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TKR Grizz Feb. 10, 2020 -TKR recovery

grizz

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Yes this is no cake walk for sure. I’m 11 days out post op LTKR with Mako robotic assist. Experienced tremendous swelling of knee down thru lower leg and ankle. According to PT a lot of this is due to the surgical procedure with ROBOTIC MAKO. Bruising and black/blue becoming quite evident in lower leg throughout ankle/heel/foot. Using lots of ice packs and elevation. Ace wrap has helped reduce swelling abit. Nurse and PT are concerned about cellulitis in shin area due to swelling and sensitivity. DR called in10 day antibiotic course as preventative. Trying to keep up with the PT exercises but swelling has been an obstacle to obtaining ROM. I went from 63 to 82 this AM . DR set a 2 week post op goal of 90. Anyone use Arcadan gel as this was recommended for swelling and bruising by PT and Nurse?
 

Jaycey

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@grizz Welcome to the other side!

The first thing I would recommend is that you stop trying to " keep up"with all that PT. You are just creating more swelling with all that exercise. And no, there is no "goal" of 90 ROM. You set any goals, not the doctor or PT staff.

Focus on icing and elevation. You are not in training and there is no window of opportunity for ROM. Here are your recovery articles:
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 Activity progression for TKRs

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 a 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 history before providing advice.
 

Celle

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Hello @grizz - and :welome:

Jaycey is right. Stop trying to please your surgeon and your PT therapists. They're all being impatient.

It's pretty obvious that, with all the swelling and bruising your leg had, your ROM is not going to increase at the rate they want.

Poor knee - how can it bend further when swelling is physically preventing it?
The last thing it needs is being forced to do exercises, in the vain hope that it will meet their unrealistic expectations.

Experienced tremendous swelling of knee down thru lower leg and ankle. According to PT a lot of this is due to the surgical procedure with ROBOTIC MAKO. Bruising and black/blue becoming quite evident in lower leg throughout ankle/heel/foot.
The swelling and bruising have nothing to do with you having had the Mako robotic procedure. They are a natural result of your knee having one of the most major surgeries it could have. Swelling and bruising are a normal reaction to that, and everyone experiences it. In your case, the swelling is made worse by everyone's attempts to make your knee bend further than it is ready to.

In spite of what you've been told, there's no need to rush to get ROM (Range of Motion) because it can continue to improve for a year, or even much longer, after a knee replacement. There isn't any deadline you have to meet:
Myth busting: the "window of opportunity" in TKR

It's not exercising that gets you your ROM anyway - it's time. Time to recover, time for swelling and pain to settle, and time to heal. Your knee has the potential to achieve good ROM right from the start, but it's prevented from doing so by swelling and pain. As it heals and the swelling goes down, your ROM (both flexion and extension) will gradually increase, even if you don't do lots of exercises.

So, try to forget about the pressure put on you to get ROM fast, and, take a big break from doing exercises. Your knee will get all the exercise it needs at this stage, just by you walking around the house and taking care of your activities of daily living.

Instead of doing formal exercises, spend as much time as you can resting, icing and elevating you knee, to try to help the swelling go down. Your knee has been traumatized and it needs time and gentle treatments, so it can heal.
 
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Yes, all the number crunching tends to make one feel short of something. Every case is a bit different. Even one knee to another -- even with BTKR's.

I had the Robotic assist TRK with no bruising and little swelling. You are only ten days in!
Though I walked about early on, I was still a zonked-out insomniac :tiredwheel:during that time.

Unable to sleep much (those first 18 days) my PT was delayed though flexion was good early on. But I didn't start to ponder the degrees of ROM until four weeks post TKR.

By then my knee was ready to move as time went on. And I was ready to record progress.

Be gentle on yourself and that baby knee!
 
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grizz

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How much is ones immune system compromised post TKR? Any suggestions on visiting PT locations? I live in CT and am a bit concerned about possible transmission of this virus. 62yo. 5 weeks post op. Comments welcome
 

sistersinhim

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You'll notice that I have merged your two threads together as we prefer that members in recovery only have one thread.

This is for three reasons:
1. if you keep starting new threads, you miss the posts others have left you in the old threads
2. it often ends up that information is unnecessarily repeated
3. it's best if we can keep all your recovery story in one place so it's easily accessed if we need to advise you.

Please keep all your questions and updates on this thread. If you would like a new thread title just post what you would like it to be and we'll change it for you
 

eaglemom

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Your concerns about COVID-19 need to be addressed with your operating surgeon. Use the patient portal or call the nurse and voice your concerns. Do not go by what you hear on the news, etc. You have to be proactive to protect yourself. Listen to what your gut tells you. Call the surgeon, now, carefully go wash your hands.
 

Pumpkln

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@grizz
If you are concerned about outpatient PT, call your surgeon for a home exercise and activity program from PT, and the ability to check in with a PT via phone or the internet to help with progressing your program and answer questions. The rules for tele health have been modified to promote contact with patients with out an office visit.

Let us know if you would like a new thread title, it looks like you are more than 11 days out from your TKR.

Stay safe, your knee will heal,
 
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grizz

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Thanks for responding. Yes please change thread title (Grizz 2/10 TKR recovery) or to whatever you suggest is most appropriate.

I did as suggested and spoke to both PT and OS. With all of the uncertainty with the transmission of the virus, they both suggested I not visit PT but continue an AGGRESSIVE at home regimen. Main concern is losing flexion and extension . I am at best @ 85 degrees flexion with discomfort. Extension getting there, approximately -8. PT sent me excercise schedule with personal contact info. Putting current PT visits on hold indefinitely. I still experience discomfort in leg after sitting for a period of time. Walking definitely helps although new knee will let me know when I overdue it. Slow and steady is certainly the key here and don’t overdue it. Thanks for all great advice everyone
 

Celle

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I've changed your thread title for you @Griff .

they both suggested I not visit PT but continue an AGGRESSIVE at home regimen.
An aggressive regimen will do more harm than good, because it will keep all your soft tissues upset and inflamed, which leads to increased swelling and decreased ROM.

Gentle movement is all your knee needs. In fact, if you rest it for a while from the aggressive PT you've had so far, you will probably see in increase in ROM, not a decrease.

It's not exercising that gets you your ROM - it's time. Time to recover, time for swelling and pain to settle, and time to heal. Your knee has the potential to achieve good ROM right from the start, but it's prevented from doing so by swelling and pain. As it heals and the swelling goes down, your ROM (both flexion and extension) will gradually increase.
 

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