TKR Abbylayla 5th August RTKR

[Abbylayla]

Surgery at 7:30 this morning. All good so far. Nerve block still masking pain but starting to wear off. Very tired from a sleepless night last night other than that ok.
Thrilled to have one less arthritic joint

 

[Celle]

I'm glad it's done, @Abbylayla .

Here are your recovery guidelines - lots of helpful articles:
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

the BoneSmart view on exercise​

BoneSmart philosophy for sensible post op therapy​

5. Try to follow this

Activity progression for TKRs​

6. Access to these pages on the website

Oral And Intravenous Pain Medications​

Wound Care In Hospital​

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.

 

[Dizzy]

 

[leejaa]

Congratulations on your new knee. Make sure you tell nurses if pain increases so that they can get your pain under control.

 

[doodlebug60]

welcome Abbylala
Glad to have you here. Bonesmart is a world wide forum that has plenty of information for you. Read the guidelines they give you and your recovery will be a lot easier. We have all been where you are now. Be prepared for a long recovery; Right now all you need to be doing is rest,ice,and elevation. Hope you have a great recovery. Doodlebug

 

[Abbylayla]

Leejaa getting pain meds is like pulling teeth. Im getting pretty disgusted

 

[sistersinhim]

getting pain meds is like pulling teeth

I agree. That's where icing and elevating can help.

 

[leejaa]

I am so sorry that they are not responsive. I guess I was spoiled by my hospital and my doctor. Have they said why they cannot give you more - sometimes it is a timing issue and other times they might need to get permission from a doctor to give a different or additional medication.

 

[Abbylayla]

Leejaa the prescribed minimal pain relief. I just don't understand this. I have PT today and I won't be able to do much of it if im in pain. It makes no sense.

 

[sistersinhim]

If you're in pain you should skip PT. Your knee is already inflamed and angry. Why add to that with PT?

 

[Abbylayla]

sistersinhim I let PT come figuring it would probably be more of an evaluation than anything, and it was.
She did a ROM check, it was 60 which is kind of odd, yesterday I has about 75. My extension is almost 0.
When she was measuring ROM she pushed my knee backwards to get 5% more & it hurt like crazy. I asked her not to do that. She said if I could not get enough ROM on my own I'd need a manipulation. How discouraging! I just had surgery Wednesday.
She also said I should lose weight because even 5 or 10 lbs would really help. I'm well aware it would be wise to help myself but I suppose it wasn't in my notes that in the months leading up to TKR I've lost 22lbs. And I am continuing to lose slowly with very little ability to exercise.
So between that & what I feel is inadequate pain management I'm slightly discouraged today.

 

[leejaa]

@Abbylayla , your PT was totally out of line to continue when you told her to stop and then try to scare you with manipulation. Your knee is swollen and will not bend with swelling. Yesterday you might have had more rest and elevation so you had more flexion. If your PT person or any one comes again have a talk before they start that they CANNOT push on your knee or force your knee. They can hold it and let you try to flex or extend to whatever degree you are able to do that. When they push past your comfort level and you tell them stop- that is abuse and they are not allowed to do it though too many think they have the right.

My choice would be not to have that person again and interview anyone else who comes as to their philosophy on recovery. I hope she helped you get comfortable with elevation and ice before they left. With all my joints I elevated constantly especially this early and kept ice on pretty much 24/7 unless I was walking to the bathroom. Your biggest activity this early should be walks to bathroom and small forays to kitchen once in a while. I had home PT for all my joints and we had talks about philosophies of recovery mine and bonesmart and theirs. All of them agreed that slow and steady and reducing inflammation was key and never pushed. They would give me exercises and show me how but if I said enough we stopped and did no more. They were encouraging but not pushy in a painful way or try to scare me. Trying to scare you with manipulation is just ridiculous and unkind.

Knees need to get swelling down before they can bend and ice and elevation are key. I am sorry you feel discouraged and upset. I hope your evening is a bit more restful. I am glad you are here sharing with us.

 

[sistersinhim]

sistersinhim I let PT come figuring it would probably be more of an evaluation than anything, and it was.
She did a ROM check, it was 60 which is kind of odd, yesterday I had about 75. My extension is almost 0.
When she was measuring ROM she pushed my knee backward to get 5% more & it hurt like crazy. I asked her not to do that. She said if I could not get enough ROM on my own I'd need a manipulation. How discouraging! I just had surgery Wednesday

Don't let anyone push on your knee. All that does is to cause more pain and swelling. If I were you, I'd cancel all the other PT appointments. The only thing your infant knee needs is to rest, ice, and elevate. Walking around to the bathroom and kitchen is all the exercise it needs. Did you read the articles that were left for you? There is a lot of good guidance in them.

 

[Celle]

I have PT today and I won't be able to do much of it if im in pain. It makes no sense.

So ear;y in recovery, you really don't need PT at all. Your knee will get all the exercise it needs, just as you walk from bedroom to bathroom and kitchen and back. Mostly, it needs lots of rest, ice, elevation and just a little, gentle movement, so it can start to heal.

 

[Abbylayla]

When my OS evaluated me in the hospital before release he was very happy w my leg. So was I, was expecting a hugely swollen bruised mess. It wasn't at all. He said my leg was exactly what they like to see & he was impressed that I had about an 80° ROM & near zero extension. He was more concerned w maintaining good extension than ROM at that point. The swelling was quite minimal.

I had PT 3 times before I left on Friday. One of those times was taking 3 stairs which I felt was kind of useless because I've mastered the art of stairs 9 months ago but it's not even part of the equation right now as I have a ground floor setup that does not require stairs unless I choose to take them for some silly reason. So the stair PT was kind of wasted pain & effort.

After 3 PT sessions in about 7 hours, albeit short, I did start swelling substantially.
The 1st two sessions I was very unsure of my knee, was not feeling extremely stable and hurt like crazy to try to walk on it. By the 3rd session they had given me something intravenously for pain & at that point I was able to put a little more weight on the leg & actually feel a little more confident of the strength of the new knee.

Again, pain management, in my opinion, is key and its not fully addressed!!
Yesterday I had some substantial swelling & probably should not have had PT at all. Why she felt the need to push my knee backwards to achieve 5° more ROM makes no sense to me.

They recommend getting up every hour. I don't do that but I am up 7 -10 times/day. When I'm sitting I do leg slides (difficult) butt squeezes, abduction & when I'm not doing those I often move my feet in circular motions & & stretch them out & up and push my thighs into the chair. So I believe I'm getting enough movement.

This rehab is especially challenging because I also need my left knee & both hips replaced. My both shoulders need to be evaluated as well. So I do not have the luxury of any strong joints to help me work through my RTKR.

Thank you all SO much for your support, patience & advice. This is my 1st replacement & I am so grateful I found BoneSmart & the voice of reason it provides.
Physical therapists often make you feel like a whiner. Something I'm not! I've powered through the last year of work in the food business dealing with debilitating pain, a 600/mile per week commute, 10 to 13 hour days on site with nothing but Advil for relief.
I'm no wimp!

 

[sistersinhim]

near zero extension. He was more concerned w maintaining good extension than ROM at that point.

If you had near 0 extension right after your surgery, then you'll have no trouble with extension once your knee is healed. Swelling will hurt your overall ROM. You had a good bend after your surgery, too, so that shouldn't be a problem, either. But, don't be surprised if your ROM gets worse. What causes that is swelling. When your swelling is no longer there, your ROM will be fine.

After 3 PT sessions in about 7 hours, albeit short, I did start swelling substantially.

Here's your cause and effect. Now, you have to recover from your PT date before your knee can get back to where it was before your PT appointment. I don't understand how they think they are helping you when you have increased pain and swelling. Don't let them cause that anymore. Take things nice and easy and your recovery will go easier.

 

[Abbylayla]

I forgot to mention, I bought a Lounge Doctor leg elevator but she told me not to use it.

 

[sistersinhim]

I forgot to mention, I bought a lounge Dr leg elevator but she told me not to use it.

Who told you not to use it? Your knee's extension is already way better than the average tkr patient's knee is at your surgery date. There is no reason to worry about your extension to worsen except for swelling and that's temporary. Using the Lounge Doctor should be fine and an easy way to elevate and get that swelling out.

 

[doodlebug60]

I forgot to mention, I bought a lounge Dr leg elevator but she told me not to use it.

abbylayla; I don't know what the heck is wrong with your PT, but if you ask me , she has a major problem. First thing she has a terrible bed side manner. 2nd, why in the world would she tell you not to use the elevation pillow when it's there to help get the swelling down so you maybe could do some PT. sounds to me like she hasn't been doing this very long. me and Sistersinhim have never seen a PT. I am almost 2weeks out from my 2nd tkr and I'm rehabbing great. I had my 1st on February 13th and it's doing great. Sistersinhim had 12 procedures without any PT and she's doing great. Sounds like you may need to think about dropping PT altogether and try rehabbing at home the Bonesmart way. Rest,ice,and elevation and ADL's ( activities of daily living). What have you got to lose? It's worked well for us; I'm sure it will work well for you also! prayers for a great recovery; Doodlebug

 

[Abbylayla]

Yes, PT told me not to use Lounge Doctor. I think she said she didn't want the knee bending. It made no sense.
A different therapist came today. She was much better & gentler than yesterday's although I do question if daily PT is needed 4 days out of surgery. These therapists really do have it engraved in their heads that everything must be accomplished NOW. And FAST. Why???
But regardless, she had a much better bedside manner. And was more reasonable. She had me using the assistant lift to move my leg without assistance. Also had me use it for some of the exercises she wanted me to do like moving my leg to the side, lifting it off the bed etc.
I made it clear that my left knee, both hips & both shoulders are also severely arthritic so I had alot to deal with. She agreed & respected that.
When I was doing heel slides she went to help push my knee back further. I stopped her before she did and asked her to please let me pull it back as far as I could and what it is it is. She respected that as well and measured my ROM under my own power, which was 65.
She didn't need to tell me extension because I could feel the back of my knee touching the bed, so once again it was either zero or extremely close.

I've been reading Bonesmart for months thank God because it gave me much needed information that I otherwise would not have & would have, as so many probably do, trusted everything the PT said....which could hurt more than help.