TKR I really didn't know what I was getting into!
- Thread starter Knees4Me
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Debdoub
new member
I saw my surgeon at six weeks with 110 flex and after tweaking my knee, at eight weeks with 100 flex. He told me it would come and that I shouldn't do anything that hurts. He is a bit of an butt, well-respected in the area for knee and hip replacements, doesn't like to think I know anything and yet he is not pushing ROM. I hope yours does the same for you!
OP
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Knees4Me
member
Hi friends. I haven't been posting much lately because, frankly, I've been discouraged and rather depressed. (The cold and grey Canadian winter doesn't help!)
My physiotherapist told me on Monday that I'd have to stay in PT longer than others in my group who had surgery when I did (Jan. 3) because my flexion just isn't good enough. Since Jan. 10 - one week post-op, I've been going to a "knee class", which she oversees, at the same hospital where I had my TLKR. She and her colleagues work closely with the orthopedic surgeons.
This PT has been warning me since the beginning that if I didn't work harder and let her push my knee to improve my degree of flexion, she would call my surgeon and I would be at risk of having further surgery due to adhesions forming. She kept insisting that there is a very small window to increase flexion.
I was depressed when I saw other people "graduating" from knee class with a certificate and bends of 120 to 130 degrees, congratulations and smiles all around. I've been made to feel like the dunce in the class and that the slowness of gaining more flexion is somehow a major character flaw.
On Monday, I did get up to 115 degrees flexion bending on my own and 120+ with the PT pushing. It hurt!! But I'm not putting up with any more of that! Because... I went to my six-week follow-up appointment with my surgeon today and left feeling much better.
She told me that I had a "challenging" knee and her plan for my replacement had to be switched mid-operation because of anomalies that didn't show up on my X-rays. She even made her assistant, an advanced practice physiotherapist, look at my X-rays because they don't see many cases like mine! That's why I've been slower increasing my bend than some other people who had a more straightforward knee replacement.
When the advanced practice PT measured my bend today she got only 95 degrees for some reason. She also measured my extension at 2 degrees and it's always been 0 at rehab. I don't understand that decline just from Monday.
Anyway, my OS said to keep going to rehab/physio BUT she'll be pleased if my flexion is 110 degrees when I go back to see her in another six weeks! So I am definitely going to tell the PT at rehab tomorrow that I want no more aggressive pushing! I'll call her bluff!! And I'll work steadily at getting a good, solid 110 degree bend. I'm sure 115 degrees will come on its own after that - and I won't need further surgery, as threatened in rehab!
The senior PT told me today that the PTs in rehab threaten these things to make patients work harder. It's a "one size fits all" approach" that doesn't work for everybody. In fact, I've been so swollen after rehab that I haven't been able to exercise for a day or two after.
I'm actually taking about 10 days off rehab because of other commitments. Another piece of good news, depending on how I look at it, is that my surgeon said she won't do my second knee this year. It's not bone on bone yet like my left one was, so she wants me to monitor whether it gets worse over the next four to six months. It has been doing yeoman's duty supporting my "operated" left knee!
A silver lining might be that my husband and I get to go on our "dream" vacation to Hawaii earlier than expected! We can always dream up another dream vacation to go on after knee #2 is replaced and recovered! Sorry this post is so long! For those of you who read it to the end, many thanks for your perseverance!!
My physiotherapist told me on Monday that I'd have to stay in PT longer than others in my group who had surgery when I did (Jan. 3) because my flexion just isn't good enough. Since Jan. 10 - one week post-op, I've been going to a "knee class", which she oversees, at the same hospital where I had my TLKR. She and her colleagues work closely with the orthopedic surgeons.
This PT has been warning me since the beginning that if I didn't work harder and let her push my knee to improve my degree of flexion, she would call my surgeon and I would be at risk of having further surgery due to adhesions forming. She kept insisting that there is a very small window to increase flexion.
I was depressed when I saw other people "graduating" from knee class with a certificate and bends of 120 to 130 degrees, congratulations and smiles all around. I've been made to feel like the dunce in the class and that the slowness of gaining more flexion is somehow a major character flaw.
On Monday, I did get up to 115 degrees flexion bending on my own and 120+ with the PT pushing. It hurt!! But I'm not putting up with any more of that! Because... I went to my six-week follow-up appointment with my surgeon today and left feeling much better.
She told me that I had a "challenging" knee and her plan for my replacement had to be switched mid-operation because of anomalies that didn't show up on my X-rays. She even made her assistant, an advanced practice physiotherapist, look at my X-rays because they don't see many cases like mine! That's why I've been slower increasing my bend than some other people who had a more straightforward knee replacement.
When the advanced practice PT measured my bend today she got only 95 degrees for some reason. She also measured my extension at 2 degrees and it's always been 0 at rehab. I don't understand that decline just from Monday.
Anyway, my OS said to keep going to rehab/physio BUT she'll be pleased if my flexion is 110 degrees when I go back to see her in another six weeks! So I am definitely going to tell the PT at rehab tomorrow that I want no more aggressive pushing! I'll call her bluff!! And I'll work steadily at getting a good, solid 110 degree bend. I'm sure 115 degrees will come on its own after that - and I won't need further surgery, as threatened in rehab!
The senior PT told me today that the PTs in rehab threaten these things to make patients work harder. It's a "one size fits all" approach" that doesn't work for everybody. In fact, I've been so swollen after rehab that I haven't been able to exercise for a day or two after.
I'm actually taking about 10 days off rehab because of other commitments. Another piece of good news, depending on how I look at it, is that my surgeon said she won't do my second knee this year. It's not bone on bone yet like my left one was, so she wants me to monitor whether it gets worse over the next four to six months. It has been doing yeoman's duty supporting my "operated" left knee!
A silver lining might be that my husband and I get to go on our "dream" vacation to Hawaii earlier than expected! We can always dream up another dream vacation to go on after knee #2 is replaced and recovered! Sorry this post is so long! For those of you who read it to the end, many thanks for your perseverance!!
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L.I.T
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@Knees4Me That's great news! Although even *I* am angry at your PT right now 
And, REALLY? They give graduation certificates? How patronizing!
It will be interesting to see how much you improve without the extra hard PT. Clearly they don't work *that* closely with your surgeon if they were unaware of her expectations for you. Lies, lies, and more lies! I'm actually quite angry at them and I don't even know them!
Lemme at 'em! I' m surprised they didn't give out gowns and a cap to go with the certificates 
And, REALLY? They give graduation certificates? How patronizing! It will be interesting to see how much you improve without the extra hard PT. Clearly they don't work *that* closely with your surgeon if they were unaware of her expectations for you. Lies, lies, and more lies! I'm actually quite angry at them and I don't even know them!
Lemme at 'em! I' m surprised they didn't give out gowns and a cap to go with the certificates
OP
OP
Knees4Me
member
@L.I.T. Yeah, they conduct the knee (and hip) classes like school and treat the patients like five-year-olds! I'm angry with the PTs there too and I'm afraid of what I might say tomorrow to the one I get! She might bend my knee even further till I yell "uncle!" But I'll be firm. I - and my knee - are in charge! There definitely is a disconnect between rehab and the surgeons, I get the impression that the PTs try to impress the doctors by reaching certain quotas of success!! But if I've learned anything from this knee surgery experience and this forum, it's that everyone is different and you can't compare yourself to anyone else!
agarrett
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@ Knees4me you are very correct on the don't compare. Very hard sometimes because everyone wants to be better sooner than later. I also had a bit of a discussion with PT to explain which ROM i consider comfortable/tolerable and thus where I consider myself. I need to progress past that but not on their pushed measurement, again setting their expectations right now I feel like progress and don't feel stuck currently.
Right TKR 27 December 2016
Right TKR 27 December 2016
eliza61nyc
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@Knees4Me, another gal ticked on your behalf, what the heck?? You're a grown adult. I've never seen anyone get better by belittling them. My p/t also thinks there is this "window" of opportunity but he listens to me and ever since I told him no aggressive pushing he's been great with finding other exercises.
Anyway you can find someone else???
Yep, you got it right everyone is different. Glad you and your sweetie have a vacation planned. Hawaii is a great reward, lol let that be your "certificate"
Anyway you can find someone else???
Yep, you got it right everyone is different. Glad you and your sweetie have a vacation planned. Hawaii is a great reward, lol let that be your "certificate"
I've long suspected that all those threats about potential MUAs were just to get people to work harder.
It's unprofessional and it's mean. It makes people feel inadequate and worried.
I'm angry with you PT therapists, too. They give bad PT and no PT at all is better than bad PT.
Tell her from the start - hands off my knee. No touching!
Don't let her bend your knee at all. You eventually get the best results by using your own muscles.
Now you know that there was a good reason why your progress was slower than your therapists expected.
I'm sure you will continue to make progress, at a pace that suits your knee, not at the pace your therapists want.
There's no need to rush anyway, since ROM can continue to improve for at least a year.
Spex10
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You poor thing @Knees4Me. I was amazed at your physios attitude before. They just wouldn't be allowed to behave like that here. That attitude must permeate down from PT management. Would you consider writing to them to complain? Do they do patient evaluations? Do they publish stats? (Sorry I'm a big fan of data from patient evaluation info- so useful as a big stick that can lead to positive change)
Sounds like you're doing fine and the OS is happy with you anyway.
Sounds like you're doing fine and the OS is happy with you anyway.
KarriB
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I'm so happy you no longer need to be threatened by your therapist and that you're taking an extended vacation from therapy. Your PT is counting on her clients being uninformed and scared, you aren't either of those. Because of my complications I never experienced the scare tactics, but I did continue to gain ROM a year after my TKR. Enjoy your non-therapyndays.
Sounds like you're doing fine. Don't worry about differences of a couple of degrees when they measure. Sometimes your knee is slightly more or less swollen so that can affect it.
OP
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Knees4Me
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@Celle @Josephine - At my last PT session, I proudly told my physiotherapist that I had just iced my "operated" knee with my trusty Cryo/Cuff machine (which I love!) before leaving home and she told me that I should ice for only 10 minutes at a time four times a day with an hour in between...because too much icing can inhibit tissue healing. Is there any truth to her statement at all?
Cratchit
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Josephine
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Actually the collective experience on this forum is that it is not true. I tend to think these people are talking about putting ice packs directly on the skin which would indeed, be most ill-advised. However, the whole point of Cryocuff and motorised ice machines is that they are used for long periods of time, sometimes even hours. BUT there must be a protective padding between the pack and the leg. Otherwise you do risk freezer burn!
What your PT said may apply to sports injuries, but it isn't true of icing after a knee replacement.
You can safely ice all night long, a long as you have some material, such as a tea towel, to protect your skin from frost bite.
You can safely ice all night long, a long as you have some material, such as a tea towel, to protect your skin from frost bite.
DebM
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@Cratchit I was interested by your post so did a bit reasearch myself and you are quite right, so may recommendations about using ice for only 20 minutes several times a day. And these were in direct relation to knee replacement.
I am glad people on BS have success with continued icing but seeing as I have continuous moderate swelling I am going to try the reduction in icing but still elevate of course.
I am glad people on BS have success with continued icing but seeing as I have continuous moderate swelling I am going to try the reduction in icing but still elevate of course.
May I remind those of you discussing studies that we require members to post links to whatever studies they are quoting. You risk having your posts deleted otherwise.
Research material out on the internet is voluminous. There are valid studies and others that are not so valid. We use scientific studies as one source for information to develop our guidance for BoneSmarties. But it's only part of the process. We also base our advice on input from orthopedic surgeons and observation of what has worked or not worked in thousands of patients over almost a decade of this forum's operation.
Obviously a person is free to do what they feel works for them. But in general, ice is one of the best things you can do for your knee or hip after surgery. As Jo said, as long as you keep a towel between your skin and the ice source or use an ice machine in accordance with its directions, you can and should ice for extended periods of time when you have pain or swelling.
You all may note that I have moved @Knees4Me 's question and the following comments to her recovery thread. They were all off topic where they were originally posted and were derailing a new member's thread.
Research material out on the internet is voluminous. There are valid studies and others that are not so valid. We use scientific studies as one source for information to develop our guidance for BoneSmarties. But it's only part of the process. We also base our advice on input from orthopedic surgeons and observation of what has worked or not worked in thousands of patients over almost a decade of this forum's operation.
Obviously a person is free to do what they feel works for them. But in general, ice is one of the best things you can do for your knee or hip after surgery. As Jo said, as long as you keep a towel between your skin and the ice source or use an ice machine in accordance with its directions, you can and should ice for extended periods of time when you have pain or swelling.
You all may note that I have moved @Knees4Me 's question and the following comments to her recovery thread. They were all off topic where they were originally posted and were derailing a new member's thread.
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I have news for you, Spex.....we've found plenty of physios in other countries besides the USA who practice the "pain and gain" philosophy. It's not just here by any means! It's a mystery how they come out of school with this idea, but it seems to be something taught and then brought into practice. It boggles the mind.
Of course this is not true. Icing a TKR knee this small amount of time is the same as not icing at all. Test it out for yourself and you'll soon see the benefit of lots of icing along with rest and elevation when you have pain or swelling. Besides, this therapist had so many other aspects of recovery wrong, I'm not sure why you'd want to trust anything she tells you. I'm so pleased that your surgeon filled you in on the facts of YOUR knee and that he basically "outed" that horrible therapist for her lying. If you want to continue therapy, can you switch to another person or practice?
It is possible to post links from an iPhone or iPad. We have members and staff who do that frequently. Since I don't have one, I cannot tell you exactly how it's done, but I do know that it's possible.
OP
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Knees4Me
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@Jamie - No, I can't switch to another PT quite yet, because she and the others in the hospital's rehab/physio facility work with the orthopedic surgeons. I don't know why there's the disconnect, except that they're on separate floors! I only have a week or two of this free rehab, then I will go to my own, gentle PT whom I've seen for other physio, although I will have to pay her!
