TKR I'm back again

[EalingGran]

He advised icing for 15-20 minutes only and only if the knee is painful/swollen

I know there is some newer research suggesting too much icing may be counterproductive but I found the cool water jacket of my Aircast Cryocuff incredibly soothing. I used it for longer than 15- 20 minute sessions and I think it helped me. It was just really pleasantly cool rather than icy cold though. I used to sleep with my knee resting on the opened cold water jacket and replace the cold water if I woke.

 

[Layla]

Hi Dolphin5,
How's it going for you over the past several days? Hopefully you're falling into a comfortable routine and still enjoying the dog walks. Let us know when you have the time.
@Dolphin5

 

[Dolphin5]

Hi Layla. Thank you for thinking of me. Good news is that I've not had any pain since the MUAs and keyhole debridement 10 days ago. I'm walking much more confidently and not so fearful of tripping over now I can lift my foot much higher. So the walks are much more enjoyable. I sometimes have to remind myself to walk normally and heel to toe as the knee still feels like it's a block of concrete. Still doing the 35 minutes.

The downside is that the heel slides are as hard now as when I came out of hospital. Every two hours I do 20. Aiming to get the foot of the 'naughty' knee level with my other foot which is at 90o. Apart from the first set at 7.30am when the knee is exceptionally stiff, I usually get the foot to where I want it by the time I get to the 15 or 16 slide. No pain, but forcing the knee back. But when I do the next set two hours later I'm back to square one .

It's contrary in a way to what Bonesmart advocate but I need to keep the ROM to what the surgeon got it to and not let it relapse or let more scar tissue form. Early days I know. The knee is swollen and the leg becomes more swollen as the day goes on. I go to the loo 6 times a night obviously getting rid of the fluid.

I'm seeing the consultant tomorrow. I've got physio in 9 days. Having checked it's not the awful woman who hurt and insulted me after the tkr, apparently I have a senior physio. Perhaps this is due to me being a private patient.

I'll let you know how it goes with the consultant tomorrow. X-ray before seeing him. So lucky to have such a genuinely caring person. It'll be a huge relief too, on the bus, not tomhave my leg sticking out the whole time worrying about getting it knocked or tripping someone up. Did I mention that the consultant reckoned my knee was at about 30o when he did the surgery?

 

[EalingGran]

I am glad the MUA has not caused any pain and you are walking better. That is real progress. Hopefully the ROM will come with gradual exercise.
As your leg gets more swollen as the day goes on- could you elevate more between walks/ exercise?
I really liked a rocking stool but any elevation when sitting helps.

 

[Layla]

Things are looking up! This is wonderful news, Dolphin
I love that your able to walk your dogs, you're not struggling with pain and you remain dedicated to your recovery. May it all work out perfectly for you in due time.
I will look forward to hearing how your visit with the consultant goes tomorrow. Best wishes!
@Dolphin5

 

[Dolphin5]

Hi all. My consultant's visit was a good one. He's sure my knee won't regress now. But he did say he doesn't think it'll ever get much beyond the 90o ROM. Perhaps reach 100o. That's ok. I'll be able to live a normal life and be able to drive again. He said I just have a propensity for stiffness and have been unlucky. On the couch I was able to reach the full 90o REASONABLY easily and discovered that the chair I've been doing the heel slides on at home is too low for my long legs. An eye opener. So the heel slides at home, whilst still an effort to pull the knee back to the 90o, is so much easier now I've put two cushions on the chair. Perhaps this is something that should be mentioned on Bonesmart? Make sure the chair suits your height/the length of your legs.

I was also pleased and a bit surprised when he told me I'd got very little swelling. I have only done one elevation and the occasional ice packs. The MUAs and keyhole were done 13 days ago.

At ease on a chair my knee is comfortable at about 60/70o. After that it pulls and doesn't like it. Obviously the aim is to get it comfy at 90o. I'm religiously doing 20 heel slides every two hours, starting 7.30am and finishing at 9.30pm.

The consultant mentioned that a colleague did a MUA on a patient and reached 95o in surgery but the knee regressed back to 60o over time. But did the patient do their exercises????

I mentioned the fact that I'd not used the Morphine I'd brought home with me and had experienced no pain. He said most people need the Morphine so at least I've had luck with this. Perhaps all the exercises prior to this recent procedure helped with this?

I will be seeing a physio next Friday.

I'd like to change the name of my thread to: A light at the end of a long, dark tunnel. Can this be done please? Perhaps my long journey will be of interest to others.

Thanks for taking the time to read this.

 

[sistersinhim]

I'll be glad to change your title for you.

It sounds like you're coming along quite well, and without pain, too. What a blessing!

 

[Layla]

What a wonderful and encouraging update to read, Dolphin. You're doing so well!
You're right about the height of the chair used for heel slides. Your hips need to be at, or slightly above knee level when seated. This reduces strain on the knee. I'm guessing the higher chair makes it easier to sit down and stand up also. A more comfortable chair / height will make it more likely you continue those heel slides every couple of hours.

Good to read you're doing well without the meds and have very little swelling. I wish you luck with your physio appointment on Friday and hope you'll continue to check in with updates. Thankfully things are looking up. Have a lovely weekend!
@Dolphin5

 

[Jamie]

Thank you, @Dolphin5, for the mention about chair height. Sometimes when we develop our guidelines for people, we miss little details like this. Heel slides are usually done in a straight chair - like a dining room or kitchen table chair, which is more likely to be the right height. You wouldn’t want to do them in a softer living room chair as you’re not as likely to get the best benefit. It never occurred to me to explain this carefully to people. The firm wood or metal chair gives you better support as you move and you are able to work toward pulling your foot back under the chair seat as you slide backwards - something that’s not possible with an upholstered chair or recliner. I will ensure our guidelines are more clear.

I’m glad to hear you’re doing well following your procedure. And the “no swelling” is wonderful! I think as long as this continues, your schedule of doing those slides as much as possible to keep challenging your knee is excellent. You may surprise yourself and your doctor with the results you see several months from now. I certainly hope so!

 

[Dolphin5]

Thank you everybody. Until a few years ago my height was 5' 10". I'm now 5' 6"! But my legs are still long!!

Amongst all the meds I brought home with me some anti inflammatory tablets were included. I finished these after about 9 days and queried with the consultant whether I should have more. The message came back that I didn't need them if I wasn't in pain. My knee has start d to ache a bit, but on,y a bit, and usually about 3/4am. I take a couple of paracetamol. I also take paracetamol through the day. Maximum 6/8. I still take just one Dehydrocodeine in the evening ING. This all works well for me.

Now whether in a week's time I'll be getting despondent if the knee is not progressing more easily to the 90o I don't know! I'm pleased that I have a 'senior' physio looking after me. The procedure I had has passed all expectations. I just hope the poor ol' knee gets less and less stiff. It's a stubborn old thing, bit like me!!

Thank you again for all your support.

 

[EalingGran]

Amongst all the meds I brought home with me some anti inflammatory tablets were included. I finished these after about 9 days and queried with the consultant whether I should have more. The message came back that I didn't need them if I wasn't in pain. My knee has start d to ache

I found one issue with anti inflammatory medication as opposed to opiates- is that they can take a few days to work and also a few days after stopping to wear off. The anti inflammatory action is slower to kick in and diminish than a simple painkiller.

 

[Layla]

You're doing so well, Dolphin. Couldn't be happier for you! Glad you have a senior PT watching over you. Trust that this is going to get you to where you want to be and keep working at it.
We'll be cheering you on all the way! I hope you have a great week!
@Dolphin5

 

[Jamie]

Try real hard not to get impatient with your knee. It’s been through a lot and it’s likely going to be more than a week before you start seeing measurable improvements. Also try to focus on the things you can do now that you’ve had this procedure and less on the degrees of flexion. You mentioned that you felt you’d be able to drive and that is a huge thing to celebrate. It is great to see things on a more positive path for you now.

 

[Dolphin5]

Hi all. Thank you for your comments and words of encouragement. I'm still a way off being able to drive. The only way my knee gets to the magical 90o is when it's forced. The only differences for me now are being far more comfortable, not fearful of tripping and more comfortable in bed. All good but I need my knee to go comfortably to 90o without me forcing it. I'll ask the physio on Friday to measure what it's comfortable at. Just for interest. I'm not sure how often I'll see her. I'll let you know the outcome after Friday's appointment.

 

[benne68]

The only way my knee gets to the magical 90o is when it's forced.

Please don't force your knee. That will increase the internal inflammation, which in turn will make bending the knee harder. It's important to keep it moving, but gentle, frequent motion is the best therapy. I found that sitting on a high chair and swinging my foot in and out worked really well to keep the knee in motion without forcing it.

And remember that there is nothing "magical" about 90 degrees. It's an arbitrary marker.

 

[Jamie]

Is it that you need something like 90 degrees in order to be able to get in and out of your car? That was my understanding from your earlier comments.

 

[Dolphin5]

Yes. My knee being 'happy' at 90o should enable me to drive again. It's a stunningly beautiful day here in the UK. I was awake at 5.30am. if I could drive I'd be driving 5 miles to the beach for an early walk with my dogs. But I can't

 

[Layla]

Boo! That's too bad. Sorry you aren't able to drive yet, Dolphin, but there's still a lot of Summer left, especially since it's not even officially here for three more days.
Cheers to driving to the beach soon for early morning walks with your furry friends!
@Dolphin5

 

[sistersinhim]

if I could drive I'd be driving 5 miles to the beach for an early walk with my dogs.

Oh, it's way too early to even think about walking on the beach! The sand adds restriction, which is like using weights. Also, it's probably many people there, increasing your chances of getting knocked down. You certainly don't want that! Exercise that patience muscle, you'll get there before you know it.

 

[Jamie]

Walking on the beach with your pups….what a lovely goal to work toward. You’ll get there…..it just takes some time after all you’ve been through.