TKR Incision site
- Thread starter MaryMC
- Start date
United States
My calf was extremely painful. During surgery, they are moving your leg in all kinds of ways. Bruising on the calf is normal, too. Mine looked like a was run over by a Mac truck! Your calf should start to calm down in a few days or a week or so.
Josephine
NURSE DIRECTOR EMERITA
We have an article in the Social Room telling you all there is to know about the members of staff The History of Bone Smart Forum. It doesn't mention the FAs in depth but two of them are qualified nurses (Celle and newlybionic) and one a PT (Pumpkln).
Then you'd be wrong. There is not that much difference between US and UK practices only in the fact that, because your PT facilities are concerned about making money, they tend to be more focused on activities than UK ones who are paid by the NHS.
I would dispute that. I read a lot of research in the medical journals and have yet to see even ONE article expressing an opinion regarding massage on wounds! In my experience, which is not insignificant, massage has no beneficial effects upon anything except perhaps, swelling. But Celle is right - you need 'scar tissue' or rather scarring, to close a wound. 'scar tissue' is a none event as far as I can see. It's a panacea to explain why they are engaging in rather pointless activities that they can charge for. Same as all the aggressive and extensive exercises they demand. (by 'they' I'm talking about PTs in the private sector be it in the US or private practice in the UK).
If fibrous material develops in the leg which causes problems with flexion, that's not 'scar tissue', it's adhesions, quite a different animal!
Honey, you have to remember that all the staff of here have had years of service at the frontline both in-real-life and on the forum. I certainly have! And I teach the staff so pretty much what I know, they know. And we really, truly wouldn't lead you astray. We understand that this is a scary situation but on the plus side, we've all had joint replacements and know about these things. We know, for instance, that the idea that the outcome of your knee replacement is not dependent on doing excessive exercises or PT because many of us, and many members not on staff, never did a scrap of exercising whatsoever. Your concern that 'if you don't do enough' you won't get a good outcome is faulted. I've seen dozens of members who managed that actually by doing too much. That's really easy. Having the confidence to do less is the tough bit! I recommend you read my recovery thread to see how little exercising I did for either knee! Knee recoveries UK style Parts I & II (Josephine)
OP
OP
MaryMC
junior member
Josephine thank you for the info. I read your own experience. You discharged on day 6 post op? I wonder, did the inpatient team work with you while you were in on movement, ROM, etc etc? I discharged the morning after surgery. I wonder if people like you who stayed longer have greater success. You were at 90 in the first few days. That is impressive. My swelling was so bad the first week I could not get any flex more than about 20’.
You are a lucky one that left surgery with great flexion.
You are a lucky one that left surgery with great flexion.
OP
OP
MaryMC
junior member
Thanks for letting me know about the info on the BoneSmart staff. When I click on yours and Celle’s profile it said unavailable for me to read. Glad to check out the info you provided.
For what it's worth, too, BoneSmart has a Board of Directors that includes several surgeons who support the advice given here.
One of the Forum Advisers (Orthodoc) is an orthopaedic surgeon who is still in practice.
One of the Forum Advisers (Orthodoc) is an orthopaedic surgeon who is still in practice.
Jajakio
graduate
I'm not sure if being discharged within 24 hours or staying longer has much to with flexion and extension. I was home in less than 24 hours and my ROM measured at 95 in the hospital. The first time I went to PT two days later it was 85 due to swelling. It took about a week or 10 days to get back to the numbers I had in the hospital. I'm one of the few people here who liked my PT. I found it pretty uncomfortable at times but not extremely painful. I think preop exercise paid off and i was back to riding the exercise bike in 10 days. It doesn't matter how fast or slow you go though. For me, it worked to push to the point of discomfort and then keep it up daily until it was easier then do more when my knee was ready. ROM came by fits and starts and more than once i did stand still for weeks then improve quickly.
I think due to so many factors including the skill of our surgeons, how bad the knee was before surgery, what kind of shape we were in preop, and any other problems we have, as well as many other factors will produce recoveries of varying speed. I pushed too hard a couple of times in the beginning leading to excess swelling. For me increasing icing and slowing down for a few days solved the problem. I learned to listen to my knee and go at my own speed. Im 9 months out now and very nearly normal. I had a fantastic recovery but it did take several months to lose the stiffness completely. I'm at a good activity level but still have a twinge of discomfort every once in a while but it isn't much and it doesnt last long. I was so sure it wasn't going to take me a year to recover completely but it appears I was wrong. It is tough to decide how much exercise you should do. My only advice is listen to your knee and let it dictate how much you can do.
I think due to so many factors including the skill of our surgeons, how bad the knee was before surgery, what kind of shape we were in preop, and any other problems we have, as well as many other factors will produce recoveries of varying speed. I pushed too hard a couple of times in the beginning leading to excess swelling. For me increasing icing and slowing down for a few days solved the problem. I learned to listen to my knee and go at my own speed. Im 9 months out now and very nearly normal. I had a fantastic recovery but it did take several months to lose the stiffness completely. I'm at a good activity level but still have a twinge of discomfort every once in a while but it isn't much and it doesnt last long. I was so sure it wasn't going to take me a year to recover completely but it appears I was wrong. It is tough to decide how much exercise you should do. My only advice is listen to your knee and let it dictate how much you can do.
Josephine
NURSE DIRECTOR EMERITA
That was for the first knee. The plan was to have gone home on day 4 but I wasn't allowed home until 'they' had supplied me with the necessary aids which they couldn't get organised until the next week which turned out to be the Tuesday. Second knee I was supposed to go home on day 1 but because I live alone, the boss kept be for an extra night. Then I got a nasty bout of PONV (po-sop nausea and vomiting) so that was another night.
Not really because I wouldn't let them! I did have the usually safety things like doing stairs and walking up and down the ward. This also to check the spinal had worn off!
OP
OP
MaryMC
junior member
Jajakio- that is very helpful to hear
I also really like my PT, and they have earned a lot of my trust by going slow, providing assurance, and recognizing that I have past medical trauma that effects my mental recovery. When I have said stop they stop. I feel like PT has helped me improve, although it’s very slow and hard to see (67 last week and 76 yesterday). I’m not sure I push in to pain, but I do push in into discomfort making sure it is not causing swelling afterwards.
Celle- it’s helpful to know that there are a board of ortho docs who support this site. I have always tried to be diligent about learning as much as I can about someone’s expertise (when it comes to medical professionals) before moving forward. I’ve had plenty of ortho docs give terrible advice, and one who botched a surgery so badly that now at my age I was left with almost nothing left of my knee. I think it has been wise for me to ask as many questions as possible, which had helped me
Please know I am not trying to be difficult. I appreciate people sharing their experience immensely. It’s been difficult to navigate when it comes to my own body when I hear so many conflicting perspectives. Of course Celle and Josephine you both would not want or desire to lead anyone in to harms way. There are lots of well meaning professionals who give bad advice. I think I’m just sharing the frustration. Also, how fear had made me question myself, which is a feeling that is unfamiliar to me. I’m working on listening to my own body and figuring out what works for me.
I also really like my PT, and they have earned a lot of my trust by going slow, providing assurance, and recognizing that I have past medical trauma that effects my mental recovery. When I have said stop they stop. I feel like PT has helped me improve, although it’s very slow and hard to see (67 last week and 76 yesterday). I’m not sure I push in to pain, but I do push in into discomfort making sure it is not causing swelling afterwards.
Celle- it’s helpful to know that there are a board of ortho docs who support this site. I have always tried to be diligent about learning as much as I can about someone’s expertise (when it comes to medical professionals) before moving forward. I’ve had plenty of ortho docs give terrible advice, and one who botched a surgery so badly that now at my age I was left with almost nothing left of my knee. I think it has been wise for me to ask as many questions as possible, which had helped me
Please know I am not trying to be difficult. I appreciate people sharing their experience immensely. It’s been difficult to navigate when it comes to my own body when I hear so many conflicting perspectives. Of course Celle and Josephine you both would not want or desire to lead anyone in to harms way. There are lots of well meaning professionals who give bad advice. I think I’m just sharing the frustration. Also, how fear had made me question myself, which is a feeling that is unfamiliar to me. I’m working on listening to my own body and figuring out what works for me.
We have all been through these doubts and fears. The 'what ifs' are awful and can drive us crazy! Please know that all of the staff want only the best outcome for all our members. We are all volunteers and spend hours a day on this site just to try and help someone!
Josephine
NURSE DIRECTOR EMERITA
Not in anyway shape or form. You will see me say outright if a member asks me something that is outside my sphere of expertise (I would say often but it doesn't happen often!)
Oh so true! And when I see it, it breaks my heart.
OP
OP
MaryMC
junior member
I did my first straight leg raise today - after trying every day for the last 3½ weeks! I was lying on the floor and it just happened. And then I did it three more times!!!
Now, flexion, come on!
Now, flexion, come on!
I saw in a couple of your earlier posts, that you can now do straight leg raises (congratulations!) and that your flexion had increased from 67 to 76 in just a week. That's good progress. Your knee is doing well.
Don't worry about how fast you achieve flexion. There's no need to rush to get ROM (Range of Motion) because it can continue to improve for a year, or even much longer, after a knee replacement. In spite of what you may have heard, there isn't any deadline you have to meet:
Myth busting: the "window of opportunity" in TKR
OP
OP
MaryMC
junior member
Thanks Celle. The flexion comes (around 75) but with lots of warming up and multiple attempts. Will this get more natural? I have about 40’ probably when I wake up, and really have to get things moving to see any more
Sure it will get more natural. It's still less than a month since you had this major surgery. Your knee still has a lot of healing to do. It will get there, on its own schedule. It knows what it's doing.
Most of us find that our knees are stiff after we've been sitting or lying down for a while. As your recovery progresses, you'll probably find that loosening up only takes a few steps.
My own, unscientific theory is that while you're resting you're not making much synovial fluid, but moving again increases the fluid, which then lubricates the joint - I think of it as being like putting oil on a rusty hinge.
Most of us find that our knees are stiff after we've been sitting or lying down for a while. As your recovery progresses, you'll probably find that loosening up only takes a few steps.
My own, unscientific theory is that while you're resting you're not making much synovial fluid, but moving again increases the fluid, which then lubricates the joint - I think of it as being like putting oil on a rusty hinge.
Super!
OP
OP
MaryMC
junior member
I want to throw it out there again. What I’m experiencing is that I wake up with about 40’ of flexion. It takes a lot 30 minutes of stretching and massage to get it to about 80’ I’m at 5 weeks today. I’m wondering if anyone else experienced this, or when people talk about stiffness if this is what they are referring to?
I see my surgeon tomorrow. His nurse had told me he wants 115’ by 6 weeks or he does an MUA. That is NOT something I want to do, but I also don’t want to have to take so much time just to get moving every day. It is very tiring.
I see my surgeon tomorrow. His nurse had told me he wants 115’ by 6 weeks or he does an MUA. That is NOT something I want to do, but I also don’t want to have to take so much time just to get moving every day. It is very tiring.
It's your knee. If you don't want a MUA, you don't have to have a MUA! Most OSs hope for 90* by 6 weeks. Your doctor is being unreasonable. What that stiffness is, is swelling inside and outside your knee. Get that swelling down and your bend will increase. It's too early to even think of a MUA. Your knee is still knitting together those cut tissues. I MUA will tear those tissues apart, setting back your recovery to almost the beginning.
https://bonesmart.org/forum/threads/myth-busting-window-of-opportunity-in-tkr.6895/
https://bonesmart.org/forum/threads/myth-busting-window-of-opportunity-in-tkr.6895/
