Revision TKR Here I go again!<<.

[Josephine]

my first day of PT after the revision my leg was sooo sore. It was sore to touch. But at 8 weeks, my leg is still sore.

Well a) 8 weeks is nothing after that amount of time and b) of course it's sore - you just had a revision!

I'd really like to offer you some structured advice but in order to do that, I also need to ask you some questions. Are you willing for me to do that?

 

[Jordon6]

Yes @Josephine

 

[Josephine]

Jolly good - here y'go then!

It would be very helpful if you would answer each one individually - numbered as I have done - in as much detail as you can then I'll come back as see where you are ....

1. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine. And don't forget to factor in other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness).

2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?

3. how swollen is your leg compared to these?

4. what is your ROM - that's flexion (bend) and extension (straightness)

5. are you icing your knee at all? If so, how often and for how long?

6. are you elevating your leg. If so how often and for how long?

7. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and

8. are you doing any exercises at home? If so what and how often?
This is the most crucial question so please help me by using the format I have left as an example
(which means please make a list and not an essay!)

Exercises done at home
- how many sessions you do each day
- enter exercise by name then number of repetitions of each
etc., etc.

Anything done at PT
- how many times a week
- enter exercise by name then number of repetitions of each
etc., etc.

 

[Josephine]

BTW, don't you think your thread title would benefit from a change?

 

[Jordon6]

1-typically 3/4. During activity about 5
2-hydrocodon-acetaminophen 5/325 1 tablet before PT, after PT and at bedtime. In between I take 2 extra strength Tylenol sometimes with 50 mg tramadol I was on Percocet until my 6 week check up and the doctor changed it.
3-I have moderate swelling
4-ROM 85 on my own, about 90-93 with help
5-I ice 10 min after PT( twice a week). Then about twice a day with elevation for an hour or more or until the ice is no longer cold( I have a machine)
6-I elevate about three times a day for about an hour. Two times with ice and before bedtime.
7-I now do light housework and meal prep about 3/4 times a week. I shop with my husband. He mainly shops I walk slowly and push the buggy!
8-I have outpatient PT twice a week. This week I only went once because I started aquatic classes at my local senior center and went 3 times a week. It's gentle exercises and I do what I can. When they run or jog in place I do gentle squats and stretches. After class, I walk the edge of he pool for about 20 min forwards and backwards. I actually prefer it to PT- I want to quit!!

PT I do five sets on a flexionator machine by sitting and cracking my knee forward. I do five sets. Then I bike for ten min. I do ten leg pulls with a strap on a weigh machine for extension. I do three sets of ten straight leg raises and leg kicks and finally wall slides. Ten reps holding three sec while bent.

On my own, I do stretches by sitting on a bench and pulling my leg behind me. It works better when I stand an reposition my feet back under the bench to stretch. I hold for 30 sec. I do this about 5 times.

This week I started riding a recumbent bike for 10 min once a day. I can make resolutions but it's a struggle so I go slow. Ten minutes is about all I can bear. Actually it's two sets of five min.

I do quad sets twice a day about 3 sets of 5 holding 5 sec.

I do straight leg raises once a day. 3 sets of 10

Also extensions stretches. I sit and stretch my leg out with my toes pointed up and arch my back and press my leg down gently. I do this once a day. 5 sets.

Sure sounds like a lot when I look at it.

 

[Jordon6]

@Josephine yes my header can change. Maybe "My revision journey"

 

[Josephine]

1-typically 3/4. During activity about 5

Okay

2-hydrocodone-acetaminophen 5/325 1 tablet before PT, after PT and at bedtime.
In between I take 2 extra strength Tylenol sometimes with 50 mg Tramadol.
I was on Percocet until my 6 week check up and the doctor changed it.

You should never take pain meds in order to cope with PT. Pain has a function which is to tell us when we are doing too much. If you mask it, then you risk doing too much and that can be very harmful.

3-I have moderate swelling

Okay

4-ROM 85 on my own, about 90-93 with help

ROM should never be measured 'with assistance'. The only number that counts is the one you can achieve n your own power. Therefore the 90-93 is invalid.

But what is your extension?

5-I ice 10 min after PT( twice a week). Then about twice a day with elevation for an hour or more or until the ice is no longer cold( I have a machine)

You accomplish little or nothing in 10 minutes. Ice for at least 40-60mins and more than 4 times a day.

6-I elevate about three times a day for about an hour. Two times with ice and before bedtime.

Elevate when you ice.

7-I now do light housework and meal prep about 3/4 times a week. I shop with my husband. He mainly shops I walk slowly and push the buggy!

Do you remember the recovery articles left you earlier in this thread? That was a while ago so I'll leave them again for you later. But do pay attention to this one Activity progression for TKRs because you are doing far too much.


I have outpatient PT twice a week.
aquatic classes 3 times a week. It's gentle exercises and I do what I can. When they run or jog in place I do gentle squats and stretches. After class, I walk the edge of he pool for about 20 min forwards and backwards.
do less than that! A lot less!

PT I do 5 sets on a flexionator machine by sitting and cracking my knee forward - don't use this machine, it's very bad for your knee
bike for 10 min - that's okay
leg pulls with a strap on a weight machine for extension x10 - never ever use anything with weights or straps
straight leg raises 3 sets x10 - Once you can do SLRs you don't need to do them any more!
leg kicks 10 x3 secs - these are not a good exercise to do, certainly not in that quantity
wall slides 10 x3 secs - no to walls slides, not any!

On my own
stretches by sitting on a bench and pulling my leg behind me 30 sec x5 - not a good idea. All you do with exercises like this is make it swell so your ROM goes down
quad sets twice a day 3 sets of 5 holding 5 sec - another ill-advised exercise that is best left out
straight leg raises once a day 3 sets of 10 - Once you can do SLRs you don't need to do them any more!
extensions stretches, I sit and stretch my leg out with my toes pointed up and arch my back and press my leg down gently. I do this once a day. 5 sets - no point in doing these - they just make your leg swell and thereby decrease your ROM
recumbent bike 2 x5min once a day - I can make revolutions but it's a struggle so I go slow - good that, just right!

Overall, I suggest you are doping far too much and what's worse, doing bad exercises. I recommend you stop everything I have crossed out. Also quit the PT sessions. You are free to do that.
Saying no to therapy - am I allowed to?
BoneSmart philosophy for sensible post op therapy

Also remember that you are not yet 4 weeks out. If you want to see improvements, now is the time to do it.
Please take action now.

 

[Jordon6]

@Josephine I'm actually 8 weeks but still I could cut back. My surgeon said that my revision was tough. I had a lot of scar tissue that needed to be cut away before he actually replaced the implant. He said it was so extensive- "worst he's even seen" Because of this and having to snip my quad he instructed the therapists to not be so aggressive. They just forget and I have to remind them!

At my 6 week check up he told me that if this was an original replacement he would manipulate me but in my case it would cause more damage so to work on stretching but to not get disappointment that my range is not great yet. Said it may take months! It's just a hard pill to swallow when this rehab is going on two years!

 

[KarriB]

While I did not have a revision, my OS said I shouldn't be surprised if I only reach a 90 degree ROM due to infection and subsequent second surgery a month after TKR. After a month of not bending my knee at all while in an immbolizer brace, my OS prescribed non-aggressive PT. It consisted of walking around my house (it was a snowy winter) and heel slides which he demonstrated by sliding my foot 2 inches. My OS said my soft tissue did not respond well to aggressive therapy.

Seven or eight months post op and I was swimming laps and riding a few miles on my recumbent bike. So I feel confident that if you cut back as Josephine suggested you'll see good results.

 

[Jordon6]

@KarriB such inspiring words! Your story sounds similar to mine. My surgeon said that he only got 90 with me on the operating table so try not to stress over higher numbers than he got under anesthesia!

 

[sistersinhim]

I bet you just might get more than 90 eventually. The body is a marvelous thing that can repair itself far beyond what medicine thinks it can! It just takes time.

 

[KarriB]

I should've added that I did go to PT where they followed my OS script for non-aggressive PT and was released with 105 or 109 (I can't remember which). But I continued to gain ROM over a year post op. So you see, all that exercise isn't necessary. After I was released from PT all I did exercise wise was ride my recumbent bike at 0 resistance and live my life. Now nearly four years later I've taken up walking again and my TKR loves it!

 

[Josephine]

I'm actually 8 weeks but still I could cut back.

OOps - my mental arithmetic must be failing me! But all my recommendations still stand. Even more actually as you shouldn't need to be doing all this stuff at 8 weeks!

My surgeon said that my revision was tough. I had a lot of scar tissue that needed to be cut away before he actually replaced the implant. He said it was so extensive- "worst he's even seen" Because of this and having to snip my quad he instructed the therapists to not be so aggressive. They just forget and I have to remind them!

Best way to 'remind' them is to quit it altogether!

Said it may take months!

Exactly. But if you kept up that routine, you could very effectively make it last years!

 

[Jordon6]

Tomorrow will be 13 weeks and I'm doing ok. My question/concern-my knee still feels so warm AND is larger than my other knee. I asked my OS if it was swelling and he said that it's mainly scar tissue that has it looking larger than the other one. He added that it's normal scar tissue that occurs at surgery- NOT adhesions! My OS said to keep massaging it and it'll eventually soften. I hope so!

But why is it still so warm? I ice twice a day about 45 min.

 

[liam2015]

mine is the same Jordon6 at almost 5 months post op. it's warm, sometimes hot and larger than the unoperated knee due to swelling. i go to p.t. twice a week for massage and other treatments but seems to remain the same. from what i can gather, it's normal. my knee does heat up quite a bit after activity such as up and down the stairs, sitting in the car, etc.

 

[Jordon6]

Ok @liam2015 thats good to hear! (Sorta!) at least I know others have this issue.

 

[Josephine]

My question/concern-my knee still feels so warm AND is larger than my other knee.

It's an indication that you are still doing fat too much!

I asked my OS if it was swelling and he said that it's mainly scar tissue that has it looking larger than the other one.

Where do these guys get these ideas from? Sometimes I truly think they just make it up as they go along! That is so much rubbish! Of course it is swelling!

 

[Jordon6]

@Josephine I agree with you--I believe it's swelling too! I had two therapist say that it's swelling! It's kinda hard, though so I'm not really certain.

I agree that I'm still doing too much. I feel like I'm back to normal most days so I end of doing too much and pay for it in the evenings!

 

[sistersinhim]

Yep, that your knee telling you that it's not happy with you doing what you're doing to it!

 

[Jordon6]

I'm at 14 weeks and my second full week back to work full time and I'm beat!

Yesterday at work I noticed some changes in my walking. I started to stumble a lot (about 4/5 times actually) while walking down the hall with my class. Almost like the soles of my shoes were catching the floor. It felt like my leg was dragging and I just couldn't get it to lift enough to make a good stride.

At first I thought it was the shoes but I had on my best pair I purchased since surgery (Sketchers go walk). Later I realized that maybe my quads were so fatigued and I started reverting back to the old walking patterns of dragging my leg. This morning I tried stretching it but it's pretty stiff!

Anyway, I hope with rest and icing that it'll get better. I pray I'm not going backwards!

Any thoughts?!