in Trolley while people were in winery which helped.
 
I’ve been training my whole life just got nervous reading some of the posts that suggest less is more and that you need time.
Well you know the old saying "slow and easy gets the ribbon" (or something along those lines!)
I don’t have a lot of time since I have to get back to work.
Still doesn't mean you can rush it.
He has me putting on a 5 pound bag of rice which is helping with getting straight.
Absolutely not! Read this BoneSmart philosophy for sensible post op therapy
What is a realistic goal of getting back on a truck and working
It would be as good to ask us "how long is a piece of string"!
 
Overdoing because you're trying to get back to work quickly can actually set you back because you get more swelling.
I found some of the exercises my PT gave me helpful but I generally did fewer repetitions than they told me to (at least at first.) IMHO, better to "risk" under-doing at first until you see how the knee behaves and then gradually increase rather than going full bore from day 1. I would try some & see how I felt. If all was good I knew I could increase a little bit.
Generally if you listen to the knee and trust your common sense you'll do fine.
 
I’ve been training my whole life just got nervous reading some of the posts that suggest less is more and that you need time. I don’t have a lot of time since I have to get back to work.
There's a big difference between training and recovering from a knee replacement.
Compete recovery is going to take a full year, although you will be able to do most things long before that.
You can't make your knee recover any faster than it wants to, no matter how much you wish you could. In fact, you can actually slow down recovery if you do too much, too soon.
TKR recovery and an analogy to athletic training
TKR: work “smarter” and not “harder”

What is a realistic goal of getting back on a truck and working . I have a route business so I’m in and out of a truck all day carrying product to stores.
We usually recommend taking about 12 weeks off and then doing a Phased return to work , if possible. In your case, since you have a job that is physically demanding, you should expect to need a few weeks longer.
He has me putting on a 5 pound bag of rice which is helping with getting straight.
It's never a good idea to use weights. They're too much for a knee that has been through major traumatic surgery.
 
Thank You everyone for the replies. I appreciate all the recommendations. I will discontinue use of the rice for straightening and use gravity as suggested. I will continue to plow through the therapy without causing any pain understanding it has to heal. It may be time to hire a helper for the route.
Thanks again
 
I don’t think you’ll be sorry you’re modifying your recovery approach. You have plenty of time to do more later.
 
I will discontinue use of the rice for straightening and use gravity as suggested.
No, don't even do that. You're not even two weeks out yet so you need to rest that knee and do no exercises or stretches. Doing them will only stress your knee, worsen your swelling and very likely make everything more stiff and sore.


I'd really like to offer you some structured advice but in order to do that, I also need to ask you some questions. Are you willing for me to do that?
 
Wow, you're only 11 days out and you are already walking without a walker or cane???
I didn't know that was even possible!
 
Hello Josephine, just curious isn’t the knee suppose to be stiff , swollen and sore at this stage of the recovery (surgery April 24th) ? I am stiff and swollen but I do feel I am progressing every day with lots of stretching and strength movements. I am down to 15mg of oxy a day. I am hoping to continue to make small gains everyday.

The physical therapist recommends what I am doing?? He also was doing deep massages on my entire leg and force stretching beyond existing ROM. I felt I gained several degrees of flex. Is this all wrong ? Or just a different approach? Also lots of exercise. The doctor and therapist have blessed this approach. I have been able to walk without cane from the beginning.
I am looking forward to the day without stiffness. I do wake up in pain but its less and I’m thinking it’s to be expected.

Regards and thanks !
 
@GiantsNY

One of the things I have learnt with researching is there are 2 opposing views on recovery.

1 take it easy, rest ice and elevate

2 Go hard or go home

It is 2 weeks today before my BTKR and I am no closer o an answer than I was when i first started this journey.

Like you I have played sport and trained most of my life and I think I know my body pretty well.... I will be aiming somewhere between 1 & 2....

Every recovery is different and post surgery lives are much different, some like me do not have to return to work so I am lucky in that regard. It sounds like a good idea to hire an offsider for the first couple of weeks so you can ease back into it.

Good luck.
 
It's never a good idea to use weights. They're too much for a knee that has been through major traumatic surgery.

Even when they were trying to get my knee to straighten more during pre-op sessions they were only using 2 pounds. Continued luck with your recovery. Mine is a week from today.

Ken
 
Giants you have hit the nail right on the head, ie, rest and heal with little or no pt., or choose to go the PT route. I have 4 friends who have all had knees done recently, and they are all doing active Pt., based on there doctors directive. This is my second knee, and in my recovery I chose to go the full PT route, because sitting around waiting for a my knee to recover without building strength around it ,didn’t make sense to me. I went full tilt Pt with last knee and same with this knee. Following my Therapists exercises, including icing and elevating frequently. I walk without assistance, Rom of over 135 with left knee from 7 months ago, and 112 with this knee 3rd week out. I exercise it daily, but not as hard as I do at Pt session. You need to decide what is right for you, having read about many different approaches fellow forum members have documented.
 
You are so right, you have to do what is best for you. This site makes so much sense, I’m leaning to gently PT this time around
 
@GiantsNY , you will get lots of differing opinions about PT. You have to do what works for you. I chose the PT route because it works for me. Having said that, the home PT that they sent to work with me at home the first 2 weeks was wanting me to do way too much way too soon. I only did a small portion of what he showed me. Really don’t do anything that causes and sharp pain. That’s a definite sign to stop that exercise or activity.

After my 2 week appointment with the surgeon, he had me switch to outpatient right away. I have a long history with the outpatient PT that I see and trust him 100%. We did a lot of work on flexion the first six weeks to get to 95 degrees. It was all slow and steady stretching to the point of discomfort. And I did those exercises 3 times/day at home, too, with plenty of ice and elevation after each session.

Recovery for me was a full time job those first few weeks. I believe and know it really helped alleviate the stiffness. In fact, the name of my PT place is OPTM which is optimum performance through movement.

Regarding work, if I had a physical job like yours, I would stay out a full 3 months. You’re very smart to hire help. I have a desk job and just started to phase back into things. I am doing 4-5 hours per day. The way I think of it, there’s a good $100,000 that went into fixing my knee. That’s a lot of people’s time and expertise. I want my knee to last 20-30 years. That’s the best case scenario. So I am not going to do anything to jeopardize that.

Be kind to your new knee the first few weeks and do what feels right for you. I know the pressure of returning to work is strong, but don’t let that dictate your recovery speed. You’ll do just great :)
 

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