TKR Incision site

[lovetocookandsew]

Welcome and congrats on the new knee! You asked about sleeping. Think of your new knee as a baby-no one sleeps much with a new baby in the house! But, as the baby grows, everyone gets more sleep. Your surgery was an assault on your knee and body, and the pain meds you need are also going to mess up your sleep schedule. But eventually, your knee will recover and you'll begin sleeping at night again. Until then, nap whenever and wherever you can. As to when that will be; just like a new baby, no one knows as everyone is different. Some people recover more quickly, others (like me) take longer. But generally, most people feel better and closer to their usual selves around 3 months, but the full recovery will take somewhere around a year.

As for swelling, your knee has just been sliced, hammered, sawed and drilled and is reacting to that assault. Our bodies react to that kind of thing by hurting, swelling, bruising and the like. The best thing you can do for your knee right now is to allow it to recover from the surgery, and do all you can to help it. Icing is great, but 20 minutes at a time isn't enough. Personally, if I was lying down, I was icing. I know you'll likely be told to keep it down to 20 minutes, etc, but IMHO, that's bad advice. As long as you protect your skin by adding a cloth between it and the ice, you can ice as often and as long as you like. I used a thin tea towel between my skin and the ice machine cuff as I liked the water cold.

Make sure to elevate whenever you are lying down, and ice away! For now, just your normal walking around to the restroom, kitchen, and similar, is all the exercise you need. There is an article in the list Celle gave you on activity progression that I would encourage you to read and memorize.

 

[MaryMC]

Boy it’s been a whirlwind! I am at 16 days post op today. Those blues everyone talks about are real- I cry at the drop of a hat it seems, sensitive about everything. I am also blown away by my community of friends and family which has come by to say hi, bring food, Drive me to PT etc. Amazing!

Sleep is still hard to come by but getting a bit better. Last week I was at 30’ flexion and 0 extension in PT and this week I am at 68 and 0. It’s still slower progress than I would like but I am trying to be patient with myself and have some grace. The surgery was much more complex than most tkr because I was also born without a hip and have some other complexities that made surgery more difficult. This is my 14th orthopedic surgery. There was a lot of clean out to do and a custom fitting of the knee because my femur isn’t shaped like normal ones. Because of all that My doc says I am more swollen and painful than most people so am not progressing perhaps like “typical” knee replacement patients. I just keep doing my exercises and taking it one moment at a time.

I realized during the first week that I was fighting this “other” inside me, this foreign object that wasn’t working the way I wanted it to. I felt like it was a challenge to overcome and master. It may sound woowoo, but I finally realized that I needed to invite my new knee to be part of me. To welcome it in, to ask it to show me how it’s going to react to situations and learn to trust one another. I am learning to listen to my body, which has not been easy because my whole life has been about pushing through despite pain.

It’s a journey for sure- days of acceptance and hope, and days of defeat and despair. One slow step at a time.

 

[SusieShoes]

It may sound woowoo, but I finally realized that I needed to invite my new knee to be part of me. To welcome it in, to ask it to show me how it’s going to react to situations and learn to trust one another. I am learning to listen to my body, which has not been easy because my whole life has been about pushing through despite pain.

What a powerful message. You've had a different journey than most, but I can see you've also acquired deep wisdom. I like to say we all become knee whisperers. We "learn" our knees and how to listen to them, so we can follow the innate wisdom of our bodies. I don't think you're woo woo at all. You understand the importance of becoming one with your new body part. It may be late to the party, but it is and will be part of you for a long time to come. I love the idea of "inviting the knee to become part of" you!

At only a little more than two weeks post-surgery, you can expect much more improvement down the line. Just keep in mind the improvement might show up one week, then nothing the next. But improve you shall!

 

[MaryMC]

So question about flexion- I’m unsure if this is common or if it’s just me. When I try and work on stretching and getting more flexion, I have tightness and pain. The tightness is all on the medial side, and the against what feels like the medial side of the kneecap as well. I don’t know if this is from the patellar tendon surgery I had years ago, or if this is common.
I keep working on stretching but sometimes it feels in vain.

Ok- let me rephrase my question- where is the common site that people have pain or tightness when working on ROM?

 

[Celle]

You can get pain all around your knee.
If it hurts, don't do it. The pain is a warning sign that at you are doing too much for your knee.

In any case, it's too early in your recovery to be working t trying to get your knee to bend. It can't bend properly, because swelling is stopping it. Your knee needs time to heal, before you stress it with exercises.

Instead, work on trying to reduce the swelling, by increasing the amount of time you spend resting, icing and elevating your knee.

It's not exercising that gets you your ROM (Range of Motion) - it's time. Time to recover, time for swelling and pain to settle, and time to heal. Your ROM is there right from the start, just waiting for all that to happen, so it can show itself.

 

[Josephine]

I was fighting this “other” inside me, this foreign object that wasn’t working the way I wanted it to.

What you need to understand is that it's not the implant that is not working properly, it's your knee! In percentages, the implants now comprise barely 20% of your knee, the other 80% is all tendons, ligaments and muscles.

where is the common site that people have pain or tightness when working on ROM?

You shouldn't have any pain when working on ROM. More, you shouldn't be 'working' on it anyway!

I'd really like to offer you some structured advice but in order to do that, I also need to ask you some questions. Are you willing for me to do that?

 

[MaryMC]

Ok

 

[MaryMC]

I would also love to ask both you (Josephine) and Celle where your expertise comes from. I mean no offense by that, but just like I would want to know the background and credentials of my doc or my PT when I consider their advise, so would i of the two of you if you don’t mind.

I understand when you say that swelling keeps the joint from moving. However in my own experience with other surgeries, I know that there is some discomfort from doing the PT and having it be successful.

Would love to hear your thoughts.

 

[Celle]

Well, I'm a registered nurse and I have had three knee replacements, so my knowledge comes from both training and personal experience.

Josephine has her work history on BoneSmart, but she also is a registered nurse, with over 40 years of orthopaedic experience, and she has had two knee replacements.

However in my own experience with other surgeries, I know that there is some discomfort from doing the PT and having it be successful.

A knee replacement is different from other surgeries, in that recovery takes much longer.
Discomfort from exercise is OK, but pain is not.

 

[MaryMC]

Are you both in the US or are you elsewhere? Seems that there are some different perspectives between regions.

 

[sistersinhim]

All of us on this knee replacement forum have had knee replacements. Bonesmart has had thousand of members through the years. This is a whole lot of experience. Experience of what works and what doesn't work. I've also have had lots of other knee surgeries, yet I didn't experience the pain of PT. I just used my knees in my daily living. I am able to do all the things I want and love to do. We aren't trying to steer anyone in the wrong direction. We are only trying to be helpful.

 

[Celle]

Are you both in the US or are you elsewhere? Seems that there are some different perspectives between regions.

It doesn't matter where in the world you live, because there are different perspectives within every country. In fact, you could say there are almost as many approaches to recovery from a knee replacement as there are surgeons. You can even find different perspectives in each town.
Each surgeon practices what he/she has been taught.

In my own city, some orthopaedic surgeons favour lots of exercises, while several others do not.
My surgeon doesn't allow any PT at all for the first month after a knee replacement. He says your knee needs that time, to start on its journey of healing. For that month, we rest, ice and elevate our leg, and walk around the house.
After that month, we just go to PT once every 2 weeks, where we are shown a few new exercises to do at home.
His patients all do well and achieve good ROM, as I did, and he hasn't had to do a manipulation to help with ROM for the past 4 years. I think that speaks for itself.

I know that it's difficult to go against the advice you are being given, but ultimately, it is your knee, you are the only one who has the right to decide what will happen to it, and it is your right to choose what feels best for your knee.
CONSENT: what it means and how it can be used
Saying no to therapy - am I allowed to?

 

[MaryMC]

What I meant by asking you are is that it seems more common that the folks from the US go through PT right away, and with more intensity. It seems that this is not the practice of those in the UK for example. Just like you did not know that massage is used to break up scar tissue, as you mentioned in another post. This is a very common practice in the US, so it was surprising to hear, but if it’s not practiced where you are then you may not be familiar with it. There seems to be trends, and I think those trends can be important. Not that they are right or wrong.

I’ve had 4 surgeries on this knee, two on the other. I’ve had 7 on my hips. I have had PT that made me cry every time I went, but it worked when they thought I would need to have another surgery and I was able to avoid it. I’m not saying this is the only way. And like anyone, I would like to avoid pain if possible. I’ve never had a knee replacement. These are new feelings for me and I’m not sure what to expect. I hear messages from both sides - you gotta push through some pain, and the other side of waiting and reducing swelling and going more easy. It’s hard to know what to do.

I’m 38. I don’t want another surgery. I was backpacking and cycling 100+ miles, and daily commuting round trip 15 miles to work right up until a month before surgery. I am fearful about not getting my life back and “doing it wrong”.

 

[HoneyB]

I had a LTKR February 2018 and plan to have a RTKR in May or June 2018. I've jokingly told my therapists that I'm going to the UK for the RTKR because they seem to be less obsessed with PT.

Seriously, I'm a Type A, competitive person. I assumed that if I worked hard at PT, I would power right through the ROM thing. I started out with great ROM and was at 95-100 degrees in week 2. Then, from week 4 - week 7, I was stuck at about 0 - 108 ROM. I didn't matter how hard I worked at all of the exercises, I was stuck at the same ROM for four weeks. I was frustrated. When I saw my surgeon for my 8-week checkup, he wasn't at all frustrated. He was very pleased with my progress, wasn't concerned that I'd been stuck at the same ROM for four weeks, and told me I needed to be less Type A about my progress. My ROM started to move again in week 8. At the end of week 8, I was at 0 - 115. I start week 9 tomorrow.

 

[Celle]

What I meant by asking you are is that it seems more common that the folks from the US go through PT right away, and with more intensity. It seems that this is not the practice of those in the UK for example.

You can't generalise like that. If you hang around long enough, you will see posts from people in the UK who say that they have been given PT therapy that is too early and too aggressive.
The difference, though, is that PT in the US is big business and there is a financial incentive for the therapists to encourage people to have therapy.

Just like you did not know that massage is used to break up scar tissue, as you mentioned in another post. This is a very common practice in the US, so it was surprising to hear, but if it’s not practiced where you are then you may not be familiar with it.

I've been on BoneSmart for 6+ years and I don't think I have ever said that I didn't know that. I'd be interested if you can tell me where you think I did.
I have frequently said that it is not possible to massage away scar tissue and not necessary to try to do so.

Genuine scar tissue is normal and it's necessary, to heal your wound. Without it, your wound would not heal.
The lumps and bumps on your incision stay until they are no longer needed and then they flatten out, all by themselves, without any massage or other treatments. That's Nature, doing the work she has been doing for thousands of years.
Massage post THR
It's not necessary to mobilise a scar, either. That will also happen spontaneously.

The type of scar tissue that PTs are always on about is more properly named adhesions and it is impossible to massage that away.
Scar tissue and adhesions - what's the difference?
MUA (Manipulation under Anaesthetic) and Adhesions

Common practice or not in the US, massaging the scar is ineffective and unnecessary. The only reason for massaging your wound is if it feels good.
I guess it makes everyone feel as though the therapist is "doing something", though.

Here's a link to the alphabetical list of articles in the BoneSmart library:
https://bonesmart.org/forum/threads/library-index.14830/
There are lots of factual, well-researched article there.

 

[MaryMC]

Celle - you are right, what you said was

I don't think a physiotherapist is qualified to diagnose scar tissue and if it does exist you certainly can't massage it away.

You can’t massage it away. But there is research that says that scar massage is beneficial.

This is exactly what I’m trying to clarify though- there are multiple views to every situation, and this just points it out. You may think that scar massage is not beneficial, where someone else does. Someone may think that PT shouldn’t be painful, where others say PT may cause pain. Start right away, don’t start for a month. As a patient, it’s hard to know what is right with so many differing perspectives. It’s hard to know who to trust, what you’re doing right, etc.

I’m finding myself fearful - fearful that if I do too much I’m going to mess it up. Fearful that if I don’t do enough...


Back to my original question however, which was - for those that have had discomfort with flexion, is there a common spot that this happens? For me, most of my discomfort had been medial. I’m wondering what other people might feel.

 

[MaryMC]

And thanks honey B- makes me remember to not get so caught up in the numbers

 

[Celle]

Mary, you are going to get conflicting advice wherever you go. As an adult, you can choose what you feel is right for your knee.
The advice we give is based on what we know has helped many people, as well as on our own knowledge and experience.

Of course it's your choice whose advice you choose to follow.

Your knee is going to do all right, as long as you don't stress it with over-exercising or expecting too much of it, too soon. That's why we advise this: "If it hurts, don't do it." Pain is a warning sign that you are doing too much. Doing too much will increase pain and swelling, which will slow down your progress.

One word of caution - you're young and you may think that will help your knee to recover faster. Unfortunately, it doesn't work like that. Your knee will take just as long to heal as an older person's knee does.
Complete recovery will take a full year, so it's going to demand lots of patience.

To answer your question - no, there is no one common spot where people feel pain when flexing their knee. Remember that your entire knee and all its surrounding soft tissues have been handled and traumatised during the surgery. All the muscles and tendons around your knee joint are handled, pulled aside, and sometimes stretched during surgery. They have to recover too.

You'll know if you're doing too much if it hurts, at the time or later, or if you experience increased pain and swelling in the next 24 hours. You won't do permanent damage, as long as you don't persist in doing too much.

You won't set back your recovery by doing less, as long as you walk around. Walking is the best exercise of all for your knee.
Many of us, from several countries, have recovered without doing any formal PT, but just by letting our activities of daily living (ADLs) be our exercise.

 

[sistersinhim]

Your pain location depends on what had to be done inside your knee. I had medial pain longer than the other areas. When I received my surgery report, in it my OS stated that he had done a medial release. Well, that explained that 'hanging on' pain. Each knee, even on the same person, is different. It's not the same for everyone. And you might have pain here today, and somewhere else tomorrow. Nothing is definite.

 

[MaryMC]

Sisters- I found out just last week I had a medial release done as well. Made sense to me why I was having so much pressure and tightness medically, I think. When I try to bend at all there is so much pressure it feels like it will pop.

Another great example -my calf pain is worse than my knee pain. They sent me to rule out a DVT. Two weeks later a PT tells me that it’s really common for folks to have calf pain long after the knee pain goes away. Geesh! I wish I had known that sooner because I was beginning to think I was doing something wrong.