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PKR Frustrated after PKR

Erinpope23

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Hi,
I'm new here (59 yo woman) and have been reading through a lot of the posts. I am 7 weeks out of a partial knee replacement (medial). I was on a walker for 1.5 weeks, then a cane until week 4. PT had me stop using that and honestly I don't feel like I need it. My problem is my flexion. I can get to 0 degrees straightening my knee, but only to 100 degrees flexion. A week ago my surgeon said I am way behind where I should be, so he did a MUA and was able to bend my knee to 130 degrees under anaesthesia no problem. But the next day and the following week in PT, I can only get to 100. Saw my surgeon today and he bent my knee until I cried. He said he did not reach the end point and the only thing stopping me is ME. He said to cry through the pain at PT, that was perfectly okay. He said just don't get to the point of vomiting or passing out. He said to take a pain pill before I went to PT to help get through the pain. He upped my PT to 3x a week vs 2. I'm still icing, elevating, doing home exercises but nothing seems to help. The pain is terrible when I'm doing my exercises. The swelling is still there, but he said not bad enough to drain. I feel like a total failure and honestly feel like my surgeon is so disappointed. Any advice would be welcome.
 

Pumpkln

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@Erinpope23
Welcome to BoneSmart, glad you joined us!! :welome:
We consider 100 degrees of flexion great at 7 weeks, swelling is what is causing your flexion to be stuck. Every time someone pushes and shoves on your knee they are irritating your knee causing further inflammation and swelling.
Most surgeon will not even attempt a MUA once a person has passed 90 degrees.
I'm still icing, elevating, doing home exercises but nothing seems to help.
Most likely because when your exercise or allow some one to push on your knee just short of vomiting or passing out, your knee responds with more swelling and inflammation, blocking your ROM and causing pain.
You are well within your rights to say no to any procedure, Saying no to therapy - am I allowed to?

I feel like a total failure and honestly feel like my surgeon is so disappointed.
You are not a failure, your surgeon has unreasonable expectations. You have been very successful with your walking, no device at 7 weeks is fantastic.
Please do not let anyone interfere with the good progress you have already made, that includes your PT and your surgeon.

Suggest you cancel your PT appointments next week and let your knee heal, with Rest, Ice, Elevation, and Medication as prescribed.
Your can do two gentle ROM activities we recommend 2-3x a day.
Heel slides and how to do them and Extension: how to estimate it and ways to improve it .

What is going to get you ROM is time, time to heal, time for the inflammation and swelling go down, and time to allow your ROM which has been there all along to reveal itself.

Please post your surgery date and MUA date, a moderator will add it to your signature for you. Having the exact dates will help us properly advise you. Thanks!

Here is your copy of the Knee Recovery Guidelines, the articles are short and will not take long to read.

Knee Recovery: The Guidelines
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

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 the 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 the member’s history before providing advice, so please post any updates or questions you have right here in this thread.
 
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ArmyVet

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Someone with the links will be here shortly, but DO NOT let your therapist put you in pain!!!!! To me, it sounds like your baby knee won't bend because it's too swollen!! Give your knee time-- REST, ICE, ELEVATE, and that swelling will go down and you WILL GET FLEXION!!!!

Someone here gave me the same advice I just typed when I came in here for my first knee replacement, and once I stopped therapy and just did what my knee told me it could do, my swelling went down and I gained all the flexion I ever needed or wanted!!! You will continue to gain flexion for at least a year after your surgery, so don't let the therapist get you down!!!!
 

Pumpkln

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Here are the ROM numbers of other members who where slow to gain ROM.

Campervan’s ROM history
92 - 8 weeks post op
105 - 10 weeks
107 - 5 months
110 - 6 months
112 - 7 months
116 - 9 months
119 - 11 months
118 - 1 yr
120 - 1yr 2 months
125 - 1 yr 8 months and still this now at 1yr 10 months

Bertschb’s ROM history
1 month
- 60 degrees
2 months - 80 degrees
3 months - 85 degrees
4 months - 90 degrees
5 months - 90 degrees
6 months - 110 degrees
7 months - 120 degrees
8 months - 125 degrees
9 months - 130 degrees
10 months - 135 degrees
11 months - 140 degrees
12 months - 140 degrees

TortiTabby's ROM
3.5 wks: 75
6 wks: 85
7 wks: 90
10.5 wks: 95
14 wks: 100
17 wks: 105
20 weeks: 110
26 weeks (where I am today): 120!!!
It has now been 26 weeks and all I do is ADL.
I did it! My goal of 120! No "pushing through pain", no PT after the first 3 visits, and most importantly to me: No MUA! My surgeon who said I would never get beyond 85 ROM without pushing through pain was wrong, wrong, wrong. I'm excited to see if it gets even better.
 
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Erinpope23

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Ok off to PT to discuss above replies and what my surgeon said today. Will be back to reply in a bit.
My surgery was 12-1-2020
My MUA was 1-14-2021
 

Jockette

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I am so sorry that you are being subjected to such painful PT and checkups. It is not necessary and we have the testimony of many members to prove it.
Saw my surgeon today and he bent my knee until I cried. He said he did not reach the end point and the only thing stopping me is ME. He said to cry through the pain at PT, that was perfectly okay. He said just don't get to the point of vomiting or passing out.
I seriously don’t understand how anyone in the medical field can recommend this approach to this recovery.

My surgeon was a fan of pushing my knee way past it‘s comfort level until I finally had enough and refused to let him do it. I despised my checkups, they were stressful before, during, and after. So not what we need, this recovery is hard enough under the best of circumstances, and what you are being told is the worst of circumstances.

I was afraid to stand up to my surgeon, I mean, he's the surgeon, the head authority in this experience, but I finally did, and I won’t ever allow anyone to do that to me again.

It is your knee and you have the final say what you will allow done to it.

If your PT doesn’t agree with treating your knee gently, find another one, or do your own rehab at home, with the exercises that Pumpkln left with you. Not all of our members go to formal PT, many do it themselves at home, and they have wonderful outcomes.

Take care of yourself. You are most definitely not a failure. You will get better results by changing to a more gentle recovery approach.

Hang out here with us.
Bonesmart has a wealth of advice, information and support.
We will offer helpful suggestions, :idea:

Cheer your accomplishments :happydance:

And send hugs when you are feeling down. :console2:

Best wishes!
 

Citylady52

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So sorry! The advisors on this forum must know of what they speak. I've been feeling very sorry for myself because I have damage to tendons in my foot and lower leg and I cannot really do much exercise. Knee swelling has gone down and my range of motion has increased all on its own just as they have been telling you. Your surgeon does not sound like a nice guy. And, he is wrong.
 
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Erinpope23

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Well you are all wonderful, and right on with your advice. My PT feels like we need to back off the excruciating bending exercises and spend the next few days just stretching out the muscles, nerves and everything else. It felt wonderful in my session today! They totally did not agree with my surgeon whatsoever. I'm so grateful for them, and for finding this forum. Thank you everyone!
 

Pumpkln

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Glad you had a good discussion with your PT and are now going to receive the treatment your knee needs.
Kudos to you for standing up for yourself, and your knee.
They can help get your swelling down with manual therapy, electrical stimulation, and gentle activity.
Which knee had the PKR?
Keep us posted on how you are doing.
 
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Erinpope23

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It was my right knee. I tore my meniscus in Jan 2020, had it repaired in Feb. then tore it again in June. Had to wait til December for the PKR as hubby was undergoing chemo/radiation for throat cancer. He's now 2 months 100% cancer free and I would love for my recovery to go as well as his has! Thank you for all the great advice
 

Citylady52

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Best of luck to you and your husband. What a difficult year you have had. Here’s hoping for light at the end of the tunnel and a great 2021 for you! Love peace health and happiness to you and yours.
 

FCBayern

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He's now 2 months 100% cancer free and I would love for my recovery to go as well as his has!
Welcome to BoneSmart and congratulations to your husband @Erinpope23! :happydance: Now that you have found us if you follow the advise here I think you can have that great recovery. I struggled with the decision about PT early, I already new the BoneSmart approach but he's the surgeon right? After one session when my knee was way more swollen and painful the next day, I decided to never go back to PT. I'm a few days away from 2 years since my TKR and my ROM has continued to improve the whole time. My TKR (and THR!) have given me my active lifestyle back. Let that poor injured knee recover gently for a while and I'm sure you will begin to appreciate the BoneSmart approach.
 

sistersinhim

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I was blessed to have a surgeon that never pushed PT. He gave me a prescription for it, which I threw away and never went. When I went for my 3 return checkups, all he wanted was to see what my knee would do. Never one question about PT! Of course, he knew I was a single lady that had to take care of myself, so obviously he trusted that I would not be just laying around all the time.

After 12 knee surgeries, I know that I do not need PT, and neither does anyone else if they do their own daily activities. My knee recovered just fine all on its own with only my daily activities. I didn't have the terrible swelling or agonizing pain that so many have after taking formal PT either. I knew the Bonesmart way worked before Bonesmart was even thought of. My surgeries started in the early 80s and I never went to PT even back then. I just didn't see the need for it. Bonesmart was formed around 2004. By then I had already had 6 knee surgeries and rehabbed the Bonesmart way!
 
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Erinpope23

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Thank you all for your thoughtful replies, advice and well wishes. My Physical therapists think there is still quite a bit of swelling, hindering my flexion. My surgeon said not really that swollen. Ugh. It feels so stiff and honestly has gotten way stiffer since my MUA. Even though I was at 108 degrees before the MUA he said that wasn't enough. Now SINCE the MUA I'm back on the pain meds (had been off for 10 days), my flexion is 100 at best with my PT really pushing, and I have WAY more pain than before the MUA. My biggest fear is that this pain will never go away. It honestly has me very scared for my future.
 

FCBayern

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Your pain won't go away until you let that poor knee rest @Erinpope23. Even if you don't have visible swelling the fluid build up in the joint capsule is going to continue to inhibit flexion. What you are doing doesn't seem to be helping, I really do believe you have a path to a good recovery by following the BoneSmart method, but it's a choice you must make. Maybe try 3 weeks of rest and ice and see if you see improvements? I hate to see you suffer so much pain when there is another way. Whatever you decide we will be here to support you!
 
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Erinpope23

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@FCBayern So when you say the Bonesmart method, do you mean just the heel slides and straightening methods above, doing them at home along with ice and elevate? And put PT off for now?
 

Jaycey

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So when you say the Bonesmart method, do you mean just the heel slides and straightening methods above, doing them at home along with ice and elevate? And put PT off for now?
Yes, this is exactly what we are recommending. This is based on thousands of members who took the same approach and had great results. All that forcing your knee will only result in more swelling and pain.
 

FCBayern

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Absolutely @Erinpope23, gentle heel slides, lots of ice and rest, and just Activities of Daily Life (ADL's) walking to the bathroom, getting a snack etc. Take a look at the activity guidelines again and realize that your recovery timeline started over with your MUA.

 

Birdgirl

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I went to PT for 12 weeks and will definitely do differently when I have my second knee done. There was never any discussion about my total body's pre-op inflammation and make the correlation to my one tkr knee lol. So PT forcing the bend...to the point of me almost passing out...did nothing but prove it would indeed bend and had more potential flex. So hurting you to prove the ROM capability doesnt make sense to me. It is the inflammation that is preventing. Our brains are amazing things. Every time I try to bend or do heel slides my brain makes me hesitate because of the previous trauma memory lol. It has been 2 months since formal PT finished and the trauma both physically and mentally is resolving. I perform my own light exercises at home and go mindlessly about my daily business. I know my limit! I know things will take time and just need to take one day at a time.
 

Muscleflex

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another voice here for the Bonesmart way - I had my bilateral a month ago today and haven't done any PT - I was a little worried for awhile that I wasn't going to be progressing fast enough, but my ROM has definitely been increasing as the swelling has gone down.
 

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