TKR Highlander's New Knee

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I have run out of Oxycodone and now only have my Tramadol/Tylenol combo. Im hoping that is going to do the job.
Was it intentional on your surgeon's part that you would run out of the Oxycodone so soon? Some people do need it for longer than thata. If you find the Tylenol-Tramadol isn't working well enough, do phone your surgeon and ask for something else. Decent pain control is a necessary part of this recovery.
Pain management: importance of managing pain after a TKR and the pain chart
 
Day 13- another visit to my PT this morning. We worked on my thigh with ultrasound. Then she had me do some gentle hanging over the edge of the PT table for flexion- just using gravity. It became very obvious what was holding my flexion back. My Sartorius muscle looked like a popped up steel cable all the way from my hip, down the middle of my thigh and then around into the medial side of the knee- actually over the VMO maybe? She said I had major tightness and "guarding" by that muscle. I didn't realize it connects all the way around on the low inside of the knee. It tightens and pokes up even more as I add to my flexion effort. So she gently massaged the "cable" all the way down and into the inside of VMO. WOW it was sore. And it is like a big rope just keeping me from good flexion. I only could get to 63 degrees- but hey- it was 51 degrees last week. But 97 when I left the hospital 10 days ago :( I go to see my OS tomorrow to get staples out. Im worried he will be disappointed with my flexion. Any others have this Sartorius/VMO issue? Its a bummer because the joint feels so smooth and good walking around on the walker.
 
If you have been given the Valium for muscle spasms then if you haven't been taking them you may want to try it for a few days. If that doesn't help let your OS know.
 
I followed the pain control chart with Tramadol and Paracetamol without this I was in agony. I live in Spain and they told me to just take Paracetamol 3 times a day and this did not touch it. I read the articles advised. And slowed the PT and waited for the swelling to go down using mess and ice packs and by my the time of the 1st referral 6 weeks later they were pleased how I walked and with the bend, etc. I keep being kind to my knee and giving it time to heal. Unfortunately I thought I'd up the PT - my knee swelled like a cabbage the next day so it was back to the mess, ice packs and 1 week on I'm fine again and walking around the house without aids and "learning to walk again ". Good luck you will get there!


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@Jo Brook, you are learned that the Bonesmart way is the best way! Good luck to you.
 
Without your advice I would not have succeeded as well as I have. Everyone keeps on about doing exercises but my knee was so swollen there was nowhere for it to be able to bend. Best advice ever !!!!! Thanks


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Day 14- "SSDD" translated- Same Stuff Different Day. Did my at home PT exercises this am and gently promoted flexion with lots of gravity hanging and massaging those dang thigh muscles and inner quad. Ive started using my headphones and listening to old rock and roll (from about the time period all my high school and college football injuries accumulated)

Puts me back in a time warp and helps me concentrate on the music instead of the pressure and tightness. Boston, ACDC, Foreigner, Outlaws, Lynyrd Skynyd, Van Halen- fun stuff to break up the absolute boredom that is consuming me! Then during icing and naps its back to the old folks meditational shamanic flute music :)
 
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PT session tonight I mostly focus on massaging the muscles mentioned above. and then work on flexion. Its just like Im hitting a brick wall to get beyond 65 or 70 degrees flexion- no joint pains- it just wont go no matter how much I focus, relax, whatever. swelling is way down too. Very depressed. I try hanging it over the bed for awhile and it wont relax and come down anywhere close to 90. I see the OS tomorrow- in a real foul state of mind...I spend all day expect for my few house walks, and my exercises- on my back- encased in the ice machine. So the RICE thing I am doing- maybe to an extreme- somethings not adding up.
 
You are actually doing better than you think. You just had surgery. It is frustrating. Like I keep telling myself, if someone sprains their ankle it takes a month!!! We had a whole joint removed and replaced!!!
 
@highlander- You must have AAA personality like myself coupled with the "hard work upbringing" your a rancher. I know the frustrations you are experiencing.

It goes against every fiber of my being to be laying around even after someone has put me into a chemically induced coma, cut my leg open, took a set of construction tools to my bones inserted some foreign material in there then sewed me back up.

The body is spending all my energy on repairing itself.

"Keep your I on the prize."


01/24/17 LTKR, then RTKR
 
@RMasano and @mg5457 Thanks for the words of encouragement. I fall somewhere between the bonesmart mantras and a pretty active PT mentality. So I think Im gonna try a little more active approach the next few weeks- but not to a point of re-injuring myself. Im an in shape, muscular, athletic guy and former collegiate athlete (same 34 inch waist and everything). Ive been talking to some of my other 50 something, athletic friends who have gone through this in the past few years- and to a person- they think I need to push myself just a bit harder and not lay on my back so much- so after my OS appt. tomorrow and a green light- Im going back into my natural athlete mode and get up on this thing more. The knee joint does not hurt- its the tight thigh etc etc---more stretching, more sensible walking, and follow my PT regimen more closely even with a little pain. It seems when I do get up and really do a complete PT session, even with a little "natural" pain from pushing- I notice a small, positive response.
 
2 week check in with my OS today- we have a 1.5 hour ride each way which isn't pleasant, but managed it fairly well. Staples out, x rays look great. Tons of yellowing all the ay up to my hip where deep bruising must still be healing up.

It was so amazing to see the before and after shots on the screen. My wife had never seen the before image and the OS once again said worst 54 year old knee he has ever repaired. He promised to make me a CD of both. He was happy even though my flexion is only 72 right now- he said to keep up my PT and move it, but not to the point of significant pain or swelling and we would get there- back in 4 more weeks and he wants me at 95 degrees or better if I can.

Then we rode back across the mountains to my PT appt. I had a good session with lots of ROM exercises, half pedals on a no resistance bike and then a lot of ultrasound. All in all a good day- but I am wiped out. On the couch with knee encased in ice now.
 
I'm glad your OS appointment went well.
Your ROM will come in time, so don't worry ab out it. My OS doesn't expect 90 degrees until about 6 weeks, so you're on target.

I'm not surprised you're tired now - OS appointment followed by PT session is a lot to do in one day, this early in recovery.
I found for quite a long while that just one extra activity per day was enough.
 
Pretty good report overall. You know at 54 as I am 53 you just don't heal like you did when you were 43.

Time is your friend right now. Gently work on the flexation and it will get much better over time. Your probably just about to have a break thru soon when more swelling goes down.
 
Day 16- went into PT center to do my own self guided ROM exercises and other stuff. They are great about giving patients access to facility on un scheduled days. And Im also doing a 2nd session at home each day.

I feel better doing these daily rather than laying around so much, and the knee is responding! For me, laying around too much and just icing promoted too much stiffness and shortening in my quads. Most on here advocate doing very little to no PT. I am now discovering that is counterproductive for me. If you are younger, in reasonable shape with a lower BMI going into surgery the mantra of "don't stand when you can sit, and don't sit when you can lie down" maybe be not be optimal. At least its not for me personally at this short juncture.

Not all OS's are uninformed on post surgery rehab (mine is very good and pragmatic) and there are some very good PT's out there too. I think everyone has to quickly find their "activity sweet spot", and in my case after just three days of a more proactive rehab program- I can tell a huge difference in my progress. So I guess I've had my first breakthrough moment. For me icing a lot, rest and elevate are still very big- but after twice daily sensible PT and walking. Ive picked up 15 degrees of ROM flexion in last 3 days- and have LESS pain.
 
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@highlander That's great that you've found your sweet spot! :yahoo: I think regardless of age or weight, we all have to find what works best for us and the only way to do that is through trial and error. I'm 44, in decent shape, healthy (other than OA) and lead an active lifestyle. PT 3x a week was not doing it for me so I have recently found that a balance between PT and my own daily activities and exercises work best for me. There is not a "one size fits all" regimen when dealing with TKR. The great thing about this forum are stories like ours that will give others ideas on what to try until they find what works for them. Kudos on your improvement! It sure feels good and makes you look forward to what's ahead! :thumb:
 
@mirelle Yes- I too have a prescription for 3X PT per week. And like you, am doing "homework" every day now in two sessions a day and my PT offered the use of the PT center anytime its open, to come do the self guided stuff. So its just great to get out of the house- my wife drives me the 8 minutes to the center- So Im sure they will get sick of seeing me in there! :)

Im using the recumbent bike and stepper to slowly go back and forth and work on flexion, which really helps, and then doing a lot of exercises to wake my quads up. The swelling is coming out and it seems the more I move the quads and do ROM stuff- the more lubed my new joint feels. Yes- everyone will have a different path and different response for sure.
 
Everyone's recovery is different and we each need to find the balance between what is "Just right" and what is "Too much" for our own knee.
The most important thing is to listen to your knee, be aware of when it is upset, and set your activity just below the level that upsets it.
Signs of upset are increased pain, swelling, stiffness, and pain at night.
 
As long as your knee agrees with your program than that is good. Your OS has given you good advice to not do anything that hurts. I did some exercises myself that were right for my knee. We don't want people to be brought to tears in pain caused by a therapist that pushes a knee too quickly for that person. I'm glad you are doing well and continue to progress smoothly.
 
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