TKR Gingerbread's RTKR Recovery Marathon

[Reader525]

Thank you @Susie-Q & @maryo52, @Jaycey & @Reader525.
Headed to PT now.
Been making strides and I won't let them push my knee to the point of pain. My hubby suggested I stop them before they even get close to my stopping point. Great idea! So what if they think I've regressed...sure...I know I'm moving ahead just fine, on my own terms

@Gingerbread I can tell you that you shouldn't push to the point of pain, but if you are at all an overachiever, or have an ex-runner's mindset, it's hard not to push. I keep reading on here how we need to let our tissues heal and how the movement will follow, BUT, I know it's hard advice to follow sometimes.
I'm at 6 weeks out as of tomorrow, and I am sort of down in the dumps, tired of feeling sore and sitting around. I do my exercises every day, try to walk my dogs a little, do some things around the house and today PT said I'm overdoing! I was told to take a day off from my exercise routine, that it cuts down on the inflammation and helps things recover. I am off the Rx pain meds but take Tylenol and Ibuprofen. Can anyone tell me when the terrible aching in the knee goes away?

 

[Jockette]

Can anyone tell me when the terrible aching in the knee goes away?

This is different for everyone but may happen sooner if you cut back (but you don’t have to stop) your activity. Don’t look at sitting around as doing nothing, look at it as giving your knee the best opportunity in which to heal.

 

[Gingerbread]

So at PT yesterday they had me get on the bike. There was no way on God's green earth I could have rotated the wheel. She simply had me go back and forth to tolerance, which, after 5 minutes, became more than enough.
Can anyone tell me when it is "normal" to be able to bring your knee all the way around? I feel like it's going to be weeks until that happens, and my PT seems not too pleased with my recovery (although acknowledging my setbacks with the ER visit, etc..).
I know in my head I cannot push this. My knee and body deserve TLC.
Just wondering if there are reasonable milestones ?
When I worked the rehab floor, the milestones were performing ADLs independently such as transfers, graduating to ambulation with minimal assist, etc. So my reference points have been met so to speak.

 

[Daveboy1810]

Can anyone tell me when the terrible aching in the knee goes away?

I know the pain of which you speak. On my first TKR that terrible bone aching pretty much let up between 11 and 14 weeks. Rest assured it DOES go away. Until then I recommend Arnica Massage Oil by Weleda. I never really believed in topical rubs but this stuff works like magic. I just reordered it on Amazon.

 

[Jockette]

and my PT seems not too pleased with my recovery (although acknowledging my setbacks with the ER visit, etc..).

I get so tired of the people on our medical teams who are not pleased with our recoveries. Most of then have never experienced this surgery so they have no idea what this recovery is like. I’m sorry you have a PT like that. You are very early in this healing process, but you are going to heal just fine, in your body’s own timeframe, not your PT’s, or even your surgeon’s, timeframe. I know it’s very hard, but try to ignore his/her attitude about your progress. It will come as you heal.

 

[Reader525]

Can anyone tell me when the terrible aching in the knee goes away?

I know the pain of which you speak. On my first TKR that terrible bone aching pretty much let up between 11 and 14 weeks. Rest assured it DOES go away. Until then I recommend Arnica Massage Oil by Weleda. I never really believed in topical rubs but this stuff works like magic. I just reordered it on Amazon.

Wow, really?! Arnica Massage Oil, huh? Did you putvitvon the whole knee, even the scar? I was told not to put anything on it. I'm game to try anything.

 

[Reader525]

So at PT yesterday they had me get on the bike. There was no way on God's green earth I could have rotated the wheel. She simply had me go back and forth to tolerance, which, after 5 minutes, became more than enough.
Can anyone tell me when it is "normal" to be able to bring your knee all the way around? I feel like it's going to be weeks until that happens, and my PT seems not too pleased with my recovery (although acknowledging my setbacks with the ER visit, etc..).
I know in my head I cannot push this. My knee and body deserve TLC.
Just wondering if there are reasonable milestones ?
When I worked the rehab floor, the milestones were performing ADLs independently such as transfers, graduating to ambulation with minimal assist, etc. So my reference points have been met so to speak.

@Gingerbread There seems to be this push from the PTs to get everyone moving to a complete rotation as fast as possible. I know we are all different, and it gets tedious to hear that all the time, but it's true. The second week, I would lie on the floor with my good leg bent, wrap my bathrobe sash around my surgical leg's foot and GENTLY pull my knee into a bend until I felt a little discomfort and then just hold. Then I'd straighten it out. I'd do it about 10 times. I'd repeat that a few times during the day. Slowly my bending became easier. It takes time for most people. It's hard to feel like you aren't passing the test, everyone wants to get that pat on the back. It will happen!

 

[Gingerbread]

Just returned from the surgeon's.
He is very concerned that I am only at 75-80 degrees flexion.
He was also dismayed that I have laxity when performing my straight leg raise.
He stated I may be a candidate for a MUA at 12 weeks.
He said I should be much further along by now.
He effectively scared my husband who now is going to be on me about performing my PT exercises diligently. My husband did nothing but console me, but is now terrified his wife will be a cripple.
I cried the whole way home, with my husband holding my hand and trying to reassure me it will be alright.
I don't know what to do. When I push the exercises, I am in excruciating pain at night.
I'm so scared.

 

[Jockette]

Take a deep breath, both you and your husband.

I’m so sorry your surgeon painted such a dismal picture.

You are 4 weeks into a recovery that takes an average of 52 weeks (one year) Where you are now is not where you will end up.

I truly believe all these issues he talked about are from overdoing your activities. That is easily remedied. Cut back on the exercises and the trips up and down the stairs. The harder you work on these exercises, the worse you are going to feel, as it will cause more pain, swelling and inflammation, which will definitely limit your ROM.

Remember this from our Recovery Guidelines:

2. Control discomfort:
rest
elevate
ice
take your pain meds by prescription schedule (not when pain starts!)
don't overwork.

You‘re lucky he mentioned the possibility of MUA at 12 weeks, and not right now, as other members have found. 8 weeks from now you will most likely be in a much better place recovery-wise.

What you’ve been doing up until now has not gained you a high ROM number. You have nothing to lose by cutting back and treating your knee gently. Give your knee the privilege of sorting itself out, and it will. Our bodies really do know how to heal themselves.

You might even consider taking a break from going to PT to give your knee a rest from all this overworking. I know that sounds like a scary thing, but really, it could be very good for you. Saying no to therapy - am I allowed to?

This is what one of our members, TortiTabby, experienced:

(Just so you know, ADL means Activities of Daily Living.)

“At my six week appointment this is what my OS wrote in my visit summary: "She reads an online website called Bone Smart which states to not push through pain following knee replacement. If she were to follow this direction, she will have to learn to live with a knee that only reaches to 85 degrees of flexion. I believe this website is very misleading."
It has now been 20 weeks and all I do is ADL and this is what my ROM has done:
3.5 wks: 75
6 wks: 85
7 wks: 90
10.5 wks: 95
14 wks: 100
17 wks: 105
20 weeks (where I am today): 110
I am so thrilled it keeps improving and improving and I know now that I will get to my goal of 120 (or even better, dare I say!)
So, if a OS or PT bullies you into thinking your ROM will not improve over time they are wrong. By the way, I haven't been back to see the OS since that horrible appointment at 6 weeks, but I sure am going back when I reach 120 just to say, "Ha! You were wrong, BoneSmart was right!" “

And,

“Just an update for those who are apprehensive about gaining ROM:
It has now been 26 weeks and all I do is ADL and this is what my ROM has done:
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!!!
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. “

 

[Gingerbread]

This is very encouraging!
What I emphasized to my husband (who understands and agrees) and to my surgeon ( who half listened and still maintained his agenda) is I am fighting a lifelong battle of chronic lymphedema in the affected extremity (R leg), which may be contributing to the continual fluid accumulation & tightness. The amazing thing is, the edema distal to my knee (especially in my foot, which has always been a problem) has improved since surgery (I always wore TEDS on the right leg, so that is not a factor).
I also had 12 weeks of intense radiation for breast cancer to my left chest in 2012-which affected my left lung, heart and thyroid. Of course this may be contributing to my impaired healing-but no one seems to want to factor any of this in!
I also have exercised faithfully (and was a runner until meniscus injury in 2002) since the birth of my first daughter in 1992-so it is absolutely ingrained in me to have a "can-do" motivational attitude. But right now my body is just saying "I can't do this, please listen!"
I think this is also harder as the doctor knows I am a nurse. Its like he feels I should know the "protocol" and not have problems. What I know is that I am the patient, I have rights. Although right now he is scaring me.
Thank you again for this insight into what our amazing bodies can do when left to heal themselves.
Does anyone have a crystal ball so I can see which path I should choose?

 

[beesknee]

First, at one month, you have plenty of time to increase your ROM before MUA needs to be considered. Your ROM is not great, but definitely sounds like the low end of the normal range.

The way my OS explained. There are three main things that cause stiffness - Excessive scar tissue in wound (I think I have this) swelling and adhesions.

Some people come out of surgery with 90+ ROM - lucky.

Me, I came out with 30 ROM and have been working hard to find the formula for me that increases ROM with minimum pain and increased swelling.

The PTs want to bend us through that scar tissue but too much overly aggressive PT just makes it swell and heal with more scar tissue.

I am in week 7 and only just hit ~112 ROM but I am gaining a little more each week. The main thing, while my knee is and feels stiff, the pain is minimal.

Here is the balance that works for me:

Mon and Wed regular PT. Push to my pain point but not past. At PT they have mey do about 8 different stretching exercises three sets of 10 reps each and 2 quad strength building. After each of these sessions I am hurting a bit I come home elevate and Ice for an hour or so. The next day I seem back to my baseline.

The non PT days I do 3 stretching exercises but go lighter and only do two sets of ten each. Plus I do the quad exercises which I like and feel good. Also, during non official PT days I try to walk as much as possible. I also, do a few heal slides while sitting around if I think of it.

For me, this combo of hard PT 2 days and light PT 5 days seems to keep me pain free while increasing ROM.

Hopefully you can find a balance that works for you. For me, I found the most important thing is to keep the knee moving and bending with both structured and natural knee bends.

POSTER LEGAL DISCLAIMER - My comments on this web site are provided for informational purposes describing what is working for me. My comments are not a substitute for advice from your physical therapist or surgeon.

 

[Jockette]

@Gingerbread I think you are totally correct that all these physical factors will have some bearing on your recovery. It really frustrates me when doctors only look at their specialty and not the rest of our body.

But right now my body is just saying "I can't do this, please listen!"

This is the heart of the Bonesmart approach to recovery. Listen to your body, not to the one size fits all rehab protocol, because we are all individuals.

 

[Gingerbread]

First, at one month, you have plenty of time to increase your ROM before MUA needs to be considered. Your ROM is not great, but definitely sounds like the low end of the normal range.

The way my OS explained. There are three main things that cause stiffness - Excessive scar tissue in wound (I think I have this) swelling and adhesions.

Some people come out of surgery with 90+ ROM - lucky.

Me, I came out with 30 ROM and have been working hard to find the formula for me that increases ROM with minimum pain and increased swelling.

The PTs want to bend us through that scar tissue but too much overly aggressive PT just makes it swell and heal with more scar tissue.

I am in week 7 and only just hit ~112 ROM but I am gaining a little more each week. The main thing, while my knee is and feels stiff, the pain is minimal.

Here is the balance that works for me:

Mon and Wed regular PT. Push to my pain point but not past. At PT they have mey do about 8 different stretching exercises three sets of 10 reps each and 2 quad strength building. After each of these sessions I am hurting a bit I come home elevate and Ice for an hour or so. The next day I seem back to my baseline.

The non PT days I do 3 stretching exercises but go lighter and only do two sets of ten each. Plus I do the quad exercises which I like and feel good. Also, during non official PT days I try to walk as much as possible. I also, do a few heal slides while sitting around if I think of it.

For me, this combo of hard PT 2 days and light PT 5 days seems to keep me pain free while increasing ROM.

Hopefully you can find a balance that works for you. For me, I found the most important thing is to keep the knee moving and bending with both structured and natural knee bends.

POSTER LEGAL DISCLAIMER - My comments on this web site are provided for informational purposes describing what is working for me. My comments are not a substitute for advice from your physical therapist or surgeon.

I'm glad to hear you found a balance that works for you. I like the combination of harder PT days vs light stretching!
I will be proceeding with 2 PT days/week as well, in the evenings at 6:30 after I take a nap after work ( I return to FT working from home next Monday ).
I see where I came from (barely being able to bear weight on the leg 2 weeks ago) to now walking many times without the walker around the house...I see strides but its the flexion they are so concerned with.
My flexion HAS improved, but everyone wants me on the same page as the typical TKR patient.
We are all different, and should be respected as such.

 

[Susie-Q]

I remember reading an article on here years ago that says it takes bone a full TWELVE WEEKS to heal so Daveyboy's range of 11-14 weeks before that deep ache goes away is right on the money. I'm sorry you are having so much trouble but I do agree that your past medical history is playing a part in your slow healing. Please take care and baby yourself for a few days.

 

[ladyjane5]

I know the pain of which you speak. On my first TKR that terrible bone aching pretty much let up between 11 and 14 weeks. Rest assured it DOES go away. Until then I recommend Arnica Massage Oil by Weleda. I never really believed in topical rubs but this stuff works like magic. I just reordered it on Amazon.

Wow, really?! Arnica Massage Oil, huh? Did you put it on the whole knee, even the scar? I was told not to put anything on it. I'm game to try anything.

I have been using Magnesium Gel from CVS for knee pain. Also I started taking magnesium supplements at night

Saw the PA today for 3 month checkup

He said my knee may be numb for a long time and that probably nerves are regenterating causing pain

The Silver Sneaker class I did yesterday called for squats and last night the knee was painful
Today that pain was gone. Anyone else have issues with squats? I think I will not go deep with them in the future

3 months seems to be the time frame for me when the pain got better.

 

[FCBayern]

Don't let anyone else drive your healing schedule @Gingerbread. We all heal at our own speed and many of us have other health issues that affect out healing time line. The "one size fits all" after care and PT that most surgeons seem to support just doesn't work for everyone.
Prior to my TKR I was aware of the BoneSmart gentle approach to recovery as opposed to rigorous PT. I was lucky enough to find the site before my TKR. Even though I knew about the BoneSmart approach my OS was all about PT and "whatever ROM you have when your scar turns silver is all the ROM you will ever have." He was the trained surgeon that has done many, many replacements, he must know what he's talking about right? So off I went to my first visit to PT, about 2 weeks out from TKR. The next day when my knee was more swollen and I was in much more pain I opted for a BoneSmart recovery. I never went to another PT session. That was one of the best decisions of my life. Not only did I suffer less pain, but my ROM has continued to improve over two years. I've been hiking over rough terrain for good distances, scuba diving, and just living a happy active pain free life with more ROM than I ever thought I would have again after many painful years. I've now had a hip replacement with equal success following a BoneSmart approach. You don't have to suffer needlessly to have an amazing recovery.

 

[BBCG]

I have a question for everyone. Has anyone used CBD post op for pain? I go to the surgeon in an hour and I will need a refill on the Oxycodone. I only need it at night and morning, as nights are dreadfully painful still right up until about now ( 8 am). Has anyone had success with CBD products or medical marijuana? I live in a state where it is legal. I really want off this Oxycodone, to the least medication possible.
Thanks in advance

I am so sorry all you are dealing with, Gingerbread! I had similar pain with TKR #1 in 2016, so I can relate. Thankfully, YOUR doctor was accessible! Mine was not and the gatekeepers were horribly cruel! But, I survived, although I waited 5 years to do #2, too!

Yes: I use CBD which is legal in Oregon. I use an organically grown and prepared tincture as well as a salve with herbs on my knee, now that the incision has closed. I'm about 16 weeks out from surgery.

Prior to this surgery, I was able to use the tincture at night in order to sleep more soundly, and I could re-take it if I awakened in the middle of the night. I also used the salve on my knee pre-surgery. I did not use any other pain remedy pre-surgery for the year before this surgery. Not the case in 2016...

This surgery, I knew well in advance that I would NOT take an opioid and in fact, they don't automatically offer it now; Tramadol is the first line of pain relief now, here at least. I have a very BAD reaction to the opioids, and I think Tramadol is related, but not the same strength, BUT, opioids didn't help my pain in 2016, but before surgery, I had no clue that was the case. I had never had surgery before. They simply do NOT work for me. But, who knew that in 2016!

Tis year, I was able to wean off the Tramadol* within the first 5 weeks; last time I didn't get to take it until 6 weeks because I spent a month trying to get help and had enough Oxycodone to last that long, even though I had a horrible time trying to get some relief since it barely helped.

I'm not sure where you are, but these two preparations did work well for me and are still working. I only need the tincture at night, unless I join the ODIC (OverDid It Club) by walking faster than my knee prefers, etc! I use the salve prior to my walks, or before I head out to drive farther than usual, etc.

I'm sorry this wasn't within the hour needed, though!

 

[Gingerbread]

Don't let anyone else drive your healing schedule @Gingerbread. We all heal at our own speed and many of us have other health issues that affect out healing time line. The "one size fits all" after care and PT that most surgeons seem to support just doesn't work for everyone.
Prior to my TKR I was aware of the BoneSmart gentle approach to recovery as opposed to rigorous PT. I was lucky enough to find the site before my TKR. Even though I knew about the BoneSmart approach my OS was all about PT and "whatever ROM you have when your scar turns silver is all the ROM you will ever have." He was the trained surgeon that has done many, many replacements, he must know what he's talking about right? So off I went to my first visit to PT, about 2 weeks out from TKR. The next day when my knee was more swollen and I was in much more pain I opted for a BoneSmart recovery. I never went to another PT session. That was one of the best decisions of my life. Not only did I suffer less pain, but my ROM has continued to improve over two years. I've been hiking over rough terrain for good distances, scuba diving, and just living a happy active pain free life with more ROM than I ever thought I would have again after many painful years. I've now had a hip replacement with equal success following a BoneSmart approach. You don't have to suffer needlessly to have an amazing recovery.

It's scary because so much is happening at once. I'm returning to work FT next week and I'm not ready. I'm having to do these PT exercises or I know my poor husband will begin to fret that I will not recover. I'm in a no win situation even though I want to follow this advice I fear I cannot. I am also afraid I'm going to lose it at some point... Not a great scenario to ponder.
Having wonderful people like you to confide in is very helpful. Thank you.

 

[BBCG]

One more thing (actually, two!): I had a difficult time after my first TKR as I said. I also was threatened with the dreaded MUA at about the 6 week mark when I had not yet achieved a ROM of 120, back in 2016. That's about when I found Bonesmart! I changed what I was doing! I did no more aggressive PT, told the PT I was the only one who could push my knee, no other hands on, and I did NOT go back to see the OS UNTIL I reached 120, at about 4 months. No MUA then! That knee has been my rock ever since, and I had come to totally rely on it to support me as the right knee worsened.

Oh, one other thing: I have a recliner, a supportive, floofy pillow AND a rolling table that fits OVER the recliner so I work with my leg in the air at about 90 degrees out from my hips. I can work there for about an hour before I need to get up and move around some... A friend borrowed a recliner form someone for her surgery, so perhaps you can rig something like that up? Ask me for links if you want to know what I use to work...

 

[BBCG]

Wonder if there is a Bonesmart post in the wings for the spouses who push the patient into putting up with too-aggressive PT exercises?! I'll look and see!