TKR Bebob's recovery thread

[Bebob]

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.

 

[mature mama]

Great update! Sorry about your fall and need to call for an assist but glad you could.

 

[Celle]

Hello @Bebob - and

It sounds as if you and your knee are doing well.

It's OK to disagree with some of the things you've read on BoneSmart. We always say that no two knees are the same, and what suits one knee may not suit another.

While some of us advocate no formal PT at all, the most important things are 1) to avoid aggressive therapy and 2) to take control of your own recovery, so that you set the amount of PT and exercise that suits your own knee. To do that, you need to listen to your knee and take notice of the messages it sends you. Pain and increased swelling are signs that what you're doing is too much for your knee.
That's why we advise this:

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.​

Although the PT therapists make a big deal out of ROM, BoneSmart advises that there is no need to rush. Function is more important than the numbers and it's not exercising that gets you your ROM - it's time. Time to recover, time for swelling and pain to settle, and time to heal. Your ROM is there right from the start, just waiting for all that to happen, so it can show itself.

When someone appears to be exercising too strenuously and their PT is hooked on the ROM numbers, we advocate icing and elevation, to try and reduce swelling, rather than doing lots of exercises. As the swelling decreases, ROM will increase naturally.

 

[Celle]

I expect you've already read these, but here is the recovery reading we give to everyone with a new knee:
Knee Recovery: The Guidelines
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​

6. Access to these pages on the website

Oral And Intravenous Pain Medications
Wound Care In Hospital​

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.

 

[Bebob]

Update, at almost 7 weeks
My 6 week follow up was cancelled by surgeons office for unknown reason, rescheduled in 3 weeks, so a bit disappointed.
In the last week, I have been able to go up and down steps with alternating feet. That was a big accomplishment, haven't been able to do that in a year. A little bit tight in the knee going down, but not too painful.
I have been doing some "work hardening" on my own. I volunteer at a garden, and there is an event I will work at next Saturday. It will involve walking on gravel, lifting plant pots (only 1/2 gallon, and none are lower than 3 feet off the ground) and loading wagons. I only committed to a 3 hour shift. Today I cleaned out the nursery shed, and did some light weeding (No, definitely did not get down on my knees for that)! , as well as walk up and down 40 steps. I had no pain during or afterwards and have not noticed increased swelling. Hopefully I will feel the same tomorrow morning!
I had started taking a muscle relaxer due to cramping in my quads, and both the PT and I have noticed better function, as well as the pain relief. I only take it a few more days, so we will see if things stay the same. I have only needed to take tylenol one day this week, otherwise am off pain pills.
My big bugaboo is standing up from a low surface. I think it is partly fear of pain, and partly my body is having trouble figuring out the motion. I keep telling myself it is like when I learned to water ski- you have to stand up by pushing down on your feet, and not pulling up with your arms! I do get a catching type of pain behind knee on medial side when I stand from low height, once "catch" releases, pain resolves. My PT thinks it may be due to tight hamstrings.
It was the 6 week mark when I finally started to feel the operation was worth it. I have heard others say they noticed relief from the arthritis type pain right away, but I felt until recently the pain and decreased function were worse than prior to surgery. At 3 weeks I told a friend I wanted my old knee back, due to the pain! So, just telling everyone it does get better, but the timing is individual for everyone.

 

[FCBayern]

If you think you reached the break even point at 6 weeks your doing fantastic! It only gets better as we move forward hopefully to a knee pain free existence!

 

[Celle]

That sounds like a pretty good result on the whole, for only 7 weeks post-op.
It's great that you can do stairs normally so early. It takes most people much longer than that.

My big bugaboo is standing up from a low surface. I think it is partly fear of pain, and partly my body is having trouble figuring out the motion. I keep telling myself it is like when I learned to water ski- you have to stand up by pushing down on your feet, and not pulling up with your arms! I do get a catching type of pain behind knee on medial side when I stand from low height, once "catch" releases, pain resolves. My PT thinks it may be due to tight hamstrings.

I think it's normal to still feel pain at thsi early stage. Maybe you're expecting a bit too much from your inee so early in recovery.
For now, help your knee by pushing down with your arms. Standing up from sitting without using your arms is another accomplishment that usually takes much longer than 7 weeks.

Remember that recovery from a TKR takes a full year and you have plenty of time on your side.
Try not to rush your knee, but let it recover at its own pace.

 

[Lindylee]

I also found 6 weeks was a turning point and had the same problem standing from sitting on the toilet or a chair, but not bed or sofa. I could only put it down to a hard versus soft surface, but not sure why. You'd think it would be harder from a soft surface.
I'm not sure I'd have been ready for a 3 hour gardening at that stage though. You're doing well.

 

[Bebob]

I will be at 8 weeks tomorrow. I made it through my first volunteer session of the season at the garden. It ended up being about 4 hours. I had more swelling afterwards, but no pain to speak of. As much as I despise it, I did ice for an hour afterwards, which helped some. What helped the most was just lying down all night, swelling decreased to prior level this morning. I will be volunteering there once a week starting in May, for 4-6 hours at a time. I am so excited to get back to my normal activities!
Last week I also mowed my lawn, front and back. My sister has been doing it for me, but her days off kept coinciding with the rain, and it was getting to the point of calling in the goats! I did take frequent rest breaks. My back whined about it, but absolutely no knee pain! That was a constant last summer.
I am decreasing PT to once a week for about 2 more weeks. My main goals are standing up from a lower surface, getting up from the floor, and continuing to improve my walking distance. I expect that to take awhile. I am not taking any pain pills regularly. So, I am happy with my recovery at this point, although I had my doubts along about 3 weeks!

 

[Bebob]

So today was my second follow up visit at the ortho clinic at 9 weeks. I saw the PA, who measured my knee flexion with me seated in a chair and pulling my leg back with no assist. She said it was 140 degrees! I was shocked, and she measured again with same number. I go to PT tomorrow, see what he gets! I would be happy with 130! My extension is 0. I continue to have swelling with activity, such as lots of standing, but the PT measures my leg circumference, and it is decreasing. I only need pain pills about once a week, and that is mostly for shoulder and back pain. I did get a shoulder injection today, which was helpful before. I have started working on getting off the floor. I don't want to lean on my knees for too long, but as long as I have a chair to hold onto, I can get up on my feet. This was a worry of mine, as I was not able to do that prior to surgery. I am not planning on falling, but as long as you fall and don't get hurt, it is nice to not have to call for help! My long term goal is to be able to get down on the ground for gardening, and then stand up again without support, time will only tell if that is feasible. In the meantime, I have my garden bench nearby. By the way, my knee feels perfectly natural, except when kneeling it feels funny.

I did ask my PA about what I read in the operative report. She confirmed that as well as doing the bone cuts, the doctor carves off bone spurs that are further away from the joint, and also cleans up any "angry" soft tissue.

I can now get off of low surfaces (good bye toilet riser)! and am climbing stairs more smoothly. From here on out, it will be a matter of strengthening my leg muscles, and increasing endurance. I still have more fatigue than prior to surgery. My doctor did say it can take up to a year for the endurance and strengthening to come. My PT keeps strongly advising me to do my home exercises, which I am resisting. Not because they are too difficult, but because they are boring! I prefer to do activities that provide strengthening, such as climbing stairs.

I hope this gives encouragement to others who are still struggling in the early weeks, there is light at the end of the tunnel. I definitely was not a happy camper the first 3 weeks!

 

[Celle]

My PT keeps strongly advising me to do my home exercises, which I am resisting. Not because they are too difficult, but because they are boring! I prefer to do activities that provide strengthening, such as climbing stairs.

You have fantastic ROM and there's no need at all to keep doing exercises - or to keep going to PT, unless you need help with balance and gait.

 

[Irish471]

@Bebob , wow! You're doing fantastic!

 

[Bebob]

@Irish471 Thank you!

I have two more PT appts. I am working on getting up from lower surfaces, and light strengthening. I am concerned about minimizing chances of falls. My philosophy about PT is that yes, I am there to rehab my knee, but my knee does not operate independently from the rest of my body. I realize now how much my arthritis was affecting my movement and posture. I was aware of having trouble getting out of chairs and climbing stairs, but I am now so aware of how much more freely I am moving. It is like a two year old learning to walk, I want to keep trying new things! I know bonesmart does not recommend strengthening at this stage, but I am not having any pain with these activities.
I mentioned in my first post how I fell on my porch a week out of surgery, and was unable to stand up without 2 people to help. Today, I sat down on that porch (7"" high) on purpose. I had my garden kneeler bench nearby, just in case. I was able to push down with my hands next to me, and come to a stand, no pain, no kneeling first required. That felt fantastic! I don't plan on sitting on surfaces that low, and I certainly don't plan on falling again, but it is a relief to know what is possible.

I had the PT remeasure my flexion today, as the doctor's measurement seemed awful high. The PT got 130 degrees, which I am perfectly satisfied with. I have one more follow up with the doctor, at 4 months.

 

[FCBayern]

@Bebob 130! Im almost a month ahead of you and measured at 111 today. You are doing great!

 

[kneeper]

I was doing some strengthening at 3 months but still taking it very gradually. As always listen to the knee.