TKR For Avascular Necrosis

[sherreern]

Question? When are you able to step up to use of a cane and then without assistive device? My Physical Therapist says he will instruct me when it is the right time. Is that the usual protocol that PT determines timeline in assistive devices?

Also, is it scary to let go of wheeled walker and step up to cane?


LTKR 9/30/2014

 

[Jane B.]

That's how it worked for me. The physical therapist let me know when she thought I was ready to go to the next device. Of course, we butted heads a bit about it, and I gave up the cane inside the house before she thought I was ready.

 

[Jamie]

Actually, you should be the one determining when you're ready to move from the walker to whatever new device you want to try. You are the one who knows how you feel. Your therapist can make suggestions, but it's your decision.

The key is not trying to move to a cane too quickly. You want to be secure on your feet and have a good strong normal gait with a walking before you transition to anything else. There is nothing wrong with continuing to use the walker (especially around the house) if it lets you walk normally. You want to avoid limping as that can slow your recovery.

As an example, with each of my TKRs, I used a walker at home for a good two months. Toward the end of that time, I was just using it at night when I'd get up to go to the bathroom. But then I went to nothing around the house. I took a cane when I went out "just in case" and as a warning to others that I wasn't 100% stable.

There is no protocol except that you need to do what feels right for you.

 

[Josephine]

My Physical Therapist says he will instruct me when it is the right time. Is that the usual protocol that PT determines timeline in assistive devices? Also, is it scary to let go of wheeled walker and step up to cane?

I agree with Jamie. Let her make suggestions but don't do anything until you feel confident to do it. If you're not feeling confident, then it will be scary because you won't have .... well .... confidence!

My experience was quite different from Jamie's. I was only allowed to use a walker for two days and then they took it away and made me use crutches! You know, I was totally fine from the get-go! But I never really used a cane because very quickly I found I was getting about the house without anything! Putting a hand on furniture and such, yes, but basically went to the kitchen and the downstairs loo without anything - after about two weeks, that was. So around 8 weeks out, when I was going out to the shops, I took a cane just for security but very quickly, and accidently, ended up leaving it in the car!

Do remember your knee is already stable and a willing workhorse for you. You just need the confidence to trust it after so long coping with the miscreant arthritic knee you had before!

 

[skigirl]

My experience was more like Jo's. I have a small house and a walker just did not work---I had to carry it from room to room. So, I just walked around the house from day one. It was much better than carrying the walker!!!

I used the crutches ouside the house for a week or two and then just began walking about. My pt never even mentioned anything about the crutches or the lack of them. I think your pt is a little out of line. You don't need her advice--when you are ready to walk without the walker, just try it at home and see how it feels. When you are comfortable walking about the house, then try it outside---you can always drag along a cane for extra help---I would have lost mine the first day!!! So, I saved myself the expense!

 

[jeano]

I showed up for my first session at PT for my second knee, not quite a week after surgery, with my cane, which startled my PT to blurting 'where's your WALKER???' I was seated in the waiting room, got up, strolled past him and asked, 'do I look like I NEED a walker?'
About a week later he asked me to put the cane down and walk back and forth while he watched. Finally he said, 'you aren't using the cane at home, are you?'
I said, 'no, I'm not. Does this mean I can quit pretending to use it here?'
He said, 'yes, i'll go against my better judgment with you, because you're usually right!'

 

[Josephine]

@jeano Love it, love it! I really like your style!


If you look on the BoneSmart website, you will see at the top some quotes from members back in 2006. One was from our old friend Doug who quite shocked his wife by walking across the kitchen without his walker! I also had a similar experience - I would often take a crutch somewhere in the house only to come back without it! I'd just forget it, you see - completely forget it. When you get to that point you'll know it's time to move on!

 

[kneeper]

I agree that the PT can help you decide when it's time to move to the cane. For me it was kind of a mutual agreement--especially with the 2nd knee. With the first knee I was a little more cautious and it was good to have the pep talk ;) by the PT that I was ready.
I know I used the walker longer with the first knee, I think b/c I was a bit weaker overall and my "good" knee wasn't great either. So basically it's a very individual situation thing.

 

[sherreern]

Had my 2 week post op appointment today with OS. Seems to be pleased with progress. I am not as pleased of my ROM extension is great but flexion of knee still at 90 degrees and painful to do. OS mentioned MUA might be needed but probably not as he says my progress is right on for him. I hope I do not have to go through with MUA. I'll keep on working on it. Any suggestions?


LTKR 9/30/2014

 

[Josephine]

Yes, I strongly suggest that you stop 'working on it' and let the poor knee rest! You're two weeks out and need to ease off on the exercises. In fact, I'm going to ask you some questions.

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? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine. And don't compare this with the bone-on-bone pain you had before surgery!

)

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

3. how often are you icing your knee and for how long?

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

5. What is your ROM - that's flexion (bend) and extension (straightness)

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

7. what kind of PT/exercises are you doing? How much and how often? (and detailed details would be appreciated, please! Reps, sets and session and all that)

Note:
If you're not familiar with this, it goes like so:
1 lift of a 500kg bell bar = 1 rep or repetition.
Doing 5 reps and then a brief rest = 1 set of 5.
And doing 5 sets and finishing = a session.

 

[kneeper]

You really don't have to work super hard. Rest, ice and elevation are most important early on.

 

[sherreern]

My pain medication is Percocet 5/325 2 tab every 6 hours 600mg ibuprofen every 4 hours and sometimes I supplement with 1000mg Tylenol.

My pain upon waking in the am is probably 7-7/10. During day pain is 0-4 most of the time.

I ice for 15 min about every hour while I am awake.
Elevate always when sitting/reclining I walk with use of walker about every hour around the house and sometimes on the back deck outside probably 5 min at a time.

I don't do much household chores as yet. I did wash dishes today. My husband and daughter have been doing the laundry cooking and cleaning. Today was the first day I stayed by myself fixed my own simple meals etc. this evening I helped my grandson with his bath as his mother and my husband both worked. I try to not overdo do it as I can tell increased pain and I am exhausted.

PT comes 3 x week plus I do the routine 2 more times a day.




LTKR 9/30/2014

 

[Josephine]

My pain upon waking in the am is probably 7-7/10. During day pain is 0-4 most of the time.

Okay

My pain medication is Percocet 5/325 2 tab every 6 hours 600mg ibuprofen every 4 hours and sometimes I supplement with 1000mg Tylenol.

Do you take a dose in the middle of the night? 6hrly should be something like 8am, 2pm, 8pm and 2am. Therefore you need to set your alarm to take the night time dose otherwise you spend too long between going to bed and getting up with no pain meds in your system whcih is why your pain is worse in the morning.

I ice for 15 min about every hour while I am awake.
Elevate always when sitting/reclining I walk with use of walker about every hour around the house and sometimes on the back deck outside probably 5 min at a time.

You accomplish little or nothing in 15 minutes. Ice for at least 40-60mins and several times a day. When you elevate, ensure you are 'toes above nose' else nothing is achieved.

I don't do much household chores as yet.

Jolly good!

PT comes 3 x week plus I do the routine 2 more times a day.

Did you miss that I asked for details? necessary if I am to help you. I also asked for ROM.

Here are those questions again.

5. What is your ROM - that's flexion (bend) and extension (straightness)

7. what kind of PT/exercises are you doing? How much and how often? (and detailed details would be appreciated, please! Reps, sets and session and all that)

Note:
If you're not familiar with this, it goes like so:
1 lift of a 500kg bell bar = 1 rep or repetition.
Doing 5 reps and then a brief rest = 1 set of 5.
And doing 5 sets and finishing = a session.

 

[sherreern]

My extension is 0 to -2 degrees. My flexion is 90-95 degrees. I did get to 96 degrees on last measurement with PT on Friday.

My ROM exercises include:

Ankle/ calf pumps 10x hr while awake
Quad sets 10 x he while awake
Gluteal sets 10x hr while awake

Heel slides 10 x for 3 x day

Straight leg raises 20 x 3 reps 3 x day

Knee stretch 10 x for
3 x day

Seated knee extension holding for 30 sec and then bringing back a little further 5 times

Walking 5- 10 min several times a day

I ice all the time and elevate.

I do not set an alarm to take pain med while I am sleeping at night.






LTKR 9/30/2014

 

[Josephine]

My extension is 0 to -2 degrees. My flexion is 90-95 degrees. I did get to 96 degrees on last measurement with PT on Friday.

My comments in bold
Ankle/calf pumps 10x hr - these are just anti-clot exercises and don't need to be done once you are up and about
Quad sets 10 x hr - okay
Gluteal sets 10 x hr - okay
Heel slides 10 x for 3 x day - these are better done 5 at a time every couple of hours during the day; never cause yourself pain; only ever go to the point of discomfort.
Straight leg raises 20 x 3 reps 3 x day - do 5 first thing in the morning and no more
Knee stretch 10 x for 3 x day - do 5 only once a day
Seated knee extension holding for 30 sec and then bringing back a little further 5 times - your already doing knee stretches so either do that exercise or this one, no need for two
Walking 5-10 min several times a day - don't make a crusade out of this; walk normally meaning to bathroom and kitchen as needed, that's quite enough.

So this tells me that you're doing far too much and need to ease back considerably on your activity. Do bear this in mind, you knee has just undergone very major surgery and needs to have time - meaning 3-4 weeks - to settle down and heal before you start working it. Even then you need to be sparing in what you do and doing 10 reps x 3 three times a day is far too much. With that kind of routine you can only expect swelling, an increase in pain and a slow increase in ROM. Stick to the mantra and the advice in the articles in post #2.

 

[Yorkimom]

@sherreern, you are a week and a half after me and I think you did great going out to the concert. I'm the one that always does things for my family, so with being a nurse,a I would think it would be even harder for you to ask for help, but you have to. This is a hard, long recovery. I think the best thing that you can do for your daughter.....after she rolls her eyes as I'm sure she will when you tell her this.....but have her watch a knee replacement surgery. There are many on the web. My hospital, Christiana Care, has two excellent knee replacement surgeries on their website, one which was done by my OS. I'm sure after your daughter sees what is done to your knee, she will have a different outlook and hopefully more cooperative when to say you need help.
Take care and remember, rest, ice and elevate. Anne

 

[sherreern]

Thanks for the advice. I guess as a nurse I think I should be doing more. I have to let go rest more although it seems like that is all I do.

I will adjust my exercise regimen in hopes to decrease the swelling.

Rest, ice, elevate!

I will also have my husband and my daughter watch the video about knee replacement. That is a very good idea.




LTKR 9/30/2014

 

[scaredinCA]

Have your daughter watch the video of a knee replacement on you tube... THEN she will understand...

 

[sherreern]

Definitely will. Thanks.


LTKR 9/30/2014

 

[sherreern]

3 weeks post op. Still feels tight and numb. Is this normal?


LTKR 9/30/2014