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[TKR] Coming along<<

Discussion in 'Knee Replacement Recovery Area' started by Elad1002, Jan 5, 2019.

  1. Elad1002

    Elad1002 senior
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    Thank God I found this site. Just a little update I've had a lot of starts and stops since my TKR on Nov 27th, 2018. I fell on my but day 2 in hospital, good thing I had some padding. Xray looked good. Stayed 2 nights in hosp because nerve block did not take- much pain. After arriving home, day 4 ended up in ED due to excessive vomiting, wretching and severe headache. I was told was a spinal headache, got rehydrated, recieved wonderful IV morphine and steroids, released feeling soo much better. Once home and on regular doses if Morphine, became severely constipated. Doc told me to use Miralax and mineral oil enemas- did the trick but had to repeat several times.
    Home PT very gentle. Had me mostly walking outdoors. 3 weeks later PT outpatient, not too bad.
    Last week PT decided to get more aggressive, omg, caused pain. I told them to never do that again, and they responded. Still doing all exercises without over exerting. My question now is my kneecap doesnt seem to be tracking properly, started to notice at week 2 . PT seems to think it will resolve with time and quad strength, feels like its catching, causes pain and inability to bend. OS agrees with PT, says I need to strengthen quads. Any one else?
     
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  2. Pumpkln

    Pumpkln FORUM ADVISOR Forum Advisor

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    @Elad1002 ,
    Welcome to BoneSmart, glad you joined us,

    Sounds like you are doing too much, and your knee is letting you know. Your knee is still in the very early stages of recovery, and needs time to heal before you start doing a lot of exercising. Right now walking is best for your knee. Your PT should have given you a few gentle targeted exercises for your knee cap tracking based on what they observe and where you specifically need to strengthen your quads.
    You can say no to PT, Saying no to therapy - am I allowed to?
    We recommend these two gentle activities, during early recovery.
    Heel slides and how to do them and Extension: how to estimate it and ways to improve it .

    Here is your copy of the recovery guidelines, the articles are short and will not take long to read.

    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
    5. At week 4 and after you should follow this

    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.
     
  3. donnag1108

    donnag1108 senior

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    Welcome! Sorry you have had all these problems! I can most definitely identify with the constipation. I spent an entire day in the er because I couldn't go for 12 days. It was misery!! I had become impacted. Now I'm staying on top of that. Miralax and stool softener. When that doesn't work magnesium citrate does the trick. My doctor calls it the big gun of constipation ha! There is a ton of support here and I couldn't imagine making this journey without the folks here!
     
  4. Elad1002

    Elad1002 senior
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    So, since PT yesterday, I have done literally nothing but rest ice and elevate. Theres an annoying little voice in my head that is worried that I will mess up my ROM if I dont continue to stretch but taking this break feels good, actually feels less swollen already. My ROM was 0/110 yesterday, hope it doesnt change. I'm more focused on getting the kneecap tracking properly again, so doing the quad squeezes and straight leg raises- that's it!!! I will also continue the ROM heel slides and chair position according to this site. I'm thinking about only going to PT once this coming week rather than 3x. They are pretty good at listening to my requests.
     
    Last edited: Jan 5, 2019
  5. Elad1002

    Elad1002 senior
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    I cant seem to post photos on this site. My incision line looks great but below my knee cap looks pinkish red, warm to touch with a little pocket of fluid. Not bright red, no fever or pain.or other symptoms of infection. Just wondering if anyone else has experienced this, I'm 5.5 weeks po.
     
  6. Celle

    Celle FORUM ADVISOR Forum Advisor

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    I'm glad you're feeling better after resting, icing, and elevating.

    In these very early days of what is a year-long recovery, you don't need to do a lot of exercise. It's important to allow your knee time to heal before stressing it with lots of exercises.
    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.

    You have very good ROM for so early in recovery and you're not likely to lose it.
    There's no need to rush to get ROM (Range of Motion) because it can continue to improve for a year, or even much longer, after a knee replacement. There isn't any deadline you have to meet:
    Myth busting: the "window of opportunity" in TKR

    PT once a week is plenty. Don't forget that your knee also gets exercise during your activities of daily living.
    You're the boss when it comes to PT, because it's your knee, and I'm glad you've already spoken up when you felt it was too aggressive for your knee.
    Saying no to therapy - am I allowed to?
     
  7. Jockette

    Jockette FORUM ADVISOR Forum Advisor

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    Your ROM will vary, which is normal, so don’t worry about it if the number goes down, it will go back up. Swelling, which changes with activity and resting, will affect that “number.”

    It can also vary because that little instrument they use to measure is not an exact measurement, they just hold it up next to you.

    They go on and on about a “number” that can change even from person to person who measures you.

    Keep in mind, where you are now is not where you will end up!
     
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  8. Elad1002

    Elad1002 senior
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    Thanks for your response. My concern now is that below my knee is still pinkish red, a little pocket of fluid and warm. Does not look red or terribly inflamed, no fever or chills. Just wondring if anyone else has experienced this. Its not new just hasn't returned to normal color yet. Top part of incision looks great.
    Should I be concerned? By the way. When they unwrapped my knee for the first time at 2 weeks, they revealed a quarter sized popped blister, probably a reaction to the dressing. They used isosorb and but me on an oral.antibiotic which worked very well. So, I have had some unusual symptoms since this surgery.
     
    Last edited: Jan 5, 2019
  9. Celle

    Celle FORUM ADVISOR Forum Advisor

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    This article may help.
    Uploading a Picture in a Post

    As for the slightly swollen, pinkish area, a photo would be good. It's probably just residual swelling that will go away, given time. Keep icing it and elevating your leg and see what happens. If it gets worse, then contact your surgeon.

    You'll notice that I have merged your newest thread with your original recovery thread. Please don't start new threads.
    For several reasons, we prefer that you only have one recovery thread:
    • That way, we have all your information in one place. This makes it easier to go back and review your history before providing advice.
    • If you keep starting new threads, you miss the posts and advice others have left for you in the old threads, and some information may be unnecessarily repeated
    • Having only one thread will act as a diary of your progress that you can look back on.
    So please post any updates, questions or concerns about your recovery here.
    Don't worry that we won't see your question because, between us, the staff read all new posts every day.
    If you need an urgent response to a question, just tag a member of staff.
    How to tag another member; how to answer when someone tags you

    If you prefer a different thread title, just post what you want and we'll get it changed for you.

    Here are the instructions on finding your thread, How can I find my threads and posts? . Many members bookmark their thread, so they can find it when they log on.
     
  10. Elad1002

    Elad1002 senior
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    Ok, posting a photo
     
  11. sistersinhim

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    As Jockette said, ROM will change as your swelling goes up and down. You have already reached 110 at this early stage in your recovery. You know you can do that! If it goes back some, don't worry, it'll be back and with an even more bend!

    Yes, I had different colors up and down my incision. The pink color and warmth is showing that there is healing going on. To answer this even better, I am going to tag @Josephine, our forum director and nurse, to address your questions.
     
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  12. Elad1002

    Elad1002 senior
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    Thank you! My knee is even brownish in spots, just not my natural skin tone yet. Struggling to post photo from my Samsung phone.
     
  13. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    That's just the inveterate nagging of PTs and such. Don't listen to it. Many members here have had a very successful recovery doing NO exercises at all. Not even so much as a single heel slide! I should know, I'm one of them!
    I suggest you don't go at all! You said earlier that your ROM is 110/0 so you really don't need it anyway.
    Don't worry about it. It will reduce and go away in time.
     
  14. Elad1002

    Elad1002 senior
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    Thank you.
     
  15. Elad1002

    Elad1002 senior
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    It's cold with freezing rain here in Connecticut USA. I can't really walk anywhere other than short lapses around my 3 bedroom ranch. I'm not getting all the walking in that I need at this point, hope that doesn't set me back. I won't be cleared to drive until my ROM is 120, feeling limited and claustraphobic.
     
  16. sistersinhim

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    There's nothing that you actually need to do to keep yourself from going backwards. Take advantage of the downtime and rest your knee. You shouldn't have to worry about how much your bend is to drive. Just try it. If you can pick up your foot and put it on the brake fast enough for an emergency stop, then you should be good to drive. Take someone with you and try it.
     
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  17. Elad1002

    Elad1002 senior
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    Thank you. I think I'm becoming anxious about doing something wrong. Since my TKR, read too many horror stories on the internet, some people have poor outcomes, and emergency situations, infections, etc. I need to relax and take each day as it comes. I didnt feel this way prior to surgery because I was focused on pain relief. I soo appreciate this site and your willingness to be here for others as they recovery from this surgery. You are a real lifeline at this point in my recovery.
     
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  18. Jockette

    Jockette FORUM ADVISOR Forum Advisor

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    I think all of us worry if we’re doing the right things or not. We are not properly prepared for this recovery, so everything that comes up scares us, and then we find out it’s par for the course.

    One of my favorite quotes from Josephine talks about “giving our knee the privilege of sorting itself out.” And over time, it does.

    As far as bad outcomes, sometimes that happens and there’s nothing we could have done to prevent it. Right now you just have to trust that all will be well when you are healed.
     
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  19. traceys

    traceys graduate

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    Hey @elad :wave:

    Hope you don’t mind if I throw my 2 cents in here as I am completely relating to your posts and actually said some of the things you mention - but have changed.

    First - I get worrying about how much you aren’t walking. Let me ask you something. If you broke your ankle and we’re in a cast and someone asked you to run a half marathon. Then one the next day. And the next day. And this continued for a month. Would you? Probably not.
    But because your knee isn’t in a cast even though part of your body was cut out on TWO bones- people (including ourselves) treat us differently.
    After the cast comes off, would your ankle start working again once it was healed with minimal help? Yup. Your knee knows what it’s job is but right now it’s sick.

    Second point? I did the route of being a “good patient” and let the pt beat my knee to hell and back 3x a week for almost 2mnths. We lost rom weekly, I swelled and bruised and cried every day. It was horrific. Then I decided that wasn’t working and am taking a waaaay more passive approach and..... am gaining function and even rom weekly again. I’m healing.

    You will get restless and claustrophobic and depressed and mad. We are all here to carry you those days like others did for us. These next few months are a drop in the bucket for the rest of your life!
     
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  20. Elad1002

    Elad1002 senior
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    Thank you Jockette and Tracys so very much. I look forward to healing, need to have a little faith and stop worrying about everything. It makes sense to let my knee do its job and heal.
    Nothing could have prepared me for this...the lack of sleep, the relentless aching, the worry about infection, the depression and anxiety and figuring out the best way to handle PT. It seems counterintuitive to start beating up my leg in the midst of healing, but on other websites, "push through the pain" is the mantra. I say, no pain, no gain- how insane! I do feel better when I am moving around- I'm tired if sitting and lying around but there's literally no where to go in this icy cold weather and walking up and down my hallway is boring and maddening. This too shall pass. Ice rest and elevate!! I think the heel slides and extension as described on this site will keep my ROM. I will continue to continue. Thanks again.
     
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