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TKR Harder than I thought, the can do gal

shasch64

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TKR 9/24/19 - Day 1 - Arrive at surgery center 6:00 am. Meet with anesthesiologist and given IV. Next memory is hearing husbands voice talking to a nurse. It is noon. Some ginger ale and I’m waking again at 4:00 pm. The OT/PT is there with some activity and lessons on how to use cane and walker. After doing some kicks and stairs, I’m ready to be released with a walker and an ice machine to go. By 5:30 the same day, I am walking up 4 steps into house with a cane and 7 steps to second floor.

Recovery has begun. Pain meds include Dilaudid (2 every 6 hours), extra strength Tylenol 3 hours after Dilaudid, Meloxicam every morning, Gabapentin every evening, and 81 mg aspirin 2x a day.

Day 2 - Not too bad. With husband as diver, I am in thecar with walker and off to my first PT session. Rocking a bike, kicks, quad squeezes, toe lifts, heel sides and leg raises. ROM 105. I think I’ve got this! Pain minimal.

Day 3 - Awoke to extreme light head and nausea. Called doctor, He said to try cutting back on meds and to skip PT this day. This is when Pain became a bear.

Day 4/5 - Tried taking only 1 Dilaudid before therapy and the Tylenol. Every 6 hours. Also 1 Dilaudid before bed. I used ice around the clock for 30 minutes at a time. Was managing the okay CONSTIPATION. Another call to doctor. Despite taking a stool softener, I was in discomfort. I was told it was the meds and I needed to stop because “pain never killed anyone”. I was told to get some Miralax and do a suppository if that didn’t work. Now I’m down to I Dilaudid a day and the Tylenol. Looking back, I should have insisted talking to doctor instead of asssistant.

Day 6 - After a great therapy session and using only a cane, I had the worst pain ever. Ice, elevation and rest was not helping with Tylenol every 6 hours. I’m in tears for the first time. I did not call doc. I began taking 1 Dilaudid every 6 hours, adding back the Gabapentin and the meloxicam. Pain still unbearable.

Day 7 - PT very hard and painful today. ROM 111. About 20 full rotation on stationary bike. Not sure I can do this. Have gone back to using walker except for stairs.

Day 8 - the Miralax finally works. The pain meds seem to be working again. I still have a lot of strange pain from burning to stabbing, to aching and soreness from my thigh to my calf.

Day 9 - PT is brutal, My ROM went backwards to 107. I’m tired and in pain that ebbs and flows from calm to sharp. How long does this last? I’m tough, But this is wearing me down. Am I pushing therapy too hard? The therapist said I was actually doing awesome. I had started my own pre-hab in July by going to gym 3 days a week and working on quads. I don’t feel awesome.

Day 10 - Pain is bearable today. Actually back to using can and making some cofee and getting a snack on my own. I’m taking 1 Dilaudid 3x a day with Tylenol in between if I need it. I also added the Gabapentin and the Meloxicam back into my meds.

Day 12 - At PT I’m doing full rotation on stationary bike (about 20 rotations in 10 mins). I have 111 degrees bending. I can do this. Therapy is rough. On my off days, I continue at home with a less rigorous version of my PT. Icing less and moving around the house more.

Day 13 - I did the bike a home today beginning with the rocking. I was able to do 3 very slow backward rotations. At the end of my 10 minutes of stretch rocking I was successful with a forward rotation, so I did 4 more. More I’d soreness and a pull than actual pain. finally I have my meds working with me.
The lesson here was NOT to Stop taking the meds as prescribed. I always think I can do it by myself. The Physxian Assistant that I talked with both times on the phone did not help matters. I will talk to my doctor about this.

Day 14 - Wow, what a roller coaster ride! Pain is minimal. ice seems to become more deterrent than help. Dull ache when the cold hits. Doing away with ice machine and relying on gel packs wrapped in a towel. more comfortable that the coldness of ice machine. Swelling is almost gone. There is not as much bruising as I anticipated. Hopefully I won’t have anymore backslides.
 
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Celle

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Hello @shasch64 and :welome:

Go easy on the PT therapy. Your knee needs to heal before you stress it with exercise.

Here's the recovery guidelines and reading that we give to everyone with a new knee:
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 to 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.
 

LindaO

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I am sorry you are experiencing the ups and downs of pain. For me, it was all about the pain control. I took my pain medicine around the clock for a couple weeks before starting to cut back.
I hope you are able to get some relief soon! Keep up the icing and elevation!
 
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shasch64

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Thanks. Doing better now that I have toned down the therapy and began taking pain meds 3 times a day. I was feeling guilty about being too weak and dis not want to depend on pills. Now I understand that the pain med is part of the PT
 

Jockette

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Now I understand that the pain med is part of the PT
Pain med should not be part of the PT because painful PT is not good for your new, healing knee.

At less than 2 weeks post op it is too early to stress your knee with painful exercises. They are not necessary, you will recover just fine, and better and with less additional pain, if you stop doing painful PT. Just some easy stretches of bending your knee and short walks around the house are all you need right now.
 

Tykey

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Hi, I'm the "Can do guy," at least I was until I realised that I need to change my name to the" Will do but only when it's the right time guy"
Four weeks ago I had my second tkr, I learned the right approach during the first.
I did nothing but rest for two weeks taking care of the pain until it began to abate as it healed.
Then it was very gentle stretches, increasing gradually as my knee recovered and the swelling reduced.
Now after 4 weeks I rarely think about it (unless I do daft things). But I can do regular stretching exercises, just to the point of discomfort, and the ROM is improving steadily.

An English expression is "don't go at it like a bull in a China shop", be gentle, be patient, healing takes time, be a tortoise rather than a hare and you'll get to the end earlier, and certainly with less pain.
Good luck

PS if anyone doesn't know Aesop's fables, maybe they aren't well known worldwide,here's the link to the tortoise and the hare story. I think it suits our own recovery circumstances.
 
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Roy Gardiner

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I took one of the pain meds 3 hours before therapy.
As has been said, please don't. It suppresses pain (of course!) which means you can push harder, damaging your knee more.
Am I pushing therapy too hard?
Yes.

Using a bike to gain ROM is pretty simple:
  • Set the bike to zero resistance
  • Set the saddle low enough so that a single rotation is a challenge; difficult but not painful. When a rotation becomes easy right from the start, lower the saddle a max of 1cm.
  • Gently turn the pedals, through discomfort but without pain.
  • Continue until the knee is 'warmed up' and the rotation is now easy, or for 2 minutes, whichever is the shorter time.
  • Repeat several/many times a day, but don't go mad. Diminishing returns will apply; my guess is that half a dozen reps would be enough
  • Do not pedal fast or for more than 2 minutes, this is a stretching exercise, not training.
  • And if you get any pain or swelling in the 24 hours after doing this, cut it down until you don't
Here is a bit more chat and some pix and how 'healing' and 'training' are different
 

LindaO

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Sounds like you have found the issue and working on correcting it! Keep up the good work!
 

InkedMarie

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I “liked” your post because you are toning down PT but no....you don’t need meds for PT. It shouldn’t cause pain.
 
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shasch64

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Thanks for all the advice. Toning down the PT has made a huge difference in just a couple of days. By not stressing the painful knee to the point of pain, I am actually feeling pretty good. After three days taking it easier, I was actually able to do a couple of full rotations on the stationary bike. There was a stretch, but no pain. Instead of trying to do as many as I could, I stopped at four, before it became painful. At PT (3x a week) they want me to keep pedaling through the pain. No more! Again, your advice has made a difference. Thank you.
 
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shasch64

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Tomorrow I get the 19 staples out. Pain much more manageable. Walking with only a cane and doing small chores like making sandwich and some dinner prep. Sitting in chair with leg on floor for short periods. PT was strenuous, but not painful. ROM 112 after warming up a bit. Overall doing well, just a bit concerned because knee feels like it may buckle from time to time. Will talk with Dr. tomorrow.
 

Tykey

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Sounds like everything is going well. Once the stitches are out, we feel a lot more comfortable and have more confidence with the exercises, no longer worried they will pull apart. 112 ROM is very good at this stage

You are now in the stage where improvements come pretty thick and fast!

I suspect your knee will just tighten up if you keep doing your exercises. My PT asked me to have my leg out straight, tense everything possible in the knee and just raise my foot up an inch or two, and hold it.

Don't worry about it, my first knee used to "clonk" for a while, but it soon tightened up.
 

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Sounds like things are going really well. Don't be surprised it you're really tired after your excursion to get the staples out. Congrats on getting a full rotation. Major Milestone!:yes!:
 

Larryhg3

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Wow so glad you are feeling better. Getting the staples out was heavenly for me. I believe that PT has a role in recovery but our knees should guide what we do. For the first 2 weeks of both my knees I iced, elevated and rested. Very easy slides and stretches. I found that those numbers are of no consequence to my life. The more I checked off things I could now do without pain the less I paid attention. Good luck on your journey
 
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shasch64

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Day 20 Progress has been level for the past week. I am getting extra naps in and keeping with the ice and elevation after PT. I have added a heating pad for a few mins when upper leg tightens up. I have experienced stiffness, burning, aching and soreness that moves around. Doing much more around the house. I even scrambled some eggs, made a sandwich and carried it with free hand to husband. I have a shoulder bag to tote items from up to downstairs and around house. Biggest improvement this week is that I could bend enough get in and out of car without help.
 
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shasch64

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Still icing several times a day 4 weeks out. Added ace bandage wrap yesterday because the slight pressure seems to help alleviate some of the pain and swelling on inside of knee area. Before surgery I would wear a neoprene wrap which helped with pain, so I thought why not try wrapping? Has anyone else had relief going this route? Almost all of the intermittent shooting pain I have left is located at the knee cap level on the inside of knee. The rest has subsided to a dull background general uncomfortable reminder. Therapy is well with ROM from 0 to 114. There is expected general soreness around the scar. Taking one 2.5 hydrmorphone at night and alternating every three hours with extra strength Tylenol and Motrin. Still waking every couple of hours. Actually managed to sleep on side with a feather pillow prop for half hour before inside knee cried uncle.
 

sistersinhim

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intermittent shooting pain I have
I imagine these pains are what we call 'zingers'. My doctor explained that it's nerves healing and re-attaching. Many of these had been cut during the surgery and are now healing. These 'shockwaves' would actually sometimes cause my leg to jump. Even now, I can have very mild ones in my still numb areas.

I found nothing helped these except for ice. They were really annoying for about a month. After that their intensity lessoned.
 

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Wow, your rom is fantastic. I'm in my 5th week and stuck in the 80's. Keep it up!
 

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I can see you're near the 1 month mark and am very glad you found what did/didn't work for you in those early weeks.

I just wanted to toss this out there though. My surgeon INSISTS no one try a stationary bike for the first 3 wks. It's the "just because you can, doesn't mean you should" approach, regardless of your range of motion. He doesn't let patients start going to PT until the 3 wk mark either.

In his words, he's tired of patients complaining about decreasing range of motion during weeks 3-5 and an increase in pain/swelling at ANY time after PT. He is also sick of having patients 8-12 weeks post-op still with lots of discomfort. When he asks about their activity level, it's always a laundry list of aggressive PT exercises, along with anecdotes of PTs forcing/pushing people's knees to a certain arbitrary number because of a ridiculous and unnecessary expectation of one having to reach 'x' degrees by 'y' weeks.

He is modern, does >400 knees/hips a year, is a revision/reconstruction specialist with a well-known research/teaching hospital. In his 25+ yrs of experience, he has seen one major trend----PT pushing TKR patients too hard, too soon. The PTs cause MOST of his patients' problems----not surgery/recovery.
 

Celle

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I just wanted to toss this out there though. My surgeon INSISTS no one try a stationary bike for the first 3 wks. It's the "just because you can, doesn't mean you should" approach, regardless of your range of motion. He doesn't let patients start going to PT until the 3 wk mark either.

In his words, he's tired of patients complaining about decreasing range of motion during weeks 3-5 and an increase in pain/swelling at ANY time after PT. He is also sick of having patients 8-12 weeks post-op still with lots of discomfort. When he asks about their activity level, it's always a laundry list of aggressive PT exercises, along with anecdotes of PTs forcing/pushing people's knees to a certain arbitrary number because of a ridiculous and unnecessary expectation of one having to reach 'x' degrees by 'y' weeks.

He is modern, does >400 knees/hips a year, is a revision/reconstruction specialist with a well-known research/teaching hospital. In his 25+ yrs of experience, he has seen one major trend----PT pushing TKR patients too hard, too soon. The PTs cause MOST of his patients' problems----not surgery/recovery.
I think my surgeon would agree with yours, Rockgirl.

My surgeon doesn't allow any formal PT at all for the first month after a knee replacement. He says your knee needs that time, to start on its journey of healing. For that month, we rest, ice and elevate our leg, and walk around the house. The walking is our exercise and we increase it a little each week.

After that month, we just go to PT once every 2 weeks, where we are shown a few new exercises to do at home each day.

His patients all do well and achieve good ROM, as I did, and he hasn't had to do a manipulation to help with ROM for the past 4 years. I think that speaks for itself.
 

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