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TKR JeremiahD's Knee Recovery

JeremiahD

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Afternoon! TKR completed on 9/8/20 @12:30pm. Took 3 hours to complete because of the enormous amount of scar issue that had to be removed.

First I would just like to thank everyone who chimed in a few months ago to give your positive support! I didn’t reply, but I did read each message, and gave me that extra little support for my decision :)

As I start day 4 of recovery, I’m feeling really good! Pain is being managed, and I’ve moved to only taking my low dose of hydros throughout the day/night. The wife has done a tremendous job of keeping me comfortable/safe, while pushing me in PT.

Although I don’t start formal PT until Monday, I’ve already been busting my butt. PT exercises/ROM during the day, foot bolster, CPM machine, along with just waking around.

Quick question about CPM as I’ve now gotten mixed messages. The company of the CPM say this should be used 3x day for 2 hours. Pre surgical testing and my nurse at PT said, “use it if you want.” Anyone have any advice/input on how much I should be in the machine?

Thank you again everyone! I’m excited to keep getting stronger
 

Celle

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Welcome to recovery @JeremiahD .
I've moved your post from pre-op adn started this recovery thread for you.
Please continue to write about your recovery on here.

First of all, don't go gang-busters on the exercises. All your knee needs right now is to be kept moving gently. If you do too much exercising, you will keep your knee irritated and inflamed, which is counter-productive.

It's not exercising the brings you your Range of Motion (ROM) - it's time. Time to heal, time for the swelling to go down. There's no deadline you have to met to achieve ROM, since it an continue to increase for a year or more post-op. We have multiple examples of that happening here on BoneSmart.

Quick question about CPM as I’ve now gotten mixed messages. The company of the CPM say this should be used 3x day for 2 hours. Pre surgical testing and my nurse at PT said, “use it if you want.” Anyone have any advice/input on how much I should be in the machine?
Of course the company would like you to use their machine as much as possible but, to be honest, the CPM machine isn't used much nowadays. Studies have shown that, while it may help with increasing ROM early in recovery, there is no difference in ROM at the end of a year between those who used it and and those who didn't.

Since your ROM was compromised before surgery and you did have adhesion from previous surgery, it is probably important to use the CPM to keep your knee moving , but the operative plan should be to only use it gently. Don't use it for as much time as the company recommends, just use it as you feel comfortable about it. Only set the bend to a degree that is comfortable for you, never to a degree that hurts.

Here are our recovery guidelines - lots of helpful articles:

Knee Recovery: The Guidelines
1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now, they are almost certainly temporary
2. Control discomfort:
rest
ice
take your pain meds by prescription schedule (not when pain starts!)​

3. Do what you want to do BUT
a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you​
b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.​

4. PT or exercise can be useful BUT take note of these

5. Try to follow this

6. Access to these pages on the website

The Recovery articles:
The importance of managing pain after a TKR and the pain chart
Swollen and stiff knee: what causes it?
Energy drain for TKRs
Elevation is the key
Ice to control pain and swelling
Heel slides and how to do them properly
Chart representation of TKR recovery
Healing: how long does it take?
Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

There are also some cautionary articles here
Myth busting: no pain, no gain
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds

We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery.

While members may create as many threads as they like in the majority of BoneSmart’s forums, we ask that each member have only One Recovery Thread. This policy makes it easier to go back and review the member’s history before providing advice, so please post any updates or questions you have right here in this thread.
 
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JeremiahD

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Great stuff to hear @Celle

I am someone who has a tendency to push things, so it is nice to get your advice/input, that, along with the other articles and threads have been extremely helpful.

keep y’all posted :)
 

Celle

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Try not to push things. This is a year-long recovery and nothing you do can speed that up. It takes as long as it takes, unfortunately.

It may help if you try to think of recovery as a marathon, not a sprint, so you remember to pace yourself.
 

LynetteCly

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I used my CPM 3xdaily, two hours each time, for three weeks. I know the research says CPM isn’t that effective.

I don’t know what it would have been like without it, But having read a lot of horror stories about people being unable to bend their knees, I was grateful to have it.

By the end, I was at about 115 on the bend and I pretty much stayed there. Initially, my swelling was enormous. Their suggestion to increase the thing by 5° a day was ludicrous.

I admit it was pretty awful, in terms of boredom. But I got hooked on a TV show I’ve never seen before. Don’t watch it much in general, but there are enough episodes of Chicago PD left to get me through my next knee, LOL.

Sounds like you’re doing great. Keep it up.
 

Kagabor

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Personally I liked the CPM machine. It seemed to loosen it up when stiff. I am 10 weeks out if TLK and about 5 weeks from my other knee. Don’t overdue it, speaking from an in shape super young ( for this type of procedure) patient. Swelling will sibside, and until that happens ROM won’t. Good luck!
 

Bum Knee

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I’m 13 weeks post op and am like you, I like to push myself. i did not use a cpm machine nor did I use outside therapy. I just did walking, exercises once or twice a day and worked myself up to a recumbent stationary after the first week. I’m almost at 100 percent with a unassisted rom of 120 and feeling great. My knee was severely bowed outward with a huge knot on the exterior of knee. Old BB injury from over 20 years ago. I’m 65 now.
 

Bob1653

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@JeremiahD Like you I had my TKR on September 8. The biggest issue I am having is the swelling that seems to significantly reduce how much I can flex my leg. My thigh feels extremely tight and sore. I had my first PT this past Thursday and my ROM was -1 and 101. Today was the first day I spent most of the day on my feet. I did ice and elevate a lot also today. Looks like full recovery is many months down the road, but I can already tell the joint pain I had before is gone. I'm trying to focus on the mini victory's. Right now I am just looking forward to the incision healing and the steri-strips coming off.
 
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JeremiahD

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@Bob1653 Good stuff! Sounds like we will be on the same timeline for the most part. Agree swelling is my worst part right now, which leads to pain/stiffness, which at that point kiss any ROM improvement goodbye.

Yep, like you just trying to take it easy the traditional ways (RICE). I’m getting around the house without much assistance from crutches anymore, but the wife is still running the household :)

Question for the group...

So I am now understanding why so many of you came hard in the paint, when it came to advocating for my recovery, before giving a damn about ROM. My PT office must be the poster child for the “No whining” “No pain, no gain” attitude.

Trust me, nobody wants my ROM back more than I do. But the more I read, it seems as though the “push past pain” attitude is silly and even counterproductive until my knee is more fully recovered. Correct statement? Peer reviewed articles and/or studies that back this up would be great reading material for me. Anyone have any other helpful links, other than what’s already on this board?
 
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JeremiahD

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Thank you all for the replies/thoughts on the CPM. I’ve been doing it once a day, for around an hour in the morning. Seems to help get me loose and going. Based on everyone’s feedback, sounds like 60 min per day is just fine/helpful :)

Thanks!
 

Jaycey

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“push past pain” attitude is silly and even counterproductive
You got it! Pushing only leads to more swelling which leads to pain. Remember you are not in training, you are healing from major trauma.

We base our recommendations on helping literally thousands of recovering members. Many times those who push have to back track and start again. The gradual approach - allowing the knee to heal and letting soft tissues settle works everytime!

I think you will fine more and more surgeons are recommending this approach with great success.
 

Oregon mom

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You've got a great positive attitude and a great wife. It sounds like you are really approaching this like the adventure it is.
I am 3 weeks post op with bilateral total replacements and aged 47 with a 7yo boy and great hubby. I also tend to push myself and it's been a new experience to allow myself to slow down just for a minute so I can heal. This site has been an absolute godsend for me in so many ways. But right now, I'm benefiting hugely from the support and information that encourage us not to push past pain, or even entertain pain.
Athletes can overdo it here because what's called for is really slowing down and paying close attention to the micro communication with your body, not the macro. I do believe that there is also an innate benefit for athletes in that we crave the pleasant physical sensations we get from healthy exercise. You know how a good deep stretch hurts in a good way? It's not really painful, but it's a different kind of feeling in your tissues. It seems to me that regaining ROM is very very similar. It's frustrating because I want to bend my knee all the way NOW. But if I slow down and just do a little stretch here and there it actually feels pleasant. And I've gotten from 50 to 90 all by myself in 2 weeks. In a way, this is a fun adventure because we're all getting a second chance at the lives we want to live.
 
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JeremiahD

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Incision is nearly heeled and pain is still being managed quite well...but a rough day nevertheless. PT was disappointed in my extension today (lack there of) at day 24. I get it...it’s bad...I can’t get past < 12 ish degrees.

Mentally this a tougher than I anticipated. I find myself in a constant struggle between giving my knee the rest it needs...and working on the extension that both PT and I want.

Swelling is still very present; even in a “calm” state, it’s much larger than my other knee. I don’t work on extension at home...cause it hurts...but then I feel silly at PT with a 2” gap under my knee.

Guess I’m just venting. Taking it easy this evening...
 

Jockette

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You are very early in this year long recovery and your PT is expecting too much. Doing painful things to increase your ability to get your leg flat is counterproductive. Causing pain also causes and maintains the swelling that is preventing that extension. It will come in time, as you heal and as your swelling goes down.

There is no rush to get your ROM back as it can/will continue to improve for a long time. My ROM improved after my first year, and, after my second year!
 

sistersinhim

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My extension was slower coming in than my bend. The only thing I did to improve my extension was to walk with a longer stride with a heel to toe gait. Walking with these longer strides helps to stretch out those huge muscles in the back of the knee. This doesn't happen immediately, nothing does, but it worked best for me.
 

Peaches0000

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It is such a fine line with PT, it is hard to find that balance, of doing to much or not enough. My extension was terrible on both knees, but from just walking around, it got better, but it took around 4 months on my May TKR to finally be normal. Don't be so hard on yourself , your swelling is keeping you from straightening it. My PT was never happy with me, but I got over trying to please him and everything has worked out in spite of my self induced setbacks.
 
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JeremiahD

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Morning!

Just checking in, letting everyone know that almost daily I am starting to feel better/stronger I’m back to doing most of my daily routines around the house, but still kicking my feet up in between to ice and relax.

ROM (especially extension) is still about 15 degrees is all I can muster on my own. It’s frustrating, not being able to straighten is really the only variable preventing me from a normal walk. I know the knee is still very much heeling, and it is still at least double the size of his brother with swelling...so patience. Still stinks...

One question (see attached pic). There is a small string (looks like a candle wick) pushing through my scar. I have a doc appt next week, so I will obviously ask then, but has anyone else experienced this? Is it a stitch pushing out?
 

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sistersinhim

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Stitches working up isn't that unusual. I think you should leave it alone and wait for your doctor's appointment for him to take care of it.
 

Starsfan22

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I had a stich work it's way out too. I just pulled it out :)
 

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