TKR Freedom works on recovery<<

[Jockette]

I’ll tag @Josephine for you.

I would avoid those machines until this knee settles down.

I think with a knee that has never been right I would seek an opinion from a different surgeon, though I know from experience that is easier said than done. I also have a knee that’s never been right, though I don’t have swelling, it’s been 2 years for me and I’ve had 2 second opinions who can’t find anything wrong.

 

[Freedom]

Hi Jockette.

This knee never "settles down." After 3 years I am sick of sitting around, watching life pass me by. Weight won't come off with diet alone, I have to keep up with exercises. That said I will wait till after tomorrow's surgeon appointment before getting back to the Y. But I already know his response. "I can give you more PT if you want." No thanks. I'm already doing much more than they have me do.

I may have to do upper body only, for a day or 3. Most of the machines I can modify to do the right leg only. As the ER doc said, this is the way this knee is. After 3 years I am believe it is NOT going to get better. I will continue to do stairs like a toddler because the left leg can't push me up. I will continue to push up with my hands/arms to get out of chairs and off the toilet, because the left leg is too weak to help. I will walk my dogs, I will exercise, I will do my gardening which was put on hold for 3 years. The rest of me will live life, while toting the left leg along whether or not it wants to come.

I won't bore you with my health insurance woes, leave it that seeing yet another surgeon is an arduous task which will involve first changing my Primary Care doc, and finding one who is at least 30 miles away so that I am out of the network which covers the area close to home. Which means when I am sick, I will have a trek to get seen. I live alone so that would be me doing the driving in such a case. I do not have the emotional energy to take that on yet. Not sure I ever will make that change.

 

[Josephine]

I'd really like to offer you some structured advice but in order to do that, I also need to ask you some questions. Are you willing for me to do that?

 

[Freedom]

Hi Josephine, sure.

 

[Josephine]

Here y'go then!

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 forget to factor in other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness).

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 ROM - that's flexion (bend) and extension (straightness)

5. are you icing your knee at all? If so, how often and for how long?

6. are you elevating your leg. If so 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. are you doing any exercises at home? If so what 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 you do each day
- enter exercise by name then number of repetitions of each
etc., etc.

Anything done at PT
- how many times a week
- enter exercise by name then number of repetitions of each
etc., etc.

 

[Freedom]

Josephine, those are the questions you ask folks who are immediately post op. I am 3 years out. It doesn't make sense to me.

1. Pain levels right now zero. I can get up, walk around, no problem. I get pain in the middle of the night, it wakes me up. So would that be a 3? ONLY if I am lying on my left side with the left knee on the bottom and the right knee either forward or behind and on the mattress NOT on the lower leg. At that point, the pain is the knee cap. During the course of a day, I do get some pain but it is NEVER in the same place. Sometimes it is the inside of the knee. Other days it could be the outside. The back center of the knee also gets a weird feeling on a regular (every other day) basis. The pain during the day is never more than a 3. If I stand, the left leg muscle on the upper leg, outside, is very sore to the touch. This is the muscle which is just NOT working much at all.

2. I do not take any pain meds nor have I been prescribed any at this time. Not taken anything in over a year. Due to the issue on Sunday the ER doc prescribed 600 mg ibuprofen every 4 hours for up to 4 days or until the swelling is gone. He marked my discharge papers as "sprained knee." I stopped taking the ibuprofen after the 11 AM today dose. I've done mostly nothing today and the swelling is gone.

3. The swelling was Sunday and it was not like any of those photos. I had a lump of fluid on the outside of the knee, lower area. It literally looked like someone stuck a softball on the outside of the leg just slightly below the knee. Apart from that the knee swells overnight every darn night. I would call it generalized swelling, by which I mean the whole knee all around is very slightly swollen. There is not a large bubble of fluid in any one place. Once I get up in the morning and start moving around, the swelling goes away. But every morning when I get up (and those middle of the night bathroom trips) I hobble and 'furniture walk' as the knee is sore and swollen. This overnight swelling has been going on over a year. Every darn night. The swelling does not move up or down the leg, it is just the knee area.

4. Straight leg. When this left leg is straight, the knee / leg "feels" like it is overextended. Surgeon says no. Also, the heel and the buttock touch the mattress (or exam table, or xray table) but the leg in between is up in the air. I can't remain in that position long as the knee feels like it locks in the straight position and becomes painful. I still have to use my hands to get it to bend, in the event I remain in that position for longer than 5 minutes. The soft tissue is not strong enough to make the knee bend. The other (right) leg, when straight, is touching the mattress/ table except a small lift behind the knee.

Flexion. I've not had this measured in years, so I can only explain it, I don't have degrees. If I use my hands and hold under the upper leg, the knee easily bends almost to the point of heel touching buttock. I have to use my hands as the muscle to lift the upper leg does not work well. Without my hands, I can't lift the leg to have the top horizontal to the floor. If I stand up and hold the counter, I can bend the knee and lift the lower leg to almost horizontal but not beyond that point.

5. Icing. No, have not iced in well over a year, closer to 2 years.

6. Elevating. No, again not for over a year closer to 2 years.

7. Activity. Weather permitting, I walk the dogs 2 miles daily, up and down hills. From last Aug to mid November we were doing 3 miles; but that is not possible here during the winter weather, too much ice, I won't risk it. We keep with the 2 miles and I am just thinking of going back to the 3 miles route now the weather is improving.

4 days a week I work out at the Y
circuit training for strength
upright bike for cardio.
Circuit training is 14 machines, each isolates one muscle to work that.
For most of the machines I am back to or exceeding what I was doing as of April 2014, before the 3 joint surgeries.

Problems:
leg press. I can NOT get the left foot up on the pad, I have to use my hands to lift the leg. Good leg can do twice the amount of weight of the left leg.
When finished, I have to again use my hands to get the foot down to the ground.
If I try with the leg muscles only, I lose control as I can't hold the leg up, so the foot just drops to the ground.
Adduction / abduction: the left leg is not able to do as much weight as the right.
Glute machine: the left leg just can't do that. As described above, with the pic of the machine.
Right leg (good leg) can do 70 pounds, 8 reps per set, 3 sets. And still improving.
Left leg, 15 pounds, I can do 3 and that is it. The muscle is not able to do a 4th lift.
Leg curl: right (good) leg does 55 pounds. Left leg struggles along with 35 pounds
I feel all the soft tissue around the left knee and the back center of the knee feels really weird when I do this.
Explain weird: it feels like there is a 2 inch piece of string hanging down inside the back of the knee. I don't know how else to describe it.
Leg extension: I no longer use this machine. Surgeon advised NOT to do this post op as it will lead to a dislocation.
The rest of the circuit is upper body
my problems are with mounting and dismounting as the left leg can't get me up and down, I have to use my hands. The machines are not built for that so finding hand holds to ease down to the saddle and to pull myself up at the end are not readily available. I still have to ask a staff member for help to get up off the pull-down machine.
That is the SAME movement we have to do getting up off the toilet. I am STILL relying 100% on the toilet stability bars, photo attached for you to see what I have here at home.
I have to use this as I sit, can't slowly lower, left side will just drop.
Getting up, I have to push myself up, the leg can't manage that either.
Using a bathroom when I am out (restaurant or shopping) is a challenge.
I make sure to use the handicap stall, as I really do need those bars. At 3 years post op I feel this is ridiculous I should be able to get up and down myself!
I still do stairs as a toddler, left leg can't get me up, can't ease me down. So right leg up first and down first, and I hold on the rail as I am afraid I will fall.
Bike: upright bike, I do 5 miles, or more. Part of why I went to the ER on Sunday, was that the knee was so swollen I could not do ONE revolution. Not had that issue in over 20 months. Normal for me now, first 3 to 5 revolutions may be awkward, but then things loosen up and I ride. Sunday was NOT normal.

I do all the house work, cooking cleaning, shopping, laundry (machines are down cellar, so down and up 1 flight of stairs - doing the toddler stairs as described above). I also garden and do yard work. Spring clean up and set up is about 75% done. But in doing all of this, the left leg is like a foreign object I am hauling around with me. It is not PART of me, it is a separate thing. Very awkward, very annoying, and very OLD after 3 years post op.

8. Exercises done at home, PT: does not apply.

 

[Josephine]

Josephine, those are the questions you ask folks who are immediately post op. I am 3 years out. It doesn't make sense to me.

Not at all. I have often asked them of people who are years out. They are just as applicable.

1. Pain levels right now zero. I can get up, walk around, no problem. I get pain in the middle of the night, it wakes me up. So would that be a 3?

You're asking me? How would I know? From what you've said in the rest of you post, I would imagine your pain score is a lot higher than 3.

2. I do not take any pain meds

Okay - but why not? Don't you even take some Tylenol?

3. The swelling was Sunday and it was not like any of those photos

Okay

4. Straight leg. When this left leg is straight, the knee / leg "feels" like it is overextended. Surgeon says no. Also, the heel and the buttock touch the mattress (or exam table, or xray table) but the leg in between is up in the air. Flexion. I've not had this measured in years, so I can only explain it, I don't have degrees.

I can do that for you. If you could get someone to take a photo of your leg (or both) in one of these positions

Please make sure you have short shorts on, bare feet and show the whole of your body from above the hip to the entire foot.

As for extension, you can assess that yourself very easily like this

1. put your leg on a bench, seat, bed, floor or anything similar but preferably something fairly firm.
2. with not too much pressure, press the back of your knee down - use your leg muscles, not your hand!
3. slide your hand, palm down, under the back of your knee

a) if you can get your entire hand under easily, it's probably about +10 degrees
b) if you can get just your fingers under, it's about +5
c) if you can get your fingers under but it's a push, it's +0
d) if you can't get your fingers under at all, it's -5 or more​

Here's a graphic to explain the degrees involved

As for the exercises you are doing, I would say they are pretty much the cause of your problems

walk the dogs 2 miles daily, up and down hills - probably rather too much. On the flat would be okay but not hills
4 days a week I work out at the Y - I wouldn't recommend this
circuit training for strength - ill-advised
upright bike for cardio - okay
Circuit training is 14 machines, each isolates one muscle to work that - using machines is ill-advised. They take a lot more out of you than you realise
For most of the machines I am back to or exceeding what I was doing as of April 2014, before the 3 joint surgeries - well don't!
leg press - don't use a leg press because it a) strains the knee and b) can create torsional stresses that can cause loosening of the tibial implant
Leg curl: right (good) leg does 55 pounds. Left leg struggles along with 35 pounds - same as before
Adduction / abduction: the left leg is not able to do as much weight as the right - why are you even trying to do these exercises? Totally unnecessary
Glute machine - you've no need to do these
Right leg (good leg) can do 70 pounds, 8 reps per set, 3 sets. And still improving - you shouldn't use weights, it will over-stress the knee
Left leg, 15 pounds, I can do 3 and that is it. The muscle is not able to do a 4th lift - same as before
Leg extension: I no longer use this machine. Surgeon advised NOT to do this post op as it will lead to a dislocation - I totally agree
Bike: upright bike, I do 5 miles, or more. Part of why I went to the ER on Sunday, was that the knee was so swollen I could not do ONE revolution - you should be going a lot easier with the bike
I feel all the soft tissue around the left knee and the back center of the knee feels really weird. Explain weird: it feels like there is a 2 inch piece of string hanging down inside the back of the knee. I don't know how else to describe it - this is very probably a tendinitis. Show me where this pain is using this chart

I also suggest you read these
BoneSmart philosophy for sensible post op therapy
PT: the seriously grave consequences of doing too much of it

 

[Freedom]

Josephine, you took so much time with this, thank you. It seems we have reached an impasse.

I live alone. I have to be self sufficient. I have lost a LOT of muscle tone in the past 4 years, starting when the pain became too much for me to do these things; I have to get that muscle tone back. I am not going to do free weights; I am and have always been much too clumsy for that to be safe, hahaaa.

I have used the circuit training to lose weight and gain muscle a few times in my life. I have to drop the 60 pounds I've gained these 4 years. I don't know any other way to do it than to work out, build muscle, monitor my diet, and get back in shape.

There is absolutely no one I could ask to take a photo for me; as I said, I am on my own. I may figure out a way to use the timer setting on the camera . . . finding the proper set up, so the camera is aimed where I am is always tricky. As for the bike, I used to do 15 or 20 miles each ride, 4 times a week. I am still trying to work up to that again.

To maintain a specific weight, you exercise 3 times a week. If you are trying to lose weight, then you need to work out at least 4 times a week. That is how I lose weight. I do not do fad diets, never have, I just eat properly; I really DO know how, although I stray often. myfitnesspal.com helps keep me on track. I can't just sit here, doing nothing, as I've done for the better part of 4 years, and have life pass me by. I cry much too often as it is, thinking about all I've missed. I have to get out and move.

I live at the top of a hill; there is no house higher than mine, in any direction. So the moment I go out for a walk with the dogs, we are going down hill. There is only one route back home, that would be UP hill. So a flat walk is not an option either.

As for your other questions / comments:
I guess I've never opened a thread from someone 3 years out, so that is why I was surprised to see the same questions you ask us post op, being asked of me here.

I wasn't sure what pain level would wake a person up, which is what I was asking.

No, I don't even take Tylenol. I spent years taking so many meds, and I have side effects from many. I refuse to take anything anymore unless it is absolutely necessary. I'll take Tylenol now and then when I have a need but I refuse to take meds on an ongoing basis ever again. I'm done with that.

If you saw my legs (legacy tree trunks are smaller!) you would know WHY I am doing these exercises. Being morbidly obese has presented me with a host of issues I really don't want to deal with.

Doing the circuit training will build muscle, tone and help drop the weight. It will allow me to do what I need to do -- lifting 30 pound boxes of cat litter, 40 pound bags of lime and garden gypsum, and doing all the other work that goes with maintaining my home, yard and pets as there is no other way to get it done. I haven't won the lottery so hiring others to do the work is not an option; plus then I'd be back to just sitting!

I used to have to ask them to open all my bottles and jars at the store, before packing them - you know, the pickle jar, the bottle of shampoo. Now I am able to do most of that myself again. That has taken 3 months of diligent work outs. Living alone with no support, you HAVE to be able to do things which means you have to have some muscle available. I am not interested in "bulking up" my muscles, I just want to get them to work the way they should.

The left leg muscle which is so weak, I've had 3 different docs tell me that most likely that muscle is not going to work ever again. So I keep trying different things to prove them wrong - I did squats for quite a long time. Just 4 or 5 at a time, 3 or 4 times a day, did that for MONTHS with no change in that one muscle. Moved on to other things to try. Unfortunately none are making any difference, yet. But I will keep trying until I am forced to give up and that will be a sad day for me.

I have dreams at night of going up and down stairs like a normal healthy person, dreams about running a few steps to catch up with my youngest dog, and so much more. 4 years of not doing this stuff is terrible.

Tendinitis: I have had that since the surgery; it is not related to my workouts. So I can't walk from the bedroom to the kitchen anymore, because that is all I was doing for so long, and I still had that feeling.

And now I am crying again, so I'll leave it at that. I'm sorry to learn you don't think I should be doing circuit training, it is all I know. It has worked for me twice in the past and if it doesn't fit in my life now then that means I have no hope of getting out of this mess I am in.

 

[Freedom]

I just realized something. Maybe I did not make this clear. ALL the issues I am complaining about, that I can NOT do, date back to the surgeries. I've only been back to the Y as of Nov last year, and walking the dogs as of Sept last year. They none of them relate to the exercises I am doing now. I have made great PROGRESS since last Sept and esp. since last Nov when I started working out again.

All I want to know is how to get the left leg muscle working again, so I can get up and down from a seat, how I can get the left knee to stop waking me up at night (which it has been doing for 3 years) and instead you are extending the "no PT" mantra to say "no exercise, no walks, be an invalid for the rest of your life."

Sorry. Not for me. I'm done here.

 

[jboles]

@Freedom I can feel your hopelessness as I read this and I’m sending you a virtual hug and pray that you will keep going and trying to find something that will work for you. I also have had dreams of doing normal things again. I’ve been in total knee recovery for 2 years now and these long recovery times take a toll on you physically and mentally. I’m fortunate to have my husband to help me, I can’t imagine doing this alone.

 

[skigirl]

I am curious, when the doctor told you that the knee would not get better did he give you an explanation? It appears that your hamstrings and probably quads are not working well on the left leg. Was there an injury to either? before or after the surgery? When you do quad sets can you see your left quad contract?

I had ACL surgery where they used a tendon from my hamstrings to replace the torn ACL. My hamstring on the left has never been the equal of the right since that surgery. My weak hamstring led to a weak left glute and I had to really work to bring some balance back to my life. However, I do not get knee swelling as a result of the weaker hamstring.

So, surely someone gave you an explanation for the problematic swelling at 3 years out? Tendonitis is a chronic problem that is aggravated by overuse. Where is the tendonitis that has been diagnosed? Is that in the left hamstring or quad?

 

[Josephine]

ALL the issues I am complaining about, that I can NOT do, date back to the surgeries

And you don't see the connection between having the surgery and doing outrageous amounts of exercising?

I'd also point out that I also live on my own and am 17 years older than you. Yet I cope very well will all those things you mention but often not without difficulty. One learns the cope with it.

instead you are extending the "no PT" mantra to say "no exercise, no walks, be an invalid for the rest of your life."

No, absolutely I am not saying that. I am saying don't do those exercises. And I have never, ever advised people to do nothing, do no walks, just be an invalid. Not in a million years! A person needs to be active and to walk to improve strength and fitness.

I would also say that if your approach to well meant advice is to have a hissy fit and walk out, then why are you here? This forum is for advice and support but it seems you have decided you know best so 'so be it'. But please don't then ask for advice if you're not open to anything that is suggested to you.