TKR Am not dead!

[Florida 1]

Ms. Fixit - I had my first therapy session in the pool today and I LOVED it! I really felt that I got good stretching and strengthening. Walking in the pool felt like "normal" did way back when. I was in the pool for over an hour and when I started up the steps it was a surprise almost how leaden and uncomfortable my legs became as I went up each one. I highly recommend it, especially if you love the water like I do.

 

[Ms.fixit]

Sigh. Not a bad day, per se, but the incessant aching gets to me..I'm waiting for my meds to kick in.
So,do any of you ever just take a day off from PT?
At day 15, that's what I am doing. I'm just so sore and raw and achey that, just for today, I want to give my muscles and tendons a day when they don't have to do anything except walk around the house every hour or so for ten minutes. I was a bodybuilder for twenty or so years and it was during the days of rest that my gains were made. Train too often or too hard and there were no muscle gains. So I am taking a page from that book for today.
Hope all of you are hanging in there too!

 

[bottomshollow]

You should be taking your pain meds on a schedule--not waiting until you are in pain--then having to wait for them to kick in. Your recovery will go so much better if you just take them every 4, 5, or hours---depending on which time frame works best for you.

 

[Ms.fixit]

Oh, I do take them on a schedule, it's just that nothing really works that well.I'm on Oxycontin and Dilaudid, plus a muscle relaxant, plus Tylenol. The Dilaudid is for breakthrough pain. If I take 4 mg. it works reasonably well, but they don't give me enough of those, so I try to get by with just 2mg. Now and then I'll sleep through a dose of something but mostly i'm punctual to the second.

 

[walkerch1]

Hey all..had the surgery last wednesday. It all went well, but I had a couple crises. One..I got evicted from the hospital 2 days early, because the flu hit with a vengance and they were afraid to keep orthopedic patients on the floor with isolation patients (not enough beds)so the strongest patients of which I was one ,were sent home early, so they'd have enough beds and we wouldn't get infected.
So, it was tough coming home 2 days before I was ready.I did great in the hospital and everyone was so nice and kind and good at their job.!!
The one area they dropped the ball was with pain control..which I stressed to them from day one. They are so paranoid about "pill seekers" that they yessed my concerns to death in this area. I had told my surgeon, his PA, my nurse and her aide that I was very concerned about my pain level going out of control when the nerve block was removed on day two. I was assured by the PA that they were anticipating this and would be standing by with extra meds should they be needed. They were needed. No one was standing by. I sobbed in my bed being consoled by the wonderful nursing staff and the lunch tray lady, for 2 hours til they got the order changed. I never really got the pain under control again..but I'm healing well and quickly.I'm down to half my initial dose of pain meds . I can actually get around fine without the walker, though I do use it, but then I keep leaving it places buy mistake. They told me in the hospital I was "the knee rock star" of the ward, because I was so strong and fit. All that pre-op training paid off..especially during the nerve block period when I was able to lift my leg with just my lower abs and hip flexors..because as you know your quads are asleep
I'm having PT here at the house once a day and really dont want to do much more the rest of the time. quad contractions, maybe a heel slide, but iced and elevated is where I want to be. I keep reminding the therapist that I'm two days behind where I look like I am.
Any suggestions welcome..So glad this is over!

 

[walkerch1]

I am out 6 weeks and what I would like to say is don't push PT if you excel to the point of the knee hurting you are probably over doing it make it stretch but don't make it hurt. Also once you have you pain under control keep it there it will make a world of difference how you feel. You will have some dull pain or nagging pain that pain meds. wont completely handle and the swelling will take a long time to go down I am still swollen and it gets worse as activity pickup. I have a catch in my knee that the DR says is ether scare tissue or a tendon rolling over the hardware.

Hang in there it is a tough process

 

[Ms.fixit]

Eeew, that little 'catch' as that tendon twangs across something! I have that too, and it's so odd feeling.
Thanks for the feedback..I am really careful not to kill myself in PT, but it helps to hear the reminder, and it also helps to know the dull pain isn't only me. My leg isn't swollen at all any more, just the knee so I'm glad about that. Looking somewhat human is always a help!

 

[kneeper]

What are you doing for PT? Maybe you're doing too much if the pain meds aren't working. Also are you icing and elevating most of the day? Remember that you are barely a blink into this process.

 

[Ms.fixit]

I am icing and elevated most of the time. My Pt is about 20 minutes long, pretty run of the mill stuff and my therapist has been very gentle. I think some of this pain is caused because my leg was frozen in a very limited range of motion for years and years. My hamstring tendon, the one that kind of wraps along the outer side of the knee and down the side of the calf, has given me pain for years. Right at the top of my Fibula it feels like a butane torch is aimed there, and now that the joint has the ability to completely straighten, and to bend, these old tendons have to move fully for the first time in forever. Also my pain got way out of hand in the hospital when the nerve block was removed and they never did get me as pain free as I was that first and second day.
Thank you for the reminder that I am very early in the process! Two weeks isn't very long at all. I keep forgetting that....

 

[kneeper]

Yes, those tendons and soft tissues are likely angry from having to act "normal" after all this time. And from the simple fact that your leg was manhandled during the surgery.

 

[Ms.fixit]

Manhandled is putting it mildly! I accidentally came upon a still photo of a knee in mid replacement the other night and I was completely taken aback by how...what...aggressive.. this surgery is? There were big clamps holding the incision open, layers and layers of soft tissue and muscle just sliced through and clamped open. All the instruments were like power tools, too, no delicate little micro tools. One look and I instantly understood why I'm in so much pain..this is rough stuff!

 

[Ms.fixit]

Really beginning to feel like me again, and an improved version at that. I was rewarded by my day of rest by much improved PT the following day; much less pain/discomfort as I did it and less aching afterward. Now, I see for myself that moderation is what my recovery needs to go smoothly!

 

[walkerch1]

If we would have seen those pictures before surgery would we have had it done I'm not sure I would of but I have one more to go through in a few months but the way I feel now I can handle it just fine. I was so bow legged I could stand up strait and my dog could walk between them so my tendons have needed stretched out and even today if I don't keep them stretched out I pay for it, I have a PT that comes to our home and works with me twice a week and on her off days I still try to do some stretching. The first 4 weeks I made sure I was about a hour in to pain meds. before my PT arrived and that helped with the pain but after that over the counter Tylenol works fine but I still have that nagging pain most of the time but it is better this week. I still have swelling in my knee and some time it gets worse then other times but I still have to Ice and elevate so keep up your good work at recovery.

Jon

 

[Ms.fixit]

Hey Jon..I'm glad to hear your tendons are responding to your efforts..that bodes well for me, too. It's great that you are feeling strong and positive going into your second surgery. I'm only 19 days post-op so I'm not at that point quite yet..thank goodness my other knee is in good shape..especially after doing all the work for 40 years!
I'm hoping my hamstring tendon calms down soon..it's my major obstacle in PT and with pain, since it's the shortest and least used of all my assorted parts. the other awful spot is where I had open-joint medial miniscus surgery and have a ton of scar tissue right under the skin, tissue that needs to become more elastic so I can bend eventually.
Gee, now that you're not bowlegged anymore, your doggie must feel confused! On the other hand, he's gonna be so excited when Pop takes him for walks soon.
Thanks for the encouragement..good luck with your other knee, too!

 

[Ms.fixit]

I did the bike yesterday..forward and backwards!! Ten interminable minutes. PT is the only place where you accomplish something and they instantly make you do something even more horrible!
Right now I am doing well, but I am having to stay mentally strong, because my PT guy really has this timeline fixed in his mind..that 6 week supposed "window", after which MUA is threatened.I have many old adhesions just under the skin from my 1971 operation..mostly where the old scar is.. and making them give way is really something, but I think I had 125 degrees inter-operatively even so.


I have full extension now! Hurts like a mother, but it's really exciting. I've never had it before, in 42 years my knee has not straightened! When I do it now, there is just a second where I feel something is wrong( "gah! its going too far back!") and I then wait for the stab of pain that used to drop me to the ground like a rock..but the knee just goes into place instead. Amazing

Flexing, I am just shy of 90 degrees,3 weeks out, so I know I'm doing well, but I feel the push to get me to flex on a timeline is too extreme. If I get to the 6 week mark and I am not where they want me to be,they will push for, and I will refuse, MUA until I am absolutely sure I cannot make further progress with PT alone. (Plus my co-pay for every session is $45..isn't private insurance just wonderful? They pay for the operation, but the part where you get better, that's out of pocket.). I just read a fairly good account here of MUA, but I cannot handle any further messing around down there, mentally or physically, and I am determined not to do it.

I am starting to look at spring SHOES!!!!! Reason to live!

 

[Ms.fixit]

Hey gang. Can anyone tell me their experience with MUA? They have been mentioning this as a possibility for me in PT recently. I am at the 4 week mark and have 90 degrees flexion and total extension(..which is very exciting for me..to straighten my leg fully for the first time in 42 years!Woot!)

My PT says that he thinks the scar tissue from my original surgery is impeding my progress, that it is very old and strong tissue and says the surgeon may well recommend MUA when I go for a recheck on Feb. 14th.

Thoughts?

 

[bottomshollow]

If you go to the Knee Replacement Recovery Area and look at what's posted---find one with the MUA yellow prefix and click on the prefix and you will get a list of all the treads by members who've had MUAs. This way you can read the different threads and you can post to specific members and ask them questions.

 

[Suziepi]

Hi Fixit,
I had a MUA at 9 weeks after a TKR. My whole leg was so stiff. It was very difficult to walk on. I had intensive PT 2 times a week as my ROM had dropped around to 65.My then, PT managed to get it to 80 just before I attended my 6 weeks checkup with the OS. At the checkup the OS recommended a MUA.

The procedure didn't take long. The worse pain I had was just after I woke up after the anaesthetic, It felt a lorry had driven over my leg. But as soon as I was given something for it I was ok. I was put on a CPM machine for 2 hours every 2 hours for a couple of days. And then spent a week in rehab receiving PT, resting and doing a set of exercises 5 times a day.

During surgery the OS was able to get my ROM to 120. I was able to get to 90 in hospital after surgery. I even managed to get a few rotations on the stationary bike. I Went home just before Xmas and continued with the exercises 5 times a day. I also went to PT twice a week. About 3 weeks after the MUA my ROM dropped to 60 and now I have worked it back to 75. So I am not sure if the MuA was that beneficial. My leg isn't as stiff as it was and walking is easier even though I can't walk on it for too long. My ROM is less than before the op. I have often felt that I have failed.

I am so glad I have joined BoneSmart! Everyone here is very supportive and informative. There has been so much pressure by most of the medical professionals I have dealt with to get that elusive ROM more than 90 otherwise I will forever have a stiff knee. I don't think that is going to be the case with me. The best advice has come from this forum. I now listen to my knee and let it decide when it will increase the ROM. I am trying to rest, elevate and ice more. I am avoiding doing anything is painful for the knee including PT. I have also changed my PT to one that not aggressive and is confident that my knee will be normal again.

I think the main cause of my stiffness was the aggressive PT I received although I may have had some adhesions that may have been there from a previous injury. The MUA did help relieve the stiffness but as you can see the ROM is going to take time.

Good luck with your knee
Suziepi

 

[Josephine]

I am at the 4 week mark and have 90 degrees flexion and total extension My PT says that he thinks the scar tissue from my original surgery is impeding my progress, that it is very old and strong tissue and says the surgeon may well recommend MUA when I go for a recheck on Feb 14th.

By which time you will be 6 weeks out! I strongly suggest you don't let him do this until around the 10-12 week mark. I think your superb extension belies the possibility of adhesions. There is no rush and it may well turn out that swelling is the only culprit. Give it time to settle down and then see what your flexion is like. Read this the ineffectiveness of early MUA (JBJS).

 

[Debbie_joints]

I was there at about where you are now. My therapist gave up on me and said he was sure I would need an MUA, after reading everything in here I said no and went to a different therapist. I should say my first therapist just had me doing repetitious things on machines and didn't touch me. My new therapist would really massage the leg working that fluid out. It did take a couple months, but she got me to 121 and that is when my insurance ran out, so I was very happy with that. Don't let them scare you into having it, give it time.