Josephine
NURSE DIRECTOR EMERITA
Hood, everyone has internal sutures! You can't not have them!
Read this Closing surgical wounds: how is it done?
Revision TKR Hood1980’s Revision
- Thread starter Hood1980
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Hood1980
senior
@Josephine thanks for the response and link to the very informative article. My question is that I’d like to know if the final skin closure is glue vs the staples I had the first time, will it eventually smooth out and look like normal skin or will it continue to look like a bad pie crust that is unevenly pinched up and bumpy along the cut line?
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Hood1980
senior
I’m scheduled to go to outpatient PT again today. I have a call into the surgeons office to discuss more about it. This is a new PT office, not the same one I used before since that one didn’t work out successful anyway. This one is affiliated with the hospital that did the surgery and follows their protocol. Little did I know their protocol involves forcibly bending my knee and threatening me with not achieving a good outcome, since I had poor ROM prior to my last surgery.
I’m on here re-reading everything and would like to see some data that shows the outcomes of the two different PT approaches. @kayow11 were you able to find and clinical trial data or at least how as your personal experience been so far? Anyone else?
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I’m on here re-reading everything and would like to see some data that shows the outcomes of the two different PT approaches. @kayow11 were you able to find and clinical trial data or at least how as your personal experience been so far? Anyone else?
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Please don’t let them force bend your knee. Are you “required” to go to this PT place? If not, call places, shop around until you find one you can live with. It truly is your choice.
You know aggressive therapy is not the way to go.
You know aggressive therapy is not the way to go.
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All I know is next time I won’t be going to PT. I hope to find a surgeon who will agree, or at the very least, agree to disagree with me. He can’t drag me to a PT office.
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Hood1980
senior
Thanks @Jockette! I want to let the surgeon’s office know what the PT office is doing and my no means will I let that happen to me. It’s either gentle PT or none at all. I will stay home and do it the BoneSmart way and then have to bite my tongue every time someone says how you have to follow the PT’s plan to be successful. The scientist in me would like to have the data that proves the BoneSmart way is just as successful as the traditional American PT approach to rehab following TKR.
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I’m sure @Josephine can quickly locate some data on outcomes about PT vs no PT.
If you want this for your own information, that’s fine. If you want it so you can prove to your surgeon or PT, I think that’s a losing battle. I don’t think you will convince them.
You have the right to refuse, period. No explanation needed. They have to a accept your “no” :
https://bonesmart.org/forum/threads/saying-no-to-therapy-am-i-allowed-to.36688/
If you want this for your own information, that’s fine. If you want it so you can prove to your surgeon or PT, I think that’s a losing battle. I don’t think you will convince them.
You have the right to refuse, period. No explanation needed. They have to a accept your “no” :
https://bonesmart.org/forum/threads/saying-no-to-therapy-am-i-allowed-to.36688/
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Hood1980
senior
Thanks @Jockette. For my own information and my husband’s, who wants me to continue with some type of Formal PT, but because he hears how it is essential for a good outcome and since I didn’t have a good outcome the first time, he thinks I need to be more vigilant with my care, including PT this time. I’d like to ease his mind with some data to explain how the Bone Smart approach is successful.
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SusieShoes
Former BoneSmart staff member
Here's a link to a current study (February 2018) that says formal PT may not be necessary after PKR. I've read some others.
Scientific studies are difficult to find in internet searches because of the way browsers prioritize search results. Physical therapy providers--most of which skew toward PT being necessary--dominate the results. Our culture is geared toward selling us goods and services, and PT is a service that wants to be used.
And then there are the personal experiences you find on here. Not quite scientific, but genuine. Mine was a hybrid (I did some PT, but refused big chunks of it and most used walking to rehab my knees). It's difficult to avoid having people tell you you are doing it wrong. Take this 8 weeks post-op exchange with my mom, who had her knees replaced years ago:
"You're doing your exercises three times a day?" She is 900 miles away. "Your knee will freeze if you don't do all your PT exactly as they say!"
"You betcha, Mom!" I am no longer doing PT.
"You also have to ride your bike every day, 20 minutes at least," she instructs.
"I do," I lie. "And I walk at least a mile a day." That part is true.
"Walking is easy. You have to do the exercises. They hurt like
, but then your knee won't freeze. You don't want frozen knees."
"I'm thinking of moving to Florida."
My knees recovered fully (-1/135) and are pain-free. To this day, Mom thinks I was diligent about doing my PT.
Scientific studies are difficult to find in internet searches because of the way browsers prioritize search results. Physical therapy providers--most of which skew toward PT being necessary--dominate the results. Our culture is geared toward selling us goods and services, and PT is a service that wants to be used.
And then there are the personal experiences you find on here. Not quite scientific, but genuine. Mine was a hybrid (I did some PT, but refused big chunks of it and most used walking to rehab my knees). It's difficult to avoid having people tell you you are doing it wrong. Take this 8 weeks post-op exchange with my mom, who had her knees replaced years ago:
"You're doing your exercises three times a day?" She is 900 miles away. "Your knee will freeze if you don't do all your PT exactly as they say!"
"You betcha, Mom!" I am no longer doing PT.
"You also have to ride your bike every day, 20 minutes at least," she instructs.
"I do," I lie. "And I walk at least a mile a day." That part is true.
"Walking is easy. You have to do the exercises. They hurt like
, but then your knee won't freeze. You don't want frozen knees.""I'm thinking of moving to Florida."
My knees recovered fully (-1/135) and are pain-free. To this day, Mom thinks I was diligent about doing my PT.
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@SusieShoes Thanks for that link!
SusieShoes
Former BoneSmart staff member
That one's for a partial knee replacement, but I've seen others for total replacements. I'll have to scout one of those out. They're easier to find when logged into medical search engines. Anyway, there is newer research out there that supports less PT.
Notice no one is saying NO physical therapy. They're just supporting that formal PT may not be necessary, and acknowledging that some patients may benefit from doing it. Someone who does not move their knee(s) at all is not going to have a good result. Someone who moves their knee(s) too aggressively for their stage of healing is not going to have a good result. What's optimal is really difficult to pin down because it differs for every knee and every patient. That's why having the patient as an active participant in deciding what therapy to use and how to apply it is such an important step toward successful TKR rehabilitation.
Notice no one is saying NO physical therapy. They're just supporting that formal PT may not be necessary, and acknowledging that some patients may benefit from doing it. Someone who does not move their knee(s) at all is not going to have a good result. Someone who moves their knee(s) too aggressively for their stage of healing is not going to have a good result. What's optimal is really difficult to pin down because it differs for every knee and every patient. That's why having the patient as an active participant in deciding what therapy to use and how to apply it is such an important step toward successful TKR rehabilitation.
Your leg was misaligned last time, that’s why you didn’t have a good outcome, it never had a chance. All the PT in the world was not going to be able to fix that.
Show him the posts here of people who have done well with no PT. Josephine has said countless times that walking is the best thing for a knee replacement, but not to excess in the early days.
Also, you have had a second major surgery on the same knee in less than a year. It needs gentle treatment more than if it was the only surgery on it.
My husband was leary of me stopping PT when I wanted to, and also that I stopped doing the home exercises. We talked and talked about it. Finally he agreed to disagree and let me make the decision I felt was best for me.
lovetocookandsew
Former BoneSmart Staff Member
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Hi @Hood1980 . Remember this, it's your knee, and therefore the decision on how it should recover is 100% yours. No one, not your surgeon, your husband, other family members, friends, etc, can decide for you how you want to go through the recovery process. They can give you their opinions and advice, but in the end, you're the one who lives with the knee and knows how it feels and reacts. Only you know what helps, what hurts, what causes it to swell and be more painful and what allows it to settle down and be calm. Therefore, only you get to decide the path to take in this recovery. Listening to your surgeon, your husband, and others is difficult when everyone has different ideas that your knee may or may not like.
My suggestion is to acknowledge their input with a smile, thank them and then do what your knee tells you to do. I am fortunate to have a surgeon who agrees with me, and with many here, that PT, as it is generally practiced today, makes things worse. I asked him why he still prescribes it if he doesn't think it works, and he said it's a delicate balance between the two choices as there are some patients who would not do anything at all, including walk around, if they didn't go to PT. I asked him why they don't just change the procedures in PT to just helping patients walk smoothly with good gaits, instead of all the unneeded and potentially harmful things they do now. His answers to me make me think a lot of the reason is that old traditions and beliefs are hard to change and take time to evolve.
My advice (because you need more advice like you need another hole in your head) is to listen to your knee, and make your decisions based on what works for you, or doesn't work, and don't allow anyone to force you to do things their way. This isn't your first rodeo, and your knee needs to be allowed to recover in it's own time and manner.
My suggestion is to acknowledge their input with a smile, thank them and then do what your knee tells you to do. I am fortunate to have a surgeon who agrees with me, and with many here, that PT, as it is generally practiced today, makes things worse. I asked him why he still prescribes it if he doesn't think it works, and he said it's a delicate balance between the two choices as there are some patients who would not do anything at all, including walk around, if they didn't go to PT. I asked him why they don't just change the procedures in PT to just helping patients walk smoothly with good gaits, instead of all the unneeded and potentially harmful things they do now. His answers to me make me think a lot of the reason is that old traditions and beliefs are hard to change and take time to evolve.
My advice (because you need more advice like you need another hole in your head) is to listen to your knee, and make your decisions based on what works for you, or doesn't work, and don't allow anyone to force you to do things their way. This isn't your first rodeo, and your knee needs to be allowed to recover in it's own time and manner.
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Hood1980
senior
Thanks for all the advice! I do appreciate it @lovetocookandsew. I’m 2 weeks post revision and everything seems to be pretty “normal”. The positives this time around include I am walking better this early post surgery vs the first TKR. I use a cane around the house and am even able to ditch that in the kitchen area while preparing small meals and doing dishes. I get a lot of walking to get up to let my senior rescue dog in and out. I’ve been able to control the pain better this time around with Dilaudid and Tylenol and am in the process of tapering down the number of Dilaudids I take per day and replacing it with Tramadol, which both seem to be working to control my pain this time around.
I have my first follow up appointment with my surgeon’s nurse practitioner on Monday. Some of the issues I have, like many here experience include not being able to sleep for more than a couple hours at a time with most nights getting only 3-4 hours of sleep. It’s starting to take its toll on me with fatigue, crankiness, lack of appetite. My incision doesn’t seem to be as neat and flat as the first time. It is also extremely sensitive. I can’t have anything touching it, so I’ll be wearing shorts and showing an ugly wound for some time. I hope this eventually goes away. My leg is definitely straighter than before surgery but still seems to be slightly valgus. Hoping it doesn’t get any worse.
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I have my first follow up appointment with my surgeon’s nurse practitioner on Monday. Some of the issues I have, like many here experience include not being able to sleep for more than a couple hours at a time with most nights getting only 3-4 hours of sleep. It’s starting to take its toll on me with fatigue, crankiness, lack of appetite. My incision doesn’t seem to be as neat and flat as the first time. It is also extremely sensitive. I can’t have anything touching it, so I’ll be wearing shorts and showing an ugly wound for some time. I hope this eventually goes away. My leg is definitely straighter than before surgery but still seems to be slightly valgus. Hoping it doesn’t get any worse.
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That’s awesome!!
Yes we care, we just should be content with our own progression and not compare ourselves to others that we think are doing better.
Is PT going ok?
Yes we care, we just should be content with our own progression and not compare ourselves to others that we think are doing better.
Is PT going ok?
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Hood1980
senior
PT is going better now. I did have the one bad session, but it has been good since then. I go Monday for my first post op appointment and am planning to make my case that I don’t need formal PT. I can do this on my own. I know my body best!
I do have a lot of knee sensitivities similar to what you describe but hopefully they will go away with time. I can’t tolerate anything touching my knee.
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I do have a lot of knee sensitivities similar to what you describe but hopefully they will go away with time. I can’t tolerate anything touching my knee.
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The sensitivity I had early on went away, what I have now is different.
I hope you at least get an “agree to disagree” from your surgeon about PT. That might make your husband happy. To get full “approval” would really be great.
I hope you at least get an “agree to disagree” from your surgeon about PT. That might make your husband happy. To get full “approval” would really be great.
