TKR 2 Weeks Post OP!

[Pumpkin]

You'll notice that I have merged your newest thread with your original recovery thread. For several reasons, we prefer that you only have one recovery thread:

• That way, we have all your information in one place. This makes it easier to go back and review your history before providing advice.
• If you keep starting new threads, you miss the posts and advice others have left for you in the old threads, and some information may be unnecessarily repeated
• Having only one thread will act as a diary of your progress that you can look back on.

So please post any updates, questions or concerns about your recovery here. If you prefer a different thread title, just post what you want and we'll get it changed for you.
If you need an urgent response to a question, just tag a member of staff.
How to tag another member; how to answer when someone tags you

Here are the instructions on finding your thread, How can I find my threads and posts? . Many members bookmark their thread, so they can find it when they log on.

 

[Pumpkin]

Pt pushed me hard today.
Feeling crappy. Sad.

Saying no to therapy - am I allowed to?

Counter productive to push and shove on your knee, only make angry, inflamed, and swollen, blocking ROM.
Tell the PT you want to work on function, walking, heel to toe gait, and getting the swelling down with ice, rest, elevation. You can also ask about electrical stimulation for swelling while in the office.

Until your swelling goes down, revealing your ROM, you knee will have limited ROM. All the PT did was cause more swelling and inflammation, possibly setting back your recovery.

Go back and read the recovery articles in post #3, there is valuable information about the the window of opportunity myth.

 

[Jockette]

What did they say your ROM was?

There is no need for them to hurt you, either physically or emotionally. It will not increase your ROM.

Also keep in mind, it’s not exercising that gets our range of motion back, it’s Time:

Time to recover.
Time for pain and swelling to settle,
and Time to heal.

Our range of motion is right there all
along just waiting for that to happen.

 

[mjmoor]

I'm so confused. What about the scar tissue forming? They tell me that exercise is essential because scar tissue is forming. If I don't get ROM now I will have to have it done while under anastasia. Then PT every day even on weekends for 2 weeks.

 

[mjmoor]

Oh! and thank you for merging me.

 

[mjmoor]

and my ROM is 89 and very close to 0

 

[Niftyknee]

That’s great ROM for where you are at with your recovery. I’m 9 days ahead of you and my ROM is 105 and -5. We are all different in our healing but agree with others no need for PT to push. My PT said my ROM is fine and reassured me that my progress is great. She’s more focused on straightening than bend. Don’t over do it as it sure does increase swelling.

 

[lovetocookandsew]

89 and 0 is great for 2 weeks. Someone will be along and explain about scar tissue since I don't know much in that area. I suspect your flex is better than mine although I don't have a clue what mine is, and as long as my knee isn't swollen eventually and I can walk and bend well, I won't worry about the numbers. But no one can make you have an MUA nor make you go to PT, so you can just say no. I wouldn't even be thinking about it this early anyway. Your knee has just been assaulted and will take quite some time to recover and stop causing swelling, which is why your ROM isn't where it will be a year from now, or even three months from now. The ROM is in there waiting to show itself as the swelling goes down, and we need to just be patient and allow that process to happen.

 

[Jockette]

A ROM of 89 at 2 weeks is great! The reason it isn’t any higher is because you just had major surgery that caused a lot of trauma to your knee and it is swollen because of that. As the swelling goes down, your ROM will improve. And that takes Time.

Did the surgeon himself tell you he was disappointed in your ROM? If so, I’m sorry he’s so impatient. Your body is in charge of this recovery, not you, not your PT and not your surgeon. You can’t speed up its healing, but you can slow it down by letting them push on your leg, which will increase the swelling which decreases ROM.

Physical Therapy can be helpful, but is NOT necessary for you to recover from a knee replacement. Not all surgeons prescribe PT. It all depends on their opinion about it. And there are many opinions. Which means there is not just one way to recover. Which then means that you get to choose how you will rehabilitate your knee.

Many on Bonesmart have not gone to PT but have used the movements within the normal course of their activities to rehabilitate their knee. It’s done as they are able, as they heal.

If you feel you want to go to PT you have some options:

Stay with the group you are with but next time you go tell them how you want it. Tell them they are not allowed to hurt you. If they do, get up and leave right then. Don’t listen to them if they tell you they have to, because they really don’t.

Or, go to a different PT group. Call places and ask about how they do things and only make an appointment if they assure you that they won’t force bend your knee.

This recovery is very confusing because of all the differing opinions.

Hugs to you as you make the best choice for you.

 

[Chemist]

Hello @mjmoor: Hang in there. Things will get better. When I was at the same point as you I swore I would never have my 2nd knee done because I was so sore and unhappy. Now 11 months later I am recovering from my 2nd TKR. I have good days and bad days but as time passes I have more good and fewer bad. As you will read throughout this forum recovery takes time.

I experienced pushing on my knee during PT after my first knee. I would end up so sore and swollen I would actually lose range of motion which resulted in more pushing. I finally checked with my OS and stopped PT. This time I talked to the PT at the first session and explained my previous experience. That resulted in much more productive physical therapy.

Again, hang in there.

Regards,
Chemist

 

[eaglemom]

It will get better, in its own time not yours. Patience isn't something that comes easily to me, but like you I've had to learn the knee is in control for the present. Rest, ice, elevate and repeat. Healing takes a long time, but your really resting the knee because as you know, its' not happy at all.

Are you taking the pain medication on a schedule? If not do so and that will help also.

 

[Pumpkin]

ROM is 89 and very close to 0

Fantastic ROM, my surgeon said 90 degrees at 3 months would be great. There is no longer any reason for you to think about ROM, it will come with healing and time.
You cannot rush this recovery, but you can set it back by doing too much too soon.

Sad that your OS and PT are bullying you into thinking you have this "deadline" or "window of opportunity".

We have many members who have gained ROM a year or more after recovery. I am one of those members, I had already great ROM at 130, one day around 18 months, I measured 135.

Here is @bertschb ROM chart.
Here is my ROM history (more or less):
1 month - 60 degrees
2 months - 80 degrees
3 months - 85 degrees
4 months - 90 degrees
5 months - 90 degrees
6 months - 110 degrees
7 months - 120 degrees
8 months - 125 degrees
9 months - 130 degrees
10 months - 135 degrees
11 months - 140 degrees
12 months - 140 degrees

You can see you are far ahead of where he was at 4 weeks and 8 weeks.

Enjoy your great early ROM, sad that your OS and PT do not recognize how great you are doing.

ROM: it's never too late to get more ROM! Skip right down to post #19 and read about campervans slow but sure success.
ROM (range of motion) information

Relax and enjoy your weekend, you are doing GREAT!!!

 

[sistersinhim]

I'm so confused. What about the scar tissue forming? They tell me that exercise is essential because scar tissue is forming. If I don't get ROM now I will have to have it done while under anastasia. Then PT every day even on weekends for 2 weeks.

Bless your heart. Don't listen to them, they are totally wrong. Yes, the number-obsessed PTs will rattle on about it as if the big. bad "scar tissue" is just sitting there, waiting to pounce if you don't do enough exercise.

Actually, it's quite the reverse. The infamous scar tissue (which is more correctly called adhesions) is very rare, and one of the easiest ways to develop it is to work your knee too hard. Over-worked knees get inflamed and hot, and hot tissues become drier than normal and more likely to stick together and form adhesions.

This article explains the difference between scar tissue and adhesions:
MUA (Manipulation under Anaesthetic) and Adhesions

You need normal scar tissue. That's what holds your incision together, and it's part of the normal healing process. Without it, you'd always have an open wound.

 

[mjmoor]

Thank You I'm feeling so much better. Both physically and mentally. Your kind words helped me beyond words could say.

 

[Celle]

I'm so confused. What about the scar tissue forming? They tell me that exercise is essential because scar tissue is forming. If I don't get ROM now I will have to have it done while under anastasia. Then PT every day even on weekends for 2 weeks.

Scar tissue (of the sort they are threatening you with) isn't forming. In spite of all their warnings, the bad scar tissue (adhesions) is quite rare and it isn't just sitting there, waiting to pounce if you don;t exercise enough.
And the story about a window of opportunity is just a myth that should have died long ago:
There's no need to rush to get ROM (Range of Motion) because it can continue to improve for a year, or even much longer, after a knee replacement. There isn't any deadline you have to meet:
Myth busting: the "window of opportunity" in TKR

Sad that your OS and PT are bullying you into thinking you have this "deadline" or "window of opportunity".

I agree.
They are misinformed and using their misunderstanding to push you into working harder.
PTs get this obsession about increasing ROM numbers quickly, because it is one way they can prove to the insurance companies that their ministrations are effective. There's no need for you to get caught up in their obsession, though.

Actually, it's quite the reverse. The infamous scar tissue (which is more correctly called adhesions) is very rare, and one of the easiest ways to develop it is to work your knee too hard. Over-worked knees get inflamed and hot, and hot tissues become drier than normal and more likely to stick together and form adhesions.

sistersinhim is quite right. Overworking your knee with too much exercise is a sure way of increasing your likelihood of developing adhesions.

All you need to do is keep your knee moving gently.

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.

TKR: work “smarter” and not “harder”
Knee recovery - Lose the Work Ethic!!

 

[mjmoor]

This makes absolute sense. So what did you do and say to your PT and OS? How do I tactfully back them down? I'm not very good at this sort of thing.

 

[lovetocookandsew]

I often smile and nod, then go home and do what I choose. But my OS is really good and mostly agrees with me and I usually agree with him, at least so far, so there's not been a problem with him about PT, etc. If it's the PT, I just tell them bluntly. This time around I told the PT bluntly what I believe when I let her come to my home one time, then I declined any more home visits, and also declined any outpatient appointments. If you try tact with the PTs they won't listen, but will try to push you and wear you down. I found telling them straight from the start that they are never to touch your leg, stop them as they begin all their memorized scripts, etc, is the best way, if you really feel you must do PT.

 

[Celle]

So what did you do and say to your PT and OS? How do I tactfully back them down? I'm not very good at this sort of thing.

You don't say anything.
There's no need to even discuss it. You won't persuade them any different from what they believe.
If you feel you must, just say that you don;t believe there is a time limit on getting ROM.

Just politely, but firmly, tell your PT that you are not going to do anything that hurts.
It is your knee and you are the only one with the right to say what happens to it.
In the PT situation, you are the boss and your therapist has to respect your wishes.
Saying no to therapy - am I allowed to?
CONSENT: what it means and how it can be used

 

[Spex10]

I was very direct with PT this time round. I quoted the research findings on efficacy of PT for knee replacement. That shut him him up with his 'come on you can do it' etc. Next time he brought his boss (obviously scared of me!) and the boss was great. He was kind and supportive and clear about what would help and why. What he said made complete sense. Even better, he said I needn't come back for 3 weeks when he'd check progress. Then I went home to rest and recover.
The first PTs inexperience really showed.

 

[sistersinhim]

In the hospital, the PT tried to push my foot with her foot to get my knee to bend more, and I strongly said "No!" She said she was going to tell on me. I told her to go ahead. During my one and only home PT visit, she grabbed hold to my leg. Again, I shouted, "No!"! This one said she was going to report me for being non-compliant. When they called to schedule another PT home visit I told them I didn't need them. My OS never said a word about it. He was happy with what I could do! Numbers didn't matter to him, just function. I wish all OSs would be like he is!