TKR Chasing 90 degrees ... LTKR 12-11-13

[Josephine]

The swelling is better but I thought as it went down my ROM would improve.

My hamstrings are soooo tight... As are my calfs (and) I am starting to feel tightness around the knee

You do realise these two comments and contradictory? Swelling occurs on the inside as well as outside. Only sneaky thing is that you can't see the inside stuff. So the tightness is ...... swelling!
Also, swelling and tightness are also manifestations of pain! So treat your pain.

Other types of pain include soreness, burning, stabbing, throbbing, aching and stiffness.

 

[sportsgurl]

Josephine,

Thank you... I guess I didn't connect the dots on that. That is why I love this site... Everyone is so helpful!
Yeh, this swelling sure causes pain.... On the advice of many who have given me advice here, I am treating the pain and not pushing. The knee does as much as it wants ... PT has been good they are not forcing the ROM... They have started me with electric stim to get the quad going, which has helped!!! I am celebrating the victories..and trying not to dwell on time... I know I will progress... Albeit I wish a bit faster!! I am seeing my surgeon next week for my second postoperative appointment...... I am told he wants me at 90 degrees and zero... We will see.. I am not there yet with PT....

Thank you so much for the information..

 

[Josephine]

I am seeing my surgeon next week for my second postoperative appointment...... I am told he wants me at 90 degrees and zero

oh does he?! Hope you will tell him that neither you nor he is in charge of this - the knee is! And at 6 weeks too - my life! He needs to learn patience!

I'm also going to get our ski-queen here to talk with you! @skigirl

 

[maryo52]

I'm curious as to how your doctor's message was delivered to you. Was it your PT? Was it the doctor himself? I wonder if the doctors actually have that thought or someone else uses it as "motivation"?

I cannot tell you how many people on here have heard a similar threat. And you know what good it does? None at all, and in fact, it is harmful. If anyone had said that to me and made me push my knee as a result, it would've resulted in exactly zero gain and probably a fair amount of backslide.

Whoever said that to you, think about a response because they need to hear that such statements are inappropriate and unhelpful. WE are the patients; they are our hired professionals. WE do not perform for them; they perform for us. And they should do better than issue cheap threats!!

Sorry for the rant!!! I've just heard this too many times from forum members.

 

[skigirl]

I, of course, will chime in to take it easy. I had two knees done---the first one I was gung ho. after all, I had bounced back from other surgeries and I was pretty strong. I pushed and pushed. By three months, I could ride my bike outside.

With my second knee, I just laid around a lot. I NEVER did any exercises at home at all. i did the ones at outpatient pt which were mostly table stuff--leg lifts, clam shells, etc. My pt never caused me any pain and I never took a pain pill to go to pt EVER!! I think that is a bad idea as you can push your knee too far and make it swell more.

With my second knee--I rode my bike outside at 8 weeks. Lesson learned!!!

I have skied with both knees after six months. My balance is so much better with my new knees that I ski better with them than I was skiing before the surgery.

I did not do any strength training until my quad was firing on it own---I started working out more at 8 weeks. Before that, the knee needs to heal, it will not gain strength because the quad is not firing properly.

Now is a time to get some good books and lie around a lot with your knee elevated and rest until that swelling goes down. I think if you push too much and are up too much, the swelling gets entrenched and it is harder to get rid of. But, until the swelling goes, your knee will complain about too much activity, so just give in and rest for a week or two. It feels good to surrender and let the knee have its way!!!

 

[sportsgurl]

Thanks everyone! Really! It was not the doctor but his PA who told me the doc wants me at 90 and zero when I see him. I will of course ask him this next week when I see him. I agree with you all that the knee is on its own schedule and this darn swelling precludes the bending of it.

I was surprised to hear that I should not take the pain medication before PT... Made good sense until now.

Today's PT was marginal due to the swelling but I did tell the therapist not to push my knee and she didn't. She gave me ice and electric stim for my quad ( still trying to get it to fire up better).

Question..... How long should I be walking with the cane? Is it one of those as long as it takes?

 

[Campervan]

Yep, walking with the cane is one of those things that its as long as it takes. I had elbow crutches and never went to a cane unless you count my hiking poles. I was told to use both crutches until I was walking correctly without limping. I stopped using them around the house at maybe a month post op but I was definitely still using them outside at 8 weeks. I did then go to one crutch and then to hiking poles more for my own peace of mind rather than needing them. After a while I would wander around town with the hiking poles in my backpack thinking I would need to use them and then I realised I was just carrying them around with me and never using them. The crutches also stayed in the car for months until I finally let my husband stash them in the loft.

 

[skigirl]

sportsgirl, what I meant was that I took my pain meds by the clock---I never took one especially for pt. So, if I had pt at 8 am and my last pain med was 4 am, I never worried about it. But, and I do think this is important--I never had any pain in pt. So, I did not have to medicate myself. If you feel the need to take a pain med before pt then I think the pt is too much for where your knee is at that time. Especially not so that someone can "push" on your knee which will cause pain and swelling.

 

[Jamie]

Walking aids are very important to a successful recovery from your TKR. They are just as the name implies....an aid to help you regain your normal gait. Therefore, it's important that you use them as long as you need them. The rule of "needing" whatever aid you're using (walker, crutches or cane) is....don't give it up until you can walk at a normal gait with no limp. This means if you move from a walker to crutches or cane and you are limping when trying to walk with the crutches or cane....it's too soon to make that switch.

We all want to move to unaided walking as fast as possible, but this is not the time to try and hurry the process. Take your time. You and your new knee have a lifetime to enjoy together and you need to give yourself the best possible beginning to that long-term relationship.

 

[Mimi]

Jamie this is very sound advice. I was on my walker for 3 months due to an infection, swelling and quads that were not firing. I was on a cane for about 6 weeks. However, the end result of all of this is an excellent walk! I worked very hard at the heel first roll to the toe walk because I had to learn to walk all over again. I needed to take time to get this walk and it is so worth it! Patience and time are what is needed in a TKR recovery. No knee will heal before its time! So listen to your knee.

I have a friend that was so happy that he got rid of his walker after 2 weeks and never used his cane. That was over a year ago and to this day he shows some limp and has a very shaky walk. He pushed through his recovery and never did get a good walk.

 

[bottomshollow]

Patience and time are what is needed in a TKR recovery. No knee will heal before its time! So listen to your knee.

Oh, @Mimi, if we could only get others to get this, absorb and internalize it, many would be happy campers so much sooner. Yes, @sportsgurl, use that cane until you can walk with no limp without it. May seem like a pain in the knee now, but you'll be very pleased down the road.

Take care and keep us posted. We care.

 

[Jamie]

Mimi....you are right on target!!! Except your post had the added oomph of a real-live personal story! Thanks so much for posting it because I think this point about how to use walking aids is often misunderstood or completely overlooked in everyone's hurry to get well as quickly as possible.

 

[maryo52]

Your knee is boss. That's the basic answer to every TKR question!

 

[sportsgurl]

Hi all,
Week seven.. Saw my doc who said my knee is a bit behind in the bending area.( can get to 90 with to PT pushing it) ..he said its a race between ROM and adhesions.... I am praying not to have adhesions, I am petrified to have to have a manual manipulation!! Still walking with my cane, Rosie ( it is pink with roses on it) but making small improvements.... But still limping when I walk without it. I begin PT in the pool this week praying it helps ROM. This weather is kicking my butt with feeling stiff and being restricted with the snow and ice with getting outside.
I have learned this knee is the boss and its on its own schedule :rolleyes:
Does anyone have information about adhesions?mis there anything I can do??

Thanks again to all of you , you are life savers!

 

[maryo52]

I have lots of information -- mainly, that they do not entirely know why they occur or have very good treatments. So it's a watch and wait game for you . . . the manipulation sounds like a repeat of surgery and all the riggamaroll, and I dreaded the possibility. But then I had to have one and it wasn't bad at all.

Mainly, if you have adhesions, pushing your knee -- doing any PT that hurts -- will feed the inflammation, and the inflammation is the setting where adhesions occur. So instead of trying to make our knees bend, we have to be really patient and settle down the inflammation as much as possible to allow the knee to find its bend. If adhesions are holding things up, there is really only the manipulation for solving that.

 

[sportsgurl]

Hi folks! Just wanted to updated all of you that have been so helpful to me. This week will be three months since my surgery and my numbers are as follows ; flexion 105 degrees and extension is -5. Still have swelling on around the knee that is causing pain and precluding ROM. I started pool therapy (jury is still out on benefit) and I am able to walk without a cane, slowly. My quad is still not doing its part , it is weak and not firing as expected.

As you all promised I am making progress, albeit slow... Slow. I think I need to get tom110 degrees to considered functional, is that true? Stairs are still elusive. I can not hold my weight to go down the stairs yet ... I was thinking by this stage in the game I would be able to.....

Thanks to all who have been interested and helpful to me thus far. You may have no idea how helpful this forum has been to me.

 

[maryo52]

I was thinking by this stage in the game I would be able to.....

That there is the rub. It's at the heart of why almost all of us join this forum.

Great progress. 105 will be 110 or 115 as the swelling subsides, and in time 120 and so forth. Mine improved for two years. (You wouldn't want to peak too early!)

Going down stairs is always one of the last frontiers, for reasons I've never understood.

 

[Mimi]

Hang in there sportsgurl!! You are making progress. Sometimes it takes longer than others. I was right where you are at 3 months. I was still on a walker and my quads did not work. I had horrible swelling due to an infection at one week out and too much PT. My swelling only went down when I stopped PT and then my ROM increased. At 3 months my ROM was like yours also. Remember, it is never too late to gain ROM. I just gained 13 degrees extension to take it to 118. And my knee continues to improve at almost 3 years out. Don't lose hope cause it all will come in time. No knee heals before its time....I truly believe this! Good luck!

 

[sportsgurl]

Hello all,
I know I have been absent as of late , I have been back to work and going to PT and this burns a day up fast!
I haven't made progress in my ROM I am still at 105.... Ughh... But I am starting to feel stronger. I am slowly working on stepping leg over leg down the stairs .... Soooo scary!

I have a question ( of course!) I am still needing pain meds at night is this typical? My surgery was December 11th and I still take two Percocet at night, and that does not get me through the night but I won't take another when the pain wakes me. My pain levels at night are around a 6.... The sweeling is going down but my quads and ITB are tight still as well as I am finding as I am trying to do more the knee swells and it plain hurts!
Should I be off the pain meds by now? I am worried I am still on them and will it be hard to get off them?
Has anyone had experience with this?

 

[DogLoverx3]

Hi Sportsgurl, I had RTKR the week after you and, like you, I'm kind of in the remedial class for recovery (darn it). I used to worry about having to take pain meds so long and kept trying to switch off everything aside from Tylenol. Guess what? They don't give any awards for being able to go off pain meds before you're ready. Who knew? ;-) Some people don't need anything past 4 weeks, I, like you, need them longer. I still need to take Tramadol at night before bed. Bedtime is hard as our new knees get to punish us for all we put them through during the day. So in answer to your question, take your pain meds as long as you need them. There is no set schedule or right or wrong. I wouldn't worry about having withdrawals from the Percocet, but if you're really worried, maybe speak to your OS or PC about switching down to Tramadol or something else?

Have you looked in the library on here for IT Band exercises? They're good ones. Keep up the great work - you're doing just fine!