TKR Help! I've developed right hip pain 3 months after LTKR.

[Dutto]

I look forward to seeing your "I have had it done!" Post.

Me? Still waiting on a date for my CT scan!! We could have been away to France for a month's holiday had we known that it was going to take this long!!

Toe Chewers of the World unite!!


Ian

 

[sunny-island]

@Dutto. You have to have a CT scan first and then the surgery will be scheduled? Does this mean you probably won't have your TKR until 2015?

 

[Josephine]

With a ROM like that you are keeping ahead of any adhesions because they form pretty quickly, as explained by this extract removed from another site:

@Dutto you really must post a link to this other site if you are going to quote an extract. However, I totally disagree with the premise that adhesions can occur 'pretty quickly'. There is no proof of that. It's much more likely that any restriction in ROM in the first few weeks is simply due to swelling and pain and nothing more. Ergo: manage the swelling and pain and the ROM will surface. It's not a mystery!

Don't forget that you will still have to move the knee to prevent adhesions and that this movement WILL be painful

I agree that we must keep our knees moving but only in moderation - a few daily heels slides and a few walks around the house are quite sufficient. It doesn't have to approximate boot camp!

But lack of movement does not cause adhesions. Other factors do that such as
a) too much exercising
b) pain
both of which also cause muscles to become hot and dry.

We should never, ever do things that cause pain. Go to the point of discomfort by all means but never more than that.

 

[tiredwife]

@sunny-island Glad you are getting your swelling under control, that is half the battle. Now about the toe biting.....LOL..... Okay if you really want to!

 

[Dutto]

@Dutto. You have to have a CT scan first and then the surgery will be scheduled? Does this mean you probably won't have your TKR until 2015?

The NHS in the UK have scheduled targets to meet and the primary one is an 18 week target from "First Appointment" to "Start of Treatment".

For myself the clock started ticking when the surgeon interviewed me on the 11th August so to meet their target they should complete the first TKR by the beginning of December. Here's hoping!!

Since the 11th August we spent the first two weeks waiting for the appointment to arrive only to discover that the surgeon had gone away on holiday and forgotten to ask for the CT scan; and the last two weeks have again been spent waiting for the morning post to deliver the appointment; which has yet to arrive!

Patience isn't my strong point but after 47 years with the same damaged knee I am quite philosophical about it; but only just!!

Best regards,

Ian

 

[kneeper]

There's a good article in the library explaining normal scarring/healing processes vs. adhesions.
https://bonesmart.org/forum/threads/mua-manipulation-under-anaesthetic-and-adhesions.3656/

 

[dovemck]

@dovemck I see that your LTKR was done on July 30. Just a few days before mine. How are you doing? Has your recovery been acceptable so far? Do you have much pain?

Unfortunately I started from a poor position and the rehab is going slower than I hoped. I'm nearly 6 weeks and have about 75 degrees flexion. It's not so painful as it is uncomfortable and achey. When I push for ROM it feels like a skewer is being pushed through from one side of the knee out the other. My initial rehab was hopeless but have lucked into a perfect physio match for outpatient. She's not keen on MUA's either so we've been pushing a bit more than normal the last two sessions to get closer to the magic 90 before I see the surgeon later this week.

BTW - twice a week, an hour each session, definitely no squats yet.

 

[dovemck]

I'm not sure what is happening with Dutto (above) but since I'm a bit concerned I'm a candidate for MUA (75 degrees at 6 weeks) I've been reading and researching and things I've seen seem to show that this is the case for me.

 

[marmora]

@sunny-island

Good Morning from Dublin,

Not as warm as Florida, but a great sunny day for Dublin !

My LTKR was 17 July & yours on 5 August, so a few weeks ahead of you.
My Flexion is up to 100 degrees on a good day, but a steady 95 most days.

Congratulations on your 46th Wedding Anniversary and it is worth celebrating with joy at such a special milestone !

Luckily, I have been seeing my PT on/off for about 10/12 years and because of our long standing relationship our session are very much about my goals, rather than her goals. Together making slow, steady progress.

Take care,
Cathie

 

[sunny-island]

@marmora. After your comment about the weather, I looked up the forecast for Dublin today and found partly cloudy with a high of 63. We have rain with a high of 90 (and a low of 73, making your high of 63 look seriously cool to me!). I love days in the 60s, though. You are very fortunate to have a PT you know so well. Maybe you'll find that you've broken free of the 90 degree range and will start moving into numbers over 100. I felt like I was stuck between 85 and 90 for a long time. Then one day it starting moving up, as the swelling started to go down. Now, everyday is a little higher than the day before and I'm only doing gentle exercises and walking. You'll get there!!

 

[Josephine]

I'm a bit concerned I'm a candidate for MUA (75 degrees at 6 weeks) I've been reading and researching and things I've seen seem to show that this is the case for me.

You should be careful what you read on the internet! Many of the articles are old and there was a time when we did believe that things had to be aggressive to get a good bend but recent research has shown this not to be true.

There are some facts that are now more widely accepted
1. adhesions are actually not that common
2. being too aggressive with a leg causes muscles and tissues to become hot and dry which can lead to adhesions
3. flexion can continue to improve for weeks and months
4. the biggest obstacle to flexion is swelling and pain. Therefore, if the swelling and pain is properly managed, so too will the flexion be

Conclusion being that the gently, gently approach recommended on BoneSmart is productive and will get results in time. However, in no way do we recommend NO movement at all. We recommend everything in moderation and nothing should be done that causes pain. I hope this clears up a few misconceptions.

 

[kneeper]

When I push for ROM it feels like a skewer is being pushed through from one side of the knee out the other.

I had something similar for a brief time at around 6 weeks too--right in the middle of the inner knee. It did end up going away. Just took time I think.

, definitely no squats yet.

I like.

 

[sunny-island]

I had my first session with my new PT yesterday afternoon. She's wonderful, knowledgeable, experienced, careful, attentive, and willing to answer questions. It was my evaluation appt and lasted about 45 minutes max. She got all the information she needed first then asked where it hurt. She massaged those areas and showed me how to do some of that at home. She measured my ROM and then directed me to do some exercises, all of which were familiar to me.

She is more concerned with extension as she says my ROM is coming along fine and will continue to increase. She had me walk back and forth and critiqued the way I was walking. That was very helpful. I'd just started walking around the house sans cane and I was developing a less than normal gait without realizing it. Now I'll be mindful of my gait so as to heal well without causing other problems.

There was only one area where she differed from what I've read on Bonesmart: she says I should not ice for more than 20 minutes at a time because the body detects the freezing and sends fluids to the area to protect it. I may not have gotten that exactly right - it was something about the body going into protection mode though. I did it her way last night and I feel good this morning (I felt good the morning before while doing it the BS way, as well). Now I'm wondering about the advisability of icing for long periods of time.

 

[marmora]

@sunny-island

Hello from Sunny Dublin.

So good to hear that your appointment with your new PT went well.

Don't know what to advise you about the ice, the BoneSmart way is to ice, ice, ice.
And lots of PTs say 20 minutes on 20 minutes off.

Immediately, after surgery when the big bandage came off, I iced for extended periods of time up to an hour at a time or sometimes longer, if I feel asleep, the BoneSmart way.
Although during that time the water in the Cryo Cuff does cool down.

I have found over the last 10 days or so, that after about 15/20 minute icing, the area gets 'uncomfortable' and I take off the Cryo Cuff then as that seems to be all that feels comfortable.
I may then walk around do something else or a few simple exercises and then re-apply for another 20 minutes and again after that time get the ' uncomfortable' feeling and remove the Cryo Cuff.

This new development seems to be my body's reaction to icing.

I am not expert enough to give you advice about your use of ice.
You know that BoneSmart philosophy has worked and is working for us here on the site.

Take care,

Cathie

 

[sunny-island]

@marmora. The subject of icing is confusing. I think nearly everyone recommends icing immediately after surgery; the question of how long to ice comes in later during recovery. I knew that the Bonesmart way was different from what I had heard before but that didn't bother me. So many people have had success with this method that I decided to follow it. In the first couple of weeks it was especially important as it helped so much with pain relief. But my new PT has made me rethink this part of the Bonesmart way.

 

[WaterWalker]

One of the reasons I am on Bone Smart is that every health care provider has a different opinion on EVERYTHING!!!! The only people I trust are those who are patients or have had this done!

My second PT person was ANTI ICE, But I found that I was not getting of the Oxycodone as quickly as I wanted. I mentioned this to a really good Visiting nurse and she said the Ice would create another sensation from pain and decrease the swelling. That made sense.

I just started the ice bags with 1/4 rubbing alcohol and 3/4 water. Great technique....a wonderful soft slushy around my knee. No narcotics last night or today. I drove for the first time yesterday!!!!

I am good with this path.

 

[sunny-island]

@WaterWalker. Your surgery was a few days after mine. You're doing great if you're already driving. You're off Oxycodone, are you on something else? I'm off Oxycodone, too but they gave me Norco for pain in its place. Norco is also a narcotic but less strong. I don't like it as it makes me feel sick to my stomach. I'll have to call my doctor's office and ask for something easier on the stomach. Everyone is different, this works for a lot of people.

I love the way icing feels, too. There's nothing else quite like it for immediate relief.

 

[WaterWalker]

I am taking double strength Tylenol along with two adult aspirins for blood thinning. I have the 5mg Oxycodone available but trying to stay off. I am not being a wuss on this. If I had sharp pains I would take them. My surgeon offered an anitinflamatory and it made me very sick. It took me awhile to figure it out.

Being off the Oxycodone is great for the bowels! Nothing like a good.....BM. I cleaned that up!!! HAHA!!!

Trying to eat small bites of food. Thinking of food as fuel helps! Have to be on the move and keep my spirits up.

This procedure is very humbling and has taught me lots of life lessons. I am so grateful to have a process that prevents me from falling victim to a dysfunctional arthritic knee that would not support me or my wonderful life. I thank God for this blessing!

 

[Celle]

I've heard the theory (usually reported as being said by physiotherapists) that you should only ice for 15-20 minutes at a time.

All I can say is that hundreds of people here on BoneSmart have iced for as long as possible, even going to sleep while icing and leaving the ice on all night. As far as I know, everyone has found that it reduces both pain and swelling and nobody has reported any ill effects. Just be sure to wrap the ice pack in a tea towel or something similar, so that you don't get freezer burn.

I plan to ice all the time I am resting. It worked for me last time and I'm sure it will work again.

 

[sunny-island]

@Celle. I have a new issue that worries me. My PT noticed a tiny red spot at the very bottom of my scar. She said it looked like it might be a stitch working its way out and that I should leave it alone. She said it would work its way out. That was the day before yesterday. This morning it remains unchanged. No obvious signs of infection. My 6-week appt with the OS's nurse is coming up - next Tuesday. If it still looks the same I'll ask her about it. I'm wondering if I should try to see someone sooner (I'd rather not).