TKR 12 Days Out from LTKR and Struggling

[Twocaledonias]

I am so grateful to have found this site. Everyone’s experiences have been so helpful as I continue my recovery from LTKR on December 21, 2022. It has been rougher than I anticipated. Surgery was on Wednesday and was released on Friday, mostly because of searing pain on right inside of my knee. I couldn’t get my left leg in or out bed or a chair without someone holding it and slowly lowering it to the floor. There were lots of challenges with getting pain meds right (sick as a dog from morphine and the surgeon’s nurse practitioner finally recommended any Oxy/Robaxin combo that helped with resting pain). I was able to take some steps on Friday and the PT and nurses felt it best to send me home (as opposed to a rehab facility) since I had my sister with me full-time.

I continued to have this 10/10 pain with certain movement, which reduces me to tears, and spoke with the surgeon’s nurse at the one-week mark. After looking at my xrays, she said this is where most of my arthritis was and where most of the work was done. She advised me not to cut back on my pain meds yet and be patient with the healing.

I have been elevating, icing, keeping up on my meds, and religiously doing gentle exercises as instructed by my in-home PT. But at 12 days out, I’m extremely frustrated that I still am not walking, putting little weight on my knee, and not able to do ADLs without assistance (for example, I have to been wheeled to the bathroom and then use the walker to shimmy to the commode). I also have a bad right knee, which hampers recovery a bit.

I know every knee recovery is different, but has anyone else’s been this slow? My first follow up with the surgeon is on Thursday, so we’ll see what he has to say.

Thanks!
Sharon

P.S. Couldn't figure out how to add myself to the December list.

 

[Pumpkin]

@Twocaledonias .
Welcome to Bonesmart, glad you joined us!!
Sounds like you are off to a slow start. You are still in the very angry knee stage, your surgeon should be able to help you through this stage.
Suggest you ask for something to help with the break through pain.

Recommend your sister goes with you to your appointment. With the elevated pain levels a second set of ears will be helpful to remember questions and answers during your appointment.

religiously doing gentle exercises as instructed by my in-home PT

You may be doing too much for your knee, during the early days it is easy to over do with just a few exercises.
What exercises are you doing? How many reps are your doing? How many times a day are you doing your exercises?

Your surgery date has been added to your signature, and you have been added to the December Supernovas 2022.

Here is your copy of the Knee Recovery Guidelines, the articles are short and will not take long to read.

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:

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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

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the BoneSmart view on exercise​

BoneSmart philosophy for sensible post op therapy​

5. At week 4 and after you should follow this

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Activity Progression for TKR's​

6. Access these pages on the website

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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.

OneStep information

 

[Jaycey]

@Twocaledonias Welcome to BoneSmart! We will get you added to the December group.

I agree with Pumpkin - go easy on the exercises until that knee settles a bit more. Ice and elevate as much as you can. These early days can be quite challenging. Hang in there - it does get better!

 

[Twocaledonias]

Thank you! I am doing ankle pumps, heel slides, glute squeezes, and quad somethings (can't remember name) right now. I do 3 sets of 10 reps, 3x/day. When I stand, I shift weight gently back and forth to each leg. I feel like these are pretty easy exercises. PT also tried to do something with a bolster behind my knee, but that triggers the 10/10 pain.

The issue with taking something for the breakthrough pain is that I don't know precisely when it's going to happen. I kind of know what movement might set it off, but it only lasts as long as the movement (and then is sore after). I hope that makes sense.

Anyway, thanks for the support. Just frustrated that I'm still so dependent on people. My sister had to return to work this week, so I had to have my daughter fly in.

 

[Annie N]

My advice is drop the PT completely for a week & see how you get on. You need to get walking a bit as a bigger priority and that's more than enough exercise in the first 3 weeks in my experience. When the pain drops is the time to get back to general physio. That's when you will find PT most effective. Just my opinion of course, don't beat yourself up.

 

[Pumpkin]

I do 3 sets of 10 reps, 3x/day

Of the exercise you are doing the heel slides may be irritating you knee in these early days.
Ankle pumps, heel slides, gluteal squeezes and quad sets, are exercises to help prevent blood clots. Talk to your PT about only doing one set 3x a day and see it that helps with your pain. You can increase as tolerated.

 

[kneeper]

Hi--3 sets of 10 seems like a lot given your pain levels and how early you are in the recovery. They may feel fairly easy while you're doing them, but we often pay for them later.

You might try something like just heel slides or cut way back on the sets and repetition (at least for a while.) I think it's ok to do heel slides more than once a day (I did), but I also did fewer than 30 each time. More like 5-10 each time in the early days.

 

[sistersinhim]

Walking around doing your daily activities is probably enough activity until your pain level goes down. Many of us members never even did any PT or exercises, just depended on our daily activities to rehab our knees and we all did just fine, ending up at the same place that those who went through the formal PT and exercises. But, we did it without all that extra pain from repetitive movements.

This recovery should be a common sense recovery. If something you do hurts your knee then don't do it yet, because it's only slowing down your recovery. You can try it again in a few weeks, and if it doesn't anger your knee, then your knee is ready for that particular movement. Just don't do too much too soon. After about 6 weeks into recovery, I would try to add one new thing. If it hurt then, or the next two days or so, then I knew it was too early for my knee. If I had just a small amount of added discomfort, then I'd wait another week or so to add another activity to it. Try to remember that this recovery is not a sprint, but a long marathon. For most, a year-long marathon!

 

[Twocaledonias]

Thanks, everyone! Saw my surgeon today for my two week follow up. He says my xrays, incision, and swelling (lack thereof) are textbook perfect and I'm ahead of the curve on this front. We agree I am behind the curve, as mentioned, on movement, but as he says, "you do you and don't worry about anyone else."

He also feels a lot of this is due to kinesiophobia, and I agree. My anxiety at the prospect of pain resulting from movement is way up there. He is having me stop muscle relaxers and says to use my judgement backing off oxy. He has recommended adding low dose Xanax to combat the anxiety. I'm willing to try anything at this point.

He also said that thier data (it is a research hospital) shows that patients who use/commit to the Force app (which I've been doing since before surgery) fare just as well as those who work with physical therapists. He feels physical therapists over emphasize flexation early on. Since I'm never seeing the same physical therapist almost every visit, I'm giving this serious thought.

Thanks for all your support and comments!

 

[sistersinhim]

He also said that thier data (it is a research hospital) shows that patients who use/commit to the Force app (which I've been doing since before surgery) fare just as well as those who work with physical therapists.

Is this application called something besides Force? I googled it and didn't come up with anything. I'd like to learn more about this.

 

[Twocaledonias]

He also said that thier data (it is a research hospital) shows that patients who use/commit to the Force app (which I've been doing since before surgery) fare just as well as those who work with physical therapists.

Is this application called something besides Force? I googled it and didn't come up with anything. I'd like to learn more about this.

"Force Patient App"
This is a program adopted by the ortho dept at the hospital. They sent me my login info and data I enter gets reported vack to them. I'm not sure what happens if you download it from Google Play and try to use it without an invite.

 

[EalingGran]

Thank you! I am doing ankle pumps, heel slides, glute squeezes, and quad somethings (can't remember name) right now. I do 3 sets of 10 reps, 3x/day

That is an awful lot of reps for early on. I did just one set of 10 reps 3x/day plus gradually increasing walking. I also had my pilates teacher 1/ week for an hour. We started with gentle stuff on other parts of the body- increasing arm strength/ stretching stiff back etc. Then after a few weeks got down on floor and did some core strength and glute work. She thinks it is better to do 5-6 reps of and exercise slowly with perfect form rather than rush through a lot of reps.
I am 10 weeks post PKR and my ROM is good. I still get stiff and warm if I do too much. Walked 11000 steps yesterday and going to back off today.
Just listen to your body and don't overdo it

 

[thneed]

Sounds like you're doing great and it's nice to have a surgeon who is so understanding and accommodating.

I had to look up kinesophobia when I saw you mentioned it in your post, I had never heard of it. It's a very interesting subject. I have always had severe guarding issues that obviously became an issue once I started PT after TKR. Not sure guarding and kinesophobia are related but I can see myself in some of the descriptions of the phobia. One article I read mentioned the vicious cycle of decreased activity that can actually make the pain worse, so just by doing some strengthening and range of motion exercises people can overcome the fear and also help their muscles recover and get stronger. Now, this article wasn't necessarily in relation to TKR specifically, but I did see the relevance. I know if I overdo my exercises it can have an adverse effect, but if I don't do them at least once every other day, my legs feel worse, so it's just a balance I had to find that works for me.

 

[Flashlight]

forcetherapeutics.
My OS had to sign me up for it and I was given pre-op exercises to do. You are assigned to a nurse navigator who you can email or text with any issues before and after surgery. The exercises have a video on how to do them, how often to walk. Exercises change as time goes on and if you have a question, you can email a therapist. You have to check in daily and send in pictures of your knee in different positions. There are other videos pre-op and post-op on what to expect and incisional care. In the beginning it is helpful but now I am tired of checking in daily. I think the end of Feb. I am on maintenance exercises and no longer have to check in. When I was discharged from the outpatient center, I was told by the therapist that the most important thing was just to try and do the exercises and not pay attention to the number they wanted me to do.

 

[Jamie]

Force Therapeutics must be accessed via your surgeon's office. Not all doctors will have that available. But you can also receive excellent recovery guidance at your own pace using the OneStep program that is recommended by BoneSmart. It's a gait based program using a phone app that has proven to work for many of our BoneSmarties. Click on the link in the sidebar (desktop) or the bottom of your screen (smartphone) for more information and to register for a 2-week free trial and a discount on the program cost.

 

[LD of Michigan]

I do those heel-slides by just taking one of those amazon order 'bubble' pack envelops on the floor and foot-slide that. Works great. My PT liked that I got enough extension and flexion so far using with this option.

I am up on walker very well, yet more lazy this time at the 72 hour mark (I was very worn-out pre-surgery from lack of sleep). But to prevent clots I do those ankle pumps and other movements while in the bed.

 

[Twocaledonias]

forcetherapeutics.
My OS had to sign me up for it and I was given pre-op exercises to do. You are assigned to a nurse navigator who you can email or text with any issues before and after surgery. The exercises have a video on how to do them, how often to walk. Exercises change as time goes on and if you have a question, you can email a therapist. You have to check in daily and send in pictures of your knee in different positions. There are other videos pre-op and post-op on what to expect and incisional care. In the beginning it is helpful but now I am tired of checking in daily. I think the end of Feb. I am on maintenance exercises and no longer have to check in. When I was discharged from the outpatient center, I was told by the therapist that the most important thing was just to try and do the exercises and not pay attention to the number they wanted me to do.

I've found the app super helpful, but I have to admit without my PT encouraging me, I might not be able to get through the fear as well as I am now.

 

[Twocaledonias]

I'm now at 3 weeks out from surgery and still "guarded," but without the over-the-top fear I had of any movement. I feel lucky to have in-home PTs who are not overly agressive. I have gotten to 50 degrees flexing and I'm walking about 100 feet. I feel like I can take on more of my ADLs without assistance. Still can't get comfortable in my own bed due to lower back strain and can't figure out how to sleep on my side yet (not a lot of control over moving my new knee/leg yet).

I have one more week of in-home PT and supposed to start outpatient PT after that, which I'm a little anxious about. My OS says his patients who use the Force app do just as well as those who do formal PT, but I might need the structure. I just don't want to face MUA.

I appreciate all of your comments and guidance above!

 

[Flashlight]

You have to do what you feel comfortable doing. At 4- weeks I had a hard time getting in and out of the car, so the Force program worked well for me. At 4-weeks I was still sleeping in my recliner. I tried a number of pillows in bed, but it was difficult to get comfortable. Sleeping on your back is the best and I am a side sleeper. You will get there but it seems like it takes forever! Best wishes!

 

[benne68]

I'm walking about 100 feet. I feel like I can take on more of my ADLs without assistance.

It sounds like you are doing well for just 3 weeks post-op.

Sleep difficulty is very common at this stage. In fact, it takes many of us even longer to get comfortable in bed. Like you, I have low back issues and was not comfortable on my back. I finally tried sleeping on my non-surgical side with my surgical knee on an oversized foam pillow. It worked ... until I tried to change position in my sleep.

I feel lucky to have in-home PTs who are not overly agressive.

This is good to hear, but -- if you choose to do outpatient PT -- be aware that very few therapists are trained in dealing with joint replacement patients. They take a training approach, as though we are athletes, rather than the recovery approach that is needed. It's up to you to make it clear that you will NOT be pushed into pain.

Here's an article from our library that may be helpful:

Myth busting: No pain, no gain

With rather blatant snitching from a couple of other sites, I give you the lie to this saying! Wikipedia No pain, no gain (or "No gain without pain") is an exercise motto that promises greater value rewards for the price of hard and even painful work. Under this concept, competitive...

bonesmart.org

Keep us posted on your progress!