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TKR June TKR newbie

Disney Mom

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Hi...I am new to this forum. I had right TKR on June 22, 2020. I am having a lot of right leg pain and hip pain and I google for answers and don't find much. My physical therapist mentioned last week that since my knee is only bending to 95 and a bit more with her help, that manipulation could be in my future although she isn't sure. UGH. I don't think I could go through all of this again. My knee is very stiff and the exercises she has given me to help with the stretching hurt a lot. I am discouraged and seriously thought that by now I would be doing better. I had an MRI done of my hip this past Friday but haven't heard anything. PT also wants me to cut back on pain meds. I have cut back to 2 percocet a day and take 600 mg ibuprofen every 6 hours although even when I took more meds, I didn't think it did much. I can't sit or lay in any position for very long til it is so uncomfortable I have to move around. I ice 3-4 times a day.

Sorry I am all over the place. I really fee like I need to speak with people who have been through this or going through this. My husband is very supportive but people can't understand if they haven't been through it. My 89 year old Mother has had TKR twice and I am certain that I didn't feel bad enough for her at the time since I have experienced it.

Thank you to anyone that replies.
 
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Pumpkln

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@Disney Mom,
Welcome to BoneSmart, glad you joined us! :welome:

My physical therapist mentioned last week that since my knee is only bending to 95 and a bit more with her help, that manipulation could be in my future although she isn't sure.
Your ROM of 95 degrees is fine, anything past 90 degrees does not require a MUA.
My knee is very stiff and the exercises she has given me to help with the stretching hurt a lot.
Suspect these exercises are irritating your knee, causing increased pain, inflammation, and swelling, blocking your ROM.
What your knee needs right now is a break from all the stretching and trying to increase your ROM. Give your knee a chance to heal, let the swelling go down and your ROM will be there, as it has been all along. Take a break from PT so your knee can have a chance to heal. Saying no to therapy - am I allowed to?
We recommend these two gentle activities for ROM.
Heel slides and how to do them and Extension: how to estimate it and ways to improve it .
PT also wants me to cut back on pain meds.
Some of us need pain medications for the first 3-4 months, as the pain and swelling goes down you will wean off naturally. No need to go through un necessary pain.
I can't sit or lay in any position for very long til it is so uncomfortable I have to move around. I ice 3-4 times a day.
Once your pain is under control and your knee has a chance to heal, you will find you can sit and rest for longer periods of time.
Be sure to read the article about ice in the Recovery Guidelines.

Here is your copy of the Knee Recovery Guidelines, the articles are short and will not take long to read.

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. At week 4 and after you should follow this

6. Access 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 a 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 history before providing advice.
 

Jockette

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Hi and Welcome!

You have come to the right place for support and camaraderie. We have all had a joint replaced and we felt just like you do right now.

The good news is, it honestly does get better. But, it takes a long time. This recovery takes an average of a year, though you’ll feel much better long before that.

Part of the reason your pain is so high is your PT. PT for a knee replacement should not be painful. I agree with Pumpkln, take some time off from formal PT and give your knee a rest from those painful exercises.


Regaining our ROM is more about Time than repetitions of a list of exercises.

Time to recover.
Time for pain and swelling to settle.
Time to heal.

Our range of motion is right there all
along just waiting for that to happen so it can show itself.

In the general run of things, it doesn't need to be fought for, worked hard for or worried about. It will happen. Normal activity is the key to success.
 
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Disney Mom

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Thank you for your replies. It is hard to think that laying off pt and exercises are the right thing to do when that is all that we are told by the therapist and the surgeon. I think the hip pain started with the cpm machine they sent me home with and insisted I do for at least 2 hours a day. It has progressively gotten worse.
 
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Pumpkln

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It is hard to think that laying off pt and exercises are the right thing to do when that is all that we are told by the therapist and the surgeon.
All the PT and exercises have gotten you are pain, stiffness and the threat of a MUA, perhaps it is time to try something else.
Giving your knee a break does not mean you are doing nothing, the activity you do around the house and the two gentle ROM exercises I gave you are plenty while you are letting your knee heal.
 
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Disney Mom

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I appreciate your help....I hope that didn't sound like I was discounting what you said. It is just new to me was all I was meaning...PT never tells me to go rest. Instead she has me lay on my stomach and tie a sheet around my ankle and then pull on the sheet until tears stream down my face and hold it for 30 seconds 10 times. That one has to be the worst. I have to say though, my tightness goes away some afterwards but doing it is sheer agony. Then the tightness comes back very soon.
 

Pumpkln

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Instead she has me lay on my stomach and tie a sheet around my ankle and then pull on the sheet until tears stream down my face and hold it for 30 seconds 10 times. That one has to be the worst.
Recommend you ask for a new PT, she sounds like she is out of date with the latest Rehab protocols.
That stretch could be irritating your hip as well.
A gentle sustained stretch is what will get you more ROM, which you can do yourself.
Heel slides and how to do them.
 
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Disney Mom

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Thanks again....also, my knee was really bad for quite sometime before I had the surgery. I probably should have had it a couple of years before I did. My ROM wasn't good at all before and bending my knee was very difficult and only went so far then. I am wondering if that is why it is so difficult now. For some reason, I thought that after having it replaced, that it would be like my other knee and I would be able to do normal things. Obviously it hasn't been that long since the surgery and I didn't expect it to happen overnight but I definitely thought it would be better than before. Maybe it will in time.
 

Jaycey

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@Disney Mom just a couple of points for you. First, PT has no business telling you anything about medication. Your surgeon or your PCP are the only people who should be recommending anything concerning pain meds. Take your prescribed dosage for now. You need the medication to continue to gain mobility.

Second - you will continue to gain ROM for a very long time. This process takes years, not months. Below are a couple of examples from members who tracked their ROM gain and their comments:

Here is betrtschb's record of how his flexion developed over time:
I'm 12 months out from my surgery and have some advice based on my experience:
1- Stop going to PT (all it will do is make your knee swell and reduce ROM)
2- Don't worry about your ROM
3- Be patient - VERY patient!!!

Here is my ROM history (more or less):
1 month - 60 degrees
2 months - 80 degrees
3 months - 85 degrees
4 months - 90 degrees
5 months - 90 degrees
6 months - 110 degrees
7 months - 120 degrees
8 months - 125 degrees
9 months - 130 degrees
10 months - 135 degrees
11 months - 140 degrees
12 months - 140 degrees

I spent waaaaay too much time worrying about ROM. I thought I'd be riding my bike a couple months after surgery but it took SIX months! Looking back on my surgery, if I knew then what I know now, I wouldn't have wasted my time with PT and I wouldn't have worried about ROM.


And I have another record, from Campervan - she discovered that her flexion had increased even at 6 years post-op:
"I had a slow recovery. Here's my flex measurements at various points:
92 - 8 weeks post op
105 - 10 weeks
107 - 5 months
110 - 6 months
112 - 7 months
116 - 9 months
119 - 11 months
118 - 1 yr
120 - 1yr 2 months
125 - 1 yr 8 months
128 – 6 years "
 

sistersinhim

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PT never tells me to go rest. Instead, she has me lay on my stomach and tie a sheet around my ankle and then pull on the sheet until tears stream down my face and hold it for 30 seconds 10 times. That one has to be the worst.
This is horrible therapy for a replaced joint. Swelling and pain are what is keeping your knee from bending more. As that goes down, your bend will increase. I agree that you need a different PT. The up to date PT know that aggressive PT doesn't work for a knee replacement. Your current PT needs to go back to school and learn the newest techniques.

Many of us never took formal PT or did exercises. I am one of them. I had 12 knee surgeries, 2 of them kneecap removals and 1 tkr. Even after those I never took formal PT. But, I didn't just sit around and do nothing. I used my knee as it was intended to be used by walking around to take care of my daily needs. As I healed I was able to do more. Icing and elevation was a huge part of my recovery.

Listen to your knee. It will tell you if you're doing too much by increased pain and swelling. When that happened to me, I found that resting, icing and elevating helped. Your knee knows how to rehab itself without being told what to do.
 

Pumpkln

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My ROM wasn't good at all before and bending my knee was very difficult and only went so far then.
Your pre operative ROM is one of the most important variables in your post operative ROM. Your expectations should be for the ROM you had pre surgery. You may achieve more with time as Campervan and @bertschb did.
 
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Disney Mom

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Thanks again everyone. Any advice on how to get some sleep? I try to put a pillow between my legs...which I did for years before the surgery but it gets pretty painful after a short time. Sleeping on your back all the time causes your back to be sore too.
 

WhenImOld

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Hi there. I'm exactly 8 weeks tomorrow and I rarely sleep a full 6 hours, let alone 4. Build a pillow nest and rearrange as needed :hugzz:
 

Jockette

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I was always a side sleeper before this surgery, but I have since become a back sleeper. I sleep with my legs elevated on a foam wedge, and that took the pressure off my lower back.
 
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Disney Mom

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It feels good to lay on my side w pillow between my legs...operative knee up of course. After maybe 10 min or so though it starts to ache and when I roll back onto my back...it is really sore and I wish I hadn't done it in the first place. I am 7 weeks today so we are about at the same place. How is your ROM and are you doing standard pt?
 
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Disney Mom

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I was always a side sleeper before this surgery, but I have since become a back sleeper. I sleep with my legs elevated on a foam wedge, and that took the pressure off my lower back.
Do you have a link or pic to the foam wedge? I dont seem to be comfortable even with it elevated on a pillow at this point although early on i used a pillow. In one of the links above they have a pic of a foam wedge that kind of curves like a wave and i tried to find that on Amazon or anywhere and don't seem to find something that shape. I too am a side sleeper but usually end up on my back. All this back laying is giving me a sore back though.
 

sistersinhim

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It does get better. Right now, sleep anyway and anywhere you can. When you're sleeping your body is concentrating on healing your knee even more.
 

amynewleftknee

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Thanks again everyone. Any advice on how to get some sleep? I try to put a pillow between my legs...which I did for years before the surgery but it gets pretty painful after a short time. Sleeping on your back all the time causes your back to be sore too.
One position that’s comfortable for me is on my back with the heel of my recovering leg hanging just off the edge of the mattress. It’s a new position for me. But my knee is comfortable with it!
 

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Hi @Disney Mom! I am sorry you are struggling so much! I can relate to several of your posts, as I am 2 days behind you. This however is my second rodeo lol had my right done in Nov 2017 and left June 2020.

It sounds like your PT is not the best place for you. Perhaps find another one if you can, or take a week off if you have to stay.Remember they work for you, so you can say no! I go to pt twice a week, we do a lot of massages, stretches, walking and such but no terrible exercises like you have been doing.

I am a terrible pt patient lol I do minimum exercise at home because I know I will recover as long as I move about my house. I do heel slides occasionally, work on my bend when I am sitting upright, leg extension/leg raises while I lay down. Other than that and just walking around my house, I do nothing else.

I have got myself down to taking percocet twice a day, when I wake up if needed or a couple hours later and at bed. I use Tylenol otherwise. I ice and elevate off and on all day. If I am not up moving, I am icing and elevating.

My ROM today was 95 without any help passively. I was at 78 when I started 2.5 weeks ago at outpatient pt. My extension continues to improve as the swelling goes down. The extreme exercises they have you doing is not helping the swelling, therefore your rom and extension are not where they could be. I really suggest taking a week off and icing and elevate and re-acess the next week. I did not start formal outpatient pt until week 4. I had 2 weeks of home health pt, week off and then started pt.

There are going to be setbacks here and there but don’t get discouraged. Read some recovery threads and see the ups/downs we all have.
 

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