TKR Careful! There Be Dragons Here! <

[newlybionic]

I hope the feeling comes back to you soon. That's amazing how quickly they acted to have you tested. I'm glad it's over for you. Rest up that knee. It deserves it.

 

[Nvstig8tr]

@sistersinhim - I am exhausted from the day's events! At only 17 days post-op, I really took a chance driving myself across town. Every minute and every bump in the road was like torture, because my meds were due at 12:00 noon and I didn't get home until 1:30 pm. I really had no other options other than calling a taxi, but I'm too frugal to pay $50 cab fare both directions. I've been elevating and icing all afternoon!

 

[sistersinhim]

It was a good thing that you hadn't taken any strong meds and was able to drive yourself to the hospital. Now that is behind you so you can take those pain meds and get that pain level back down. You've earned a restful weekend. Enjoy it.

 

[Nvstig8tr]

Back to the Over Did It Club (ODIC)

Got a little over zealous yesterday (Sunday) and revisited the ODIC by walking the perimeter of our cul-de-sac twice (probably 150 meters total). Everything felt fine and I could have made four or five trips; however, my knee began complaining in the night so I had to cancel my PT and I began icing my knee from 6:00 am until around 12:00 noon. The pain was actually not too bad, perhaps a 6 or 7 and easily handled by a Tramadol and two extra-strength Tylenol.

Experimenting with Pain Meds

Today is 20 days post-op and I decided to reserve the Hydrocodone-Acetominophen 7.5/325 for my midnight dosage only. My dosing schedule is 6-12-6-12 on the clock. This morning at 6:00 I took a 50 mg Tramadol and two extra-strength (500 mg) Tylenol and repeated the same at noon. So far so good. I may make an exception on the days I have PT, but I'm not sure yet.

Sleeping on My Side

I can't wait to sleep on my side again!! I've tried it two or three times during the day, just for a short nap with a memory foam pillow between my legs, and within 5 minutes I have to lay on my back.

Hope everyone is having a great day!

 

[sistersinhim]

I can't sleep on my side yet either. I looking forward to the night I can.

 

[Tabbycat]

Hi Bill
Just catching up with your thread, you have had a challenging few weeks. I'm glad you got that testing over and done with quite quickly (I would have freaked out big time over those needles ). Really hoping your problem will be resolved sooner rather than later.
Make sure you continue to take sufficient pain meds to keep you comfortable, not just before PT. I hope you got over your little visit to the ODIC, try not to go there again!
By the way, your garden is lovely.
All the best,
Tabby

 

[uva55]

@Nvstig8tr Bill have you tried the Tylenol arthritis formula 650 mg extended time release? It works much better than the extra strength formula.

 

[Celle]

have you tried the Tylenol arthritis formula 650 mg extended time release? It works much better than the extra strength formula.

If you're going to use the Tylenol arthritis formula, you can only take it 3 times a day (2 x 650 mg =1,300 mg, eight-hourly). Doing it that way would give you a total daily dose of 3,900 mg in 24 hours, which is very close to the recommended maximum of 4,000 mg in 24 hours.

I think that if you're taking Tylenol in conjunction with Tramadol, it is easier to stick to what Josephine recommends, which is 2 x 500 mg = 1,000 mg, 4-6 hourly, to a daily total of 4,000 mg. As long as you take this regularly, you will keep up an effective level in your bloodstream.

 

[Nvstig8tr]

@uva55 and @Celle - Thanks for this information! I had looked everywhere for @Josephine's recommendation but couldn't find it. And it's good to know they make the extended release when Tramadol is no longer needed.

ROM (is driving me crazy!)

My last ROM measurement (four days ago) was 56˚ and I'm really starting to obsess over my progress. I'm meeting with the OS on July 5th and I'm afraid he's going to recommend MUA which I plan to politely postpone; however, what if he takes a hard line and refuses to continue treatment if I don't follow his recommendations? From what I've read here at BS, the consensus seems to be that the MUA is a questionable procedure that, over the long term, does not really provide any significant benefit to ROM when compared with those who have not had the MUA.

 

[sistersinhim]

If your OS turns hard and doesn't respect your wishes, do you need him anyway? I would want someone who was emphatic and would let me be the boss as long as I wasn't harming myself. ROM can come even after a year, as I read on here. There's no rush unless you want it to be!

 

[Tabbycat]

Hi Bill,
I'm right there with you in terms of obsessing about ROM and worry about lack of progress, but when you see your OS in July that will only be one month post op. From what I've read on here, an MUA shouldn't be on the cards until 12 weeks, and even then it's ultimately your decision. @Suz had a similar worry, and hers improved a great deal recently. I'm learning that it's like 'a watched pot never boils', but the more you stress about it the more anxious you become and then you can get into a vicious cycle. Your knee is in charge and will bend in its own good time. Trust that the healing process is going on quietly but surely.
Best wishes,
Tabby

 

[Josephine]

however, what if he takes a hard line and refuses to continue treatment if I don't follow his recommendations?

He can't. Not without your consent. And even if he does want to be hard-nosed about it, you have the upper hand in that he cannot require you to comply.

I had looked everywhere for @Josephine's recommendation

Josephine's recommendation is to take 1,000mg 4 times a day. Personally, I wouldn't take the T Arthritis as you are depriving yourself of the full dose. The only benefit in it is it's made in a tri-layer and each layer is released sequentiality. I don't see any 'magic' in this.

Also, Bill - can I ask you to please not make my name a tag when used in the general course of conversation. Thank you. Of course you are more than welcome to tag me any time you really want my input but otherwise, please don't.

My last ROM measurement (four days ago) was 56˚ and I'm really starting to obsess over my progress.

This comment concerns me: 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)

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?

6. are you elevating your leg, 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. 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
(which means please make a list and not an essay!)

Exercises done at home: (how many sessions each day)
enter exercise then enter number of reps and sets
etc., etc.

At PT (how many times a week)
enter exercise then enter number of reps and sets
etc., etc.

 

[uva55]

@Nvstig8tr bill don't stress about so much, it will happen in due time, if you ask your doctor for more time I don't see why he would be upset!

 

[Celle]

Bill, it's much, much too early to be worrying about ROM. Remember that ROM can continue to improve for a year, or even longer, after a TKR, so you really have all the time in the world. You don't have to achieve a certain ROM by a certain date.
Myth busting: the "window of opportunity" in TKR

Don't let your therapist's timetable or your surgeon's expectations become your targets. Your knee will continue to improve its ROM according to its own schedule. Trying to meet other people's expectations will just make you worry needlessly.

Don't go trying to improve your ROM by working harder, either, because doing that just seems to make things worse.
TKR: work “smarter” and not “harder”

 

[Nvstig8tr]

@Josephine - Here are my responses to your questions. I didn't fully understand how the tagging worked, so I will only use it if your input is needed (like now).

1. what are your pain levels right now? When resting, my pain level is 3-4. When walking around the house with cane, it moves up slightly to 5-6 (with pain meds).

2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often? I take my meds at 6 am, 12 Noon, 6 pm, and 12 Midnight. Currently taking 2 each Hydrocodone-Acetominophen 7.5/325 mg at midnight. For other doses (6 am, Noon, and 6 pm), I'm taking 1 each Tramadol 50 mg and 1 each 500 mg Tylenol.

3. how swollen is your leg compared to these? Slight swelling right now. I was moderate the first two weeks post-op.

4. What is your ROM - that's flexion (bend) and extension (straightness) 56˚ flexion and 12˚ extension.

5. are you icing your knee at all? Yes, I have a Polar Care Cube and usually ice 2-4 hours in the morning and again 2-4 hours in the late evening.

6. are you elevating your leg, how often and for how long? Yes, I use four stair-stepped pillows on the couch with head supported by a relatively flat pillow. I wear compression hose (knee-high), then wrap my leg with 6" Ace bandage all the way up to thigh joint. Wrap stays on about 6 hours. Elevation three to four times daily for at least an hour each time.

7. what is your activity level? I walk around the house 8 to 10 times per day. I try to walk the perimeter of our cul-de-sac (about 100 yards) on a daily basis. Shower every other day. Drive myself to PT 3 days per week (about 5 minute trip).

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
(which means please make a list and not an essay!)

Exercises done at home: (how many sessions each day) enter exercise then enter number of reps and sets etc.

• Heel slides 2x daily (5 times each set)
• Foot/Ankle pumps 3x daily (50 times each set)
• Knee bends 3x daily (5 times each set) - Not sure what to call this. I stand at kitchen counter and allow my body weight to push while bending my knees, holding for 5 seconds.

At PT (how many times a week) enter exercise then enter number of reps and sets etc.

• Three 1-hour PT sessions per week.
• Not sure what to call each exercise, but all focus on bending my knee.
  • With heel on an inflatable ball, I use a strap to pull my foot toward me, causing my knee to bend. 10 minutes.
  • While standing at parallel bars, doing the same knee bends I do at home (5 times each set for 3 sets, holding each bend for 5 seconds.
  • Tissue massage for 5 minutes to relieve swelling.
  • Icing/compression sleeve for 10 minutes.
  • Pushing pedals on recumbent bike for 10 minutes.
  • Stretching ham string, heel on ground and foot elevated on a curved platform for 5 minutes.

 

[Suz]

Hi Bill- my flexion has jumped 42*s in only 2wks! On the 14th of June it was 50*s. Yesterday my PT measured me at 92*s with only two hours of gentle exercises from PT since the 14th and very occasional 5 minute gentle stretches at home. I promise- your flexion is there & will return as you continue to allow your knee the time it needs to heal-!

 

[Nvstig8tr]

@Suz - That is SO encouraging to hear! Thanks!

 

[Suz]

You bet @Nvstig8tr, Bill! I really like my surgeon and didn't like going against his lead. It was super challenging for me to attempt common ground with him regarding PT. When he recommended an MUA at 6wks post-op because my flexion was only 50*s I respectfully asked him for a little more time. I hadn't been doing any exercises up until that time but assured him I would begin addressing his concern for my lack of flexion. So many here have a much better flexion outcome at 6wks than I had.

I didn't want to go to an outpatient PT facility but thought maybe it might help. In my recovery journal, (you can access it in the link below in my signature), I detail how I began official PT at 6wks. I pretty much told them how we were going to work things and of course they wanted my business so obliged! I also did allot of research right here within Bonesmart searching out articles and other's exercise patterns post-op. I learned allot in posts from many long standing members but two that stand out in my mind right now are Roy and referee54. Both males with strong physical drives.

At 6wks most of my 'raw' pain had ceased. My knee was just really tight. So I knew it was ok to begin exercising at 6wks to a point of 'discomfort'- my term for a strong stretching/pulling feeling but to stop at anything feeling close to 'raw' pain. I can honestly say I haven't felt pain anywhere near what I felt in the first 3wks post-op. Just a strong stretching & pulling. So I've been good with the 'few' uncomfortable safe exercises with a PT 2xs a wk for one hour in an attempt to dodge an MUA this early in my recovery.

Josephine, our Nurse Director, recently said that an MUA can help get ROM in some circumstances if one can't get an increase by a certain point. That it's a relatively simple procedure with good results if you get to that place of need.

So my mindset after leaving my surgeon's office 2wks ago was this- I'll do it my way for a few weeks and if no improvement, I'll consider his!

He wanted to see me again in two wks and that appointment was actually this morning! I read your concerning post while sitting in his reception area and responded my above post with my iPhone while sitting there- haha! When I was called back he was ecstatic that I had made such an improvement and praised my efforts. The MUA is off the table and I see him again in 2 months for an X-ray and check to make sure things are progressing along affectively!!

I'm a month ahead of you in my replacement. You've still got some time on getting that flexion back Friend! I didn't do anything but elevate and ice for 6wks then started my PT! I felt guilty about it at times but decided to let my knee heal first. So glad I did because she was ready to go to work at 6wks!

 

[newlybionic]

IMO I think you are actually doing too much PT. three times a week is a lot. I could never handle more than twice a week if I had that much at all. I did not squats at all. My flexion prior to my revision was only 95. After my revision ( that's where they have to remove all the hardware, smooth out the bone and hammer in longer stems) I measure 110 at 4 weeks out, 127 at 11 weeks out and I'm even past that now. My extension has slowly increased to about 3 now. Take a week off, ice and elevate as much as possible and I'll bet you will see improvement.

 

[Nvstig8tr]

Thanks for all the input. I cancelled my 3rd PT session @newlybionic as you confirmed what I was already thinking.

@Suz - I was able to read your entire journey and I am so appreciative of the time you invested in the effort to chronicle your recovery! Thanks! You've encouraged me greatly and I plan to decline the MUA if my OS brings it up on July 5th. Sounds to me like I could put him off for at nearly 8 more weeks before I have to make a firm decision on the MUA.

The Morning Adventure

I had PT this morning at 8:00 and another therapist stood in for my usual guy. Just when I thought I had one therapist broken in, I had to put my foot down SO many times this morning and the guy was very argumentative and condescending. He literally said, "No pain, no gain!" I laughed and advised him, "I don't subscribe to the NPNG!" Every single exercise involved bending my knee in an effort to obtain more ROM. I finally asked him what difference it made whether I spent an hour on the exercise bike or six 10-minute sessions doing other exercises that duplicated the same movements. What a racket! And he stayed so far across the room, it would have required shouting to get his attention; and it was obvious he was avoiding me like the plague, probably negatively briefed by my regular therapist.

After PT, I planned to stop at Winn-Dixie Grocery Store for a few items. It's only 1/4 mile from the PT facility. As I turned in, I noticed a nail salon and popped in to inquire about getting a pedicure. I normally go every other month with my wife (she goes monthly), but she didn't think I would be able to soak my feet in the foot tub because of my limited ROM. The manager took me to a chair that had a large fixed column right next to it, so I stood in the foot tub, holding the column with my right hand and my cane in my left hand. They were very accommodating and my feet feel/smell/look better.

Then I spent an hour in the grocery store, picking up some things for the next couple of weeks. Yes, my wife always asks if she can bring me anything when she makes the rounds to all the stores, but I can never remember everything. You just have to troll the aisles!

Got him at 12:00 noon, had a sandwich, took my meds, loaded up the Polar Care Cube , and I hope to stay ahead of the pain that may result from my 60-minute PT session!