TKR Andy Booth's Recovery thread<

What a wonderful statement of your healing philosophy! Slow and steady gets you to the finish line and with far less anxiety and pain. So very happy to hear you’re doing this well!
 
Walking is one of the best things you can do to rehab your knee! After all, that is what it is made to do!
 
Andy what a lovely testimony! And packed with personal experience of your use of BoneSmart protocol.
Thank you so very, very much. It means such a lot to all of us!

Happy Christmas and a lovely, mobile New Year!
 
Happy New Year to all!

I’m now just about 5 weeks after left knee TKR surgery. My flexion is around 80 degrees when warmed up, about zero extension and neither have changed much in the last two weeks.

Other posters have mentioned rubber band knee and I am having similar symptoms. Very localised swelling around the knee surrounding the patella, with tightness in the attachments of the quads above.

Walking is slow, but with full weight, and using a stick only for safety. Steps are just getting possible in normal method but angled to the side a little due to restricted ROM.

After extension exercises, some additional swelling behind the knee, and after heel slides, some additional swelling around the patella but they go down after elevation and icing.

Still mostly just sitting or laying and elevating throughout the day, with maybe four icing sessions after activity. Walking around every hour or two for several minutes, occasional up stairs trip.

Still very tired after any exertion, and sleeping is still a couple of hours at a time separated by a shuffle around.

I recognise all posters have different symptoms, and that it’ll take as long as it takes, but its frustrating all the same.

I don’t know how some even think of going back to work at six weeks.
 
Last edited:
Other posters have mentioned rubber band knee,
I think you mean this "Tight band" feeling across the front of my knee
After extension exercises, some additional swelling behind the knee
Extension exercises are unnecessary if you have zero extension! In fact, it's a jolly good way to lose extension so I suggest you stop it!
after heel slides, some additional swelling around the patella
Same here. Are you doing 10-20 of these 23 times a day? If so, that's a bad way to do them. Read this Heel slides and how to do them properly
with maybe four icing sessions after activity
But for how long? Ice for at least 40-60mins and more than 4 times a day.
Still very tired after any exertion
Of course - remember this article? Energy drain for TKRs
sleeping is still a couple of hours at a time
This is most likely due to low grade pain.
I don’t know how some even think of going back to work at six weeks.
I quite agree!

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?
 
Hi Josephine,
No worries on the questions, grateful for any advice. I certainly am not over doing the exercises, and am following the Bonesmart method of heel slides, and only a few gentle reps maybe 3 times a day, if that.

My pre-op ROM was not good for months before the op, about 90 degrees, so I surmise that my muscles will have shortened as a result, so gains will be slower for me.

From your replies, I will increase my icing again, although I cannot keep it on anywhere near as long as the beginning. I feel the cold a lot quicker now. I am guessing that's because there is a lot less swelling and hot blood swilling around!

I am not going to throw away everything by suddenly going mad on PT in an attempt to progress, just a little down over lack of progress past two weeks.

On the positive, I know I am a lot stronger in the knee area, and walking is easier, just ‘steady as she goes’.

Thanks.
 
No worries on the questions, grateful for any advice.
Does that mean you do or don't want me to post my questions? It's entirely up to you!
My pre-op ROM was not good for months before the op, about 90 degrees, so I surmise that my muscles will have shortened as a result,
Not necessarily. Not unless it wasn't good for 2-3 years pre-op. It could just be you still have swelling (internally, probably).
I will increase my icing again, although I cannot keep it on anywhere near as long as the beginning. I feel the cold a lot quicker now. I am guessing that's because there is a lot less swelling and hot blood swilling around!
You mean you can't stand the cold ice? Then put more padding between skin and ice pack! It only needs to be cooler, not necessarily cold!
 
Yes, please post your questions! thank you [emoji3]

Yes i use padding, but i guess I will use more to get to the 60 mins sort of time.
Was just saying that my tolerance for the same level of padding is a lot less now [emoji3]


Sent from my iPad using Tapatalk
 
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?
ai63.tinypic.com_eta39s.jpg


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.
 
Hi there,
OK, here we go.

1. Pain now consists of a dull ache in the background say a no2 level, mostly at night.
Only occasional sharp stabs, say a no6. More like a nerve stab feeling.
No extra pain when walking or climbing steps.
Stiffness all the time. A little more in the mornings, then loosens throughout the day.

2. Prescribed co codamol 30/500 up to 8 a day plus paracetamol as required originally.
Now on only one co codomol a day before bed, and maybe two or three paracetamols rest of day.

3. Between slight and moderate picture for swelling. Swelling increases after sitting, standing, walking etc, then goes down to base level after elevation and icing.

4. Rom about 80 after warming up, and around 5 for straightness.

5. After your advise now icing maybe 4 time day, for an hour a time.

6. Elevating as per guidelines maybe 80 percent of waking time. Good to bed with elevated leg, but then
Move to flatish halfway through night as back gets gripey.

7. I wander around house, toilet etc every hour maybe 3/5 mins each time. Shower, make cups of tea etc.

8. All at home. Daily.
Leg extensions with ankle on chair, 3 times day, 5 reps, slight pushing down for 5 secs each rep.
Leg raises and clenching with support under knee. 3 times a day, 5 reps holding clentch for 10 secs.
Heel slides, 3 times day, only to point of max stifness, no extra assistance, hold 5 secs.
If knee is more swollen than base level, then dont do exercise .

Nothing at PT.

Thanks
 
1. Pain now consists of a dull ache in the background say a 2 level, mostly at night. Only occasional sharp stabs, say a 6. More like a nerve stab feeling.
Stiffness all the time.
Did you factor in this stiffness and swelling into your pain score?
2. Prescribed co-codomol 30/500 up to 8 a day plus paracetamol as required originally. Now on only one co-codomol a day before bed, and maybe two or three paracetamol rest of day.
Since your pain score is obviously higher than 2, probably a 6 all day if I'm any judge - then you need to be taking 2 co-codomol at a time or 1 co-codomol and one paracetamol and take them 34 times a day. You also need to take the last dose about 15 minutes before retiring so you get good night time cover. You're only 5 weeks out and this isn't enough right now.
3. Between slight and moderate picture for swelling. Swelling increases after sitting, standing, walking etc, then goes down to base level after elevation and icing.
mentioned above
4. ROM about 80 after warming up, and around 5 for straightness.
Yes, you do need better pain management.
5. After your advise now icing maybe 4 time day, for an hour a time.
Jolly good!
6. Elevating as per guidelines maybe 80 percent of waking time. Good to bed with elevated leg, but then
Move to flatish halfway through night as back gets gripey.
That's about right!
7. I wander around house, toilet etc every hour maybe 3/5 mins each time. Shower, make cups of tea etc.
That's fine


All at home. Daily.
Leg extensions with ankle on chair, 3 times day, 5 reps, slight pushing down for 5 secs each rep - I've never been persuaded that these actually improve extension. Walking is the best for that. Besides which, 15 reps a day is far too much
Leg raises and clenching with support under knee. 3 times a day, 5 reps holding clentch for 10 secs - again, far too much and likely to cause an increase in pain and swelling. I suggest you stop it
Heel slides, 3 times day, only to point of max stifness, no extra assistance, hold 5 secs - another exercise I've never been convinced works. But doing them in three bouts is not good.
If knee is more swollen than base level, then don't do exercise - glad to hear it

In short your pain is a fair bit more than you think it is and you're not taking anywhere enough pain meds.
And as for your exercises, I doubt they are doing you any good at all and you'd be better off stopping them. 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). Others have also done their TKR rehab with no exercises whatsoever. Just walking and ADLs (activities of daily living) Read this BoneSmart philosophy for sensible post op therapy
 
Hi Josephine,
Thanks for the answers and advice.
Regarding pain, I didn’t/don’t class stiffness as pain, just a limitation of movement.
Including that in the score, i still would only put it at about 5, I have suffered a couple of separate ruptured spinal discs in the past, now thats a 10 score! this for me doesnt really get on the same scale, but i take your point, i am probably understating the situation.

I have gone back to 1cocodamol plus 1paracetamol 3/4 times upon your recommendation.
Elevation and icing continuing.

Regarding excercise, i had only really started to do any over the last week , after reaching the ‘magic’ point where suddenly i felt a lot stronger and better in myself ( others have mentioned this at week 3, for me it was into week 4 ).
I have now chastised myself and have gone back to just pottering around etc.

Thanks again
 
Pottering around. I just love that term. It sounds... cozy. :) It's true... the minute we start to feel a little stronger and the pain pulls back just a bit, we think "Aha! I've turned a corner. I can do more!" It's so tempting. Why keep doing what's working, when you can do... more. Humans are plucky that way. But our knees quickly remind us to back off.

You're doing wonderfully!
 

BoneSmart #1 Best Blog

Members online

Forum statistics

Threads
65,179
Messages
1,597,054
BoneSmarties
39,364
Latest member
All2Gd88
Recent bookmarks
0
Back
Top Bottom