I had a right TKR on February 25, 2019, so am at almost 6 weeks. I have read the Bonesmart forums extensively, and the approach seems to help a lot of people. I believe in a more moderate approach.
I don't agree with aggressive PT, and what some of you have gone through is distressing. However, I do believe in PT after TKR, and have benefited from it. I think we need to approach PT with communication in mind, being clear about what we can and cannot tolerate.
Even though I was warned, I was surprised at the intensity of pain. I was told I would likely have a pain level of 2-3, after being medicated. I was not worried, as I have a high pain tolerance.
I was disappointed in pain control my first weeks. I knew there were changes due to the opiate crisis. I had hoped to used Tramadol and ibuprofen. However I couldn't do Tramadol due to another med I was on, and I had kidney issues after surgery which prevented me from using Ibuprofen. I went home on Norco, and when I took the max prescribed amount of 2 every 4 hours, the pain was tolerable.
However, my surgeon's office told me then I was getting too much Tylenol. In addition, my insurance would only authorize a weeks worth of pills at a time. To get a refill, I would need to go in person to the doctor's office, then across town to the pharmacy.
At that point, it felt like too difficult to arrange transportation. So, after a week and half, I was able to take ibuprofen, and alternated between that and Tylenol. (That is one point I disagree with Bonesmart- I have always found ibuprofen much more effective than Tylenol, and don't feel I take enough to worry about side effects).
I was able to do my ADL'S within a couple of days time. At this point, I do everything for myself except yardwork. I started driving at a little less than 3 weeks.
I started outpatient PT 2 days after returning home. The first visit was only measuring and looking at my gait, I was pretty painful. I have continued 2x a week focusing on swelling, extension and quad strengthening.
I know that bonesmart does not recommend strengthening so early, but it is gentle, and I have activities I need to do and can't due to weakness. That was my other surprise after surgery, how weak my quads are. I was able to do a straight leg raise and get in and out of bed right after surgery.
I still have pain and difficulty standing up from a chair or the toilet. I put my toilet riser on top of my high toilet, so now I have the highest toilet in the west, but it works!
What's funny is I have no difficulty standing up from my bed, which is lower.
I was having severe muscle cramps in my quads when standing up, and the cramp would ease quickly, but leave me with thigh pain for several days. My doctor prescribed a muscle relaxer, and that has helped with the cramps, and also relaxed my knee. This is one reason why I feel it is essential to work on quad strength at this time.
I am not yet able to go up steps reciprocally, but am working on it in PT. My other big goal is to be able to get off the floor. I fell on my porch a week after surgery, due to being stupid. I was not hurt at all, but was unable to get up. I ended up having to call 911, and two big paramedics came and picked me up and set me back on my feet. They were gracious, I was mortified!
I am retired, but hope to start looking for part time work in about a month.
My rom is good, 0-120, and as high as 125 actively. I am not working at it much at all, except some on extension, as it still feels tight. My leg still has moderate swelling, mostly above the knee. I am not worried about that much either. The PT is doing some treatment, and I have slowly lost weight, so it is resolving.
I did elevation and icing the first 2 1/2 weeks, with some intermittently since. I find icing unpleasant, and the whole thing not very effective. I am like bonesmart people are about rom - the swelling will resolve on it's own eventually. My knee was swollen and warm for a year before surgery, it is not any warmer now.
I think if I had to do this again, I would change some things. (Fortunately my left knee has no issues). I would definitely have a conversation with the surgeon ahead of time about specific pain control measures. I would also figure out transportation to PT, etc. better. My surgery was moved up a few weeks, so less time to plan.
I don't know if there is anything to do about the boredom of being stuck at home during the day. Driving for me is not just transportation, but recreation, so that was the worst part!
I would like to add that I used a walker for first three weeks. I tried a cane for a couple of days, but found it awkward, so am walking with no device. I am taking only tylenol, as needed. I have not needed it today at all.
I don't agree with aggressive PT, and what some of you have gone through is distressing. However, I do believe in PT after TKR, and have benefited from it. I think we need to approach PT with communication in mind, being clear about what we can and cannot tolerate.
Even though I was warned, I was surprised at the intensity of pain. I was told I would likely have a pain level of 2-3, after being medicated. I was not worried, as I have a high pain tolerance.
I was disappointed in pain control my first weeks. I knew there were changes due to the opiate crisis. I had hoped to used Tramadol and ibuprofen. However I couldn't do Tramadol due to another med I was on, and I had kidney issues after surgery which prevented me from using Ibuprofen. I went home on Norco, and when I took the max prescribed amount of 2 every 4 hours, the pain was tolerable.
However, my surgeon's office told me then I was getting too much Tylenol. In addition, my insurance would only authorize a weeks worth of pills at a time. To get a refill, I would need to go in person to the doctor's office, then across town to the pharmacy.
At that point, it felt like too difficult to arrange transportation. So, after a week and half, I was able to take ibuprofen, and alternated between that and Tylenol. (That is one point I disagree with Bonesmart- I have always found ibuprofen much more effective than Tylenol, and don't feel I take enough to worry about side effects).
I was able to do my ADL'S within a couple of days time. At this point, I do everything for myself except yardwork. I started driving at a little less than 3 weeks.
I started outpatient PT 2 days after returning home. The first visit was only measuring and looking at my gait, I was pretty painful. I have continued 2x a week focusing on swelling, extension and quad strengthening.
I know that bonesmart does not recommend strengthening so early, but it is gentle, and I have activities I need to do and can't due to weakness. That was my other surprise after surgery, how weak my quads are. I was able to do a straight leg raise and get in and out of bed right after surgery.
I still have pain and difficulty standing up from a chair or the toilet. I put my toilet riser on top of my high toilet, so now I have the highest toilet in the west, but it works!
What's funny is I have no difficulty standing up from my bed, which is lower.
I was having severe muscle cramps in my quads when standing up, and the cramp would ease quickly, but leave me with thigh pain for several days. My doctor prescribed a muscle relaxer, and that has helped with the cramps, and also relaxed my knee. This is one reason why I feel it is essential to work on quad strength at this time.
I am not yet able to go up steps reciprocally, but am working on it in PT. My other big goal is to be able to get off the floor. I fell on my porch a week after surgery, due to being stupid. I was not hurt at all, but was unable to get up. I ended up having to call 911, and two big paramedics came and picked me up and set me back on my feet. They were gracious, I was mortified!
I am retired, but hope to start looking for part time work in about a month.
My rom is good, 0-120, and as high as 125 actively. I am not working at it much at all, except some on extension, as it still feels tight. My leg still has moderate swelling, mostly above the knee. I am not worried about that much either. The PT is doing some treatment, and I have slowly lost weight, so it is resolving.
I did elevation and icing the first 2 1/2 weeks, with some intermittently since. I find icing unpleasant, and the whole thing not very effective. I am like bonesmart people are about rom - the swelling will resolve on it's own eventually. My knee was swollen and warm for a year before surgery, it is not any warmer now.
I think if I had to do this again, I would change some things. (Fortunately my left knee has no issues). I would definitely have a conversation with the surgeon ahead of time about specific pain control measures. I would also figure out transportation to PT, etc. better. My surgery was moved up a few weeks, so less time to plan.
I don't know if there is anything to do about the boredom of being stuck at home during the day. Driving for me is not just transportation, but recreation, so that was the worst part!
I would like to add that I used a walker for first three weeks. I tried a cane for a couple of days, but found it awkward, so am walking with no device. I am taking only tylenol, as needed. I have not needed it today at all.
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