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TKR 15 week update

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One week update! I realize every knee is different but I never really knew exactly how different they actually could be. I'm walking with a walker, no knee buckling, and no limp when I really focus on squeezing the quad.

I'm messing up my pain management & I know it. I'm trying to get on a schedule but it's so hard because the pain cycle is really weird - when I wake in the morning it's the worst, around a 7-8 till I get limbered & iced up. And I do take the meds during the night so I'm not behind in the morning. Then in the evening it's the same thing - a spike up to 7-8 starting around 8pm. But during the rest of the day I'm at a 3 even after moving around. So I take Dilaudid 6 mg upon waking & just before bed, and 2-4 mg of Dilaudid every 4-5 hours during the day. Plus I take Tylenol 1 gm every 6 hours. My pain is also very different from last year - now last year there was lots of discussion on this forum about the tight band feeling - and I had it also, going around my thigh. This year I have a tight band (really a hard stop) starting about 2" above the kneecap to about 6" above. But it doesn't go around the thigh, it's in more of a rectangular shape , 4 inches wide, & it seems to be all quad. It stops the bend & is very painful to touch.

I don't do much during the day, walk around the house for 5-10 minutes, heel slides, quad sets, leg lifts, light marching. I don't really exercise, never have for any of my surgeries, but rather I incorporate the exercises throughout the day. I ice & elevate almost constantly, and the back of my thigh has lovely shades of green, yellow, & purple down past the knee. I'm swollen but nothing outrageous. I have full extension and a bend to about 90 degrees. Home PT has started, she's pleased with my gait & the "numbers", wants me to take it slow, & not do all the exercises they gave me from the hospital. They'll be coming out 3 times a week - she wanted to schedule 5 times a week & I said no! My spirits are decent, my energy levels are really low, my appetite is pretty poor, and Miralax is taking care of my gut issues. I'm a bit bored to be honest, I can't focus for too long on any one thing, so I watch TV, then read, then nap, then get more ice, etc etc.

@kneeper you are right, it does help to know what to expect & so far at least, it's better than what I expected. I'm almost waiting for the other shoe to drop, since this is soooooo different. I'm in real danger of over doing it, so I'm trying to be very conscious of everything. Slow & steady is my mantra.
 
So I'm 2 weeks post op and I did what I swore I wouldn't do - I screwed up! I was on the stairs & my husband called out to me & sounded like he was in distress. So I turned to go back down and instead of stepping down with my new knee 1st, I put my 1 year old knee down, and then completed the step with the new knee. So the good news is I didn't fall, & I know I can take a normal step down the stairs. The bad news is that I've been sitting in ice & elevating almost the entire day - the knee feels tight & swollen. I know it's just temporary, but I'm so mad at myself! I can't do the mantra of up with good & down with the bad as my 1 year old knee doesn't really feel any better than the 2 week old knee. And BTW, the hubbie wasn't in distress, he just learned he was going to be a great grandpa for the 1st time & was a bit emotional.

Other than this setback the knee was doing real good. It felt loose, not horribly swollen, and my flexion was slowly getting easier. I was walking with 1 crutch or sometimes - for short distances in the kitchen- with nothing at all. Sleep for some reason was a bit more elusive, I was waking in pain despite medicating right before going down. But overall, I'm pretty happy with how I feel and how the knee is progressing. My quad has gotten stronger, the numb area is there but not as dense as a year ago, the incision looks good, and my extension is at 0. So more of the same for the next week, moderate exercise, walking 10 minutes a couple of times a day, icing, & taking it easy. I still have lots of HGTV shows on the DVR to keep me entertained, although I am bored to tears. All is good in my slow and steady state of mind!
 
Congratulations on the great grandchild!
Sorry to hear you knee was overworked when you stepped down with the good leg. :censored:
Hope your knee is starting to feel better, sounds like you are doing great otherwise.
 
Congrats and so happy for you that things are going so well.


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It's now 4 weeks & 2 days and fortunately I'm still doing great. I went for my 1st post op appointment with my OS who is quite happy with my progress. I'm at 118 with no effort and 0 extension with just a tad of swelling. I am still quite stiff in the morning when I get up or when I've sat in one position for some time. He told me to remember my knee was still healing and the soft tissue swelling was still a risk as he told me to begin to ramp up the exercise - my quad is visibly atrophied & needs some attention. He does want me to continue with outpatient PT which I wasn't planning on doing but he thinks I should cuz of the quad. I'll give it a go, but I'm not enthusiastic and I have to find a new PT agency - I won't go back to the one I used last year.

So my question for those with more experience - what exercises should I focus on to strengthen the quad? Right now I'm doing the bike with no tension for 10 minutes every day sometimes twice a day. I also do a combination of straight leg raises, glute squeeze with my heels on the ball, then I put my feet on the ball & roll it back towards my butt, mini squats (but really they are so shallow they get my glute & not really my quads), some band exercises where I stand in 4 different directions (N, S, E & W) and abduct each of my legs, & stair lunges - most of these are done 10 times once a day, not all at once, and honestly are easy for me to do. And I walk but not far cuz we live in a hilly area & he didn't want me to do hills. I'm not killing myself on the exercising

So what else do you recommend I add to my repertoire - remembering I have a tendency to overdo it which I am trying to avoid by being smart & having a game plan. I figure if I plan my exercises each day then I won't be as likely to go overboard. I'll also ask my current PT who I trust a lot but I also know there's way more experience on this forum. I appreciate any advice that comes my way.

Other than that, my sleep is still crummy, with my most significant pain occurring in the nighttime. I still take Tylenol 3 times a day along with Dilaudid, 2-4 mg in the morning, late afternoon & bedtime. My incision line is beautiful - really - and I can start to use Vitamin E cream or oil to keep it supple. I survived the 1 hour car ride to the OS office, sitting in his waiting room for 2 hours (yes he was way late & that's most unusual) and then the 1 hour ride home but I'm pooped right now. My 1 year old knee feels worse than my 1 month old knee and I don't think that will ever go away. No pain, but stiff and it feels like I have a heavy weight in a half moon shape around the outer aspect of my kneecap. They did start a new protocol since the last knee - I don't remember the name of the med, (trans... something) but I got 3 pills just before surgery & 3 pills after the surgery that is suppose to help prevent blood loss. And Dave said they have some indication it also keeps the swelling down & they are seeing less pain in the patients who take this med. Plus he gave me IV steroids in the OR & post op as I have had such a strong inflammatory response in the past. He also reminded me that I've had 3 major surgeries in 2 1/2 years & it takes a toll physically & mentally. But so far, this is the easiest of the 3 - and I'm keeping my fingers crossed it stays that way!

Thanks for any advice you can throw my way!
 
Hello @dtmbf

Your recovery seems to be going very well. You're doing so much, so well. I hope my recovery goes along similar lines.

I was ever so pleased to read your update. It was so nice and positive. I think you are probably doing enough exercise but it doesn't hurt to ask. Your 1yr old knee is still having to compensate for the new RTKR. Mine really ache's sometimes but it's doing the Job that it should.

Will look forward to your further updates

Love Nana moon 27 x
 
You do seem to be doing very well. Get plenty of rest, icing, and elevation after such a busy day. As for exercises, at this point, it sounds like you're doing plenty.


Jean

LTKR (Stryker Triathlon): 21 April 2015
Right Knee Arthroscopy: 25 July 2006
Left Knee Arthroscopy: 10 February 2005
 
I had such a huge quad muscle going a month or so after surgery my sister insisted the infection was there, also when I was wearing an imbolizer after my 2nd surgery a month after the first I could still do straight leg raises with the imbolizer on! It was heavy! So I'll chime in here, I did 3 reps of 10 straight leg raises twice a day, 30 quad squeezes twice a day, 30 squeezes with a ball or pillow (I used a convenient teddy bear) 2x a day and 9 weeks after surgery I was doing clams with a rubber band. All those were just for quads I believe, none of those had any impact on my ROM, which I only did heel slides early on then biking and some machines 3 months after. Hope this helps your quads!
 
dtmbf said:
what exercises should I focus on to strengthen the quad?
Click to expand...
At only 4+ weeks since your surgery, it's too soon to be thinking about strengthening exercises. Your quads will recover with daily use and you can start strengthening exercises in about another 6 weeks or so. Right now, your wounded tissues still need gentle treatment as they heal.
 
@Celle - that's exactly what I was wondering about. I'm not particularly twisted about my quad as I know I can get it back in shape. But the timing of doing that wasn't clear to me. I am totally committed to a steady recovery & you've just helped me keep on track. Thanks!
 
At 5 weeks post op I'm focused on regaining strength in both my legs. I'm not going overboard but I have ramped up some of the PT. Once I got the OK from my OS to walk on slopes, I've been out walking 3 times a day for no more than 10-15 minutes at a time. Plus I'm on the bike with no tension for 15-20 minutes and then I have some band exercises I do. The GOOD news is that I came downstairs this morning & told my husband I didn't even feel as if I had a knee replacement - it just felt like a normal knee - stiff & a bit tight, but it felt normal!!! Which is so unlike my 1 year old left knee. So I talked to the PT today & she suggested I try some manual PT like myofascial release on the left. Does anyone have any experience with that modality? I am still densely numb on the left knee also so I was also thinking of getting a neuro consult and that something like the gabopentien might help me if the concrete feeling is due to the numb sensation. Who knows, I know I'm really reaching here, but when the right knee at 5 weeks feels awesome & the left still gives me fits I've got to make one last stab for total normality.

Back to the right knee - I also walked up & down the stairs reciprocally. I was thrilled - and down was way easier than up which I believe is unusual but my quad is so weak going up is challenge. And I have a tired leg tonight but no pain or increase swelling. Sleep is still sporadic, so I don't go to bed without a book to read in the middle of the night.

All I can say is thank god I got the bad knee done 1st - if I had had the right knee experience a year ago I would be hysterically worried now going thru what I went thru last year. But next week should be more of the same, and then I start outpatient PT on July 6. Even tho I didn't want to, I made the appointment today at a different agency. Fortunately my focus is not on my flexion but on my strength. Onward I go!







.
 
6 weeks post op & I'm still on track for a slow & steady recovery. I am a bit more achy which I attribute to PT advancing my exercises - my quad is very weak which is affecting the knee so we decided to focus on that since my flexion is just fine. I can do all the exercises without any pain so I'm not too worried. Discomfort yes, but no pain. Now, I don't have any more lower extremity joints to replace, but I was in the worst shape ever pre-op for this knee, and I'm paying for it now. I still take some pain meds throughout the day, I tried to step down from Dilaudid to Vicodin but it was a no go. The Vicodin did nothing for me at all.

I got out of the house finally this week - made it to the mall for about an hour of shopping & survived walking with my crutch. Went to a big home improvement store today & it was OK. When I do something like that I don't go walking during the day. And tomorrow is a pedicure!

So, I'm doing OK. The knee is still VERY stiff & numb & I tend to revert to a peg legged gait around the house. I'm perfectly capable of walking heel - toe, but I find myself just subconsciously favoring the knee. When I realize it, I immediately correct the gait, but it's frustrating cuz it's not automatic. I can come down stairs reciprocally but going up I can only manage 4-5 steps before I begin to use my arms to pull myself up the stairs. That pesky quad again! I still ice religiously. My incision is beautiful & my conditioning is slowly improving. Outpatient PT starts next week. This knee recovery is SO much better than the last one, so I have no real complaints.
 
That is so awesome Mary Beth!! Just be careful about doing too much. At six weeks I remember going out to Home Depot and surely paid for it the next day!! I also take dilaudid but mostly limit myself to taking it at night. Aleve and Tylenol are great during the day. Started using that kinesiology tape and I must say, I feel less stiff with it! Who knows, a gimmick or there is something to it. Anyway, bravo to you for doing so well!! I found out that I also have osteoarthritis in my hips as well...tell me how was your hip replacements? You did them both at the same time??? Wow!
 
So happy for you! Wish I could say the same about my 2nd knee (done 2 weeks ago). My 1st recovery was so easy I guess I was spoiled because this one has been the exact opposite. I have not been able to get good pain relief and actually have more pain when resting with my leg elevated than sitting up. Needless to say my progress with exercises has been affected. I see my OS tomorrow and get the staples out so maybe that will help, but we're going to have to talk about pain meds because the Tramadol doesn't seem as effective as it was the last time, and I had him change me to Percocet from Norco this time because I didn't think it helped but I can only take half a dose because it makes me so nauseous. Uggg... just trying to keep my eye on the prize because I know it will get better eventually, but like you said if I had done this one 1st I would definitely have been cautious about going through this again.
 
@bluejuju - the hips are WAY easier than the knees. Not a piece of cake, but I was so glad I did them both at once, although I did have to go to an acute impatient rehab for a week. mainly to get me going, then i flipped over to outpatient PT. Less pain as its a deeper joint, post op focus is on strength rather than flexion. My OS kept telling me the knees were way harder & he wasn't joking!

Glad the K tape is helping. Who cares if its psychological, if you feel better and it doesn't hurt you, go for it!
 
@Gigi32 - I am so grateful my not so good knee got done 1st as it makes this recovery seem like a breeze. It isn't really, except by comparison. I have the same home PT as the 1st knee & she could not believe I went back for the 2nd knee so soon. I am so happy I didn't have staples - I can't imagine how that feels. Like you, Tramadol did nothing for me, Percocet had me break out in hives, so he switched me to Dilaudid which has worked OK, but it does make me tired. Swelling & pain control - if those 2 were mastered our recoveries would look very different!
 
Staples are not that bad. You can't feel them anyhow. Removal was quick and trouble free.


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7 weeks and still counting! Not much is different from last week. I'm walking a 28 minute mile (really only walk a 1/2 mile) which is down from when I first started walking outside (48 minute mile the 1st week or so). We have 15 - 9" steps in our house between each floor so walking reciprocally is a challenge. I go up reciprocally about 1/2 of them, down 3/4. They are L shaped so turning the corner & hanging on is not easy. The knee is still very stiff, drives me bonkers.

I went to outpatient PT for the 1st time - which went well. Very professional agency, I was impressed. It was interesting that their questionnaire actually asked if you thought PT should cause pain, or if PT should push you even if it caused pain. Needless to say I answered no to all. The PT actually didn't think I needed to go to PT, but I think he was basing that on my flexion of 123, and I pointed out my strength & balance needed work. Anyway, he really honed in on the exercises he thought I would get the most out of. - so I ended up with 4 new ones, using a balance ball or a step - both of which I have at home. Plus he wants me to walk every day & ride the stationary bike. I'm only going to go once a week, mainly to keep myself on track. - I do pretty good exercising myself. This knee is just so very different from the 1st one - and I'm not unhappy bout that!
 
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