TKR Indieknee trying to recover

[indieknee]

Well, Ive been to the pt group - it was all I expected it to be. 4 hulking blokes prancing around as if their knees didn’t hurt. One of them actually said - “you have to work through the pain”.
The therapist put us through all kinds of excercises and I said that it hurts now but that’s nothing on how it will hurt later.
He said the excercises would help the swelling otherwise it would go hard and be very difficult to get rid of. My knee is hard like a lump of wood so I think it’s too late for me.
Anyway I have promised to do the home excercises and let them know if I decide not to come back.
Another thing he said was that at 8 weeks I should be weaning off painkillers and just using ice.

 

[SusieShoes]

Gotta love the “4 hulking blokes prancing” line!

There’s always someone whose recovery looks easier than ours. Be happy for them. Your recovery is the only one that matters.

And don’t think any part of this recovery is “too late” for you. Two months is still early! It really is. What’s making your knee hard is the swelling. Anything you can do to reduce the swelling will not only relieve that hardness but will allow your knee to bend more. Some exercises do help swelling — like walking, walking does help swelling by moving the fluid. Lots of PT exercises, though, like the ones that force the knee to bend (especially through pulling on straps), don’t help swelling one bit. The notion that your knee will “freeze” if you don’t force through the swelling is a myth.

Do what exercises, or no exercises, work best for you.

How is your pain at this point? You mention taking oxy for sleep. Do you still take it during the day for pain?

 

[indieknee]

Susieshoes - I take 5 mg oxy shortec every 4 to 6 hours along with paracetamol - although I do miss a dose quite often. Oxy 20mg longtech every 12 hours. I have horrible pain in the morning and late evening/night.
I would like to come off the meds but only if my pain reduces.

Sorry about the “prancing blokes” line - but whatever image it conjured up in your mind - that was them. But I do wish them well.

 

[SusieShoes]

I thought the "prancing blokes" image was a hoot.

If you're missing doses, you could try weaning yourself from the oxy. Try taking half-doses and see how that works. You can combine it with Tylenol. I'll tag @Josephine, our Nurse Director. She can advise you about your knee and your meds. She will ask you some questions about your recovery.

The first couple of months of recovery are rough. Hang in there!

 

[indieknee]

Thanks susieshoes- I’ll wait to hear from josephine

 

[indieknee]

Here we go

1. I always find this Difficult - 4

2. Oxycodone 20mg longtec every 12 hrs.
Oxycodone 5 mg shortec every 4 to 6 hours - some days I miss a dose
1000 mg paracetamol every 4 hrs

3. Swelling moderate.

4. Rom - no idea

5. Yes I ice my knee all the time

6. I try to elevate it every time I sit or lie down

7. Activity level - not much, washing, walking around the house, up and down stairs

8. 1 or 2 sessions a day, sometimes none. Sometimes I just just choose 1 or 2.
Straight leg rise 10 times.
Knee extension 10 times
Knee flexion 10 times
Heel slides 10 times
Calf raises 10 times
Squats 10 times
Standing knee flexion 10 times
The one we’re you put a ball under your knee and squash the ball by pressing down 10 times

Physio - I have been to a one to one session and a group session both were horrible.
I don’t know the names of the exercises but the warm up seemed to go on for ever and included extension and flexion exercises.

Then there was an assault course of steps, a bike, lying on a bed with my leg on something and a weight on my ankle. Walking about without a crutch and not limping - if I put my weight on my knee, it hurts which is why I use a crutch, so it was a bit difficult to do this.

Then it becomes a blur.

 

[DIYSteve]

4 hulking blokes prancing

3 French hens
2 turtle doves
and a partridge in a pear tree

Hang in there indieknee!

 

[kneeper]

Josephine will be along to comment, but let me add my 2 cents. As you've discovered you really don't need to do all the exercises they've given you. The ones I think just make an angry knee more angry that I spot on your list are squats (from personal experience a big ) and putting a weight on your ankle.
I like that you are starting to listen to your knee and not doing all of them. Even my PT told me to pick and choose and don't do as many if it made the knee feel worse. By the time of my second tkr, I did even less than she though I was doing and did fine in the end.

 

[indieknee]

I love this forum

 

[Jockette]

I love this forum

Hang out here with us.
Bonesmart has a wealth of advice, information and support.
We will offer helpful suggestions,

Cheer your accomplishments

And send hugs when you are feeling down.

Best wishes!

 

[Josephine]

4. Rom - no idea

Well there are two parts to the ROM: flexion and extension.

The extension you can assess yourself this way

1. put your leg on a bench, seat, bed, floor or anything similar but preferably something fairly firm.
2. with not too much pressure, press the back of your knee down - use your leg muscles, not your hand!
3. slide your hand, palm down, under the back of your knee
a) if you can get your entire hand under easily, it's probably about +10 degrees
b) if you can get just your fingers under, it's about +5
c) if you can get your fingers under but it's a push, it's +0
d) if you can't get your fingers under at all, it's -5 or more


Here's a graphic to explain the degrees involved

As for the flexion, I can do that for you if you would be kind enough to send me a picture of your knee in one of these poses

When you're supplied me with these, I can address your answers.

 

[indieknee]

This is terrible ` I'm sure it used to be better than this.

Extension = 10+
Flexion - get ready:

 

[Jockette]

I always had trouble bending my knee laying on my back. I did better in a chair. Is yours better in a chair?

If you look at my surgeon’s records you’d see great flex numbers early on. But, my leg was always pushed by someone else to those numbers. No way could I get them myself.

My inner swelling continued for about a year. It wasn’t until after that, and especially in recent months that my leg relaxed enough to get a decent bend. I’m 17 months post op and my bend is still improving.

Surgeons and PTs make a huge deal about ROM, but as in my case, it can continue to improve for a very long time. My entire first year was so stressed about ROM and would the surgeon be happy or not. No way will I stress like that again next time.

Though my forced numbers were good early on, I had a set back at 4 months post op and I could hardly bend my knee and it took months to improve. But it did! My bend now is almost what the other leg is.

You have lots of time ahead of you for improvement.

 

[indieknee]

@Jockette - thanks so much for the reassurance.
Yes, my knee bendiness is definitely much better in a chair.
You mention about your leg becoming relaxed enough to bend. I wonder if some kind of massage would help my knee swelling?

 

[Jockette]

I didn’t have any massage after I was released from PT st 8 weeks post op.

After my huge set back at 4 months I considered massage, the back of my thigh and calf was so tight.

I really could have used some gentle massage at that point, but I didn’t know where to go. I refused to go back to PT as I didn’t trust them and I figured they’d want me to do exercises again, and I am of the Bonesmart mindset in that department.

I’ve had massages in the past and they didn’t agree with me. My daughter gave me a gift certificate for one as a thank you, it was a relaxing massage, 30 minutes, and I was in a lot of pain after it. I got in the car thinking, I thought you were supposed to feel like jello after a massage. Then several years later I had a massage on 2 different occasions for back pain and it took me 2 days to recover from both of them.

So I was very leary of ANYONE touching my leg at this point. So I didn’t go. It took months for my leg to settle down.

If you can find someone who will be gentle with your recovering leg it might help. But you are still very early in this recovery and what you need most is to just give it time to heal. We all get tired of hearing that, but it’s true.

 

[indieknee]

One day someone might discover a way to allow knees to heal painlessly without the swelling. This forum has been running for about 10 years, looking through it I notice that people are still having similar recovery problems to back then. Have there been any advances in the way surgery is done and post op healing?

 

[Jockette]

That would be lovely, wouldn’t it?

My non medical guess is, you can’t cut into the body without causing trauma, and the body’s reaction is to swell in defense.

@Josephine, can you define for us the purpose, or rather the reason, of swelling?

 

[Josephine]

OH Jockette! You do have big asks!

Swelling is a normal reaction of the body to an injury. Sometimes, though, the body goes overboard, and the inflammatory response is excessive and can actually begin to cause more damage than good. Acute injuries are easy to recognize: first comes the pain, and then comes the swelling. Chronic, or long term injuries, take weeks, sometimes even months, to develop, but it is the same story: first comes the pain, and then comes the swelling.

When physical damage to the tissues occur a biological process called inflammation occurs then white blood cells are rushed to the area in order to fight off any bacteria or harmful waste leakage from damaging the cells further. In order to get the white blood cells to the site of damage faster, the body induces a process called vasodialation where the arteries are expanded and blood is rushed to the site.

This causes the site of injury to swell and redden, two signs of inflammation. The white blood cells release chemicals that kill off bacteria and waste in the area. If the site of impact begins swelling within a matter of hours, it is likely acute inflammation is occurring and the body is rushing blood to the site. However, if swelling occurs on a more rapid time scale it is more likely that this fluid is from the damage of the impact itself and the cells and capillaries are leaking blood and extracellular fluids.

 

[Josephine]

Indie, that photo is no good for me. Look again at the example I showed you. I need to see the greater trochanter, just like it is shown.

 

[Jockette]

@Josephine
That was quite the definition!!
Thank you!!