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Bilateral TKR 9 months post op and new pain<^

DLC1128

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Found this forum and reading comments has helped a lot. Had bilateral TKR on 9/19/17. Spent one week in in-patient rehab. Home now and getting around pretty good.

Week 4 starts today. I am walking without my walker and pretty much on my own...no cane either. The left knee is doing okay, responding to PT and I can pretty much straighten it and it is 100 degrees. The right knee is giving me fits. It is only at 80 degrees and it does not straighten at all. I work very hard when walking to walk upright and to consciously not bend over.

PT twice a week. Had PT Monday and usually afterwards I am tired but I ice and take ibuprofen and do okay. This week my knees have not recovered and I find that I tire easily. I’m assuming this means I should REST and ice and elevate.

It is hard for me to sit still! And I want it to be done now!

Diana
Surgery 9/19/17
Bilateral TKR
 

Josephine

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Oh you are having a tough time!

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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And here are our recovery articles for you to read. They are very important so do read them carefully.

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

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 a 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 history before providing advice.
 

skigirl

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It is so annoying when the knees will not co0perate and act exactly the same!!! Usually the other knee comes around, so relax for now and focus on reading or knitting!!
 
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DLC1128

DLC1128

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well, week 4 began on Tuesday so I think that officially puts me at week 4 1/2. Yesterday the PT had me lay on my stomach and hang both legs off the end of the mat. He wants me to do this for 3-5 minutes per day. Somehow there must be a better way to get my legs to straighten up! He said ankle weights would come next. I have to say that I am finding his approach very disconcerting. After PT on Monday, I could barely walk upright on Tuesday and Wednesday. Thursday they were just recovering. I am still very stiff, which makes perfect sense to me. But I may have to quit outpatient PT if he keeps this up...or switch to another therapist!

I am having pain in my right knee which was non-existant before Monday. I did tell him no strength training right now but he said with mobility exercises you had to have strength training or you would not maintain your gain.
So I'm not sure how to proceed. Any advice?
 

SusieShoes

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I'd say hold your ground on no strength training. My OS said no weights, bands or machines before 3 months. At my seven week checkup he released me from PT, so I never did any strength training. :snork:

Let your knees be your guides. They'll tell you what's working and what isn't!
 

skigirl

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Laying on your stomach and letting the legs hand off is a good, slow way to get more extension, it is what I did with my right knee. But NO ankle weights, that is much too aggressive and most of all, unnecessary. You will gain extension with just the stretch and weights will hurt!!

I like PT, but I think you need another person. My PT did mostly stretching and non weight bearing exercises---like quad sets, leg lifts, clam shells for the first four weeks. At 5 or 6 week, he began adding some yellow bands. But, no weights or stiff bands. You do not need to be that aggressive---your PT is not correct. We all get ideas set in our head and his are hurting you because they are too aggressive.

Your have had major surgery, your bones were sawn and new parts were glued into the bones. If you had a bad sprain, you will baby it for four or five weeks---yet, he thinks you should begin strength training before your tissues are fully healed.

Your muscles are not at full strength right now, so they cannot fully support your leg. Therefore when you are standing, the joint itself has to bear more weight than it really likes to bear, so it reacts with swelling and pain and stiffness. You can do stretching, and easy strength training like leg lifts right now. in another three weeks, you will be able to step up the pace a little as your soft tissues heal and your quads and hamstrings wake up and begin to work better.

Do you really think it is wise to do exercises that make you painful and stiff for two or three days afterwards? That does not sound like a path to healing to me.
 

Celle

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After PT on Monday, I could barely walk upright on Tuesday and Wednesday. Thursday they were just recovering. I am still very stiff, which makes perfect sense to me. But I may have to quit outpatient PT if he keeps this up...or switch to another therapist!
I think you need to have a serious talk with this therapist. What he is doing is not good for your knees. All this pain and stiffness is a direct result of the over-activity. It's your knees giving you a message that they need a rest.

These are your knees and you have the absolute right to say what happens to them. You can set the limits on what you do at PT and your therapist has to comply with your wishes. You're not there to please him. He has to please you.
CONSENT: what it means and how it can be used
Saying no to therapy - am I allowed to?

So, speak up for your knees. Tell your PT that you will not do any exercises that cause pain, at the time or later, and he is not to push or pull on your knees or use weights. If he says he can't comply, either choose another therapist or stop going to that clinic.
Remember this at all times:
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.

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.
 
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DLC1128

DLC1128

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Why oh why is the pain so unbearable at night??? No answer needed. It just is.

My real question is about extension and flexibility. My extension on my left knee is still at 10 degrees and my right knee is still aroun 25 degrees. At four almost five weeks out am at a good place or should it be better then that by now. My flexibility on my left knee is 101. My right is only at 90.

Thoughts?
 

Celle

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Night pain is often a reflection of two things - too much daytime activity, and insufficient pain medication.
You're tired and probably more susceptible to feeling the pain, too.

Your flexion (bend) is good. Most surgeons are happy if you reach 90 degrees by 6 weeks.

Extension often takes longer to achieve that flexion. It takes quite a long time for those large muscles and tendons at the back of your knee to stretch back to normal length, especially if your knees were a bit bent before surgery.
You can't rush this, but need to work gently at it.
This article suggests some ways you can help your extension to improve:
Extension: how to estimate it and ways to improve it
 

kmak81230

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I would agree with the others: extension generally takes longer to come, no weights for where you are in recovery, and it sounds like your PT is much too aggressive. My extension has been very slow to come and I am still at 3 at almost 6 months - it is very slowly improving. I do allow my legs to hang off the bed while laying on my stomach - but no weights. You have plenty of time to gain strength and you will continue to get stronger without using weights. Walking, particularly using a heel to toe longer stride is good for improving extension - as well as improving leg strength. Many docs are happy with 90 degrees flexion at 6 weeks so it sounds as though you are right on track. Hang in there - you are still in a very painful phase of recovery.:flwrysmile:
 
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DLC1128

DLC1128

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Ah, and when does the “painful phase of recovery” end???? I’m ready for it!
 

DebM

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Just an aside.... you will probably find your knees will progress differently....weird I know. Mine continually
swapped between naughty and nice for the first few months. Now at 9 months they have settled on the left one being a bit more of a problem child.
 

Roy Gardiner

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My extension on my left knee is still at 10 degrees and my right knee is still aroun 25 degrees. At four almost five weeks out am at a good place or should it be better then that by now
There is no 'should be'. All recoveries are different.

See my exercises thread below for stuff on extension stretches.
 

SusieShoes

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Ah, and when does the “painful phase of recovery” end???? I’m ready for it!
Isn’t that the worst part? Wondering when the good things will happen? Stay the course... they happen!

There is no should, there is no magic number of days or weeks. There is only you. You will recover as quickly or slowly as your body allows. Even without setbacks, this recovery takes its own sweet time.

Take my knees. My right knee was pain-free and all systems go at eight weeks. It was almost that good at six weeks. What a great knee! But my left knee... oh, my left knee. Lefty continued to hurt and stiffen and complain with every bend —walking, PT, in bed, sitting, didn’t matter— for eight MORE weeks. Lefty was worse at bending and worse at extension. Lefty was a royal pain.

I asked my OS at my seven week checkup if Lefty would ever be normal. “Oh, yes,” he assured me. “In almost every bilateral, one knee lags behind the other.” I was soooooo ready for Lefty to stop lagging.

Sure enough, at four months, about 8 weeks later, Lefty stopped hurting. Lefty was straight, finally. Lefty had arrived. I have two pain-free knees.

The good things start to happen right around where you are now. Sometimes sooner, sometimes later, but around eight weeks. And they keep coming from there. Little by little. A little unevenly, perhaps. But you will be very happy one of these days. No one can tell you just when, though. :shrug:
 

sistersinhim

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As you have heard, each knee is different, even on the same body! In time, that pain will slowly go down and then you'll be glad you had this surgery!
 
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DLC1128

DLC1128

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Almost at six weeks. Tight hamstrings and calves are hampering my flexibility and extension. I’m also having sharp pains through my knees. I think I’m trying to do too much...
 

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