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Bilateral TKR I had both knees tkr and am struggling

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Perry

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Thanks Pumpkin,
Now I just have to figure out how to convince my doctors to let me do this
 
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Perry

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@pumpkin
I visited my surgeon today and he drained fluid out of my left leg and injected some cortisone.
Some relief, and YES, I am thankful for this.!
---------
Here is what I am presently dealing with:
1. flexation 107 R ; 100 L most days. But still significant swelling and burning mostly during the day.
(Knee swelling starts within 5 minutes of getting out of bed and continues to build all day)

2. Can only stand still for 5-10 minutes before becoming painful and uncomfortable and must walk or sit

3. Can only walk around 30 minutes before area at and above knee become to painful and uncomfortable & swollen to do more.

4. * Had a accident on Aug 3 while I was trying to do a light rotation set on a stationary bike with a 60% tilted
straight bar seat, like a recumbent bike. I was at a location where I had not been, and unfortunately was unfamiliar with how this bike worked.
I had the seat highly elevated to work for me, my weight was on the seat(215lbs). I had placed my stronger leg on the floor and the left leg was still on the pedal and strapped down. Because the positon was painful, I tried to move the seat up but instead of a crank type control, the knob was a absolute spring loaded release, which dropped my full body and weight to the bottom position 18-20 inch drop . (OMG) My left leg was unable to support my weight and bent back significantly " but the left folded back and touched my butt. !!!!!!! "

5. Immediately went home and iced top and bottom for long time. My PT and Doc both say I did no damage but my legs are very unhappy and docs refuse to offer any pain meds as they say I have had enough and should not be in pain at this time....3 months out. I agree with them that I should not be in pain at this time but I am.
I am using a topical crème which offer short but good deadening relief and Aleve over the counter..

6. My PT had been having me doing machine leg lifts and presses, which I have told her I cannot/will not be doing for a while as this is (I think) causing more pain. All I am doing now is walking, streaching, bending, icing and feeling VERY disgusted with my progress at this point.

Thanks for allowing me to vent and complain; and all works of advice and support are always appreciated.
 

Pumpkln

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Perry,
You did an MWA Manipulation Without Anesthesia. Follow the Bonesmart Mantra, and you will do much better with an angry knee, Rest, Ice, Elevate, and Medicate on schedule.
Happy to hear you got some relief from the cortisone.
You should contact your primary for pain control, but be ready to be referred to a pain clinic.

Here is a copy of Josephines questions from an earlier post, please answer them so she can better assist you.

I'm going to ask you some questions and it would be very helpful if you would answer each one individually 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 compare this with the bone-on-bone pain you had before surgery!
aflagsforworship.co.uk_jo_pic_images_nonofisss.gif
)


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

3. how often are you icing your knee and for how long?

4. are you elevating your leg, how often and for how long?

5. What is your ROM - that's flexion (bend) and extension (straightness)

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

7. what kind of PT/exercises are you doing? How much and how often? (and detailed details would be appreciated, please! Reps, sets and session and all that)

Note:
If you're not familiar with this, it goes like so:
1 lift of a 500kg bell bar = 1 rep or repetition.
Doing 5 reps and then a brief rest = 1 set of 5.
And doing 5 sets and finishing = a session.

Take it easy, and keep us posted on how you are doing,
 
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Perry

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I have answered the questions below.
* My primary doctor who I had a great relationship with, has parted ways with the group show she was with and has not opened a new practice.
So I was forced to see a new primary care doc who I had never met, and she only knows me from the former docs notes. She treated me as a drug addict and even went so far as to imply I might be wanting medicine to sell on the street. "REALLY" I can't even walk down the street .... give me a break. Bottom line she refused to write any pain meds.
--------------------

1. what are your pain levels right now?
Right now a level 4 but this is 75% of the time .... wears me down mentally

2. pain medications
Ketoprofen 10% & Lidocain 5% topical cream to numb burning and stiffness pain when present. Aleve (over the counter) 220mg, 1 for day time & 1 for night time

3. how often are you icing your knee and for how long?
3-4 times per day

4. are you elevating your leg, how often and for how long?
while sleeping and now 2-3 times per day

5. What is your ROM
Both legs are almost perfectly straight with mild effort left 100 and right 107

6. what is your activity level?
very light lifting of items, driving OK, walking around ½ mile per day

7. what kind of PT/exercises are you doing?
PT Session 3 times a week (1 day in the pool)
incumbent bike 10 minutes
toe and heel lifts 3 sets of 5
calf stretches 3 sets of 30 second
leg press machine single legs 60lb 3 sets of both legs 100lbs; single legs 60lb
leg lift machine 3 sets both legs 70lbs; single legs 60lb

* Please read post #122 to get more info.....Thanks
 
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I am constantly doing manual massaging of the knees and small vibrator massages
Both of which give very good relief....but only last for very short times.
Is going to a pain clinic successful and do many recovers do this ?
 

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When my lower back acted up last summer (I think due to all my elevating) and that was more painful than my knee, I asked my doctor for Medrol dose-pack and was told steroids such as that were not allowed for six months after surgery as it lowers the body's immune system. I practically begged, since that's what I had always needed when my back was particularly bad, but wasn't able to get it.


Sent from my iPad using BoneSmart®
 

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@Josephine,
Perry has answered your questions in post #124.

Thanks Perry for answering Josephines questions.
Sorry to hear about your primary, it is awful to be treated that way. I have been with my primary 20 years, and had to sign a contract that I would not sell or buy street drugs.
These new narcotic regulations are driving a wedge between doctors and patients, and interfering with people receiving appropriate care.
 

Josephine

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1. what are your pain levels right now?
Right now a level 4 but this is 75% of the time .... wears me down mentally
I bet it does!
2. pain medications
Ketoprofen 10% & Lidocain 5% topical cream to numb burning and stiffness pain when present. Aleve (over the counter) 220mg, 1 for day time & 1 for night time
Ketoprofen is a topical NSAID and I don't know if you are aware of it, but it's just as hard on your stomach as oral meds, so be careful. You don't say you are taking any Tylenol - why not? It's the best non-prescription pain med available. Take 1,000mg 4 times every 24hrs. I think you will find that very effective.
3. how often are you icing your knee and for how long?
3-4 times per day
4. are you elevating your leg, how often and for how long?
while sleeping and now 2-3 times per day
Not bad but you haven't told me the crucial bit which is how long for!
Both legs are almost perfectly straight with mild effort left 100 and right 107
Well, if your legs are still swollen (are they?) then you'll not get much better than that right now.
activity level? very light lifting of items, driving OK, walking around ½ mile per day
Okay

Exercises
My comments in bold
PT Session 3 times a week (1 day in the pool)
recumbent bike 10 minutes
toe and heel lifts 3 sets of 5
calf stretches 3 sets of 30 seconds

You've not told me if you do these exercises at home and if so, how many times a day you do them. Until you do, I cannot advise you.

leg press machine single legs 60lb 3 sets of both legs 100lbs; single legs 60lb

leg lift machine 3 sets both legs 70lbs; single legs 60lb

I think you should stop these. General opinion (amongst surgeons) is that leg presses are not good for TKRs in under 6 months or even a year. Too much for your muscles.

I am constantly doing manual massaging of the knees and small vibrator massages
Both of which give very good relief....but only last for very short times.
If the relief only lasts a short time then it's not beneficial.
Is going to a pain clinic successful and do many recovers do this ?
Very few. They tend to tie you into contracts (as I understand it) which give you very little room for manoeuvre. I think you should try the Tylenol I suggested earlier.
 
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@Josephine
Thank you for your response,,,,, here is the info you said I had left out
++++++++++++
*Exercises My comments in bold PT Session 3 times a week (1 day in the pool)recumbent bike 10 minutes toe and heel lifts 3 sets of 5 calf stretches 3 sets of 30 seconds You've not told me if you do these exercises at home and if so, how many times a day you do them. Until you do, I cannot advise you.
I usually do these at least once every day along with other stretching, walking, and movement and stair climbing, when they start to tighten up.
I ice and elevate the legs about three times a day for 15-30 minute periods.
I also use a TENS machine which helps somewhat.
When the pain is constant (at whatever level) anything that brings relief is welcomed such as the temporary massaging of the knee areas.
 

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Perry, I think you need to read this How to quote a post.

PT Session 3 times a week (1 day in the pool)
recumbent bike 10 minutes
toe and heel lifts 3 sets of 5
calf stretches 3 sets of 30 seconds

I usually do these at least once every day along with other stretching, walking, and movement and stair climbing, when they start to tighten up.
Well, here you go again! What kinds of stretching, walking and stair climbing? How much and how often? I really cannot advise unless you tell me everything! If you recall you were asked this at the start
7. what kind of PT/exercises are you doing? How much and how often? (and detailed details would be appreciated, please! Reps, sets and session and all that)
If youdon't help me I cannot help you. I am not psychic!
I ice and elevate the legs about three times a day for 15-30 minute periods.
You accomplish nothing with 30 mins. To do any good it has to be at least an hour of each.
I also use a TENS machine which helps somewhat.
And here again - how often do you use the TENS and for how long?
 
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Good Grief ...... I really am trying to give you a picture of what I am doing but as my pain and discomfort varies, so does my daily routine's. My days' routines, as my aches and problems, are somewhat unpredictable

Visited the PT today and stopping all weight bearing exercises and they said that I could probably do everything I need/or want to do on my own and want to cut me loose.

I have one flight of stairs (18 steps each way ) that I walk up and down usually 1 time a day.
I stick leg straight out on top of second step and reach to and try to hold toes for 30 seconds 3 times each leg
one time a day.
On second step I bend each leg (90 degrees or more) 3 reps of 10 times each.
When pressure and pain are intense I use the TENS machine for 20 minute intervals on knees and above knees.
I use the Tens machine when and as needed not on a predictable regular basis. But very rarely more than one time a day.
These following are daily:
recumbent bike 10 minutes
toe and heel lifts 3 sets of 15
calf stretches leaning forward, 3 sets of 30 seconds each
Walking on High school flat track for 1/2 mile daily (unless in pain)
 

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I know - I bet you think I'm a real pest! Sorry about that. But we're getting there/
I have one flight of stairs (18 steps each way ) that I walk up and down usually 1 time a day.
That's okay. Just take it gently.
I stick leg straight out on top of second step and reach to and try to hold toes for 30 seconds 3 times each leg once a day.
Well just make sure this never ever causes you pain, okay?
On second step I bend each leg (90 degrees or more) 3 reps of 10 times each.
Do you mean 10 reps x 3 sets? I think you'd be better doing these just one set of 5 reps each day. And again, never ever cause yourself any pain.
When pressure and pain are intense I use the TENS machine for 20 minute intervals on knees and above knees. I use the Tens machine when and as needed not on a predictable regular basis. But very rarely more than one time a day.
Gosh I never used it for only used it for 20 mins. More like 1-1½hrs. Have a look in here as see how I used the electrodes as well. You get a 'double wammy' with it that way. TENS machines for pain management. The trick is to never turn it up when the signal fades as that is when the machine is working at peak efficiency. But I rate TENS machines very highly. I've used them so much I've worn out three over the years! Now on my fourth.
recumbent bike 10 minutes
That's okay.
toe and heel lifts 3 sets of 15
I'd say don't do these as they stress the muscles and don't actually contribute much.
calf stretches leaning forward, 3 sets of 30 seconds each
3 sets of how may reps? 10? I'd just do one.
Walking on High school flat track for 1/2 mile daily (unless in pain)
I'd also give this a miss for a while as it's also unnecessary stress.

So to summarise, all you have described in post #122 is being caused by all this activity. Quite simply you are doing far too much and the result is this inflammatory conditions you have. Please do cut back hugely on all this before it all becomes chronic and untreatable. I don't say this easily but I have seen people who have embarked on such intense regime of activity (yes, I know you don't think it's intense but it is) and they've ended up in a bad way for years after. Just something you should bear in mind.
 

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Perry, I know it can be frustrating to have to go slow with the resumption of activity and exercise. Take heart in knowing that all of us were impatient to some degree. It somehow seems that everyone is moving right along and our recovery is just sooooo slooooooow.

It was important for you to provide all those details to Jo, so glad that you took time to do it. Once it's all written down, the information does paint a picture of some pretty strenuous activity for this point in your recovery. You know, this is almost always the case with folks we see on BoneSmart. So you're certainly not alone.

I'm betting you're normally a fairly active guy and you're just itching to get back to some of the things you used to do before your knees began to let you down. You'll get there!!! Honest! So try and hang with the program of gradual increases in exercise and activity and you won't regret it. By this time next year, you'll be singing a much different story and I'm betting you'll be deep into those things you're wanting to do.:thumb:
 

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Hi Perry,
I had my right TKR about a month after your bilateral. My knee is still stiff when I do what I consider to be my normal daily activity. You do a LOT more exercise than I do. It gets a little better each week and I am able to do a little more. A bilateral is harder, so you are probably on track. This is a slow recovery. Hang in there!

Cindy
 

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@Perry how are you doing after your MWA? ( a lot of us have had those accidental super bends :scaredycat:) Has it settled down a bit?
 
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@kneeper
Hi Kneeper,
Thank you for asking........Answer is Yes and no.
Left leg still extremely bothersome with muscle cramps, swelling, stiffness, excessive pain, and burning.
The heat has finally left the knee area , so the healing should be complete but the constant ebb and flow of the above symptoms (up to 7-8 pain levels) are driving me nuts !!!
Right leg is doing fine, which really worries me that something may be going wrong with the left one since they are evolving so differently.
 

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Try not to worry, Perry. It's very, very common for knees to progress at totally different rates in recovery. Remember, the knees may have both hurt, but they were not twins in their degeneration. One may have required more work and manipulation by the surgeon. Then, of course, you had your own manual manipulation.....

Healing takes time and it's normal to have pain get worse and better as you go along. Just listen to each knee and respond accordingly. When pain ramps up, it's a signal to step back for a bit and rest, ice and use pain meds. You'll get there! It's only been a little over 3 months....still early, my friend!!!
 
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