TKR kathyjo007's recovery thread<

[kathyjo007]

So glad to have found this site! I’m just getting by right now, frustrated because recovery is so slow and yet trying to manage the many daily excercises recommended by my surgeon’s office. At three weeks I had 110 degree flexation with lots of thigh pain and nighttime nerve pain surrounding the incision. As this is my first TKR I was surprised by my level of exhaustion with minor daily efforts. This site is hugely beneficial at setting my mind at ease and allowing my healing journey to occur at my body’s pace.

 

[Pumpkin]

@kathyjo007
Welcome to BoneSmart, glad you joined us!

yet trying to manage the many daily excercises recommended by my surgeon’s office.

Suggest that you do not need to do these exercises every day, give yourself days off between doing the exercises.
For the most part the walking you do around your house is enough exercise in the early days.
You can do these two gentle exercises 1 - 2x a day.
Heel slides and how to do them and Extension: how to estimate it and ways to improve it .

Here is your copy of the 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
elevate
ice
take your pain meds by prescription schedule (not when pain starts!)
don't overwork.​

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

the BoneSmart view on exercise
BoneSmart philosophy for sensible post op therapy​

5. At week 4 and after you should follow this

Activity progression for TKRs​

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.

 

[deedee65]

This is so helpful! I had a LTKR on Monday, November 26, 2018.

 

[Pumpkin]

@deedee65 ,
Why don't you start a thread in the recovery forums and tell us more about yourself.
Starting a new thread and posting
I have added your surgery date to your signature for you, thanks! Having the exact date will help us properly advise you.

 

[Josephine]

@kathyjo007 I'd really like to offer you some structured advice but in order to do that, I also need to ask you some questions. Are you willing for me to do that?

 

[kathyjo007]

Yes I’d be more than happy to answer some questions.

 

[Roy Gardiner]

surprised by my level of exhaustion

Don't be. At the moment your body is taking all the resources available to heal, leaving as little as possible over. This is a good thing!

yet trying to manage the many daily excercises

Good news. Don't sweat it, exercise is useful in moderation but not essential, less is more!

 

[kathyjo007]

So glad to have found this forum as it is allowing me to feel normal versus struggling with post surgical expectations from my surgeon’s office! I’m now into week 5 of my recovery and I’m finally starting to adjust to the realization that this noisy joint is mine. Yes it clicks and clacks sometimes (Zimmer joint) and my surgeon’s office said this will dissipate as my muscles around it become stronger.

I’m off all narcotics since week 4 and instead taking 1000 mg of Tylenol as needed. I’m definitely feeling much more clear headed! Sleeping is still a huge challenge as I’m a side sleeper trying to change my nighttime world to become a back sleeper. Most nights result in about 6 hours of sleep and 3 hours of tossing, turning and pillow adjustments.

I have an ice machine that I’m using faithfully every 2 daytime hours. I only periodically elevate due to needing sofa space for my 4 month old puppy to lie beside me. Daily exercises are consuming at least 1½ hours of my day as recommended by surgeon.

I’m finding my knee is ranging from fairly tight upon waking to ready to burst at bedtime. Besides this I have what I suspect is night time nerve pain on the outside of my knee. I know this sounds weird but I’m wrapping the knee in plastic wrap to sleep and it’s helping the nerve pain. Saw it on YouTube. Does this sound reasonable?

 

[bottomshollow]

@kathyjo007, from the November Recovery Club thread into your own recovery thread where it properly belongs. You and your questions and concerns will get the attention they deserve here. The recovery club thread lets members see who's had surgery the same month they did. Questions, observations, experiences should be shared in each member's own thread.

 

[Jockette]

Sleeping is still a huge challenge as I’m a side sleeper trying to change my nighttime world to become a back sleeper.

I was always a side sleeper, too, until I couldn’t due to this surgery. What helped me sleep on my back was to elevate my leg all night, and eventually I put both legs on my wedge and I’m very comfortable on my back like that all the time I’m sleeping.

Daily excercises are consuming at least 1.5 hours of my day as recommended by Surgeon.

This is way too much and most likely is causing this:

I’m finding my knee is ranging from fairly tight upon waking to ready to burst at bedtime

Take a break from those exercises. Keep in mind, it’s not exercising that gets our range of motion back, it’s Time:

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. Exercise as in strength training is counter-productive and in the early weeks does more harm than good. Normal activity is the key to success.

 

[Josephine]

Daily exercises are consuming at least 1½ hours of my day as recommended by surgeon.

So what kind of exercises - and how many - are you doing?

I’m finding my knee is ranging from fairly tight upon waking to ready to burst at bedtime.

At 5 weeks out, I would imagine your activity is somewhat excessive which is why your knee is hurting.

I have what I suspect is night time nerve pain on the outside of my knee.

I think that might be Numb area after TKR: how long will it last?

I’m wrapping the knee in plastic wrap to sleep and it’s helping the nerve pain. Saw it on YouTube.

Indeed it does! We have that vid in our Library!
Night pain solutions using moist heat and clingfilm


I'd really like to offer you some structured advice but in order to do that, I also need to ask you some questions. Are you willing for me to do that?

 

[kathyjo007]

Thank you for the all information!

In addition to walking 45 minutes per day my recommended daily excercises include 4 sets of (10-30 of each).
1. Heel slides
2. Simple thigh squeeze
3. Thigh lift
4. Harder thigh sqeezes
5. Sitting knee straitening
6. Sitting knee bend
7. Standing knee bends
8. Standing knee lift
9. Mini knee bends
Excercises to improve recovery:
10. Knee straitening with band
11. Knee bending with band
12. Sit to stand
13. Lying on stomach knee bend
14. Lying on stomach knee stretch
15. Sitting knee stretch
16. Straitening knee with band
17. Step up step down
18. Split squat lunge
19. Calf stretch
Needless to say after all these I’m tired and very sore!

 

[sistersinhim]

I’m finding my knee is ranging from fairly tight upon waking to ready to burst at bedtime.

All those exercises? You have got to be kidding! No wonder your knee feels ready to burst at bedtime! I didn't do a single one of them and my knee rehabbed just fine! I just did my daily activities.

 

[Josephine]

I totted up this list and it looks like you are doing over 2,000 reps a day! Not even an Olympic athlete would do that much! But let me give an opinion on each of these considering you are only 7 weeks out.

walking 45 minutes - that's actually far too much. Read this article Activity progression for TKRs
Heel slides 4 sets x10-30 - these are largely unnecessary, specially at 7 weeks and that number is outrageous. No wonder you have pain! Read this article Heel slides and how to do them properly
Sitting knee bend 4 sets x10-30 - same as above
Standing knee bends 4 sets x10-30 - same as above
Mini knee bends 4 sets x10-30 - same as above
Knee bending with band 4 sets x10-30 - same as above but NEVER use straps, bands or weights
Lying on stomach knee bend 4 sets x10-30 - same as above
Lying on stomach knee stretch 4 sets x10-30 - same as above
Straitening knee with band 4 sets x10-30 - same as above
Split squat lunge 4 sets x10-30 - same as above
Step up step down 4 sets x10-30 - same as above

Simple thigh squeeze 4 sets x10-30 - irrelevant for knee
Thigh lift 4 sets x10-30 - I'm assuming you mean a straight leg lift. Well once you can do these, you no longer need to do them!
Standing knee lift 4 sets x10-30 - same as above
Harder thigh squeezes 4 sets x10-30 - irrelevant for knee

Sitting knee straitening 4 sets x10-30 - this is also called extension but I wouldn't recommend them as most 'extension' exercises only cause more swelling and this block the ROM
Knee straitening with band 4 sets x10-30 - same as above but NEVER use straps, bands or weights
Sitting knee stretch 4 sets x10-30 - irrelevant
Calf stretch 4 sets x10-30 - the only one I'd say yes to but cut the number to about 3 reps x 4 times a day.

Where I have just said 'irrelevant' I mean that those exercises are only likely to cause more pain, swelling and similar issues. They definitely don't help the knee to heal! That's because it's not the exercising that gets you your ROM, it's time. Time to recover, time for swelling and pain to settle and time to heal. One thing that seems to be missing from all the PT's protocols is that all your ROM is there right from the start, just waiting for all 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. Exercise as in strength training is counter-productive and in the early weeks does more harm than good. Normal activity is the key to success.

There are many members on this forum (including me!) who have done their recoveries but with NO exercises whatsoever! It's a fact that has been proven over and over again here, that while PTs might tell you that you have to 'work hard' and have a 'no pain, no gain' approach, neither of these is true. In fact, they are positively harmful!

Needless to say after all these I’m tired and very sore!

I am not in the least surprised! My only amazement is that you can still walk at all!

I'd really like to offer you some more structured advice but in order to do that, I also need to ask you a few more questions. Are you willing for me to do that?

 

[Roy Gardiner]

Goodness me.

What you are doing is training, and healing and training are different http://bonesmart.org/forum/threads/post-operative-exercise-–-the-bonesmart-view.25463.

You don't need to do ANY training, as Jo points out. Gentle mobility stretches are all you need.

 

[kneeper]

Josephine has given you good advice above, of course.

I'm one who did do some exercises and found some of them helpful, but I never did more than about 5-10 reps at a time and no more than 2 sets of anything a day. In fact though my PT for knee #2 gave me a list (not nearly as long as yours), she said to mix'n'match and not do them all in one day. I did some heel slides every day, but nothing too intense. I might do 2 exercises a day and a short walk--increasing the time as the knee tolerated.
​

Any type of squats or standing knee bends or lunges can be very hard on the knee & sensitive tissues early on (meaning the first several months). I learned that the hard way with knee #1 when I was trying to be "compliant."

I refused squats and the like with knee #2 and actually healed as well or better than with Knee #1. People know this is my hobby horse, because I wound up with tendonitis from the squats and overdoing with with knee #1's PT and I want to save people unnecessary pain and suffering. I found that your leg strength comes back as you heal and are able to do more daily activities. It is a pretty natural process actually.

I did do your #13 but not as something to pull the leg to get more bend. It was more of a muscle stretch and as my PT explained it if you use a band at all it is to allow the leg to relax in position, not to pull it. (I tend to get very tight muscles so learning a few gentle stretches was good for me in general.)

Walking is good for recovery but 45 minutes per day at your stage sounds extreme. Even if you can do it, that doesn't mean you should. In fact your knee seems to be giving you those clues.

​

 

[forbesy]

Hi @kathyjo007 it sounds more like you have been sent to a boot camp than sent home to recover. I will echo what others are saying and you need to minamise your exercise and take things easy or even to give yourself a couple of days break to get things back on track. I use a skateboard while sitting on a chair which helps pull and push the leg without dragging it back.

 

[kathyjo007]

All your replies have been timely and so appreciated! I nearly stopped the above vigorous routine about 48 hours ago and found that last night I was actually able to sleep without pain meds. I am elated and my knee is feeling great! I am continuing with some of the strengthening exercises but not to the point of pain. A TKR for a first timer can definitely be overwhelming, frightening and totally exhausting. I am also using the Plastic Wrap trick during the day and night finding it keeps my nerve pain down considerably. I am struggling with the noisy prosthetic joint yet though. Will this diminish eventually?

:tree lights:

 

[Jockette]

I’m glad you’re feeling better, but you really should wait until about 3 months post op to do any strengthening exercises. Right now there’s not been enough healing for that.

Your knee/leg will strengthen on its own as you heal and are able to do more daily activities. Walking, but not to excess, will also strengthen your leg. Extra strengthening can be done later.

 

[schpooko]

HI, I am post op Week 11 and please do yourself a favor and take the advice listed above. I did no PT. I had a home PT come 2 times the first week I was home after surgery and then told her she did not need to come anymore. Then I only went to Outpatient PT once and I never went back to them again. The best advice Bonesmart has given me was to let my knee heal and only do ADL's. That advice helped me so much. I have no ROM problems, no swelling and I am able to walk grocery stores and do the recumbent bike, etc...

This forum is an abundance of info and great info at that...