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Bilateral TKR Indigo_bunting’s BTKR recovery

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Indigo_Bunting

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Day 28
- I was discharged from home PT yesterday. He didn’t measure my flexion (as he’d said he would) presumably bc it was clear I had regressed after two long car trips
- Started outpatient PT. Measured flexion at 41 R and 50something L, the lowest yet. She said that the OS, who I see Thursday, would recommend urgency in working my bend regardless of swelling still present. Mentioned MUA. She did show me some massage techniques that helped get my quads to stop guarding so tightly. Definitely bendier at the end (not measured).
- Once again struggling to get pain meds, which both PT and PA have told me to take before PT. First the pharmacy said I didn’t have prior authorization. Now that I have that, pharmacy says state law won’t let them fill it until a date 22 days post previous fill of a 1-week supply. Medical assistant in ortho dept confirmed this is BS. I believe it’s actually the terms of CVS’s settlement with the state AG, as interpreted by idiots. So advice to anyone in Massachusetts: get your meds filled anywhere but CVS.
 
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Indigo_Bunting

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Day 29
- Knees were fine today post 1st outpatient PT yesterday! I feel like the swelling is finally down to where I can start to bend. Did all assigned PT today (it’s not that much; 3 exercises x 10 reps x 3 sessions) plus additional stretches of my own, some while massaging the quads and some with a heating pad over the quads. Feels more comfortable to bend anyway and I’m able to walk a little less penguin-like.
- Got Covid booster & so far no side effects. The walk across the medical campus to the vax clinic and back was my longest walk yet. Between that and the PT & stretches I’ve thrown a lot at my knees today and they don’t hurt and so far seem no stiffer.
- Does anyone know of a meaningful reason why PTs are so into heel slides on the back? Especially with a strap? Both PTs have talked about this. Why wouldn’t you do the strap thing standing, like dancer pose in yoga? Holding on to something, obviously. Some of these PT exercises seem really divorced from real-life function.
 

WFD

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Why wouldn’t you do the strap thing standing, like dancer pose in yoga? Holding on to something, obviously. Some of these PT exercises seem really divorced from real-life function.
These exercises often seem to be designed for the patients with the most challenges. Some folks couldn’t do it standing and would risk falling if they tried. You can’t hurt yourself if you are already lying down.
 
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Indigo_Bunting

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Day 30 - 1 month post op appointment
- 2nd session outpatient PT. I like the exercises and they are not painful. ROM not measured but little improvement if any. I’d say at most 60 L, 50 R based on the now all too familiar bend I’ve been stuck with for weeks.
- immediately followed by meeting with OS. He didn’t measure but (no surprise) said my flexion is not good. He said he could feel hard stops when he attempted to bend them. I am scheduled for 2xMUA next week, exactly 5 weeks out. I have read many MUA-havers’ stories on here and plan to go ahead with it.
- on a positive note, I can walk or stand for 15 minutes without pain. That is an improvement over my pre-BTKR situation.
 
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Indigo_Bunting

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Day 37
BTKR Nov 2
Bilateral MUA Dec 8

My ROM did not take advantage of the extra week to show up, so I went ahead with the MUA. It really was OK, not traumatic. Pain level only a 4 right after, nothing 1x2 mg dilaudid couldn’t handle. I took one more in the afternoon and didn’t need any at night, slept through.

My leg muscles were firing all over the place for the first few hours, making it hard to stand and walk. I have muscle relaxants but held off on those because anesthesia + dilaudid made me loopy enough. Today my quads are very sore and I’ll use a heating pad on them before attempting heel slides.

I went to PT a few hours after the MUA. At PT the increases were measured as follows:
R from 41 to 80
L from 50 to 88

Throughout the afternoon I did 2 slow heel slides each side every hour. There is a visible increase in swelling, mostly in the thigh above the knee, so I elevated a lot to try and keep the fluid out of my knees. I am aware that I may not reach the above numbers today due to swelling. At least the loss is likely to be temporary.

I know 5 weeks is early to go ahead with an MUA. The OS told me I could wait if I wanted, but the timing was right for me because I have a few more weeks of leave from work making it possible to control pain appropriately, elevate, attend appointments, etc. And here is another reason someone with extremely low ROM, like me, might not want to delay MUA: the nurses at the hospital pointed out that I have trained myself to walk with my hips since I lacked the ROM in my knees. I didn’t have the muscle coordination to work on this yesterday but will ask to focus on gait at PT today. Walking correctly will be key to keeping and extending the ROM I’ve gained and the sooner I can improve my gait the better.

ETA: 90 degrees on the L, 83 on the R. I met a milestone!!
 
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hawk2go

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I'm glad you got the treatment that worked for you. Keep us posted. We're here for you.
 
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Indigo_Bunting

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Day 43 (feels like forever)

Swelling from MUA last week was gone after about 3 days, at least so far as I could see or feel it. Maintaining ROM gains with gait drills and stretches several times per day. Got a cane and went for a 20-minute walk outside, my first without a walker. By the end, walking was painful and I had swelling the next day. My conclusion was that PT exercises don’t cause increased pain and swelling but walking does. Then I went to PT yesterday, and that also resulted in increased pain and swelling. New conclusion: *everything* requires a more gentle approach at the moment, probably because the MUA is still affecting me in ways that aren’t obvious.

Measured flexion at PT yesterday. 90 L (no change) 88 R (+5).
 

hawk2go

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@Indigo_Bunting - Don't overlook your excellent milestones while you rest to reduce the swelling. Great news on switching to the cane and being able to walk for 20 mins. I constantly toy around with my daily limits because they change, sometimes daily.

btw - I continue to marvel at your resilience.
 
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Indigo_Bunting

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Thank you, @hawk2go. I really appreciate your support.

I start the stretches etc by sitting on the edge of the bed with a heating pad on my quads and letting my shins relax down. Today for the first time my right leg isn’t noticeably sticking out more than the left. Something to celebrate.
 

Susie-Q

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Wow, so much has happened in the last week! Glad you got the treatment you needed. Yes, you need to take it slow and easy after your MUA. It's good you are seeing progress.
 

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