TKR DodgyKnee no more<

[Josephine]

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

Okay

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

With this you're only taking 300mgs Tramadol of a possible daily max of 400 and only 3,000mg paracetamol out of a possible daily max of 4,000. This means you are under-medicated.

So I suggest you tweak your regime a bit and try this schedule. However, you could just take 50mg Tramadol once or twice during the day but always take 2 paracetamol.

Moderate swelling

Okay

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

There is a way you can estimate it yourself - try this Extension: how to estimate it

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.

'at least twice a day'? what, exactly, does that mean. I always recommend at least 40-60mins and more than 4 times a day.

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

So tell me, do you have your leg totally straight when you elevate? It's not uncommon for people to be told that they must not, on any account, lay with their knee bent or it might end up permanently stiff. But that's nonsense and I suggest this happy medium!

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.
Only visits outside of house are to physio (twice a week) and to wound care place (once/twice a week).

Okay!

My comments in bold
5 minute or so walk every couple of hours - did you read this in the recovery collection in post #2 of this thread? According to that, you should "increase walks to out in the garden or street; to 20mins or longer if you feel up to it" and some other activities.
Maybe 5 seated heel slides every time I get up for above walks - heel slides are very easy to do badly so I suggest you read this (which was also in your recovery collection!) Heel slides and how to do them properly.
Dangle leg from side of bed for a couple of minutes 5 times a day - you only need one exercise for flexion. I suggest you stop these.

Physio twice a week - may I ask why? You're 5 weeks out, no need for physio now
Quad clenches x 10 - these will be causing your pain when walking
Straight leg raises x 5 (these are still hit and miss) - same here. I suggest you do 1 or 2 SLRs before you get up in the morning. Use a strap or leg lifter to help if it's difficult or painful. But once you can do it with a fair ease, then you don't need to do it any more.
Attempting to use leg muscles to press back of knee down on physio table x 5 (nothing much happens) - quite so, so stop trying!
15 minutes on mega pulse machine just sat sitting on physio table - I've never seen the point of these machines. It's much much better to get there under your own steam.
Dangle leg over side of table, supported by physio to slowly reach lowest point - see what I said about this above
Then she gently moves it to the "just a bit more" point, holds for a few seconds, releases and repeats x 10 - never ever allow that. No-one should ever push on your knee. It achieves nothing and only causes pain and swelling
Seated back on table, heel slides - again, see what I said above and read the article.

My suggestion here is that you read this BoneSmart philosophy for sensible post op therapy and stop going to physio. Having swelling and pain at this stage suggests you are doing too much but clearly you are not, except for the home exercises and the physio. So stop them all and just go about your ordinary daily activities with plenty of icing and elevating. Oh yes, and increase your pain meds a bit for a few weeks then go back and read the recovery articles!

 

[DodgyKnee]

'at least twice a day'? what, exactly, does that mean. I always recommend at least 40-60mins and more than 4 times a day.

I mean I use all 5 pairs at least twice a day, so that's a min of 10 times a day.

So tell me, do you have your leg totally straight when you elevate

No I do not, I use three stacked pillows.

5 minute or so walk every couple of hours - did you read this in the recovery collection in post #2 of this thread? According to that, you should "increase walks to out in the garden or street; to 20mins or longer if you feel up to it" and some other activities

And what if that causes pain @Josephine? "If it hurts don't do it" -? Is this an exception to the rule? I am MORE than aware of the recommended activity levels and my miserable failure to achieve them due to excessive pain and swelling sensations - feel like my leg will burst!

15 minutes on mega pulse machine just sat sitting on physio table - I've never seen the point of these machines. It's much much

The machine seems to reduce swelling. My best days of the week are the two following physio.

s then go back and read the recovery articles!

Probably, like everyone who is struggling, I have read and re-read these, time and again.

 

[Josephine]

I am MORE than aware of the recommended activity levels and my miserable failure to achieve them due to excessive pain and swelling sensations - feel like my leg will burst!

Okay, then just do what you can and according to your comfort level. I'm sorry I mixed it up.

The machine seems to reduce swelling.

I see, then okay. Forget I said that!

Probably, like everyone who is struggling, I have read and re-read these, time and again.

Aw bless you. I never meant to make you feel like that.

 

[DodgyKnee]

Morning
The 6 week visit to my surgeon yesterday went pretty much as I expected. He suspects an MUA will be necessary. He estimated my flexion as 70° and extension as 10°. When it was last officially measured, flexion was 85, so it is going backwards.

@Suz In your thread, where you quickly increase your ROM over a couple of weeks, post #179 says "a few simple stretching exercises". Please would you be so kind as to describe exactly what those exercises were, how often you did them and how many repetitions? I'd be very grateful.....

Anyway, he has asked me to see what I can get it to over the next 2 and a half weeks - aiming for greater than 90° - before we discuss again.

I know all the arguments about early MUAs, so please don't feel the need to be outraged on my behalf. I will be 9 weeks before I next see him, and this is on the UK NHS, so I daresay I'll be post 12 weeks before it's done if I do consent to it.

This has been one of my greatest fears since the early days of the op as after the original bike crash that damaged my knee in 2003, that healed virtually completely straight.

 

[Tabbycat]

Hi @DodgyKnee
An MUA is not a foregone conclusion, at least not before 12 weeks, and a lot can happen before then. When I was measured in hospital I was 85 which went down to about 75 and stayed that way until about 10 weeks when it was measured at about 90+. My surgeon mentioned MUA, but said he'd like 90 by 12 weeks, I think because of the state of my knee and the RA. It's only about 105 now, and extension is still about 10. You can't get increased ROM by trying, only by waiting for the swelling to go down, and by not aggravating it further. I was just wondering what your flexion was in that knee before the TKR, since you said it healed completely straight after your motorbike accident.
Please try not to worry, you are only 6 weeks out yet, still very early days.
Tabby xxx

 

[DodgyKnee]

Hi @Tabbycat.

After the accident, at 5 months, my leg was straight. This same surgeon removed the scar tissue via arthroscope and I went on to very very good flexion, back at work 8 weeks after.

Tabby, I feel I cannot keep on doing the same thing I am now as I am going backwards - definition of madness etc expecting a different outcome! I need to do something different to help myself. x

 

[Tabbycat]

@DodgyKnee
If you had very good flexion before I can understand why you are so worried about lack of it now. I also really feel your frustration at the lack of progress and wondering what in the world to do about it. I'm in the same boat at nearly 5 months, is it just a matter of patience . Any suggestions BoneSmarties?
I know you had a particularly rough time at the start getting your pain under control. I'm really interested to know to what extent poor pain control in the beginning affects long term recovery.
Let's keep hoping things will improve.
Tabby xxx

 

[sistersinhim]

I was 90* in the hospital, and that was with the bandages on. But, I had PT come and massage me at home and it was 70/15. The swelling made it go down. It was over a month before I hit 90/10 again. And I stayed there a long while. I was getting frustrated so I quit measuring for a few weeks. The next one was 104/4. Now, it's 124/0. This is without any PT and exercising. My 'exercises' were living my daily life.

Your knee is a newborn baby. It takes time to heal and grow into a toddler. Then a child, preteen, teenage and then finally an adult. We're talking about at least a year here. I am right there with you wanting it right now, but I know it's not going to happen! Please don't beat yourself up for something that you have no control over except to not over work it.

 

[DodgyKnee]

Can anyone help me understand why my extension is getting worse too?

It wasn't an issue at first, either in the hospital or when I first came home - not completely flat, but not far off.

Now it's a long way from flat and is really affecting my walking, I am unable to do a smooth stride and am rolling and limping horribly.

The size and shape of the knee, to look at, is much less swollen now than, say, 3 weeks ago - so I'm a bit puzzled.

 

[Celle]

Swelling can have an impact on extension, as well as flexion. I know you don't have much visible swelling, but it's a very small space inside your knee joint and it only takes a little bit of extra fluid to "gum up the works", so to speak. It's reasonable that, after you car journey to see your OS, both flexion and extension could have decreased.

You have been quite active in your recovery so far and it's only just over 6 weeks since you had this major surgery. Since ROM can continue to improve for at least a year after a TKR, there's no need to rush to achieve certain numbers.

Can I suggest you scale back your exercise and activities severely for two or three weeks, and concentrate much more on rest, ice and elevation? See if that helps at all. You have nothing to lose by doing this, because there is no deadline and you could always have an MUA at a later date, should it prove necessary?

 

[DodgyKnee]

Thanks for the reply @Celle. I recognise (and can feel!) it's still swollen, but I'm finding it difficult to see how I can be much less active though!

I've put a pause on going to Physio to see if that makes any difference - last went 9 days ago. I still can't get my leg elevated comfortably downstairs, so spend much of the day icing and elevating in bed. I get up for a couple of hours around lunchtime and the same around dinner time, but that's it. When I am downstairs, I maybe do one or two things a day - EG yesterday I put a wash on and hung a few things on the line to dry, today I've put meat and veg in a pan and got a stew going.

I'm walking even less than I last reported above (which was already way less than the recommended activity levels) due to the awful gait from poor extension- it's causing back and hip pain now. So pretty much all I'm left with besides that is a few heel slides a few times a day and a bit of rocking pedals backwards and forwards on one of those portable pedal thingys - once a day.

 

[Tabbycat]

@DodgyKnee
I could be reading my own thread here, and I'm nearly 5 months out. I can't tell you how many times I've paused physiotherapy, I can't bear the look on Garry's face when I say I'm not doing very well, again. All I can say is what everyone keeps telling me, which is that healing takes time, and for some of us that is longer than for others. I know it's not much comfort at the moment. There are so many different experiences of this surgery, and no two are alike. We have good support on this forum, and at least don't have to feel alone.
Tabby xxx

 

[greatlakes]

I'm so sorry, it must feel like groping your way blindfolded, I just wish there were more studies on knee recoveries. Sounds like you're doing everything right, taking a long healing break to see if that's what your knee needs right now. Best wishes to you.

 

[Josephine]

Can anyone help me understand why my extension is getting worse too? not completely flat, but not far off.

It really doesn't take much swelling - actually very little - to impede extension. And there is a way you can assess it for yourself. Read this

I still can't get my leg elevated comfortably downstairs, so spend much of the day icing and elevating in bed.

Tell me something - are you elevating with your knee totally straight? Because that will cause enough pain and stiffness to impede extension too. Read this Elevation is the key to controlling pain and swelling.

So pretty much all I'm left with besides that is a few heel slides a few times a day and a bit of rocking pedals backwards and forwards on one of those portable pedal thingys - once a day.

Heel slides are very easy to do badly - read this Heel slides and how to do them properly.

This has been one of my greatest fears since the early days of the op as after the original bike crash that damaged my knee in 2003, that healed virtually completely straight.

You know, this changes the picture completely. With that history and a ROM of 70 degrees, you probably would benefit from an MUA by about 12 weeks, maybe even earlier. And you won't see me saying THAT very often!

 

[DodgyKnee]

I was 8 weeks yesterday, so thought I'd do an update.

• Resumed Physio after a 2 week break as the break made no difference in the amount of swelling. She is a really nice lady, only gentle movements involved and listens to what I say about enough being enough. No increase in swelling since going back.
• Pain - the past few weeks, the only type of pain I have between getting is from stiffness and swelling. Meds, of any sort (paracetamol, tramadol, ibuprofen) do not seem to make any impact on these.
• Pain meds - GP has switched me from tramadol to codeine but again this is not having an impact on the swelling and stiffness pains. Therefore, I have between cutting back with no noticeable difference.
• Walking - still not walking much as this immediately increases swelling but I am now down to one crutch. Around the house, I practise not putting any weight on it for a few steps at a time and this is going well.
• ROM - saw surgeon 2 weeks ago and he estimated me at 10° - 70°, but of course the car journey plus walking a bit, plus sitting in the waiting room with the leg down, increased the swelling. This week I just about scraped a 90° flexion reading at Physio . Now just got to do that repeatedly under normal conditions! Also been working on extension and that was measured at 5°.
• I've bought some compression stockings to see if that helps keep the swelling down, so will let you know.
• MUA - I'm still hoping to avoid this. I seem to keep getting the rough end of the stick in terms of likelihood for things (microfracture success, ROM over time etc). So, I really really really don't want to chance the odds for complications following this procedure.

On a different note, had trouble falling asleep last night for the first time (yes, I do know how lucky I am) due to twitchy, spasmy legs. I already take magnesium supplements and frequently drink Indian tonic water - (sometimes with gin ice and a slice ) so can anyone recommend anything else? Oh, and I always take a full dose of pain killers before bed.

 

[dianehelen]

If you are taking Tylenol before bed, switch to Tylenol PM. OR the same sleep aid without the tylenol is to take a couple of Benadryl. I keep Advil PM & Tylenol PM on my night table to have right there for those nights.

 

[Tabbycat]

Hi @DodgyKnee you are making progress your ROM is coming on now, 90 is good, and will gradually increase. I don't think you'll need an MUA. Sorry to hear you've got some night time discomfort keeping you awake, I hope it's a temporary thing.
Tabby xxx

 

[sistersinhim]

I hate that nighttime pain. It seems to always be worse then than during the day. Maybe once we relax those muscles at night, then they start complaining about what we did during the day!

 

[greatlakes]

Wishing you a good sleep!

 

[julesm86]

I hope the spasms stay away tonight & you can sleep well!