Revised PKR to TKR Agilitymom's revision recovery<<

[Celle]

PS: Would you like us to change your thread title now?

 

[agilitymom]

@Jockette my knee felt unsteady or wobbly whenever I took stairs the normal way. Finally got to the point I had to wear a knee brace and do stairs one ata time. Also, standing more than 5 minutes got my knee to swelling painfully.

@Celle yes please change it for me. Not sure to what. My right TKR revision was on 22 October. Some kind of Stryker implant.

 

[Celle]

@agilitymom - I've changed your thread title to "Agilitymom's revision recovery." If there's another title you'd prefer, please let me know.

 

[agilitymom]

Exactly 2 weeks post and going in today for first Dr visit since leaving hospital. Swelling seems under control until I overdo it, which is often. Lots of pain in the inside part of my knee so will ask about that.

 

[Jockette]

I think extra swelling when you overdo it is to be expected at 2 weeks post op.

 

[agilitymom]

Haven’t posted in a bit. At 2 weeks post saw the Dr and he was excited that the swelling was so minimal. I think the Game Ready icing and compression really helped with that. However, he was not happy with the 45 degrees ROM. He wants me back this coming Tuesday, 4 weeks post-op, and will check ROM. It is better but any time I push it I get stabbing pains in the inside part of my knee. Then it swells up and I can barely Ali the rest of the day. Dr Is threatening a MUA next week if not up to 100 ROM. My PT says no way. I have tried so hard but it is like a brick wall when I hit the limit and I can’t get through it.

I am also experiencing severe pain in my right foot. The ankle is still severely bruised. The pain is when I am sitting or lying down not when walking. Any thoughts on why this is happening? It is so severe it feels like it is burning from the inside. Weird.

 

[Jockette]

I’ll tag @Josephine for you.

 

[sistersinhim]

https://bonesmart.org/forum/threads/myth-busting-window-of-opportunity-in-tkr.6895/ There is no reason for your OS to even consider a MUA this early in your recovery. You have much more healing to do. As you heal your ROM will improve.

Many of us never took formal PT or did exercises. I am one of them. I had 11 knee surgeries, 2 of them kneecap removals and 1 tkr. Even after those I never took PT. But, I didn't just sit around and do nothing. I took care of myself, my house and yard as my knee allowed me to do. As I healed, I did more. But, my knee was always in control! This was enough therapy for me and would be for any tkr patient. All the awful pain of PT is so unnecessary.

All you have to do is use it in your daily living! Your knee knows how to rehab itself and doesn't need anyone telling it how. Just use it and it will come back like new! You have to be patient, though, it doesn't happen quickly! ADL,(activities of daily living), going to the bathroom, brushing your teeth and bathing, fixing a light meal, getting something to drink and or a snack, those kinds of things will be all the exercise your knee needs. If you just use it daily in your living, you can have a less painful recovery. We know what works, we've been there!

 

[flsungirl]

I also had the foot pain. It prohibited me from laying anywhere! It couldn’t touch the bed, sheets, socks, etc.. plus my feet were freezing and I couldn’t put anything on them. My doc was going to do a nerve conduction study but that slipped through the cracks like most of my post op surgery follow up. It resolved with in 2 weeks but super hard to get through. The foot pain started at 2 weeks out then my hip kicked in. Hip pain is still not gone but much better. That was the beginning of insomnia for me which lasted until week 6. Thankfully things are getting better with tomorrow starting week 10! Can’t wait till it’s all over

 

[Josephine]

I am also experiencing severe pain in my right foot. The ankle is still severely bruised. The pain is when I am sitting or lying down not when walking.

Was there a specific reason for the bruise? Otherwise, it's quite possible to get referred pain from knee surgery.

I'd really like to offer you some structured advice but in order to do that, I also need to ask you some questions. Are you willing for me to do that?

 

[agilitymom]

Was there a specific reason for the bruise? Otherwise, it's quite possible to get referred pain from knee surgery.

I do not mind questions at all.

Had good news. ROM was up to 70 so no talk of MUA at this time. I think I will lower my PT expectations for a while since I am good for at least 6 weeks now.

 

[Josephine]

Was there a specific reason for the bruise? Otherwise, it's quite possible to get referred pain from knee surgery.

You never answered this question


Here y'go then!

It would be very helpful if you would answer each one individually - numbered as I have done - in as much detail as you can then I'll come back as see where you are ....

1. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine. And don't forget to factor in other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness).

2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?

3. how swollen is your leg compared to these?

4. what is your ROM - that's flexion (bend) and extension (straightness)

5. are you icing your knee at all? If so, how often and for how long?

6. are you elevating your leg. If so how often and for how long?

7. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and

8. are you doing any exercises at home? If so what and how often?
This is the most crucial question so please help me by using the format I have left as an example
(which means please make a list and not an essay!)

Exercises done at home
- how many sessions you do each day
- enter exercise by name then number of repetitions of each
etc., etc.

Anything done at PT
- how many times a week
- enter exercise by name then number of repetitions of each
etc., etc.

 

[agilitymom]

Josephine, supposedly the bruised ankle is from pooled blood during revision surgery. It is not swollen but at 4 weeks it is still severely bruised and painful. I think I have finally found a temporary fix for sleeping. I wear a compression sleeve I used for plantar fasciitis and that seems to do the trick.

1. Pain levels vary of course.
7 when walking more than just around the house.
8 sometimes out of the blue with stabbing pain on inside of knee.
as low as a 3 when icing and resting unless the 8 stabbing pain hits.

2. Oxycodone 5mg 2 every 6 hours. (I take every 5 hours when it is bad pain)
Celecoxib 200 mg 1 daily for swelling
Acetaminophen 500mg times x2 3 times per day
Aspirin 325mg once a day for blood clots
I also use a blend of essential oils to help with pain relief and swelling: frankincense, helychrism, birch and wintergreen. Helps to almost immediately drop pain level to tolerable when pain meds not working.

3. Most times my leg is slightly swollen. After icing it looks almost normal. Keep in mind I am 5 feet tall and weigh less than 100 pounds, i.e., a slight person. Any swelling in my knee is painful.

4. Flexion is 75 and extension, not sure of the number but I am almost able to touch the table with back of knee.

5&6. Yes am icing my knee while elevating about 20 min at a time 5 to 6 times per day.

7. I am trying to rest and relax as much as possible. I am retired but am a Search and Rescue volunteer so my normal activity level is very high. My activity level now at 4 weeks includes 30 min per day work in house with my SAR dog, light cleaning, light cooking (the hubs has been good about doing everything except dog work for me but he is getting tired of being a housewife and chauffeur. I am not vacuuming or anything heavy. I guess I would say I spend about 30 minutes doing stuff and then back to elevating and icing and resting for an hour or two. No shopping except on line and only trips have been to PT and twice to visit family.


Home
Walking for 15 to 20 minutes x3 times day
heel slides x15 3 times day
ankle pumps x15- all day long and at night to keep leg cramps at bay
side leg lifts x15 2 times a day
calf stretches 30 seconds 2 times a day
gentle knee flexion using a towel 15 seconds 3 times a day
sitting in chair and using good leg to pull revision leg back gently x2 times a day.
TENS unit 2 times a day for 15 minutes

PT:
Bike gently trying to get around all way, not there yet for few minutes
Massage with gentle flexing at same time
Gentle scar massage
Heel slides

Hope this helps. Thanks for all your caring and help.
Happy Thanksgiving!

 

[Josephine]

Heel slides

I need to know how many of these you do at PT

 

[agilitymom]

15 times 2

 

[Josephine]

1. 7 when walking more than just around the house.
8 sometimes out of the blue with stabbing pain on inside of knee.
as low as a 3 when icing and resting unless the 8 stabbing pain hits.

Okay but a Bit high for 5 weeks out.

2. Oxycodone 5mg 2 every 6 hours. (I take every 5 hours when it is bad pain)
Celecoxib 200 mg 1 daily for swelling
Acetaminophen 500mg times x2 3 times per day
I also use a blend of essential oils to help with pain relief and swelling: frankincense, helychrism, birch and wintergreen. Helps to almost immediately drop pain level to tolerable when pain meds not working.

Good

3. Most times my leg is slightly swollen

Okay

4. Flexion is 75 and extension, not sure of the number but I am almost able to touch the table with back of knee.

Good

5&6. Yes am icing my knee while elevating about 20 min at a time 5 to 6 times per day.

You accomplish little or nothing in 20 minutes. Ice for at least 40-60mins and more than 4 times a day.

7. I am trying to rest and relax as much as possible. I am retired but am a Search and Rescue volunteer so my normal activity level is very high. My activity level now at 4 weeks includes 30 min per day work in house with my SAR dog, light cleaning, light cooking (the hubs has been good about doing everything except dog work for me but he is getting tired of being a housewife and chauffeur. I am not vacuuming or anything heavy. I guess I would say I spend about 30 minutes doing stuff and then back to elevating and icing and resting for an hour or two. No shopping except on line and only trips have been to PT and twice to visit family.

You need to take a break from the S&R stuff. You can't do that while you're recovering if you're to have a half decent recovery. I don't wonder you have so much pain.

Home
ankle pumps x15- all day long and at night to keep leg cramps at bay - these aren't exercises, they're anti-clot activities.
Walking for 15 to 20 minutes x3 times day - did you read this article Activity progression for TKRs? It states in there that at 5 weeks, walking should be no more than 20mins or longer if you feel up to it but don't forget that means 10mins there and 10mins back!
heel slides x15 3 times day - with these, do fewer more frequently - read this Heel slides and how to do them properly.
side leg lifts x15 2 times a day - this is not an appropriate exercise. Stop them
calf stretches 30 seconds 2 times a day-nor is this
gentle knee flexion using a towel 15 seconds 3 times a day - definitely not this!
sitting in chair and using good leg to pull revision leg back gently x2 times a day - or this
TENS unit 2 times a day for 15 minutes - are you using this at home?

PT:
Bike gently trying to get around all way, not there yet for few minutes - yes, good oh!
Massage with gentle flexing at same time - okay
Gentle scar massage - you don't really need this
Heel slides 15 times 2 - stop these, read above

Summary:
You need to cut WAY back on your walking, some exercises as per those crossed out, and any S&R stuff you are doing. This is the cause of your pain and your low ROM.

Please also note this:
It's not the exercising that gets you your ROM, it's time. Time to recover, time for swelling and pain to settle and time to heal. One thing that seems to be missing from all the PT's protocols is that all your ROM is there right from the start, just waiting for all that to happen so it can show itself. In the general run of things, it doesn't need to be fought for, worked hard for or worried about. It will happen. Exercise as in strength training is counter-productive and in the early weeks does more harm than good. Normal activity is the key to success.

 

[agilitymom]

Josephine, I am using the TENS unit at home. Had it from previous surgeries.
I have read heel slides info and read activities progression. Guess I am over doing it in most every way.

I was terrified I would have to have a MUA this past week as my military Dr was way under impressed with my ROM and had that dangling over my head. Passed that and am now going to try not to overdo it. I am not patient.

I have curtailed all SAR training except for a bit. Have to get creative with training from the couch.

Thank you for your comments. I will cut back on walking for sure. I will also check out the thread you suggested.

 

[Josephine]

Well done you! THAT's what I like to hear!

 

[agilitymom]

It’s been 8 weeks tomorrow since revision surgery. I had to go off pain meds for 2 reasons. 1. Dr said I did not need them and would not re up my Rx and 2 horrible constipation despite doing everything I could to combat it.
So now I am still in pain with every step I take and super worried that this stupid knee is never going to stop hurting. I am now using Tylenol, Motrin, essential oils and cbd cream to try to control pain. The swelling is way better but still swells a bit but feels super tight after just a 10 minute walk.
I am off PT for 3 weeks and just doing light exercises from PT. Still not at 90 ROM and can’t quite straighten my leg.
I know everyone is different but I am getting so discouraged with this recovery. The sharp pain is becoming very hard to deal with. Any suggestions?

 

[Jockette]

I’ll tag @Josephine for you. I’m sorry things are not going better for you.