TKR April 20th TKR

[12stringer]

Hello everyone. Thank you for all the reading I have been doing about all of you! I am at 46 days and I am roughing it hard but, I cannot believe how I get so confused about.. push that rom, don’t push. Walk, don’t walk it swells you leg!

So many different approaches. I have underlying problems after chemo with feet and nerves so, not easy. Today, day 46, I am taking it easy but still going to do exercises gentler. I have not come across any pt that has said the word gentle. I have heard the word, brutal rehab so many times.

I am mentally and physically feeling a backslide. It is very painful and keeps swelling up and it’s like starting over every day right up today 46. Forcing my leg to 97° without I watering sickness level is the best I can do.

I go to June 12 to discuss a Mua. I did not like the sound of that and it feels like possibly it would be starting over but, I really don’t want to be stuck like this.

I was very physically prepared in my upper body for this, so I had no problems with that. I had my hip replaced by the same people seven years ago. Was an extreme sport person. It’s perfect. I just have never in my entire life had such a difficult time trying to achieve something. I am a very physical high tolerance of pain person and discovered that that didn’t happen this time. I know or I hope it gets better with Time.

Any suggestions on earlier but effective ROM? I slide the feet I lean forward in my knee on the steps I walk between eyes straighten my leg I am at -4, but I go from range of motion from 87 to 97 and I never get past it. Any things that all of you have done that was helpful and didn’t hurt so bad you couldn’t think or function would be very much appreciated.

Thank you guys for writing all your personal things on here so I decided that I would give it a shot and see what happens. Thank you so much.
Frazzled in CT

 

[Layla]

Hello and Welcome to BoneSmart!
Please provide the exact dates of your surgeries and which knee you had replaced on each occasion so we‘re able to create a signature for you.

I am not sure whether you’re icing for the swelling, but if you’re not, I’d advise you start some routine icing / elevating several times per day. You will find an article on each ICE and ELEVATE in the Recovery Guidelines below.
PT should not be brutal, nor should it hurt. If it does, it’s too aggressive and more than your knee can tolerate as it heals from the controlled trauma of major surgery.
Please refrain from engaging in movement that causes discomfort or pain. Do not allow anyone to forcefully manipulate your leg. While your range of motion is currently limited, it will naturally increase as the swelling subsides and the pain eases. Give it time.

I am sure others will stop by with words of encouragement or support while sharing their opinions or what’s worked for them. I think you need to give this more time as you’re still in the early weeks of a recovery that can last a full year for some and even longer for others, still noticing improvement into their second year.

I wish you comfort and clarity in making decisions as you move forward.
Thanks for joining us!

 

[Layla]

KNEE RECOVERY GUIDELINES

As you begin healing, please keep in mind that each recovery is unique. While the BoneSmart philosophy successfully works for many, there will be exceptions. Between the recommendations found here, your surgeon's recovery protocol and any physical therapy you may engage in, the key is to find what works best for you.

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

the BoneSmart view on exercise​

BoneSmart philosophy for sensible post op therapy​

5. At week 4 and after you should follow this

Activity progression for TKRs​

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.
@12stringer

 

[12stringer]

Oh thank you so much!
April 20th, 2023 TKR. Left, same side a total hip replacement 6 years ago.
I have an ice machine and I use it countless times a day.
Elevated every time I ice. A lot.
Thank you for helping with my odd text. I hope I am doing this right.
I did same exercises today as best I could without pushing it to the point of eye watering pain. It will be the first time I have done it this way. I am just nervous that I might lose a lot of range of motion.
Thank you sooo much!

 

[Layla]

You’re very welcome!
You’re posting just fine and we’re happy to have you.
Thanks for the dates, we’ll create your signature and add you to the April team thread where you’ll be able to follow others that are recovering right along with you!

I think you will read many threads here of members concerned about ROM, but do find that with healing, time and patience, ROM does improve. So hang in there and stop back often for support. We’ll be here!

Following is an account of a single member that shared their progress over the course of a year. You may find it enlightening and interesting, it’s been posted around the forum many times.

“At my six week appointment this is what my OS wrote in my visit summary: "She reads an online website called Bone Smart which states to not push through pain following knee replacement. If she were to follow this direction, she will have to learn to live with a knee that only reaches to 85 degrees of flexion. I believe this website is very misleading."

It has now been 20 weeks and all I do is ADL and this is what my ROM has done:
3.5 wks: 75
6 wks: 85
7 wks: 90
10.5 wks: 95
14 wks: 100
17 wks: 105
20 weeks (where I am today): 110
I am so thrilled it keeps improving and improving and I know now that I will get to my goal of 120 (or even better, dare I say!)
So, if a OS or PT bullies you into thinking your ROM will not improve over time they are wrong. By the way, I haven't been back to see the OS since that horrible appointment at 6 weeks, but I sure am going back when I reach 120 just to say, "Ha! You were wrong, BoneSmart was right!" “

And,

“Just an update for those who are apprehensive about gaining ROM:
It has now been 26 weeks and all I do is ADL and this is what my ROM has done:
3.5 wks: 75
6 wks: 85
7 wks: 90
10.5 wks: 95
14 wks: 100
17 wks: 105
20 weeks: 110
26 weeks (where I am today): 120!!!
I did it! My goal of 120! No "pushing through pain", no PT after the first 3 visits, and most importantly to me: No MUA! My surgeon who said I would never get beyond 85 ROM without pushing through pain was wrong, wrong, wrong. I'm excited to see if it gets even better. “

 

[sistersinhim]

I go from range of motion from 87 to 97 and I never get past it.

This much bend at 6 weeks out is actually quite good. Most OSs don't expect 90 degrees until 6 weeks and you have passed that, which means it's not necessary to have a MUA. It is also normal for the ROM to fluctuate. It all depends on the amount of swelling you have. As you are more active you will swell more. This will lower your ROM, (which is your bend and extension). Swelling is both outside and inside your knee. With all that fluid in your knee, it's harder to bend because the water is in the way! Concentrate more on getting the fluid out and less on exercising. Those exercises can keep your knee inflamed and that means more swelling. Most of us have found that doing just normal daily activities is enough to rehab our knees. I'm one of them. I never did any exercises or PT and recovered quite well.

Let your knee's swelling be your guide. If you see or feel swelling with tightness, then realize that your bend will be less. This is normal.

 

[12stringer]

Yesterday and today.. I took all the readings from all your experiences, Laylas information, now you. I did more gentler longer things. I go tomorrow to PT building and see how it goes.Bits of house work, short walk. All the things that are no in my rehab word! I think I’m being pushed a bit more as the same people replaced my hip and know I do (well, did as of right now) extreme sporting of many kinds even after hip full hip replacement. If it takes longer and less “It’s a brutal” therapy? PT people use those words. I’m in for the more sanity and no brutality. Thank you so much all of you. I hope to be able to pass on something helpful as you all are! Here I go tomorrow.
Huge thanks..

 

[InkedMarie]

Hi @12stringer ! I did not do “brutal” therapy. No one even touched my knees without asking me and getting permission. Just say NO. They work for you, not the other way around.

Marie

 

[12stringer]

Thank you so much!
Yes, today is a PT day and it’s the fist time since Friday June 2nd, I didn’t have a stomach ache from pain.
I did more house work, stretched like a normal human being, walking even though I have neuroma in both feet, my knee
And feet liked it better. Of course it swelled but ice elevate. I thank you guys, I mentally should have prepared for this. Blew my socks off. June 12th is Surgeon to see how it all is going.
Thank you Marie, alot!
Dorene

 

[12stringer]

Hello everyone,
Probably doing this wrong but, I wanted to keep in touch here.
I had the MUA on June 15th, Thursday. PT every day as best as I could, outpatient and at home. Great at first, Then Sunday onto Monday?? I feel back where I started but apparently this can happen and the sore muscles from manipulating are wow. Every day at 2pm to PT but need to keep ROM, which they have not told me really what is. When I was out of MUA Doc showed me a solid 120 degrees and said there was a lot of scar tissue. Geeze, at this point I’m thinking, can it grow overnight? I am trying hard and it feel like it’s happening quickly!. Really would like to know, how fast does scar tissue grow? I cannot work to pain level of horror anymore any they understand you can only do the best you can. But I’m not sure that’s enough. I guess after all this babbling my question is how fast does scar tissue grow?
Thank you all for all the reading and information,
12stringer
Dorene

 

[benne68]

You are posting in exactly the right place, @12stringer! We prefer members to have a single thread for recovery, so all the information is in one place. That helps, us help you.

The scar tissue isn't growing back "overnight." I think what is happening is that your knee is angry and inflamed. Between the trauma of the MUA itself and overly aggressive PT, it is likely very swollen inside.

If it was me, I would back off the exercises and focus on elevating and icing for a few days so that poor swollen knee has a chance to recover from all the trauma. You will be surprised at how much your bend improves once the swelling goes down!

 

[12stringer]

Thank you so much!
I have spoken to a few different people about this scar tissue issue.
I am resting it more but, I cannot let it take over.
Swelling, tissue, both.
I have been less aggressive in this knee world after great information from you all on here. and as you said, I am sure this is much better for healing and getting ahead!
A recumbent bike at home for keeping it moving smoothly!
Thank you for responding, big time!
Dorene
12Stringer

 

[benne68]

recumbent bike at home for keeping it moving

That's perfect! Just be sure to keep it set for NO resistance. You want to move the joint, but not put any stress on it at this early stage of recovery.

 

[Layla]

Stopping by to say
It's been a month since the MUA and we haven't heard from you in a few weeks.
Wondering how you're doing? Hopefully well. Let us know when you have time, we'd love to hear from you.
Take good care!
@12stringer

 

[12stringer]

Hey Layla and all.
First your caring feels good. Thank you so much for this. I play the guitar for hospice and I hope my help with my caring feels to them the way yours helps me. Caring.. You Rock!
I am doing my best to keep range of motion and flexation after MUA on June 15th. I have a recumbent bike I use which I think has helped a lot with range of motion. The flex straight excercise is difficult but I don’t push anymore. I have lost no range of motion but stayed the same around 89-104 degrees. The straight is being lost be the Dynasplint which I am not really liking and have more questions about this contraption. I am in alot less pain because ( I believe ) of not “pushing through” as they say. I have been listening more to my own body. It has been 90 days Since TNR. I would like to have known about this fibrosis issue. I believe I am heading in the right direction but slow and steady is a long time but worth it.. That’s my positive spin on a difficult situation. I have had my hip replaced. IMO, you cannot compare the two. And everyone is different. if you’re older, I also believe your nerves handle it better so things might feel a bit easier than a younger person. I know, just observation from both of my experiences. This site and all of you have helped a lot. And keeping it together mentally… doing your best not to lose a positive attitude. So important. I try to start every day
With thinking on how I will use my new day! Accept help when needed and try to be positive. Thank all of you on this site. I hope maybe some of my babble will be a tiny bit useful. Selfishly, for me writing this helps. Thank you all really huge ..
Dorene

 

[benne68]

I am in alot less pain because ( I believe ) of not “pushing through” as they say. I have been listening more to my own body.

Good for you for listening to your body and not pushing into pain.

It's hard to stay upbeat during this long, slow recovery, but it seems you have the right approach and a great attitude.

We're here to listen and support you on your journey. Sending hugs

 

[Layla]

I play the guitar for hospice and I hope my help with my caring feels to them the way yours helps me.

What a thoughtful and generous way to bring comfort to those in hospice.
You really do have a positive attitude, which is refreshing.
Three months since your TKR...Happy Anniversary!
Enjoy the weekend.

 

[Layla]

Two months to date since your MUA. Hopefully you’re enjoying steady progress.
Wishing you a beautiful rest of Summer!
@12stringer