TKR Hello! TKR April 18th

[Knitgirl]

Hi Y’all! I’m so happy to have recently found this forum. Somehow my idiot self ended up in the hip recovery group. It must have been the pain distraction that made me screw that one up.

I had right TKR done in April and just went to my 1 month follow up. Needless to say it didn’t go well. I found that due to the fact my therapy didn’t start until the week after surgery (insurance takes a week to approve), I am way behind. My Dr. Is not happy with me and basically read me the riot act. I’m at 90 degrees and have been told that I need to be at 120 by next month or they will do a procedure to force the knee and break up the scar tissue.

I also found that I’ve been taking the pain meds all wrong. Now he wants me to take 2 before PT and that’s it. Stop taking them every 6 hours and only take Tylenol. He called the PT place and told them to be aggressive.

Up till now I have done everything single thing that the PT folks have told me to do and have taken my meds according to all of the literature I was given from the Hospital.

This next month will be very unpleasant, I predict. So frustrated.

I didn’t mean to vent. I’m usually very laid back
KG

 

[FourCats]

Your doctor’s expectations are absurd and will not be helpful in the long term. One of the moderators will post lots of helpful information soon. Read it and ask questions. Folks here have the experience of undergoing knee replacements, something I doubt your doctor has had done. Come and vent anytime!

 

[Jockette]

Hi and Welcome!

I removed you from the Hip Surgery Team Thread, and added you to the knee team, thanks for clarifying.

I found that due to the fact my therapy didn’t start until the week after surgery (insurance takes a week to approve), I am way behind.

There is absolutely nothing wrong with PT not starting right away, some surgeons actually recommend this. I’m sorry yours disagrees so strongly.

You are not way behind.

90 degrees at one month is perfectly fine. There is no date by which you must have a certain number. We all recover on our own timeline and yours is just fine. You can always say no to the MUA, he can’t do it without your consent. He can recommend, but you don’t have to agree.
Saying no to therapy - am I allowed to?

Myth busting: "window of opportunity" in TKR

This "six week window of opportunity" surgeons often speak about is little more than a myth. It presupposes that all patients have the ability to create adhesions which is far from the truth. It also ignores the simple fact that in the first 3-4 weeks after surgery, swelling reactive to the...

bonesmart.org

His pain medicine protocol is also rather different from most. Again, he can recommend, but you don't have to agree. You have the right to continue taking your medication according to previous instructions.

 

[Jockette]

This next month will be very unpleasant, I predict. So frustrated.

This next month does not have to be very unpleasant. I will leave you our Recovery Guidelines. Each article is short but very informative. Following these guidelines will help you have a less painful recovery.

Just keep in mind all people are different, as are the approaches to this recovery and rehab. The key is, “Find what works for you.“ Your doctors, PTs and BoneSmart are available to help, but you are the final judge as to the recovery approach you choose.

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​

elevate​

ice​

take your pain meds by prescription schedule (not when pain starts!)​

don't overwork.​

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

​

the BoneSmart view on exercise​

BoneSmart philosophy for sensible post op therapy​

5. At week 4 and after you should follow this

Activity progression for TKRs​

6. Access to these pages on the website

​

Oral And Intravenous Pain Medications​

Wound Closure​

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.

 

[Jockette]

He called the PT place and told them to be aggressive.

This is not in the best interest for most of us.

BoneSmart philosophy for sensible post op therapy

You will have noticed there is a significant opinion here about the potential hazards of PT. You may feel that your therapists are experts and know what you should be doing. However, over the last several years I've been here, I have observed that the more intensive the regimen of exercising...

bonesmart.org

 

[Knitgirl]

Many thanks! I can’t lie, there were a few tears shed in the good Dr.’s parking lot. Again, glad that I discovered this forum while searching for itching after TKR. Pure cocoa butter works wonders BTW! I have read the literature and appreciate all of the resources this forum provides. KG

 

[Jockette]

I can’t lie, there were a few tears shed in the good Dr.’s parking lot.

I’m so sorry he made you feel so bad. This is so wrong. You are trying your best to recover from a very major surgery, and are very vulnerable right now.

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

Cheer your accomplishments

And send hugs when you are feeling down.

Best wishes!

 

[Jockette]

When you are ready to take Tylenol, the most effective way to take it is 2 x 500 mg tablets every 6 hours, to a total of 4,000 mg (4 doses) in 24 hours. You need to take it regularly, to keep up the levels in your bloodstream. If you just take the odd dose now and then, it's far less effective.

Check all other medications you're taking, to make sure there is no Tylenol/Acetaminophen/Paracetamol in them. If there is, scale back one or two of your regular Tylenol doses, so you stay within that safe 24 hour limit of 4,000 mg.

 

[Knitgirl]

You can always say no to the MUA, he can’t do it without your consent

Is there any way for him to tell if there actually are adhesions, or are we just assuming there are if the target ROM is not met? KG

 

[Knitgirl]

This man came very highly recommended by quite a few people, but boy has he turned out to be a sergeant major! KR

 

[Jockette]

No, he can’t tell if you have adhesions just from looking at you. Since you already have 90 degrees, at one month (some of us take way longer to get to 90) it is highly unlikely that you have adhesions. He is just being very impatient with your ROM. Not all surgeons are like this.

You will have some scar tissue, temporarily, because without it, your wound would not heal. You will also have Stiffness/Tightness for a while, which is a normal occurrence after this kind of major surgery. Your surgeon did major carpentry work and disturbed every millimeter of soft tissue in this area. You aren't tight because your muscle is underused and needs to be stretched and rehabbed. You're tight because your tissue is healing...and full healing takes a full year or more.

 

[Jockette]

One more post, here is a member who refused to do aggressive PT:

(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. “

 

[Jamie]

Just remember than you know your body better than anyone. You don't have to make these decisions immediately. There is no "window of opportunity" beyond which all will be lost and you'll have a "stuck" knee, providing you are doing at least routine gentle bends and stretches throughout the day and some walking every couple of hours. If your gut feeling is that you need to keep working with your knee gently, that's your choice. It's your knee and your recovery.

It is true that in past years there was a strong feeling in the medical community that people needed aggressive therapy early on after a knee replacement to get the best result. If there was a lot of pain, a patient should just deal with it. We've never believed in that approach here on BoneSmart as we've seen far too many people who didn't do well with it. Granted, you will find some people (usually those who have been very athletic prior to surgery) who do take a more active approach to their therapy. But even these folks practice what we tell people about listening to your body and responding accordingly. Increase activity and exercise gradually. Observe the result the next day following an increase. If there is pain or swelling, it means your knee isn't ready for that level just yet. Scale back for a few days and try again.

If you instantly start pushing on your knee as your surgeon suggests (or worse yet, allow someone else to do it who cannot feel what you are feeling) or do a lot of exercise all of a sudden, you can pretty much guarantee a painful and swollen knee will follow. This inflammation is counter to a good recovery and, if done consistently, could actually lead to chronic pain. Likewise, it is not a good idea to take pain medications so that you can more easily endure a therapy session. Your body tells you something hurts for a reason. It's so you know you are pushing your limits and need to stop. During therapy you may experience some discomfort....that's normal. But when it crosses over to actual pain or even tears, that's not helping you at all.

Trust your gut feelings here. Take a breath or two and make your decisions based on what you believe will work best for you.

 

[sistersinhim]

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 was interested in was to see what my knee would do and never measured. He never even asked about PT! Of course, he knew I was a single lady that had to take care of myself and obviously trusted that I would not be just laying around all the time.

After 12 knee surgeries, I know that I do not need formal PT, and neither do many others if they do their own daily activities and not just sit around all day and night. 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. 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!

 

[kneeper]

I would have been thrilled to be at 90 at one month. It took me 6 weeks to get there. Once the swelling reduced, I gained faster. It can be an interesting dance of keeping the knee moving while not overdoing and worsening the swelling.
For me it seemed to be a combination of swelling slowing me down and muscles and soft tissue that weren't used to my knee bending fully. I had to listen to my body and just work on it bit by bit.

 

[InkedMarie]

You’re just three days ahead of me. I’m sorry your about your Doctor. It is up to YOU to tell PT what you will and won’t do. When I was scheduled for my first TKR in 2018, I went searching for a PT. I talked to three of them and chose the third. I did great. I told him then and reminded him at this TKR of the fact that my other foot and hands work fine. No I wouldn’t have hit him but the threat is there.

I hope you will reconsider the MUA and I hope you just say NO to aggressive PT. If you say no, they stop. If they won’t, you can call any PT’s in your insurance network to go to. If your doc won’t send a referral, call your insurance company.

Marie

 

[jtrahan]

I didn’t get to 121 until week nine. Your swelling will definitely restrict your ROM. Give it time and don’t push to you feel pain. It’s okay to feel a stretch, but when it starts to hurt, you went too far. My therapist cranked on my leg to get a maximum degree flexion. That entire weekend my knee was swollen and in pain. That will never happen again. You are in control of your therapy. You need to stretch if you want to get better but never to pain.

 

[Samsrf]

@Knitgirl I get your frustration! I believe the bonesmart way is the way to go. I was 70 @ 3 weeks 90 @6 weeks. I do PT because I like the structure, but I stop at the discomfort threshold. 2 weeks ago I “pushed through the pain” and I couldn’t walk well for 2 days, I have also switched PT’s twice already due to their lack of respecting my input and threatening MUA every appointment (they aren’t even the surgeon) now at 7.5 weeks 105 … slowly but surely it is coming back. Less is more. Happy Healing

 

[Knitgirl]

Update. I’m at 6 weeks now and 101. I’m worried because I was told that 6 weeks the scar tissue is laying down and there will be little progress. Also my insurance has deemed that 14 PT visits is plenty, but they are reviewing my case and will let me know in a couple of weeks if I can have more. ‍. Good news is that pain is not a huge issue any longer, just bad ROM. I do my exercises and ride my little stationary bike Not sure what more I can do in between now and when I see my Dr. I’m also able to side sleep again which is great. I walk around and drive, so that is good. Still having massive anxiety attacks over the ROM and no more PT.

 

[Jockette]

I’m worried because I was told that 6 weeks the scar tissue is laying down and there will be little progress.

This is not true and I don’t understand why they don’t know this, with all their education. Most of us do not have full ROM at 6 weeks. I certainly didn’t. Mine continued to improve well into my second year, and even a bit more in my third. So, it’s nothing to worry about, yours will also continue to improve.

We regain our ROM as we heal. Sometimes PT helps, sometimes it hinders. If your insurance doesn’t approve more appointments, you will be fine. I would think any now you know the exercises well enough to do them on your own.

And, anyway, regaining our ROM is more about Time than repetitions of a list of exercises.

Time to recover.
Time for pain and swelling to settle.
Time to heal.

Our range of motion is right there all
along just waiting for that to happen so it can show itself.

In the general run of things, it doesn't need to be fought for, worked hard for or worried about. It will happen. Normal activity is the key to success.