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DebP

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Had a Makopoasty of the left knee on the 7th of January. This will be my post-op report rant and rave. I am 12 days post-op. My pain is decreasing, have cut back to one narcotic pain pill about 3 times a day. Still using a walker but getting more brave with the cane. Have had the post-op tears several times. One thing this site is very helpful and realistic about is the need to rest and heal. I tend to think that I need to push myself to get better. Came back to this site in desperation for tips and stories to help me understand that I am in recovery. It is hard to remember. I want to do so much more. Am hopeful of being able to return to my nursing career in about 6 weeks. It is just hard to see the light at the end of the tunnel and hope it is not a train.
 

Larryhg3

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At 12 days it is very hard to see the end that is for certain. Right now your knee needs ice,elevation, rest and pain management. Please resist the urge to work hard as it can set you back both physically because of increased swelling and pain and mentally because it doesn’t yield the instant gratification we expect. No matter how hard we work our knees will recover at their own rate. I went back to my desk job at 8 weeks for both knees and that was a struggle if you are looking for a gauge. The good news is that there IS light at the end of the tunnel it just may be further away than you think.
 

Roy Gardiner

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I tend to think that I need to push myself to get better
But you don't, rather the opposite. Let the body do its thing, healing.
Am hopeful of being able to return to my nursing career in about 6 weeks
Try to plan for 12 weeks from date of operation, returning too early can slow recovery by doing too much.

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. Here is a week-by-week guide for Activity progression for TKRs


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.
 

maryo52

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You WILL certainly return to your nursing career, especially as there is a nursing shortage (in our state of Maine at least) and, besides, older nurses are treasure troves of knowledge, skill and judgment. Don't forget that! I remember when PT was a novelty. Remember how patients were confined to bed and told not to move? Now they are walked down the halls within a short time of having power tools used on them! But think about all that cutting and sawing and manipulating tissues in order to install implants. It's called TRAUMA. So try to hold your knee and hear its little voice pleading for TLC and a chance to knit tissues back together before making it work very hard at all. The minimum PT will not slow down recovery and may even speed it up -- and consists only of keeping things moving a little bit every day and some quad strengthening. "Less is more." From a fellow nurse.
 

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Yes, there is an end in sight, but a TKR is one of the most traumatic surgeries you can have, and it will take time to recover. It's not like many other surgeries, where recovery is complete in about 6 weeks.

Complete recovery takes as long as a full year, although you will feel much better long before that. you should be able to do most things, and probably go back to work, at about 12 weeks post-op, but your knee will still swell and let you know when you're doing too much for it.

If you think of it in terms of a race, it's more like a marathon than a sprint - so you have to pace yourself.
 

andpeaches

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:wave:Hi dear @DebP ! I just read your thread starter. Oh man it hurts at 2 weeks :bawl:and I can relate. Except that it sounds like you had a partial on the L AND a TKR on the R? Is that correct? If so you are pretty much a bilateral TKR at this moment. My BF also a nurse had her single R partial makoplasty a year ago and it took her the full 12 weeks to get back to work. So you have both out of commission for a while! I wasn’t very prepared knowledge wise prior to my TKR 4 months ago and didn’t know what I was in for and truly expected myself back to work as a neonatal nurse NP at 7-8 weeks post op :rofsign:and even told my job that’s when I’d return. oh yeay! How brilliant right??? So I went into full depression panic anxiety mode at 6 weeks when I found myself still needing cane, walking like a 110 yr old, not sleeping more than 1-2 hrs without waking up in PAIN and still needing Vicodin 5 mg 2-3 x day!! I remember feeling like I was a TKR failure! I truly started to believe I wasn’t the strong healthy 62 yr old that I thought I was. I sunk into a funk until I discovered this wonderful BS forum and started to read how others in my stage of recovery felt exactly the same! I had been pushing myself to walk a mile, ride stationary bike for 10 min and try and do grocery shopping and cooking for 2-3 people at 6 weeks and all I could do was cry from the never ending knee pain!! So in a nutshell, gurrrrl, let go of your worrying and let yourself rest, elevate (knee above your nose elevated!!:yay:) and keep it iced for most of the day and night!! Give yourself permission to binge watch those TV shows you wanted to catch up on! Let your sister and nephews still help you with shopping and cleaning and preparing meals!! I truly didn’t start to feel better until I stopped trying to get better if that makes sense? Yes do the gentle exercises and walk around your house every few hours as much as you like. But don’t worry about the next 6 weeks! You WILL feel better! Promise!
:flwrysmile: -Carrie
 

SusieShoes

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Hi @DebP and, yes, there's definitely an end to this tunnel. And no trains.

I notice your signature says you had a right TKR on January 7. But in your rant :) you say you had a left Makoplasty on January 7. Did you have both done? Or was it the left? Just want to give you credit for any and all surgeries!
 
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DebP

DebP

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I am 4 weeks and 2 days post op now. Going to PT twice a week. The PTA is kicking my butt. Usually with the regular PT's I am there for just a little over an hour. Today she had me there for almost 2 hours. Start out on the bike but have not been able to do a full rotation either way. I was also more swollen and sore today before going. Noted that. She pushed me and got me to 100 on my flexion. I am able to do 95 on my own. Then went back to the bike and was able to pedal backwards but very painful. I was hollering and it was downright embarrassing. I am sure some of the new patients were not given a good impression as I yelped and groaned with each pedal. It did get a little easier by the end of the 5 mins but I was tired and hurting by the time I left. My left leg has been disabled for so long I am sure that my muscle strength is poor compared to where it should be. I am just scared that even with 4 more weeks I will not be able to return to work as a nurse who works 3 12 hours shifts each week. Taking 1 percocet just about every day mostly to help with sleep mostly. I keep thinking that I need to start pushing myself so I can be stronger in 4 weeks. Just don't want to overdo it.
 

Jaycey

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@DebP You will notice I moved your post (above) to your own recovery thread. Please keep all updates or questions about your own recovery here so that we have a history in one place and can advise you if needed.
 

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I keep thinking that I need to start pushing myself so I can be stronger in 4 weeks. Just don't want to overdo it.
It's a trap. Thinking you need to push yourself harder is one of those things that seems like it should work -- it's worked before -- that doesn't. If you study harder, you get better grades. If you work harder, you get promoted (or so we're promised). If you speed up, you get where you're going sooner. And so on. Our lives are full of "push harder = better results" examples.

I winced when I heard you hollered in PT. :scaredycat:PT shouldn't cause pain like that. Discomfort is inevitable with joint replacement. Moving parts that have been operated on hurt when asked to move. They shouldn't hurt so much they make you scream. That much pain is the body's way of saying, "Stop! Too much!" If it hurts that much, you are risking additional injury to your already aggravated, still-healing tissues.

Please pull back on the PT. Pushing harder will do the opposite of what you want. Pull back. Your knee only needs ordinary activity to heal and recover fully. It's not lazy. It will get stronger as you use it in ordinary ways: walking, stairs as usual in your life, daily activities, getting up and down from seating. All these things strengthen your muscles.

You're a nurse, so of course you know already everything I'm saying. It's funny how we can know things intellectually and yet respond emotionally. Wanting, even needing, to return to work can hang over one's head.

Give yourself a week, better yet two weeks, off from PT. Or find a way to cut down on the exercises -- especially the ones that hurt! And no more forcing the knee -- for your visits. Doing so will help you reach your goal faster than if you push yourself harder.
 
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DIYSteve

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Around 4 months post-TKR I stopped thinking about the end and started celebrating the beginning of new life with a new stable pain-free knee. Hang in there!
 

Jamie

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These folks are absolutely right. Pushing when you're having pain will ultimately slow things down for you in terms of recovery. This is a time that you must give yourself permission to take the time to properly heal. I know it's a difficult concept to accept sometimes, but in some ways we all experience that drive to get back to normal as fast as possible. It's okay to give yourself the time you need to do it right.
 

Jockette

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2-hour PT sessions are entirely too long at 4 weeks. Pain like you had is counterproductive.
 

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I am 4 weeks and 2 days post op now. Going to PT twice a week. The PTA is kicking my butt. Usually with the regular PT's I am there for just a little over an hour. Today she had me there for almost 2 hours.
@DebP - two hours of PT is far too long, at a month after a knee replacement, or at any time. PT shouldn't hurt, either. If it hurts, it's bad PT and it's doing more harm than good.
Remember this, from the post-op reading we gave you?
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.

You are in charge of what happens to your knee. Not your surgeon, not the PTs, not anyone else. It's your knee and you are the only one with the right to say what will happen to it.

So, if PT hurts, or if the session goes on for too long, remove yourself and your knee. Walk out.

In case you think you're not allowed to do that, read these articles:
Saying no to therapy - am I allowed to?
CONSENT: what it means and how it can be used

My surgeon doesn't allow any PT at all for the first month after a knee replacement. He says your knee needs that time, to start on its journey of healing. For that month, we rest, ice and elevate our leg, and walk around the house.
After that month, we just go to PT once every 2 weeks, where we are shown a few new exercises to do at home.
His patients all do well and achieve good ROM, as I did, and he hasn't had to do a manipulation to help with ROM for the past 4 years. I think that speaks for itself.

I am just scared that even with 4 more weeks I will not be able to return to work as a nurse who works 3 12 hours shifts each week.
We usually advise taking about 12 weeks off work and then doing a Phased return to work . People with physically demanding jobs may need even longer.

Contemplating going back to 3 x 12-hour shifts per week as a nurse at only 8 weeks post-op is unwise and unrealistic. It's far too soon. No matter what you do, your knee won't be ready, and if you persist with aggressive PT it will be even less ready.
You cannot make your knee recover faster, no matter what you do, but it is possible to retard its progress if you over stress it now.

If you can, ask now to be allowed a full 3 months for recovery. It's easier to take that time and go back earlier if you do feel ready sooner than it is to go back, find your knee isn't up to it, and have to beg for more time.
 
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Need to check in and hopefully get some feedback. I am now 10 weeks post op from my Left Makoplasty. Hoping to return to work in a about 10 days. Right now I am not ready as far as my knee healing. I overdid walking, did a mile on flat surface and I was sore then several days later. Walked a mile on a hilly area where I used to walk often.

That was last Monday, then PT on Tuesday and Thursday. I over did it. My leg is not really swollen but I can feel it in the knee joint. Made a point of resting, icing the knee and not doing activity if the pain was greater than 5/10. It is now early Monday morning. Rest has helped a great deal. I will see the surgeon in 9 days and hopefully he clears me to work. I think I am done with PT.

Will call later today to make sure I have graduated. This will give me 9 days to recoup from the exercise. I forgot to take my cane with me to church yesterday and I had some discomfort but felt pretty steady with pain at 2-3 out of 10. I am taking Celebrex 200 mg daily and 1 gram of Tylenol 1 to 2 times a day. The Tylenol does help.

If I don't feel better and strong enough to work a 12 hour shift on my floor by the time I see the doc then I will ask to go the full 12 weeks which will be the 5th of April. Just updating and charting my progress. Sleeping well at night. I might ask for something like Ultram to get me through the first couple of weeks when I do finally return to work. I love this site.

As a staff nurse on a Peds and women's surgical floor I might not walk as much if I worked in LDRP or med surg. I love my job and want to return as I have just 2 more years to work before I can retire. Rest, ice and moving should help.
 

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@DebP I guess the big question is why are you doing all that walking AND PT. Yes, you did over do it. Ice, elevate and let that knee settle.

I would not recommend returning to work until you feel totally ready. Sounds like the demands of your work dictate that you either do a phased return or wait until you are a bit stronger on the knee.
 

maryo52

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Oh dear. Were you one of those people who was going along fine with 8 (or more like 8.5) hour shifts, then computers and 12 hours shifts came along to make you feel prematurely old??

If tylenol helps, why not take it round the clock, 3-4x a day?

Also (wagging my bony finger), do avoid movements that are painful. To me 1 or 2 on the 0/10 scale is "discomfort" and "tightness"; 3 and above should be avoided. Just don't do it, it causes inflammation and more swelling which in turn congests tissues and inhibits healing plus makes you less comfortable than you could be.

It's really you who should decide if you've graduated from PT. I wholeheartedly support your aim to do nothing. Really, nothing but whatever walking a restful day makes entails. If you stretch, go only to the point of tightness. I'm a nurse too and know how hard it is to give in and baby myself. But think of it this way: you'd be giving your knee 9 full days to mend tissues.
 
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DebP

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10 weeks out now. Saw my esteemed surgeon yesterday. I have only been able to get my knee bent to 95 degrees. He pushed and pulled and bent but not the the point of causing pain which I was grateful for.

We discussed manipulation under anesthesia to get more range as he was able to get me to 120 degrees right after surgery. I still have 7 weeks of paid time off from work so that is a blessing. I will however have to reapply for my job as I will be past the 12 week FMLA guidelines.

I have read up on the manipulation and I trust the doc. I think he was discouraged because it obviously affects his stats for success. Meanwhile I will do the exercises given to me by PT to get the muscles stronger before the procedure which will be done on the 27th of March 2019.

Is my result because my leg was sub par in function for the last year? The PT would push me and I felt like I was a woosie because I would not allow her to bend the knee past 100 degrees especially because it was very painful. Perhaps she was trying to break up adhesions without anesthesia.

I spoke with the PT about having the manipulation and she agreed that I was too young to be left with only this amount of range of motion. I enjoy this forum to vent my thoughts and read up on others experiences especially from other realms.
 

Jockette

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At 10 weeks out you are still very early in recovery. Where you are now is not where you will end up.

It’s a shame that surgeons give us the impression that they care more about their stats than about us as an individual.

I’ve been reading members experiences here on Bonesmart for about 2 years now. I’ve learned a lot! I’ve learned that each of us has our own healing timeframe. Some of us faster, some of us slower. I’ve read about MUAs that took care of an actual adhesion, and other MUAs that didn’t really improve things for long, because there was no adhesion, only swelling.

I’ve also come to the conclusion that I would not agree to an MUA at only 10 weeks post op and with a bend of 95. I would give myself more time to heal and for the swelling to go down.

One of our members, Bertschb, kept a record of his ROM process. He agreed for us to post it for those of you that are afraid you're stuck. The key is to have patience! Bertschb says:

“I'm 12 months out from my surgery and have some advice based on my experience:
1- Stop going to PT (all it will do is make your knee swell and reduce ROM)
2- Don't worry about your ROM
3- Be patient - VERY patient!!!

Here is my ROM history (more or less):

1 month - 60 degrees
2 months - 80 degrees
3 months - 85 degrees
4 months - 90 degrees
5 months - 90 degrees
6 months - 110 degrees
7 months - 120 degrees
8 months - 125 degrees
9 months - 130 degrees
10 months - 135 degrees
11 months - 140 degrees
12 months - 140 degrees

I spent waaaaay too much time worrying about ROM. I thought I'd be riding my bike a couple months after surgery but it took SIX months! Looking back on my surgery, if I knew then what I know now, I wouldn't have wasted my time with PT and I wouldn't have worried about ROM.”
 

Jockette

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Also, keep in mind, it’s not exercising that gets our range of motion back, it’s Time:

Time to recover.
Time for pain and swelling to settle.
Time to heal.

Our range of motion is right there all
along just waiting for that to happen so it can show itself.

In the general run of things, it doesn't need to be fought for, worked hard for or worried about. It will happen. Exercise as in strength training is counter-productive and in the early weeks does more harm than good. Normal activity is the key to success.
 

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