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

[kneeper]

6 weeks is just phase one of recovery.

It sounds like your surgeon is fine, it's the unreasonable PTs that are the problem. I think they overemphasize exercises because they have the false idea that if they don't we will all sit around like lumps after surgery.

My first PT (I realize in retrospect) tried to rush me and I wound up dealing with tendonitis. My second PT recognized that I wasn't going to get much increase in bend until we managed the swelling. So exercises were fairly light to start and increased only as long as they didn't increase swelling. I did a few heel slides and other exercises (not many all on one day), a little walking (gradually increasing from 5 minutes to 10 and so on).

I got about the same ROM with the more aggressive PT (but lingering tendonitis) as I did with the more reasonable PT approach (with a knee that healed smoothly and with no lingering issues).

So much of tkr recovery is individual. It it important to listen to your body and think in terms of increments.

 

[Knees4Me]

@kneeper - The surgeons and physiotherapists work together at the hospital where I'm having both knees replaced. If you don't progress to the PTs' satisfaction, which includes their "assistance" aka pushing!), they threaten to phone your surgeon on the spot! They constantly warn that if your range of motion (ROM/flexion isn't at least 115 degrees one month after surgery (mine's only been 102 - with a push!), there is a high risk that scar tissue is growing rapidly and impeding any progress with flexion, so the surgeon will have to do a Manipulation Under Anesthetic (MUA) to force your poor knee to bend until the're satisfied. The PTs say the surgeons spent a couple of hours doing their job during your operation and now it's the patients' responsibility to hold up their end of the bargain by putting in the required hours of exercise and rehab. Otherwise, you risk the surgeon's ire at your six-week post-op follow-up appointment! And the doc may cancel your second surgery date, if you have one. I can tell you that I did not sign up for being treated like a recalcitrant three year old! But this hospital boasts an excellent reputation and many, many joint replacement successes!! So they obviously are confident that their program and approach work well. I have learned that everyone's recovery is an individual thing. I also discovered that my surgeon did some "realignment" to correct some bow-leggedness (I never knew I had!), so that could be slowing down my recovery. I suppose she'll need to do the same thing to my right knee so my legs "match." I sure do talk about my recovery as "incremental." I'm still in a lot of pain (yes, I do rest, ice, medicate and elevate - a lot!), I still have a lot of swelling (I'm allergic to anti-inflammatories) and bruising, I have back pain from sitting in bed too much and sleeping with a full-leg brace on - that is, when I can catch a few minutes here and there, and I am still wondering why on earth I agreed to have this surgery! And I've never felt so disabled and dependent on others. It's all so frustrating and just seems to go on and on and on.... Thanks for listening to my pity party rant!! How are you?

 

[RMasano]

This process, I am finding out, requires a lot of patience. We all hear your pain. I had my surgery on January 9th, with realignment also (knock knee). I have a great PT who doesn't push and does just enough and is always asking me about my pain during exercises. My OS, who is out of Rush hospital in Chicago, wants a good ROM, but he realizes everyone is different and never makes me feel like I'm terrible patient. Rush is a leader in orthopedic surgery and I know all the docs pretty much follow the same mantras. From what I am picking up on they are very compassionate and not pushy with their patients. I have to say, I am very stiff and that band feeling is there, but I am not in a crazy amount of pain. I only take tylenol during the day and maybe a half a norco or trandol at night. Sleeping is still very hard because I am used to sleeping on my side or stomach but each day gets better. Morning stiffness is awful.

We need to give ourselves a break. We had a knee taken out and a new foreign one put in. It will take a while but we will get there. Trust me there are many times I want to take my walker and throw it across the room!!! Wishing you luck.

 

[Knees4Me]

@RMasano - Our situations do sound similar. I'm usually a side sleeper myself and got back pain while sleeping on my back with the brace/immobilizer on my leg in the hospital. Did you have one of those on for the first while? Still can't get comfy so I'm suffering from a certain amount of sleep deprivation. I'm not familiar with your meds, except for the Tylenol. Maybe they use different drugs up here in Toronto. I'm taking Hydromorphone for pain - a form of morphine, I suppose. It's like Vicodin, which is what TV's Dr. House was addicted to! I won't become addicted - in fact, I'd love to get off it, but I still have too much pain, including bad morning stiffness...so I ice. Nobody warned me about just how long this road is. Six weeks kept coming up pre-op. I guess I'm adjusting my expectations. But I'm still an impatient patient, with knee op#2 waiting in the wings. My milestone today was switching to just one cane. I refrained from throwing my walker across the room, though. Haha! All best wishes to you. Getting your reply gave me a little boost. Thanks!!

 

[Ronsgirl]

I am very fortunate to have had great therapists with both my knees, and my OS and his PA never expected a certain ROM at a certain time. In fact they have never even measured it. Could it be that it is just a scare tactic on the part of your therapist? If I were you I would set some guidelines for her or him, and not worry about it until after you see your OS at your checkup. Then if your OS won't operate on your other knee I am sure there are other good surgeons in Toronto. Just my two cents worth, but I wouldn't be bullied into letting them hurt me. I also have some bowing in both my legs, and now I have two nice straight legs. A lot of us have to have some realignment done, probably most of us, but I have never been told that it would cause my recovery to be slower or longer. I am also a side/stomach sleeper and have found the only way I can get comfortable is to sleep in my recliner. If you have a recliner you might give it a try. It also helps my back to not hurt like it does if I try to sleep on my back.

 

[Spex10]

That sounds awful @Knees4Me. Re sleep: my friend has a bad back and recommends pregnancy pillows. Basically they are very long C shaped pillows that curl round you and support you. They can be used either side or they also make double sided ones. She loves hers and said its like being firmly hugged! I was going to get one but suddenly found I could sleep on my sides and front again. It happens! Good luck.

 

[Knees4Me]

@Ronsgirl - I suspect you're right about the PTs' scare tactics. If that's how they're trained, I'm not impressed! No, I don't have a recliner. Too big and awkward for our little condo. I do have our whole queen size bed to try to get comfy in, though, because poor hubby has been relegated to one of two love seats in the living area for the duration. At least our laundry is in a closet and we don't have to go up and down stairs to do it like we did in our house! We sold and then bought this condo because we knew I needed both knees replaced, so we wanted to be all on one level. Also, I would like my current surgeon to replace both knees. We'll see what she has to say at my six-week follow-up appointment on Feb. 15! All the best to you!

 

[Knees4Me]

@Spex10 - I have nowhere to store a pregnancy pillow, but I'm sure it'd be a fine idea. I'm getting a similar effect, though, from arranging the six pillows on our bed around me. Doesn't eliminate the back pain, unfortunately, but makes the bed more comfy...and that's where I've been spending more time lately than when I was a babe in arms, I'm sure!

 

[Spex10]

It takes up less room than 6 pillows!
PS what's a love seat?

 

[lene']

@kneesforme...What!!!!...First, I would ditch that surgeon and PT in a BIG hurry...I would throw that stupid brace out the window, yesterday! I don't think I heard ANYONE on this forum say they had to wear a brace for 3weeks, that is insane... (although you may be out of it now?) Take charge of your recovery..., it's your body, it's your money... the hospital that did my surgery also boasts of being in the TOP 10% of Joint replacement hospitals, but I was not about to be bullied by anybody, and when they started pushing I told them STOP! Get your hands off me, I will not accept pushing and if you do it again I am walking OUT! I did PT once a week for about 4/5 weeks, then I said no more, I am doing just fine. My surgeon asked me just last week, if PT kicked me out and I told him "No, I kicked THEM out" He said, "Well Your doing great". I move just fine and walk a mile or more a day now. When I left PT, I was about a 3/4 on extention, the PT told me I was going to have to work, EXTRA hard to get that extention....PFFFT... I am pretty darn straight now and who cares if I am not 0?? I don't see anyone running around with one of those stupid measuring things checking on me...

I heard the person story too about how much my surgeon did for me and I shouldn't disappoint him...Ha, he better not disappoint ME!

they threaten to phone your surgeon on the spot! They constantly warn that if your range of motion (ROM/flexion isn't at least 115 degrees one month after surgery (mine's only been 102 - with a push!),

So what, let them phone your Surgeon on the spot....You think he is really gonna take the call? After they dial, ask to speak to him/her...call their bluff...they are BLUFFING!!

I guess I just have too much moxy to let ANYONE push me around too much!!

 

[newlybionic]

@lene'

Please don't let PT push your leg. It only leads to more swelling and defeats what they say is there purpose to increase your range of motion. Pain medication is needed to help keep your swelling down as well as ice and elevation. I didn't allow anyone to touch my knee after my revision and I've done extremely well. Actually much better than my OS thought I would do after my botched original TKR. I'm not sure I would go back to your OS for another knee replacement. He and his office staff seem to be behind the times.

 

[KarriB]

@lene'

 

[RMasano]

Hope the days are getting easier!!! Why do they have the brace? I do not one. I agree with the responses above. Are you sure you do not want to research other OS? Not very compassionate bunch. They need to be proactive, but this about you not them!!!!

 

[kayjay]

wow, i evidently zoned out and missed a lot of this. i think the one question i would ask of knees4me, do you feel that the hydrocodone at 2mg is helping with the pain? it really is a small dose. less than my oral surgeon gave me after tooth extractions. i'm on the big gun, oxy 10, but able to space it out for 6 hours, this means i can actually get almost 6 hours of solid sleep!! that helps a great deal. my os has had a hip replacement and said it was the only thing that was effective for him. i also got lucky as my home P.T. has been understanding that i can't do big bends because i still have quite a bit of swelling. my left knee is about 3 inches larger around so we may press it a bit to get a stretch but i'm not giving me all for a one time bend of grand proportions - i'm close to the same date for surg. as you and getting 88 to 92 as best. my os is ok with that. i know i still have a ways to go, my righty will be one year ago in march and it's still a work in progress.

nonetheless, you have a wonderful goal - that trip to hawaii. you'll make it just be gentle and kind with yourself.

k

 

[Knees4Me]

@kayjay - I'm actually taking Hydromorphone 2 mg. (not Hydrocodone). Does that make a difference in your opinion that I'm getting too low a dose of painkiller to deal with my pain? I also take 1,000 mg of extra-strength Tylenol every 24 hours. My oral surgeon gave me Tylenol 1 (which has a bit of codeine added) for a molar extraction in the fall. That was painful for several days! I really don't do well on any level when I'm in pain. But it seems I can't escape it! How discouraging to read that your first knee to have TKR surgery is still "a work in progress!" Hawaii sounds farther and farther away...

 

[Celle]

We'r not qualified to give specific advice about the pain medication, but it does sound as if you are under-medicated.
Phone your surgeon's office and say that the present meds aren't adequate. They may prescribe Tramadol, which you can take four times a day, in combination with Tylenol 1,000 mg each time. That usually works well.

 

[Red's Mom]

@Knees4Me Im just sending good thoughts your way. It sounds like your still on a rough road! If I had a magic wand I would wave it for you! I also want to encourage you to ask, tell then demand adequate pain control for yourself. Don't compare your medications to others. Compare your pain management to your pain levels. Your OS and or GP need to get your post op and back pain under control! Please be the squeaky wheel to get a good pain control plan in place. Keep us posted. In the meantime I'll be putting your Hawaii travel agenda together. You WILL get here!

 

[jdrham]

@Knees4Me - I am distressed to learn of your post-op experience. I am about to embark on a multi-year project to replace marrow for metal in multiple joints.

I will have my hip done this month. I am afraid. And even more so that we share the same health care system where 12 month cues for replacements are the norm rather than the exception..and where caveat emptor has little significance.

I am also fearful that I might be taking the same path by attending the same hospital as you. It sounds awfully similar: great reputation, specializing in orthopedic conditions, central location etc....

I was lucky to get in to see a great surgeon with a great reputation, but it is a teaching hospital and I am not sure how much will be done by the fellows (students) rather than by the staff...

I will make sure to be on guard if i meet up with any aggressive physios.

I hope you turn the corner soon.

Your neighbour - Anne

 

[Knees4Me]

@jdrham - I am upset that my posts here have made you distressed! While it's normal to be nervous when you are going in for surgery, you should remember that everyone's experience is different! I have read that what some people (e.g., me!) perceive as pain, others people perceive as merely discomfort. Fingers crossed that you'll be one of the latter! I did not have time to talk much to my surgeon before my operation. And I don''t know how much of the surgery, if any, that a resident was allowed to do! I didn't ask and I don't want to know! You are having what sounds like a much different and complex procedure - or series of procedures. I hear hip replacement surgery is "not as bad" in terms of the amount of pain and the rather aggressive, lengthy rehab involved. I'm not at the stage where I can say I'm glad I had the surgery. And I wil likely have my second knee replaced and leg "realigned" within six months. That is, if I can satisfy my surgeon's range of motion (ROM)/ flexion expectations with this first knee. I'm falling short at this point in my recovery because I have so much swelling! But my six-week follow-up appointment with the surgeon is on Feb. 15. I'm afraid I'll need to have the dreaded Manipulation Under Anaesthetic (MUA) because of scar tissue impeding my ROM! We all have our hopes and peers. Just use this forum for venting, like I do! You'll get a lot of support here, including from me! When do you get your hip "done?" I wish you all the very best!! Let us know how it goes.

 

[Knees4Me]

@Red's Mom - Thanks so much for the well wishes! Yes, I'm still not having a great recovery. It goes on and on without much to show for it! I go to physio/rehab twice a week for two hours each time. The same evening, I always swell up and need to ice and elevate. I can't do any exercises the following day, so visions of scar tissue/adhesions/MUI start! Yesterday, the PT got me on the stationary bicycle. I wanted to just gently rock my feet back and forth on the pedals to get the feel for it before I was ready for a full rotation. But she forced my "surgery" knee to go around and it hurt so much - it was really painful! - I was nearly in tears. Also, my husband, volunteers, other patients and everyone in the gym had an almost 360 degree view!! I'm a very private person and don't like an audience!! Especially for something like that! I'm keen to start using the recumbent bicycle in our condo building, but I don't know how I'll ever get a full rotation on my own! I wish I could get off the opiaite drug I'm taking. I think I'm well medicated for now. I take a total of 4,000 mg of Tylenol x-strength plus 24 mg of Hydromorphone every 24 hours. I haven't given up on Hawaii. In fact, I already have a blueprint for our far away, two-island, 15-day trip. I'll PM you later - probably tomorrow or Sunday. I hope you're relaxed and happy and in the warm sunshine. C u later!!