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

@Knees4Me so sorry about your experience. I am 5.5 weeks and tried the bike today but without moving my hips to avoid the last few degrees of bend I cannot make it around so we got off the bike. PT gave me my choice to stop. And although I really want to progress, I know it is better to wait a little longer. I have 4 mg hydromorphone and oxycodone. I haven't moved off prescriptions due to my pain levels. I was rotating every two hours between the two, so four hours between same dose at the beginning. And I thought I had a high tolerance for pain. I know others have moved to only Tylenol and as hard as it is not to compare to others, I try not to and just do what I need. I only started sleeping solid for more than four hours consecutively at night last week. The first two weeks were horrible waking up every hour or two, which meant even before I could take the next dose of meds. I am to the point to say each week does get better, the starting point just sucks. Hang in there and truly listen to your knee. There were days I slept almost all day and just laid on the couch. And even now I have an active day and know the next day needs to have recovery time. The first two weeks of PT, I needed a nap after each one and my Therapist said two hours isn't a nap but a sleep. I just did what my body needed, do two hours it was. I am looking forward to the next several weeks. I am staying positive that they will be better than the first five weeks with more progress.


Right TKR 27 December 2016
 
Knees4Me said:
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.
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@Knees4Me
You aren't making recovery easy for yourself at all.

Scar tissue will not build up if you don't work hard enough. That is a fallacy. They tell you that, to frighten you into working harder.

You should never do or allow anything that hurts your knee. You are in charge. The PTS work for you and they have to please you. For goodness' sake tell them to stop hurting you. All they are doing is irritating and inflaming your knee. It needs time and gentle treatment, so it can settle down and heal properly.
Remember this, from the mantras?
- if it hurts, don't do it and don't allow anyone - especially a physiotherapist (PT) - to do it to you. exercise only gently
- if your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again

It is your absolute right to speak up on behalf of your knee and stop this mistreatment.
Saying no to therapy - am I allowed to?
BoneSmart philosophy for sensible post op therapy
 
@agarrett it will be better! Soon you will be glad you have a new knee. It sounds like your listening to your body and exercising patience which will all help in the long term. This is a long journey to recovery. One day at a time!
:console2:
 
Please don't dread a MUA. I had one and it was absolutely fine. Made a huge difference. I'm very lucky indeed with my physio who would never ever treat me the way yours seems to. A gentle encouraging approach with no forcing and asking permission all the time has great results.
By the way, the OS was very clear that my development of adhesions was part of a genetic likelihood to overheal. He's done research into it. A key indication is that the patient (me!) has co operated and tried to do exercises as stipulated but ROM sticks and reduces gradually. Recent research indicates that OS should think of MUA sooner rather than later and ideally before 12 weeks. Its not very traumatic then. Good luck.
 
I think jrdham is distressed that he may have to endure the same treatment at PT. They aren't helping you at all, instread they're causing more trauma to your already traumatized soft tissue. The PT could've caused real damage by forcing the bike to a full revolution. It is OK to rock the pedals back and forth until your ready for a full revolution.

I often think this recovery is like watching a toddler progress. We don't force toddlers to speak in full sentences before they say words, or to climb stairs when they're just walking around furniture. But that's exactly what's happening to you at PT and consequently it will take longer to recover because your soft tissue has to continuously heal after every PT session.

Due to complications I wasn't allowed to bend my knee for a month and wore an imbolizer. My soft tissue was so compromised the only way to calm it was to not bend. With every OS visit I asked if my knee would ever bend and my OS said you're knee will bend when we tell it to bend. It did! When I was permitted to bend we began slowly with non-aggressive PT, no one pushing it or forcing. It took 2 weeks of rocking the pedals, but each rock was a little closer to a full rotation and when my knee was ready I was able to go the whole way around. I was able to drive 3 weeks after we started bending my knee and went back to teaching 5 weeks after being allowed to bend. Forcing a knee to do something it isn't ready for is counter productive.
 
@Knees4Me I had a hip replacement and found BoneSmart after a few weeks in. My PT was having me do some things contrary to the BoneSmart philosophy. I ended up canceling PT only to resume it 3 months later.

My back hurt as well. I use a heating pad and sometimes a large gel pack, both of which feel divine. I love to ice my back because the pain actually disappears. Good luck.
 
I'm sorry to read you are still being tortured in PT. 2 hour sessions? Way too much--no wonder your knee blows up.
In many of our experiences, PTs "threaten" to tell the doc or warn of MUAs and the surgeons are fine with the progress at our appointments. You won't get more bend when the knee is so swollen.
I was very slow in gaining bend until the swelling decreased.
 
Dear Friends , Today marks five weeks since my LTKR surgery and I feel as if I'm in limbo. I can't detect much improvement, although I did work hard at PT/rehab yesterday to reach flexion of 112 degrees and finally do a full rotation on the recumbent bicycle without the therapist "assisting." I simply took my feet out of the stirrups when she approached me! I could only do three or four revolutions before the pain was too much, though. At this stage I'm feeling totally fed up and frustrated at the continuing pain. It's not just at night, but nags me all day. Are the pain meds supposed to kill the pain completely - or just dull it? I take 4,000 mg of Extra Strength Tylenol per day, divided into two tablets every six hours, at 6 am, 12 noon, 6 pm and 12 midnight. I take two tablets of Hydromorphone 2 mg every six hours, along with the Tylenol. To help with breakthrough pain, I also take one Hydromorphone 2 mg pill at 3 pm, 9 pm, 3am and 9 am. This is all as prescribed by my OS. However, because I need to set my alarm to wake me up to take my meds, I never get a decent nights' sleep! I envy all those people who say they stopped taking opioids a couple of weeks post-surgery and just take Tylenol before bed! I fear that I may have accidentally dislodged my new artificial knee in my sleep and that's why I 'm still feeling pain five weeks after my operation. Is this normal? I have my six weeks appointment with my surgeon a week from tomorrow and I'm told she expects to see a 120 degrees R.O.M., which I don't have because of continuing swelling, in spite of constant icing and elevation. One more thing: ever since I had my catheter removed in the hospital, I've had to get up to pee about once every hour, night and day. This further interferes with my ability to sleep and rest. I haven't had a good night's sleep since last year - literally! Has anyone else had a problem with frequent urination post-op? Is there a pill for that? How long does it go on? (At least I've had no BM problems - don't know which would be worse!!) I was hoping that after six weeks, I'd get off the Hydrmorphone, get my surgeon's okay to drive again - and be able to toast my beloved on Valentine's Dat with a glass of red wine - and celebrate his 70th birthday on the 23rd with a glass of bubbly and a toast! Looks like that's not going to happen. Wish I had my old knee back. Feeling glum. Apologies for the pity party!! Hope everyone else is making great strides - literally!
 
Have you been checked for a urinary tract infection? Could some of the other medication have a similar to UTI side effect? I know meloxicam (a nsaid) gives me a side effect as if I have a UTI. When I had a scope of my bladder, I was given a short course of antibiotic to prevent a UTI. The post operative antibiotics may not have reached/controlled the UTI bacteria???
 
It is my belief you are in limbo due to all the "work" you're doing. In this recovery the harder you work the longer and more painful your recovery is as you're seeing with your night time and nagging daytime pain.

I didn't get on a bike until a month post op and it took me several weeks of rocking back/forth before I got a full revolution and it didn't hurt at all. I'm sure the PT forcing your revolution caused your soft tissue to swell. You really can't hurry this recovery along, your ROM will come when the swelling goes down. A garden hose full of water won't bend and that's your knee right now, full of swelling so it cannot bend with force and the force causes more swelling.

Quite a few times I felt as though my TKR had popped or dislocated in bed, but it was just fine. Not sure what it was, but I've read of several who've experinced this.

I think you should give your PCP a call about the urination issue you're having, especially as ypunhad a catheter. I've heard this happening to others, but 5 weeks is a while for it continue.
 
@Knees4Me First dear knee friend I'm sending hope and a bit of faith that things will get better. Second, please call your PCP right away and have a urine culture done. Next, I have to agree with KarriB. Your trying to be a good patient and follow all the rules right now. When you see your OS next week can you ask him if you can stop PT for 8 weeks and follow the bone smart mantras? I was FLABBERGASTED when my OS totally supported my decision to quit PT when I explained to him that with PT I was seemingly going backwards. Once I fully committed to the BoneSmart mantras I started going forward bit by bit. I still need Tramadol periodically at 10 & 14 weeks. I take Tylenol 1000mg twice every day and sometimes 4 times a day. I think you need two weeks of nothing but ADLs rest, elevation and ice. That might help you get back on track. Please be gentle and patient with yourself, you ARE going to get better.
 
@Arttie - Good point about being tested for a UTI. (If only I could get downtown to my family doc!) It doesn't feel like one, tho'. Maybe it's just that I drink gallons of water with the pills I take 8 times a day, plus what I drink with meals and in between. Or it could be a side effect of the the Hydromorphone. After all "hydro" means water. I can't take Nsaids. Unfortunately, I'm allergic to all anti-inflammatories.
 
@KarriB - It was a month before I got on the stationary bike to just rock back and forth. I should have been more vocal about my PT not pushing my leg around before I was ready. Having said that, I am motivated to reach that all-important 115 degrees flexion. Without it, I can't go up and down stairs, drive, sit at a table or in a restaurant or theatre comfortably or ride a recumbent bike for exercise. I'm motivated do all of those things and I've been told all along (outside of BonesSmart, which goes against the conventional wisdom!) that I may be able to do some or all of those activities in after about six weeks? I am going stir crazy lying in bed for most of every day, hooked up to my cryo cuff with my toes above my nose, not able to focus on reading a novel or watching a movie because of the opioids - and being dependent on my poor husband to run around for me, do all the dog walking, shopping and cooking, etc. I'm going to have my other knee replaced in the early summer, so I don't want to sit around hoping knee #1 will just get better when it feels like it!
 
@Knees4Me today was six weeks for me and my story is very similar to yours. I have my OS checkup tomorrow, not sure what to expect, but best measurement has been 100 degrees at this point for me. I still have a bunch of narcotics including the hydromorphone. I am still not on the bike, need a few more degrees for flexión for it to be comfortable. I know the swelling has been limiting me, but so has the tightness in my surrounding muscles, including very tight calf muscle. When I get a really good stretch like off a curb it makes a big difference and it feels much better including bending more and straightening more as well. This is slower than I thought and yes frustrating but have been learning to change my expectations and have more patience. Days have gotten better and I have learned one day forward may mean one or even two days backwards, but then forward progress starts again. Have faith!


Right TKR 27 December 2016
 
@Red's Mom - What's my PCP? Maybe it's called something else here in Canada. I will try to get a urine sample in for testing, but I'm already having a hard time getting my family doc to okay my prescription refill for pain meds!! We had freezing rain in Toronto today, which brought the city to a virtual standstill and her office closed early! The only time I get dressed these days in street clothes and go out is on Mondays and Thursdays when hubby drives me to physio. It's been like that for five weeks. I haven't been laid up this long in my 67 years - certainly not when I had my two babies!! And it now looks as if it'll be for a lot longer than six weeks!! It really is hard to remember why I had a replacement - and signed up for a second one in a few months. I keep thinking of all those people who said, "You'll be back to normal in no time." They should have said "a long time." The surgeon's and the physiotherapists work hand in hand at the hospital where I had my surgery. I'm told that my OS tells patients at their six week follow- up that the need to work harder on their ROM, not hang back. My compromise right now is to no exercise for one or two days between physio appointments, then just do gentle stretches the day before my next session so I don't lose the ROM I've worked so hard to gain. I have a question: where do the BoneSmart mantras come from? Doctors and nurses? (I'm ruling out physiotherapists!) I know that Josephine in the U.K. is an experienced nurse who is a strong believer in doing minimal or no exercise. But, then again, I recall reading her own account in which she said she always had a good Range of Motion. So maybe the mantras work best for those lucky people who have no trouble with their ROMs to begin with! What say you?
 
@agarrett - Thanks for your positive thoughts! Others have sent similar words and I really appreciate and need them, as all can see from reading my posts. I think I did have very high expectations...in an attempt to be positive before my surgery. Then reality (and pain - I HATE the pain!) set in. And the helpless, sedentary lifestyle. Maybe I should lower my expectations! If it worked for you, it might work for me too. And then I can plan better for knee replacement #2 this summer. Ugh!! I just want to feel normal again and start traveling to faraway places as we had planned to do in our retirement! My husband retired in September (he turns 70 this month!) and has now become my nurse and minder. Not exactly how he envisioned his new found freedom! I just hope I heal enough so we can have some fun together before his A-fib gets worse or other health and/or family issues catch up with us! I'll try to look beyond the dreary Toronto winter we're having to the sun, flowers and singing birds of springtime - which, thankfully arrives next month!! Thanks so much for listening...
 
PCP is primary care physician, your general every day doctor. I'm not sure where the mantras "came from". What I do know is that they work and that they make sense physiologically. If you have a deep cut on your hand and you keep using it, picking at it, pulling or pushing on it would it take longer to heal than if you bandaged it and rested it for a bit? If you have a broken bone and do not have it set and casted will it take more time to heal than one that is set and put in a cast? Over the years we learn new things, new ways to treat illness and healing. The mantras make sense as a healing technique. No where do the mantras say lay in bed and do nothing. I hear them saying live life don't overdo, assist the healing with elevation and ice. Use your household and personal activities as your therapy. Don't do things that cause reinjury as evidenced by increased pain and swelling. My guess is that this recipe for post TKR care is going to be the normal in the future. I think we're hearing that out of Mayo and some more recently trained OS and PTs. I'm also sure that in the OR when your wound hadn't yet done the swelling and inflammation of healing, you had full extension and good flexion. It's always been there it just can't show itself to you until the swelling and inflammation settles. You will see it one day, it's just a matter of time.
 
@Knees4Me your welcome. And some background, I am 42 years old, I was a college athlete..soccer player, so my advise on slowing down doesn't come easy. This was my 6th surgery on this knee over 16 years. My personal recovery expectations have been missed as well, but adjusting so I stay sane and encouraged. I very much want to be full functional again and soon as well. Hang in there. Where do you want to travel? I love to travel and there are exciting places to see. Luckily I am in Texas and we have had some 70 degree days mixed with the 30s and all between. I enjoy the sun very much!


Right TKR 27 December 2016
 
@Red's Mom - Yes, the philosophy and mantras do make a certain amount of sense. My fave analogy is that the swollen leg is like a garden hose full of water. It won't bend! Another I like is that you wouldn't be as rough on a broken leg as some PTs are on a leg that's just had knee replacement surgery. Believe me, I am inclined to do as little as possible. But the hospital I'm going to does knee and hip replacements almost exclusively (it's an assembly line!) and they produce patients with excellent results. So I have to keep that in mind too. Also, I know a woman who needed to have a MUA. It wasn't pleasant and she nearly had to go back to the beginning to heal again. So I want to avoid adhesions and a MUA, even though @Spex 10 had one and says have no fear! It will be interesting to see my surgeon next week and hear what she has to say. Apparently, I'll see a resident beforehand, who does the requisite texts and measurements...then I'll spend all of about 5 mins. or so with the surgeon, assuming everything is "normal." Has your OS spent much time explaining everything knee surgery related to you?
 
@agarrett - Hawaii is our destination to reward both me and my husband after both my knees have fully recovered. I love warm places - especially during the long, dark, cold Canadian winters. We've been to Antigua, Mexico (twice - loved it!) and Cuba (wonderful people and culture!). We also lived in London, England for three years and really saw the sites in the U.K. and Ireland (where my husband's from - and his first name is Garrett!) we also visited France, Italy, Spain, Switzerland, Germany, Belgium, the Netherlands. I love Europe and want to go back. Parts of South America beckon too. I may study Spanish now that I have so much free time. I must start soon. Do you have any travel destinations to recommend?
 
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