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[TKR] Anxious<

BB57

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I had a left TKR on 1/19/16. I am doing ok & pain is much better but I have some questions I hope I can find answers to.
My knee is very stiff...almost like it's stuck. It feels quite swollen but actually looks better. I really can only get about 45degrees flexion with it. I have not started my PT yet...just home exercises that I faithfully do (to the point of tears)twice a day. I have appt next Wednesday & I'm afraid they will hurt me & be upset that my ROM isn't any better. I also need my pain meds every 4-6 hours & im afraid they are going to say "no you don't". Am I just being a nervous Nelly? Is there more I can do? I hurt so badly before surgery & I really want 100% mobility & use. Can someone ease my mind?
 

kneeper

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Hi and Welcome. You should not be doing exercises to the point of tears. It sounds like all the exercise might be causing more inflammation--even if you don't see it, it's there. Your knee is very new and it feeling very stiff is normal. Are you elevating and using cold packs--gel packs, a polar ice machine or home made ice packs?

Pain medication every 4 hours sounds normal to me. That's what I was doing at your point in recovery.

One of the moderators will be along with a handy list of links, and don't forget you can explore the forum Library --lots of good stuff there.
 

newlybionic

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I agree with kneeler. You shouldn't be to tears with exercises. So soon after surgery all I did was to elevate my leg with ice wrapped around it almost constantly. I did a couple of short periods of a few exercises and just walking to the bathroom and back and that was all. There is swelling that goes on inside the knee that you can't see. Your knee is still very new.
 

Pumpkln

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BB57,
Welcome to Bonesmart, glad you joined us.
A stiff swollen knee is normal after a TKR, a major surgery. Your bones were sawed off, soft tissues cut, the pulled back, metal parts pounded, screwed and glued into place, the soft tissue stitched, glued, and stapled.
Your ROM is there, when the stiffness and swelling goes down your knee will be able to bend. Your job is to let it heal, you cannot rush healing.

Exercising to the point of tears is only irritating and inflaming your poor knee and soft tissue is counter productive and will only cause increased swelling and pain. Suggest you cut your exercise way back, doing Heel slides and how to do them, and your normal activities and walking around is enough.
Spend more time following the Bonesmart Mantras, Rest, Ice, Elevate, and Medicate on schedule as prescribed.

I'm afraid they will hurt me & be upset that my ROM isn't any better.
They should be no more than concerned about your ROM, and then give you help reducing the swelling and stiffness with Ice, Elevation, and gentle massage pushing the fluids back towards your heart. Do not let them push and shove on your knee, causing further inflammation, swelling, and pain.
Remember the PT works for you, when you say NO, they have to stop. Do not allow anyone to push you past the point of discomfort.

Please add your surgery date to your signature, hover over your username, click on signature and add your information there, Thanks!

First are the BoneSmart mantras ....
- rest, elevate, ice and take your pain meds by the clock
- if it hurts, don't do it and don't allow anyone - especially a physiotherapist - to do it to you
- if your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again
- if you won't die if it's not done, don't do it
- never stand when you can sit, never sit when you can lie down, never stay awake when you can go to sleep!
- be active as much as you need to be but not more than is necessary, meaning so much that you end up being in pain, exhausted or desperate to sit down or lay down!

Next is a FAQ (Frequently Asked Questions) thread.

And here are some very crucial articles
The importance of managing pain after a TKR and the pain chart
Myth busting: no pain, no gain
*Swollen and stiff knee: what causes it?
Activity progression for TKRs

Healing: how long does it take?
Chart representation of TKR recovery
Energy drain for TKRs
Elevation is the key
Ice to control pain and swelling

Home physio (PT) and activity progress: suggestions
Myth busting: the "window of opportunity" in TKR
*Myth busting: on getting addicted to pain meds
Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

And then some wise words from members who have shared their experiences ...
Where are you in recovery?? (TKR)
Five “P’s” of knee recovery
TKR: work “smarter” and not “harder”
Recovering a knee - from one who knows!
It's never too late to get more ROM!
It's worth the wait for ROM
 

Josephine

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In order to give you accurate advice, I'd like to ask you some questions if you don't mind, and 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 compare this with the bone-on-bone pain you had before surgery! :no-fin:) Also don't forget to include 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 often are you icing your knee and for how long?

4. are you elevating your leg, how often and for how long?

5. What is your ROM - that's flexion (bend) and extension (straightness)

6. how swollen is your leg?
ai63.tinypic.com_eta39s.jpg


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

8. what kind of PT exercises and exercises at home are you doing? How much and how often?
This is the most crucial question so please help me by using the format I have left as an example

Exercises done at home: 3 sessions a day
Heel slides x10 (reps)
Straight leg raises x10
Steps x10

At PT
Squats x5 (reps) x2 (sets)
Wall slides x5 x2
Clamshells X5 x2
 
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BB57

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Hi. Sorry I got my threads in wrong place!

1. My pain level varies from 2-7. It's a deep pain mostly...along with stiffness.

2. Hydrocodone 10/325. My last refill they would only give me 5/325. Allergic to tramadol. I have been taking it every 4-5 hours. Also Aleve & Tylenol Arthritis strength in between to try & stretch it out.

3. I ice my knee whenever I sit or lay down. Constantly.

4. I do elevate my leg. Probably for an hour at a time, most of the day. The OS says I should be up on it...using it & not laying around. I'm so confused!

5. Extension is 4 degrees from perfectly normal. Flexion is 45 degrees with much discomfort.

6. Moderate

7. Activity level is good. I do cooking, cleaning on surface-nothing deep. I do go out & plan to go back to work Tuesday...desk work only

8. Exercises done at home: 2-3 sessions/day
Heel slides : 10/ session
Pull-ups: 10/session
Knee bends from chair: 5/session
Squats: 10/session
Stretches: 5 min/session
Quad flexes & straight leg raises: 10 of each/session

Just starting PT so not sure what they want yet.

I hope this helps! My biggest concern is all the conflicting instructions. Thanks you!
 

Pumpkln

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BB57,
Sounds like you are doing way too much. You are up using your knee, the walking around the house, and the light cleaning are plenty of activity this early in recovery.
Generally we recommend people go back to work after three months, on a Phased return to work .
If you are going back to work, be sure you can elevate and ice during the day. Also on the days you work you do not need to do any other exercise.
Before you go to PT be sure to read the articles I left you in my earlier post.
Josephine will be along and address the answers to her questions.
Good luck Tuesday.
 

sleepilu

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Dear nervous nelly!
Please give yourself a break. You're not even a month out of surgery. Take care and time to mend.


Sent from my iPhone using BoneSmart Forum
 

Josephine

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1. My pain level varies from 2-7. It's a deep pain mostly...along with stiffness.
Pain is pain, sweetie. I only give the other types to ensure you count them in. For these purposes, I'm only interested in the overall pain score and yours is high!
2. Hydrocodone 10/325. My last refill they would only give me 5/325. Allergic to tramadol. I have been taking it every 4-5 hours. Also Aleve & Tylenol Arthritis strength in between to try & stretch it out.
Well then take two! But what instructions does it actually say on the bottle?
3. I ice my knee whenever I sit or lay down. Constantly.
4. I do elevate my leg. Probably for an hour at a time, most of the day. The OS says I should be up on it...using it & not laying around. I'm so confused!
Well he's a silly billy! He's completely misunderstood the difference between sensible, required resting and moderate activity. Did you read the articles left you you earlier in this thread? One is particularly appropriate here Activity progression for TKRs

So yes, you do need to active on it but you also need to rest it while it's healing. He's being a bit 'all or nothing' in his opinion and obviously doesn't understand the credo of moderation in all things!
5. Extension is 4 degrees from perfectly normal. Flexion is 45 degrees with much discomfort.
Never go into 'much discomfort'! More about this later.
6. Moderate
As I would expect.
7. Activity level is good. I do cooking, cleaning on surface-nothing deep. I do go out & plan to go back to work Tuesday...desk work only
Read that article again - NO cooking or cleaning and NO work until about 12 weeks out. It matters not that your 'only doing desk work', that's every bit as punishing as being a waitress or something similar. Read the article about a phased return to work that Pumpkln left you.

My comments in bold
Exercises done at home: 2-3 sessions/day - I suggest you do ONE session per day and none at the weekends
Heel slides : x10 - there's no benefit to be gained by doing two intense session. You need to read this Heel slides and how to do them.
Knee bends from chair: x5 - this is also a flexion exercise just like the heel slides. You only need one such exercise.
Squats: x10 - squats are also a flexion exercise but more, they are very punishing on a new knee, most likely to cause excess pain so please stop doing them
Quad flexes: x10 - okay but don't cause yourself any pain whatso ever
straight leg raises: x10 - let me give you a tip about these, one you can do them you don't need to do them any more. Not a lot of PTs will tell you that!

Pull-ups: x10 - can you please explain what you mean by 'pull-ups'
Stretches: 5 min - can you also explain how you do these?

Just starting PT so not sure what they want yet - well be careful and make sure she doesn't do any of the following

Squats, clamshells, standing on tip toe, steps, lunges, using a Theraband to pull on your foot, weights or pushing on your leg. It can take a bit of assertiveness to stand up to them as they will come out with all sorts of threatening myths such as the 'window of opportunity' and 'no pain no gain'. Articles about these two myths are in the collection of articles left for you earlier. Do not fall for these myths.

You should also bear in mind that the ROM is there right from the start, just waiting to show itself. It's only blocked by swelling and pain. With gentle treatment, rest, elevation, icing and appropriate pain management, the swelling will go down, the pain abate and the ROM will be able to show itself.

As regards doing no exercises at all, I recommend you read my recovery threads to see how little exercising I did!
First knee. Knee recovery - UK style
Second knee. Josephine's 2nd knee story - short version where I did even less!
 
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BB57

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Pull-ups are when you support knee & pull it to chest bending at the knee. I got thru 3 1/2 hrs today before I had discomfort. But now (bedtime) it's is quite sore & almost cramps feeling in my calf, shin, & behind my knee. I did get a new PT person & I love her! She didn't make me cry!!
 

newlybionic

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Hopefully you didn't hold your knee like that for 3 and 1/2 hours. That's definitely would be the cause of your pain now. Even though you are only using gravity to help bend your knee that just about the same as a pt pushing on it. I did that occasionally but I stopped at the point of starting to feel uncomfortable. I always packed my knee with ice every night with my leg elevated. I hope you get some sleep.
 

Josephine

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Pull-ups are when you support knee & pull it to chest bending at the knee.
Dead right, Marian! BB57, do read my post again. I said quite clearly that IF you do flexion exercises, you only need to do one. Doing more only increases the stress and pain you experience. So please stop it along with the others I crossed out, then you might be more comfortable.
 
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BB57

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Ok ladies I do understand but then when I go back to PT & have no improvement she works me harder! I don't know what to do. It's really upsetting at times. I would rather baby my knee because it hurts less but like I said....if I'm not aggressive with it I have NO improvement & pay the price. I'm 5 weeks out tomorrow & still walking with cane & at 65 degrees flexion. I'm sure I should be decisive but it's hard when I have all these voices clamp ring at me that I should be completely better...off the cane...&. @ 120 degrees by 6 weeks!! I wish I had never done this!!
 

Josephine

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It's all about being assertive and remembering that these PTs work for you, not the other way around! You have the right to choose what you feel is right and to close your ears to their demands. They're trying to force a written down protocol on you which is wrong. This recovery doesn't go according to dictates schedule. Also You are correct to want to baby your knees and should not listen to PTs who tell you these old wives tales about getting such-and-such a degree of ROM by 6 weeks. I can promise you that if you - or they - are aggressive you're much more likely to not get improvement.

Did you read the articles left for you in post #4? Then you know this 'window of opportunity' nonsense is just that - nonsense! It really, truly isn't true. Cut yourself adrift from them and let yourself heal. Because it's not the exercising that gets you your ROM, it's time. Time to heal, 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 does more harm than good. Normal mobility and stretches are the key to success.

Remember the correct mantra is "no pain MORE gain". There's no need for you to allow yourself to be hurt, so don't do it. If you want confirmation this approach works, I recommend you read my recovery threads to see how little exercising I did!
First knee. Knee recovery - UK style
Second knee. Josephine's 2nd knee story - short version where I did even less!
 

Celle

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Ok ladies I do understand but then when I go back to PT & have no improvement she works me harder! I don't know what to do
@BB57
It's your knee and only you have the right to say what will happen to it. Just tell your therapist "NO. That's enough", and walk away. They may claim to be the experts, but how many knee replacements have they had?

Don't listen to all their threats and dire predictions. Less work will bring more progress.
Have you read these articles?
TKR: work “smarter” and not “harder”
Life in the slow lane
and this:
Myth busting: the "window of opportunity" in TKR

For what it's worth, after my last TKR I did no PT at all and almost no exercises on my own.
I just concentrated on doing lots of these:
- rest, elevate, ice and take your pain meds by the clock.
MY knee straightens fully and I estimate its bend to be over 125. i can do everything I want to with it.

It's mostly swelling that is stopping your knee from bending. Elevation and ice will help to reduce the swelling, but too much exercise will increase it. Reduce the swelling and your knee will be able to bend.
 

newlybionic

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It is difficult to hear so many different voices about PT after TKR. I can just tell you that I did not find this forum early in my recovery and went along with everything they told me to do. I wound up with excruciating pain many times afterwards with increased swelling. I really feel I suffered more than I needed to.
 

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Just throwing in my two cents here... I had my tkr on Jan 14. I have been reading posts on BS since Christmas and quickly understood the BS mantra of not overdoing when it comes to PT. For the first three weeks post surgery, I pretty much followed everything I was told to do. However, my PT was not intense. But, by the third week, I was starting to feel all kinds of pain in my knee and decided to stop my home exercises all together. Within a week or so, after being good about resting, elevating, icing and taking meds, my knee feels so much better. I still go to PT at the hospital twice a week, but that is all. I am starting a regimen of walking short distances at home, and I still do the occasional heel slides. I really think that your knee will heal at its own pace, but it will do better without all that extra stress on it. Be gentle on yourself!
 
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BB57

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Well I am now almost 7 weeks out. I have 75-80degrees flexion. My Pt was increased to 3 times/week & I take 2 Lortab before I go with no real results. It hurts horribly but my OS says if I'm not at 100 degrees by 3/16/16 we need to do MUA or o will never have use of my knee. I'm back to work 32hours/week & walking on my own although my family rides me CONSTANTLY about walking stiff leg. I drive & they think it's time for me to be better. I'm so discouraged & depressed & I feel like a lazy failure. I ice, I elevate, I exercise.....nothing works!
 
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BB57

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I forgot to add my foot swells a lot as well as my calf & knee. Incision looks great but it always feels hot & tight. Cramps pains in my thigh & outer calf.
 

Pumpkln

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BB57,
You are doing way too much for your knee this early in recovery, which can take a year or more. Working is plenty along with a few Heel slides and how to do them . There is NO window of opportunity for ROM, we have members who have increased ROM over a year after surgery.

ROM: it's worth the wait for ROM
ROM: it's never too late to get more ROM!
ROM (range of motion) information
Myth busting: the "window of opportunity" in TKR
Myth busting: the "window of opportunity" JBJS

Swollen and stiff knee: what causes it?

I think your family needs to see these photos, so they can see what your knee went through and why it is taking so long to recover from TKR. TKR surgery - WARNING: real life photos

Give your knee time to heal and follow the Bonesmart mantra Rest, Ice, Elevate, and Medicate on schedule as prescribed.
I feel like a lazy failure
I think you are anything but lazy, you work 32 hours a week, you go to PT 3x a week, you do your exercises.
IMO you are doing way too much for your recently operated and injured knee (see photos in link above), you need to work smarter, not harder. Sometime the hardest work in being patient while your knee heals, and doing less not more.
Please give your knee a break from all this work and let it heal.
:sleep::ice::elevate: and :chillpill: on schedule as prescribed.
 

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