TKR DodgyKnee no more<

[DodgyKnee]

Absolutely @Apple pie. There is a saying isn't there, that the world would be boring if we were all the same.

However, I would like TKR recovery to be the exception to this - then we would know exactly what to expect when, what behaviour to undertake, and when we would get there!!

 

[KarriB]

It was nearly two weeks before I could do a straight leg lift. The pt tried all sorts of things to remind my body, but in the end I think practicing using my leg lifter did the trick. Each day I'd lift my leg straight up using the leg lifter, as time went by I used less arm power and more leg power. Definitely dont compare your recovery to anyone else's. I also felt more successful with heel slides sitting up, but for some reason PTs liked to measure while laying down.

 

[DodgyKnee]

@KarriB Do you think the measurements will be different or just the same but more/less difficult to achieve?

 

[uva55]

I also can do heel slides better rather than laying down....my home therapist told me that while doing heel slides when you get to the point of discomfort to hold it there for 90 seconds then relax, she said it takes that long to retrain your muscles, I don't know how true that is but I did it, 90 seconds felt like forever!

 

[KarriB]

My measurements were different laying down than sitting, I always felt more discomfort while laying down. I felt it was harder to achieve ROM while laying down and never even did it at home on my own. The PTs always measured laying down but often set me up to work on my knee hanging over the PT table, encouraging me to push back under the table. I felt that was more helpful. My OS never mentioned or measured where ROM was concerned which may have been due to my complications, but he also did a friend's TKR and she said he never mentioned numbers either. My OS seemed more concerned with the functionality of the TKR, he'd slide it around, back/forth and sideways and always wanted to know what I was able to do in daily living.

 

[uva55]

My OS only measured on my visit because I told him I didn't want to keep going to PT, like KarriB said, he just move it around, my extension was fine and my gait were fine, he was happy with results!!!

I also had better measurements sitting than laying down.

 

[DodgyKnee]

Hi again everyone - I've missed you all the last few days whilst the site was down!

Well, at 3 weeks and 3 days, the leg finally lifted - but then I wasn't able to do it again for a further 2 days!

I have begun the dangling technique (supported by other foot) and this feels THE easiest way by far to progress ROM - slowly and gently. 4 weeks tomorrow, just back from physio where ROM was measured at 75° - so it's inching forward thankfully.

Lots of pain today in medial part of knee - Physio says this is because leg is now an anatomically correct shape and everything is having to stretch to accommodate it.

Hopefully tomorrow (if it's good news) will be my final wound check. Let's hope those last 2 bits have sealed.

 

[Josephine]

Pain on the 400 mg of tramadol plus 4000mg of paracetemol

400mgs? Didn't you mean 50 or 100?

I *think* the surgical pain (at day 12) has subsided sufficiently to allow tramadol and paracetamol to actually feel like they are doing something!

Yeah! That's good news

I bought one of those wavy elevators pictured in the library but that is now going in the bin as it causes pain both in bed and on the couch. I tried any combination of pillows and cushions I have downstairs, but all to no avail. Any ideas anyone?

Yes, just do what is comfortable for you.

but back then the doctors repaired it by fixing it in place so she could stand up and walk - after a fashion. No knee prostheses back then.

That's a fusion or arthrodesis. The only thing we had to offer people prior to 1980s.

I just assumed some people are quick skin healers and others take a little longer.

Quite so!

So, 3 weeks yesterday. Still feel very much behind the curve, especially after watching a bloke only 2 weeks out of surgery virtually stroll down the corridor at the wound care place!

Well you know what? HE didn't have your history and surgery and YOU didn't have his! That's the difference!

My measurements were different laying down than sitting, I always felt more discomfort while laying down.

Well of course - when laying down, you're trying to lift the entire leg against gravity. Did you know that one leg is equivalent to one third of your total body weight? Any amputee will tell you that!

And then if you are doing a SSL sitting, you are only lifting the leg from thje knee down! About a ¼ of the weight of the entire leg.

 

[DodgyKnee]

400mgs? Didn't you mean 50 or 100?
.

I was quoting the daily dose Josephine.

Well you know what? HE didn't have your history and surgery and YOU didn't have his! That's the difference!
Well of course - when laying down, you're trying to lift the entire leg against gravity. Did you know that one leg is equivalent to one third of your total body weight? Any amputee will tell you that!

And then if you are doing a SSL sitting, you are only lifting the leg from thje knee down! About a ¼ of the weight of the entire leg.

Blimey, that's todays learning!

Thanks for the commentary @Josephine - especially about the man strolling down the corridor.

 

[Josephine]

I was quoting the daily dose Josephine.

Blimey, that's todays learning!

 

[sistersinhim]

My medial side of the knee has hurt from the git go and still is. Also, I bought two of those elevators and found that they were too long. I cut off about 4" on the end of them and they worked just fine for me. That might help you, too.

 

[DodgyKnee]

How did you work out it was too long Paula? I was thinking maybe the opposite was my problem, but I don't know?

I am 5ft 8in and a lot of that is my legs - proportionally, they are very long.

 

[sistersinhim]

I couldn't get the bend for the knees in the correct position before cutting it off. I'm 5'6" and pretty long-legged, too. Before I cut them, when I laid back, my butt would push the lifter too far forward.

 

[zzevi]

Very interesting I often wondered why heel sides where so difficult laying down, I've really sucked at them, my bend in the beginning was pitiful at best, but it has been getting better. I also have very weak stomach muscles so if they have to help at all there not a help. I agree always, always do better sitting up. Another good way lately for me to bend is to use the wall and walk my surgical leg down the wall. Also I've been sitting on a bench and using a soft rope under my foot (arch area) and gently moving the foot back by lifting and using the rope to ease it back.

 

[DodgyKnee]

Morning all. I just thought I would update my thread for my own benefit of tracking progress and for anyone else who may be interested.

So, I am now at 5 weeks.

• My ROM, when last measured, was up to 85° although I have to say, this doesn't feel very "useful". Leg still feels like an unwelcome burden on the rest of my body. Stiffness is still a major issue.
• I am still using 2 crutches but trying to only lean on the left one. My RTKR leg gives way and buckles a bit sometimes, so I don't feel ready to go to one at the moment.
• My general pain levels have dropped down another notch, but the horrific swelling sensations when I am doing ANYTHING other than laying flat with my leg elevated, are another matter. This includes sitting with it elevated, which is a bit of an issue!
• My incision is still not completely sealed, although looking much more likely to get there soon.
• Although I've always been able to sleep, the last few days I'm finding I'm able to do stretches of 6 or 7 hours - so that's really good.
• I'm off to see consultant in 10 days time and am fearful he will start talking about MUA. Physio is now giving me the window of opportunity spiel and is looking increasingly worried.

So overall - general pain diminished, still very stiff, ROM not tip-top, generally not able to do much at all due to extremely painful swelling sensations.

 

[Tabbycat]

Don't let the physios anxiety rush you into an MUA. It will improve when the swelling goes down and there's plenty of time. My OS gave me 12 weeks to get to 90. Everything else you mention is not out of the ordinary for 5 weeks out. I can relate to most of it. Sleep is improving, so that's good. Keep using the crutches for support until your muscles strengthen and you find that your knee doesn't buckle. You are doing well, it's still very early days.
Tabby xxx

 

[Celle]

I'm off to see consultant in 10 days time and am fearful he will start talking about MUA. Physio is now giving me the window of opportunity spiel and is looking increasingly worried.

Oh for goodness' sake!
Why on earth these physios get so obsessed with the numbers is a mystery to me (and it makes me cross). Frankly, I think it's because they can only demonstrate their effectiveness by showing an increase in the ROM numbers.
It's wrong and completely unnecessary to worry their patients about it, and that is what your physio is doing. She/he is trying to frighten you into working your knee harder, in order to get the numbers she/he wants.
You don't have to work hard to increase ROM. Instead, concentrate on reducing the swelling, with lots of rests, ice and elevation. It's really the swelling that prevents your knee from bending further.
TKR: work “smarter” and not “harder”

In any case, a bend of 85 at 5 weeks post op is perfectly OK. No need to worry at all. It will continue to improve as your knee heals and the swelling goes down.

To talk about a window of opportunity and start to mention a possible MUA is uninformed and indefensible. There is no such thing as a window of opportunity. It's an old myth that should have died long ago. ROM (Range of Motion) can continue to improve for a year, or even longer, after a TKR.
Myth busting: the "window of opportunity" in TKR
ROM: it's worth the wait for ROM
ROM: it's never too late to get more ROM!

If your surgeon should happen to mention a MUA (which is unlikely) remember that he can't do anything without your consent. All you have to do is say that you would like a little more time, to see what happens. There's no critical time within which you have to have a MUA. Should it prove necessary (which I doubt), you can always have one done later.

Keep using two crutches for as long as you feel it is safer to do so. It's better to do that than to have a fall.

 

[Josephine]

5 weeks. My ROM, when last measured, was up to 85
I'm off to see consultant in 10 days time and am fearful he will start talking about MUA. Physio is now giving me the window of opportunity spiel and is looking increasingly worried.

Considering all you've been through, 85 at 5 weeks isn't bad and you should not allow yourself to be railroaded into an MUA. There is plenty of time for it to improve.

Stiffness is still a major issue.

Well, of course it is! That's why you only have a flexion of 85.

My incision is still not completely sealed, although looking much more likely to get there soon.

From what I recall, it's only superficial so stop worrying about it!

My general pain levels have dropped down another notch, but the horrific swelling sensations when I am doing ANYTHING other than laying flat with my leg elevated, are another matter. This includes sitting with it elevated, which is a bit of an issue!

This bothers me so I'd like to ask you some questions if you don't mind, and it would be very helpful if you would answer each one individually - numbered as I have done - in as much detail as you can then I'll come back as see where you are ....

1. what are your pain levels right now, including other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine)

2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?

3. how swollen is your leg compared to these?

4. What is your extension (straightness)

5. are you icing your knee at all?

6. are you elevating your leg, how often and for how long?

7. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and

8. what kind of PT exercises and exercises at home are you doing? How much and how often?
This is the most crucial question so please help me by using the format I have left as an example
(which means please make a list and not an essay!)

Exercises done at home: (how many sessions each day)
enter exercise then enter number of reps and sets
etc., etc.

At PT (how many times a week)
enter exercise then enter number of reps and sets
etc., etc.

 

[zzevi]

@DodgyKnee sorry to hear that the P/T is badgering you about a MUA, heard that and been there. Think my ROM may have been around where yours is at the same stage. I just haven't moved up very quickly. But at 5 wks I still had swelling also and a pocket of of fluid to the rt side of my incision that my body has had to deal with. The swelling, the fluid all seemed to keep me from bending, plus the fact I wasn't elevating high enough. Probably just with in the last 3-4 weeks I finally got feed up about hearing about the possibility of a future MUA and want to see on my own what I can do. My feelings are with the others and it took me a bit to finally just say to them I am satisfied where I am at right now and want to see what I can do in time. But I know and understand how your feeling, we want to be able to bend and get there, and were swollen and frustrated, I know just by listening to everyone I was confused on what the right move and directions should be. I finally went with my gut feeling, never felt I was able to really give my knee a true chance of what it can do and once I made the decision I've been happier, taking things at my pace, listening to how I feel and overall doing ok. Follow your instincts I don't think that will miss lead you, deep down inside how do you feel about where your at????

 

[DodgyKnee]

Hi @Josephine - answers below. Thanks for your time.
1. what are your pain levels right now, including other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness?

I'm currently laid icing and elevating - ~2. Just before that, on walking, ~ 7 (swelling and stiffness pain).

2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?

Tramadol 50mg and paracetemol 500 mg every 4 hours or so (6 times a day).

3. how swollen is your leg compared to these?

Moderate.

4. What is your extension (straightness)

Never been officially measured - but it's certainly not zero, definitely room for improvement.

5. are you icing your knee at all?

Frequently! I use gel icepacks, have 5 pairs and use them all at least twice a day. I leave the packs attached by velcro wrap until they are no longer cool.

6. are you elevating your leg, how often and for how long?

Most of my day is spent with it elevated. If I'm still, it's elevated. Only truly comfortable (and effective for swelling refuction) when I am laid down and elevating.

7. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc.

Activity level is low.
Housework - load the washing machine (only recently and only twice a week).
Cooking - odd bits of prep (5 mins max) and making a piece of toast/cup of tea type thing on a daily basis.
Cleaning - nope!
Shopping - nope again.
Only visits outside of house are to physio (twice a week) and to wound care place (once/twice a week).

8. what kind of PT exercises and exercises at home are you doing? How much and how often?

Exercises done at home: (how many sessions each day)
enter exercise then enter number of reps and sets
etc., etc.

• A 5 minute or so walk every couple of hours.
• Maybe 5 seated heel slides every time I get up for above walks.
  
• Dangle leg from side of bed for a couple of minutes ~5 times a day.

At PT (how many times a week) enter exercise then enter number of reps and sets

• Physio 2 times a week
• Quad clenches x 10
• Straight leg raises x 5 ( these are still hit and miss)
• Attempting to use leg muscles to press back of knee down on physio table x 5 (nothing much happens)
• 15 minutes on mega pulse machine just sat sitting on physio table
• Dangle leg over side of table, supported by physio to slowly reach lowest point. Then she gently moves it to the "just a bit more" point, holds for a few seconds, releases and repeats x 10.
• Seated back on table, heel slides.