TKR erichknipp's Recovery Thread

[Rockgirl4]

I'm just adding to the calf pain discussion. Some of us had severe calf pain/tightness that hurt as much as the operated knee. I remember last summer when there were 4-5 of us talking back and forth about it, as we had surgery with 2-3 weeks of each other and were all miserable together.

Keep in mind I was only 46 and in fantastic shape before surgery. I stretched my hamstrings/calves daily and had absolutely no idea after surgery I wouldn't be able to stand flat-footed on my TKR leg for 4 weeks. That's how bad the calf tightness/pain was. I had severe swelling though. My surgeon preferred to call it an acute inflammatory response to surgery, over and well above normal, with all sorts of miserable post-op complications.

He explained it might take weeks to walk without the walker because my entire leg, from hip to toes, was NOT happy. He was spot on, and my physical therapy was spent mostly on leg massage to loosen the muscles around the knee and down into my foot. My whole-leg bruising lasted 5-6 wks, and it wasn't until the bruising was gone that I could use my ankle/calf normally and actually stretch it out.

So that's my long and drawn-out way of saying you're totally normal, and now you'll be walking differently with the new knee. I was one of those that had to throw out shoes and buy new ones, plus my back was 10X happier because my gait was normal again. My TKR literally changed how I stood, walked, sat, laid down, etc. All of that means your other body parts have to adjust.

 

[Jamie]

Take it easy.. 2500 steps is what you get when you take a 5-10 minute walk around the house, in between elevating and icing 12-14 hours a day. I am not doing anything excessive. My physical therapist is similarly not pushing me, just encouraging me and helping to identify the best exercises. I would of course love to be further along, who wouldn’t, but don’t project impatience on me. I ask questions because this is a new experience for me, not to challenge anyone.

2500 steps for a person with a normal gait could be done in 20 minutes and would equal about a mile in distance. I'm going to assume you're not walking this many steps at one time and that you're walking considerably slower than normal on a new knee. So, 2500 steps this soon after your surgery actually could be quite a push for you. The important thing in recovery is to listen to YOUR body. Each one of us is unique and recovers differently, so it becomes important to constantly assess how your body is reacting to whatever exercise, therapy, activity, icing, resting, etc. you're doing. If there is pain or swelling after any activity (up to 24 hours later), you're pushing yourself a bit too much.

Walking about the house several times a day for 5-10 minutes should be just fine. You would want to start with the 5 minutes and gradually increase to the 10 minutes over at least a week IF you didn't have any pain afterwards. Pain means it's too much for this stage of your recovery and you should cut back for a few days and try again.

Are you using your walker when doing these walks around the house? If not, you should be using some type of walking aid (walker or crutches) to give you the stability needed at this early stage. If you have a limp when you walk, you still need a walking aid. The goal in recovery is to use the walker to help you regain your strength and proper gait. When you use this aid, you will eventually be able to take longer strides that are more normal with the correct heel-roll to toe movement.

 

[JennyLynne]

Post-op, It has taken me time to walk “correctly” - heel/toe stride. I tend to stay on my toes too much and end up with shin splits. I wouldn’t be surprised if some of the calf discomfort is from not being ready to walk normally yet. Also, I was knock kneed and the straightening of my leg caused muscles everywhere to flare up. You body will adjust!

 

[erichknipp]

Take it easy.. 2500 steps is what you get when you take a 5-10 minute walk around the house, in between elevating and icing 12-14 hours a day. I am not doing anything excessive. My physical therapist is similarly not pushing me, just encouraging me and helping to identify the best exercises. I would of course love to be further along, who wouldn’t, but don’t project impatience on me. I ask questions because this is a new experience for me, not to challenge anyone.

2500 steps for a person with a normal gait could be done in 20 minutes and would equal about a mile in distance. I'm going to assume you're not walking this many steps at one time and that you're walking considerably slower than normal on a new knee. So, 2500 steps this soon after your surgery actually could be quite a push for you. The important thing in recovery is to listen to YOUR body. Each one of us is unique and recovers differently, so it becomes important to constantly assess how your body is reacting to whatever exercise, therapy, activity, icing, resting, etc. you're doing. If there is pain or swelling after any activity (up to 24 hours later), you're pushing yourself a bit too much.

Walking about the house several times a day for 5-10 minutes should be just fine. You would want to start with the 5 minutes and gradually increase to the 10 minutes over at least a week IF you didn't have any pain afterwards. Pain means it's too much for this stage of your recovery and you should cut back for a few days and try again.

Are you using your walker when doing these walks around the house? If not, you should be using some type of walking aid (walker or crutches) to give you the stability needed at this early stage. If you have a limp when you walk, you still need a walking aid. The goal in recovery is to use the walker to help you regain your strength and proper gait. When you use this aid, you will eventually be able to take longer strides that are more normal with the correct heel-roll to toe movement.

its 2500 steps total for a 24 hour period. I have stopped using the walker most of the time because I am not limping. I walk heel to toe, this was something the PT person commented on right away.

 

[Jamie]

Good work by your therapist in starting with proper gait instructions. The thing to watch then, is whether you're having any pain immediately and up to 24 hours after this much walking. If you are having calf pain like you're describing, then you might want to try cutting that amount of walking in half for a few days to see if the pain improves. If it does, you know it's just a bit too soon for that level of activity.

If you haven't purchased new shoes to walk in, you might want to do that. Your old shoes have wear patterns that can impact your gait now that you've had your knee properly aligned. This also could give you lower leg pain.

The reality of knee replacements is that a lot of soft tissue is manipulated and realigned to the point that it's possible to have many types of pain or discomfort while things are realigning. This is not the time to try and push through any pain you might have. You are VERY early in your recovery. It's much better to do gentle exercises that provide movement and non-painful stretching and bending and allow things to adjust gradually.

 

[SpaceGirl]

It sounds like you're doing pretty good considering you're not too far from surgery. I would suggest taking it easy for a little bit and see if it improves your swelling. I remember reading tons of recovery threads from people who joined the over did it club simply by walking too much etc. I know it is hard to sit around doing nothing while you feel like you're relatively pain free, but remember that you did have a major surgery and it will take more time than you want or realize. Some people do have incredibly speedy recoveries and are back to normal in no time. Ex. an older lady at our church had one knee done and was at church walking with no cane a few weeks later and was like I am doing great! Then I thought dang, I was limping along and still on pain meds at that point. Each person, each knee, each surgery is just different. Don't get caught up in trying to go to hard to fast. Wishing you a speedy but sensibly recovery! Will add your thread to my watching ones so I can keep up to date.

 

[erichknipp]

Next question. I think my recovery is going well. The only thing that gives me pause is the poor ROM. You have all told me I don’t really have poor ROM and shouldn’t worry. Let me tell you why I am worried. My surgeon kind of terrified me when he explained the day after my surgery that patients who don’t achieve ROM by pushing through pain in PT wind up with scar tissue, which he has to break up with manipulation under anesthesia, effectively starting recovery over. I’ve come to understand that scar tissue means adhesions. I also understand that BoneSmart’s position is not to worry about adhesions forming. Why don’t I need to worry about adhesions?

 

[sistersinhim]

The scar tissue (which is more correctly called adhesions) is very rare, and one of the easiest ways to develop it is to work your knee too hard. Over-worked knees get inflamed and hot, and hot tissues become drier than normal and more likely to stick together and form adhesions.

This article explains the difference between scar tissue and adhesions:
MUA (Manipulation under Anaesthetic) and Adhesions

You need normal scar tissue. That's what holds your incision together, and it's part of the normal healing process. Without it, you'd always have an open wound.

 

[Jamie]

My surgeon kind of terrified me when he explained the day after my surgery that patients who don’t achieve ROM by pushing through pain in PT wind up with scar tissue, which he has to break up with manipulation under anesthesia, effectively starting recovery over. I’ve come to understand that scar tissue means adhesions.

This is something some surgeons or therapists will do to their patients to try and get them to be more active in recovery. I'm sure they mean well, but these types of comments tend to scare patients needlessly and can sometimes make them believe they are not having a "normal" recovery when in fact they are. With knee replacements, the range of what is "normal" is quite broad. You might reread the post I gave you (post #21) that talked about this. There is no "window of opportunity." We have members who gained ROM even after a year to two. It all depends on your body, how it heals and what it's been through prior to this surgery (knees that have had a lot of procedures can sometimes take longer to heal).

Please don't be fearful of an MUA even though your surgeon threatened you with one. You have the right not to have one if you prefer to continue working on rehabbing your knee with time and progressive exercises. Even if it was necessary because you were one of the rare cases with arthrofibrosis, it's not the end of the world. Try not to focus on the "what ifs" and just take things day by day. With knee replacements, you really don't measure progress daily anyway.....it's better to think in terms of weeks when looking at progress. You may not begin to feel normal until 3-6 months out from surgery.

 

[erichknipp]

Thanks, that’s helpful. I was able to get to 80-85 degrees this morning in PT with help.

 

[Jamie]

Be sure if your therapist is "helping" you or you're using a strap or band for "help" that you only allow the movement to be mildly uncomfortable. This is not the time to "work through pain." It's really better to focus on your functionality (like how you're walking, your ability to do certain everyday tasks, etc.) rather than numbers. Causing yourself pain trying to reach some numerical goal can slow your recovery. Pain causes swelling and inflammation, neither of which are good for a healing knee.

 

[kneeper]

What many people find is that if they move the knee through its range every day--such as with heel slides-- balanced with rest and icing--they will bit by bit gain more bend. My PT said it was ok to do fewer repetitions twice a day rather than many repetitions all at once.
On the other hand, when the knee is swollen it will only bend so far. I found that I plateaued a bit a few weeks in until the swelling came down a bit, then I began gaining bend. Kind of a catch 22--overdoing causes more swelling which means you're not going to bend much. But you do need to do some activity. Finding that balance is part of the rollercoaster of recovery from a TKR. Ultimately the knee is in charge and everyone is a bit different. It sounds like you're doing fine. Hang in there.

 

[Rockgirl4]

Bonesmart is here for people like me, and I'll apologize now any anger/sarcasm in this post.... This emotion isn't directed at you at all, but I hope you and anyone else stumbling upon it takes it to heart.

If I could JUST have had someone tell me certain things 5 yrs ago. It could have saved me soooooo much pain, anger, money, and a new distrust of PTs. ........................

First, Doctors and PTs do NOT know everything nor always stay current with research. It is a big problem in Orthopedics and why there's so many varying experiences discussed in our forums. You will find a multitude of medical opinions on everything from icing/elevating/medications...all of it. I even had one highly recommended surgeon tell me obvious lies during my first visit, as I was looking for a TKR surgeon----things I knew were impossible, yet he expected me to take his word for it. When I called him on it, he made up more lies and treated me like a silly school girl. I was actually more offended by his lying that his patronization of me. This is one of many reasons a lot of us don't follow blindly anymore--- especially when it comes to PT---I was one of many here who tried the "push through the pain" method and it failed miserably.

My PT story is one for the record books!!!!! It started with scar tissue removal surgery (LOA---lysis of adhesions) 10 weeks post-op in 2016.....followed by MUA 9 days later. This was from another type of open-knee surgery in Dec 2015 (not a TKR, but something just as miserable)....My ROM increased slowly post-op, but not fast enough for the surgeon/PT, though I kept making steady progress. After the LOA, I supposedly <<needed>>an MUA 9 days later when "the scar tissue just came roaring back." Say WHAT???

1) Now I know how badly I rebound-swell after forceful bending and too much PT. I've regained ROM in my left knee post-op from other surgeries just from rehabbing slower and with no forced bending. 2) I didn't know better then though. My surgeon/PT had scared me into the LOA surgery, saying I'd never walk right again. Then they had me believing SOMEHOW it all grew back just like that. My ROM dropped from 125 to 105 over a weekend following the LOA. I'd had 3 brutal PT sessions in 4 days following the LOA--where they bent it so much my stitches ripped open. I had 2 days off for the weekend, and by Day 7 my knee was HUGE again, only bending to 105. Instead of asking what else could cause this, they immediately scheduled an MUA.

3) My mistake was not asking questions. I let them do their thing and trusted blindly, going in for the MUA. 4) It didn't gain me much ROM. I had to slllooooowwwwlly get it back over the next 4 months....all because THERE WAS TOO MUCH SWELLING IN THE KNEE. Nothing and No One was going to convince that knee to bend any faster.

The thing both nightmares had in common was forceful, aggressive PT where the therapist forced the bend when I couldn't. I did my part in spades, with bad results. The knee stayed chronically inflamed. If my numbers went down daily, the amount of "forcing" went up daily. It was a vicious cycle.

What makes me so angry is I was the poster child for the patient that does everything right. Heck, I even had spreadsheets to show I was doing my home exercises and bending stretches. Instead of looking at my hard work, they accused me of being lazy. If I had a dollar for every time I heard "the numbers don't lie, I'd be a VERY wealthy lady!!! " !
.
The Result---a knee full of scar tissue. Yes, I got some bend back, but during my TKR, the (new) surgeon found a knee full of scar tissue and nerve damage. All because of that push to get me to push harder, bend more, etc etc etc back in 2016. e.


It was a 2 yr nightmare, and I ended up needing a TKR less than 3 yrs later. The chronic inflammation made MORE scar tissue form, causing nerve impingement/pain that I still deal with even after my TKR. ((There was no way to remove 100% of the scar tissue around the top of my fibula during the TKR. The peroneal nerve runs through that area, and is aggravated when the knee swells. That wasn't a problem ever before--only after the months of aggressive post-op PT.))----YES---I actually MADE more scar tissue because chronically inflamed tissues get dry and sticky--meaning they stick together----THAT's an adhesion.....this is something they don't tell you but IS well understood/studied. This also meant I didn't gain as much ROM after my TKR as I had hoped. My ROM was already limited/affected from that 2 yr nightmare, and pre-op ROM is usually an indicator of post-op ROM unfortunately.

All of that led me to research my TKR surgeon before I chose one. I went with a Knee/Hip Reconstruction and Revision Specialist who has seen/done it all and is associated with a large, major teaching University. He said to never let a PT force my knee to bend or straighten. If he/she did, I was to find a new one ASAP. He said the PT protocols are outdated, and many PTs are stuck in their ways. Many recent PT graduate know "less is better" and the "no pain, no gain" mantra is OUTDATED!!! He even says a lot of his patients don't need PT for numerous reasons I won't go into now but make perfect sense. Last but not least, he gets tired of seeing patients come in for their 4 wk followup feeling great, but still going to PT....then they come in at 8 wks just miserable from swelling/pain that is often higher than they had at 4 wks. The common denominator is ALWAYS aggressive PT. The PTs keep telling people to bend more, walk more, lift more, DO MORE, etc. Once he tells these 8-wk follow-up patients to back off and STOP going to PT, they thank him later, saying PT was most of the problem.

Forgive my novel, but people need to know this. Orthopedic surgery and technology has come so far in the last 10-20 yrs, but PT protocols have not. It is up to each PT to stay up on current recommendations, and many just DON'T. They think their yrs of experience is enough. New knowledge should ALWAYS come first though...even if that means PTs change their ways and get with the times.

 

[erichknipp]

I am so sorry to read about your rough experience. For one thing you've shown me that I need to set expectations with my PT very clearly - discomfort is OK, pain is not.

 

[InkedMarie]

Next question. I think my recovery is going well. The only thing that gives me pause is the poor ROM. You have all told me I don’t really have poor ROM and shouldn’t worry. Let me tell you why I am worried. My surgeon kind of terrified me when he explained the day after my surgery that patients who don’t achieve ROM by pushing through pain in PT wind up with scar tissue, which he has to break up with manipulation under anesthesia, effectively starting recovery over. I’ve come to understand that scar tissue means adhesions. I also understand that BoneSmart’s position is not to worry about adhesions forming. Why don’t I need to worry about adhesions?

there is a whole bunch of people here who did no formal PT. I did PT but I interviewed two physical therapists. One said “oh I’ll get that knee bent” and I said, nope, not a chance.

Think about this. You push through the pain. That’s going to cause more swelling which is going to hinder ROM. Stop worrying about the number. I had two surgeons....my original, who did first hip & needed surgery himself before he could do my other hip & knee and my surgeon who did them.

Neither one was remotely concerned about numbers. It was all about functionality. Could I do what I needed to do?
MUA: you can say no! It’s your journey, your recovery. Your surgeon can’t make you do anything. It takes time to get ROM. Some people gain “better” ROM early; some are slower.

You‘re very early in your recovery. Please relax, carry on with life, don’t do too much. Let your body heal.

 

[erichknipp]

So, the last few days I have tried more "static" stretching rather than only doing the typical heel slides (I am still doing these). It occurred to me that heel slides are good, but you only spend maybe 30-60 seconds at the maximum bend of the stretch. I wasn't seeing ROM progress doing these, although I was consistently doing 3-4 sets of 5 each day, and pushing myself to discomfort (NOT pain; one of my top learnings from this whole experience has been my ability to discern the difference between discomfort and pain). I know folks have told me not to worry about ROM and that it will come. At the same time, if I can do some mild things to hasten it along, why not try?

As for what I mean by static stretching. Well, I started by using a strap (around the heel) to hold my heel slide bend longer than I otherwise could. Even with the strap, it was hard to hold the stretch more than a minute. So, then I took the CPM machine, which I have learned to fear because I think I overdid it last week, and used it to do static stretches. I started out cycling modest bends (for me, this was 60-70 degrees), worked up to more challenging ones (initially 80 degrees), and then stopped the machine at the maximum bend. This allowed me to use the CPM machine to hold a static stretch for 10-15 minutes. I did several sets of these at either end (-2 on the straight part to ensure that my knee is truly flat as in a bridge - the padding from the Polar Cube ice pack seems to add a couple of degrees). After each set, I felt looser. Today I've been able to get to 90 degrees. This is a huge improvement. So much so that this morning when I went upstairs to get something from my office, without even thinking about it, I started to take the stairs normally - left, right, left, right - rather than one at a time. It took me a couple of steps to stop myself and remember - oh, wait, you're not supposed to do this yet - but then I said the heck with it, and took all the stairs that way, but supporting myself with the railing. This was a massive jump in capability for me. I literally cannot remember the last time I was able to take stairs more than one at a time.

Anyway, I wasn't able to find much in the forums on static stretching although I did find quite a bit on other Web sites. It *seems* to be helping me, and I will proceed to cautiously push my ROM by a few degrees each day (but never into pain - only discomfort). So far I've had no increased pain, swelling or soreness as a result. Has anyone else had experience with this kind of approach?

 

[erichknipp]

Just got back from my post-op appointment. 90 degree bend! My surgeon liked my static stretching concept as well.

 

[JennyLynne]

That’s great!! How did it feel getting out of the house?

 

[erichknipp]

Great but I have been out of the house daily to walk around the block, so not that unusual.

 

[JennyLynne]

There’s something about getting in the car and going somewhere that feels different to me... like a little adventure. But maybe that’s because I’ve been stuck mostly in this house for 2 months now!