TKR Abbylayla 5th August RTKR

[Celle]

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???

No, of course daily PT isn't necessary - at any time. Your knee needs time and gentle treatment, so it can start to heal. Rest, ice, elevation, and gentle walking around the house are all your knee needs right now.
If your PT does massage to help reduce swelling, that's good, but the exercises aren't necessary.

The therapists want quick progress and rapid increase in Range of Motion (ROM) for two reasons.
First, that's the way they were trained - it's a bit old-fashioned now. Second, increasing ROM numbers are something definite they can record, to show how effective their treatment had been.

But 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 knee has the potential to achieve good ROM right from the start, but it's prevented from doing so by swelling and pain. As it heals and the swelling goes down, your ROM (both flexion and extension) will gradually increase.

You can go to PT and do exercises, or you can let your Activities of Daily Living (ADLs) be your exercise.
Your knee will increase its ROM either way.

 

[leejaa]

Let me send you kudos for speaking up and not letting her push on your knee. Just keep remembering you are in charge and they are there to help and not torture you. However, I totally agree that at this point you really do not need PT but rest/ice/elevation and just movement that are required for daily living and even those in moderation. I have 4 replaced joints and with each life gets better as each one that causes us pain is removed. I hope you have a restful night.

 

[Abbylayla]

So I had PT today. 5th day in a row & I was scheduled for tomorrow as well. I canceled tomorrow but therapist said I couldn't because 6 days in a row is protocol.
In what became a 10 minute or so conversation I explained my leg IS feeling stronger & I am walking better and with more confidence. But my hips & especially shoulders, are also severely arthritic & they are screaming at me from overwork. And my knee is difficult to get excess swelling out of w PT everyday with no break in between. I told her I had a follow up w my OS tomorrow & I felt that was PT enough
Right now my extension, just resting, no pushing at all, negative 2.
My flexion, w no pushing is 65. And as I said, I definitely do feel my knee getting stronger.

I have the next 3 days off from PT!! I plan on easy walking around the room. Doing my exercises at my own pace throughout the day rather than squeezing them into 45 minutes. And lots of elevation, ice & rest in between

 

[leejaa]

Good job advocating for yourself. I cannot imagine 6 days of PT in a row or even 5. Your body needs rest and recovery in between. I had visits 2x/week and could do whatever exercises I chose on the other days and even when they were on site we did very few reps it was more just to see how I was progressing. Enjoy your 3 days off from official PT. I hope they are restful. Take ice for your knee in the car with you for your visit with the OS and possibly an extra pack in a cooler for the ride home. It really does help with the extra movements involved in an office visit and so early in your recovery.

 

[Celle]

I canceled tomorrow but therapist said I couldn't because 6 days in a row is protocol.

It doesn't matter one little bit what their protocol is. This is your knee and you are the only one with the right to say what happens to it - therefore, it's your protocol that is paramount.
Your knee told you that it didn't want PT on consecutive days and you did the right thing by listening to your knee. Well done!
You have the right at any time to say how much PT you will do and what exercises you will do as well.
Saying no to therapy - am I allowed to?

I have the next 3 days off from PT!! I plan on easy walking around the room. Doing my exercises at my own pace throughout the day rather than squeezing them into 45 minutes. And lots of elevation, ice & rest in between

Good plan!

 

[Jockette]

t doesn't matter one little bit what their protocol is.

I agree. That is their protocol, which is quite different than most PT offices. I did not have PT every day. My 3 days a week was too much, but that was because of overactivity during each session, which was my PT’s protocol.

If I ever do this again, my protocol will be no formal PT, I will do my own rehab at home and recover just fine.

 

[sistersinhim]

I canceled tomorrow but the therapist said I couldn't because 6 days in a row is protocol.

Who's protocol? It certainly isn't Medicare's and it isn't yours, which is the only protocol that counts! Many OSs don't schedule any PT for the first month or so. They believe that the knee needs that month to heal and reduce swelling before starting any PT. They have a good, less swollen and painful recovery.

Many of us never took formal PT or did any exercises. I am one of them. I had 12 knee surgeries, 2 of them kneecap removals, and 1 tkr. Even after those I never took formal PT. But, I didn't just sit around and do nothing. I used my knee as it was intended to be used by walking around to take care of my daily needs. As I healed I was able to do more. Icing and elevation were a huge part of my recovery.

Listen to your knee. It will tell you if you're doing too much by increased pain and swelling. When that happened to me, I found that resting, icing, and elevating helped. Your knee knows how to rehab itself without being told what to do.

 

[Abbylayla]

Sistersinhim My OS follow up today was rescheduled to tomorrow. And I did cancel PT. I spent the day doing light exercises, walking a bit, lots of elevation & ice, babying my arthritic hips/shoulders w a heating pad and oddly, sleeping. I've been having a very hard time keeping my eyes open today. When I ice/elevate in my recliner I also do foot pumps, heal slides & leg lifts as best I can.
I don't know what to think about this "protocol". I have PT friends, they lnow nothing about it. Know others who used same OS & hospital who did not have this protocol. So I'm really not sure what to think but I will not allow back to back sessions going forward. I am 8 days out of surgery & today is really the 1st day I've gotten any meaningful rest.

After next week I will move to outpatient PT, of my OS wants me to. But I will go no more than twice/week. I will not get locked into this again.
I had a choice of using the hospital PT or a local private PT agency. I had a good hospital experience so I chose them for the initial in home PT. But I have no idea who put this schedule together or why. Especially when they are aware of my arthritic hips & shoulders which are incredibly painful.
I just don't know what to think.

 

[sistersinhim]

It's your body and YOU are the boss, not anyone else. The OS and PT work for you. What you say goes. Your knee and body should always be the boss of what happens to it. Things that make it hurt aren't helping you one bit. You have to take care of you.

 

[Abbylayla]

1st follow up with OS today. Changed the bandage, took xrays. He was very happy w how everything looked. There isnt even any bruising.
Extensive was completely straight. Flex was about 70. He said they like to see about 90 at this point, 9 days out of surgery.
He was good with PT everyday, but I'm not so I won't be doing that. He also wants me to start walking more & more on my own rather than using walker.

I'm pretty wiped out tonight. Leaving the house, walking distance, in & out of car, its incredible how those simple everyday things wipe you out!

But other than tired & sore I'm ok. Just baffled as to why there seems to be such a push to escalate recovery in this type surgery.
Exercise, experts, exercise. The mindset is more is better

 

[leejaa]

It is your body and your knee and you know it best. They want to check off items on their list but sometimes that just does not work. I was amazed that he wants you to walk without any aids. I used my walker for 2-3 weeks and then a cane (another 3-8wks) till I felt secure and strong and could work correctly instead of limping. I also wanted the extra security of support in case of anything. I had great recoveries and no accidents.

A trip to the doctor is very exhausting this early in recovery. I hope you came home elevated and iced that knee and just napped a little. My first visit was at 1 month and I kept telling my husband we would go out to lunch afterward but when that day came - came straight home and into my recliner and napped. The body said rest you over used me today.

Keep listening to your knee and your body. Have a peaceful evening.

 

[Abbylayla]

leeja, your 1st OS follow up sounds very similar to mine. I actually had overzealous thoughts of possibly meeting a friend for dinner afterwards. I don't know what I was thinking. I had nowhere near the energy left for that. I guess we all just want to get back to normal asap.
I am trying to use my knee more & more, in part to take some of the burden off my arms & shoulders which are arthritic and screaming at me. But my leg is still very sore and I'm very apprehensive of putting full weight on it.
I think my main frustration is it seems to be overlooked that I also have an arthritic left knee & hip both diagnosed as moderate to severe and a right hip diagnosed as severely arthritic. Plus my shoulders!
So my rehab & recovery is not going to be the same as an able bodied person w just a bad knee. If it was just this one knee I would be able to do a whole lot more e the support of my other strong joints.

One thing yesterday, after pushing my knee at the OS office to get 70° flex it hurt through most of the night & the ice/elevation didn't help as much as it normally does.
I'm told I need to do that type of push multiple times a day to reach 90°.

 

[leejaa]

Please do not push that hard to get to 90 by a miraculous date of tomorrow or next week. Give your knee time to heal and keep elevating to keep the swelling down. Knees cannot bend or move with swelling in the joint and healing tissue. Give it time and rest and it will get there.

You have all those other hurting joints so as you say your recovery will be more challenging due to the pain in your hips and other knee. My first knee recovery was harder than the second since I still had one bad knee. At that point my newly replaced knee became my good knee as it improved and healed. Can you tell me why you are apprehensive about putting full weight on it? Does it hurt? Did anyone tell you not to do it?

 

[Abbylayla]

No, I'm told to put as much weight on it as comfortable. It does hurt on the occasion I put full weight on it. I guess is partly psychological. Im afraid the knee won't hold my weight. I cannot walk "normally" like at a quick pace and I'm still working on the heal to toe motion since I've been on crutches for 8 months.

 

[leejaa]

It is a strange feeling to trust your new knee. I know with my first one in the hospital it was very hard to believe that I could stand on it right away. However, the doctor and therapists and nurses were right. I could stand on it and put weight on it. Try to put weight on your knee, it is stronger than you think. It is amazing how strong it is. Try to have faith in your new knee after all your surgeon would not let you go full weight bearing if he thought it would not hold your weight. It might help with some of the other pains around your knee and body if you can walk more normally.

Walking fast is not the goal at this stage of recovery. Walking correctly is the aim and the heel/toe motion really helps.It takes a while to get the correct gait when we have limped or used canes/crutches for any length of time. I used to walk around saying heel/toe out loud at home so that I would concentrate and get over the automatic limp. There is no rush to give up crutches or walker as long as we are learning to walk correctly with our new parts. I tended to stay on the walker for quite a while as it helped me get a good gait. Keep practicing in small distances and it will progress. Slow and steady will get you through recovery. I hope you have a good day.

 

[Abbylayla]

Thank you leejaa. That is very good advice I will certainly take it. I walked around my house a couple of times today concentrating on the heel-toe. Its amazing how something you've done unconsciously your whole life has to be relearned afyer a relatively short time of not doing it.
I have PT tomorrow with a different therapist than last week. I am going to tell her I will do PT on my own Monday & she can come back Tuesday. I want every other day, not every day.
We'll see how that conversation goes.

 

[Abbylayla]

Hopefully this isn't a foolish question but, does anyone else have difficulty regulating their body temp post surgery & if so, how long does this last?
I am 12 days post surgery & when I run the AC I sometimes get extremely cold which then take quite a while to warm up. Same w heat. If I let myself get too warm, like sitting outside, I have to practically sit next to the AC to cool off.
Has anyone else experienced this? It was not the case pre-surgery

 

[capecoral]

Yes I have I'm cold all the time I have to wear a sweater and socks

 

[leejaa]

I had mainly feeling of being cold or cool which was unusual for me as usually I am quite warm. I think partially by BP was lower than normal due to pain meds and the relaxing drain post surgery. It evened out after a while so I did not even notice when it happened.

 

[Dizzy]

I feel like I'm having occasional hot flashes again!