TKR 9 weeks post TKR

[Joy77]

Hi @Silvernail02! I'm also from California - Southern California.

My surgery was 3 days after yours (today is day 10). You appear to be doing amazing and so much further ahead than me. I seem to be having a lot of pain thus on Percocet 10-325 every 4 hours. I had the same as you - a nerve block, spinal and also twilight sleep. I'm still on the walker and my last home PT is this Wednesday. Friday I go to outpatient PT. I have bad swelling and aching, lots of stiffness and difficulty bending my knee. I wasn't told to try to keep my leg straight so I don't pay attention to that. I'm guessing it will be straight on it's own. I wasn't given a pillow but I wish I was. I can't get my legs up to where they should be and I'm messing up my back terribly trying to shove pillows under my legs which is leading to a sore back. I have just ordered a Lounge Dr. Pillow which I hope helps with my knee elevation.

I'm not worrying about the pain medication anymore. This is what it was made for so I'm taking it to feel comfortable so I can move more. My Drs aren't concerned so I'm not. And I'm only 10 days out! Don't let your pain dictate your meds. My Drs told me to take the pain meds on schedule so I'm always "ahead" of the pain. Once the pain starts the meds have to work harder to bring it down. Wow you are only taking 3 Norcos a day. I think that's amazing.

You can sit like a normal person! Great success. (I'm not near that yet as I can't get the bend do to the swelling)

Like you said, and I agree, this is the most painful thing I've endured.

Focus on all your successes! I think you are doing very well. I'm sure at times it doesn't feel like it but you really do seem to be doing great. Great job fellow Californian!

 

[jmschmidt]

Keep in mind there really is no "typical" recovery. I had my left TKR in January - the recovery was hellish. Apparently I had an unusual reaction to the nerve block - every muscle in my leg left refused to function for months- tons of pain, couldn't conquer alternate legs on stairs for 4 months, at 6 months the knee was still stiff and partly numb. Had my right TKR in late July and insisted on no nerve block - the difference was like night and day. Walked right after surgery, walked half a mile within a week, and ditched all the drugs in 5 weeks (vs 12 for the left). In general move as much as you possibly can - using the legs heals all the parts. Be very careful not to ditch a walker or cane too early - walking unevenly, leaning to one side or putting more weight on one leg or the other often causes plantar fasciitis in one foot, strain on the hamstrings, femur pain, and pain in your sit-bones.

 

[Silvernail02]

Thank you, appreciate all your comments.

 

[NavyGunns]

@Silvernail02 glad we are able to help. You can count on all of us to provide support, coaching, a place to vent, and a place to celebrate throughout this journey.

 

[Silvernail02]

I am looking forward to tomorrow getting the staples removed. I have my first out patient PT. I am a little scared of the pain I have when I flex to a certain point. It's a super sharp intense pain above my kneecap and then spasms. I think that's the qudracep tendon? Lol. Anyway, doesn't hurt at all with walking. But when I sit and move my knee back, or stand and bend knee, when I get to a certain point it very painful above the kneecap. I still can't do straight leg raises because of that pain. My PT said its cause I am using quad and tendon to try to lift instead of using my hip muscles. Most likely from compensation for pain for such a long time I have been using wrong muscles for so long, I have to retrain my brain. Well, will see what my new out patient PT says.

 

[Celle]

My Drs told me to take the pain meds on schedule so I'm always "ahead" of the pain. Once the pain starts the meds have to work harder to bring it down.

That's the advice we give, as well.

I am a little scared of the pain I have when I flex to a certain point. It's a super sharp intense pain above my kneecap and then spasms. I think that's the quadriceps tendon? Lol. Anyway, doesn't hurt at all with walking. But when I sit and move my knee back, or stand and bend knee, when I get to a certain point it very painful above the kneecap. I still can't do straight leg raises because of that pain. My PT said its cause I am using quad and tendon to try to lift instead of using my hip muscles.

When you reach the point of pain, stop trying to do the exercise. Pain is a warning sign that you are trying to do more than your knee is ready for at this stage of recovery. "If it hurts, at the time or later, don't do it."

What your knee can't tolerate now, it may be able to handle when it has recovered some more.

The straight leg raises will come, given time. It's still so very early in your recovery and you have plenty of time.
There's no need to rush to recover and there isn't any deadline you have to meet:
Myth busting: the "window of opportunity" in TKR

 

[sistersinhim]

when I get to a certain point it very painful above the kneecap. I still can't do straight leg raises because of that pain.

That's your knee telling you it isn't ready to do that anymore. Doing so will just cause more swelling, pain and a setback in your recovery. Leting your knee always be in control during this recovery will work well for you.

 

[Camsmimi]

I'm 5 days out from a ltkr and the stiffness has driven me nuts. I can get out of bed to the bathroomvbut getting back into bed I need help. I'm still taking the pain pills every 4 hours but I'm taking dilaudid(think thats how its spelled)
It seemed to be the only thing to control the pain at the hospital.
Had my first pt today and did well. Not sure on numbers but not trying to be super woman either. I'm only 51 so hoping that helps in my recovery

 

[Joy77]

@Silvernail02 I wanted to check in and see how your first out patient Physical Therapy appointment went? I hope it went well and they recognized how well you are doing. You were also getting your staples removed. I heard it's not as bad as one would think. I bet it feels good to have them out.

Looking forward to getting an update.

 

[Silvernail02]

@Camsmimi , I hear you! I will be 51 in a couple of weeks. Yes the stiffness sucks!! I found that doing the exercises before getting out of bed, like bending it and ankle pushes helped me a lot. It is getting better each day, but it is slow.

 

[Silvernail02]

@Joy77 , hello ok so last night had an awful scare.

I was going into a deep sleep on my right side with pillow between my legs. I was dreaming I stepped off a curb and my left knee jerked into a flex that woke me up screaming. OMG, it was horrific pain and I had no idea how much I flexed it, I think it was the sudden jerk that caused the pain. So I cried for about 3 minutes, put some ice on it, freaked out a bit that tweaked it bad, after 5 minutes fell asleep.

A little extra sore in the morning. Got the 50 staples removed, it was pretty painful and the nurse did like 3 or 4 then she had to pause for a few seconds. Surgeon says looks good. I am like a week or so ahead of schedule.

Flexion 90 degrees and up to 110 with my good foot pushing back the bad one. My extension is 10 degrees away from 0, so that is good. PT was rough. He took away all the little exercises I was doing and gave me 3 main ones.

My quadriceps in that left leg are just short, not really working since I basically limped everyday for 3 months prior to surgery. So he wants me to focus on building the quadriceps. 3 exercises. 2 for quads 1 for flexion.

First one is lying on bed leg straight and flexing the quadriceps while pushing my knee down. First time my quadriceps didn't do anything. I have to really focus and try hard and then I see and feel little twitches, he said that is exactly what I need to see that the neurons are firing and trying to get that whole quadriceps working.

I do 10 sets, hold the position 10 seconds, 3x a day. 2. Sitting with knees apart shoulder width, leaning forward and using both legs equally to stand and sit. I was using just the right leg to stand and sit. 10 reps 3x a day. And last sitting in chair flex knee back as far as I can try then take my good leg and use my good foot on top my bad leg to push it back farther.

OUCH!! LOL. hold for 10 seconds, 10 reps 3x a day. I also got the clear to walk up and down stairs normally. To start walking 30 minutes a day. Out patient PT will be once a week for 4 weeks right now, with me going those exercises daily. Goal is to get to straight leg raise, next week. I couldn't do one.

 

[Celle]

Part of the stiffness is caused by swelling. Rest, ice,and elevate, to help the swelling go down. It's all normal at this early stage of recovery.

Remember that complete recovery is going to take as long as a full year, although you will feel much better long before that.
Unfortunately, this is one situation where your relative youth won't give you a quicker recovery. Your knee is going to need just as long to recover as it would if you were 81.
This recovery is truly a marathon, not a sprint.

 

[Celle]

Flexion 90 degrees and up to 110 with my good foot pushing back the bad one.

That is very good at this early stage.
However, please don't use your good foot to push the other foot back. It's not good for your new knee.
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

PT was rough. He took away all the little exercises i was doing and gave me 3 main ones. My quadriceps in that left leg are just short, not really working since i basically limped everyday for 3 months prior to surgery. So he wants me to focus on building the quadriceps. 3 exercises. 2 for quads 1 for flexion

PT should not be rough, or painful.

Your new knee is very new. It's been through major surgery that has caused a lot of trauma and it needs time and gentle treatment, so it can heal. Stressing it with demanding exercises will keep it angry and inflamed and that could actually slow down your recovery.

I'm sorry, but I completely disagree with your PT therapist's approach. The exercises he has suggested for strengthening are inappropriate so early in your recovery. They are more suited to about 3 months post-op. Heal first, then strengthen.

Don't do any exercises that actually hurt. Doing those is bad for your knee.

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.

 

[Jockette]

Sitting with knees apart shoulder width, leaning forward and using both legs equally to stand and sit. I was using just ty he right leg to stand and sit. 10 reps 3x a day. And last sitting in chair flex knee back as far as I can ty hen take my good leg and use my good foot on top my bad leg to push it back farther.OUCH!!

It is way too early to be doing this type of exercise. Your new knee is just a baby and needs to be treated gently, not forced like this.

I was also told to sit in a chair and have my husband force my foot back under my chair. We did this for a whole weekend so that I could reach the 95 degrees that my PT said my surgeon expected at my 2 week check up. I cried in pain every time.

At 4 weeks post op I found Bonesmart and learned that doing that was not only unnecessary but was keeping my knee swollen and inflamed.

The surgery takes its toll on the quad. It will strengthen all by itself as you heal, which will enable you to use it more, and using it will strengthen it. It’s a process and takes TIME, something PTs (and some surgeons!) don’t allow us. They want us to recover NOW. The body can’t recover now, it needs time.

Don’t do anything that hurts. We hurt enough in recovery because of the trauma of the surgery. Doing any exercises that hurt is needless additional pain.

If I have another knee replacement I will not be going to PT. Been there, done that. It is only an option, not the requirement we are led to believe. I will only do what Bonesmart recommends and I will have a better and less painful recovery.

 

[sistersinhim]

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!

 

[InkedMarie]

My in home PT told me to put my operative foot on a washcloth; while sitting on a chair, she would get behind me and help slide my foot back. This was post op day 3 or 4. Yeah....no!

 

[Silvernail02]

Wow, such great information. I really don't understand all the hoopla about PT!! It's just crazy.

I am in tears this morning from my first outpatient PT yesterday. It really seems barbaric what they are asking me to do. The sitting in a chair and flexing my knee back is fine just to a slight pulling sensation, no pain, but to use my good foot to scoot it back, OMG, what is the hurry?

I do understand my quadriceps in that left leg are really just about absent. When I tighten my right quadriceps I see it clearly. With my left, nothing happens it's just atrophied over the last 6 months. I think logic dictates that quadriceps are atrophied and not working cause I was limping and not using it for such a long time before surgery.

Now with my new knee and no more arthritis pain I won't need to limp and muscles will strengthen slowly on their own. My orthopedist has a different view, but so many of surgeons in the US feel this same way and I am not sure why. I don't want my numbers to regress and disappoint my surgeon and PT, but yet I am cringing at the thought of performing these exercises 3x today.

I have read so many posts in this wonderful site about no need for painful or aggressive PT and it turned out just fine. I think I am going to compromise a bit and do my home exercises like PT said, but I will absolutely not do them to pain like yesterday. I will do it gently and let my knee be in control, not me.

Thank you everyone for such words of wisdom and experience they are so helpful. I am so glad I stumbled on this site. I thought my age would be helpful in my recovery and I totally realize age doesn't matter. It's all individual having nothing to do with age.

Well my Norco is starting to kick in so off for my first shower in 2 weeks, I am so done with sponge baths.

 

[skigirl]

I think recovery is a balancing act. For instance, it is good to do the quad sets---doing them makes the quad wake up!! But sadly your PT has not taken any new training on TKR recovery---he is still back in the nineties!!

If your quad is not working, then your muscles are not helping to hold up your leg. That means that the joint has to hold you up while you do the sitting, standing mine squat exercise. Now, if you had a broken leg would you do that exercise? no, of course not. But, yet you are supposed to jam onto your joint every time you do it???? Could that be positive? no way.

Pushing your operated leg back with the good foot will buy you more swelling and pain---so why do it? Your knee is still swollen---like a full garden hose---can you bend it??? no, of course not. instead you need to lie down more and put that leg up on three pillows. For the first 3 weeeks I was in bed about 80% of the time. By the end of three weeks, the worst of the swelling was gong.

I tried to rush recovery too!! It was painful and it did not work. With my second knee, I gave in and realized I was not doing "nothing" but instead was actively working to heal my knee. So, Pt was leg lifts, clam shells, quad sets, biking and lots of massage of the soft tissues. I then iced for 20 min before I left. I did nothing at home!!! I walked around the house and did take short walks outside. by the fourth week, I began, slowly and carefully to strengthen the leg--although I avoided squats even for that.

So, you don't disappoint your PT----he is disappointing you. You are paying for his service, you owe him courtesy and nothing else. It is okay to say, that exercise is too much at this stage, I would like to do more table exercises and massage until my quad is working again. If he cannot accomodate your wishes---well . . . let's face it, someone in that office will be glad to have you as a patient!!!

By the way, I skied at five months---100 days. I have a rom of 140 on that second knee. So, don't believe the stuff that you have to do this now. You just had major surgery and now you need to allow yourself to recover and to heal the swelling in your leg. Of course, quad sets will help that quad wake up---I did lots of them when i was lying down, but I did not bother to push me knee down, just contract the muscle and tell it to wake up!!

 

[Roy Gardiner]

no more arthritis pain I won't need to limp and muscles will strengthen slowly

Exactly. And when your soft tissues are fully healed, you can train as much as you like.

PT is IMO excellent for coaching in new gait and posture and so on, which doesn't require pain to get right!

 

[NavyGunns]

@Silvernail02, so you’ve received a LOT of information and opinion here as well as from your PT and OS. Now it’s up to you to decide what to do with it.

In my case, I found BS about a week after surgery. My OS already had informed me he would not schedule PT until after my first follow up between 2 & 3 weeks post op. When I met with him, I discussed PT and shared my concerns, especially with regards to the BS approach (didn’t mention BS specifically just that I didn’t want forced bending, etc). He fully supported my concerns and even stated there was no reason to be forcing the knee to bend. I had a similar discussion with my pt at my first visit. I also made it clear to him I’d find alternate services if he could not comply with my approach. He also supported and advocated the BS approach.

Now you need to decide what approach you feel works in your best interests. Once you’ve made that decision, you’ll know what to say and what to expect as an outcome.

My only caution is that if you go with your current pt approach, don’t be surprised to find you suffer pain and swelling longer and may not even achieve the results you were hoping for. No guarantees you will with the BS approach, but you’ll at least minimize the pain and swelling, giving your knee time to heal.

Your call. Us BoneSmarties will still be here for ya though!