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TKR 6 months po on TKR and knee is swollen and stiff

Condo9

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Had TKR on March 18th. I am going to therapy 3 days a week. They pushed me to stop using a walker 1½ weeks out. Each time I have therapy they push me for increased ROM and the next day I have increased swelling and can barely walk.

I am now 4 weeks out and last week at therapy they used a cupping method on my knee and an exercise where I lay on my stomach and push their hand back with my foot. The next day my foot was swollen and I can’t put weight on it.

I’m now 3 days with elevating and icing it. I’m addition I’m fearful I hurt my knee because I had to walk on the side of my foot. Very depressed. I’m going to see if I can see Dr tomorrow.
 

Jockette

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Welcome to Bonesmart, we’re glad you joined us.

Your “therapist” is using aggressive measures on you that are doing more harm than good. The good news is, you don’t have to comply. Tell them to stop doing those painful things and ask for massage instead. If they refuse, you can look for another facility that has a gentle approach. There are lots of PT facilities, you don’t have to stay where you are being hurt.

I am going to tag @Josephine
our forum administrator and nurse director to address your concerns.

I will leave you our Recovery Guidelines. Each article is short but very informative. Following these guidelines will help you have a less painful recovery.

Knee Recovery: The Guidelines
1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now, they are almost certainly temporary
2. Control discomfort:
rest
elevate
ice
take your pain meds by prescription schedule (not when pain starts!)
don't overwork.
3. Do what you want to do BUT
a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you
b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.​
4. PT or exercise can be useful BUT take note of these
5. At week 4 and after you should follow this
6. Access to these pages on the website

The Recovery articles:
The importance of managing pain after a TKR and the pain chart
Swollen and stiff knee: what causes it?

Energy drain for TKRs

Elevation is the key

Ice to control pain and swelling

Heel slides and how to do them properly

Chart representation of TKR recovery

Healing: how long does it take?

Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

There are also some cautionary articles here
Myth busting: no pain, no gain
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds

We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery.

While members may create as many threads as they like in the majority of BoneSmart’s forums, we ask that each member have only One Recovery Thread. This policy makes it easier to go back and review the member’s history before providing advice, so please post any updates or questions you have right here in this thread.
 

Jamie

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Hi, @Condo9, and welcome to BoneSmart. You'll notice that I've moved your thread to our Post Op Recovery Forum, as this is the place where you talk about your recovery journey.

I hope you quickly take time to read the articles Jockette left for you. They will give you a lot of information about what your recovery should be like. It's NOT what you've experienced so far. As you instinctively know, therapy that rushes you and puts you in the kind of pain you're describing does more harm than good. Be firm and stop it right away. Also, there is no way you should not be using a cane, crutches or a walker (whichever one works best for you) if you are still limping. The purpose of a walking aid is to give you the bit of extra support you need until you are strong enough not to limp. For example, I used my walker around the house for almost 6 weeks. I could have walked without it but it would have been much more slowly and hesitantly as I just wasn't strong enough yet to walk normally unaided. With the walker, I was strong and could take good long strides. This helps build strength. Walking without an aid when you're limping does not. All you're doing is forcing your body to try and compensate for that weakness and teaching it the wrong gait.

At your next therapy session, you'll need to explain all the things you've told us here. Let the person know how the aggressive therapy left you the next day or so. Tell them you will no longer allow any movements that bring more than just mild discomfort. If they cannot live with that requirement, then shop for another therapy group immediately. You are their customer and you are in charge of your treatment. Trust me, there are therapists out there who will understand the meaning of a more gentle approach. Both you and your knee will be much happier.

I must ask....it would appear that your age in your profile is not correct. You're not really 17, are you? I'd like to get that corrected if you wouldn't mind. Either let us know your birthday or make the change yourself. Your correct age is important because sometimes our advice may be different depending on your age.
 
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Condo9

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My birthdate is 1950! I am 68. I was unable to figure out how to change. Thank you. Thank you for your response. I am going to try and see my Dr tomorrow or his PA. I am concerned I have hurt my knee as it is very stiff and swollen again. I will discuss with them the PT. I believe it is time to find a new therapist, one that isn’t pushing me in pain and one that doesn’t compare me to others. It has added to my depression.
 

Rick951

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@Condo9 Sorry to hear that you are having such difficulty! The best advice I can give is, Slow down, Ice and elevate! I pushed myself to hard the first couple of weeks. I paid for it.. I made the most progress when I slowed down, Iced and elevated.
Let your body heal, it takes time. In the end it IS worth it!
Good Luck!
 

Jockette

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I am concerned I have hurt my knee as it is very stiff and swollen again
I had this same fear at 3 weeks after riding the bike at PT. I was afraid I had moved the implant out of joint and I had increased pain. It turned out it was “just” increased swelling. I had forced the rotation, because I thought I had to work really hard at PT. I hadn’t found Bonesmart yet.

All my therapists forced my knee to a painful place, and my surgeon did also, at each check up. Never again.
 
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Condo9

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Thanks for your encouraging words. Praying everything is ok. I’m elevating and icing both knee and foot in hopes I’ll get back to where I was!
 

Jockette

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I found Bonesmart shortly after I was 4 weeks post op. The week after I hurt myself on the bike they put me in pool therapy. For me, that was even worse. The first session was 50 minutes long and I did countless bending exercises and walking: frontwards, sidewards, and even backwards !:yikes: I was so scared as the pool had too many other people in it and my balance was still off on land, let alone in a pool with water that had a lot of movement to it. It was a very long 50 minutes. It took me 3 days to recover the increased pain I had.

That’s when I googled stopping therapy and found Bonesmart. :loveshwr:

Bonesmart taught me there are different opinions about this recovery and that I had the right to choose which approach I would follow. I chose the gentle Bonesmart approach, as outlined in the guidelines.

I cancelled some PT appointments, said no to some things at PT when I did go, and they never argued when I said no, and thankfully I was discharged by 8 weeks post op. :happydance: Next time I won’t go to PT at all. It’s not as essential as we are led to believe and I’ll recover better at home.
 

rosieNZ

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Dear @Condo9 We had surgery at around the same time. I'm a 68yr old woman. Its hard to go against what "experts" tell you.

With my first TKR I did everything they told me to do and became the queen of swelling. My wound came apart and it was miserable. After 8 weels I cancelled appointments and did my own thing. I found as the swelling subsided my ROM increased and pain/aching lessened.
With my current TKR (5th March) I followed Bonesmart philosophy. I just either didnt make or cancelled all PT appointments made for me and engagwd a private physiotherapist who I have seen twice only for some massage and suggestions.

Everyone is different and you must be guided by your doctor to ensure that there is oversight. But is there need for aggressive and painful therapy?
If it were me I would ceases the PT until the swelling subsided. I just wouldnt go unless my doctor had very good reasons for wanting it.
Elevating for me would be toes above nose high (irritating but works best).
Icing would 1 hour on 1 hour off frequently during the day. I would do this until the swelling subsided and then cut back.
I would use some form of compression as well if possible (I have knee wraps and gel pads, an Aircast ice machine plus I hired Game Ready in the early days).
This is standard treatment for an injury and not outside mainstream medicine.
With excessive swelling knees can't bend. The swelling gets in the way.
I would also ask my doctor about a course of regular anti inflammatory medication (if she thought it would help).

Swelling made me so miserable last time. Until I thought about things and realised that the PT expectations couldnt work because all that fluid in my tissues was solid and didnt let the range of motions occur.

With this knee I was discharged with swelling but stuck with rest, ice, compression and elevation totally. I slept with Game Ready on an auto programme. You can use ice packs and a neoprene knee wrap for example in its place if you think compression would help. I never realised with my first experience that I needed more icing and elevation (being the queen of swelling). I've been ruthless this time and it worked.. Be brave and don't let anyone cause you pain. Once the swelling subsides there are exercises you can do to increase your ROM. Have faith xxx
 

Celle

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Hi @Condo9 - I think a break from PT would help your swollen knee and foot. Your PT therapist has been much too aggressive with therapy and it's not the right thing to do.

Your poor knee isn't lazy or unfit - it's wounded. It needs time and gentle treatment, so it can heal, not PT boot camp.

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

You have plenty of time to achieve those "good" numbers your therapist is hooked on, so don't let him/her abuse your knee any more. Your knee can't bend more while it's swollen anyway, so there's no point in trying to force it - that just keeps it more swollen.

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.

It's your knee and you are the only one with the right to say what happens to it, so tell that therapist to STOP the approach he/she is using. If they won't listen to you, walk away. There are other therapists who use a kinder, more gentle approach to PT, or you can just rehab at home. Helpful PT is good, but bad PT, such as you have had, is a hindrance to recovery.

You are the boss when it comes to PT. Those therapists work for you, not the other way round. You don't have to please them. They have to please you. So speak up, to protect your knee.
Saying no to therapy - am I allowed to?
CONSENT: what it means and how it can be used
 

swmrgirl

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I’m sorry you’re having such a tough time of it. I can only echo what others have said here, and once I stopped the PT, my knees healed nicely on their own. It’s difficult to say no because there is so much pressure to perform in the early weeks. When I went to my most recent knee replacement class, the health educator told everyone that if we didn’t follow the PT instructions to the letter, we would have a “bad outcome”. I just looked at my husband and rolled eyes — I am living proof that resting and healing properly does not produce a bad outcome. Hang in there, friend!
 
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lovetocookandsew

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I have found over many knee surgeries that PT has been very harmful and no actual help. So, for my revision (last June) I decided to forego the PT altogether and just let my knee recover from the assault that is a TKR, and not allow any PT to continue assaulting my knee. I did no exercises of any kind to force it to bend nor did I do any kind of exercise; all I did were daily activities of normal living. I noticed small increases in my bend as time went on, but had/have no clue what the actual numbers are, and it doesn't matter to me what they are. What I wanted was for my knee to heal well and that I could eventually walk long distances with a nice gait, ride my bike, sit and play games for hours, swim, and so on.


When your knee recovers and the swelling goes down, it will bend. It's not the new implant that won't bend; it's the injured tissues and such that are swollen from the surgery preventing your knee from bending. Forcing it to do so when it's still trying to recover may give you temporary numbers that please your PT, and maybe even your doctor, but as soon as your knee reacts to being over stressed by those exercises, you lose the bend, not to mention all the pain it causes, plus it often will swell and hurt even more after that. Think about a hose full of water; you might be able to force it to bend some, but as soon as you stop pushing it, it stops bending. But, when it's empty of water, it bends easily. It's your knee and only you can decide how you want it to recover. But, PT or no PT, you need to spend a great portion of your day with your knee elevated and iced. Read the articles left for you-including the activity progression one. I read that one almost every day to remind me not to overdo, or do too little, at any given stage.


If you change how you're recovering so far, and start to do less PT, or no PT at all, and start icing and elevating a lot each day and night, I suspect your pain and swelling will lessen. You're still in the very early stages of this recovery and have a long way to go. Ice and elevation really do help with pain and swelling, so do that a long time every day. You should feel a lot better somewhere around three months, but it takes, on average, a full year to recover.

As for the walker and/or cane, that is also your decision. Only you know when it’s time to leave each one behind, and that’s when you should ditch them. When you no longer need a walking aid, you’ll find yourself forgetting to grab them and then you’ll know you no longer need them. That’s not to say you should use them for the next year…lol…just that a month out may be too soon to ditch the help altogether, although many people no longer need them after a few weeks while others need a couple of months or more. The point is you decide; not your Dr, PT, spouse, family, friends etc. Good luck and keep us posted!
 
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Condo9

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Thank you so much for your response. I have canceled my PT and contacted my Dr. As I am concerned about my knee. It feels like something is going on since I twisted it. I have an appointment tomorrow to see him. I’ll keep you posted. Praying for good news. Still, icing and elevating!
 

Josephine

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I'll bet you're concerned. But I doubt there's any real need to be. I'd really like to offer you some structured advice but in order to do that, I also need to ask you some questions. Are you willing for me to do that?
 

Josephine

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Here y'go then!

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 forget to factor in other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness).

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

3. how swollen is your leg compared to these?
ai63.tinypic.com_eta39s.jpg


4. what is your ROM - that's flexion (bend) and extension (straightness)

5. are you icing your knee at all? If so, how often and for how long?

6. are you elevating your leg. If so how often and for how long?

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

8. are you doing any exercises at home? If so what and how often?
This is the most crucial question so please help me by using the format I have left as an example
(which means please make a list and not an essay!)

Exercises done at home
- how many sessions you do each day
- enter exercise by name then number of repetitions of each
etc., etc.

Anything done at PT
- how many times a week
- enter exercise by name then number of repetitions of each
etc., etc.
 
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Condo9

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1. Pain level is 5.

2. Hydrocodone7.5-3.25, every 4-6 hours.

3. Swelling is moderate at this time.

4. ROM measured 6 days ago was 110. They did not tell me how straight it measures.

5. I had cut back on the icing at 4 weeks, with the exception of after PT. Since last week when I hurt my foot and twisted my knee I have been icing for about 20 minutes every few hours during the day and a few times during the night.

6. I elevate whenever sitting during the day and in bed all night. The past week I have been elevating most of the day.

7. Up until a week ago I was pretty active. Assisting my husband with all household chores. No shopping yet.

8. Twice a day at home:
Ankle pumps x 10
Short arc quads x 10
Straight leg raises x10
Seated knee flexion x 10
Knee extension stretch x 10
Hamstring stretc x 10

At Pt 3 x a week for 1 hour

They would have me do bike for 10 minutes
Leg raises x 20
Seated knee flexing 20
Last week is when they became more aggressive using the cupping method, wrapping my entire leg tightly to reduce swelling. I don’t know the name of the exercise but they had me on my stomach and would push my leg towards me and hold it with their hand and have me push their hand away with my foot. I think that’s how I bruised my foot. They had me in a machine laying on my back and pushing a flat surface with my feet at 40 lbs. sorry not a very good explanation. This was the last day I went to pt 6 days ago as the next day I had the bruising and pain in my foot and increased swelling and stiffness in knee.

They were always very focused on my ROM, trying several different approaches and then measuring and remeasuring after each.
 

Jockette

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They were always very focused on my ROM, trying several different approaches and then measuring and remeasuring after each.
That just causes a lot of stress! :doh:

My ROM has improved into my second year post op, proving there is no window of opportunity.

I was pushed to high numbers early on but those “assisted” numbers were worthless to me at home because I couldn’t do them myself so I couldn’t take advantage of the function that number “theoretically gave” me.

As I’ve said before, I won’t go to PT next time, and I’ll have a better recovery. My current one was extremely stressful.
 

Irish471

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@Condo9 , I am so sorry that PT seems to have caused you so much agony! It’s good to have a check in with the doctor. Praying everything is okay and will be interested to hear what they say. Hugs!!!
 
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Condo9

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Thank you! Praying I hear good news!
 

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