TKR 19 Dec. 2014: santa brings me a new knee
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skigirl
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Wow, that is a long scar!! Mine is 3.5 inches long---I guess surgeon's differ in how long to make the scar.
My OS did an OATS procedure even though the lesion was also bigger than it should have been. Then, no weight bearing for six weeks and supposedly CPM for six hours per day. I was pretty good the first week---did about 4 hours per day, but after that I barely did one hour--I hated the thing. The "walking" drove me nuts. Even when it was pressed against a wall, it still moved sideways. We don't have carpets---no footboards on the bed, even the couch could not contain the stupid thing!!!!
Of course, I ended up with a TKA a year later, so it was all for naught.
My OS did an OATS procedure even though the lesion was also bigger than it should have been. Then, no weight bearing for six weeks and supposedly CPM for six hours per day. I was pretty good the first week---did about 4 hours per day, but after that I barely did one hour--I hated the thing. The "walking" drove me nuts. Even when it was pressed against a wall, it still moved sideways. We don't have carpets---no footboards on the bed, even the couch could not contain the stupid thing!!!!
Of course, I ended up with a TKA a year later, so it was all for naught.
OP
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treypops
Sr Bonesmartie
OK, so here I sit on day 15, and recovery is progressing. ROM is about 105 degrees (can go up to 120 in the cpm). Extension is at about five degrees.
I am doing the following exercises easily:
leg lifts (from flat on my back, on my side, and on my stomach)
heel slides
bicycle kicks
quad presses (put a pillow roll behind my knee and press my leg downward toward the bed surface)
calf raises
free squats
There is one exercise that is giving me trouble, and that's the hamstring curl. I've tried it both ways, on my stomach and lifting my leg back toward my butt, and from standing position, lifting my heel up toward my butt. With both, it feels like my incision wants to rip open when I get to my ROM limit. I hope that's not an adhesion or something in there.
Other than that, everything seems to be going well. I am walking everywhere without the walker, I am able to perform tasks without totally exhausting myself, and I am occasionally driving here and there. Yesterday, I traveled about fifty miles outside of town to spend New Year's Day with family and had no issues.
I have cut back on my pain medicine. Now I am only taking one before bed and one first thing in the morning, and otherwise taking Tylenol.
The sum of my frustration at this point is covered here: lack of sleep and inability to get comfortable. I wish I had better ROM or could move around faster but I know that I have to be realistic about that just fifteen days post-op. But the discomfort at night is exasperating. I hope I can figure that out soon.
My last in-home therapy session was Wednesday, and I begin on-site therapy this Monday (I am driving myself). I expect business will be picking up on that day.
I hope everyone else is doing well, and I hope all have a blessed and prosperous new year.
I am doing the following exercises easily:
leg lifts (from flat on my back, on my side, and on my stomach)
heel slides
bicycle kicks
quad presses (put a pillow roll behind my knee and press my leg downward toward the bed surface)
calf raises
free squats
There is one exercise that is giving me trouble, and that's the hamstring curl. I've tried it both ways, on my stomach and lifting my leg back toward my butt, and from standing position, lifting my heel up toward my butt. With both, it feels like my incision wants to rip open when I get to my ROM limit. I hope that's not an adhesion or something in there.
Other than that, everything seems to be going well. I am walking everywhere without the walker, I am able to perform tasks without totally exhausting myself, and I am occasionally driving here and there. Yesterday, I traveled about fifty miles outside of town to spend New Year's Day with family and had no issues.
I have cut back on my pain medicine. Now I am only taking one before bed and one first thing in the morning, and otherwise taking Tylenol.
The sum of my frustration at this point is covered here: lack of sleep and inability to get comfortable. I wish I had better ROM or could move around faster but I know that I have to be realistic about that just fifteen days post-op. But the discomfort at night is exasperating. I hope I can figure that out soon.
My last in-home therapy session was Wednesday, and I begin on-site therapy this Monday (I am driving myself). I expect business will be picking up on that day.
I hope everyone else is doing well, and I hope all have a blessed and prosperous new year.
OP
OP
treypops
Sr Bonesmartie
@skigirl
When I went in for my OATS procedure, my doctor told me that because they were moving a bone plug from a non-weight bearing location, I would be able to bear weight immediately and would be walking around and feeling great after a couple of weeks, but with the microfracture, there was definitely no weight bearing for six to eight weeks because you had to give the cartilage time to form. We were hoping the OATS could be done because it would've been a much easier recovery. Unfortunately he had to go with microfracture, and I was on crutches for two months (and all for naught, as it turned out).
Anyway, I find it interesting that you would be six weeks non-weight bearing after OATS. I'm sure you're glad that it's all water under the bridge now, though.
When I went in for my OATS procedure, my doctor told me that because they were moving a bone plug from a non-weight bearing location, I would be able to bear weight immediately and would be walking around and feeling great after a couple of weeks, but with the microfracture, there was definitely no weight bearing for six to eight weeks because you had to give the cartilage time to form. We were hoping the OATS could be done because it would've been a much easier recovery. Unfortunately he had to go with microfracture, and I was on crutches for two months (and all for naught, as it turned out).
Anyway, I find it interesting that you would be six weeks non-weight bearing after OATS. I'm sure you're glad that it's all water under the bridge now, though.
skigirl
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I think the reason you cannot get comfortable at night is that you still need pain meds and for some reason don't want to take them!! I had a script for Tramadol (brand name is Ultram) at this time. It made sleeping much easier and I did not have the fuzzy head that I got from Percoset. I think you need to take a mile pain reliever like tramadol during the day too. The restlessness and inability to be comfortable is plain old pain raising its ugly head!!!
There is a danger here---I know this from personal experience, by the way--to think that you are bouncing back from this surgery. But, you cannot do that---when I was at three weeks, my doctor told me that I needed to rest for two hours for every one hour that I was up and around. You have just had major surgery and your tissues and bones need to heal. You are doing very well---but you are not healed. Rest, elevation and ice are still needed to avoid overstressing your joint.
Your muscles are still not strong enough to support that joint, so while you are walking around you are causing some stress on the joint itself. If you do too much---pain and swelling are your reward---remember, I know all about this!!! I did too much--anxious to prove that i am an athlete and can bounce back from anything---I was in the worst pain of my life---i spent one whole night in agony---my joint was very inflamed from my stubborn resistance to rest!!!
You are doing great---but you have a long way to go to recover your stamina and to the point where your muscles are strong enough to support that new joint.
There is a danger here---I know this from personal experience, by the way--to think that you are bouncing back from this surgery. But, you cannot do that---when I was at three weeks, my doctor told me that I needed to rest for two hours for every one hour that I was up and around. You have just had major surgery and your tissues and bones need to heal. You are doing very well---but you are not healed. Rest, elevation and ice are still needed to avoid overstressing your joint.
Your muscles are still not strong enough to support that joint, so while you are walking around you are causing some stress on the joint itself. If you do too much---pain and swelling are your reward---remember, I know all about this!!! I did too much--anxious to prove that i am an athlete and can bounce back from anything---I was in the worst pain of my life---i spent one whole night in agony---my joint was very inflamed from my stubborn resistance to rest!!!
You are doing great---but you have a long way to go to recover your stamina and to the point where your muscles are strong enough to support that new joint.
skigirl
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yes, He did an Oats and some micro fracturing since the leison was too big---hence the crutches. Yes my new joint gives me a lot less trouble than trying to salvage the old one did .
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treypops
Sr Bonesmartie
@skigirl
I am taking my meds - I'm just taking them at night before bed and early in the morning to help go back to sleep. I'm not doing too much during the day - I think I easily surpass the two-for-one ratio of rest for activity. I spend most of the day in the recliner with my leg elevated or in the cpm with my leg elevated, and constant icing. The pain is very manageable with Tylenol during the day at this point.
I understand that stiffness and tightness are forms of pain, but I don't think that's the primary cause of my discomfort at night. I'm a fairly active sleeper, always have been, and have always slept on my stomach. Well, I can't do that right now, so I try to situate myself on my right side with a pillow between my knees but it just isn't comfortable for me. I'm sure I will find the winning combination at some point.
I am taking my meds - I'm just taking them at night before bed and early in the morning to help go back to sleep. I'm not doing too much during the day - I think I easily surpass the two-for-one ratio of rest for activity. I spend most of the day in the recliner with my leg elevated or in the cpm with my leg elevated, and constant icing. The pain is very manageable with Tylenol during the day at this point.
I understand that stiffness and tightness are forms of pain, but I don't think that's the primary cause of my discomfort at night. I'm a fairly active sleeper, always have been, and have always slept on my stomach. Well, I can't do that right now, so I try to situate myself on my right side with a pillow between my knees but it just isn't comfortable for me. I'm sure I will find the winning combination at some point.
kenslover
new member
i haven't been here in a while but I just read thru your thread. Congrats TreyPops on your recovery. My first knee recovery was like yours. My second and third.. Not so much.. Keep up the good work.
Hi TreyPops, I am 17 days post op. I am starting to feel the knee loosening out, I knew if would take time to get the bend in the knee as my leg before hand also had no bend. I have not used a CPM machine as nobody in the hospital of physio have mentioned this, I rang a company today that rents them and there should be one available next week. Would you recommend me to use the CPM machine, I do not yet have a comfortable rom of 90 but I do feel a slight improvement each day, I do not want to push to aggressively to cause inflammation or swelling. I am also able to pedal forwards and backwards on a stationary bike, but have the seat quite high so the bend is not too much, is the bike equal to the CPM machine or is it completely different.
In saying all of the above, I am delighted with my new knee, cannot believe the full extension I have, so great to stand up straight, no more back or hip pain. Feel very strong but would like to work more on my rom.
Looking forward to your reply.
Holly
In saying all of the above, I am delighted with my new knee, cannot believe the full extension I have, so great to stand up straight, no more back or hip pain. Feel very strong but would like to work more on my rom.
Looking forward to your reply.
Holly
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treypops
Sr Bonesmartie
@Holly
I am glad your knee feels like it is loosening up. That is, if you mean that in a positive context.
It seems the consensus at bonesmart is mixed on the CPM; some folks love them and some folks don't see the benefit in them. For me personally, it's nice fore a couple of reasons. It really gets a good stretch on my muscles while moving my knee without me having to exert valuable effort at this point. I can set it to a specific ROM setting and know I'm getting a certain amount of bend. I've also found it to provide relaxing comfort at times - I can elevate my leg in the CPM and just turn it off and let it act as a harness for my iced leg.
I had tremendous pain and bruising in my thigh, about six inches north of my knee. I am certain that this was damage done to my quads by the tourniquet they used during surgery. As I used the CPM, I could feel those quad muscles benefitting from it. I could set it on 90 and feel the burn as my quads stretched, but after ten or fifteen minutes, they would loosen up to the point that I could bump up the setting to 95. In my mind, it's been a benefit. You just have to make sure that the company you rent it from sends someone out to train you on how to use it and set it up. As @skigirl has mentioned, they will slide if you aren't careful and the last thing you want is a CPM machine falling off a bed or a sofa with your leg strapped into it. Also, you don't want to get caught up in the flex setting on the CPM. I was in it earlier today, set to 120. That doesn't mean I'm getting 120 degrees of flexion, though; the real number is probably close to 105-110. But I definitely rely on mine.
There are exercises you can do that are equally as effective as using a CPM. For example, if you have a rocking chair, you can put your left foot on the ground and use it to rock yourself. You will get bend close to 90 degrees doing that, and because it's a rocking chair, you won't have to exert too much energy to do it.
Heel slides is another exercise you can do and I'm sure you're familiar with that one. It takes a little more energy to do those, though.
Bottom line, though, is that ROM just isn't as important as we think it is at this point. I think you had your LTKR a couple of days before mine, and at our stage, our focus should be on reducing swelling as much as possible - RICE (Rest, Ice, Compression, Elevation). That will be the quickest way to achieve greater ROM and extension, but is also the best way to reduce pain and improve recovery time. That just seems to be my experience, though.
I really hope this helped.
I am glad your knee feels like it is loosening up. That is, if you mean that in a positive context.
It seems the consensus at bonesmart is mixed on the CPM; some folks love them and some folks don't see the benefit in them. For me personally, it's nice fore a couple of reasons. It really gets a good stretch on my muscles while moving my knee without me having to exert valuable effort at this point. I can set it to a specific ROM setting and know I'm getting a certain amount of bend. I've also found it to provide relaxing comfort at times - I can elevate my leg in the CPM and just turn it off and let it act as a harness for my iced leg.
I had tremendous pain and bruising in my thigh, about six inches north of my knee. I am certain that this was damage done to my quads by the tourniquet they used during surgery. As I used the CPM, I could feel those quad muscles benefitting from it. I could set it on 90 and feel the burn as my quads stretched, but after ten or fifteen minutes, they would loosen up to the point that I could bump up the setting to 95. In my mind, it's been a benefit. You just have to make sure that the company you rent it from sends someone out to train you on how to use it and set it up. As @skigirl has mentioned, they will slide if you aren't careful and the last thing you want is a CPM machine falling off a bed or a sofa with your leg strapped into it. Also, you don't want to get caught up in the flex setting on the CPM. I was in it earlier today, set to 120. That doesn't mean I'm getting 120 degrees of flexion, though; the real number is probably close to 105-110. But I definitely rely on mine.
There are exercises you can do that are equally as effective as using a CPM. For example, if you have a rocking chair, you can put your left foot on the ground and use it to rock yourself. You will get bend close to 90 degrees doing that, and because it's a rocking chair, you won't have to exert too much energy to do it.
Heel slides is another exercise you can do and I'm sure you're familiar with that one. It takes a little more energy to do those, though.
Bottom line, though, is that ROM just isn't as important as we think it is at this point. I think you had your LTKR a couple of days before mine, and at our stage, our focus should be on reducing swelling as much as possible - RICE (Rest, Ice, Compression, Elevation). That will be the quickest way to achieve greater ROM and extension, but is also the best way to reduce pain and improve recovery time. That just seems to be my experience, though.
I really hope this helped.
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Thanks TreyPops, to me your experience with the CPM machine seems very good, so I think I will go with that and feel I will defiantly use it to my benefit. I also have a rocking chair so will work on that until I get the CPM machine next week. And yes the knee is loosening out in a good way 
.
I find the heal slides quite difficult and I also had that same pain in my thigh as you mentioned, but this has eased out a lot, I think the exercise bike helped with that.
Many thanks for taking the time to respond, I am also resting, icing and elevating, have not did the compression, but will organise stockings also. You seem to be doing fantastic, the surgery was nothing like I expected it to be, and all the fears I had were for nothing. I can also walk around the house with confidence and very strong better than I have done in a few years and walking up and down the stairs as normal with a little bit of help from the banisters, hope to be running up and down in a few weeks
I am sleeping like a log, I would normally twist and turn a lot during the night, but since this surgery I just take my pain meds, get the pillows sorted, elevate my leg, pack the ice onto my knee and then just drift off into a deep sleep and awake in exactly the same position. 
And ready for breakfast in bed, pain meds and ice. 
Looking forward to following your recovery. Holly
. I find the heal slides quite difficult and I also had that same pain in my thigh as you mentioned, but this has eased out a lot, I think the exercise bike helped with that.
Many thanks for taking the time to respond, I am also resting, icing and elevating, have not did the compression, but will organise stockings also. You seem to be doing fantastic, the surgery was nothing like I expected it to be, and all the fears I had were for nothing. I can also walk around the house with confidence and very strong better than I have done in a few years and walking up and down the stairs as normal with a little bit of help from the banisters, hope to be running up and down in a few weeks
I am sleeping like a log, I would normally twist and turn a lot during the night, but since this surgery I just take my pain meds, get the pillows sorted, elevate my leg, pack the ice onto my knee and then just drift off into a deep sleep and awake in exactly the same position. And ready for breakfast in bed, pain meds and ice. Looking forward to following your recovery. Holly
OP
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treypops
Sr Bonesmartie
Maggie94
post-grad
hi @Holly sounds like you are doing really well - just keep doing what you are doing. I like you comment about the surgery not being as bad as you expected - that is great to hear. Mobility is fantastic and what more I am guessing it is knee pain free - just surgery pain. Keep going on the recovery path - cheers Maggie x
Yes Maggie, only surgery pain, and my pain meds are controlling that so pain is 0. I want to stay on the pain meds as described as I think this is helping the healing process and allowing me to work through my exercises, I am getting more and more mobile and confident each day and just love to stand tall and straight and feel all the muscles especially in the thigh firing as in pre surgery they were not working on the injured leg, no more arthritis type pain. I can honestly say for me the whole experience with my TKR was a "walk in the park", still in recovery but that is a challenge that I am going to grip with both hands no matter how long it takes until I am 100% and then I am going to look after that knee like gold dust. My advice now that I am on the other side, is a strong and positive mind, positive thinking, even if you have a setback turn it into a positive, never allow negative thoughts into your mind, and smile. 
Holly
Holly
I'm surprised you can do squats. The ripping feeling on the hamstring curls may be because of some internal swelling. Your scar looks great. Just keep listening to the knee.
Maggie94
post-grad
Hi Holly - thanks for your advice. Like you I will focus on the positive - this means life say 12 week out when I should be back to "normal"ish... pain free & mobile maybe a little pilates... wait and see. The positive day to day will be an interesting exercise but I will find something - or perhaps lots of things
. I think I will include these in my post op journal just to remind myself of where I started and where I have moved to.
Keep posting - lover hearing about your progress
. I think I will include these in my post op journal just to remind myself of where I started and where I have moved to.Keep posting - lover hearing about your progress
OP
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treypops
Sr Bonesmartie
Well, today is day 16 for me.
I am getting fairly routine at this point. I wake up in the morning, and after eating breakfast and icing the knee, I get in the CPM for a couple of hours. I am now running the CPM at 120 degrees of flex. This morning I tried to work it up to 125 but I wasn't quite ready for that.
I have a relatively steep staircase in my house and I'm scaling it nine times over the course of the day - three times in the AM, three times around midday, and three times in the evening. I am also doing a number of exercises on my own - heel slides, quad raises, hamstring curls, etc. I am also walking as much as possible around the house without assistance. I still have a limp, but when I really focus on my gait, it's not as bad as I thought it would be. I'm not winning any races anytime soon, but I'm getting around okay.
I am only taking Tylenol during the day, and I'm taking Percocet at night, one before I go to bed, and one usually about six hours later. I have been lectured about this not being enough pain medication, but I feel like I'm maintaining pretty well at this point. I think I'd like something a little stronger to take during the day that's not going to make me loopy. I am planning on calling my dr tomorrow to look into some tramadol or something similar.
I start on-site PT tomorrow, and will go three times per week for the next month. I expect them to get me on the bike, put some weights on my quad raises, and generally push me a little harder than my in-home therapist did. The therapist I'm visiting is the same one that rehabbed me after my microfracture surgery, so I know what to expect from her, and I don't expect any problems.
My incision is healing nicely. My biggest issue, honestly, is restlessness at night because I struggle to get comfortable. Once I can fool my brain into thinking I'm comfortable, I can usually drift off for a couple of hours.
I am enjoying reading new posts of those who just had their own TKR, or who are about to have it. I hope that I am able to help in some small way by sharing my experiences to this point.
More to come.
I am getting fairly routine at this point. I wake up in the morning, and after eating breakfast and icing the knee, I get in the CPM for a couple of hours. I am now running the CPM at 120 degrees of flex. This morning I tried to work it up to 125 but I wasn't quite ready for that.
I have a relatively steep staircase in my house and I'm scaling it nine times over the course of the day - three times in the AM, three times around midday, and three times in the evening. I am also doing a number of exercises on my own - heel slides, quad raises, hamstring curls, etc. I am also walking as much as possible around the house without assistance. I still have a limp, but when I really focus on my gait, it's not as bad as I thought it would be. I'm not winning any races anytime soon, but I'm getting around okay.
I am only taking Tylenol during the day, and I'm taking Percocet at night, one before I go to bed, and one usually about six hours later. I have been lectured about this not being enough pain medication, but I feel like I'm maintaining pretty well at this point. I think I'd like something a little stronger to take during the day that's not going to make me loopy. I am planning on calling my dr tomorrow to look into some tramadol or something similar.
I start on-site PT tomorrow, and will go three times per week for the next month. I expect them to get me on the bike, put some weights on my quad raises, and generally push me a little harder than my in-home therapist did. The therapist I'm visiting is the same one that rehabbed me after my microfracture surgery, so I know what to expect from her, and I don't expect any problems.
My incision is healing nicely. My biggest issue, honestly, is restlessness at night because I struggle to get comfortable. Once I can fool my brain into thinking I'm comfortable, I can usually drift off for a couple of hours.
I am enjoying reading new posts of those who just had their own TKR, or who are about to have it. I hope that I am able to help in some small way by sharing my experiences to this point.
More to come.
Your flex is great. You should be able to ditch the cpm any time now. Do you have it for a set number of weeks?
I don't do that many steps in a day and I'm not recovering.
I think you have a good idea to check with the doc about a milder painkiller if you don't want to take percocet during the day. I had percocet for a couple of weeks and then stepped down to a milder painkiller.
As I'm sure you know, be sure to ice like crazy after PT
and pay attention to how the knee feels. Let us know how it goes.
I don't do that many steps in a day and I'm not recovering.
I think you have a good idea to check with the doc about a milder painkiller if you don't want to take percocet during the day. I had percocet for a couple of weeks and then stepped down to a milder painkiller.
As I'm sure you know, be sure to ice like crazy after PT
and pay attention to how the knee feels. Let us know how it goes.
DogLoverx3
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Thank you for popping by my thread last week @treypops . I appreciated the support. Your pics are great! I can't believe how little swelling you have had from day 1 and how great your incision looks. Good for you! I think Tramadol might be a good one for you during the day. You can pair it with Tylenol and it works pretty well with no loopy-ness. As for getting comfortable at night, odd as it may seem, I actually found it more comfortable to sleep on my TKR side; with my TKR leg on the bed and the non TKR leg on top of it (with or without a pillow in between). I found the pressure from having the other leg on top of my surgical leg actually helped. I hated having my TKR leg on top - it just felt weird and very uncomfortable. Wasn't sure if you had tried sleeping the opposite of what you're doing now or if you had heard not to sleep on your TKR leg. You can. I would have them slightly bent, 1 on top of the other and while I certainly couldn't sleep more than 20 minutes at a time for over a month (boo me), it was the most comfortable position that I found.
I hope you had a good PT session today and didn't work too hard. Please be careful now that you're doing outpatient PT paired with all you're doing at home on your own. On PT days, at least to start, I think those should be the majority of your exercises for the day. The rest should simply be walking around.
I know you're not going to like this piece of advice either, but if you're walking with a limp, you should still be using some sort of aide. I hated using a cane (I'm not old, I'm injured), so when I finally gave up my walker (talk about feeling old), I switched to crutches for support and to make sure I was walking with the proper gait and not limping.
Just some thoughts. From the sounds of it though, you don't need any advice as you're having a stellar recovery! Keep up the great work!
I hope you had a good PT session today and didn't work too hard. Please be careful now that you're doing outpatient PT paired with all you're doing at home on your own. On PT days, at least to start, I think those should be the majority of your exercises for the day. The rest should simply be walking around.
I know you're not going to like this piece of advice either, but if you're walking with a limp, you should still be using some sort of aide. I hated using a cane (I'm not old, I'm injured), so when I finally gave up my walker (talk about feeling old), I switched to crutches for support and to make sure I was walking with the proper gait and not limping.
Just some thoughts. From the sounds of it though, you don't need any advice as you're having a stellar recovery! Keep up the great work!
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