Revision TKR 3 years out - Injury?worked

[LFitz]

Oh my goodness gracious God bless you. I believe most doctors like to see you at 90 by your 6 week, and you are a long way off from that. Remember all the stuff you did yesterday well today your knee showed you not to be doing that and that you are doing to much too early. Try not to worry right now, take the weekend and rest, ice and elevate. I wouldn't worry about an infection right now if you have none of the indications of an infection. I believe that pulling/tearing is quite normal for tkr. At least my knee has had those feelings. I'm so sorry that you are feeling fearful right now but do try to relax and rest and I hope things look brighter tomorrow.

 

[sistersinhim]

Don't you worry about that flex. It'll come. Most doctors say 4 to 6 weeks to get to 90 degrees. You are pushing yourself way too hard and that's keeping the inflammation and swelling up in that knee. No wonder it doesn't want to bend. Many times I felt like the staples were pulling. I think it's only natural, cause they are! When you swell, they pull. You shouldn't even be taking PT. You should be healing only!

 

[HookEm613]

Thanks Ladies! The plan is to do NOTHING this weekend. I really think that will help.

I am so overly paranoid about infection, my anxiety levels are so high as it is, that just sent me over the edge. If I could drink right now, I would lol.


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[newlybionic]

NOTHING is the best thing you can do to get better ROM. Add a bunch of elevating and icing and that's the perfect formula. If your knee is swollen it will make it seem like something is pulling. You have staples outside and stitches inside.

 

[uva55]

I don't have staples, only stitches, I still have a bandage on the wound but sometimes it does feel like it's pulling, specially when I'm doing my bending exercises or if I'm very swollen...you did a lot of cleaning and moving around yesterday, and you also had a busy weekend, so your knee is probably unhappy and swollen, it needs TLC.

You need to rest, ice, and elevate, I hope you feel better soon!!!

 

[HookEm613]

Yup, that's the plan, I already told the Mr. He got tickets for us to go see the new Independence Day tomorrow, so we are just going to go to IPic, have breakfast and relax.

I didn't think about the swelling causing the pulling sensation, but I bet that is it. It's pretty painful, but only when I bend. I think I will feel 100% better after resting for a few days. I am cancelling PT on Monday too. I don't want my doctor thinking I'm not doing enough, when I'm actually doing too much.


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[HookEm613]

And my doctor definitely expects 90 degrees by day 14, I confirmed it in the paperwork. That seems so aggressive to me, I'm freaked out about it!


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[charmed-life]

I am not against manipulation the way some people are on the forum, although I have not had one (other than during TKR). Three months after my accident but before TKR, I only had about 55 degrees of flexion and we talked manipulation. It finally was decided I needed to have the plate removed from my tibia (it was adhered to my skin and tibia was healed), have a TKR (knee was still not lined up right) and a manipulation for adhesions and it was all done at once soon after that.

After the TKR, although it was discussed earlier, my doctor eventually gave me to 3 months to get to 90-95 degrees. At one month I had only 75 degrees, at 3 months I was around 90 degrees, and now at 4.5 months, I am at 105 degrees. SLOWLY increasing. I did have extra damage to my knee in an accident but I think it shows that you can get more with time - I did PT for 2+ months but since then all I'm doing now is stretching on my own, walking as much as tolerated and riding an exercise bike (finally!!). I think my early at home PT was helpful but outside PT (although I liked the guy) did causes more pain and swelling so I quit with the blessing of my doctor)

I did consider an MUA and occasionally wished I'd just done it - most people I've talked to here and in person seemed to have some additional pain and swelling for a few days but then things were better. I have some additional pain and swelling all the time from trying to stretch tight ligaments and adhesions (which I know I have - from past experiences). But I was afraid of an MUA at the same time I just wanted more ROM - but I did decide to rely on my doctor's very considerable experience with similar patients and now it looks like it was the right way to go! There is a huge difference in function between 85 degrees and 105 degrees! If six weeks after the decision I was still at 85-90, I'd be doing it.

I would tell your doctor you want to wait awhile more before considering an MUA. It may be his experience that it works well to do it at that point but you don't HAVE to do that. Talk it over with him, if he will. My doctor was fine with giving me more time. If you do not get any further with ROM in a couple of months, it's considered best to do in the first 3 months but even later they can be done. As long as you are improving, I'd wait. Don't be too freaked out if that's his recommendation, you can decide for yourself.



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[Celle]

So I am really worried about next week, my 2 week check in. I am supposed to be at a 90 degree bend, and today at PT, I only measured 67 degrees. I'm doing all of my exercises, and if anything, doing too much. I am going to take it easy this weekend and see how it goes, but I am scared the doctor is going to want to do a manipulation...if that's what it's called.

I hope your appointment goes well but, as the others said, don't worry if your surgeon is disappointed. His goal of 90 degrees by two weeks is very optimistic. My surgeon doesn't expect that until at least 6 weeks.
If he mentions MUA, just say that you would like to wait a while. There's no need to rush.

right now, the main reason why your knee can't bend more is because it is still wounded and swollen. It's like a hosepipe that is full of water. That doesn't bend easily. But, if you empty out the water, the hosepipe can bend much more easily. The same is true of your knee. Get rid of the swelling and the bend will come, without any need to work at it.
So, spend as much time as you can doing this, to try to reduce that swelling:
rest, elevate, ice and take your pain meds by the clock

You don't have to do lots of exercises to rehab your knee. In fact, doing too much can have an adverse effect, making those wounded tissues irritated and inflamed, which will increase the swelling. Having a manipulation at this stage would further damage the soft tissues, making the situation even worse. In any case, there is no need to rush, because ROM (Range of Motion) can continue to increase for a year or more after a TKR.
TKR: work “smarter” and not “harder”
Myth busting: the "window of opportunity" in TKR

Oh, and I have one more thing for your boyfriend to read, just to remind him that you are not swinging the lead or milking your recovery. This article gives guidance on what your level of activity should be:
Activity progression for TKRs

 

[Gigi32]

IMHO, it's not just PT that can cause you problems with swelling but it's all the other activity you are doing as well. Expecting to go to a movie today, less than 2 weeks after this kind of surgery is insane! It may seem like a relaxing activity, but getting up, getting dressed and getting there, getting into the theatre, getting up(or down) steps into your seat and then sitting with your knee bent for 2+ hours is going to cause more pain than you are probably prepared for or expect. It was a good 3-4 months before I could sit through a movie and then I made sure to go when it wasn't crowded so I was sure to have an empty seat next to me so I could prop my leg up if I needed to. You really need to curtail all your outside activities and focus on resting that knee or you are going to derail your recovery. By the way, my surgeon's expectation was a 90 degree bend before I left the hospital because his reasoning was you need that to get in and out of the car to go home, and most all of his patients are able to achieve that on discharge. He also requires complete bedrest the first week with CPM 24 hours a day except to go the bathroom, and minimal activity the second week. I had 90 degrees on discharge with both knees, 105 degrees by 2 weeks and continued to progress from there. If you'll rest and control the swelling and allow the knee to heal your flexion will come. If you continue to beat your knee up, the swelling remains and it stays inflamed you will develop scar tissue and you risk needing a MUA to get flexion. It's that simple really.

 

[LFitz]

Does the IPic have recliners? Going for breakfast and a movie is still a lot at this point. I went over to the moviehouse for my 27th anniversary at 10 weeks and they have recliners and that was enough of an outing for me. Hopefully at breakfast you'll be at a restaurant that has benches so you can elevate your leg. One of the hardest parts of this is wanting to do everything now because our minds are ready, but our knees not so much yet. Have a great day. I'm looking forward to seeing that movie as well.


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[Suz]

@HookEm613, I'm so glad you come here to vent & receive support. Unless someone has been through this surgery they have no clue how to advise you. I'm going to step out on a limb and say I'm of the opinion that surgeons who do these procedures don't know fully how we feel afterwards either- LOL!

You do suffer that first month. The encouraging aspect, or was for me, is that just like that.. the raw pain left. Like a bad storm moving out to sea! I get swollen and tired still but not that, what I term, 'raw' pain anymore!

You've got this!

 

[Majella]

glad you are staying another night! I had to as well for the same reason (pain control) it was well worth it!
Best of luck to you

 

[HookEm613]

What is the normal pain regiment after surgery? Reading this thread has made me question my own.

I am taking 2 Tylenol 4, every 4-6 hours. I've been letting myself sleep at night, instead of waking up for the medicine. I'm actually doing ok without it, I mean I get uncomfortable but it's not horrible. The longest I've gone without it is about 10 hours at this point, but only because it was over night. When I wake up, I take two pills and relax for about 30 minutes while it kicks in. I am going to talk to my doctor about just taking tramadol, so I don't get so sleepy. I do think I need stronger pain meds for physical therapy though, so not sure about that just yet.



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[HookEm613]

The IPic has recliners and it went really well, I was actually really comfortable. My knee has felt a lot better today, and I've been able to bend it a little more. When I sit on a bed and hang my legs over, I am easily at 90. When I am laying flat and have to bend my knee from that position, not so much. The key for me, at this point, is taking it easy. I know going to the IPic may not seem like a good plan for some, but it was good for me. We also have two little ones at home, 2 and 6, so although I would love to relax a little more, it's just not possible. My family has helped out a ton, and their dad has too, but only mom can give out "boo-boo kisses", do hair, etc. LoL my range of motion will come along, it's amazing just the difference between yesterday and today. I just need to be patient.


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[Suz]

I started taking 1000mgs Tylenol with 100mgs of Tramadol per Josephine, the forums Director Nurse, every 6hrs at 2wks out and it took care of recovery pain for me! I stayed strict to that schedule even through the night until I was about 6wks out. I'll post the 2 dosing charts Josephine recommends. The second chart worked really well for me.

I'm amazed you can sleep through the night w/o pain meds at only 12 days out. That's great!

 

[uva55]

I know it must be hard at home with little ones. I'm glad the theater was comfortable for you, Get some rest.

 

[Pumpkin]

What is the normal pain regiment after surgery?

Everyone is different, you really cannot compare the need for pain medications with others. I was on pain meds for over 3 months. Everyone should be treated as an individual with adequate pain relief after joint replacement.

 

[HookEm613]

You too, Uva! How has therapy been for you, by the way?


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[sistersinhim]

I'm so glad you enjoyed your outing yesterday and your got in one of those recliners at the movies! It does us good to be able to get out and do something normal. And great that you're feeling better!