Revision TKR ArmyVet's recovery thread<<

[Celle]

16 days post op. Extension 9 degrees, Flexion 120 degrees!!!! I WILL get that leg straight soon!!!

Your ROM, both flexion and extension is terrific for so early in recovery.

Make sure you go easy on all the exercises You really need very little at this early stage.

And, there's no need to worry about extension. It's normal for it to take longer than flexion. That's because you have such large muscles and tendons at the back of your leg. They need to be stretched slowly and gently.

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

 

[ArmyVet]

Your ROM, both flexion and extension is terrific for so early in recovery.

Make sure you go easy on all the exercises You really need very little at this early stage.

There's just so much I want to do!!! It's hard for me to go slow-- I hurt for so long before I had this surgery!! I was told at 35 I would need this surgery, and just now had it done 5 months before I turn 55- It's unbelievable how I got used to the pain every day, and now that I don't have that type of pain, I want to do more!!! I need to learn how to slow down!! I started using a cane today instead of the walker at my therapist's recommendation, and since I had been using one before the surgery, it is like 2nd nature to me.

 

[SusieShoes]

Slow down now and see better results faster than if you try to push yourself. It’s only for a little longer. You can do this.

 

[sistersinhim]

Therapist suggested I try walking backwards

I think that is a really bad idea. It is dangerous on a knee so young. You definitely do not want to fall! My extension took quite a while to come in, about 4 months. I improved it by walking with longer strides, heel to toe. While I did this I always made sure I had something to hold on to just in case the knee gave out on me.

 

[ArmyVet]

Thought I would share.. this is today, 17 days after surgery.

 

[sistersinhim]

Yay, those staples are out! What a relief from that pulling!

 

[kneeper]

One of my PTs suggested walking backwards, but not so early. Also she said to do it alongside a couch or counter so you could grab onto it if needed. I only did it at the PT clinic where I had the bars to use for balance. Even then I wasn't too thrilled with it.

 

[Mutti3]

Same here, PT wanted to walk backward slowly on a treadmill. Didn’t care for it, and found it useless. I found it easier to walk backwards on my own power.

 

[ArmyVet]

Yes, I have a waist high railing I use for security. I can feel the difference, and I do go SLOW...

 

[ArmyVet]

Hey ya'll... quick question!! I am used to my knee hurting before it rains (it seems to go away once the storm is on it's way away from me), and the last couple days, my knee has started to hurt AGAIN before it rains, but now to the point where I'm crying. Does this stop once my knee is healed, or will I always be able to predict the weather???

 

[sistersinhim]

Hi back at ya! Yes, pain before storms will go away! But, it'll be a while yet. Probably about 6 months or so. At least it was for me. Now, not a bit of pain before weather changes! At least, not in the new knee! Your pain will go away, too. But, it has to heal first.

 

[ArmyVet]

Need more advice.. The inside of the new knee is KILLING me.. Severe, sharp pain in it, almost constant. What could it be?? Doc wants me to wean off painkillers, but this hurts!! It's actually the worst pain I've had since the surgery!! And can anyone offer me advice on my calf? The swelling is down, but it feels like I have ripped the muscle if I try to do foot pumps or calf raises! It's a solid knot!! Help!!!

 

[Celle]

It sounds as if you could be trying to do too much exercise, while also trying to cut back on pain medications.

I'm going to ask @Josephine to advise you.

 

[Josephine]

@ArmyVet Would you tell me where your pain is using this chart, please?

I'd also 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?

 

[ArmyVet]

@Josephine ask your questions.. Pain is D rf2-- it's Totally on the side of the knee, though, not front or back.

 

[Josephine]

Pain is D rf2

Take a look at this Pes Anserine and MPFL pain


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?

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.

 

[ArmyVet]

Here you go @Josephine!!


1) pain is about a 4, maybe a 5--mostly on that medial aspect of the joint replacement. I'm honestly pretty good except for that place.

2)Oxycontin 10mg. Started taking 1 every 4 hours after surgery, now spacing them as far out as I can tolerate before the next dose. Tylenol 500mg, 3x daily. Aspirin 81mg, 2x daily, Meloxicam 7.5mg 1x daily, Gabapentin 300mg, 3x daily.

3) moderate swelling, mostly lower calf and foot. The swelling I had at the knee and top of the calf is mostly gone.

4) PT measured me the other day... 8 degrees of extension, 120 flexion.

5) Icing as often as I sit with my leg raised. Pretty much 5 times or so a day, at least 20 min at a time.

6)elevation all night, probably 4+ hours at varying times during the day on top of when I sleep.

7.) activity? I do what my knee allows me to do. Having waited for TKR for 20 years, I have learned to "read" my knee and what I can and can't do at certain times. I'm washing dishes, cooking, laundry, etc. Not brave enough to walk my dog yet, but working on it.

8)exercises at home all done 3x day: straight leg raises 3 sets of 10 / heel slides 30 / leg extensions 30 each towards front, back and side / partial squats 3 x 10 / SOME backwards walking along a railing (about 20 feet, 3x back and forth) / and I walk about 2 blocks at a time.
I only do these ONCE on days when I have PT.

Pt is one hour, 3x a week. I do all the above, plus a heel ball thing, where my heels are on a huge ball and I bring the ball as close to my butt as I can for 3 minutes, quad tightening 5x 40 seconds, today, we added a short step, where I used my new knee FIRST up a stair, and did 30 normally like I would use a stair, and then 30 sideways, using the new knee first again. Heel slides, 3 min. I think that's it..

 

[Josephine]

Sorry, I need a bit more info

8 degrees of extension, 120 flexion.

Is the 8 extension plus or minus?

at varying times during the day on top of when I sleep.

on top of what?

8)exercises at home all done 3x day: straight leg raises 3 sets of 10 / heel slides 30 / leg extensions 30 each towards front, back and side / partial squats 3 x 10 / SOME backwards walking along a railing (about 20 feet, 3x back and forth) / and I walk about 2 blocks at a time.
I only do these ONCE on days when I have PT.

Pt is one hour, 3x a week. I do all the above, plus a heel ball thing, where my heels are on a huge ball and I bring the ball as close to my butt as I can for 3 minutes, quad tightening 5x 40 seconds, today, we added a short step, where I used my new knee FIRST up a stair, and did 30 normally like I would use a stair, and then 30 sideways, using the new knee first again. Heel slides, 3 min. I think that's it..

All these exercises, you will note in my questions I asked this:

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.​

 

[ArmyVet]

I guess it's plus 8.. it's 8 degrees from straight.

On top of?? Meaning PLUS when I sleep.

exercises at home all done 3x day:
straight leg raises 3 sets of 10
heel slides 30
leg extensions 30 each towards front, back and side
partial squats 3 x 10
SOME backwards walking along a railing (about 20 feet, 3x back and forth)
and I walk about 2 blocks at a time.
I only do these ONCE on days when I have PT.

Pt is one hour, 3x a week. I do all the above,
a heel ball thing, where my heels are on a huge ball and I bring the ball as close to my butt as I can for 3 minutes,
quad tightening 5x 40 seconds,
today, we added a short step, where I used my new knee FIRST up a stair, and did 30 normally like I would use a stair, and then 30 sideways, using the new knee first again.
Heel slides, 3 min.
and 30 practicing getting up out of a lower chair without using my arms.

I think that's it..

 

[Josephine]

Thank you!

1) pain is about a 4, maybe a 5, mostly on that medial aspect of the joint replacement. I'm honestly pretty good except for that place.

Got it

2) Oxycontin 10mg. Started taking 1 every 4 hours after surgery, now spacing them as far out as I can tolerate before the next dose.
Tylenol 500mg, 3x daily.
Aspirin 81mg, 2x daily
Meloxicam 7.5mg 1x daily
Gabapentin 300mg, 3x daily.

Assuming the Oxy has NO acetaminophen in it, up your Tylenol to 1,000mg 4 times a day - it will help.
Aspirin is used as an anticoagulant, not a pain med.
I would suggest that one dose of Meloxicam is almost of no therapeutic value!

3) moderate swelling, mostly lower calf and foot. The swelling I had at the knee and top of the calf is mostly gone.

Sounds like you just might have a dose of cellulitis there. When did your doctor last take a look at it?

4) PT measured me the other day... +8 degrees of extension, 120 flexion.

okay

5) Icing as often as I sit with my leg raised. Pretty much 5 times or so a day, at least 20 min at a time.

You accomplish little or nothing in 20 minutes. Ice for at least 40-60mins and more than 4 times a day.

6)elevation all night, probably 4+ hours at varying times during the day on top of when I sleep.

Good

7.) activity: I do what my knee allows me to do. Having waited for TKR for 20 years, I have learned to "read" my knee and what I can and can't do at certain times. I'm washing dishes, cooking, laundry, etc. Not brave enough to walk my dog yet, but working on it.

That's a lot for only 3 weeks out. Read this and adjust your activities accordingly Activity progression for TKRs

exercises at home all done 3x day: - once session a day is more than enough and none at all at the weekends!
straight leg raises 3 sets of 10 - 30 reps a day is far too much. Do 2 or 3 in the morning, no moare
heel slides 30 - again, 90 of these a day is far too much - read this Heel slides and how to do them properly. Though actually, your flexion is excellent so really you don't need to do these at all!
leg extensions 30 each towards front, back and side - here again you are doing 270 reps a day - far too many! That's very likely why you have limited extension. You can improve that by cutting out this exercise and just allowing walking to do the job
partial squats 3 x 10 - squats are not a good exercise. I suggest you stop them
SOME backwards walking along a railing (about 20 feet, 3x back and forth) - this too is not a good exercise. Stop it
walk 2 blocks at a time - also too much for 3 weeks out, read the activities article again.
I only do these ONCE on days when I have PT - shouldn't do any when you have PT!

Pt is one hour, 3x a week. I do all the above,
a heel ball thing, where my heels are on a huge ball and I bring the ball as close to my butt as I can for 3 minute - not a good exercises
quad tightening 5x 40 seconds - okay
my new knee FIRST up a stair, and did 30 normally like I would use a stair, and then 30 sideways, using the new knee first again - this is an awful lot for only 3 weeks
Heel slides, 3 min - what you do at home is plenty - these on top are unnecessary. Besides which, your flexion is excellent and you don't really need them
and 30 practicing getting up out of a lower chair without using my arms - here again, unnecessary.

You know, you are doing far too much exercising (or PT, whatever you choose to call it - they're both the same to me!) I have found that less is more - less exercising produces a lot more improvement. I suggest you do what many of us on here have done which is absolutely NO exercising or PT at all. Truly! The usual advice that one has to work hard and push through the pain is a total myth. 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)

And if you are concerned about refusing to do therapy, you need to read this Saying no to therapy - am I allowed to?