TKR It's The HoneyB's Knees

[HoneyB]

Thank you, @Celle. Please know that I do value the input from all of the Bonesmart advisors. I am being careful and cautious because I went into this “new to me” type of rehab for knee #2 not knowing whether it would be right for me. I still scrutinize everything that is suggested to me at therapy. I think you would feel better about it if you were there with me to see how things are being done. It’s very one-on-one. Someone is always beside me as I start an exercise to watch my reaction and ask, “Is it just difficult or is it painful?” For example, when I did the leg extensions sitting on the side of the table, as the weight changed from zero, to 1.5 pounds, to 3 pounds, I was told each time to gently TRY to raise my leg and if/when it hurt to tell them where it hurt and how much it hurt. It hurt in the exact same spot for all three weights, and the pain was the same (about 2-3 on a scale of 1 – 10 with 10 being the worst) for all three weights. Pressing a specific place on my quad muscle while doing this exercise would make the pain disappear. The therapist said it’s a pain resulting from a weak quad muscle rather than a “knee” pain. I have the same pain in the same place at the same intensity when using the leg press machine. In that exercise, I’m told to do as many reps as I’m comfortable with, but no more than 30 reps. I kept going to 30 reps because the pain/difficulty at #30 was no different than it was at #2 (#1 is always the hardest because I’m timid with #1 of each exercise). The various exercises are designed to strengthen the muscles above, below, and surrounding the knee so that (1) the knee is stabilized and (2) the knee isn’t carrying more than its fair share of the load.

When they mention ROM (and today they said my ROM was great), I tell them that I’m not yet concerned with ROM, and I’ve told them that my OS was very pleased with a ROM of about 100 – 105 at eight weeks so my OS would not be concerned yet, either.

@pacosmom - I still have some quad strength problems (side-to-side strength) with my left leg. We'll start addressing those at therapy when my right knee and leg are ready to work on side-to-side strengthening. Other than straight leg raises to the inside and outside, I haven't done any side-to-side strengthening exercises.

 

[Katlyw]

HoneyB,
Congrats on all the fun stuff going on in therapy!! I told my mom that it felt easier today and he increased some weight, reps, and added new exercises. Stopping at the mall to walk on the way home! You are doing an amazing job!! I have but one question. Was the NFL player in question pretty to watch?? Have a great rest of your day!

 

[pacosmom]

Just because HoneyB's knee can do doesn't mean yours can do it. Always let your knee be your guide. Healing knees have inside stitches that have to knit together. No one wants to pull those stitches apart!

Agree

 

[pacosmom]

@pacosmom - I still have some quad strength problems (side-to-side strength) with my left leg. We'll start addressing those at therapy when my right knee and leg are ready to work on side-to-side strengthening. Other than straight leg raises to the inside and outside, I haven't done any side-to-side strengthening exercises.

I have a lot of quad issues lol I'm sure if it would have been stronger & more used prior to my surgery, it would be a big help now! I only do the laying on my back, straight up & down leg raises, and yesterday was the first time she added 1.5 lbs. I'm careful because of the swelling, I don't have pain that is really bad (off pain meds now). We laughed at PT yesterday, she was doing a lot of massage & work on my quad and knee. I was laying and had my leg bent as far as I comfortably could and she was working on the knee cap & sides of my knee and every time she touched 1 certain spot up there, the inner side of my quad started shaking. It was really odd - no pain at all, just funny to see

 

[HoneyB]

@pacosmom - Interesting about touching that spot on your knee and your inner quad shaking. It's a spot on my inner quad that when pressed/massaged causes my inner knee pain to disappear.

@Katlyw - I told my therapist that the exercises the NFL player was doing looked way easier than what I was doing. I could have aced those exercises. He appears to be working on some small muscles in his ankle and shoulder while I'm working on those big leg muscles. From the looks of his legs, he would have absolutely no trouble with the stuff I'm trying to do.

 

[NightQuilter]

Hi @HoneyB ... just catching up here. You are doing great. I too had heard about the sun vs. scars. We went to Hawaii about 5 months after my TKRs ... photos of me In the sun with white lines of 50+ on each knee. Worth the "social stigma"!!. As others have mentioned, I too am a big fan of effective massage therapy post-TKR. My massage therapist was fully trained in Shiatsu and lymphatic massage ... after 3 treatments on each knee, at my 3 week follow up with my OS, he was shocked that my swelling was gone. If we can reduce the swelling by moving the fluids through, the pain from the he compression in that surgical zone will be reduced. Good luck to you!

 

[Jajakio]

HoneyB, I'm truly enjoying your thread. I've had one conformis knee done and may do the second one this fall or wintwr. I pretty much feel like you do about PT and I'm jealous of your good PT group. I didn't find PT too difficult and i think it helped me. I used weights earlier than recommended too and had no ill effects.

Wonder if it has anything to do with the custom conformis knees we both have? My surgeon told me I'd come along quicker because of less cutting and less bone loss. He told me they would be removing about 20-25% less bone than with an off the shelf knee. I think in the beginning i was well ahead of typical but the differences gradually tapered off and by 6 months I think my progress was good but no longer so far ahead of the curve. But anything that lessens those first few bad weeks, right?

Hang in there and if it is working for you, keep it up.

 

[HoneyB]

• @Jajakio - I agree with you. Based on what I saw and heard at physical therapy, I think I started out ahead of the curve on pain and rehab with the ConforMIS knees, but things leveled off with the people with "off-the-shelf" knees after a while and then we were all just trudging along at the same speed. I do like that I never had any of the clinking/clanking sounds and feelings that I've heard others mention.

 

[HoneyB]

I need some medication advice. With knee #1 (LTKR), I took Percocet 10/325mg for three weeks, starting with one tablet every 4 hours and ending with one tablet every 6 hours. I had no problems with Percocet and it did a good job of controlling my pain. The only noticeable side effect was drowsiness. After three weeks, I was switched to Tramadol 50mg, one tablet every 8 hours. The pain relief wasn’t as great as with Percocet, but it was adequate. I felt more stiffness with Tramadol than with Percocet. I took Tramadol 50mg every 8 hours for 3 weeks. The side effect was loud ringing in my ears for the entire 3 weeks I took Tramadol, and for a while after I stopped taking it. After 3 weeks of Tramadol, I stopped all medications except for 1000mg of Tylenol at bedtime.

With knee #2 (RTKR), my medicine routine has been the same as with knee #1. I took my final dose of Percocet last night at 7:00 p.m. I took my first dose of Tramadol this morning at 1:00 a.m. Based on medical advice I’ve seen on Bonesmart from @Josephine, I took 1000mg Tylenol with my first dose of Tramadol. I slept well last night, but when I woke up this morning, the first thing I noticed was loud ringing in my ears. As before, the pain control seems to be adequate, but I feel more stiffness than I felt with Percocet.

With knee #1, I endured the loud ringing in my ears because I was afraid of the pain if I stopped taking the Tramadol, even though I've, so far, not had really horrible pain with either knee. With knee #2, I surely don’t want pain, but I’m not sure I want to endure 3 weeks of loud ringing in my ears. Does anyone have any advice? Does this ringing in my ears mean that I should stop taking the Tramadol because it’s doing something harmful to me? Aside from medications for knee surgery, I don’t take any medications on a regular basis. I take Tylenol for occasional headaches, but that’s all I take during “regular life.” Many medications make my ears ring including antibiotics and even Tylenol if I take the maximum 4000mg/day. I can’t take any of the typical “arthritis” medicines: Meloxicam/Mobic, Piroxicam, Lodine, Celebrex, etc. They all make me swell a lot and quickly. Even OTC ibuprofen makes me swell, though not as quickly as the prescription drugs. Does anybody have a suggestion for a non-narcotic (I want to start driving) replacement for Tramadol that I could ask my doctor about? My next dose of Tramadol is due now. I’m trying to decide whether to take it or to skip it and risk having pain. Thanks!

 

[Katlyw]

@HoneyB I went from Norco to Tylenol arthritis. But it may be too high of a dose for you. (Each is 650 mg) I switched to ibuprofen because of a little inflammation (tylenol doesn't help with that) but not sure if you can't take that. I get a little pain, mostly if I sit too long, but got rid of my narcotics early so I could drive...

 

[SusieShoes]

I went from oxy to Tylenol. There was still some pain but it wasn’t terrible. I managed exercise well. You could try just Tylenol to see how that works for you.

I’m tagging @Josephine for advice on your question about Tramadol and ear ringing.

 

[Josephine]

After three weeks, I was switched to Tramadol 50mg, one tablet every 8 hours. The pain relief wasn’t as great as with Percocet, but it was adequate.

The pain relief wasn't as good because you weren't taking it to best effect. I always recommend 50 or 100mg Tramadol take with 1,000mg Tylenol. They make a really good companion pair and give excellent pain management.

Does this ringing in my ears mean that I should stop taking the Tramadol because it’s doing something harmful to me?

Central nervous system side effects of Tramadol have been reported that include tinnitus. Since it stopped after a few weeks, this would appear to have been a temporary thing but, according to the literature, it is quite rare. So whether you ever take it again or not would appear to be entirely up to you.

 

[HoneyB]

Thank you, Josephine. Since 50mg of Tramadol makes my ears ring so loud, I'm afraid to double that dosage. I've called my OS office to see if they have any suggestions and I'm waiting to hear back from them. I would sure hate for this ringing to become permanent. I'm wondering if I'm brave enough to skip a dose of Tramadol and try using just ice and TENS for pain. Yikes! Also, the pain isn't horrible. It's a nagging ache always in the background and a good bit of extra stiffness. I know that it'll probably be better in a few days.

 

[Celle]

You could try just Tylenol 1,000 mg 6-hourly - to a total of 4,000 mg in 24 hours. That's all I was given after a month, and I found it worked well.

 

[HoneyB]

Yes, @Celle, and even though Tylenol makes my ears ring if I take 4,000mg in 24 hours, I'm pretty sure that is a ringing that won't become permanent. I have a fear of the Tramadol ear ringing becoming permanent since it lasted for a while after I stopped taking it the last time.

 

[HoneyB]

New Knee #2 Day 25: I’m happy to report that I made it through physical therapy today with no setbacks due to the reduction in pain medication. With one Tramadol 50mg plus two extra strength Tylenols coursing through my body, I was able to do all of the exercises listed for last Wednesday (Post #177), and some things, like the leg press machine and the sitting leg curl machine, even felt easier today. When I finished 30 reps of leg presses with both legs and 30 reps of leg presses with just my right leg (new knee #2), out of curiosity I did a few leg presses using only my left leg (new knee #1). I was thrilled that there was zero pain with knee #1 and the reps were extremely easy. My ears are still ringing loudly from the Tramadol and that’s annoying, but I’m marching toward New Knee #1 (LTKR) Week 19 / New Knee #2 (RTKR) Week 4 with optimism and just a little extra background ache/pain from the reduction in pain meds.

 

[NightQuilter]

What a wonderful report. I hope the machines were set for about 5 lbs! I can't even imagine doing significant weight at just a month out!

 

[Katlyw]

Going to ask my therapist about weight levels for machines at the health club. So we'll see what happens But way to go getting those knees strong!!!

 

[HoneyB]

@Katlyw - I wouldn't be brave enough at this point to do weight machines at a health club without my therapist there watching over me. If the machine isn't set just right for your height/leg length, or if you use the machine incorrectly, you could do some damage. I have a friend that uses weight machines at her health club now that she's finished therapy, but her TKR was in early February.

@NightQuilter - The leg press machine is set at 40 pounds when I'm using both legs. When I'm using just new knee #2, all the weights are removed so it amounts to 10 pounds of just machine parts. The sitting leg curl machine is set at 30 pounds and I'm using both legs on that machine. I wish I'd paid attention to the amount of weight those machines were set to in late May when I went for my pre-surgery evaluation, but they were probably still set lighter than normal because they knew I'd gotten a new left knee in February.

 

[Celle]

Going to ask my therapist about weight levels for machines at the health club. So we'll see what happens But way to go getting those knees strong!!!

It's a good idea to be cautious about starting weights early in recovery. To me, it makes sense to allow your knee sufficient time to start healing well first. That's why we usually recommend waiting until about 3-4 months after surgery. "Heal first, then strengthen." In the early months post-op, your muscles will be strengthening themselves, as you use them to get around.

I wouldn't be brave enough at this point to do weight machines at a health club without my therapist there watching over me. If the machine isn't set just right for your height/leg length, or if you use the machine incorrectly, you could do some damage.

Very wise, HoneyB !

While your knee is still new, those soft tissues that were handled during surgery can be more easily damaged than later in recovery.