TKR I really didn't know what I was getting into!

[Laurenkate]

My left tkr isn't until next Friday so I don't have much to add except......why do we always forget that surgeons and doctors and physical therapists work for us? After years of taking care of mothers, uncles, aunts and a brother and hauling them to a lot of different doctors, one of the things I learned was not to be intimidated by them. I agree with Josephine; so what if your surgeon disowns you? There are other surgeons and you might find one who is more concerned about you than his and the hospital's bragging rights!

 

[Jamie]

Hi, Knees......I'm so glad you are posting and venting your frustrations. You've received so much good advice that there is not much I can add except to say I hope it has helped to hear from others who have been through similar experiences.

Stay assertive with anyone who tries to have you do things that make your knee hurt. You are in charge of this process! And all that threatening......it's one of the worst cases I've heard of where a patient was bullied with threats. Let me tell you they are all meaningless. I would be very surprised if your surgeon knew about all that threatening or if he would actually disown you.

At this early stage, all you really need is to be up and walking about the house every hour or two and doing some gentle bends and stretches of your knee several times a day. Ice and elevate toes above the nose as much as you can (even through the night). If you don't want to get up to take your meds, keep them by your bed with some water and a cookie or cracker to eat along with the pill so your stomach doesn't get upset. However, I used to find it beneficial to get up and walk around the house in the middle of the night for about 5 minutes just to stretch things out. Just me and my walker in the dark.....there were several of us going through recovery at the same time and we called ourselves The Night Stalkers! All this is temporary.

How much longer do you have to wear that dreaded brace? I'm with Jo that it may be the cause of your pain at night or at least a contributor. Why not leave it off for a night or two and see what happens. If it's noticeably better, call your surgeon's office and see if you can cancel its use.

Remember that pain can manifest itself in many forms. If you are still experiencing pain, let us know what is going on and we can make some recommendations. Hang in there.....it will get better.

 

[Red's Mom]

Other than agreeing with everyone who says "if it hurts DONT DO IT" Here is my two cents. It is going to be a LONG time before the "let it heal" concept is adopted. In part because of the incredible physical therapy infrastructure and staffing of the joint replacement industry. Best practice vs revenue stream is a difficult pill to swallow for organizations who provide dual services. In all likelihood it will be the payors who catch on and refuse to pay for PT in the first 30-45 days. Unfortunately that is often what drives our pay and play system here.

 

[kayjay]

i was told to wear the immobilizer for 3 weeks when sleeping. it added greatly to my pain, so much so that i switched to my knee brace and am doing fine and so far haven't done anything "CRAZY" ! sometimes logic must enter in. it keeps my knee stable and i can sleep in it. just a thought.

 

[Knees4Me]

@kayjay I ditched the knee brace after the PT told me I could, because I had a measurement of 0 degrees extension in my knee. Yay. Flexion is still under 90, though, nearly three weeks (on Tuesday) after my op. My bend was 90 degrees on the day after surgery, but declined to 80 and 70 as the extensive bruising and swelling came in over the next two days. The bruising is subsiding, but the inflammation persists, making it very hard to bend my knee. I'm just going to ignore the physiotherapists' threats of MUA and further surgery!

I'm up now in the middle of the night with excruciating back (sciatic?) and knee pain, which often come at night. I'm about to take a painkiller pill (hydromorphone 2 mg), then ice, elevate and try to find a comfortable position to get some sleep since I go to physio tomorrow.

The PT wants to start pushing my knee to increase my ROM. She'd better be careful or I'll push her! I've felt human this weekend for the first time since surgery, if a little emotional, if anyone looks at me sideways. I actually got out of bed, had a shower, dressed in casual clothes and joined my family at the dining room table for dinner. And today I helped to pack up the last of the Christmas decorations (no heavy lifting!) so my husband could take them all down to our condo's storage locker.

I hope that by the time my husband and I decorate again next year, I'll be almost recovered from my RTKR and getting ready for our dream vacation to Hawaii in January 2018! Talk soon.

 

[Knees4Me]

@Red's Mom Because we're in Canada and have a different health care system, I suspect that pushing all patients towards fast and exemplary outcomes has more to do with maintaining the reputation of the hospital, the surgeons and the rehabilitation program. It feels like an assembly line of knee and hip replacements, with everyone getting the same physical therapy in post op knee or hip "classes" in the same time frame. The whole experience has made me feel rather like a sheep. And I'll be having my other knee replacement surgery sometime in the next six months - IF my surgeon deems me to have passed the ROM test! Baaaa!!!!

 

[Cratchit]

@Knees4Me and @Red's Mom I`ve just been reading through this thread and am thinking about the financial and reputational reasons for pushing ROM and PT in the immediate post-op period. I don`t think we have those drivers here in the UK yet still the push to increase ROM to beyond 90 in the first couple of weeks is rammed into us. I received a leaflet outlining the Rapid Recovery Programme which, in the event, wasn`t followed. So why, with nothing to lose, is this false message re ROM still pushed in the UK? If practice is supposed to be evidence-based then why are so many practitioners stuck in a bygone era?

I hope you reach that turning point soon @Knees4Me

 

[L.I.T]

@Cratchit, that's a very good question... Although, I notice when I'm perusing the "scholarly articles" section of Google (yup, I'm a nerd), most of the studies to determine outcome success are based on 6 month target numbers. I found very few that went out to a year, and can't seem to remember a single one that extended to two years. Why? I have no idea - funding perhaps?

Anyway, perhaps that is part of the problem. I know when the hospital I worked in started doing liver transplants, there was a specific time period in which the transplant was considered a "success" - and, of course, the more "successes" you had, the more livers were allocated to you. I saw some really shady ethics in this program - going to great lengths to try to keep a liver or patient viable until the 'target date' was met. I was terribly ashamed. I suppose that's what happens when health care is statistic based. I get quite despondent over the whole thing.

We are not sheep or cattle, we are people. Every person is different, and one size rarely fits all. I like to see my patients as someone who need my care and support catered to them - not as a statistic which I must meet in order to keep my job. OK, rant over... I'm off my soap box!

 

[Knees4Me]

Fascinating discussion from (so far) three nations! Great for insomniacs like me and nerds like you, @L.I.T.! Haha. You sound like the type of nurse I like to get. Too few are compassionate these days and see patients as individuals, each with his or her specific needs. Certainly, a "one size fits all" system doesn't work in the long run, except financially. So maybe cost is a driver!

Since BoneSmart's nurse, @Josephine, is U.K.-based, and she's firmly in the anti-"no pain, no gain" camp, maybe she can shed some light on why so many hospitals/institutions, surgeons and the physical therapy community are in such an all-fired hurry to get to 90 degrees.

Is it really all about rapidly-growing adhesions, as explained to me by PTs? In other ways, if you ask them, they appear to say that everyone heals differently, at his or her own pace. There certainly appears to be an anomaly.

Or maybe it is about quotas, keeping one's job by meeting certain criteria, and about moving sheep, um, I mean knees and hips, along the assembly line. Ethics, indeed! For the first time, the idea of a good, private hospital appeals to me as an individual. But I couldn't afford one!

 

[Spex10]

Well at my UK hospital before I was discharged I fearfully said to the PT that I thought I had to be at 80 degrees. She firmly told me that was nonsense and not to bother about it.
My current OP PT is excellent. No pressure. She really thinks about why I might have pain in certain spots and explains what she's doing and why. She does massage and manipulate carefully and above all is kind! I've discovered that she's actually the boss in her dept and is pretty senior. There seems to be a gulf between the physios who actually do the business and those involved in research. If all physios were like my one I reckon the world would be a different place for us new knee people. Now if I could work out a way to clone her...

 

[Knees4Me]

Yes, I'll take a clone of her - IF she doesn't push! I can't understand why a fair number if PTs I've met seem to have a sadistic streak and tell me, almost gleefully that the exercises will hurt and there's nonwaybarous the pain, except to take prescribed painkillers before my PT session and ice after.

I suppose they tell themselves they're helping people. But have they ever felt the post-op surgical pain from knee surgery? Not most of them. They should all have to feel it themselves in training, before they ever touch a patient - and they should get regular refreshers, lest they forget. And they should drop the smug attitude that it's the patient's fault if ROM isn't over 90 within two weeks of surgery. One of them actually said "pretend you're in school again and have to follow teachers' orders!" I said out loud, to nobody in particular, "I thought those years were behind me - long ago!.

I wonder why they don't have each patient's chart with notes from the surgeon about the specific "slicing and dicing" done on each person's knee. Surely that has a major bearing on when 90 degrees can realistically be reached for each person's case. And notes could flag which exercises could hurt the new knee rather than help. As if any of us would want to be stuck without a full range of motion! That's precisely why I elected to have LTKR now and why, despite the misery I've experienced over the past three weeks, and continue to experience, I will elect to have RTKR later this year. Unless, I don't have a 120-degree-plus ROM by the time I see my OS for my six week follow-up appt. On Feb. 15.

I must keep that Hawaiian vacation in my mind's eye. Trouble is, it keeps looking farther and farther away...! :(

 

[Spex10]

No my physio doesn't push. Other therapists seem to have to be more empathetic and patient focused. Maybe its the ethos of the hospital I attended? Patients are people seems to be the mantra . Immediately post op the nursing staff were excellent -very caring but efficient. This physio is the same. That attitude can only come down from the management and I think they've got it right there. Sorry. That's no help to you. Its just made me realise how lucky I've been.

 

[Pontoon]

I too came home with that awful brace to keep my leg straight at night. They wanted me to wear it for four weeks. At my 2 week checkup he told me I could stop wearing it.

I found it was easier to sleep by putting my operative leg over my other leg which was flexed at a 90 degree angle. I also was prescribed a mild sleeping pill, which helped as well.

 

[KarriB]

@Knees4Me youll be happy to hear that we have a member who had her TKR done at the Mayo Clinic and NO therapy was prescribed at all, just a few stretches. If you are experiencing an aggressive PT ask for another or cancel PT. A few heel slides are all you really need, also I found riding a bike at 0 tension helped to loosen up my knee beautifully and help with ROM.

 

[Red's Mom]

@Knees4Me you will make it to Hawaii! There is hope, recovery and healing. Even with knee #2 in the future. At least with that knee you will have an idea how this all goes. Who knows, maybe that one will be a breeze! Hawaii is in your future, I can see it!

 

[L.I.T]

@Knees4Me, my flexion is good, but I still have the 'band from he**', so I end up sitting on the side and manually lifting my leg over... I then use my arms to lower myself in - and my other leg as balance. My PT told me to find a hot tub, but the nearest fitness center that has one is over an hour away... So I opt for the soaker tub. It also provides my cats with great entertainment, since they've never seen me take a bath! They like to reach over and paddle in the water

 

[Josephine]

maybe (Josephine) can shed some light on why so many hospitals/institutions, surgeons and the physical therapy community are in such an all-fired hurry to get to 90 degrees.

So why, with nothing to lose, is this false message re ROM still pushed in the UK? If practice is supposed to be evidence-based then why are so many practitioners stuck in a bygone era?

It's mostly because medicine always does move very slowly. Currently I am on committees of 4 different research projects. Each of them have been about 1 year in planning and applying for funding, the research will take from 2-4 years with at least one extra year to analyse the findings and write up the paper and get it published. And I'm hoping to get my own philosophy of no exercising researched and it's not even on the planning stage yet! It could be another 2-3 years before it gets under way. After that, people have to read it and talk about it at conferences in order to get it 'out there' so changes occur. It could be ten years before that happens!

Or maybe it is about quotas, keeping one's job by meeting certain criteria,

Sadly that's exactly what it is!

I wonder why they don't have each patient's chart with notes from the surgeon about the specific "slicing and dicing" done on each person's knee. Surely that has a major bearing on when 90 degrees can realistically be reached for each person's case. And notes could flag which exercises could hurt the new knee rather than help.

Sounds like a good idea but like a lot of good ideas, it isn't exactly realistic. Each patient is an individual and cannot be downgraded to a list of ticks in boxes!

 

[KarriB]

Jo, will your research groups look at what Mayo is recommending now or only look at U.K. data?

 

[newlybionic]

I followed what the OS office told me after my revision. "If it hurts, don't do it". I had allowed a PT to push all his weight on my knee after my original surgery because I wanted to go with what I thought was right. I almost went through the wall pulling away from him. After my revision I was ready to stop anyone who wanted to hurt me. I took my time rehabbing my knee. I skipped the step ups, squats and everything else tough on new knees. I can flex my knee to 130 degrees. That is far better than this knee has done in over 30years. Tell them up front not to hurt you or you will walk out and stick to it! A very loud 'OW' would probably be good too,

 

[Josephine]

Karri - of course we will!