TKR Hanging in there

[FCBayern]

Skin sensitivity is a very common after TKR, the nerves get seriously disrupted @Firefly7554, that feeling should fade with time.

 

[sistersinhim]

Oh yes, that skin sensitivity is a common complaint after this surgery. After a few weeks, it gets much better, or at least, mine did.

 

[Jockette]

This is very common, it eases up after a while.

 

[Michigan Mitten]

Hopefully your mood has been uplifted as a few days have passed. I am almost 4 weeks into recovery and still have “dumpy” days due to lack of sun or just bored or just lazy or sore . I live in northern Michigan where the sunny days are few and far between, so I take vitamin D to help combat. Today I layed in bed and spent some quiet time reflecting and activities I look forward too come spring. It’s totally normal to have dumpy days and I wanted to let you know it will get better in time. Try not to set your expectations to high with recovery and emotional state of being as it’s a roller coaster.
The skin sensitivity is part of the recovery process. My first TKR I couldn’t bare to have anything rub against my skin, it’s the nerves and swelling that creates that sensation. It should be subsiding soon, the intensity however my June 2020 TKR still gives me A dullness on the skin by the knee. I just ignore it and grateful that I still can feel it!! Warm up some lotion and treat your leg and knee with a warm massage, it will help and feel good.

 

[Firefly7554]

Michigan Mitten, thanks for the encouraging words. Tomorrow I see the doctor for my first postop. I don’t expect him to say anything except that everything looks good.
it will be interesting to see what pain meds I will be able to take once I am off the Coumadin. Right now I have been dealing with about thousand MGs of Tylenol four times a day. It doesn’t seem to help a great deal, but then I haven’t gone without it so maybe it is helping.
If I am gloomy at the California gray, the Michigan cold would be even more difficult. (Not all California is warm and sunny.) I like the warm lotion and massage idea. Unfortunately I don’t think I can reach down that far yet.LOL

 

[Firefly7554]

Almost 4 weeks postop; I am walking with a cane and have appropriate ROM for the length of time since surgery. My question is why does my knee get so stiff when I can bend it during PT and when I am walking but after sitting for a while it’s like board.

 

[FCBayern]

The reason you lose range of motion after PT is swelling. That's one of the reasons the BoneSmart approach excludes PT that causes your knee to swell and limit range of motion, it's counter productive and leads to excessive pain. Take another look at the activity progression for TKR. All you need is activities of daily life to rehab that knee. Make sure when it's tight to elevate and ice @Firefly7554, it's your best friend right now.

Why resting is critical after joint replacement surgery

Even with so many advances in surgical methods that allow surgeons to replace traditional open surgery with less invasive approaches like robotic, laparoscopic, or arthroscopic surgery, any procedure is considered to be a major stress on the body and mind. Your body spends a lot of energy...

bonesmart.org

 

[Firefly7554]

5th week post op: I thought I was doing so well, and then I had a new PT who gave me a pretty stringent program. Since he was here this morning I have had my feet elevated and lots of ice and am in more pain than I have been in the last several days. Obviously it was too much. I know we don’t want Scar tissue to build up; how do we know how much is too much and what is the right program to continue to move forward. Everybody seems to have a different opinion. Frustrating.

 

[Celle]

I know we don’t want Scar tissue to build up; how do we know how much is too much and what is the right program to continue to move forward. Everybody seems to have a different opinion. Frustrating.

It's a myth that you have to exercise to prevent scar tissue (adhesions) from forming. They aren't just there, sitting ready to pounce if you don't exercise enough. In fact, doing too much, aggressive exercise actually increases the risk of getting adhesions.

Why? Because over-exercising keep your soft tissues hot and inflamed. Hot tissues are drier than normal tissues and dry tissues tend to stick together more easily than normal tissues, forming adhesions.

You know how much exercise is too much if you experience pain at the time or later, or experience increased stiffness or swelling, at the time or within 24 hours.

So please tell that new PT that you won't be doing so much again. It's your knee and you have the right to do that. Saying no to therapy - am I allowed to?

Remember this:

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.​

 

[sistersinhim]

I know we don’t want Scar tissue to build up;

The scar tissue (which is more correctly called adhesions) is very rare, and one of the easiest ways to develop it is to work your knee too hard. Over-worked knees get inflamed and hot, and hot tissues become drier than normal and more likely to stick together and form adhesions.

This article explains the difference between scar tissue and adhesions:
MUA (Manipulation under Anaesthetic) and Adhesions

You need normal scar tissue. That's what holds your incision together, and it's part of the normal healing process. Without it, you'd always have an open wound.

 

[Firefly7554]

Approaching five weeks post op tomorrow.I know I am making progress, but I am so tired of elevating and icing. The pain, though mild, is ever present. My knee feels hot and prickly. Normal? I am getting my first Covid shot on Wednesday and have been told that I should not be taking any pain relievers 1 to 2 days prior to the shot. That doesn’t help with my pain, but I think an effective Covid shot is more important than the pain. I will deal with it. I would like to start doing some gentle exercises on a stationary bike. Is it too soon?

 

[sistersinhim]

You can try the bike without tension for about 5 minutes and see how your knee likes it. If you have increased pain and swelling that night or the next day then your knee isn't ready for it yet. Wait at least a week then try it again. Remember that your knee is different from everybody else's knee and you are the only one who knows how it feels.

 

[Firefly7554]

It has been nine weeks. I am still waiting for the day when I will say I’m so glad I had this done, and wish I had done it sooner. I guess I’m doing pretty well: I I can walk on my own, get in and out of the car, sit with my foot down, but the pain is ever present and I don’t last long. I am taking NSAIDs around the clock, but I am never without pain. And nighttime is terrible. What’s with that?

 

[Jockette]

I guess I’m doing pretty well: I I can walk on my own, get in and out of the car, sit with my foot down,

They are very good accomplishments for 9 weeks.

but I am never without pain. And nighttime is terrible. What’s with that?

9 weeks is still early days in the recovery that can take an average of 52 weeks.

It sounds like you may be too active for your particular knee, at this stage. What activities are you doing? What does a normal day look like for you?

 

[Firefly7554]

I had eight sessions of PT the first four weeks after surgery. I have been on my own since then, I live alone. I do one set of PT exercises each morning, but I don’t push or strain. It takes about 30 minutes. After that I elevate and ice, play games on my iPad lying down, sit and read awhile, walk to the mailbox which is in front of my house, fix simple meals and clean up........that is about it. I really don’t do much.

 

[FCBayern]

What exercises are you doing @Firefly7554? 30 minutes seems like a lot for as early in recovery as you are.

 

[Firefly7554]

Really? 30 minutes is too much? I do ankle pumps, quad sets and gluteal sets I do heel slides, short arc quad‘s, straight leg raises,Seated knee flexions, ankle plantar flexion’s, baby squats, passive knee extensions, and calf stretches. Hum, when I write it all down it does seem like a lot. I haven’t had a lot of guidance; I was told I was supposed to do those twice a day but I only do it once.

 

[Jaycey]

30 minutes is a lot of exercise and your knee is confirming this. Back off and give that new knee a rest. Focus in ice and elevation to get the swelling under control. You are not in training - you are healing.

 

[FCBayern]

Yup, too much. I would especially drop the leg raises and baby squats, knees really don't like them this early, and as Jaycey said, you are healing, not recovering from a sports injury where aggressive PT can help. Try backing off that regimen for a few days and see how you feel, all you have to lose is the pain and swelling @Firefly7554.

 

[kneeper]

I can tell you I found even "baby" squats very aggravating to the knee. I also divided my exercise up over the course of the day--my PT actually suggested that. Do a few in the morning and a few later in the day. I may have done about 20 minutes total over the course of the day.