TKR 5 Weeks Post TKR

[ExRunner1973]

8 weeks today and I still have the tight band feeling off and on which is annoying as it prevents good mobility! It looked great upon waking but as day went on the swelling got worse .
My P. Therapist who is also the owner is on vacation for 2 weeks so I’m assigned an assistant. Well after PT yesterday and doing the shuttle leg press with 50 lb wt increased from 37.5lb both my knees today really ached and my TKR leg was slightly edematous with pitting edema on my knee cap and ankle area . I had to see a new young PT person today to reevaluate for Medicare approval but she didn’t have time to msssage me. Well this therapist tells me that it looks like I have lymphedema and to elevate and do pumps again.
Today when I did the shuttle leg press they lowered the weights telling me perhaps it was too much weight yesterday. I’m a bit annoyed about the no massage and that I won’t be seen at PT again till next week. I feel like when the boss is away the kids are going to play .
I’m getting impatient as I feel like I should be doing better . My bend is I think she said 105-110 on my own but could bend more if she did it .
Thanks for listening to my frustration!

 

[Jamie]

First and most importantly is to NOT let the therapist try to bend your leg for you. That’s a sure recipe for pain and swelling. If you are at 110 at almost 2 months out, you’re doing just fine. It’s too soon for weights on a leg press. That’s a strengthening exercise and as you found out, your leg is not ready for that just yet. I know it seems like you’ve been at this recovery thing for a long time, but keep in mind that full recovery can take up to a year. Sometimes even longer. Try to be patient for another couple of months. This is all temporary and you want to do it the right way. During this time you can gradually introduce more activity and exercise. But, when you do, pay attention to your body’s signals. If you get pain or swelling during or afterwards, it means your body is not quite ready to go there yet.

It’s unlikely that you actually have lymphedema, since that’s not been a problem up until you did the exercise with increased weights. It’s probably just a case of overdoing things. The massage will help and I suggest you request that it be done at each visit with a therapist. You really should try to schedule your therapy visits so there is a “recovery” day in between. I know that’s not always possible with their scheduling, but just keep that in mind.

When you start thinking you should be doing “better,” try to identify exactly what you believe you should be able to do at whatever point you are in recovery. Post that here and we can talk about when you might be able to reach that milestone. It’s good to have goals as long as they are realistic. If we know what activities you’re most eager to return to, we can help you set realistic expectations. Just be prepared that goals should be set based not on time since your surgery, but on the activity levels your body has reached.

 

[Layla]

Hello and Happy Wednesday!

I’m getting impatient as I feel like I should be doing better .

Understandable and I'm sorry you're not where you want to be. Have you considered the PT may be what's hindering your progress?

Well after PT yesterday and doing the shuttle leg press with 50 lb wt increased from 37.5lb both my knees today really ached and my TKR leg was slightly edematous with pitting edema on my knee cap and ankle area .

At two months post op, your knee is still healing and excessive strain like this can slow the process, or cause complications. Pressing so much weight may put necessary stress on the joint and surrounding soft tissue. Pain, swelling and increased stiffness is a sign to scale back.

I understand your disappointment in missing the massage, but the main goal in PT is to help you regain strength and mobility over relaxation and maybe there was a time constraint today? Or they spent more time prioritizing exercise today, or didn't feel whatever you did today required a massage? If it happens again, consider asking for suggestions on ways to relieve muscle tension at home.

Hopefully rest and icing helps relieve any discomfort you're dealing with soon.

 

[benne68]

My bend is I think she said 105-110 on my own but could bend more if she did it .

Please don't let her force your bend -- that's not a realistic measure of what YOU can do. And, forcing the bend could actually cause inflammation that sets your recovery back. I understand your impatience and desire to do more, but the truth is that your bend is great for just two months post-op so there is no need to push.

I want to echo Layla's concern about the fact that your PT is having you do weighted leg presses this early in recovery. Your body has not recovered enough from surgery to be using weights. It takes 12 weeks for all the tendons and ligaments to heal and overdoing things now can prolong your recovery. I'm guessing the weights are what is causing your swelling.

This is a recovery that requires a LOT of patience. You can't speed it up by pushing harder.

I encourage you to take a step back and look at how far your've come in just 8 weeks!

 

[ExRunner1973]

I too believe my inflammation and swelling comes from the leg press shuttle and doing it 2 days in a row which should not have happened regardless of the weight used!
These 2 young PT’s just graduated in Dec with their PT credentials and may not yet be experienced enough to judge and separate each individual patient as to that patient’s needs and ability to recover. A 70 yr old like me isn’t at the same level as an 50 or 60 yr old despite the activity level preop. Everyone is dumped into the same regime plan !
I can’t wait for my PT to return from vacation!

 

[benne68]

These 2 young PT’s just graduated in Dec with their PT credentials and may not yet be experienced enough to judge and separate each individual patient as to that patient’s needs and ability

Sadly, very few PTs are specifically trained in working with joint replacement patients so they default to what they've learned about rehabbing someone from injury. It doesn't work.

Everyone is dumped into the same regime plan ! I can’t wait for my PT to return from vacation!

Can you cancel any appointments until your preferred PT returns? Might be better for you in the long term.

 

[ExRunner1973]

I only have one appointment next Tuesday and we leave for up north for 4 days 2 days later so I’ll make sure I don’t do the leg press or anything that will hurt me.
What I want is the massage over the knee area . I had quad sparing TKR and my quad obviously is good but the youngster PT insisted on massaging that area never touching the knee or the IT band area.
I’m a retired Oncology Nurse Clinician and tried to keep my mouth shut at PT but between my medical knowledge and this fantastic website I think it’s time I speak up.

 

[Layla]

Everyone is dumped into the same regime plan !

It certainly seems that way at times. I read that here often, so you're not alone in noticing this. I think they follow standard protocols for surgeries like TKR's based on research and general recovery times. However, as we know, not everyone progresses the same way for a variety of reasons, so a one-size-fits-all approach is not the best.

Do speak up and ask for what you want. If something isn't working or feels too aggressive, request they modify it.
If massage is important to you, make that known at the beginning of your sessions so they allow time for it in case it's a time constraint issue.
Have a wonderful weekend!

 

[benne68]

Agree with Layla: do speak up! It is YOUR knee and YOUR recovery -- and the PT works for YOU. So don't be shy about telling her what you want (and don't)!

Safe travels!

 

[Layla]

Good Morning, ExRunner,
I hope today brings you joy. I hope the sky is blue, filled with sunshine and the weather outdoors feels perfect.
I hope you feel the love and care of all those you hold dear and have many moments of comfort throughout the day. It's a special day, two months to date since surgery.
Happy Two Month Anniversary!
@ExRunner1973

 

[benne68]

have one appointment next Tuesday and we leave for up north for 4 days 2 days later

How did your session go today? Hope you are feeling better and are ready for your trip.

 

[ExRunner1973]

have one appointment next Tuesday and we leave for up north for 4 days 2 days later

How did your session go today? Hope you are feeling better and are ready for your trip.

We had to be forceful and repeatedly tell the PT assistant that I would not do the leg press but she kept insisting that I do it until my husband got quite annoyed and told her it’s hurting my progress , it’s causing pain and swelling and a patient has the right to say NO!! She finally got it!
She insisted again on massaging my quad despite its fine but totally ignored the knee cap and it band area! Definitely lack of experienced personnel covering for my PT !!
Ready for my trip ! Walking better! Wearing Sorrel lace up boots which feel like I’m walking on air !! They were a good buy and very supportive!!

 

[BothKnees]

I have had ITB issues with both of my TKR recoveries. Hip mobility stretching, for me, has been the key to releasing that ITB, and I cannot recommend hip focus enough!

Best of luck!

 

[benne68]

my husband got quite annoyed and told her it’s hurting my progress , it’s causing pain and swelling and a patient has the right to say NO!!

Thank goodness he was there to advocate on your behalf!

Glad you are walking better. Hope the new boots make your travels a bit easier. Keep us posted.

 

[mendogal]

Good for you and your husband tag teaming that person! I didn't start on the leg press or other strength machines until I was eight months postop. Maybe more conservative than necessary but it's worked out fine.

I had some ITB issues with my second TKR. My massage therapist had me side lying on my non-surgical side, new knee leg fully supported at hip height on a huge bolster, and did sacral and hip releases that really helped.

I also used a rubber ball and a wooden rolling pin on ITB and trigger points in my lateral quads since I wasn't mobile enough to use my big foam roller on the floor.

 

[sistersinhim]

We had to be forceful and repeatedly tell the PT assistant that I would not do the leg press but she kept insisting that I do it until my husband got quite annoyed and told her it’s hurting my progress , it’s causing pain and swelling and a patient has the right to say NO!! She finally got it!

There are few PTs that know the correct way to rehab a joint replacement. Doing it the wrong way may only extend the healing time. Great that you had your husband there to press the point, though he shouldn't have had to!

 

[benne68]

Checking in to see how you fared during your recent travels, @ExRunner1973. ( I think you are back home now?)

Give us an update on how you are feeling -- and how the travel went when you have a chance.

 

[ExRunner1973]

Checking in to see how you fared during your recent travels, @ExRunner1973. ( I think you are back home now?)

Give us an update on how you are feeling -- and how the travel went when you have a chance.

Hi !!
I actually did really well. Thank you for asking!!! On way to NJ I used a wheelchair at the airport but I did ok walking the airport on the home .
The 4 days on Jersey Shore were easy as I wore Sorel Lace up Boots with a thick chunky rubber heel with compression socks . I love these boots !! Wish I could use them here in Florida!! Too hot!! I highly recommend them as very supportive and funky looking esp with bell bottom jeans!
My knee did pretty good no pain just some swelling and stiffness in the AM but the day after I got back Tuesday I went to PT and yesterday I was in agony w/ both knees and lower back from having done the sled with 37 lbs after not doing it 2 weeks ! Today I refused the sled and my knee feels ok . At 10 weeks I should be closer to normal . I did start driving and sometimes I can do the stairs like most people,
In 2 months I leave for Italy and I’m gone 5 plus months ! Hope my knee gets totally normal!

 

[benne68]

Today I refused the sled and my knee feels ok

Good for you for taking control! Don't let them make you do anything that puts you in pain the next day == that's counterproductive.

You are doing great and I'm sure that in another two months you'll be ready for Italy. Just remember that this is a year-long recovery and you won't be 100% by then, but you will be able to enjoy your trip.

 

[Jamie]

Please stay off that sled until you are much farther along!! It’s done you in twice now. I’m thankful you didn’t try it again. You don’t need it and your body is telling you it’s too soon for that type of exercise. You made a very tough trip. You’re doing fine. And actually, your recovery is very much normal.