PKR JusticeRider’s rehab adventure

[benne68]

I'm so sorry this happened to you, @JusticeRider. I think some surgeons are more like mechanics than doctors and forget they are dealing with human beings. We are not machines and this isn't car repair!

You are right: we have plenty of members who were no where near that 120 flexion number at 2 months post-op. I'm one of them -- and now, a year out -- my bend is better than 130.

This is your recovery and only you can decide what is right for you. Be assured that we are here to support you, whatever you decide.

Sending hugs

 

[Jockette]

He said it was very unlikely and we had limited time to get it back

This is absolutely not true.

Myth busting: "window of opportunity" in TKR

This "six week window of opportunity" surgeons often speak about is little more than a myth. It presupposes that all patients have the ability to create adhesions which is far from the truth. It also ignores the simple fact that in the first 3-4 weeks after surgery, swelling reactive to the...

bonesmart.org

but inside I was thinking angrily, “I DON’T WANT TO DO THAT! I don’t HAVE to do that. This is MY body. They can’t make me do that!!!”

I agree with you. This is your decision, not theirs. They can recommend, but you don’t have to agree. They can’t do an MUA without your written consent.
Saying no to therapy - am I allowed to?

It is way too early in your recovery to consider an MUA. Your “lack” of increased ROM is due to swelling, and an MUA does not make the swelling go away.

Regaining our ROM does not require forceful bending or 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.

 

[JusticeRider]

Thank you both. I feel like I need to keep hearing that, over and over. Because the dr’s keep the pressure on and I try to ignore it, but it gets in your head, you know? And that nagging doubt…what if they’re right and I make the wrong choice and I end up a 45 yo cripple?? I know the post op depression can mess with your head that way too. Please keep the positive messages coming to counteract the others! I really appreciate this forum and the people who unselfishly take the time to encourage others.

 

[Jockette]

6 weeks post op is so early in this recovery that takes an average of 52 weeks.

If it was me, and knowing what I know now, after 5 years on Bonesmart, I think I would stop going to PT, and I would also postpone some appointments with my surgeon, until I was in a better place ROM-wise. You are not going to change your medical team’s minds and they will continue to cause you stress.

At some point in my recovery it was suggested not to keep my 7 month OS appointment, but I was too afraid not to. I no longer feel that way.

This is what one of our members, TortiTabby, experienced:

(Just so you know, ADL means Activities of Daily Living.)

“At my six week appointment this is what my OS wrote in my visit summary: "She reads an online website called Bone Smart which states to not push through pain following knee replacement. If she were to follow this direction, she will have to learn to live with a knee that only reaches to 85 degrees of flexion. I believe this website is very misleading."

It has now been 20 weeks and all I do is ADL and this is what my ROM has done:
3.5 wks: 75
6 wks: 85
7 wks: 90
10.5 wks: 95
14 wks: 100
17 wks: 105
20 weeks (where I am today): 110
I am so thrilled it keeps improving and improving and I know now that I will get to my goal of 120 (or even better, dare I say!)
So, if a OS or PT bullies you into thinking your ROM will not improve over time they are wrong. By the way, I haven't been back to see the OS since that horrible appointment at 6 weeks, but I sure am going back when I reach 120 just to say, "Ha! You were wrong, BoneSmart was right!" “

And,

“Just an update for those who are apprehensive about gaining ROM:
It has now been 26 weeks and all I do is ADL and this is what my ROM has done:
3.5 wks: 75
6 wks: 85
7 wks: 90
10.5 wks: 95
14 wks: 100
17 wks: 105
20 weeks: 110
26 weeks (where I am today): 120!!!
I did it! My goal of 120! No "pushing through pain", no PT after the first 3 visits, and most importantly to me: No MUA! My surgeon who said I would never get beyond 85 ROM without pushing through pain was wrong, wrong, wrong. I'm excited to see if it gets even better. “

 

[JusticeRider]

I was actually thinking I might take the next 2 weeks off of PT. Cancel all my other appointments for the next two weeks to give my knee a break from driving. I live in the country, so a lot of my appointments are around 40 minutes away. (I usually have something 4-5 days a week).Maybe I’ll just take a couple trips to the IGA right down the street to practice walking with the shopping cart. I don’t know what to do about the weekly updates the PA requested. Lie? Haha. I’m not usually so conflict averse but something about dr’s is intimidating! I took a screenshot of TortiTabby’s post and I will read it when I need a confidence boost.

 

[Jockette]

I don’t know what to do about the weekly updates the PA requested. Lie? Haha.

There is no need to lie to the PA. It’s your knee. No need to say anything. If at the next appointment they ask, tell them you feel it’s in your best interest to take a break from PT.

I understand being intimidated by your medical team, I was, too. But that was then, and after 5 years on Bonesmart, I now know I have a choice, and how I ”rehab” my knee is my decision and no one else’s.

Have confidence in your own common sense in taking care of your knee.

 

[Layla]

I would suggest you be firm, but honest. It will feel empowering, rather than lying. It is your body and your choice, no one can tell you how to recover.

I’m not usually so conflict averse but something about dr’s is intimidating!

You're not working for him. He's working for you. Bring someone with you if possible, you'll be less likely to feel intimidated. Don't be afraid to agree that you disagree as we can do so politely. Be brave. Good Luck!

 

[JusticeRider]

I don’t think I could bring myself to lie anyway! But it is going to be very awkward. And honestly, it would be easier if they were just mean jerks. Then I would just tell them off! But even though I don’t want to do what they say, both my surgeon and the PA are actually very sweet. My PT as well. Jockette and Layla, thank you for the pep talk. I guess I’m just going to have to try to reach down inside and find some more bravery.

 

[Layla]

You can do it!

 

[JusticeRider]

Quick question for you all. Does anyone have any knowledge about autoimmune disorders as relates to post surgical swelling and inflammation? I have borderline lupus, and I don’t think about it often because so far I have very few symptoms. But today researching things to do for swelling, I stumbled upon a mention of lupus being a cause of inflammation and joint swelling. I’m wondering if that could be part of what’s going on with my knee?

 

[Jockette]

This is one reason it’s too early to consider an MUA. We don‘t all recover in a cookie cutter fashion. It’s also another reason we shouldn’t compare ourselves to other people’s recoveries. Maybe the lupus is contributing to your swelling. Is your surgeon aware of your borderline lupus? It may not affect his opinion, but maybe he should know about it.

 

[JusticeRider]

Jockette, I don’t think he knows. My PCP knows, obviously, but as far as I know the only info he got from her was a basic form she had to sign attesting that I was healthy enough to have surgery. And it’s never really come up. But yes, I think you’re right and I should mention it to him. It would explain a lot. My PT said ‘Your knee just likes to swell’ and I thought it was funny but I guess there might be a reason for that I hadn’t thought of.

 

[JusticeRider]

Happy news! My sweet husband knows I have been struggling, mentally and physically. He went online and found shorter crank arms to fit the pedals on my stationary bike, ordered them, and installed them. So now the rotation to turn the pedals is a smaller diameter…which I just discovered means I can turn a full rotation backwards!! So I can actually use my bike without feeling discouraged! Yay hubby!

 

[Mouser]

Hey JusticeRider, Hang in there. The exercise bike has really help my ROM before and after surgery. Just take it slow and recognize the little improvements. Just think of how it was earlier in your recovery compared to now. I am sure progress has been made. Please try to focus on that when others tell you where they think you should be. Sending good vibes your way...you can do this!

 

[JusticeRider]

Thanks Mouser! Good vibes are much appreciated

 

[sistersinhim]

Flexion is 90 if really pushed. You can guess what he said. They are not happy with my flexion. They want me to push through the pain to get my ROM. He said it might have to be extremely painful for a while. He said they want an update every week and would expect 120 degrees flexion in two weeks and if it’s not at least 110 they will want to do MUA.

Most OSs don't even consider a MUA once your bend reaches 90 degrees. I suggest you just ignore your PA's order for an update every week. That is ridiculous. There are changes in the swelling in the knee up and down for months yet and you are in the early days so it's going to swell. Don't bother to call or text with any info. To forcefully try to increase your bend will have the opposite outcome. It will inflame your knee which will cause it to swell more which will decrease your bend. It is a cause-and-effect thing. Rest and ice that knee. Just do your daily activities and your ROM will come in nicely. There is no need for PT for more people.

inside I was thinking angrily, “I DON’T WANT TO DO THAT! I don’t HAVE to do that. This is MY body. They can’t make me do that!!!”

You are exactly right! Just try and ignore them. If anyone puts their hands on you after you told them not to, that is assault, and tell them so! So far as a MUA goes, you are already hitting that 90 degrees so just refuse. As you say, it's your knee!

Why do they do this to us??

I wonder that myself. We have seen over and over again on here that forcing and over-exercising an inflamed knee does not help most of our members. We have been through 1000s of recoveries with 1000s of members and what works for that individual is what works for them. No two recoveries are exactly the same. What is the same for most is aggressive, painful exercises, and pushing the leg does not help with healing a knee.

I stumbled upon a mention of lupus being a cause of inflammation and joint swelling. I’m wondering if that could be part of what’s going on with my knee?

I think swelling at your stage is completely normal. It would be a good thing to text or message your doctor and tell him so your borderline lupus can be added to your chart. My dad had lupus and what you are saying doesn't sound like what he had.

 

[JusticeRider]

Thanks, sistersinhim. I’m gonna hold strong on the MUA. I’m not going to do it. I think they’re expecting more because of my relatively young age, but it is going to have to heal in its own time. As for the borderline lupus, I had never considered it a factor in my joint pain because I had wear and injuries that caused mechanical damage to my cartilage, and because I only have a few other symptoms and the positive ANA test. So I’m considered borderline and it is something I don’t think of often. But trying to resolve this swelling had me searching around and I thought it was interesting that that came up. I am taking the week off of driving since that seems to aggravate it, and just being kind to my knee. It is doing its best! So hopefully things will improve.

 

[Jockette]

But trying to resolve this swelling had me searching around and I thought it was interesting that that came up.

Could you find that article again and PM me a link? I’d like to look at it.

 

[kneeper]

To my knowledge joint inflammation can be a symptom of lupus but you've just had surgery and so will be dealing with normal post surgical swelling. I can't say my swelling was any worse because of my RA.
There are a lot of individual factors in who has swelling hang on that may have nothing to do with your other medical issues.
It's still early days. Just keep up your focus on ice, elevation and gentle ROM exercise.

By the way, I was still fairly swollen at 6 weeks but in the next couple my swelling started to come down more and I gained bend.

 

[JusticeRider]

Good to know, kneeper! I hope mine will do the same. Jockette, it wasn’t so much one article as just something that kept popping up in reference to swelling in the joints. So it piqued my curiosity. Although I didn’t see anything about post surgical swelling specifically, so I wasn’t sure if it was relevant to me or not.
As I read the comments here, I am feeling more peace and acceptance with where my knee is at. Hopefully I can hold onto that! Sometimes I just have to actually say out loud to myself ‘it’s going to be ok’. Haha, I’m going to get caught talking to myself and my neighbors are going to think I’m crazy (-;