TKR Almost one year, still a bit sore
- Thread starter Irelandliz
- Start date
United States
Josephine
NURSE DIRECTOR EMERITA
The first 6 weeks are always what we call the "angry tissue" stage!
This make me want 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?
OP
OP
Irelandliz
member
Hi everyone
Well I went to the doctor this morning, my first post op visit - and my husband was amazing getting me to and from the car painlessly. I had a fair walk to the doctor's office and didn't have to wait long, thank goodness as having my leg down for 5 mins or more is quite sore. He only took half of my staples out and as I was in a bit of a state (I do not tolerate pain well) I didn't ask why that was. I had thought that they were all coming out today! I had three X-rays taken (also uncomfortable) and he told me I should start coming in for PT at his offices next week after I get the rest of the staples out.... I don't think I'll be doing the former no matter what the doctor says!
He said my leg was good and straight and that the wound looked good.
I feel that some good old plain recovery time is due without physical therapy - at least until it stops looking like a big ol Pumpkin !!
And Josephine,
Yes I am happy to answer any questions - I did stop the physio therapist from proceeding with the home visits but my doctor has now asked me to start with PT at his Sports Medicine offices next week which I don't want to do either at this point!
Well I went to the doctor this morning, my first post op visit - and my husband was amazing getting me to and from the car painlessly. I had a fair walk to the doctor's office and didn't have to wait long, thank goodness as having my leg down for 5 mins or more is quite sore. He only took half of my staples out and as I was in a bit of a state (I do not tolerate pain well) I didn't ask why that was. I had thought that they were all coming out today! I had three X-rays taken (also uncomfortable) and he told me I should start coming in for PT at his offices next week after I get the rest of the staples out.... I don't think I'll be doing the former no matter what the doctor says!
He said my leg was good and straight and that the wound looked good.
I feel that some good old plain recovery time is due without physical therapy - at least until it stops looking like a big ol Pumpkin !!
And Josephine,
Yes I am happy to answer any questions - I did stop the physio therapist from proceeding with the home visits but my doctor has now asked me to start with PT at his Sports Medicine offices next week which I don't want to do either at this point!
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liam2015
post-grad
that went well ~ good to know your leg is straight and the incision is healing properly. it really does take a lot out of one, getting the staples out and the same day going for x-rays where one has to get into different positions on that metal table which is slippery even with a sheet on top. good for you ~ you got through today and i agree you should take some good old plain recovery time!
@Irelandliz
You are in charge of your knee. Other people can advise, but it is your choice whether or not to accept that advice.
So, if you don't want to go to PT therapy, you don't have to go. I must say that I don't think a place that specialises in sports medicine is going to be the best place for recovery from a TKR anyway.
Saying no to therapy - am I allowed to?
In any case, 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 ROM is there right from the start, just waiting for all that to happen, so it can show itself.
It's possible to rehab a knee without going to PT . Many here have done it, including me. The normal activities of daily living are sufficient exercise for a recovering knee.
My surgeon doesn't allow any PT at all for the first month after a knee replacement. He says your knee needs that time, to start on its journey of healing. For that month, we rest, ice and elevate our leg, and walk around the house.
After that month, we just go to PT once every 2 weeks, where we are shown a few new exercises to do at home.
His patients all do well and achieve good ROM, as I did, and he hasn't had to do a manipulation to help with ROM for the past 4 years. I think that speaks for itself.
You are in charge of your knee. Other people can advise, but it is your choice whether or not to accept that advice.
So, if you don't want to go to PT therapy, you don't have to go. I must say that I don't think a place that specialises in sports medicine is going to be the best place for recovery from a TKR anyway.
Saying no to therapy - am I allowed to?
In any case, 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 ROM is there right from the start, just waiting for all that to happen, so it can show itself.
It's possible to rehab a knee without going to PT . Many here have done it, including me. The normal activities of daily living are sufficient exercise for a recovering knee.
My surgeon doesn't allow any PT at all for the first month after a knee replacement. He says your knee needs that time, to start on its journey of healing. For that month, we rest, ice and elevate our leg, and walk around the house.
After that month, we just go to PT once every 2 weeks, where we are shown a few new exercises to do at home.
His patients all do well and achieve good ROM, as I did, and he hasn't had to do a manipulation to help with ROM for the past 4 years. I think that speaks for itself.
Pheebs52
big-cheese
@Irelandliz, I'm glad to hear half of your staples are out, but curious as to why half remained in? Oh well, you know what they say about curiosity, eh? I recall my first visit to the OS at 2 weeks for the same exact reason; staple removal. My husband dropped me right at the door while he went to find parking. I waited for him, standing (ugh) and then finally took what seemed like a mile long walk down the building's hallway. Upon arrival, I found I couldn't sit comfortably for more than 5 minutes with my leg down. I had to wait 45 minutes that day, and the floor looked very tempting. Basically, I just paced his waiting area and hallway with crutches until I could be seen; ugh! Remarkably, at my next visit at 6 weeks post-op, the mile long hallway had *shrunk.* Funny how that works! I still couldn't sit with leg down for more than 10 minutes or so, and that made it a pacing scene again. All this to say, I'm glad to hear you didn't have long to wait! That first visit is really a bear but each subsequent visit improves.
I don't blame you a bit for delaying PT, and frankly, if you do decide to go the PT route, I would look for a practice unaffiliated with your OS. To my way of thinking, that's just a sideline *money-maker* for the OS and they may not be the best possible therapists for you to work with. I'd shop around a bit (by phone) and see if you can find a local practice that's independent and practices gentle therapy. They exist.
I don't blame you a bit for delaying PT, and frankly, if you do decide to go the PT route, I would look for a practice unaffiliated with your OS. To my way of thinking, that's just a sideline *money-maker* for the OS and they may not be the best possible therapists for you to work with. I'd shop around a bit (by phone) and see if you can find a local practice that's independent and practices gentle therapy. They exist.
I think OS offices should have some ottomans in the waiting rooms, don't you! My knee is still uncomfortable in certain chairs, I think the seat height has something to do with it. And I've done my share of walking the waiting room at my chiropractor's office for that same reason.
Glad you got through the staple removal and I would be disappointed also to only get half of them out. I didn't have staples, I had stitches, and I couldn't wait to get them out! But to my disappointment they then put steri strips on and these I couldn't shower with for 3 days. I had been allowed to shower while I still had the stitches.
I'm glad you seem to be feeling a bit better! And I hope you manage to avoid PT, and I agree, I don't think a sports medicine place is the one to go to!
My PT experience was not totally awful, but they did do some aggressive things that I now know were not good.
I'm praying you get through Irma okay!! I have friends and family in West Palm Beach and Sebring.
Glad you got through the staple removal and I would be disappointed also to only get half of them out. I didn't have staples, I had stitches, and I couldn't wait to get them out! But to my disappointment they then put steri strips on and these I couldn't shower with for 3 days. I had been allowed to shower while I still had the stitches.
I'm glad you seem to be feeling a bit better! And I hope you manage to avoid PT, and I agree, I don't think a sports medicine place is the one to go to!
My PT experience was not totally awful, but they did do some aggressive things that I now know were not good.
I'm praying you get through Irma okay!! I have friends and family in West Palm Beach and Sebring.
OP
OP
Irelandliz
member
I am really loving coming on here and reading about your experiences and your thoughts as to my recovery and helping me understand that my knee is exactly that - my knee! It is so easy for me to just go along with what I'm told to do and not ask questions, a lot to do with my Irish upbringing I think. Like not asking why only half my staples came out instead of all of them 
The reason it's a Sports Medicine practice is because so many orthopedic doctors are needed for all the spring training here in South Florida. My doctor is the Astros orthopedist for the team while they're here in Jupiter. He performs tons of knee replacements and was referred to me. However you are so right... I don't think sports physiotherapists are right for me either....
And Jockette, I agree wee ottomans make a great deal of sense to me too...
I do want to mention one very helpful iPhone app that I found to help me with my medications with fun alarms etc I copied a link so you can have a look at it and no I don't work for the company lol. I looked for something while I was in the hospital to remind me of my medications and I think it's awesome.
"Please check out the best pill reminder app for iOS. You can try it for free. Just copy and paste if the link doesn't open
You can find it by tapping on this link:
https://itunes.apple.com/app/id816347839
My leg is pretty achey now and has been since this morning so a bit of icing I think is definitely called for.
Night all and hope you all get some good sleep tonight!
The reason it's a Sports Medicine practice is because so many orthopedic doctors are needed for all the spring training here in South Florida. My doctor is the Astros orthopedist for the team while they're here in Jupiter. He performs tons of knee replacements and was referred to me. However you are so right... I don't think sports physiotherapists are right for me either....
And Jockette, I agree wee ottomans make a great deal of sense to me too...
I do want to mention one very helpful iPhone app that I found to help me with my medications with fun alarms etc I copied a link so you can have a look at it and no I don't work for the company lol. I looked for something while I was in the hospital to remind me of my medications and I think it's awesome.
"Please check out the best pill reminder app for iOS. You can try it for free. Just copy and paste if the link doesn't open
You can find it by tapping on this link:
https://itunes.apple.com/app/id816347839
My leg is pretty achey now and has been since this morning so a bit of icing I think is definitely called for.
Night all and hope you all get some good sleep tonight!
I wonder if as the storm gets closer to you it might make your knee feel worse, so be prepared for that. My knee is bothered by storms but not everyone's is. And not every rain or storm bothers me. Very strange. It didn't before I had my replacement.
Maybe because there can be some discomfort with taking staples out, maybe that's why they only did half of them at a time. I think I read that happened to someone else. But I think I'd rather just get it over with!
Maybe because there can be some discomfort with taking staples out, maybe that's why they only did half of them at a time. I think I read that happened to someone else. But I think I'd rather just get it over with!
Josephine
NURSE DIRECTOR EMERITA
I totally agree! It's all unnecessary anyway!
I'll echo what Celle said. You're not a puppy and your surgeon isn't the dog whisperer! It's YOUR choice. Just say no - I did!
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.
I said no the PT, too! Are you able to leave if Irma heads your way? Please make sure you safe. Many are praying for the storm to break up.
Ruby9297
senior
Yes, I bought those and found them to be very helpful-- also got a tote to Velcro to my Walker.
Sent from my iPad
LTKR scheduled on July 11th, 2017 [emoji51]
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OP
OP
Irelandliz
member
Ok here goes
1. Pain level at the moment is 5
2. Acetaminophen/Codeine (300/60mg) 1 tab every 3-4 hrs (I am now taking one every 5 hrs)
3. Between huge and moderate
4. Straightness is really good (as per doc today)
ROM - best flexion is 68 deg
5. Icing about 10-12 hrs per 24 hrs
6. Haven't elevated the past two days but will from tomorrow when my leg pillow arrives.
7. Not doing any housework at all
8. I walk about 3 times per day around my living room for 3-4 mins.
I do foot pumps several times.
I do foot rotations 10 each foot.
With the PT
4 minute walk
10 foot pumps
10 foot rotations
10 ball of foot raises
10 side lifts
10 gentle knee bends
10 rolling foot on polystyrene roll on floor
10 knee presses & butt squeezes at the same time
10 horizontal leg slides
1. Pain level at the moment is 5
2. Acetaminophen/Codeine (300/60mg) 1 tab every 3-4 hrs (I am now taking one every 5 hrs)
3. Between huge and moderate
4. Straightness is really good (as per doc today)
ROM - best flexion is 68 deg
5. Icing about 10-12 hrs per 24 hrs
6. Haven't elevated the past two days but will from tomorrow when my leg pillow arrives.
7. Not doing any housework at all
8. I walk about 3 times per day around my living room for 3-4 mins.
I do foot pumps several times.
I do foot rotations 10 each foot.
With the PT
4 minute walk
10 foot pumps
10 foot rotations
10 ball of foot raises
10 side lifts
10 gentle knee bends
10 rolling foot on polystyrene roll on floor
10 knee presses & butt squeezes at the same time
10 horizontal leg slides
Ruby9297
senior
Sounds like Hibiclense-- antibacterial soap. I was told to bathe with it for a week prior to surgery and until my incision was completely healed.
Sent from my iPad
LTKR scheduled on July 11th, 2017 [emoji51]
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Josephine
NURSE DIRECTOR EMERITA
You're lucky!
Codeine is unsuitable for TKRs. You really need something like Tramadol and to take 50/100mgs every 6 hours along with 1,000mg Tylenol.
Well you did see that swelling is part of the pain picture, didn't you? You really are seriously under medicated.
ROM is both flexion and extension. And your flexion is pretty bad at 68 degrees but that's to be expected with such woefully inadequate main management.
That's not what I asked - I asked "how often and for how long?" meaning how long each time!!
Well that could be contributing to the swelling without a doubt.
Good!
I walk about 3 times per day around my living room for 3-4 mins - that's okay but make it 'got to' trips like the bathroom or kitchen. Don't do these as well as the 'got to' trips!
foot pumps several times and foot rotations 10 each foot - these are not exercises as such, just devices to ensure you keep your circulation going and ward off clots. One you are more mobile you can stop them.
With the PT
foot pumps x10 and foot rotations x10 - read above
all of these are not a good idea as you're only 2 weeks out. This all amounts to 60 reps which is not a good idea
horizontal leg slides x10 - sorry, I have no idea what these are, you'll have to describe them for me
You haven't told me if you're doing any exercises on your own so I'm assuming you're not.
You also haven't told me how often your PT comes.
I suggest you cancel the visits from the PT and don't book any sessions at the PT unit either.
Fact it that 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.
And if you feel awkward about doing this, read this Saying no to therapy - am I allowed to?
I should also tell you that there are many on here who have done their TKR recovery without any exercising at all! Yet we got really good outcomes! I recommend you read my recovery thread to see how little exercising I did for either knee! Knee recoveries UK style Parts I & II (Josephine)
OP
OP
Irelandliz
member
Hi everyone
Well with Hurricane Irma and all the shutdowns my lounge doctor pillow never arrived! I'm praying it will arrive tomorrow! We fared well through the storm and are feeling very blessed.
I wanted to ask another question - were any of you as scared as me to try and bend your knee? Every time I try to bring the knee in a bit closer I get all dizzy and panicked. I know my Knee angle is not where it should be but am hoping it will eventually start to soften and it will become easier.
Looking forward to hearing your comments...
Well with Hurricane Irma and all the shutdowns my lounge doctor pillow never arrived! I'm praying it will arrive tomorrow! We fared well through the storm and are feeling very blessed.
I wanted to ask another question - were any of you as scared as me to try and bend your knee? Every time I try to bring the knee in a bit closer I get all dizzy and panicked. I know my Knee angle is not where it should be but am hoping it will eventually start to soften and it will become easier.
Looking forward to hearing your comments...
So glad to hear from you, glad you fared well! I've been thinking of you!
I wasn't afraid to bend my knee I just didn't like to because it hurt so much if I bent it too much, or when my PT/surgeon bent it too far to measure rom.
It will get easier to bend as the swelling goes down, and that may take a while.
I wasn't afraid to bend my knee I just didn't like to because it hurt so much if I bent it too much, or when my PT/surgeon bent it too far to measure rom.
It will get easier to bend as the swelling goes down, and that may take a while.
SusieShoes
Former BoneSmart staff member
A big sigh of relief that you made it through the hurricane safely. Lots of people have been praying for you!
While I was never afraid to bend my knee, I didn't like the way it felt like I was about to rupture my incision. A few hours after surgery, when my OS visited me in my hospital room, he asked me to bend each knee for him.
I did, but gave him my best evil eye (the Italians do it better), and said, "You know, it feels like my incisions are going to bust open."
And he promised me they would never do that. "I stitched them in several layers of unbreakable sutures. You can bend them as far as you're able. They won't open."
So I never feared they would open, but it still always felt like they would. That's a very disturbing feeling. After a couple of weeks the feeling became less like ripping open and more like a kind of tightness. That tightness lasts a while, but it too is going away.
You'll get your bend back as your knee's swelling goes down. It's the swelling that's causing all the pain and tightness right now, so as it subsides you will naturally feel much more comfortable.
While I was never afraid to bend my knee, I didn't like the way it felt like I was about to rupture my incision. A few hours after surgery, when my OS visited me in my hospital room, he asked me to bend each knee for him.
I did, but gave him my best evil eye (the Italians do it better), and said, "You know, it feels like my incisions are going to bust open."
And he promised me they would never do that. "I stitched them in several layers of unbreakable sutures. You can bend them as far as you're able. They won't open."
So I never feared they would open, but it still always felt like they would. That's a very disturbing feeling. After a couple of weeks the feeling became less like ripping open and more like a kind of tightness. That tightness lasts a while, but it too is going away.
You'll get your bend back as your knee's swelling goes down. It's the swelling that's causing all the pain and tightness right now, so as it subsides you will naturally feel much more comfortable.
OP
OP
Irelandliz
member
Sorry I guess that's what I meant - I'm afraid to bend it because each centimeter I bring it in seems to hurt that much more. And the PT that came to the house at the end of every session told me to keep bringing it in until I was eventually crying. So I fired him and continue to do the exercises on my own.
And yes Susieshoes I guess that is it exactly - I still have 20 staples in and when I bend the knee it just doesn't want to go - it's so tight!! And I'm afraid those staples are going to shoot right out
And yes Susieshoes I guess that is it exactly - I still have 20 staples in and when I bend the knee it just doesn't want to go - it's so tight!! And I'm afraid those staples are going to shoot right out
SusieShoes
Former BoneSmart staff member
Oh, I didn't realize you meant forcing your knee to bend in that way. You did the right thing! Anyone who would tell you to force your knee to bend until you are crying is being a tyrant intent on "results" instead of on healing. Pain is the body's way of telling you something is wrong. Pain is a sign of distress.
Might you feel some pain when moving a healing knee? Yes. It hurts to move it. But only bend your knee as far as you can until you feel the beginning of pain. Pain is where you stop. That pain is telling you you've reached the limit of your's knee's swelling and ability to bend. As your swelling goes down, so will your pain and you will be able to bend the knee more. I'm bending my knee very well now, but there's still a point at which it goes "Pain! Stop!" And I stop. Maybe in another month it will go past that point, but not now.
I don't know whether to laugh or shriek at the image of staples shooting out of your knee!
Might you feel some pain when moving a healing knee? Yes. It hurts to move it. But only bend your knee as far as you can until you feel the beginning of pain. Pain is where you stop. That pain is telling you you've reached the limit of your's knee's swelling and ability to bend. As your swelling goes down, so will your pain and you will be able to bend the knee more. I'm bending my knee very well now, but there's still a point at which it goes "Pain! Stop!" And I stop. Maybe in another month it will go past that point, but not now.
I don't know whether to laugh or shriek at the image of staples shooting out of your knee!
