TKR 9 Weeks Out - Questions on Recovery

[dpcmgr]

Josephine,

1. The pain can range from 2-6. When relaxing it really doesnt feel painful just stiff. When I am up on it and after walking or doing activities it can get to a 6.
2. I have Oxicodone 5 mg which I take when needed which lately has been 1-2 per day at the most. I found in the library your suggestion on a combination of Ibprophen (2,400 mg per day maximum) and Acetaminophen (4,000 mg per day maximum). This helps me minimize having to take the Oxicodone.
3. Now that I am on limited duty at work I ice my knee 2-3 times after I get home till bedtime on the weekday and 4-6 times pre day on the weekend when I am home not working.
4. I elevate my leg above my heart and use two thick pillows when relaxing and icing.
5. Today my flexion at PT session was flexion 80 deg., extension 3-5 deg.
6. Activity level is moderate. I dont push it to much but still like doing things around the outside like preparing for winter and helping out doing house work and things. Nothing I would say is over doing it and I always ice and elevate after I am done.
7. PT exercises are leg lifts to stretch hamstring (2 sessions 10 per session), roll the ball with foot bending the knee
(2 sessions 10 per session), straight leg lifts tightening muscle at the knee joint holding up for 4 seconds (2 sessions 10 per session), then the same things with foot pointed out to side. I also have a device I wrap around my thigh which stimulates the muscles through am electrical currect and when it i feel the currect i tighten the muscles just above the knee and hold for 5 seconds. That session is 20 mins long and i do it once a day or so.
I hope these answer your questions, if not I will be more than happy to clarify.
Thanks.

 

[dpcmgr]

I just had someone tell me from work I really need to get on the stationary bike and work my knee since I am having muscle issues. It will be painful he says but it will get your muscles moving and working like they should. Any thoughts?

 

[jeano]

You might not have enough ROM to make a complete revolution but pedaling is a great way to loosen a sticky knee, but GENTLY. Set the seat as high as you can, make sure the tension is at the lowest setting, and just rock the pedals back and forth eventually you'll get full revolutions but do NOT push so hard that you aggravate your knee further.

I just had someone tell me from work I really need to get on the stationary bike and work my knee since I am having muscle issues. It will be painful he says but it will get your muscles moving and working like they should. Any thoughts?

 

[dpcmgr]

I understand jeano but how long would you suggest I do this for each session so I dont over do it. You see I am an awful judge when it comes to that because over doing tasks is my nature. It is in my blood to push hard and I have learned on this site that is not the answer.

 

[jeano]

Gosh, just rock the pedals for a couple of minutes per session, that ought to be plenty. The idea is to very slowly and GENTLY push the knee to the point of discomfort, and then back off. Sometimes its easier to get that first full revolution going backwards. It doesn't need to hurt. You cannot muscle through this recovery. Well, you CAN, but it won't be as good a recovery if you do. Some great guru of marathon training, I forget who, used to advise, 'start off slowly, and then taper down.'

 

[tiredwife]

@dpcmgr Why not start with 3 minutes and see how that goes, you can always add more time after awhile.

 

[Josephine]

1. The pain can range from 2-6. When relaxing it really doesn't feel painful just stiff. When I am up on it and after walking or doing activities it can get to a 6.

Well, stiffness is a form of pain so it needs to be medicated. But those pain levels are quite high.

2. I have Oxycodone 5 mg which I take when needed which lately has been 1-2 per day at the most. I found in the library your suggestion on a combination of Ibuprofen and Acetaminophen. This helps me minimize having to take the Oxycodone.

But what are you prescribed? If you have ongoing pain it needs to be medicated regularly. Read the article on pain management you were left in post #6. Do be careful with NSAIDs - read this Medications: NSAIDs, acetaminophen (Tylenol, paracetamol) differences and dangers.

3. Now that I am on limited duty at work I ice my knee 2-3 times after I get home till bedtime on the weekday and 4-6 times pre day on the weekend when I am home not working.

You haven't told me how long you ice for.

4. I elevate my leg above my heart and use two thick pillows when relaxing and icing.

okay.

5. Today my flexion at PT session was flexion 80 deg., extension 3-5 deg.

hmmm ....

6. Activity level is moderate. I don't push it to much but still like doing things around the outside like preparing for winter and helping out doing house work and things. Nothing I would say is over doing it and I always ice and elevate after I am done.

okay ....

Your exercises - my comments in bold
how many times a day do you do these?
hamstring stretches 2 x10 - that seems okay
roll the ball with foot bending the knee 2 x10 - a version of heel slides, you'd be better doing these just 5 every couple of hours during the day. But never make yourself hurt doing them. Go to the point of discomfort only
straight leg lifts 2 x10 - given that you are 10 weeks I don't see the point of doing SLRs at this point. Surely they are not difficult now, are they? If they are then I am wrong, if not then they are unnecessary.
then the same things with foot pointed out to side - eh? never heard of that one before!

I also have a device I wrap around my thigh which stimulates the muscles through an electrical current and when I feel the current I tighten the muscles just above the knee and hold for 5 seconds. That session is 20mins long and I do it once a day or so - I think that's an e-stim. No harm in that

I just had someone tell me from work I really need to get on the stationary bike and work my knee since I am having muscle issues. It will be painful he says but it will get your muscles moving and working like they should. Any thoughts?

Use of an exercise bike is is very good therapy for knees. But the others are correct, with a flexion of only 80, you may find a full rotation is impossible so the rocking is the thing to do to start with. Another tip is to have the seat at its highest when you start. The first time you go all the way round you will find it takes your breath away but thereafter it gets easier.

 

[kneeper]

The rocking is how most of us have started on the bike. Even just 5 minutes is helpful. You may find you feel looser by the end of the 5 minutes than at the beginning.
Gentle stretching may also help you feel looser.

 

[dpcmgr]

Josephine,

I do the exercises twice a day. I have done and will continue doing the heel slides but as odd as this sounds pain is not the issue. When I slide it back on a ball or flat on the floor my knee stops bending on its on no matter what i do. Someone can force it and yes then I will feel the pain but on my own it will go so far and then stop. You are correct, leg lifts are quite easy and I have no difficulty doing them. The company called me yesterday that makes the device (e-stim) and advised me that my insurance will not pay for the unit and I will not be charged if I send it back immediately. I believe it was like $2,500 US dollars. It will be sent back.

 

[dpcmgr]

I would like to re-post the following question: Has anyone had or knows of someone that has had botox injections in order to calm the muscles around the knee allowing it to increase the ROM? I did get a few people who responded, Josephine did and I am incline to agree with her opinion but what is really bothering me is I posted this question online and my surgeon suggested I do this as if it was a regular procedure done all the time. Tomorrow I am scheduled to see the Dr. who does this and I am only going to gather information. I have no intentions of doing anything like this until I can discuss this with other people that have done it before. I have followed the lead of PT's and my surgeon where their direction given to me for my recovery was wrong. Thanks to this forum, I have learned so much and have read so many different circumstances that we truly are all different when it comes to how we heal after something to major. My knee may take a very long time to heal and I will need to be patient but thanks to people on here I believe my body will guide me right and one day I will have the desired outcome. Once again, anyone knowing someone who has had this procedure please respond. Thank you all for your time and support. I will continue spreading the name of this great forum to others who need this type of help and support. Thanks!

 

[Josephine]

When I slide it back on a ball or flat on the floor my knee stops bending on its on no matter what i do. Someone can force it and yes then I will feel the pain but on my own it will go so far and then stop.

This bothers me as you are not yet 4 weeks out from your MUA and only 10 weeks out from your TKR for that matter. Tell me, did you surgeon give you a report on the MUA? Did he say if it was tough to do, that adhesions were broken or what degree of flexion did he get it to? And is your knee very swollen right now?

I posted this question online and my surgeon suggested I do this as if it was a regular procedure done all the time.

No it's not and I've never EVER heard of anyone having this done! I was outraged at the suggestion, I am even more outraged that the surgeon suggesting this treatment should ask you to see if it was 'done all the time'. It is not - not in my experience, anyway.

 

[scaredinCA]

I've been on this forum along time and I've never heard of anyone using botox to loosen muscles. Surely if it were done all the time, then someone on this forum would have posted about it.. (or maybe I missed it?) I was wondering if you have a sit down job, like in front of a computer all day, that would be a good reason that your leg/knee is stiff.. Or are you moving around at work?

 

[dpcmgr]

Josephine - The MUA, according to my surgeon, I was at 130 degrees and had very little adhesions impeding the bending of my knee that he had to break apart. However, afterwards I discovered I had better mobility before than I did after which even to this day seems to be the case. My knee is still swollen (about twice the size as my other knee) and as God is my witness I would swear there is something around my knee that is preventing it to bend. Every time I take a step and try to follow through bending my knee that is where I feel the resistance. My PT has been massaging my calf and the back side of the thigh trying to get it to loosen up so I can straighten it out fully but from the top left side of the knee down around the front I swear there is something wrong. I do not feel any resistance anywhere else in my thigh or calf. Could I have fluid built up around the knee? This feeling I am describing is so prominent when I try and bend my knee. I just have no idea what could be holding it back from bending.

Scaredinca - I actually have a job where I am up and around and can sit. Doing either at my discretion. You are correct, when I sit for a long period of time it stiffens even more but it also does that if I walk for longer than I probably should. A mix of both actually feels pretty good.

 

[wolf woman]

@dpcmgr sorry you are having all this trouble. I am having a very slow recovery as well. However, after finding this site and having Josephine set me straight about several things, life is getting better!

I wanted to address the issue of the e-stim machine that you are returning. They are also known as TENS units (transcutaneous electric nerve stimulator) and can be found from other sources besides companies that overly inflate the prices. Try Craigslist, ebay, searchtempest, or similar. Empi used to make a very nice machine and I believe they were bought out by Don-Joy. So, either of those two should be nice machines. I use mine for numerous issues and suspect you may be glad to own one yourself. Let me know if you find one.

Being here has been a great asset in my recovery and I come here for support in various areas. Sometimes it's nice to just have a friendly ear.

Best of luck,

Mary

 

[Josephine]

The MUA, according to my surgeon, I was at 130 degrees and had very little adhesions impeding the bending of my knee

As I suspected. You never needed ther MUA at all.

However, afterwards I discovered I had better mobility before than I did after which even to this day seems to be the case. My knee is still swollen (about twice the size as my other knee) and as God is my witness I would swear there is something around my knee that is preventing it to bend.

Of course there is - it's swollen. Did you not read this article Swollen and stiff knee: what causes it??

My PT has been massaging my calf and the back side of the thigh trying to get it to loosen up

It doesn't need 'loosening up', it needs less of everything and more rest. I think you've been punishing it far too much with all the exercises, e-stims and everything else. In my experience when people get problems like this, they invariably fall into the trap of trying to find that extra exercise they can do to resolve a pain or something. It's a sure way to just making things worse.

I can tell you with some degree of certainty that if you've been keeping up this level of exercising since August 5th, you are fast moving into the realm of chronic pain and trust me, you do NOT want to go there. Your method of avoiding this is to stop your exercises, you don't need then now anyway since your ROM is at 130, and concentrate on getting that swelling under control. Do this by resting and elevating as much as you can. And I mean HIGH "toes above nose" elevating. If you have no pain then you don't need to ice but elevate.

You will note I said your ROM IS at 130 because that's what the surgeon got it to. Why you can't get there now is for one reason only - the swelling. Once you get that down, you will that ROM is there just waiting to show itself. It's as simple as that.

 

[referee54]

Good Morning All - Now 10 weeks out and still feel very stiff.

I returned to the classroom at eight weeks and was stiff for almost four months---and I had a slight limp at the five-month mark---still! You have to understand that your knee has sustained some very serious surgical trauma! It can take upwards to a year to fully recover.

Patience is not one of my strongest attributes but I do understand it.

You simply reach deep inside of yourself and find the patience that yo did not know that you had. You cannot simply rush these things--you are on your knee's schedule, and there is nothing you can do to change that.

Feels like I have a brace on constantly. Any thoughts?

It took me six months to get to 80%-85% and eight months to get to 90%-95%. By the end of the school day, I was stiff and sore. I took Sunday off---after church, I iced and elevated and rested.

While you cannot speed up your recovery, there is plenty that you can do to slow things down.

 

[referee54]

Your method of avoiding this is to stop your exercises, you don't need then now anyway since your ROM is at 130, and concentrate on getting that swelling under control. Do this by resting and elevating as much as you can. And I mean HIGH "toes above nose" elevating. If you have no pain then you don't need to ice but elevate.

And this is what it is all about.

Your knee is telling you that all of this is not doing it any good, and you are working too hard.

Any time you get the urge to work harder, fight it!

It is not about working harder, it is all about working smarter, and "less is more."

To me, it sounds like you are entering the "vicious cycle." You are not seeing the results that you want, so you work harder. You still do not get the results you want, so you work harder still.

Your knee is trying to tell you something. Read the other threads---others will tell you that, as soon as they cut back and iced, elevated, and rested more---and did less---they saw results.

Take a look at this, please.
TKR: work “smarter” and not “harder”

 

[dpcmgr]

Good Morning All - Well I am 13 weeks out and my anxiety is building with each day. My wife is sick of hearing me whine about my knee and the fact I am seeing no improvement so most of my frustration and depression I have to hold within myself. My PT is trying really hard to remain positive and I know many here just advise me to be patient and it will come. I believe in that but right now every step is painful and after sitting for a bit and getting up I feel as bad as the day after surgery. It is hard to even imagine men and women 20 years plus older than I am go through this with little effort (my dad did it at 73 and I am 57). I cant even sit without feeling the pain shoot through my leg. I believe I am doing everything I can to help minimize my discomfort. Icing with leg fully elevated above my body, pain meds, muscle relaxers, anxiety meds on and on and on. I will admit when I take my pain med and muscle relaxer I can move a bit better and it feels better for awhile but it is short lived. I cant help thinking something is wrong but I am the only one who thinks this and cant get anyone to offer any suggestions except my Surgeon who believes

 

[Josephine]

Have you reduced your exercises as I suggested? Did you follow my advice in post #35?

 

[dpcmgr]

Yes Josephine I have. I do some light stretching but I do not try and do anything that produces pain. Basically I try and stretch up to the point of being able to walk normally and nothing beyond that. I for some reason did not finish my thought in my last post. My surgeon has only suggested botox injections for which at this point I am very leary of. In his ten years of doing TKR he has only three people who have had this done. Here in the USA most insurance policies start over after Jan 1st so I am considering seeking a second opinion prior to that date otherwise anything after that I will have to pay the first $5,500. I know this will take sometime to heal but my muscles , hamstrings and calf muscles are hurting so bad I made an appointment just to see a woman who does light massaging in order to try and get some relief. She is not a PT, she just does massages. I need some relief and time is not helping me right now.