KarriB
Former BoneSmart staff member
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TKR Careful! There Be Dragons Here! <
- Thread starter Nvstig8tr
- Start date
What wonderful information and ammo for us who are defending the bonesmart way.
OP
OP
Nvstig8tr
junior member
Yes! Thanks for everyone's contributions!
OP
OP
Nvstig8tr
junior member
Four Weeks Post-Op Today!
Pain Management: Still taking 2 Tramadol & 2 Extra Strength Tylenol every 6 hours for pain. I'm nearing the point where I could "get by" on 1 Tramadol, but I haven't made that transition yet. Too much activity can really send me the other way, as I found out on Sunday when I cut my front lawn on the riding mower (zero-turn, so no pedals involved), cooked enough food on the grill to feed 19 people, and walked a bit more than I should have done. It took complete rest on July 4th with a lot of elevation and icing to get my knee back to how it normally feels.
The New Knee: There is still a lot of numbness on the top of my knee, near the incision, and the skin/tissue seems hard as a brick. My range of motion (ROM) is around 60Ëš right now and I am able to walk freely around the house without requiring a cane or walker. Just to be safe, I always carry the cane when I go outside or on short trips around town (doctor & very limited shopping). I have my 4-week post-op visit with the orthopedic surgeon today and I'm hoping he will be satisfied with my ROM progress, since two weeks ago he estimated that I was 30Ëš- 35Ëš ROM.
Physical Therapy (PT): I'm done with any formal PT and I plan to begin walking as my primary exercise with limited use of a recumbent exercise bike (cannot make full revolutions yet) until my ROM has progressed to the point where I can ride the bike as my primary activity.
Hope everyone enjoyed a wonderful Independence Day celebration! We hosted our three daughters, three sons-in-law, ten grandchildren, and one other person for a cookout on July 3rd, complete with fireworks. Everyone wanted to keep the 4th as a day to relax at home.
Pain Management: Still taking 2 Tramadol & 2 Extra Strength Tylenol every 6 hours for pain. I'm nearing the point where I could "get by" on 1 Tramadol, but I haven't made that transition yet. Too much activity can really send me the other way, as I found out on Sunday when I cut my front lawn on the riding mower (zero-turn, so no pedals involved), cooked enough food on the grill to feed 19 people, and walked a bit more than I should have done. It took complete rest on July 4th with a lot of elevation and icing to get my knee back to how it normally feels.
The New Knee: There is still a lot of numbness on the top of my knee, near the incision, and the skin/tissue seems hard as a brick. My range of motion (ROM) is around 60Ëš right now and I am able to walk freely around the house without requiring a cane or walker. Just to be safe, I always carry the cane when I go outside or on short trips around town (doctor & very limited shopping). I have my 4-week post-op visit with the orthopedic surgeon today and I'm hoping he will be satisfied with my ROM progress, since two weeks ago he estimated that I was 30Ëš- 35Ëš ROM.
Physical Therapy (PT): I'm done with any formal PT and I plan to begin walking as my primary exercise with limited use of a recumbent exercise bike (cannot make full revolutions yet) until my ROM has progressed to the point where I can ride the bike as my primary activity.
Hope everyone enjoyed a wonderful Independence Day celebration! We hosted our three daughters, three sons-in-law, ten grandchildren, and one other person for a cookout on July 3rd, complete with fireworks. Everyone wanted to keep the 4th as a day to relax at home.
KarriB
Former BoneSmart staff member
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Rocking back and forth a bit every day on the recumbent bike will help to finally get it around and with ROM.
Bill, great that you're quitting PT. You'll be fine. I know, cause I've 'been there and done that'! Friday was the first time I could make a full revolution backwards. Forward it is way too painful to try going all the way around yet. I don't understand why it's like this, but it is. You might want to try backwards first. And you are cutting your grass again! I am still afraid to try that. I have about an acre that is cleared and quite a few bumps on it. It bothered my knee even before my tkr. Thank God my roommate is cutting it for me. She said not to worry about it, that she'd continue do it as long as I needed her to. I am blessed!
Sounds like your 4th on the 3rd was a lot of fun! We went geocaching and then Marilyn cooked some turkey burgers on the grill yesterday. It has rained every day this month, so far, and yesterday was no exception, but we were still able to get out of the house for a few hours. Every outing is that much closer to being normal again!
How are you feeling today?
Sounds like your 4th on the 3rd was a lot of fun! We went geocaching and then Marilyn cooked some turkey burgers on the grill yesterday. It has rained every day this month, so far, and yesterday was no exception, but we were still able to get out of the house for a few hours. Every outing is that much closer to being normal again!
How are you feeling today?
Happydale
senior
Wow, Bill - it sounds like you're doing really well despite the various challenges you've faced along the way. By comparison to mine, your July 4th celebration was an out and out blow out! That size of a crowd and that much hosting would be out of the question for me right now!! Glad you had a great 4th.
I wanted to weigh in on the questions you posed about PT. Like you, I was having a very difficult time trying to understand why my doctor, PA, nurse practitioner, and 5 PTs (3 in the hospital and 2 at my home) all told me to do the exercises, and BS was saying the opposite. I spent a long time looking at the PubMed website to read scientific articles on the topic. It is difficult to go against directions from the medical staff I chose and trust. I wanted some scientific evidence to show them. The conclusion I drew from the research articles I read was this:
1. Rehab after TKR is an under-studied aspect of joint replacement research. Much more is needed! Maybe that explains why there are such different expert opinions about the best way to rehab.
2. Compared to TKR outcomes even 10 years ago, today's TKR patients are doing really well and way better than they used to, regardless of rehab approach. We are lucky to be doing this now!!
3. Some research seems to conclude that aggressive rehab after TKR does not do harm. (My thought - SO WHAT? Who wants to put themselves through agony if they don't get way better results by doing so?)
4. It seems like physical therapy may help patients achieve rehabilitation somewhat sooner than those who do much less physical therapy. For me, I am not in any big rush. I am trying to avoid pain and suffering. If I was trying to return to a professional career in sports, I may be pushing myself more than I am now.
5. One hospital studied whether two PT sessions a day in the hospital improved outcomes over one session per day, and they concluded it did not make any difference long term. I'm not sure if this can be extrapolated to post-hospital rehab, but it is something to think about.
6. I believe several studies concluded that around 94% of TKR patients gain sufficient ROM to move as they want when it is assessed one year post op. So chances are really good that we'll be great no matter what!
After my own reading of these articles, as well as all the advice on BS and from my medical team, I came up with my individualized approach. I am so determined not to be in pain, and so many BS folks (yourself included!) have warned me about the Over-Did-It-Club. I am trying very hard, and thus far succeeding, in not doing too much. I am doing the exercises my PT gave me, but I had her just show me how to do them and told her I'd work on them on my own. When she visited, I showed her how I was doing them, so she could correct me if it was wrong. I started very slowly, and I build up just a little bit more each time. I am doing exercises 2X/day. I'm a bit uncomfortable right when I finish (each session is almost an hour!), but if I ice and elevate right away I get instant relief. If the discomfort continues whatsoever, I would cut back, but that hasn't happened.
I think maybe one of the reasons this approach seems to be working FOR ME, is that I have two to three adults nearly full time waiting on me hand and foot. (Embarrassing but true!) I think if I was doing all the necessary tasks myself, like laundry, meal prep, dog care, etc., then I wouldn't do as much PT. You, on the other hand, are amazing to me with the energy you have to mow the yard, drive yourself around, BBQ for a crowd, etc. So maybe in your case, that's enough. As long as we're seeing improvement based on what we're doing, and we're not hurting ourselves, we're probably good. You have really helped me prepare myself for how I will talk to outpatient PT. I'm always so compliant, and you are a good example of someone who has stuck up for himself. I'm sorry this post was so long! I would have preferred to have a chat with you in my living room, but writing will have to do!
I wanted to weigh in on the questions you posed about PT. Like you, I was having a very difficult time trying to understand why my doctor, PA, nurse practitioner, and 5 PTs (3 in the hospital and 2 at my home) all told me to do the exercises, and BS was saying the opposite. I spent a long time looking at the PubMed website to read scientific articles on the topic. It is difficult to go against directions from the medical staff I chose and trust. I wanted some scientific evidence to show them. The conclusion I drew from the research articles I read was this:
1. Rehab after TKR is an under-studied aspect of joint replacement research. Much more is needed! Maybe that explains why there are such different expert opinions about the best way to rehab.
2. Compared to TKR outcomes even 10 years ago, today's TKR patients are doing really well and way better than they used to, regardless of rehab approach. We are lucky to be doing this now!!
3. Some research seems to conclude that aggressive rehab after TKR does not do harm. (My thought - SO WHAT? Who wants to put themselves through agony if they don't get way better results by doing so?)
4. It seems like physical therapy may help patients achieve rehabilitation somewhat sooner than those who do much less physical therapy. For me, I am not in any big rush. I am trying to avoid pain and suffering. If I was trying to return to a professional career in sports, I may be pushing myself more than I am now.
5. One hospital studied whether two PT sessions a day in the hospital improved outcomes over one session per day, and they concluded it did not make any difference long term. I'm not sure if this can be extrapolated to post-hospital rehab, but it is something to think about.
6. I believe several studies concluded that around 94% of TKR patients gain sufficient ROM to move as they want when it is assessed one year post op. So chances are really good that we'll be great no matter what!
After my own reading of these articles, as well as all the advice on BS and from my medical team, I came up with my individualized approach. I am so determined not to be in pain, and so many BS folks (yourself included!) have warned me about the Over-Did-It-Club. I am trying very hard, and thus far succeeding, in not doing too much. I am doing the exercises my PT gave me, but I had her just show me how to do them and told her I'd work on them on my own. When she visited, I showed her how I was doing them, so she could correct me if it was wrong. I started very slowly, and I build up just a little bit more each time. I am doing exercises 2X/day. I'm a bit uncomfortable right when I finish (each session is almost an hour!), but if I ice and elevate right away I get instant relief. If the discomfort continues whatsoever, I would cut back, but that hasn't happened.
I think maybe one of the reasons this approach seems to be working FOR ME, is that I have two to three adults nearly full time waiting on me hand and foot. (Embarrassing but true!) I think if I was doing all the necessary tasks myself, like laundry, meal prep, dog care, etc., then I wouldn't do as much PT. You, on the other hand, are amazing to me with the energy you have to mow the yard, drive yourself around, BBQ for a crowd, etc. So maybe in your case, that's enough. As long as we're seeing improvement based on what we're doing, and we're not hurting ourselves, we're probably good. You have really helped me prepare myself for how I will talk to outpatient PT. I'm always so compliant, and you are a good example of someone who has stuck up for himself. I'm sorry this post was so long! I would have preferred to have a chat with you in my living room, but writing will have to do!
Josephine
NURSE DIRECTOR EMERITA
Bill, Bill, Bill! Did you not read this recovery article? Activity progression for TKRs
You know what that's called - swelling !!
Does anybody ever look in the Library? Numb area after TKR: how long will it last?
This article is in the Library! TKR: Evidence shows that less really is more when it comes to exercising!
We haven't heard from you in a few days. How are you doing?
This is normal and will go away over time as the swelling decreases. I hope you've been taking it easy after that busy 4th. Extra TLC for that knee.
tpellerin
junior member
Party for 19 was impressive! I couldn't have pulled that off. Party for two would be my speed at this point.
OP
OP
Nvstig8tr
junior member
Sorry I've been offline for a couple of days. The 4-week post-op visit with my OS went well, although he mentioned that he wanted to schedule an MUA. I told him that I would prefer to wait before making that decision, in order to allow my ROM to improve on its own timetable. He seemed okay with that and said, "It's ultimately your decision. That's fine if you want to wait."
I've had three or four days in a row where I have slept at least 4 hours at a time, which is amazing and SO welcomed after 4 weeks of sleep deprivation. I'm resting a LOT and icing/elevating much more than usual (4-5 hours per day) and my stride seems to be much more natural than a few weeks ago. Seems like I'm the brink of a breakthrough in my ROM...hope so!
Took my truck to the Chevy dealership this morning for a routine oil change (about an hour sitting in the waiting room), then home for ice therapy and long naps, and then out to dinner at Texas Roadhouse with my wife and one of her co-workers/friends. We sat in a booth so that I could extend my surgical leg for comfort. We were out for about two hours and now home with ice/elevation again.
I need to get caught up on reading everyone else's progress! Hope you're all doing well!
I've had three or four days in a row where I have slept at least 4 hours at a time, which is amazing and SO welcomed after 4 weeks of sleep deprivation. I'm resting a LOT and icing/elevating much more than usual (4-5 hours per day) and my stride seems to be much more natural than a few weeks ago. Seems like I'm the brink of a breakthrough in my ROM...hope so!
Took my truck to the Chevy dealership this morning for a routine oil change (about an hour sitting in the waiting room), then home for ice therapy and long naps, and then out to dinner at Texas Roadhouse with my wife and one of her co-workers/friends. We sat in a booth so that I could extend my surgical leg for comfort. We were out for about two hours and now home with ice/elevation again.
I need to get caught up on reading everyone else's progress! Hope you're all doing well!
OP
OP
Nvstig8tr
junior member
Bill, your thread title is changed. 
Tabbycat
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Well done Bill, it's great when you get more sleep, and it's so important for healing. You must be relieved after your appointment, I know you were a bit anxious about the threat of an MUA, but it would be much too soon. The ROM will come in its own good time. You are doing the right things, icing and elevating as much as you can. My ROM which I've worried about for a long time now, has gradually crept up to about 100 at just over 11 weeks, but it seems like yours is improving already. You will get there!
Tabby xxx
Tabby xxx
KarriB
Former BoneSmart staff member
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Recovery is all about making accommodations to allow yourself a little bit of a normal life at this point. Keeping your leg up whenever possible is one accommodation I found that helped me do a few "normal" things. Good to hear you feel things are going well.
dianehelen
supremo
@Nvstig8tr love your new title, but took me a while to find it and realize it was you so im a bit behind. Sounds like you are making progress but almost seems conflicting to me how much you are doing compared to the pain and swelling you are dealing with. Hope you continue to improve.
So annoying with all we have to deal with, we have to battle with PT people. But keep up the good fight.
As for your title,
is that a Game of Thrones reference? (Huge fan, I SOOO want a dragon)
As I start to countdown to my surgery, very scared and apprehensive, I will keep following your progress and hope to hear daily improvement.
Also thank you for the mention of acorn.tv I had not heard of it and really enjoying it.
So annoying with all we have to deal with, we have to battle with PT people. But keep up the good fight.
As for your title,
is that a Game of Thrones reference? (Huge fan, I SOOO want a dragon)As I start to countdown to my surgery, very scared and apprehensive, I will keep following your progress and hope to hear daily improvement.
Also thank you for the mention of acorn.tv I had not heard of it and really enjoying it.
OP
OP
Nvstig8tr
junior member
@dianehelen - Thanks! I was a cartographer (map draftsman) for the U. S. Air Force during the Vietnam War. "Here, There Be Dragons" is a phrase found on some of the earliest medieval maps, which were often very crude and based more on superstition than science/facts. The earliest appearance of this phrase was found on the Lenox Globe produced in 1510. Since we are in uncharted waters, so to speak, when we go through our first TKR, I thought it was an appropriate phrase for our adventure.
