TKR After 9 weeks, am I doing okay?

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Floridagirl

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Hey everyone! Hope you all had a wonderful Christmas!

I had a total right knee replacement on 10/26, after years and years of needing one. I am "self pay", having no insurance (but I am part of a "bill sharing" program, which was very helpful.) We had to pay for my in-home PT, so we could only afford 13 visits, which stopped at week 7. Because we had a limited time together, the PT person worked hard with me. I reached my goal ROM of 115 by the 7 week mark.

Now, at 9 weeks, I've finally started to drive, and I'm walking semi-well with a cane, and without a cane around the house. But now I have some questions I'd like to run by you folks to see how I'm doing.

1) STIFFNESS: After sitting more than 30 minutes I am tremendously STIFF! I mean, painfully stiff! Is this normal? When will this go away?

2) MEDS: I'm now at the point where I'm taking the prescription meds about twice a day: once before I go to bed, (and I basically sleep thru the night) and around noon. My doctor mentioned that this last scrip will be my last. So is this normal? I have about 5 pills left. With this much stiffness, will advil or tylenol still work?

3) PT: I think my PT person was aggressive with me, knowing he only had 7 weeks to work with me. His suggestion was 8 times a day, which wouldn't allow the "rubber band" to shrink back and get stiff again. I never could quite work in eight, or even six for that matter. I usually did four or five times a day. Now I'm doing one or two. Is that normal for nine weeks, or should I being doing more sessions? Could only doing PT once or twice a day be the reason for my stiffness? And how long do you think I should be doing these little sessions before just daily activity will suffice?

4) TIRED: Is it normal (at 9 weeks) to be extremely tired after spending about 15 to 30 minutes in a store?

I know, lots of questions! Sorry, but I've been thinking about this for awhile. Thanks so much for any suggestions you may have. :)
 
The stiffness will go away, but it takes months, probably a year for me before I didn't have to 'just move my knee'. It did not like staying in any one position for very long. Hang in, it will go away.
Everyone is different for the meds, but you seem about right, from what I remember.
The PT, it depends on what you are doing 6-8 times a day. How strenuous is the exercise? I personally think the body needs some time to recoup. Granted, many on here, Josephine it particular, have more experience and knowledge, but it does seem alot of work with little recovery time to me. Especially if there is any swelling associated with it at this point.
Tired. Oh yeah, that is normal. your knee was taken apart and put back together. Things are still making 're-connections' every little thing is more difficult as they find their way. Give it time and continue to walk and try to do your normal activities and all will be well.
 
Welcome Floridagirl, you are in the right place. I think for 9 weeks you are doing really well. :thumb:

You will have stiffness for some time. It is natural to be stiff when sitting and standing for a long time. I still get stiff at 8 months. Also you get stiff when you over due and over work the knee and it swells. This makes the knee very stiff . That is when you need to ice the knee, elevate it and rest it.

If you no longer have pain and just stiffness, you might want to try Jo's over the counter mix. She will probably post it to you soon.

Do your stretches and work on extension and flexion, but don't overdo. I found that my ROM increased the most when I was done with PT and walked heel first and forgot about the rest. What really happened then was my swelling finally went down and things started to work well. You are far ahead of where I was at 9 weeks! :yes 4:

Tired, yes you will be tired for a very long time. I still take afternoon naps when I need them :sleep: .Listen to your body cause it will tell you what it needs.:loll:
 
Welcome Floridagirl! Sounds like you are doing well at 9 weeks out. Here is my take on your questions:

1) Stiffness--yes, it is normal, and unfortunately, can be long lasting. I am 13 weeks out today and I have stiffness and tightness all of the time. I am still waiting for that magical time when the swelling/stiffness starts to ease up.

2) Meds--I started to wean myself from the narcotics at about 6 weeks and was taking pretty much only OTC meds by 8 weeks. I had an unusual circumstance though and wasn't able to start walking and doing real PT till 9 weeks out--so I have had to go back to using the hydrocodone intermittently over the last couple of weeks since walking and PT is new to my knee. But I am able to get by on 1,000 mg of Tylenol about every 6 hours during the day and most nights--just need the hydrocodone on PT days/nights.

3) PT--Wow! Can't imagine doing exercises 8 times a day! I do nothing at home on PT days except some gentle flexion stretches. On days that I don't have PT, I do the bike at the gym for 15 minutes and also flexion stretches. That's about it. HOWEVER, your flexion at 7 weeks is much better than mine at 13 weeks--so maybe I should be following your program!:snork:

4) Tired--Oh yes, expect it! It takes a few months to get your stamina back. Everything will make you tired. Nap as often as you need to. I think at 7 weeks I was still napping every day, and even now I still nap when I feel the need.

This recovery takes time. It's easy for me to tell you that and to tell you to be patient, but I know just how hard it is to do that! Patience is tough! Hang in there. Niki
 
3) PT--Wow! Can't imagine doing exercises 8 times a day! I do nothing at home on PT days except some gentle flexion stretches. On days that I don't have PT, I do the bike at the gym for 15 minutes and also flexion stretches. That's about it. HOWEVER, your flexion at 7 weeks is much better than mine at 13 weeks--so maybe I should be following your program!:snork:

Alot of us would think Niki's approach is too aggressive if you did it before about 8 weeks. I really wish we could eliminate all post op PT, other than gentle stretches.
The downside of this would be that people would have no problems to bring to us, and we'd have only half the friends that we do.
 
Hi there and welcome to BoneSmart! All of the answers are given on the understanding that 9 weeks out is still very early as others have said. You said yourself that your knees started to deteriorate "years and years" ago, so what ever made you think the surgery to fix it would all be over and done with in just 9 weeks?

1) STIFFNESS: perfectly normal for 9 weeks when you are still in the middle of the 'angry tissue' stage and not yet finished healing by any stretch of the imagination. You've also not mentioned doing the rest, elevation, ice and medication thing. It's still extremely important for you now
How Long Does Healing Take ......
Why Do I Have That "Tight Band" Feeling Across The Front Of My Knee?
Elevating your leg to control swelling and pain
Using ice

2) MEDS: Well, you can stop prescription stuff at this stage, it all depends what levels of pain you are experiencing. Tylenol and ibuprofen would be perfectly okay provided you take a good enough dose. Read here Tylenol/ibuprofen cocktail
The importance of managing pain after a TKR and the pain chart

3) PT: Holy cow! I think one could easily say that PT was totally over the top! I surprised you ever got such a good ROM after that. Talk about flogging a (nearly) dead horse! Have a look at these articles and note the table of progression in the PT one
Some suggestions for home physio (PT) and activity progress
Work “Smarter” and not “Harder”
About recovering a knee - from one who knows!

4) TIRED: Well, of course you get fatigued - you've just had major surgery and that takes some recovering from. Not to mention the after effects of the anaesthetic. You need to temper your activities with plenty of rest. Read these
Energy drain for TKRs
Chart representation of TKR recovery
 
Thanks, everyone, for your thoughts. Josephine, if I came across impatient, I didn't mean to. I mean, recovery is taking a long time, but I understand why! :) I guess we all need a little encouragement that we are doing okay. I've read most of these articles that you posted (and thank you for doing that!) but I wanted to address my specific issues.

My main confusion lies in the PT. My PT person explained how my muscles are like rubber bands that need to be stretched every two hours. If I let it go longer than that, I need to do the hard work all over again. I also had to rip through scar tissue, which was very painful. That's how I got to 115 in 7 weeks. Do you subscribe to that? If not, is it the difference between how the UK and US believe in doing therapy?

But here is my main question: What kind of PT/stretching/exercise should I be doing now at 9 weeks and from here on out?

Thanks again so much for taking your time to help!
 
Agree with what others are saying. Specific to your latest post - IMO at 9 wks your every day activities can take over for pt as long as you do some gentle streching. By the way, sleeping through the night is no problem? Wow, what I would have given to make hat statement at 9 weeks! Congratulations on your great recovery.
 
My main confusion lies in the PT. My PT person explained how my muscles are like rubber bands that need to be stretched every two hours. If I let it go longer than that, I need to do the hard work all over again.

I also had to rip through scar tissue, which was very painful. That's how I got to 115 in 7 weeks. Do you subscribe to that? If not, is it the difference between how the UK and US believe in doing therapy?
Well that's just rubbish and I certainly don't subscribe to it. In fact, since adhesions really don't occur that quickly, I would say that the 'ripping through scar tissue" was actually just undoing the natural healing. I think it highly likely you'd have achieved 115 in that time anyway as I and many others did. In fact, I was at 120 in about that time and I did hardly any PT, just a few simple exercises at home and as you can see here My knee recovery - UK style I did very nicely, thank you!
But here is my main question: What kind of PT/stretching/exercise should I be doing now at 9 weeks and from here on out?
Read my recovery article. That's what my surgeon has for his patients and he does hardly any MUAs on his patients. You could also read this article and get some simple exercises to do at home
Some suggestions for home physio (PT) and activity progress
 
Hi, Floridagirl...welcome to BoneSmart! I'm glad to hear you are doing okay even at this early stage of recovery. I agree that you should be fine with just your normal activity and some gentle stretches and bends throughout the day. That's what I did. One thing that will GREATLY impact your ROM (flexion) is swelling. So, whatever you do, you want to keep swelling at a minimum. And overdoing the exercises or activity can make you swell....so keep an eye on things!
 
Thank you all for your helpful suggestions. One final clarification: when you say "gentle stretching" what is that specifically? I am sitting in a chair and bringing my knee back as far as it can go and gently rocking (not bobbing), counting to 100, about once a day. Is that good?
 
Hi I'm at 15 weeks??? (I think that is right)
I think your situation sounds normal, this is an amazingly difficult surgery to "recover" from. It takes time and nothing can be rushed. It just takes time!! I wish it went faster but is just takes time!! and working "with your knee" and making sure you give it and your BODY time to heal.

I have found that at 15 weeks out I STILL try to get up at work every 30 min to take a short walk. I know that as I sit here right now my knee is TIGHT (I also forgot to take my anti inflam this morning) One of the best things I have done is easy riding on my stationary bike, I have it sitting in front of my TV. This morning I did 16 min and I KNOW it set me up a bit better for today. I think there is something magic about pedaling for my knee, and I'm doing my darnedest to get back on track riding my bike at least 10 min morning and night.
Also I know I still iced my knee a lot at 9 weeks. Shoot I still ice it from time to time.

I can also tell you that my first TKR is almost 1 yr old and it feels 100% part of me, I hardly EVER think about it.
 
Thank you all for your helpful suggestions. One final clarification: when you say "gentle stretching" what is that specifically? I am sitting in a chair and bringing my knee back as far as it can go and gently rocking (not bobbing), counting to 100, about once a day. Is that good?

Gentle stretching means any movement that does not jerk or force your knee into a bend. It could be sitting in a chair with legs and slowly creeping your leg back into increasing bends. It could be lying down with your leg bent and inching your foot back toward your bottom. It also could be putting your foot up on a stair and bending into your knee slowly. The key is that you are gentle with your motions and not causing yourself a lot of pain....just some mild discomfort as you push lightly into the movement.
 
You count to a 100? You mean you hold your knee in a bend to the count of 100? I really never heard of that before! That's not gentle. To a count of 5 would be quite sufficient and then do 5 repetitions of that move. Repeat that set of exercises 4 or 5 times a day. That will be much more effective than doing one long one once a day.

Have a look at this article and digest Some suggestions for home physio (PT) and activity progress
 
I agree with all the above. I worried a lot about these things for my first TKR and only a little for my second (4 weeks ago). Am 6 months post first TKR and still have a little stiffness, am not too worried about it - is slowly subsiding. I overdid it all the first time and never made progress until PT told me to slow down! That helped me make progress. I cannot imagine a knee bend count of 100. I count to 20, pushing a little on the last 5 seconds. I exercise my new knee about 20 minutes 2 times a day and walk frequently. The exercises are a small set of stretching and strengthening that PT gave me and she is very careful not to tell me to do more than I should.

You are ready to stop the pills and you take so few, it will not be a problem.
 
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