Revised PKR to TKR 12 months later but can’t find my thread

[Pumpkin]

Shelli22,
Sounds like this PT is not for you, seems they want to pile up pain on top of pain.
They should be working on getting your swelling down with retrograde or lymphatic massage, electrical stimulation, ice and elevation in the clinic. Lunges are only going to make your knee .

I gained ROM at about 18 months after my revision, there is plenty of time for ROM. Seeing how you are less than a month out from your Revision, your wounded knee needs time to heal. If you had broken you leg, you would not walk on it until it is healed, your knee needs the same kind of TLC to heal.
As you heal, you will find your ROM and strength returning.

 

[Celle]

I am using a walking aid if I go anywhere as I get too tired without it. I forget it at home as I have a very small home, it’s two steps from the lounge to the kitchen and four to the bathroom. I’m not doing any exercise and spend most of the day sitting, icing and elevating unless I have an appointment or need the chemist or grab some shopping.

I'm glad you are using a walking aid. What made me concerned was that you said this, several posts ago:

My knee has had time to do some healing and I’ve been able to walk without aids since the day I arrived home from hospital however I use a stick when I go out for safety purposes.

It's still too early in your recovery for you to be going out to get shopping.
Check your activity against this: Activity progression for TKRs

For at least the first month, your nee needs minimum activity. As Pumpkln said, you wouldn't be trying to do these things while walking on a broken leg. Your knee has now had several surgeries and those cause just as much trauma as a bad fracture - possibly even more.

The physio has now written a note requesting a plan to start exercising the knee. He was telling me what he intends to do and that includes half lunges to work hips. Not sure I like this idea. He is now saying it might be time to start pushing through the pain and putting up with a bit of pain to gain ROM. I don’t like that idea either.

As the others said, this is not the physio for your knee.
It sounds as if he is impatient and he plans to do far more than your knee will tolerate.

Lunges may work the hips, but they are very bad for a new knee.
And anyone who talks about pushing through the pain is not going to be a friend to your knee.
Myth busting: no pain, no gain

Either find another therapist who will treat your knee more gently, or don't go to PT at all. A good therapist is a help, but doing no PT therapy at all is better than having bad therapy.

Only you have the right to say what happens to your knee. You are in charge.
Saying no to therapy - am I allowed to?
CONSENT: what it means and how it can be used

There are many of us here who did no PT at all, but just let the normal activities of our daily living be the therapy for our knees - and we got good results. That's what I did for my last 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. Your ROM is there right from the start, just waiting for all that to happen, so it can show itself.

My surgeon doesn't allow any PT at all for the first month after a knee replacement. He says your knee needs that time, to start on its journey of healing. For that month, we rest, ice and elevate our leg, and walk around the house.
After that month, we just go to PT once every 2 weeks, where we are shown a few new exercises to do at home.
His patients all do well and achieve good ROM, as I did, and he hasn't had to do a manipulation to help with ROM for the past 4 years, because nobody developed adhesions. I think that speaks for itself.

 

[Josephine]

comments in other threads regarding revision TKR and whether they are easier to recover from.

They're only easier if they're done just for loosening. Otherwise they can be a bear! It very much depends upon a) the reason b) how the surgeon performed the surgery (rough or gentle) c) how you are reacting to the recovery. And it seems to me that you are not reacting very well (which isn't your fault!).

I am struggling with the pain of this latest one

I've debated on this but I suppose it's worth another try - 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?

 

[shelli22]

Yes @Josephine.

Why have you debated on it? I may be a nurse but it doesn’t mean I know this stuff. Yes I’ve been around a long time but each one of my four recoveries on the same knee have been totally different. I’ve always taken pain in my stride but I’m at a loss with this one.

I keep trying different pain regimes and the only thing that works at the moment is the slow release plus endone for break through pain but you’ll see that in my responses. I spend every night reading this forum in the hope I get some clue to help me with my own recovery.

But Josephine I listen to all your suggestions and try and adhere to them and the BoneSmart way. The only thing I have done wrong - I went to shops and chemist because I didn’t want my mother to pay for anything more for me - they’re on a pension and my dad is having the same surgery on the 14/3/18. She won’t take no for an answer so I went so I could pay myself. The rest of my outings are surgeon, GP and physio.

 

[shelli22]

@Celle no you didn’t say it was easier to recover from revision. As I said I was reading your comments regarding that question and you said it was very individual. I realise I said originally that I was not using a walking aid at home and I should have put that in context. This house is tiny and it really is only two to four steps to get to anything. Otherwise I use the stick.

I wouldn’t say medication is sufficient partly because I took what the surgeon said to the pharmacist to heart and tried to comply - he was giving me slow release Oxycodone 20mg three times a day instead of two so I could wean off the endone. So I tried to do that. Fail.

With regards to the physio, he has written a note for me to take to the surgeon. This is a good thing because rather than him writing directly to him and thus I have no say, I now have the opportunity to discuss what the physio intends with the surgeon and tell him no. I won’t be doing lunges and nor will I push through the pain. We’ve made that mistake before and I ended up in a vicious cycle of pain and swelling and eventually adhesions +++. I have a voice here and I’m not afraid to use it. I was just writing what he said.

I see the surgeon Monday who will be cross with me for not exercising but so be it. It’s too swollen and painful right now even though I ice and elevate all day and all night when ever I’m sitting or lying on the couch which is most of the day unless I have appointments but the second I get home I set up my couch with heat pack for sciatica and ice for my knee. The elevation pillow is always on the couch ready and waiting.

 

[Celle]

I wonder if your PCP/GP would be more helpful about your medications? They often are.

 

[Josephine]

Why have you debated on it?

I only meant I had debated whether to leave you the questions again but since you seem agreeable, here they are! Thew last time was on December 20th

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.

 

[shelli22]

@Josephine

1. Pain levels - at worst 7 - 8.

2. Medications: Tramadol SR 200 mg - one twice a day at 6am and 6 pm.
Oxycodone SR 20mg - one three times a day at 7am, 3 pm and 11 pm.
Lyrica 75 mg twice a day at 6 am and 6 pm.
Aspirin 300 mg once a day at 6 pm.
Endone 5 mg 4 times a day at 10 am, 4 pm, 10 pm and 4 am. I take one during the day time and two for the night doses.

3. I would say huge. But I took a photo.

4. ROM is still the same. Flexion 90. Elevation no idea but can just get my fingers between my knee and the table.

5. I ice most of the day for hours on end. Unless I’m out I am on the couch icing and elevating. As soon as the ice pack gets warm I get up and replace it so it’s continuous and for hours.

6. Elevation is the same as above. I may do something like feed the dogs, then I’m back on the couch elevating and icing.

7. Activity level is minimal. I will not cook. Just make Ryvita with salad and cheese or something. I might pick up bits of sticks the puppy has brought in and I walk outside and water the plants. Wipe down benches. Put washing on. Hang it inside on clothes rack.

8. Exercises at home:
Heel slides 10 reps, hold for 3 secs, once a day.
extension exercise, activate quad to straighten leg 10 reps once a day hold for 3 secs.

Exercise at PT. None to date. PT has only been lymphatic massage and massage for sciatica.


Sent from my iPhone using broken link removed: https://r.tapatalk.com/byo?rid=75543

 

[Celle]

My revision was from a failed PKR to a TKR. After 11 years with a PKR that I used in a normal, active life, the spacer had worn thin and one day, without warning, it broke. That left me unable to walk at all.
I was on crutches for 4 months by the time I had the revision and could walk again with a stick.

In spite of that, my revision was an easier recovery. I attribute that to the skill of my surgeon and also to knowing to ice and elevate, which I didn't do for the original surgery.

 

[shelli22]

@Celle my gp won’t prescribe any pain relief. She thinks that’s the surgeons call. Everyone has gone silly over the new rules that have just eventuated.

We have just had all codeine products removed from the shelves. Anything stronger than Panadol and ibuprofen has to be prescribed. They are pushing for everyone to use a product that contains 500 mg paracetamol and 150 mg ibuprofen. Now watch the increase in the number of stomach related issues. I can’t believe they have actually done this.

I wonder if that’s why the surgeon is giving me slow release. Although he does insist they work better I wonder if that is so he doesn’t have to prescribe so many of the short term and I don’t have to keep calling in for scripts as he can only prescribe 20 at a time. I called yesterday for the endone and he has honestly never denied or argued with me. He just writes it and faxes to my pharmacist.

@Pumpkin. I am having massage to get swelling down and I purchased a tens unit from the physio yesterday for the sciatica. It’s amazing. I tried it last night, followed by heat pack. It doesn’t resolve the pain but it feels great while it’s on.

I won’t be doing those exercises. I have a terrible history of adhesions and swelling. I’m not going there again trust me.

@Jockette. He can remain my therapist but we won’t be doing those exercises and nor will we be pushing through pain.

This new response from the physio is all about workcover and getting back to work in a timely manner. What they seem to forget is the more I push through the pain and do exercises that increase swelling and cause pain the longer my recovery will be. I’ve explained this a million times but I’m convinced they think I don’t want to return to work. I do but I’m not going back with excruciating pain that I have to drag my leg that feels like lead out to the car at the end of my shift.


Sent from my iPhone using BoneSmart Forum

 

[shelli22]

@Josephine my TKR revision is a bear !!!!!

 

[Pumpkin]

Happy to hear the TENS unit is helping your Sciatica, you can also use it on your knee.
TENS machines for pain management
Sorry to hear they are putting so much pressure on you to return to work.

We recommend 3 months off after TKR, if you are on your feet your may need longer. When you return we recommend a Phased return to work .

 

[shelli22]

@pumpkin I’m a nurse/midwife. I’m on my feet the whole shift. I won’t be going back until this has all settled down and I have minimal pain. Thankfully the surgeon will only clear me when he is satisfied that I’m ready and it will definitely be a phased return. The physio will go along with what the surgeon responds. So I guess it’s up to me to let the surgeon know that pushing through pain won’t be happening and half lunges are not a good idea.

 

[Jockette]

It must be such a joy to deliver babies!

 

[shelli22]

@Jockette it sure is though I had to give that up due to my knee but now I work in a neonatal unit so I still get to work with babies ️️

 

[Josephine]

1. Pain levels - at worst 7 - 8.

Well, you're only 4 weeks out so hardly surprising.

2. Medications: Tramadol SR 200 mg - one twice a day at 6am and 6 pm.
Oxycodone SR 20mg - one three times a day at 7am, 3 pm and 11 pm.
Endone 5 mg 4 times a day at 10 am, 4 pm, 10 pm and 4 am. I take one during the day time and two for the night doses.
Lyrica 75 mg twice a day at 6 am and 6 pm.
My GP won’t prescribe any pain relief. She thinks that’s the surgeons call. Everyone has gone silly over the new rules that have just eventuated. Panadol and ibuprofen has to be prescribed

My goodness! So you have 3 major pain meds at your disposal. But did you know that Endone is also oxycodone? So really you shouldn't need anything else though a change might help. But if your two supervising medics aren't being helpful, it seems like you're stuckered!
I've worked out that you are taking 80mgs oxycodone per day.

You haven't said, but have either of those oxycodones got paracetamol in them? If not, you could bolster your pain meds with 1,000mg pracetamol 4 times a day - 6hrly. It could make quite a difference.

3. I would say huge

So would I!

4. ROM is still the same. Flexion 90. Elevation no idea but can just get my fingers between my knee and the table.

Did you mean extension? If so, that would probably indicate a +5 according to the table in here Extension: how to estimate it which is fine.

5. I ice most of the day for hours on end.

Okay - well protected I hope?

6. Elevation is the same as above.

Good

7. Activity level is minimal.

Okay

Exercises at home:
Heel slides 10 reps, hold for 3 secs, once a day.
extension exercise, activate quad to straighten leg 10 reps once a day hold for 3 secs.

Since your ROM is 90/+5. there is no need for you to do either of these. Most of the problem is from the swelling anyway and since these exercises will increase the swelling, you can see that they are totally counter-productive.

 

[sistersinhim]

Are you elevating toes above your nose? That swelling looks so painful. How much longer do you have to wear the Teds? That also looks very painful.

 

[jboles]

I agree with @sistersinhim that Ted hose looks super painful, could it be contributing to some of the knee swelling?

 

[shelli22]

@sistersinhim I am elevating toes above nose

 

[shelli22]

Teds are to be worn for six weeks, that’s his rule. I sneak them off for an hour or so to breathe