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TKR Abby's Recovery Thread

abbyannie

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Had my TKR on October 30th. Finding these bonesmart threads very helpful to read. Presently trying to figure out how hard to push PT. From what I'm reading, most of you do not push into the 'high pain' area which makes a lot of sense to me since we want to keep pain and inflammation down. However about 2 years ago, I broke my wrist and ended up with CRPS (chronic regional pain syndrome). Fortunately for me, with aggressive PT, I overcame the CRPS. No one knows if I have or will have CRPS as a result of this surgery. But if I have it or will get it, aggressive PT is most likely to overcome it. (It can become permanent and spread throughout the body if the flare-up isn't controlled early on; early and aggressive PT is the key to control CRPS).

Also, my knee (leg) was quite stiff before the surgery. I have read that if your leg was stiff before surgery, it's most likely going to be stiff afterwards i.e not as good an outcome as someone who had less leg stiffness before surgery. That's another reason that I wonder if pushing the PT would be a good idea?

On the whole, I think I'm doing okay for being 12 days post surgery. I'm going for walks around the house with the walker, pain level is tolerable, doing my physiotherapy twice a day, alternating between Tylenol and Ibuprophen and occasional Dilaudid. Not sleeping very well though as still can't sleep on my side. I've tried the 'trick' with a pillow between the legs. BTW, I've never been a good sleeper. Still haven't learned to do steps with crutches. That's scheduled for tomorrows physiotherapy session. (They didn't think I was strong enough to do steps at the start and I know many people do steps while still in hospital). And yes, I live in a 2 storey house and so looking forward to a shower!!!!

Appreciate reading everyone's experiences on this website. It's helping a lot. Also appreciate being able to ask questions here as well. Good luck to all of us in recovery!

By the way, I live in British Columbia. Any other Canadians on here?
 

Celle

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Hello @abbyannie - and :welome:

I have read that if your leg was stiff before surgery, it's most likely going to be stiff afterwards i.e not as good an outcome as someone who had less leg stiffness before surgery. That's another reason that I wonder if pushing the PT would be a good idea?
For some people, stiffness before surgery is only an indication that recovery may take a little longer. But since complete recovery from a knee replacement takes a full-year anyway, a little bit longer is not worth worrying about.

Just know that, for many people, their knees recover just fine, even if there had been some stiffness beforehand.

Fortunately for me, with aggressive PT, I overcame the CRPS. No one knows if I have or will have CRPS as a result of this surgery. But if I have it or will get it, aggressive PT is most likely to overcome it. (It can become permanent and spread throughout the body if the flare-up isn't controlled early on; early and aggressive PT is the key to control CRPS).
Aggressive PT therapy is not the way to overcome CRPS, even though it worked for your wrist..
In fact, it's just about the worst thing you can do after a knee replacement. While it may have worked for your wrist, it is much more likely to cause complications for your knee

Your knee has been through major surgery that has caused a lot of trauma. It needs rest, ice and gentle movement, so it can heal. It's not lazy or unfit - it's wounded.
Stressing it with aggressive PT would only cause all those wounded tissues to become hot and inflamed, and it will slow down healing. It could even be one of the contributing causes of adhesions and chronic inflammation. Please don't go there.

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

This is the approach to recovery that we recommend:
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
ice
take your pain meds by prescription schedule (not when pain starts!)​

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

6. Access to these pages on the website


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.
 

tlfiore

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@abbyannie So happy you found this forum! Like so many here, I would be lost and beside myself had I not found the wonderful people and most helpful advice on BoneSmart.

You and I had surgery on the same day, October 30, 2019. So, today we are 12-days post-op. The recovery is much more arduous than I envisioned. I sorta pooh-poohed the statement when my OS told me, "It's not the surgery per se that holds people back from moving forward with the surgery...it's the recovery."

I definitely see what a roller-coaster ride this process is. Pain management has been difficult for me. I'm also not at all a proponent of aggressive PT. I've had PT intermittently over the years for back-woes but nothing pertaining to surgery, or a broken bone. Aggressive PT at this point seems to grate my sensibilities. As my bones, tendons, joint, ligaments, tissue, etc heal, I'm more than happy to throttle up my PT.

Welcome to the forum! Hope you find lots of help here.
 

caredFL

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Not sleeping very well though as still can't sleep on my side. I've tried the 'trick' with a pillow between the legs. BTW,
Sounds like you are doing well. I had my TKR on 10/28 so a few days before you and I too cannot get comfortable on my side even though my knee pain hasn't been bad since the first week and is well under control, thankfully. Hang in there and I'm sure that side sleeping will return soon.
 
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abbyannie

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I am 11 weeks Post Op and still don't have great flexion and lots of stiffness in knee despite all exercises. Has anyone tried cold laser treatments to break down scar tissue? If so, how successful and how many treatments till you noticed any change? This is what a chiropractor is suggesting to help; he said about 4 - 6 treatments.
 

sistersinhim

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You will notice that I have merged your two threads together as we prefer that members in recovery only have one thread.

This is for three reasons:
1. if you keep starting new threads, you miss the posts others have left you in the old threads
2. it often ends up that information is unnecessarily repeated
3. it's best if we can keep all your recovery story in one place so it's easily accessed if we need to advise you.
 

Jockette

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You don’t need any treatments, what you need is time. At 11 weeks post op stiffness and less flexion than we want is par for the course. This recovery takes an average of a full year. You are only about 25% healed right now.


I read this that one of our other advisors wrote:

“Many members think PT is needed to alleviate tightness. Tightness is a normal occurrence after this kind of major surgery. Your surgeon did major carpentry work and disturbed every millimeter of soft tissue in this area. You aren't tight because your muscle is underused and needs to be stretched and rehabbed. You're tight because your tissue is healing...and full healing takes a full year or more.”
 

Jockette

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You also might be overdoing your exercises. What ones are you doing?
 
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abbyannie

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You also might be overdoing your exercises. What ones are you doing?

Also want to say that my quad strength is good and so is my knee bend. I'm probably overexercising too as I've irritated the anterior tibias to the point that I have to wear a heating pad when doing knee bends to my bum and heel slides. Even then it's painful. I did get some exercises to strengthen ankles and improve ROM in ankles but these exercises pull on tibialis muscles too which irritates them. How do you find the right balance?

Exercises I do:

thigh squeezes with towel under knee

knee straightening with towel under heel

clamshell

Hamstring stretch

assisted knee bend for flexion — foot under chair

step lunge on stairs - lean into the knee a step above the non-surgical knee to stretch surgical knee

calf stretch

bending heel to bum

mini knee bends - holding on to counter and bending down (hard to explain)

toe - heel ups

wall slides
 

kneeper

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Feeling stiff at 11 weeks is normal--particularly with all the exercises you're doing. If your bend is good, you don't need all those exercises. Personally, I'm not a fan of the lunge exercise.
If you want to do some exercises, I'd pick a couple from that list per day, not all of them.
 
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abbyannie

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If your bend is good, you don't need all those exercises

Thanks for your reply Kneeper.

My main problem is knee flexion. I THINK that my
tibias pain has been brought on by my heel slide type exercises. I do the variation with putting the knee under a chair. I have to wear a heating pad doing this because it's so painful. But my flexion isn't changing.

Right now, I am resting my leg for a few days as I don't know what else to do. Just started with chiropractor and he's doing MLS (a cold laser treatment) for the tibialis and shockwave therapy to loosen scar tissue in the knee. Only 1 treatment so far with no results. He has said 4 - 6 treatments to see results

Have researched those treatments a bit on the internet and some studies show some results while others do not.

Will probably head back to my surgeon in another couple of weeks to get her take on things. Only saw her at 5 weeks PO and I'm still at the same point at 11 weeks PO
 

Jockette

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This recovery takes a long time, a full year, on average, and it varies for each of us. Sometimes you just have to wait for your knee/leg to heal. Sometimes the more exercises we do and the more treatments we do just upset it further.

If an exercise is painful, stop doing it. It’s not helping you if it’s hurting you.


This is what @TortiTabby experienced. (Just so you know, ADL means Activities of Daily Living, which means just go about the normal things you do in the course of your day, and not doing a “list of exercises.”)
Just an update for those who are apprehensive about gaining ROM:
It has now been 26 weeks and all I do is ADL and this is what my ROM has done:
3.5 wks: 75
6 wks: 85
7 wks: 90
10.5 wks: 95
14 wks: 100
17 wks: 105
20 weeks: 110
26 weeks (where I am today): 120!!!
I did it! My goal of 120! No "pushing through pain", no PT after the first 3 visits, and most importantly to me: No MUA! My surgeon who said I would never get beyond 85 ROM without pushing through pain was wrong, wrong, wrong. I'm excited to see if it gets even better. :happydance:
 

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