TKR Careful! There Be Dragons Here! <

[kneeper]

The Polar Cube is your friend. particularly after another trip to the ODIC --PT and the grocery store with a baby knee not a month old?

 

[Suz]

OMG- I LOVE THIS Bill:

I laughed and advised him, "I don't subscribe to the NPNG!"

I'm nominating you for our new Anti-PT Forum Coordinator-! What a great response-!! I bet you received more effective flexion therapy getting your pedicure & trolling the isles at the Winn Dixie-!!

I loved your post just now- what a great 'No-Pain-Flexion-Gain' example you are to us now-! I'm looking forward to following your recovery! I just know you're flexion increase is about to happen! BRAVO-BRAVO!!

 

[sistersinhim]

Good for you sticking to your guns and putting that therapist in his place! Everyone of them need to be trained in rehabbing a TKR knee!

 

[Tabbycat]

They need to go through a TKR themselves, then they would change their tune. Well done for putting them right!

 

[Josephine]

1. 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).

Okay

2 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.

That's a very poor medication routine. You really need to take more and I suggest Tramadol 100mg + Tylenol 1,000mg 4 times a day. This is the routine I used for my knee and it was very effective. Try it and see if it helps. I would also recommend it with the 2am dose as it breaks up the night.

3.Slight swelling right now. I was moderate the first two weeks post-op.

Very often there is swelling but it's not immediately visible. That's internal swelling which can be every bit as obstructive and the external type.

4. 56˚ flexion and 12˚ extension.

Considering you are barely 3 weeks out, that's okay.

5. I have a Polar Care Cube and usually ice 2-4 hours in the morning and again 2-4 hours in the late evening.

You could ice more

6. 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.

You could also elevate more.

7. 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).

You never said how long each of these walks take but even if they are 5 mins each, that's a bit too much. Restrict your in home walking to just 'as needed' activity such as the bathroom and kitchen for drinks and snacks.

My comments in bold
Foot/Ankle pumps 3x daily x50 - these are just anti-clot exercises and given the amount of activity you already have, these are now unnecessary

Heel slides 2x daily x5 - heel slides are terribly easy to do badly and doing just two sessions a day is badly! Read this Heel slides and how to do them
Knee bends 3x daily x5 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 - they are squats and an exercises I have never felt to be very good for knees. I suggest you stop doing them

Three 1-hour PT sessions per week. Not sure what to call each exercise, but all focus on bending my knee - exactly! And one flexion exercise is plenty for any session
heel on an inflatable ball, I use a strap to pull my foot toward me, causing my knee to bend x10 minutes
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 - these two are not good for so early in your recovery
Pushing pedals on recumbent bike for 10 minutes - considering your low ROM, it's not surprising that you are unable to do a full rotation. But rocking the pedals is good to start with. Just don't push to make that full rotation until it just happens on its own!

Stretching hamstring, heel on ground and foot elevated on a curved platform for 5 minutes - you have tight hamstrings then?

Tissue massage for 5 minutes to relieve swelling, icing/compression sleeve for 10 minutes - these are okay
My overall opinion of this is that you are doing far too much and this is keeping your flexion back. I think quite probably you have been doing far too much since day one! I strongly suggest that you give yourself a total break from all forms of exercise, both at home and PT, for at least 3 weeks. See if that doesn't get your ROM improved some. But you must focus on more rest, elevation and better pain management.

 

[pdx]

@Josephine might have thoughts on this, but wondering whether keeping your leg wrapped for six hours' straight (though I understand compression) could be contributing to the ROM issue. Just a thought. Hope things improve for you.

 

[Josephine]

@pdx I can't see where this is mentioned - can you quote that part of the post where it is mentioned?

 

[newlybionic]

@Josephine He mentions the Ace wrap on top of compression stockings for six hours in the answer to your question number 6. I too was thinking that if the ace wrap wasn't needed in addition to the compression hose especially if it is not applied correctly and if he is wearing that when being measured it would give a much lower flexion than he might really have.

 

[Josephine]

Oh I get it - thanks Marian. And I quote it!

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.

I think pdx has a point, Bill. Keeping your leg straight for 6 hours is not a good idea.

 

[pdx]

Suggestion #2 -- Take the Ace bandage in and ask the PT to go over wrapping technique & how often to loosen it (or whether to loosen) to do heel slides/whatever.
Suggestion #3 -- Ask about switching to support hose, size XXL or ??? I bet they make something that would fit you.
Suggestion #4 -- Drink lots and lots of water. Sounds backwards, but it really helps flush out fluids.
Hope you continue to improve.

 

[Nvstig8tr]

Strange Thing Happened Last Night (Accidental Manipulation)

I had my leg propped up really high on the couch while icing my knee with the Polar Care Cube and watching television. My surgical leg was parallel to and closest to the front of the couch. At some point I fell asleep and then my leg slid off the stack of pillows. Obviously, the weight of my leg and the ice pack caused a pretty quick descent, approximately 3-4 feet to the floor; and to my horror I woke up and tried to stop my leg before it could hit the floor. I swear my leg must have flexed to 90˚ or more!! It hurt like hell for a couple of minutes, but I felt that something had broken loose (in a good way) inside my knee. The rest of the evening and today, I have felt some type of release that may have given me a little more flexion.

Fired by My Physical Therapist!

Because of what happened last night, my leg felt very stiff and a little sore this morning, so I called at 7:00 am to cancel my 9:00 am PT appointment. They put the Physical Therapist on the phone and he advised me that he thought it was a waste of my time and his time for me to continue coming into the facility for outpatient PT. He also told me that he had contacted my OS and shared with him that I had been a very difficult patient and unwilling to permit them to do their job. I'm sure I'll hear all about it next Tuesday morning when I see my OS again. Funny thing is, I had already decided that I did not plan to EVER go back to this physical therapy facility or any other PT facility.

 

[sistersinhim]

Bill, don't worry about what PT said about telling on you. Mine also said the same thing and my OS never mentioned it when I saw him Tuesday. Those pt are full of it and all they care about is getting your insurance money. Your therapist was hoping you'd cave in and come back and do it his way. There are some wonderful therapists out there, but our fellow bonies sure have run into some that are not so wonderful.

 

[charmed-life]

Maybe that's what you needed - an accidental manipulation! Hope it feels better and works better after loosening a little tissue!


Sent from my iPad using BoneSmart Forum

 

[uva55]

Ouch Bill...this falls under "don't try this at home", are you billing the insurance company for the at home MUA?

I hope the knee feels better!!!

 

[sistersinhim]

Hooray for your 'free' MUA. All you have to pay now is the pain it causes for the next couple of days. Then you get the benefits!

 

[Celle]

I'm glad you're not going to that PT facility any more, Bill. No PT is better than bad PT.
As for your therapist threatening to tell your surgeon on you - how childish! I'm sure you'll be able to explain to your surgeon if it should be necessary, but probably it won't. All you need to show is that your knee is progressing, with or without PT.

 

[Suz]

Sorry you were treated disrespectful by the idiot PT Bill. Sounds like his and the office he works for has the attitude, 'it's there way or the highway'. You are in so much better hands now- YOUR OWN! As far as your OS, I told mine the way it was going to be regarding PT. I don't know if he hasn't had many patients do that before or what, but when I left we had met on mutual grounds!

Envision your time with your OS as beneficial for your recovery and I bet it will be! Have a restful and iced Saturday-! Looking forward to your new and improved flexion number soon!

 

[FlaGranny]

@sistersinhim & @uva55 - Got my staples removed on Tuesday & the nurse put Steri-Strips along the entire incision. When the OS came into the exam room, he actually advised me to get into a pool or even the Gulf of Mexico (I'm in Pensacola) as early as the next day. He said the incision would be "sealed" within 24 hours of removing the staples. Just to make sure I understood him, I asked "What about these Steri-Strips?" and he said it could take several days for them to fall off on their own, but I could get in the pool before they come off.

I wouldn't be getting into the Gulf of Mexico with any open wounds. Did your OS not hear of the Vibrio problem? Eight illnesses and two deaths recently, all, I believe, from people getting into the water with open wounds. (Ok that was last year, but I heard just a week or so ago of more cases in the Gulf). I'd make sure I was 100% healed before getting in that water.

A link: https://gcrl.usm.edu/microbiology/vibrio.vulnificus.threat.via.wounds.php

 

[sistersinhim]

I still have some slightly opened places and was told to avoid even sitting in bath water. I'd think twice before getting into any water.

 

[Suz]

Good exhortation from you for us all Bill~!