TKR Following My Instincts

Samsrf

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Hi There- so glad I found this forum! I am 43 and @4 weeks post op for a R TKR. I actually have less knee pain now than for the 8 years (when they first told me I needed TKR) prior so I am stoked and trying to just lean into recovery until my schedule picks up at weeks 6. Now that I can drive the first PT I went to Monday & Wed- I was not impressed. She literally yanked on my leg for 15 minutes until it was hot and swollen and then gave me exercises to do on my own while some kid watched me and asked “does it hurt?”. All while saying I should have a better ROM ( 0-70) I had a feeling this wasn’t good for me as my TKR comes after an injury 25 years ago- which over the years involves lots of guarding and compensating. I have had 2 surgeries on that knee and my leg was all out of alignment with 3 bone spurs and quite painful. I tried to explain that right now I would like to focus on walking without a limp and the fact that I was 0 extension was a huge win since I haven’t been at that since 2015. I feel like My body is adjusting to my new super smooth joint, and range of motion.

Following my gut I did some research and found a different PT I saw this morning who had a different approach. We worked on gait and when she measured my ROM I was at 76. My surgeon wants me at 90 last week- although I am not there, I told him I was still making progress on my own. Everyone (PT, Surgeon) keep mentioning a MUA as if the threat is going to magically make my muscles release and my knee bend I totally take my ROM seriously. I can’t wait to surf again! But I don’t think the professionals always understand the individual. Anyway- anyone who is struggling because “they” say you should be doing, bending or feeling different- if your gut is telling you something is not right for you, it probably isn’t.
 

kiwicurls

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@Samsrf
Welcome! You will get lots of help and encouragement here; I certainly have.
You sound very sensible and your instincts are correct. Sorry you had such a bad experience with the physio.
Don’t worry about your ROM. You’re doing fine. I am sure one of the staff members will be on soon, to give you the fantastic guidelines we all find so reassuring.
All the best!
 

Jaycey

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@Samsrf Welcome to BoneSmart! Indeed one size does not fit all. The approach to recovery is very different for each individual. You have the right attitude - if it hurts it isn't for you.

Please don't worry about MUA or goals set by anyone. There is no timeline.

Here are your recovery guidelines.
Knee Recovery: The Guidelines
We are all different, as are the approaches to this recovery and rehab. The key is, “Find what works for YOU.“ Your doctor(s), physiotherapist(s) and BoneSmart are here to help. But you have the final decision as to what approach you use.

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
ice
take your pain meds by prescription schedule (not when pain starts!)​

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 Activity progression for TKRs

6. Access these pages on the website

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.
 

glidefloss

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But I don’t think the professionals always understand the individual. Anyway- anyone who is struggling because “they” say you should be doing, bending or feeling different- if your gut is telling you something is not right for you, it probably isn’t.
Hi @Samsrf , it never ceases to amaze me to see postings of this sort where the surgeon and/or the PT are insensitive to the patient's condition and push them through a "one size fits all" type of recommendation regardless of the fact that one size does not fit all!

I've been super lucky to have an amazing surgeon and PT group and only wish all patients had access to such wonderful practisioners!

Good for you though. I wish you all the best on your recover!! Surf's up!!
 

sistersinhim

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With your level-headed approach to your recovery, you should do just fine!
 
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Samsrf

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Thanks everyone! What a crazy process this is.

Was doing heel slides and felt a sharp pain on incision this am. Apparently I have a small Seroma on the top portion of my incision. When I bend it looks like a envelope flap opens a bit with a wet look. I wasn’t noticing this because besides showering I am in a compression stocking 24/7. After a Saturday call to the OS - he said just ice, elevate and do straight leg strengthening for a couple of days (easy on the bending) And see if it dries out/ closes up. If it starts dripping or oozing call them and I will get antibiotics and see them Monday. Kinda bummed because I [email protected] 4.5 weeks out the wound portion would be healed. But alas - rest ice and elevate it is.
 

Jockette

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Kinda bummed because I [email protected] 4.5 weeks out the wound portion would be healed. But alas - rest ice and elevate it is.
My friend told me something years ago, as we were getting older and getting pains here, there and everywhere, she said, “every day is a surprise!” We laughed. This recovery is a lot like that.

I see we don’t have a date for your surgery. Please tell us and we’ll make a signature for you. :flwrysmile:
 
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Samsrf

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Having some elevated blood blood pressures 5 weeks out post op. Put a call into doctor & have an appointment next weeks. I have been fortunate that pain hasn’t been too bad (already less than pre surgery!! Unless I get twisted up sleeping) Stopped taking oxy day 5 except a 1/2 dose couple times to sleep in the first 2 weeks. Have been taking Tylenol 1000mg was taking 4x day (per OS) week 4 :2- 3x In last few days have cut back to 500mg as needed (usually before bed and using ice as first line for pain) 1-2xday. Was on Feldene (piroxicam) but stopped that week 3 because BP was rising. Now take Aleve before PT 3x week and full strength (325) Aspirin each morning for clot prevention. OS says that the only thing I must take. Not sleeping well (2-3 hour stretches but in bed at regular time and for 8-9 hours).
I will talk to GP next tues when She can see me, but wondering if anyone has any experience with this? Not sure if it is medication, before surgery I only took occasional aleve when pain was unbearable. OS couldn’t believe it - told him I was grumpy a lot! :heehee: Or lack of quality sleep, or just part of the process.

Any input is appreciated Thanks!
 
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sistersinhim

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Be careful taking Aleve and Aspirin at the same time. They are both NSAIDS and they can raise your blood pressure plus be bad for you in other ways. Google the effects of NSAIDs and find out what to look out for. Most of us took a low dosage aspirin for a few weeks after this surgery, not a full strength one. Please be careful.
 

FourCats

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Hope your doctor gets to the root of the problem.
 
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kneeper

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Be careful taking Aleve and Aspirin at the same time. They are both NSAIDS and they can raise your blood pressure plus be bad for you in other ways. Google the effects of NSAIDs and find out what to look out for. Most of us took a low dosage aspirin for a few weeks after this surgery, not a full strength one. Please be careful.
I agree with this. I would double check with your doctor about this as you can also get serious stomach issues from combining NSAIDS. Sometimes the docs tell you something and forget what you are already taking.

After getting an ulcer from NSAIDs I can't take them anymore, but several times over the years I've had a doctor or nurse offhandedly mention taking something like Aleve and I have to remind them I can't do that. The good news is that I did fine on Tylenol with my second TKR--an anti-inflammatory wasn't needed.

Also, we generally advise against taking meds in order to do PT.
 
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Samsrf

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@kneeper @FourCats @sistersinhim
Thanks for the responses!!. All those meds were prescribed by OS so he knew exactly what I was taking- just told me to go to my primary doc. Saw her this week and you were all right! She said “girl your kidneys can’t handle all that” so because the only thing OS said I HAD to take was aspirin 1x day for first 3 months (I am also in very cool compression stockings for the 12 weeks) we agreed to manage pain with Tylenol only but stay on the schedule 1000 mg every 8 hours and add the 4th dose as needed and drop the other nsaids. I am now 6 weeks out so if I need additional pain help she gave me a muscle relaxant. NSAIDs, Pain and additional fluid from the surgery IV’s and lack of cardio activity during recovery can all creep it up. She told me to have some Grace with myself and relax, she suspects in the next 4-6 weeks it will return to normal as activity increases and pain subsides. OS also approved me to swim again so I swam an easy 10 laps and stretched in the water and it felt SO good. What a long strange trip this is!
Fascinating how every OS has their own protocol? My surgeon had this surgery 4 years ago and just got back from skiing in the Alps, so I was following his orders to a T - but everyone’s recovery is unique. Thanks Bone Smart community ❤️
 
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Samsrf

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@kneeper My PT just said I should take Oxy before I come!! I was like “ummm… no . I have to drive to and fro and that doesn’t seem responsible” Surgeon said I have 6 more weeks to get 40 more degrees in flexion. At 6 weeks I am at 0-93 always progressing , just little 1-3 degrees every few days mostly through stretching and yoga postures. These people are crazy with their “numbers” and make me second guess myself.
 

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At 6 weeks I am at 0-93 always progressing ,
This is excellent! There is no window of opportunity. As I’ve posted many times, my ROM increased in my second year, as my whole leg continued to relax and heal.
These people are crazy with their “numbers” and make me second guess myself.
Yes, my medical team caused me a lot of stress which caused me to second guess myself, also. But, as I said, my ROM came along fine, within its own timeframe. If I do this again, I won’t stress about it.
 

sistersinhim

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The ROM numbers aren't important, it's what you can do. Who cares what the numbers say as long as the knee is improving, even if it's only slowly. It's the function, not numbers!
 

kneeper

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@kneeper My PT just said I should take Oxy before I come!! I was like “ummm… no . I have to drive to and fro and that doesn’t seem responsible” Surgeon said I have 6 more weeks to get 40 more degrees in flexion. At 6 weeks I am at 0-93 always progressing , just little 1-3 degrees every few days mostly through stretching and yoga postures. These people are crazy with their “numbers” and make me second guess myself.
Maybe they assumed someone was driving you, but still... I think sometimes PTs assume that people will not want to do any of the exercises if they have any degree of discomfort.

If you are 93 at 6 weeks you are on your way. Just keep doing your stretching, bending, and daily activities as tolerated and my guess is you'll continue to gain. It took me 6 weeks to get to 90. My OS at that point said just keep doing what you're doing. In the coming weeks I noticed I could do more things that required bending my knees and looking at the pictures on Bonesmart realized I had gained about 10 degrees.
 
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Samsrf

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Feeling super down today. PT was a little rough yesterday and feeling defeated. She told me “I can guess what you did over the weekend- Nothing” because my first ROM measurement was 85…. Well I Am competitive and although I didn’t do what she told me, I did walk an uneven construction job site without falling or incident and made a long travel car ride and didn’t destroy myself. All of which I was proud of. So I got to 97… I slept 7 hours straight for the first time (no meds) and thought I should be feeling great today - but I am not. I had to cut a meeting short because The uncomfortable tightness signaled it was time to ice & elevate. I am weepy and frustrated. I feel like everyone around me has forgotten I had this violent surgery (I literally just got asked if I want to walk 2 miles by a dear friend because “you have to be feeling better by now”) and my family is patient but their are 5 loads of clean laundry piled up to be folded and “ran” up the stairs and it is all I can do to get dinner on the table and drive sports carpool at 8pm at night. I am tired of asking for help and quite frankly it appears some are tired of me asking as well. I know this is a long game , I am only just shy of week 7 - but today, it just sucks and I am staring at the ceiling- again with my knee above my heart and ice feeling like I’m not doing ANYTHING (PT, ADL, ROM) very well.
 

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