5 month birthday of my new right knee!

[kneeper]

As I have recently re-learned, (I can hand wring with the best of 'em ) try not let the ROM talk scare you. For many of us it comes slowly in large part due to swelling. Now that my swelling is much better I've gained about another 5 degrees this week after seeming to be stalled for a week or so prior.

If you are making at least some gains (over the course of a week--don't look day by day) you likely will be just fine.

If you truly get "stuck" an MUA is an option, but by everything I've learned here it's much too early to be thinking about that.

 

[MathSci4me]

Thanks @bottomshollow and @kneeper for the encouragement! I'm usually always a positive, upbeat person, but this TKR has thrown me for a loop. I had no idea what I was getting myself into and how long of a process it is going to be to recover.

I had my first outpatient PT session today and it was pretty good. The PT put heat on my quad muscle for 12 minutes before doing anything. Then he massaged the quad (and oh boy was there some soreness there!) and we did a lot of the same exercises that I had done with home PT. Afterwards my knee had ice for about 12 minutes. He did measure my ROM and extension before we started but he didn't say what the numbers were. He gave me some exercises to do at home twice a day and also information about icing and when/where to use heat. He seemed really knowledgeable. He wants me to come twice next week so I set up appointments for Monday and Thursday afternoon. My next OS appt is August 20th so praying I have some progress to show the doctor by then!

 

[Old Texan]

This knee surgery can turn the cheeriest of us into weepy old grumps! And when we have OS and PTs telling us that if we don't get ROM and extension by a certain date, we're stuck forever or headed back to surgery, that doesn't help. My OS told me before surgery that this was painful and recovery was long. He didn't push ROM. But, I thought I would come through like a champ, and as the weeks passed and I wasn't doing as well as I thought I should, I was often frustrated. There are good days/weeks and bad ones. Take your time and try not to put too much pressure on yourself. Glad your PT is working well with you--that can make a big difference. Hope you feel better. You are doing just fine!

 

[MathSci4me]

5 weeks since surgery! Things are improving ever so slowly! Getting a little more sleep at night now. It seems like I sleep in 2 hour intervals now for some reason. Sometimes when I wake up in the middle of the night, I can't go back to sleep for a while so I've been watching quite a few old episodes of TV shows Seems like I can always find a "Friends" episode on some channel! I can tolerate laying on my side but can't seem to fall asleep like that. Getting in and out of the car seems to be a little easier. I hope that means that my ROM is improving!

I had my 2nd outpatient PT visit today and they added a few new exercises. Everything goes pretty well but at the end he massages my quad and knee and tries to "help" me bend my leg further. He says that it is the tightness in the quads and other muscles that are preventing me from bending the leg further and I need to relax those muscles. I don't know how I'm supposed to relax those muscles when he is pushing on the leg! Afterwards, they use the ice machine to ice my knee down and that feels like heaven!

 

[zlady]

Sounds like you're doing great! Like Old Texan said take your time & try not to put too much pressure on yourself.

Take care,
Gina

 

[Quasi]

Wow! Sounds like you are progressing well and are starting to relax a little with the numbers! It took me at least 6 weeks to finally start listening to all of the great advice here! Ice is your best friend. Yes it often! I hope you get a good nights sleep sometime soon. It can't come soon enough! I left PT today feeling like I should be doing more, but honestly, with working and not getting enough sleep I find it difficult yo do my homework. But I have made a chart, so I can record all the exercises I'm doing (and not doing) so I can see what I really need to work on. I walked up and down the steps this morning with my cane, bending my knee! Excited, but I have to admit , hurts a little tonight,

Wishes for at least 3 hours if sleep for you! Tiny, baby steps, and before we know it we will be brand new!

 

[MathSci4me]

The sleep seems to be hit or miss! Some nights I can get a good amount, even with waking up every 2 hours, and other nights it is so difficult to fall asleep even though I am dead tired. I couldn't fall asleep last night and I needed to get up early because I was going in to school to cover for the front office because everyone was going to be out this morning. I never thought I'd say this, but it was actually nice to hear that alarm clock this morning and have a purpose to get up and showered!

Had another session of PT this afternoon. The PT says I am getting more bend, but he hasn't taken any measurements which is probably a good thing so I don't obsess about the numbers.

People keep telling me to use "Mederma" (sp?) for my scar. I guess that it is OK to use now??? I have been putting some Neosporin on it just because I have dry skin and the scar needs some moisture on it and I didn't want to put lotion on it.

 

[Jamie]

That's the way it is with sleep after surgery. Sometimes that irregular pattern can go on for a month or more. It's why we tell folks to sleep whenever you can and not try to maintain any type of "normal" routine during recovery. Your body is in control and you're just along for the ride .

I see from your post that you are starting back to work. Just remember that we recommend you allow 10-12 weeks off from work and then start back with a part-time schedule. If you start back earlier, be aware that you may find yourself extremely exhausted and/or having some additional pain and swelling from the activity. Your body is still healing.

You can put Maderma or other similar products on the scar if it is completely healed. Normally you should wait until at least the 6 week mark for that. Check with your surgeon if you feel you really want to use something. But....I must tell you that our experience with scars is that they heal just fine without using these products. It does take up to a year or more for the scar to turn white and not be so prominent. You can use Vitamin E Oil for a little moisture massage on the skin around the incision.

 

[MathSci4me]

I wasn't really starting back to work today. I'm a teacher so I'm off for the summer. The person who works in our front office needed to take her husband to get a CAT scan and everyone else that works in the summer was either off today or out of the building. She was stressing about what to do so I just came in and sat in the front office and answered the phones for about 3 hours. It was easy work. Only had about 5 phone calls. I sat at the desk and had my knee propped up with ice on it for most of the time. Then I came home, ate lunch and took a nap before my PT appointment this afternoon.

I think I have some Vitamin E so I'll have to try that!

 

[Jamie]

Oh good. That doesn't sound too bad then!!! I like that you iced and elevated while there....and napped when you got home!

 

[MathSci4me]

I always rest up for PT! I schedule my appointments for the afternoon so after I eat lunch, I take a nap and set my alarm to make sure I don't oversleep. I used to think my naps were what was making me not sleep at night, but I went through a few days of not taking naps and it didn't have any effect on how well I slept at night. So now, if I can fall asleep, I do... no matter what time of day it is! I'm really going to miss those naps when I do have to go back to work in September!

 

[MathSci4me]

Cleaning does not agree with my knees so I'm giving up on cleaning! My niece, her husband and 2 kids are coming up for the weekend. I tried my best but my knee is saying enough. Hope they don't refuse to stay here because of the mess! Off to do my PT exercises, take a nap and shower before they get here!

 

[MathSci4me]

It's the 6 week birthday of my new right knee today and celebrated with another PT session. Had some weight added to my ankle for one of my exercises and he added a new exercise for me to do. It'sso funny because when he's bending my knee, he tells me to "Relax!" I would if I could! I think/hope my ROM is getting better ever so slowly. I seem to be bending it a little more. The PT hasn't measured the ROM since my first meeting with him a week and a half ago though and I kind of like that. Takes the pressure off! I know I'm not at 90 degrees yet though :( I really would like to at least be at 90 degrees when I see my OS on the 20th. Got 2 more weeks to get there! My PT is going on vacation next week though! How can he leave me in my time of need! :D I've noticed that after doing some of the exercises at PT that my knee really itches!! I was wishing I had some lotion with me today to put on it while I was there. After PT I went to the grocery store and noticed they had some Vitamin E oil so I bought it because some people had mentioned it to me. That oil is thick! Not sure I really like it but I'm giving it a try.

So that's my 6 week update! I had some questions that I wanted to ask when I got on here, but for the life of me I can't remember what they were now that I am online! I'll be back soon once I remember what they were!

 

[MathSci4me]

Had my yearly physical today and complained to my doctor that my body is falling apart! My right wrist/thumb area has been bothering me and I knew it was from using it to help get me up from chairs,etc. She diagnosed me with de Quervain's tenosynovitis and now I have a Spica splint to wear to immobilize my thumb. She also said I could take some Advil or Aleve to help with the inflammation. I thought I couldn't take that, but she said that was just when I was on the Xarelto. I'm on 10 mg of Oxycodone every 4-6 hours now as needed and I've also been taking Tylenol 3x a day. She said if my wrist isn't better when I go to the OS in 2 weeks that I should ask him to shoot a little cortisone in that tendon while I am there.

We also talked about the school year starting and I told her I was trying to figure out what to do about fire drills as I teach on the 2nd floor. We do have an elevator but we can't use it during a fire drill and I would need to go down the stairs. I could use the elevator after the drill to go back upstairs. She said to absolutely not use the stairs because it is extremely important to not fall. So now I need to talk to my administrators and figure out what I can do.

I'm looking for some nice ice packs for the knee that I can keep at school with me when I go back to work. I thought I could get 2 and keep them in my freezer at school to use to ice my knee during my planning period. I'm looking for something that will strap to my knee and stay in place in case I need to get up out of my chair. I've got big thighs so I need something extra large. If you have any recommendations, please let me know. Thanks!

PS (Cholesterol was up slightly but she gave me a pass this time because she said she knows how it is after you have major surgery!)

 

[MathSci4me]

PT today and he added something new. I think he called it soft tissue manipulation with instruments. He had these metal pieces and he rubbed them on and around my scar. It felt kind of strange because the area on one side of my incision is still numb and the area on the opposite side is really sensitive to touch. He said it would help to break up scar tissue, smooth it out, and bring blood to that area that needs healing. I sure hope it works! He said the scar tissue is what is preventing my ROM right now. Afterwards it did seem like my knee was bending a little more but maybe that is just my imagination. I'm wondering if I can accomplish something similar with the scar tissue by massaging my knee in a certain way. Anyone know?

He's going on vacation so he won't be there for my Monday visit. I normally also go on Thursday but I changed that to Friday because he will be back to work then. I'm really impressed with him. He seems to take a lot of time with each patient and really think through what exercises we need. I have 3 more PT visits before I see the OS again. Keeping my fingers crossed that I have enough ROM that the OS will let me just continue with PT and not want to do a manipulation.

Stopped by school today and got 2 young men to put my chairs, tables and desk in place in my classroom. I was wondering how I was going to get that stuff moved and was fortunate they just happened to be at school today. I'm excited for school to start and to get back into a routine, but I'm a little concerned about my stamina and making it through the entire day.

 

[Josephine]

Three weeks since the surgery. PT came today and still only have about 62 degrees ROM. It's so depressing. He worked the knee pretty hard. He (Dr) said I definitely need to go to outpatient PT for that ROM.

sorry, but I think not. (more later)

He also said that it was important to get the leg straight - that there were things they could do to improve ROM but there wasn't anything they could do to get the leg straight. I didn't ask him what those "things" were to get more ROM and now I'm wishing I had.

I will say something later!

PT today and he added something new. I think he called it soft tissue manipulation with instruments. He had these metal pieces and he rubbed them on and around my scar. He said it would help to break up scar tissue, smooth it out, and bring blood to that area that needs healing.

What a load of ..... They run this nonsense out with unerring regularity and it means nothing! It's just stuff to make them look good. You don't have any 'scar tissue' that needs breaking up and the scarring you have you need because it's what's holding your incision closed!

It felt kind of strange because the area on one side of my incision is still numb.

That's normal - you can read all about it here Numb area after TKR: how long will it last?

He said the scar tissue is what is preventing my ROM right now.

I very much doubt it.

Which brings me to my need to make an apology. Way back in this thread I asked you some questions and you answered them but I never got back to you on it. So would you mind answering them again? I promise I'll address them this time!

I'm going to ask you some questions and 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 compare this with the bone-on-bone pain you had before surgery!

)

2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?

3. how often are you icing your knee and for how long?

4. are you elevating your leg, how often and for how long?

5. What is your ROM - that's flexion (bend) and extension (straightness)

6. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and

7. what kind of PT/exercises are you doing? How much and how often? (and detailed details would be appreciated, please! Reps, sets and session and all that)

Note:
If you're not familiar with this, it goes like so:
1 lift of a 500kg bell bar = 1 rep or repetition.
Doing 5 reps and then a brief rest = 1 set of 5.
And doing 5 sets and finishing = a session.

 

[kneeper]

They did something like that to me after my last knee when I had continuing soreness in the quad area. I think it did more harm that good, though I have no evidence. If it feels better, I would just go ahead and massage it yourself.

 

[MathSci4me]

Here are my answers:
1. Pain ranges from 1 to about a 4 depending on what I am doing. I have no pain sitting with leg propped up. If I get in car to drive, pain starts to increase as I drive so I try to limit my driving to no more than 30 minutes. Also, if I go out to lunch and have to sit for a while, the pain increases. I just can't sit comfortably for much length of time because the leg aches. I'd rather be walking around if I can't prop my leg up. Obviously during PT the pain is higher than 1.

2. I currently take 10 mg of Oxycodine a few times a day. The prescription says to take it every 4-6 hours as needed. Right now I tend to take a pill when I get up, another around lunch time, and then another around 8 pm. Sometimes I wake up in the middle of the night and may take another one. If I'm going to PT, I always take a pill about half-hour to an hour before I go. I try to time my pill schedule around what I'm doing. For instance, if I'm driving somewhere or if I'm going to be sitting somewhere for a while (like at lunch today) I'll adjust my schedule so that I am taking a pill about half-hour or hour before. I was taking Tylenol 3x a day (morning, 2 pm, and before I went to bed), but since my regular doctor said I could take Aleve for my sore wrist I have been taking Aleve instead in the morning and at night for the past 2 days.

3. I ice my knee after doing my exercises for up to an hour (just depends on how much time I have to sit). At night, I'll put an ice pack on my knee around 9 pm and watch some TV/work the computer in bed. I'll bring extra ice packs to my room in a cooler and I'll generally change my ice pack as I get up throughout the night.

4. I will elevate my knee when I am icing after my exercises (2x a day) and also at night while I sleep. I think I'm addicted to elevating my leg at night now because I don't know if I could fall asleep now without doing it! I do wish I could sleep on my side some, but the knee is just not there yet.

5. I really don't know what my ROM and extension is right now. I think I am within a couple degrees for extension, very close to straight and so much straighter than my unoperated knee. As for ROM, I don't think I've hit 90 degrees yet, but I'm definitely closer to it than I was a few weeks ago. When I had my last home PT visit, we were pushing it and I wasn't getting to 70 degrees. Outpatient PT only measured ROM and extension on my first visit to them 2 weeks ago and he did not tell me what the numbers were. He hasn't measured since then.

6. I do light housework, laundry, and food shopping. I go up to my school to hang out and socialize for a few hours Monday-Thursday. I go to outpatient PT twice a week. I do my exercises twice a week. If the weather is good, I'll walk some outside. I do stairs at my house a few times each day.

7. Heel slides - 10 reps, hold for 10 seconds.
Quad Set (slight flexion) - towel under knee, tense muscles on thigh to press towel down, hold 5 secs. 15 reps
Stretch Calf with towel - hold 30 secs, 3 reps
Sitting Knee Flexion/Extension - push right leg back with good leg and hold 3 seconds, push right leg up with good leg and hold 3 seconds. 15 reps
Knee extension - do with beach towel rolled up under knee and lift let up. Set of 10 twice during 1 session.
Stairs Flexion - I do on ladder, put foot on first run and lean forward as far as I can, hold 10 sec. 10 reps
Partial leg lifts - lay on back with good leg bent, lift right leg up straight about halfway. 20 reps
High step - lift leg like I am going up a step. 20 reps
Lift leg back - lift leg back as far as I can. 20 reps

There are some additional exercises I do at outpatient PT with equipment. I do 6 minutes on the NuStep machine and do 20 reps on the leg press (75 pds, I think?). I was using 2 legs on leg press, but that was pretty easy so last time he had me do it with the one leg.

So Josephine, those are the answers to your questions, but I do have a couple questions that I'm going to put in next post.

 

[MathSci4me]

So the soft tissue manipulation isn't going to be helpful? Would massaging the knee area help it from feeling so tight? And when the PT was talking about getting blood to the area, it made me wonder if I was icing too much. I was reading some posts on the forum and somewhere I saw something about not icing more than 20 minutes because after that coagulation (?) would happen. Does too much icing make it even stiffer???

Also, besides the numb area on my knee, the inside one-third of my right foot is numb. Have you heard of that before?

Thanks!

 

[Josephine]

So the soft tissue manipulation isn't going to be helpful?

Not particularly, in my opinion.

Would massaging the knee area help it from feeling so tight?

If you remember, tightness is one of the manifestations of pain for which you need pain killers!

And when the PT was talking about getting blood to the area, it made me wonder if I was icing too much.

Chalk and cheese. Take no notice.

I was reading some posts on the forum and somewhere I saw something about not icing more than 20 minutes because after that coagulation (?) would happen.

I think that would be someone quoting that their PT had told them. If I answered, I would have refuted hat and so would most of the staff.

Does too much icing make it even stiffer???

Not at all.

Also, besides the numb area on my knee, the inside one-third of my right foot is numb. Have you heard of that before?

Yes, it can be some temporary damage to the peroneal nerve but it should abate in time.