TKR Freedom's right knee<

[Freedom]

Here I go getting myself all worked up.

First, the last time I saw OS, in his office, he said he would like me to try and finish in home PT at 4 weeks this time with a 90 bend.

Next, in hospital, with nerve block but post op, I was 65. PT reminded me that once block wore off, that would drop.

Here I am in rehab barely getting 53.

I am following bonesmart doing rest, ice and elevate

OT has involved getting on and off toilet, in and out of a chair, short hall walks, washing self, shower. I've not seen anything there to modify to the bonesmart way.

PT has involved longer hallway walk but sitting before returning. Lying back and using a sheet for heel slides set of 10 rest and another 10. Since I was holding the sheet, I was in control. I did just beyond comfort level, definitely no pain. Held for count of 10 and release. Sitting in chair sliding foot back, I didn't like that one so we stopped after 3. I found it easier sitting in wheelchair, foot planted and I control rolling forward, hold and back.

The PT today, she has worked PT for 11 years, most of that in Florida at a rehab thar was part of a joint replacement hospital. She has been here 2 weeks. She told me she has never worked with anyone with tkr who was under 100 after nerve block wore off. She said at the place in Florida, they were always 120 or higher with the nerve block. I asked if it was the quad sparing surgery, she said probably.

I came back here and checked @Josephine's recovery thread UK style, she was at 100 when block wore off.

Why am I so far behind? What causes this, do I do something? Having met with Pain Management, I went in to this surgery calmer, expecting to do well. Here I am 53.

I did get TEDs compression socks today those are a first. And they're on both legs. My left had been over 110, but when they measured it here 2 days ago, it was 85. I know it has also become swollen.

 

[newlybionic]

I don't think that PT knows what she is talking about. I know with both my surgeries I was well under 90 for sure. The second time I couldn't even get my heel on the ground for the first three days. I'm sure it's just the swelling that holding the flexion from being greater.

 

[Freedom]

Thank you yes swelling is my big issue. I'll have to see how I will deal with inhome PT when the time comeshe.

I like being in rehab as I have the hospital bed. I am constantly shifting heights. Someone else deals with meals planning, prep and clean up . And I am having trouble getting to the toilet on time; here, in rehab someone either helps me or handles the entire cleanup. Bed to toilet at home is about 4 times the distance. I seem to get little warning that I have to go. And getting out of bed is a convoluted series of movements. Once I am up, have my balance then I move slowly with the walker.

 

[Tabbycat]

@Freedom
I think you are doing well for one week out. You are not doing anything wrong, you just had very major surgery! I wish these physios would encourage instead of making you feel like a failure. I had a nerve block too, but it only gets you over the first couple of days. As you have a lot of swelling the ROM will be low, you are not behind, you are at the start of your recovery, and it's not a race.The stockings should help a bit, they are hard to get on and off, and uncomfortable in the heat, but they do help with the swelling. My OS wanted me to wear them day and night for six weeks and I complied (for five weeks and five days!)
You are doing ok, don't let anyone tell you different!
Love, Tabby xxx

 

[Josephine]

It's quite common for a knee to have excessive swelling for a variety of reasons. But it's the swelling that blocks the ROM, nothing else and certainly nothing you did.

But I'd like to ask you some questions if you don't mind, and 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)

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?

6. are you elevating your leg, 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. what kind of PT exercises and exercises at home are you doing? How much 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: (enter number) of sessions each day
enter exercises + enter number of reps and sets
etc., etc.

At PT
enter exercises + enter number of reps and sets
etc., etc.

 

[Freedom]

1. Pain well managed, 3 or 4 max. Even in /after PT I make sure to stop at uncomfortable
Exception: area on inside of leg next to kneecap and extending down. If 8 bend too much, if I don't have foot planted properly on floor and put weight, that area hurts 10 plus, I scream and reposition. Relief is instant, no lingering pain.

2.meds
A Oxyconton 10 MG scheduled 12 hours apart. This is extended release.
B. Oxycondone 5 or 10 MG every 3 hours. Last 2 days, been taking 10 MG at a time, 2 or 3 times in 24 hours.
Clearly. Lyrica 75 mg morning and night schedule during, for 14 days, 1 week pre op 1 week post op. Part of my individualised pain management plan. I was told it builds up and coats nerve endings so they are not as reactive.
D. Aspirin 325 mg morning and night schedule do to prevent clots.

3. Swelling. Leg was huge. I've had compression socks on about 24 hours. Clearly smaller, not yet down to moderate.

4. ROM Flex 53, extension 8, measured yesterday morning before compression socks put on. Flex had been same for 3 days. Extension improved from 12 to 8 during same 3 days. Note in hospital post op, nerve block still wo6, I got 65 on my own and easily.

5. And 6. Ice and elevate at least 15 hours daily.

7. As I am in rehab minimal activity. Each time I go pee (which seems constant, ) I take walker for a short spin in the hallway.

8 etc. I have PT once a day. Lie on back use towel for heel slides, 2 sets of 10. Quad sets, 2 sets of 10. Or we may take a long walk - double what I am authorized to do on my own, sit rest and return. One day she tried me sitting in chair sliding foot back, I didn't like that so we stopped after 3. Moved me to wheelchair, foot planted and I roll forward hold and back, that was OK, did 10. But that day I did not do the slides with the towel. They mix it up.
I also have OT once a day. Early on, this involved me getting out of bed, so she could see how I do it--I use a leg lifter. In to bathroom, sit on toilet lid down, then get up. Next day involved me walking into bathroom (5 steps with walker, it is en suite and next to bed), and I had to wash up, involves standing, balance. Another time I sat in chair, she put cones on floor in half circle and I had to pick them up. First with grabber gadget, second time they were closer and I had to get them with my hand. Another time, walker down hall to shower, have shower and back up.

PT today only did 10 heel slides with towel. New one, still on my back, slide right leg out and in. Initially I couldn't move the leg at all, so she helped me get leg out. Then I slowly brought it back. Took lots of concentration but I did 7 on my own.

 

[Clipless]

@Freedom , someone gave me the best tip after my 2nd TKR: place the top of your other foot under your fresh TKR foot (like at the instep) and use your stronger leg to "boost" your heel slides. This works great, doesn't require a strap or towel, and keeps your other knee moving, too!

 

[Keen Skier]

If you go to a bike shop or running store you can find compression socks which aren't as hot or as tight as the TEDs( the ones with the hole) but they are totally adequate for swelling while at work. I wore them pre-op at work whenever I scrubbed in the OR with good results and I've been wearing most days post-op and been totally comfortable. The bike ones, especially, come in great colours and are way cheaper than medical grade.



Sent from my iPhone using BoneSmart Forum

 

[kneeper]

The PT today, she has worked PT for 11 years, most of that in Florida at a rehab thar was part of a joint replacement hospital. She has been here 2 weeks. She told me she has never worked with anyone with tkr who was under 100 after nerve block wore off. She said at the place in Florida, they were always 120 or higher with the nerve block.

Well isn't that special. I don't think most people are anywhere near 120 in the hospital. I was only around 60. Try not to let that PT get to you.

 

[sistersinhim]

Don't you just love the way they 'fib'!

 

[newlybionic]

I don't think I would use the word 'fib'!

 

[Josephine]

1. Pain well managed, 3 or 4 max. Even in/after PT I make sure to stop at uncomfortable

Jolly good!

A Oxyconton 10mg ER scheduled 12 hours apart.
B. Oxycondone 5 or 10mg every 3 hours. Last 2 days, been taking 10mg at a time, 2 or 3 times in 24 hours.

Okay

C. Lyrica 75 mg morning and night schedule during, for 14 days, 1 week pre op 1 week post op. I was told it builds up and coats nerve endings so they are not as reactive.

That is sheer make believe! Lyrica (pregabalin) affects chemicals in the brain that send pain signals across the nervous system.

Flex 53, extension 8

Gosh!

3. Swelling. Leg was huge. I've had compression socks on about 24 hours. Clearly smaller, not yet down to moderate.

I would expect that given your ROM.

5. And 6. Ice and elevate at least 15 hours daily.

Good.

7. As I am in rehab minimal activity. Each time I go pee (which seems constant, ) I take walker for a short spin in the hallway.

Also good.

My comments in bold
PT once a day - I wouldn't do any just yet as you are only one week out. Leave it until week 4 at the very least. Better yet, do none at all!
Lie on back use towel for heel slides, 2 sets of 10 - heel slides are very easy to do badly and doing them this way is badly! To start with don't use straps or towels to 'assist'. Read this Heel slides and how to do them.
Quad sets, 2 sets of 10 - leave these for the time being, like 3-4 weeks
Or we may take a long walk - double what I am authorized to do on my own, sit rest and return - that's far too much for one week out. Three or four 5 min walks around the house plus trips to bathroom and kitchen on an 'as needed' basis are more than enough.
One day she tried me sitting in chair sliding foot back, I didn't like that so we stopped after 3. Moved me to wheelchair, foot planted and I roll forward hold and back, that was OK, did 10. But that day I did not do the slides with the towel. They mix it up. - all of this is too much for one week out. Refuse to do it. Better yet, tell them not to come. You're better off just resting the first 3-4 weeks. That's one of the reasons your knee is swollen.

PT today only did 10 heel slides with towel. - don't do any!
New one, still on my back, slide right leg out and in. Initially I couldn't move the leg at all, so she helped me get leg out. Then I slowly brought it back. Took lots of concentration but I did 7 on my own - if you can't do them on your own, then don't do them at all!

My assessment is that you are doing too much. Remember the mantra - rest, elevate, ice and take your pain meds. You don't need all that other stuff. If you doubt my advice, I recommend you read my recovery thread to see how little exercising I did for either knee! Knee recoveries UK style Parts I & II (Josephine)

 

[Freedom]

Don't know what gosh means for my ROM. That's what bothers me, why am I so low. I've read your recovery threads you were at 100 flexion so that is not encouraging.

I am in rehab for PT so I can't not do it, my insurance coverage will stop. Living alone with a weak to nonexistent support network 8 cats and 5 small dogs I really can't go home with such limited rom.

A 3 or 4 minute walk around my house, kitchen, bathroom, would be a LOT more walking than I am doing here in rehab. The double length walks I do with PT are the distance from my bedroom to my living room. It is not far at all. Everything done here is aimed at having me able to function at home when my insurance cuts me off.

For my left knee, insurance cut me off at 5 days. Everyone here knew there was no way I could go home, so they kept me 3 more days. I never got a bill.

As of now I have again been here 5 days. I know my insurance called for an update, staff is required to tell me that.

As for the side slides, how else do you get the muscles to wake up. That 8s hip not knee, I think.

As for the Lyrica, obviously I misunderstood. What you described ties in with the SPS trait I have.

So I am still left with WHY are my numbers so off, and what am I going to do. I am fine here in rehab, but going home will just repeat last time with left knee--2 weeks of overwhelming activity just moving around the house to get my food and such.

 

[newlybionic]

I'm sorry that you are having so much problem post op so far. I do understand about having to deal with your pets and having to take care of yourself when you are alone at home. I hope you start to do better in the coming days.

 

[sistersinhim]

I'm home alone taking care of 11 cats, except for the litter boxes on the screened-in porch and that only because they are down steps without rails. I not only fix my meals, I fix my roommate's dinner. It can be done. My numbers were 88/15. I am walking around 1500 steps a day with lots of ice and elevation during my rest times. I am doing no pt. They haven't called to set it up and I haven't called them. If they do call I'll probably tell them no thanks, I can do it myself! If you go home, you can handle it and you'll have control of everything you do. You just take tons of breaks. Good luck to you.

 

[Freedom]

I am NOT having so much problem, or any problem. I am trying to learn why my numbers are so low. In the process I was asked to reply to a list of questions. The reply to my answers was not relevant. Telling me to not do PT, telling me to walk around my house which would be more walking than I am doing now, just don't applyou.

And I still don't know WHY my numbers are so low.

 

[sistersinhim]

I'm so sorry. I didn't mean to upset you. With your being so swollen, I thought you were doing to much pt. I was only trying to help. Here's wishing you a quick and successful recovery.

 

[Freedom]

@sistersinhim , my reply was to the post above you.

And I am upset but not with anyone here. I just don't understand why I have to start so very far away from the goal. The goal we all work towards, at our own rate. The goal of good ROM.

I want to fuss and cry and kick, and yell it is not "FAIR. "

For the left, my OS said no driving for 4 weeks. But I started so far back, well I started driving at 5.5 weeks but I had to use handicap spots as I needed the door fully open to enter and exit. Now for the right, my OS says no driving for 6 weeks. I won't be driving till Christmas!!!

Starting so far back means I have to put my life on hold for longer than others. I read and research to prepare myself only to find I do not fit the norm, not by a long shot.

I know it is temporary, I know I will get there eventually, I know people have much worse hardships. I don't get why I have to do this starting so far back.

I hope that makes sense to you.

 

[Pumpkin]

You are only a week out, give your poor knee time to heal. It was recently cut open, skin pulled to the sides, ends of your bones sawed off, a prosthesis was pounded, screwed, and glued into place, then your soft tissue was pulled back, stitched together, then glued, or stapled together. TKR surgery - WARNING: real life photos
Try not to think about your ROM, sounds like you have a lot of swelling which will block your ROM until it goes down. Just do a few gentle, Heel slides and how to do them and let your knee heal.
Right now you want to work on getting in and out of bed, walking to the bathroom, a few stairs, sit to stand from a chair, simple meal preparation, dressing, bathing, and other functional activities.

For driving you need enough flexion to move between the brake and gas pedals, most importantly you need to be able to switch between the two quickly enough and with enough strength to slam on your brakes to avoid an accident, injury, and worse yet injuring another person.

I won't be driving till Christmas!!!

You mean Christmas in July? I know some summer resorts celebrate Christmas on July 25th. (Yellowstone)

Good luck, wish I could wave a magic wand and heal your knee,

 

[sistersinhim]

Maybe your knee was in worse shape than the average knee going into your surgery and had to have a whole lot more work done to it. Your doctor should be able to tell you. But, I know how you feel about numbers. My flex wasn't that bad, but my extension is only 15. I was always so happy with my extension after my patellectomies. That seemed to be the only thing the doctor was concerned about, my extension. Now, I have a terrible extension and that bothers me. So yes, I sure do understand your frustration. I pray that both of our numbers move the way we want them to move!