TKR I'm back again

[Dolphin5]

Thank you everyone for your comments. Your kindness and obvious caring has made me tear up. My son has urged me to walk outside. One reason I haven't is leaving my dogs behind. I'm sorry for them having had so few walks over the past nearly 8 weeks. I will do the suggestion though of 10 mins outside and the rest indoors. I'm a very outdoors person and always so physically active which is why this situation is so hard. I'll have to look up the stretching and bending exercises to remind myself what they are.

Another question is the dull, almost permanent ache going up my leg from the knee to the hip. Is this due to the knee or due to another problem? I have two replacement hips. I'm also thinking the ache could be due to the way I'm walking/limping.

I'll let you know how my visit to the consultant goes today. Again thank you all SO MUCH.

 

[Andypandy]

@Dolphin5 I think the rest air helps, there is a difference from walking indoors to outside. I find my gait is better outside walking. You're aches are probably the way you are walking/holding yourself. I have horrible back issues and this has really given me problems. Back to my osteo yesterday as I need a tweak. That's what is so challenging with this journey, not just our knee to look after but all the other bits it causes. Hope all goes positive today, I made notes and found that really helped. Let us know how you get on. Sending hugs and wishes x

 

[mendogal]

@Dolphin5
Re the ache... Besides healing...
This is what I've come to think of as the Great Structural Reset.

Our arthritis-affected weight bearing joint, over time, creates a lot of structural changes as the body tries to compensate. Some muscles and tendons lengthen and stretch while their counterparts contract and tighten. This can happen slowly and below our level of consciousness even as these forces start tugging at bones, skewing our pelvis, our posture, our gait.

All at once in surgery everything is essentially reset by the surgeon. Part of recovering from a hip or knee replacement, besides the actual healing, is a re-modeling of our structure to adapt to our new improved structure. This can be a long term but evolving process.

Practicing heel toe walking will help!

 

[Layla]

Hi Dolphin,
If you remember the exact dates, or even the year of each THR, identifying which hip goes with each date, we will add that info to your signature. Happy Tuesday! I hope it's a good one.
@Dolphin5

 

[beralc]

One positive thing is that I've lost 8lbs in weight since my op. I've taken advantage of being slightly 'off' my food whilst eating very healthily. I'm keen not to lose muscle and want to keep fit (I was walking 2 miles a day with my dogs pre op). Prior to the physio incident I was walking a total of 40 mins each day round my bungalow (20 mins + 10 + 10). Is it ok to continue with this? Yesterday I only did 10 mins due to the aftermath of the physio and 2 minutes marching. It's hard to get the balance right. I wont do much today due to the long trip tomorrow.

For about two weeks now I've been taking two Dihydrocodeine (30mg) before bed and two paracetamol morning and afternoon as needed.

Hi Dolphin. You had your surgery about 5 days after mine. Similarly to you I’ve had things happen that meant I’ve not been able to have the sort of recovery I hoped for but that doesn’t mean you can’t achieve success.
I agree the start you had didn’t help along with the aggressive PT! One thing I can add,(apologies if someone else picked up on this already) one really important thing you mention is not wanting to lose muscle,while losing weight. Whilst exercise will help with that, at present you’re not going to achieve enough exercise, to rely on that alone to retain muscle mass.To retain and build muscle we need protein. So at this stage you really need to add in a lot of protein into your diet everyday day, because if you’re losing weight and have reduced exercise, muscle mass is what you’ll be losing. At present I’m having around 100g of protein as suggested through an app I use.

Hope all goes well today. What a journey!

 

[Dolphin5]

Today's visit to the consultant wasn't good. Still trying to process it. He basically said what the physio said which is to take painkillers before exercise and push it. He said if I don't do this then it's going to be too late, implying I'm stuck with what I've got. I showed him photos of my excessively swollen leg just 6 days after the op and another similar one 3 weeks after the op and told him I'd had a blood clot. He said I missed doing the exercises at a crucial time due to the swelling and the clot. I told him I'd done the bed exercises but can't actually remember how much I did of everything during that time. He got me doing a heel slide and he said it's 45o. It should be much better at this stage. He wasn't really interested and just said to stay with physio. I did question whether doing excessive exercise would cause the knee to swell but he said no, take painkillers beforehand.

To say I was, and still am, very upset, is an understatement. I was out for 6 hours. 1 bus, 4 taxis and two ferries, all to see him for 15 minutes. He was so dismissive when saying it could be too late if I don't push these exercises though he said he could do a MUA but didn't really want to.

So what exercises should I do now? 10 minutes x 2 (one outside, one in the bungalow). Pressing the back of the knee into the bed? Operated knee over rolled towel and lift heel off the bed? Passive knee stretches? Any heel slides at all including knee bend on the bed? Please advise.

I now have a better icer. One that totally wraps around the knee rather than just half way round. I've not done proper elevation as it hurts my back. Tomorrow I will try lying on the bed and put my leg up on a stool whilst icing.

The thought of my knee never bending again doesn't bear thinking about. I'm such an active person. I'm really upset.

My sons want to get me a lymphatic drainage machine. Does anybody think this could help?

Thank you for reading this.

 

[Dolphin5]

Beraic thank you for your info about protein. My hips were done in 2008, one January and one November.

 

[Jockette]

I’m so sorry that your surgeon is so uncaring. And, I disagree with all he said.

Yes indeed, all you went through traveling to see him will I make your swelling worse. I’m so sorry that’s what you have to go through to get there.

Try very hard to put his words out of your mind.

Re-read the following articles:

There are also some cautionary articles here
Myth busting: no pain, no gain
Myth busting: the "window of opportunity" in TKR

This is what one of our members, TortiTabby, experienced:

(Just so you know, ADL means Activities of Daily Living.)

“At my six week appointment this is what my OS wrote in my visit summary: "She reads an online website called Bone Smart which states to not push through pain following knee replacement. If she were to follow this direction, she will have to learn to live with a knee that only reaches to 85 degrees of flexion. I believe this website is very misleading."

It has now been 20 weeks and all I do is ADL and this is what my ROM has done:
3.5 wks: 75
6 wks: 85
7 wks: 90
10.5 wks: 95
14 wks: 100
17 wks: 105
20 weeks (where I am today): 110
I am so thrilled it keeps improving and improving and I know now that I will get to my goal of 120 (or even better, dare I say!)


And,

“Just an update for those who are apprehensive about gaining ROM:
It has now been 26 weeks and all I do is ADL and this is what my ROM has done:
3.5 wks: 75
6 wks: 85
7 wks: 90
10.5 wks: 95
14 wks: 100
17 wks: 105
20 weeks: 110
26 weeks (where I am today): 120!!!
I did it! My goal of 120! No "pushing through pain", no PT after the first 3 visits, and most importantly to me: No MUA! My surgeon who said I would never get beyond 85 ROM without pushing through pain was wrong, wrong, wrong. I'm excited to see if it gets even better. “

 

[Dolphin5]

I'm really concerned that whilst my whole leg was ballooned out from toe to hip for over two weeks that, according to the consultant today, I may have 'missed the boat' with not doing many exercises and am now going to be stuck with this 45o flexion. Finding hard to bear.......

 

[Dolphin5]

What happened to TortiTabby?

 

[Dolphin5]

Sorry, just reading it now......thank you.

 

[guitar lady]

About PT: I've wondered for years if it does many people much good. Maybe, ice and elevation do as much? I researched online and found mixed results. I'm not convinced it works. I have a good friend who is a retired PT and wouldn't tell her this. My PT now is a kind young man, knows a lot about medicine, but he says if I don't do my kick out and push back knee exercises, the scar won't heal well. I'm not about to argue with him, but on the other hand, I'm glad I only get PT once/week. I totally agree with bone smart that if it hurts, stop. If your leg swells, don't push it because the knee has reacted to pain and is trying to fix itself. Makes complete sense!
guitarlady

 

[Jockette]

according to the consultant today, I may have 'missed the boat'

I disagree!

I had a tough first year and my ROM continued to improve all through my second year, and even a bit more in my third year.

Your leg has had extra things to deal with and heal from, a blood clot is no small thing. Lots of swelling is no small thing. Time will be the best healer.

Regaining our ROM does not require forceful bending or painful exercises. That is counterproductive.

Regaining our ROM is more about Time than repetitions of a list of exercises.

Time to recover.
Time for pain and swelling to settle.
Time to heal.

Our range of motion is right there all along just waiting for that to happen so it can show itself.

In the general run of things, it doesn't need to be fought for, worked hard for or worried about. It will happen. Normal activity is the key to success.

 

[beralc]

@Dolphin5 here’s my opinion and to give a view from someone who is very close to where you are ie. Dates of our surgeries. So at day 49 so 7 weeks post surgery I think I’d had about 26 days being well enough to do anything beyond bed exercise . I won’t bore you with all that happened other than my autoimmune diseases plus a fall then anaemia meant I didn’t see a PT until I was 7 weeks, post op. I haven’t had another PT session since(a clerical error on their part) and won’t have one now until the 21st of the month by which time I’ll be 10 weeks. I had not”missed the boat” at 7 weeks.

When I saw them at 7 weeks he said I was 82 degrees by the end was 90 degrees. I’ve still had a few days since when I’ve been unable to really exercise consistently, yet today I reached a target they said I had to reach in my flexion and have done 2 successful descending the stairs, foot over foot rather than one at a time which I know requires more flexion. I haven’t adopted any of the exercises they suggested because I knew I’d react badly. So I’ve made progress without PT.
My point is that despite not doing exercises that really hurt and allowing myself a healing day between more active days I’ve still made progress.

I can’t understand why any consultant would say no when asked the question if aggressive exercise would cause swelling. I don’t believe taking pain killers will help with anything other than pain. Unless you’re taking anti inflammatory meds, they’re not going to help with swelling. Just so you know that Medics don’t have all the answers, when I asked my Surgeon if my autoimmune diseases would impact my recovery, he said, No, I don’t see why they should!! I’ve had no end of problems as a direct result.
I believe what helped me most were the hours of continuous elevation, which then helped with swelling and flexion I can only tolerate ice now for a short period because of Raynauds but I did stop icing all together at one point and just elevated. Round the clock night and day outside of the usual bathroom breaks and other light activities. The elevation hurt my back initially (old sciatic problems) but I just kept trying until I found something comfortable and now it’s fine. I use the pillow stack (I’m sure the mods can put a picture up) approach but there are foam wedges you can buy too.

It’s always a big leap trusting in anyone outside of the medical team. But the more you question here I believe the more confident you’ll become, to be able to really listen to your body. So in my opinion the first thing is to just rest today you’ve had a long journey an uncomfortable and demoralising appt and it’s left you confused and anxious. The next step is getting on top of your pain. Then make a plan with help from the mods here who will suggest a plan of the exercises that will be most beneficial. I really hope this helps a bit but you can’t rush healing no matter what they say about pushing. I also read an article that followed people who had aggressive PT and a group who only did exercises at home, at the end of the trials there was no significant difference, in either group.

Lastly yes I’d go for the lymphatic massage. I looked it up online and have been doing some myself for about 10 days and I’m sure I’ve seen an improvement. Your muscles are part of what helps with drainage and while your muscles aren’t working well at present, any help they can get the better.

 

[EalingGran]

He basically said what the physio said which is to take painkillers before exercise and push it. He said if I don't do this then it's going to be too late, implying I'm stuck with what I've got.

This simply isn't true. I never pushed to pain and used a gentle pilates based recovery plan. I now have almost as complete flexion on my operated side as my 'good" side ( 150 degrees versus 160 degrees). The only things I can't do anymore is a standing quad stretch or sit back fully in child's pose. I would never take painkillers before exercises as it would mask things and make injury risk easier and increases inflammation.
It's good to keep moving. Walking/ gentle exercises are all great but definitely no pain.

 

[beralc]

He basically said what the physio said which is to take painkillers before exercise and push it. He said if I don't do this then it's going to be too late, implying I'm stuck with what I've got.

I would never take painkillers before exercises as it would mask things and make injury risk easier and increases inflammation.

This is so true. Pain is there for a reason in this situation.

 

[Layla]

Hi Dolphin, It is understandable that you're upset, especially after the long trek to the surgeon's office. You must feel exhausted. I am sorry.

Recovery is not one-size-fits-all. Everyone heals at their own pace. Try to refrain from comparing your recovery to that of other's which is easier said than done when you're participating in a joint forum.
Let go of unrealistic goals and timelines. Look at the progress you've made because even small improvements matter. Healing isn't linear, your body is recovering from the controlled trauma of major surgery and set-backs and stalls in the process don't mean failure. Others have been in your shoes and still ended up with the desired result.

I may have 'missed the boat'

Recovery doesn't have an expiration date. Try to shift that mindset and realize that although progress isn't happening as quickly as you like it doesn't mean that you won't get to where you want to be.
Keep moving forward.

Regarding Lymphatic Drainage Massage, I am tagging former staffer @CricketHip to give you some advice since it is the field of work she was involved in. Check back because she does stop by often. I will add that Elevation will help. It is our lymph system that rids the body of fluid (swelling). So you want to get the fluid to the lymph nodes in your torso area so your body can more quickly process it. The lymph system works rather slowly on its own and much more efficiently with the assistance of gravity. The fluid isn’t draining into the hips, but contained with the lymph system and moving to the torso and lymph nodes located there.

I shared this with you earlier, but it bears repeating in light of your OS's advice today -
Pain is your body's way of signaling that something is wrong. If you dull that signal with medication, it's easier to overexert and cause more damage. It can also lead to set-backs in recovery prolonging the healing process. Pushing too hard often leads to more inflammation and swelling afterward.

I wish you a peaceful evening and some restorative rest after your long trip and disappointing post op
visit...again, I'm sorry.
Big Hugs

 

[Jamie]

@Dolphin5 … I’m looking into some possible options for you in dealing with your extreme swelling. I know your surgeon was on the Mainland. Can you tell me his name and the hospital where your surgery was done? Also, where is your GP located and what hospital is he or she associated with?

 

[Dolphin5]

I can't thank you all enough for taking the time to write to me. I'm tearing up again. I'm so emotional these days and to be honest, scared. Walking is everything to me. I live on a beautiful island but now can't get to the sea. I do reread posts and try to absorb everything. Looking at the way to do the elevation was making me anxious with the dos and don'ts! Worried about doing something wrong. My leg/knee is understandably worse today after yesterday. So do I still do a 10 mins walk or just rest, ice and elevate today? Looking back I think my leg was (unbelievably) swollen for at least 3 weeks before I started blood thinners (Apixiban) which got the swelling down substantially. My surgery/GP delayed things and despite putting in a complaint the practice manager never got back to me . I have no choice of surgery where I live.

My surgeon is Mr Baboli at the Royal South Hants hospital in Southampton. I couldn't fault the treatment I had there and even the food was good! My surgery is Ventnor Medical Practice, Ventnor, Isle of Wight. We have one hospital on the island which is St Mary's. I'm supposed to be ringing them at the end of April regarding having my other knee done. Can't see that happening now!!

To be clear, there is very little swelling now in my leg/ankle but my knee feels like a block of concrete still.

I'd be grateful if someone can please clarify what stretching exercises and gentle bends I should be doing.

Also should I ring my surgery and ask to see a different PT or just not bother? Unable to drive and finding I have virtually no friends here (I'm newish to the island and a few 'friends' I'd made have greatly disappointed me) so will probably have to get a taxi unless it coincides with one of my sons coming over.

My son has also suggested a vibration plate.

 

[Dolphin5]

Beraic thank you for your comments. Both my sons are keen to get a lymphatic drainage machine and also a vibration plate. My circulation has never been good anyway so these should help generally. The main difference between you and me is that you had 26 days initially to do exercises/activities. The photo I took of my grossly swollen leg was only 6 days post op. The next photo of similar was 3 weeks post op. I think now it was at least 3 weeks before I was eventually put on the blood thinners (very high dosage the first week) which got nearly all the swelling down. Not inside the knee or course. I'm on the blood thinners for another 5 months, having a blood test in two months. I have no idea of the status of the blood clot, apparently small and behind the knee.