TKR Adventures with a new right knee

[abers47]

Princess, my knee spasms all the time. It comes on suddenly and is painful. And then it is over.

I planned the first time out driving, I was supposed to take our son to the airport. Instead I was rolling around on our bed moaning and groaning with a spasm. My husband walked in and said, "I guess you aren't going to the airport..."

THIS DARN KNEE!!!!

I got that too, it felt like a major cramp! Am now 7 weeks PO and not getting it at all now!

 

[kneeper]

So glad you were able to get to shower.

 

[PrincessTia]

More then 4 1/2 weeks out, and I think I'm doing pretty darn well. I've been sleeping in my own bed for the past four nights, and occupying the recliner during most of the day. The first couple nights in the bed were fairly restless: my knee didn't know what to do with itself, and it was hard for me to get comfortable (I'm a dedicated side sleeper). Once I got to sleep, however, I was out for the rest of the night.

The second night, I added my brand new CPAP (continuous positive airway pressure) machine, since I have sleep apnea. This is my third CPAP, and the new mask is a little hard to get used to. But the knee has not been complaining at all, no matter which side I sleep on. And I have brand-new sheets made of microfleece that are simply heavenly during cold weather! So my last few nights have felt rather luxurious, once I was able to settle in.

I stopped taking my pain meds last week, and have not needed any, not even Tylenol. I feel very fortunate in that I have experienced very little pain so far during my recovery; I hope this can continue! (knock on wood!

)

I am still icing during the day for about seven hours with the Polar Care Cube. I have not been using it at night, as it always seems like too huge a chore close to bedtime, when I'm worn out. I keep thinking I'm going to get the thing in there and hooked up and going, so that I can find out if it helps to keep icing during the night. But I already feel tethered by the CPAP tube, and feel oddly reluctant to tie down my leg with more tubes.

When I'm up and around, I'm trying to use my cane more than the walker. But I can't seem to get a good rhythm in my walk using the cane. It may have to do with the fact that my left knee is still quite bent (extension is about 30°), while the new knee has extension that is closer to 5°. The unevenness translates into a weird sort of limp, which I haven't been able to get rid of. Now I understand a little better why my surgeon wanted to do both knees as close together as possible.

My first appointment for outpatient PT is next week on Thursday. If this weren't Thanksgiving week, I probably would be going this Thursday instead. I'm terrible at keeping up with any exercises on my own, and I worry that my recovery is slow because of my laziness.

 

[PrincessTia]

Hope everyone's Thanksgiving weekends were good! (And if you don't celebrate Thanksgiving, I hope you had a great weekend anyway! )

I had a wonderful time on Thanksgiving, and enjoyed the drive over to my friend's; I realized that it was only the second time I have been out driving around since my surgery(!). I loved seeing all the new fall colors. Now, we've had two days of mostly rain (yes, you read that right! Rain! ). Today was glorious, with clouds and sunshine mixed, and very comfortable temperatures. I even opened a couple of windows, and now the day is finishing with a very pretty sunset.

At 5 1/2 weeks post-op, I'm gimping around the house, alternating between the walker and my cane, and feeling pretty good about my recovery. The caregivers are only coming about three times a week now, and I'm able to fend for myself a lot more. Because of the holiday, there's been a hiatus with physical therapy; my outpatient therapy will start on Thursday. I can tell that my non-operated leg is keeping my gait at a fairly dysfunctional level, since it is quite bent. I hope I can get some pointers at PT about how to relearn walking during this period between surgeries. I don't want to screw up the new muscle memories I have to develop.

I finally switched my Polar Care machine to my bedroom, and use it to ice my knee at night. During the day, when I'm not puttering around, I stay in my recliner with my leg elevated. I ice it off and on with gel packs, but they don't stay cold enough for long enough, and they keep clumping up. I have a stash of ace bandages around here somewhere, but I cannot figure out where yet.

But I am relatively pain-free, and sleeping through the night, except for occasional bathroom breaks. I've been taking Tylenol at night because my leg below my knee sometimes just starts aching. Otherwise, I haven't needed any pain medication (although that may change when I start PT).

At Thanksgiving, my new knee and good recovery were at the top of my gratitude list. And THANK YOU to everyone here at BoneSmart!

 

[kneeper]

You might want to get some gel packs for when you don't want to bother with the ice machine.

 

[PrincessTia]

Just got back from my postop appointment with my OS, and I'm all excited for several reasons!
One, I can drive now.
Two, I walked farther today than I have in years, without having to sit every two seconds and rest.
Three, I got copies of the operating notes and my x-rays from today.
Four, I think I have an itty-bitty crush on my OS.

Now I'm home, elevating and icing to beat the band.

What a great day!

 

[Clipless]

It sounds like you're starting to feel much better. Way to go!

 

[Minnie's knees]

Congrats! Being able to drive gives you back some independence and feels great. Yeah for being able to walk farther....Celebrate each victory!

 

[sandbar525]

@PrincessTia Wonderful progress report. Keep doing what you're doing...it's obviously working!

 

[PrincessTia]

@kneeper @Minnie's knees @Clipless @sandbar525 Thanks for all the encouragement and cheers!

I forgot to post anything about my first outpatient PT (I went last week at 6 weeks post-op). One of the first things he told me when I arrived was that I only had till week 12 to gain my full ROM! I immediately told him about all the experiences recorded here about steadily gaining ROM for months and even years past the TKA. He wasn't buying it, though, because all the accounts on here are only anecdotal, and not peer-reviewed research.* So we kind of got off on a wrong foot. But the exercises he gave me were reasonable, and he did not want me to push till I hurt, so he was okay that way. He wasn't impressed with my 90° ROM, and estimated my extension at about 20° (I know it's better than that, but he was just eyeballing it). He gave me a printout of the exercises to do at home, and I go back next week (every two weeks). Apparently there's a knee group PT, but he said I wasn't ready for it yet.

I think the printout lists way too many sets for me to do. For instance, for quad sets, it says, "Complete 100–200 repetitions per day, 10–20 at a time." I can do 10 at a time, but ten times a day?! (At first, I totally misinterpreted it to mean 100 times a day! ) So I'm doing one or two sessions a day, which makes my knee tired enough.

*Does anyone know of any "real" research about how long it's possible to increase ROM after a TKA? I'd love to help enlighten this guy!

 

[Celle]

I think the printout lists way too many sets for me to do. For instance, for quad sets, it says, "Complete 100–200 repetitions per day, 10–20 at a time." I can do 10 at a time, but ten times a day?! (At first, I totally misinterpreted it to mean 100 times a day! ) So I'm doing one or two sessions a day, which makes my knee tired enough.

*Does anyone know of any "real" research about how long it's possible to increase ROM after a TKA? I'd love to help enlighten this guy!

You're correct. Once or twice a day is plenty. You can do a couple of heel slides whenever you're sitting down, too - just gently.

Don't waste your time or your breath trying to convince this PT guy! He won't listen anyway.
Just do things your way. We know from experience that ROM continues to improve for a year or more. He's been taught (incorrectly) differently.

You might be interested in this, but he won't be:
Myth busting: the "window of opportunity" in TKR

 

[kneeper]

I think 10x, 2-3 times a day for just about all the exercises is pretty much what my PT told me and that seemed plenty. Some days I didn't do them all.

For me, I'd say my major gains came in the first 12 weeks, but they didn't come by overdoing. They came as the swelling came down and I persevered with (not super intense) regular exercises and gradually increasing activity.

I don't think PTs will listen to Bonesmart b/c that's not what a lot of them have been taught. There are some PTs who apparently have been taught more of the Bonesmart way.

Bottom line is use your best judgment. Challenge the knee a little but listen to it when it protests.

 

[Clipless]

My PT and I had a similar discussion yesterday, however she agrees with Bonesmart that it can take many months to achieve full ROM. My knee was swollen and irritated (from doing too much the day before), so she told me to skip the quad sets for a couple of days and focus a little more on extension.

I am by nature a high achiever, unfortunately I am learning that the knee is in charge. If I push too hard the knee pushes back. I am trying to find the middle ground toward comfortable progress.