5 month birthday of my new right knee!

[Josephine]

1. Pain ranges from 1 to about a 4 depending on what I am doing.

Does that include soreness, burning, stabbing, throbbing, aching, swelling and stiffness? Those are types of pain too.

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. I try to time my pill schedule around what I'm doing. 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.

You should stick to a schedule for pain meds. The need to be taken on a regular schedule and not here and there. And you can still take Tylenol even though you're taking Aleve. But have you read this? Medications: NSAIDs, acetaminophen (Tylenol, paracetamol) differences and dangers

3. I ice my knee after doing my exercises for up to an hour

So how often each day? Just that once?

4. I will elevate my knee when I am icing after my exercises (2x a day) and also at night while I sleep.

Okay.

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

If you would get a photo of your bent leg from the side, I can measure it for you. But you will need to make sure it includes the top of your hip and your foot. Similar to this but more!

6. I do light housework, laundry, and food shopping.

good but you are only 7 weeks out so should be more careful about what you do. Check in this Activity progression for TKRs

You haven't said how many times a day you do these.
Exercises: my comments in bold
Heel slides - 10 reps, hold for 10 seconds - these are best done about 5 at a time every couple of hours during the day and never cause yourself pain, only ever go to the point of discomfort.
towel under knee, tense muscles on thigh to press towel down, hold 5 secs. 15 reps - do 5 only once a day
Stretch Calf with towel - hold 30 secs, 3 reps - 20 seconds is plenty, once a day
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 - do 5 once a day and never cause yourself pain
Knee extension - do with beach towel rolled up under knee and lift leg up. Set of 10 twice during 1 session. - do 5 only once a day
Stairs Flexion - I do on ladder, put foot on first run and lean forward as far as I can, hold 10 sec. 10 reps - leave these till later, maybe week 10
Partial leg lifts - lay on back with good leg bent, lift right leg up straight about halfway. 20 reps - you already do these so they are not necessary
High step - lift leg like I am going up a step. 20 reps - too much, stop these
Lift leg back - lift leg back as far as I can. 20 reps - not good exercise, stop these

In addition, make sure you have one or two days off each week. These exercises I have suggested dropping are because they will be likely to cause swelling and discomfort. I also think you do have pain but aren't recognising it as such. Swelling and pain/discomfort will hamper your ROM. If you want it to improve, you have to manage the swelling. See here Swollen and stiff knee: what causes it?


Here are some additional exercises done at outpatient PT with equipment.
6 minutes on the NuStep machine - okay
20 reps on the leg press (75lbs 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 - don't use a leg press. It's the only machine in the gym that's not recommended by surgeons as it causes swelling which will hamper your ROM.

 

[MathSci4me]

8 week anniversary of my surgery! Bending a little more now. Progress is slow to me, but at least it is progress. The PT has not measured my ROM since my first outpatient visit to him, but he did today because I have an appointment with my OS on Wednesday. I did all my exercises and the PT did his thing to warm me up and we got a ROM of 93 degrees! I was so hoping I would get to 90 degrees by the time of this upcoming doctor's visit! Now I know my doctor will not be as happy with that as I am because I know how he is, but I'm thrilled! I really want to just keep working with PT and not have the OS do the manual manipulation. I'm hoping the OS doesn't pressure me to do it.

I'm still taking Oxycodone 10 mg but I'm doing it 3 times a day. I'm also taking Tylenol. When I got my last prescription refill, I noticed it was written for 40 pills and not the usual 60 that they have been writing it for so I'm wondering if they want me to stop taking it. How long are people normally on their pain killers?

 

[kneeper]

They are probably figuring you won't need the pain meds much longer or that you need fewer during the day if they've reduced to 40 pills. Everyone varies. I just recently gave up the Norco--I gradually found I needed less and less. and switched to plain tylenol.

 

[MathSci4me]

I was so stressed about today's 8 week appt with the OS! My appt was at 10 am so as soon as I woke up I took a pain pill. Then after breakfast and a shower, I put a heating pad on my quad (like they do in PT) and then did some of my PT exercises to try to get as loose as I could before seeing the doctor. My PT had warned me that the doctor would be verifying that I could get to 90 degrees like I had in my last PT session. I also took some Tylenol before getting into the car to drive to the appt and put a heating pad on my quad on the drive over. AND I took a pain pill 30 minutes before my appt. I was determined I was going to get that knee to bend for the doctor!! I had worked myself up so much over this appt and what the possibilities were going to be if he was not pleased with my progress.

So when I arrived at the doctor's office, I made sure that I was walking as well as I could, concentrating on having good gait and not limping and to have a happy, positive attitude for the doctor. He came in, asked how I was doing, and was I pleased with the progress. I made sure to tell him that I was pleased because I had improved about 30 degrees on the ROM in outpatient PT. I said I was at 90 degrees and he asked to see how far I could put my foot back while sitting in the chair. It wasn't quite 90 degrees, but it was close enough for him! He said to come back in a month and he wants to see 20 more degrees of motion by then! It was the quickest doctor's appointment I think I have ever had! I was so relieved!

So now 110 degrees is my new goal!! If anyone has any advice on how to get there, please let me know! The PT had said the other day that he felt that 110 degrees was a good, reasonable goal for me but that it was very important that I get there within the next month (I think he said because after that time the scar tissue starts getting harder or something like that).

As a sidenote, I'll be going back to work on Monday as it is the beginning of teacher work week. So I asked the nurse if she could bring up the x-rays on the computer that were taken during my last visit of my new knee so that I could show my new students what I did this summer!

 

[Pumpkin]

PT had said the other day that he felt that 110 degrees was a good, reasonable goal for me but that it was very important that I get there within the next month (I think he said because after that time the scar tissue starts getting harder or something like that).

Most likely you need to work on swelling, even if you cannot see it, it is in the joint where you cannot see swelling.
When you can Rest, Ice, Elevate, and Medicate.
Your PT should have Electrical Stimulation that will help get the swelling down, ask about it.
Here are a couple of articles in the Library about Myth busting the window of opportunity.
Myth busting: the "window of opportunity" in TKR
Myth busting: the "window of opportunity" JBJS
Wishing you all the best, one month is a lot of time for your knee to heal,

 

[MathSci4me]

Thanks, Pumpkin! I feel like I'm doing the best I can here and just have to be patient - which can be hard at times. The husband of someone I work with had TKR 4 weeks ago and he's already getting as much ROM as I have now. But on the other hand, he cannot get his leg straight and he had some terribly huge blisters after surgery (they think due to an allergy to the adhesive tape). I've been very fortunate that I have not had any complications like that (knock on wood!). And I feel like I have a great PT working with me so hopefully I'll achieve my new goal. And if I don't, it's not the end of the world and I'll just keep working on it and resting, icing, elevating and medicating!

Speaking of medication, is there a time period after surgery that the OS will stop prescribing pain killers? Will he say "This is your last refill I'm giving you" to give me some warning? I've been trying to cut back on the prescription meds and just use Tylenol, but sometimes at night when I'm trying to sleep the only thing that works is the Oxycodone.

Thanks!

 

[kneeper]

Every doctor is different, though I would think they'd be getting more stingy soon. Though if you explain you're still having pain at night they may give you a refill. Is the tylenol working ok in the day? I know some of us mostly just need something stronger at night at around 8 weeks.

 

[martyz4]

Just been reading this thread and some things sound so familiar. I had surgery on June 30th 2014, I left the hospital on Wednesday and was given prescriptions for Lovinox (blood thinner) and Percocet 5-325. No pharmacy around me had percocet, I had nothing and the 4th of July holiday was upon us. Finally the doctors office found a place not too far. Also for some odd reason the insurance said I had a prescription filled already that I couldn't get anything yet.

Called the doctor back and somehow at 8 pm my husband got everything I needed. I was so mad that they didn't have us fill these scripts before the operation so they would be there when we needed them at home. That wasn't something to come home to.

I also went from 5-325 Percocet to 7-325 Percocet because then pain never left and I had no relief. The stronger ones were more helpful. Then when I saw the doctor last I asked for something a lot weaker so she gave me a perscription for Norco 5-325. I stopped taking them a few days ago. Maybe you could ask the doc for something milder so you can taper off of them altogether. Just don't stop abruptly because it isn't fun!!

You sound very enthusiastic about your recovery so you should do well. Take it easy at work and rest with feet up when you can. All the best to you.

 

[Jozilla]

My OS switched me from percocets to Vicodin at about five weeks. At the time I just went back to my neurologist who has treated me for about five years and ensures I always have some available. The latest though is that the doctors around here are having you sign pain management agreements and can give you a urine tests. They can actually cut you off if you have none, too little or too much in your system. You actually have to take your meds as prescribed - not none if you feel ok or two if you are hurting. I understand why they are doing this as there are so many new laws here where their licenses could be in jeopardy. So if you talk to your OS just ask for a lower mg or weaker medication.

 

[Josephine]

I'm hoping the OS doesn't pressure me to do (an MUA).

You're 8½ weeks out. 90 is fine. Should things not work out, you don't have to comply with an MUA. He can suggest but it's your choice. You are perfectly at liberty to say "no thank you, not yet!"

How long are people normally on their pain killers?

I was on my full prescription for 4 months.

So now 110 degrees is my new goal!! If anyone has any advice on how to get there, please let me know!

Yes, rest, ice and elevate! Do a few gentle stretches like heel slides each day and walk some.

The husband of someone I work with had TKR 4 weeks ago and he's already getting as much ROM as I have now.

DON'T compare yourself with anyone else! You didn't have their op and they didn't have yours. Chalk and cheese!

 

[MathSci4me]

Finished my first full week of work this week, although it was our Teacher Work Week (the week before students come back) so it wasn't as strenuous as it will be this coming week when the students come back. I thought I did pretty well although I was certainly more than ready for bed each night! Thursday night was our Open House/Back-to-School Night and I mostly sat in a chair the whole time and let the parents come to me. I mentioned to them that I was sitting because of my RTKR and they certainly understood.

We have off Monday for Labor Day and then it is back to school for everyone on Tuesday. I've got a picture of the x-ray of my new knee to show the kids! I was concerned about what to do about fire drills because we are required by law to have one every week for the first month of school and my classroom is up on the 2nd floor. My GP did not want me going up and down stairs in a hurry so my admin said it was fine if I use the elevator. Not sure if that complies with the fire code but I'm taking the elevator!

 

[Jamie]

Definitely abide by what your doctor asks. But.....I really don't like your idea about using the elevator. How is that preparing you and your coworkers for the disaster of a real fire? It would be much wiser if you and your principal developed an evacuation plan for you as a temporarily handicapped individual. There are transport wheelchairs that could be rented or purchased (it's a good idea to have one around no matter what) that allow one or two able bodied people to get you down the stairs. One should be purchased, you should have monitors appointed and all of you should practice getting down the stairs. Otherwise you might as well just stay put in your room and wait for the drill to be over.

Can you tell I was an occupational safety manager in one of my former jobs?

 

[MathSci4me]

I know, what the administrator told me to do for fire drills is questionable. We haven't had one yet but it is coming.

 

[MathSci4me]

The last 24 hours has been so frustrating. I guess you can say I got a "pep talk" or a "talking to" by my PT guy yesterday afternoon. He says I have to really push to get more ROM and that it is going to hurt to get that ROM. He bends my knee and he says to relax the quad muscle. Wish I could! I can feel my quad muscle tensing up but I don't seem to have any control to make it stop. He bends the right knee and I instinctively raise my right hip to try to lessen the pain or I slide back on the table... so much so that my back starts hurting and cramping up which doesn't help the situation. I really wish I wouldn't seem to be fighting against him. It's just so frustrating! The spirit is willing but the body isn't!

And so today I notice that the pain pills are getting low. I have been cutting them in half and use them at night, but I do take a whole one before going to PT. I figured after yesterday's PT session I should get a new prescription to help me get through the pain the PT says I need to be putting myself through. So I call my doctor's office and his secretary makes me feel like I'm crazy or some drug addict for calling up for a refill. It's been 10 weeks and yes, I'm sure I could get by without them and I have no plans to use them up quickly, but I thought it would be best if I had them for PT. I almost hung up and just forget about it, but I didn't. However, it is definitely the last prescription I'm asking for!

Thanks for letting me vent! I am just so frustrated that I can't get my body to cooperate.

 

[Jamie]

Don't let these medical staff members guilt you out of pain medications you need!!! There are always alternatives. If your SURGEON (not a nurse or secretary) wants you off opiate drugs, ask to switch to Tramadol. And if the surgeon is not cooperating, talk to your GP.

It is not a good idea to break pills unless you discuss that with your doctor. Some of the medications are a time release formula and when you break them apart, you risk getting too much of the active ingredients too quickly. So please don't do that on your own!

You can see by your reaction to what the therapist is trying to do that it's not a good idea. You and your body are just naturally fighting it! Don't feel bad about this. Just tell the therapist you want to take things more slowly. You really have that right! There is no point making yourself hurt to try and meet someone else's goals. The real person in charge of your recovery is you and your knee. Nothing is going to happen bad if you do GENTLE bends and stretches just to the point of discomfort. And quite likely, you will get the ROM that is there, but now hidden by internal swelling.

 

[kneeper]

He bends my knee and he says to relax the quad muscle. Wish I could! I can feel my quad muscle tensing up but I don't seem to have any control to make it stop. He bends the right knee and I instinctively raise my right hip to try to lessen the pain or I slide back on the table...

Of course you do. I think he needs to back off a bit when that happens. Or even better have you do the motion without him manhandling you. My PT mostly had me do the motions myself while she coached. My hip would come up too and I had to work to keep it down. But that also meant I just couldn't bend quite as far--but gradually I could do a bit more

 

[MathSci4me]

Thanks for the advice! Jamie, my GP told me that I could cut pills in half to start cutting back on them when I saw her a few weeks ago. I'm on oxycodone and they aren't time-release pills. However, they are small so very difficult to cut them perfectly in half! So if I feel like I need more pain meds, I take the bigger half. If I feel I can do OK with less, I take the smaller half! The prescription that I just got is for a dosage of Oxycodone that is half of what I am presently on and very tiny pills. I won't even attempt to cut those in half!

Two weeks until I see the OS again which means 4 PT visits until then. I'm trying to do some gentle bends throughout the day hoping I can get to our goal of 110 degrees by then, but now that I am back at work teaching, I get so busy with work that I don't get those bends in until I get home at night.

I think I may be addicted to icing my knee! I ice after I do my PT exercises at home and I also ice when I go to bed. I think it has become such a part of my going-to-bed routine that I wouldn't be able to fall asleep if I didn't do it!

 

[Celle]

The last 24 hours has been so frustrating. I guess you can say I got a "pep talk" or a "talking to" by my PT guy yesterday afternoon. He says I have to really push to get more ROM and that it is going to hurt to get that ROM. He bends my knee and he says to relax the quad muscle. Wish I could! I can feel my quad muscle tensing up but I don't seem to have any control to make it stop. He bends the right knee and I instinctively raise my right hip to try to lessen the pain or I slide back on the table... so much so that my back starts hurting and cramping up which doesn't help the situation. I really wish I wouldn't seem to be fighting against him. It's just so frustrating! The spirit is willing but the body isn't!

Oh no! Please don't listen to your PT! In fact, why are you still going?

You're back at work, teaching too, which is demanding. Just getting up, getting dressed, travelling to and from work, and teaching all day is more than enough exercise for your knee. You don't need PT on top of that.

It's not even three months since your surgery and your poor knee is getting no chance to rest and recover. You do know it can take a full year to recover fully, don't you?

Instead of doing PT, I think that when you come home, you should rest, elevate your leg and ice it. After all you are doing, it is probably internal swelling that is delaying your ROM. The last thing your poor knee needs is to be pushed further. That could even slow down your progress.

Concentrate on getting rid of that swelling and you may find that your knee bend was there all the time!

 

[MathSci4me]

I'm going to PT because that is what the OS said to do. Never thought that quitting was an option. I have made progress on my ROM during my time there, although I'm sure like everyone out there I wish it was faster progress. My real hope is that when I see the OS in 2 weeks he'll say that I can stop PT, but if he doesn't maybe I need to consider stopping it myself. So hard to figure out what is best.... I know I have made progress, but would I have made more progress doing things differently???

 

[Celle]

I'm going to PT because that is what the OS said to do. Never thought that quitting was an option. I have made progress on my ROM during my time there, although I'm sure like everyone out there I wish it was faster progress. My real hope is that when I see the OS in 2 weeks he'll say that I can stop PT, but if he doesn't maybe I need to consider stopping it myself.

It's your knee, not the surgeon's. You have every right to decide. The surgeon gives advice, but you have the choice whether you follow it to the letter, or not.

Did your surgeon know you were back at work when he gave you that advice? Being back at work does put a different spin on exercise.