Hinged Joint 8 month regression^

Tanya76

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hello all,

I am 3 weeks in after TKR and have limited bend. I have a huge history with knee and have had over 20 operations. I can get 80 on CPM but only get 40-45 degrees alone. It just feels so tight. I think its psychological due to the previous operations and the fact I can get 80 on CPM

I am feeling very deflated and tearful, in fact all I do is cry and wish I never had this done. Family are being so patient but I have two young children and I can't do anything for them

Any advice is really welcomed

Thank you
 
Tanya76,
Welcome to BoneSmart glad you joined us.

You are still very early in this year long+ recovery, though most start feeling better at around 12 weeks, some sooner, some later.

I suspect you are trying to increase your ROM too soon for your knee, no need, it is there waiting for your knee to heal, and will increase as swelling and inflammation resolve.
Research has shown no difference in recovery with or with out. CPM. Some members found it soothing and liked using it, others are glad to be rid of the machine.
There is nothing you can do to speed up your recovery, you can set it back by doing too much too soon.
TKR: work “smarter” and not “harder”
Myth busting: no pain, no gain

I think its psychological due to the previous operations and the fact I can get 80 on CPM
Your knee just went through a major traumatic surgery, TKR surgery - WARNING: real life photos , and needs time to heal. It is not you, it is your knee while it is healing. There is no rush to gain ROM, we have members who have gained ROM a year or more after TKR.
ROM: it's worth the wait for ROM
ROM: it's never too late to get more ROM!
ROM (range of motion) information

Here is your copy of our recovery guidelines, the articles are short and will not take long to read.

Knee Recovery: The Guidelines
1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now, they are almost certainly temporary
2. Control discomfort:
rest
elevate
ice
take your pain meds by prescription schedule (not when pain starts!)
don't overwork.
3. Do what you want to do BUT
a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you
b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.
4. PT or exercise can be useful BUT take note of these
5. At week 4 and after you should follow this

The Recovery articles:
The importance of managing pain after a TKR and the pain chart
Swollen and stiff knee: what causes it?
Energy drain for TKRs

Elevation is the key
Ice to control pain and swelling
Heel slides and how to do them properly

Chart representation of TKR recovery
Healing: how long does it take?
Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

There are also some cautionary articles here
Myth busting: no pain, no gain
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds


We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery. While members may create as many threads as they like in a majority of BoneSmart's forums, we ask that each member have only one recovery thread. This policy makes it easier to go back and review history before providing advice.

Keep us posted on how you are doing.
 
Thank you very much for your comprehensive reply. My physio is really pushing it and she’s making me feel like I have failed. I was advised by all at hospital that I should have had a 90 degree bend prior to leaving hospital. Physio said that she’s going to have to bring my 6 week review forward as I’m likely to need a MUA.

I think I would be better if I was allowed to relax and keep trying but I’m being told there’s a window of opportunity.

I’m icing as much as possible and also elevating. I know the CPM is passive but hoping it will prevent adhesions.

I will keep trying.
 
You are right that you would be better off if you were allowed to relax, and let your knee heal at its own rate. No one can make it heal any faster than what your particular knee was designed to do. Why oh why don’t the surgeons and PT’s get that?

Take charge of your recovery and do what you feel is best for you. It’s your knee and you have the final say what you will and won’t do. I did not learn that soon enough. But I know it now.

This recovery is hard enough without being made to feel we have failed in an area in which we actually have no control.

Hugs to you. :console2:
 
Please post your exact surgery date, a moderator will add it to your signature for you, Thanks!

I think I would be better if I was allowed to relax and keep trying but I’m being told there’s a window of opportunity.
Your intuition is right, you would be better off relaxing and letting your knee heal.
There is no window of opportunity. Myth busting: the "window of opportunity" in TKR

It is your knee, you can say NO to all the pushing and shoving. Saying no to therapy - am I allowed to?
Your PT is working for you, suggest they should work on your gait, stairs, and getting your swelling down with retrograde massage, elevation, and electric stimulation.

Saying no to therapy - am I allowed to?

I’m likely to need a MUA.
You are too early for a MUA, please give your knee a chance to heal first.
 
Hey Tanya76:
I also think you are probably doing too much, particularly the aggressive PT. If your knee bends to 80 in the CPM machine, it is most likely bendable. I'm guessing the aggressive PT and even the CPM are causing swelling and inflammation which is inhibiting your bend. There is no "window" of opportunity - that is old thinking about this recovery. Many docs are happy if you get to 90 at 6 weeks, but even if you're not there, there is really no rush to get an MUA. I was also doing aggressive exercises and was only at 83 at 4 weeks. Once I stopped pushing my knee to bend (my PT didn't push me - I was doing it to myself based on what everyone was telling me I needed to do) I started improving slowly. Ice, elevate, and rest and don't be pressured into anything at this early stage of recovery. You'll get there.
 
Thank you. Today been particularly difficult due to pain and swelling. I’ve done minimum exercises today. Dreading physio tomorrow
 
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, ut doesn't happen quickly! ADL,(activities of daily living), will be all the exercise your knee needs. If you just use it daily in your living, you will have a quicker and less painful recovery. We know what works, we've been there!

Be careful to not overdo. Sometimes PT can get carried away and end up causing a set back. You stay in control and not let them push or pull your knee. My PT at the hospital was sneaky and tried to push my foot with her foot and I strongly told her, "No!", and she stopped. You have that right, too. You can't force your knee to heal any faster by exercising, but you can sure set it back. If you follow the BoneSmart guidelines you'll have a quicker and a much less painful recovery! Trust all of us who have been through what you are going through! Experience knows!

Your knee is damaged requiring healing, not unfit needing training. Bending past the point of pain is not helping your recovery but compounding the damage done by the surgery. Your knee needs GENTLE stretches only, without pain.
 
Thank you for your reply. I’m beginning to dread every physio session. It’s always 30 minutes of her trying to push my knee that little bit further and telling me to try harder. Last session I was told that my consultant will need to be contacted. I have a very complicated knee history which includes 20 plus operations. At this stage I am only comfortable with leg elevated and can only do light duties with ice on knee and with crutches.

Glad I found this forum.
 
HI @Tanya76
I'm sorry your PT therapist is worrying you about ROM. She's using an out of date approach to recovery.
There's no need to rush to get ROM (Range of Motion) because it can continue to improve for a year, or even much longer, after a knee replacement. There isn't any deadline you have to meet:
Myth busting: the "window of opportunity" in TKR

I suggest that you stop trying so hard to increase ROM with exercise and, instead, concentrate more on resting, icing and elevating your leg, to try and decrease swelling.
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.
 
Tanya76,
Listen to your knee, it is happy when it is elevated and iced, and very unhappy during and after PT.
You can say NO to PT, Saying no to therapy - am I allowed to?
All the pushing for ROM you are allowing the PT to do is setting back your recovery.

I agree with Celle, you need to let your knee heal, rest, ice, elevate, and medicate on schedule as prescribed.
 
Thank you. Will be very firm tomorrow. From what I can see, PT’s in England seem to take a very different approach to America. I keep getting told that I will get adhesions. Thank you again for all your support and encouraging words.
 
So sorry to read about your pain, discouragement and PT. I am 7 weeks tomorrow and have been where you are - not in number of surgeries. I had the adhesion scare within the first 4 weeks, the pushing to increase ROM. That was home health PT. Then I went to PT facility and got the same push for ROM. I finally came to believe that all that pushing set me back in terms of bend and mental state (feeling I was going to be a failure, blah, blah, blah), Had an epiphany on Wednesday of last week and so I iced and elevated for the better part of 4 days. Sunday night I decided to do some gentle testing. My knee said "no, I'm not ready- more rest, please". If you read my thread for today, you will see that I took some action at PT facility. I found out my job is secure for 6 months. Of course, I cannot afford to stay away that long, but the knowledge relieves me of the stress of thinking I should be back at work yesterday. I don't know if I'm a slow bender or what, but I do know that I have been doing way too much because I have compared myself to the miracle people who seem to bounce back right away. Hope this helps. I have found great comfort from the positive responses and encouragement. Maybe PTs get bonus money for raising ROM numbers. They sure do push it.
 
Thank you for your reply. I am glad you had your epiphany and are listening to body. I have to agree that the words of encouragement and support on this forum are so supportive. It must be relief to know that job is secure. I am supposed to go back to my part time role in three weeks time.

I am really stressing myself (and my family) out over the lack of bend. I am trying to walk properly with the crutches and do the exercises but I have found that I default into walking stiff legged. The knee is still so very swollen and I think it needs time to heal and settle. I will speak to PT tomorrow. She's so obsessed with bend. Her measuring device will be out ready.
 
I am really stressing myself (and my family) out over the lack of bend. I am trying to walk properly with the crutches and do the exercises but I have found that I default into walking stiff legged. The knee is still so very swollen and I think it needs time to heal and settle. I will speak to PT tomorrow. She's so obsessed with bend. Her measuring device will be out ready.
Do try not to stress about ROM. It will come, but your knee needs to heal more first.

Of course your PT wants it to increase quickly - that's what she's been taught, and the increasing numbers make the PT facility look good when they report to your insurance company. However, rapid increase is not the best thing to aim for while your knee is still swollen.

At the moment, your knee is like a garden hose that is full of water - the water makes it stiff and it won't bend easily. Get rid of the water and the hose will bend more easily. The same thing will happen with your knee - get rid of the swelling and it will become easier to bend. Trying to force your knee to bend whiled the swelling is inhibiting it is pointless and will only make it swell more.

Tanya, you haven't told us the date of your knee replacement. Please do that, so we can make a signature for you.
 
Hi, thank you for words of wisdom. Operation date was Friday 3rd November
 
Hi, I’m in the UK. I didn’t want the PT the hospital offered so went to a private one who I’d met before. I told her I would not do anything to the point of pain and she didn’t think that was necessary either. I only saw her twice. She just eyeballed my knee and suggested a few exercises. There are good Physios out there if you look. I would not allow anyone to touch my knee at all. You have the right to say no.
 
The knee is still so very swollen and I think it needs time to heal and settle.
You hit it on the head! Your knee doesn't need PT yet. It needs ice and elevation! When the swelling goes down it will naturally bend. You never have to force it to. And to do so, just makes it more swollen and sets you further back in your recovery. Hands off of your leg!
 
Why did I ever agree to have this operation? I can't cope with anything at moment. I'm a misery to live with and can't see any light at end of the tunnel
 
PLEASE PLEASE stop panicking. You are four weeks post-op, the absolute worst time in recovery when your knee is at maximum reaction and these people are not helping you.

My physio is really pushing it and she’s making me feel like I have failed
She is failing you by trying to push you when it's not appropriate and is possibly doing more harm than good!
Physio said that she’s going to have to bring my 6 week review forward as I’m likely to need a MUA
Rubbish! Nonsense! She has no way of knowing at this stage whether you will need one.
Dreading physio tomorrow
Don't go!

I keep getting told that I will get adhesions
Grits teeth. Yes if people mess with your knee and cause more swelling, that's quite possible. If they leave it alone it's most unlikely.
The knee is still so very swollen and I think it needs time to heal and settle
You know more than your so-called carers, this is exactly correct.
 

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