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

[Condo9]

I saw my Surgeon today and they did xrays. Everything is fine with the implant. He thinks I pulled ligaments and tendons in leg and foot. My ROM is back to 70 :(

He wants me to go back to therapy but doesn’t want them to do anything to hurt me. We live in another state and are hoping to get home soon. He wants to see me in a week and reassess.

 

[Josephine]

1. Pain level is 5.

3. Swelling is moderate at this time.

You do know that moderate swelling adds about 4 points to your pain score. Therefore your pain score is 9, not 5.

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

I do hope you are taking this at the upper end which is every 4 hours, not just 6.

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

You can assess you own extension though. It's quite easy:
1. put your leg on a bench, seat, bed, floor or anything similar but preferably something fairly firm.
2. with not too much pressure, press the back of your knee down - use your leg muscles, not your hand!
3. slide your hand, palm down, under the back of your knee

a) if you can get your entire hand under easily, it's probably about +10 degrees
b) if you can get just your fingers under, it's about +5
c) if you can get your fingers under but it's a push, it's +0
d) if you can't get your fingers under at all, it's -5 or more​

Here's a graphic to explain the degrees involved

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.

If your swelling is moderate then you shouldn't be cutting back on the icing. Rather increase it.

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

Good. And do you ice while you elevate?

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

Twice a day at home:
Ankle pumps x 10 - these you should do whilst you are early in your recovery and not very mobile. You're getting up and about now so no need to do them any more.
Short arc quads x 10 - no need for these
Straight leg raises x10 - or these
Seated knee flexion x 10 - or these
Knee extension stretch x 10 - these are useless too
Hamstring stretch x 10 - and so are these

At Pt 3 x a week for 1 hour - okay
They would have me do bike for 10 minutes - that's good
Leg raises x 20 - but these aren't!
Seated knee flexing 20 - nor these
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 - I think it's an 'assisted' flexion which is, in my opinion, by far the worst thing you can do - well those are bad anyway!

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

Don't do this - not at all good

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

Not a good idea! Not at all!

 

[Condo9]

Thanks for your response. I am taking the pain meds every 4 hours. And I do elevate my leg whenever icing it. I will on your suggestion ice it more frequently.

I went to therapy today as my Dr asked. I told them I will not allow any more therapy that is hurting me. They mainly massaged my leg and knee today to get the tightness out. They had me lay down and put my leg over their arm and let it relax and hang. Also lay next to edge of table and hang leg down. They measured my ROM which was 97

 

[Josephine]

They had me lay down and put my leg over their arm and let it relax and hang. Also lay next to edge of table and hang leg down.

Neither of these are a good idea. They strain the knee.

They measured my ROM which was 97

ROM is both flexion AND extension. I am supposing what you posted was flexion, yes? So what was extension?

You can actuallt assess you own extension. It's quite easy:
1. put your leg on a bench, seat, bed, floor or anything similar but preferably something fairly firm.
2. with not too much pressure, press the back of your knee down - use your leg muscles, not your hand!
3. slide your hand, palm down, under the back of your knee

a) if you can get your entire hand under easily, it's probably about +10 degrees
b) if you can get just your fingers under, it's about +5
c) if you can get your fingers under but it's a push, it's +0
d) if you can't get your fingers under at all, it's -5 or more​

Here's a graphic to explain the degrees involved

 

[Condo9]

My extension would be 10 as I can get my entire hand under the knee

 

[Condo9]

What is the best exercise I can do? My knee is still swollen and stiff. I am walking more every day.

 

[Jockette]

What is the best exercise I can do? My knee is still swollen and stiff. I am walking more every day.

Short gentle walks and just your normal daily activities.

Lots of resting, elevating and icing, so your body can heal.

It’s not exercising that gets our range of motion back, it’s Time:

Time to recover.
Time for pain and swelling to settle.
Time to heal.

Our range of motion is right there all
along just waiting for that to happen so it can show itself.

In the general run of things, it doesn't need to be fought for, worked hard for or worried about. It will happen. Exercise as in strength training is counter-productive and in the early weeks does more harm than good. Normal activity is the key to success.

 

[Condo9]

Thank you for your response. I agree with you. The PT I have done so far has not been positive.
I am doing all the things you suggest. Progress is slow but I’m moving forward.

 

[Celle]

Progress is slow but I’m moving forward.

As long as you're making progress, that's all that matters.

There's no need to rush. You have all the time in the world. Your PT therapists may be number-obsessed, but try not to get that way yourself.
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

 

[Condo9]

My Dr wants me to continue with the PT and my feeling is I’d like to stop and see what happens. My knee feels like a vice is around it, so tight and swollen. We would like to travel home in a few weeks by air and make plans to do so but I’m concerned I’ll be ready by then.

 

[Jockette]

It is your choice whether or not to go to PT. Some doctors don’t believe going to PT is necessary, it’s all just their personal opinion. You are entitled to your opinion also.

Saying no to therapy, am I allowed to:
https://bonesmart.org/forum/threads/saying-no-to-therapy-am-i-allowed-to.36688/

 

[lovetocookandsew]

Just remember; it's your knee and your recovery. I listened to my OS and people here at BS, then made the final decision to have no PT at all. I found out later my OS actually agreed with me (and thus the BS way). In the end, you have to decide what works for you and what doesn't, and then do what works. You don't need to follow any advice you don't want, regardless of where it's from. If PT helps and works, then that's great; if it not only doesn't help, but makes things worse, then why do it? We are often reluctant to ignore advice and recovery procedures from our doctors because they know more, right? But, they are not perfect and in the case of recovery from this surgery, I have found they are often wrong. Since PT hasn't been helping, why not stop it and try another approach?

 

[sistersinhim]

My Dr wants me to continue with the pt and my feeling is I’d like to stop and see what happens.

It's your knee, not your doctor's. You are the one who has to go through the pain, not the therapist or your doctor.

Many of us never took formal PT or did exercises. I am one of them. I had 11 knee surgeries, 2 of them kneecap removals and 1 tkr. Even after those I never took PT. But, I didn't just sit around and do nothing. I took care of myself, my house and yard as my knee allowed me to do. As I healed, I did more. But, my knee was always in control . This was enough therapy for me and would be for any tkr patient. All the awful pain of PT is so unnecessary.

All you have to do is use it in your daily living. Your knee knows how to rehab itself and doesn't need anyone telling it how. Just use it and it will come back like new. You have to be patient, though, it doesn't happen quickly. ADL,(activities of daily living), going to the bathroom, brushing your teeth and bathing, fixing a light meal, getting something to drink and or a snack, those kinds of things will be all the exercise your knee needs. If you just use it daily in your living, you can have a less painful recovery. We know what works, we've been there.

 

[Condo9]

Hope everyone is having a good day! I feel I’m a strong person and I certainly didn’t expect having a tkr would stretch my patience like it has. The constant swelling and tightness no matter how much elevating and icing I do, the frustration on depending on others to do for me, the exhaustion from not sleeping, and hating myself for occasionally taking it out on my husband. Today was not a good day, hopefully better tomorrow.

 

[Jodingers]

@Condo9 I'm the same time frame as u and I certainly feel ur frustration.
I've only had 1 PT session here in the UK, my pt was great, she showed me to how massage behind my knee as I was very tight there and told me to go on an exercise bike for 5 minutes several times a day. No other exercises. Just gradual increased walking. I can cycle full rotation easily on my bike, walk foot after foot upstairs, walk straight without stick or crutches. Regular pt has not been essential for me, following the expert advice on here has been my salvation.
But yes, I do get that very tight vice like feeling, especially after my long walk or standing still. I find it eases if I massage gently or walk around a little in the house or if I pop on my bike. I do rest, ice and elevate constantly in between.
I keep telling myself that time is my friend and that progress is slow but steady. I did read on an old thread that using an ACE bandage was useful but I don't know what that is? Does anyone have any information or advice ?

 

[Condo9]

I have also read using an ace bandage can help with swelling. It comes in a roll and is stretchy.

 

[lovetocookandsew]

I understand all the emotions, frustrations, impatience, and the rest, as I've gone through them all many times. All I can say is it does get better with time and patience. I know that doesn't help today, but it will. There will come a day when you look back and realize how far you've come. There will also come a time when you actually forget you had a bad knee and then you'll know it was all worth it. Until then, I know it's difficult to see past this moment in time, as it's all you can focus on right now. But it will get better; until that day know that what you are going through is what most of us go through. It's not easy, but it is necessary in order to take our lives back from our knee's limitations. Hang in there, and feel free to come here and vent whenever you feel the need.

 

[Condo9]

Thank you for listening

 

[Condo9]

I cancelled pt on Friday but went yesterday and it will be my last visit. I was 6 weeks yesterday from my tkr. I reminded the therapist that my Dr. Wanted them to dial it back. She told me if we aren’t aggressive now you might have to have it manipulated under anesthesia. The head therapist had her have me sit at the end of the table and she put a strap around my ankle and then put her foot in the strap and push my knee back. Today I am again stiff, swollen and miserable. I canceled the appt for tomorrow. I see the Dr on Thursday and I will let him know my decision.

 

[Jockette]

I’m so sorry that they will not only not listen to you, but they are ignoring your doctor’s orders, too. You don’t need PT that causes so much discomfort after.

You’ll do much better without them.