TKR Katt’s Recovery Journey

[Katt]

So happy to find this forum and thread. Had my RTKT 07/ 27. My swelling is slowly going down. I saw the surgeon yesterday and he is happy my bend is at 93-95. He also said sweeling will last months and recovery up to a year. He seems very balanced in his approach.I was concerned because my PA I saw at 2 weeks said I only had 6 weeks to get to 120 and that scar tissue would prevent further bend. It's amazing that there are such differing opinions within the same practice.

I gently push myself, but not to the point of pain. I can ride the bike 10-12 minutes with discomfort. No more pain meds. I could use them occasionally, but the tylenol appears to be giving me a headache and advil upsets my digestive issues. My leg still feels tight which I think is normal.

 

[Jockette]

@Katt Hi and Welcome!

I’ve started a recovery thread for you so the history of your journey will be all in one place.

It sounds like you have a great surgeon with reasonable expectations for recovery. I hope the PA will learn from this surgeon!

I will leave you our Recovery Guidelines. Each article is short but very informative. Following these guidelines will help you have a less painful recovery.

Just keep in mind all people are different, as are the approaches to this recovery and rehab. The key is, “Find what works for you.“ Your doctors, PTs and BoneSmart are available to help, but you are the final judge as to the recovery approach you choose.

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.​

​

If you want to use something to help heal the incision, ​

BoneSmart recommends hypochlorous solution. Members in the US can purchase ACTIVE Antimicrobial Hydrogel through BoneSmart at a discount. Similar products should be available in the UK and other countries.​

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​

6. Access to these pages on the website

​

Oral And Intravenous Pain Medications​

Wound Closure​

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.

 

[Jockette]

I was concerned because my PA I saw at 2 weeks said I only had 6 weeks to get to 120 and that scar tissue would prevent further bend.

Just to let you know, my ROM improved quite a bit in my second year, as my whole leg continued to relax and heal, and it even progressed a bit more in my third year!

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

 

[Susie-Q]

My leg still feels tight which I think is normal.

Yes, totally normal. You are only a little over a month into a 12 month recovery. There is no need to push yourself to the point of pain. That tightness is swelling and the more you push your knee, the more you will have continued swelling. Gentle movements and stretches while your knee is healing and activities of daily living (ADLs) are all you need at this early stage. Continue to ice and rest your baby knee as much as you can.

Best wishes on your continued recovery! Keep us posted on how you're doing.

 

[mendogal]

I add to the above excellent advice: there's a big difference between stretching/flexing a swollen, upset joint (which just further upsets it!) and simply slowly and gently letting it relax and move through its comfortable range of motion. I have found the latter to be very good to temporarily relieve stiffness especially just before getting up to walk.
In the first couple of months I do some heel slides, done only to the point of comfort, as well as a combination of active and passive (using both hands) ROM. With my over 6 month old knee, which gets quite stiff with inactivity, I still do active ROM.

 

[Katt]

Thank you for all the helpful links. I have visited the library several times and gotten some great information. I go to physical therapy weekly and my physical therapist works on ROM and stops when it becomes too painful. In the last few weeks, I have developed pain at the top of my fibula. Most of the bending exercises cause a lot of pain so I have backed off except for tailgate swings and gentle activities. I walk without assistance and do not limp. I am able to walk upstairs normally. ROM is in the mid 90s. Do I continue gentle movement? I know to not push through the pain.

 

[mendogal]

You're only at two months out. Your walking, stairs and ROM are fine! Yes it needs babying.
The PT who "...works on ROM and stops when it becomes too painful" is not what I call babying. It shouldn't hurt, period - pain is over-stretching and over-flexing and causing more swelling.
Doing gentle range of motion means going within the edges of the current comfort range, slowly and repeatedly to loosen things in a relaxed way.

 

[Layla]

Glad you’re backing off from anything that hurts, because rehab shouldn’t hurt.
You will get there through gentle movement and the activities of daily living. Lots of time left and room for improvement at only two months into what is a year long recovery for many. Happy Two Month Anniversary, Katt!
@Katt

 

[Katt]

I've decided to speak with my physical therapist on Monday. He has me using a weight to do leg lifts and the inside of my knee hurts for 2 days after he does this. I'm going to dictate the pace more. I've tried it his way and don't sleep Monday nights and am miserable for 2 days. My husband and I went for a pleasant walk this morning. No pain. My whole point of knee replacement was to enjoy retirement with my husband and go for regular walks( I was unable to enjoy walks for the 2 years preceding my replacement). Thank you for encouraging me. The more I learn the more I realize I have a say in my rehab.

 

[Jaycey]

He has me using a weight to do leg lifts and the inside of my knee hurts for 2 days after he does this. I'm going to dictate the pace more.

Totally ridiculous! Tell your PT you are healing, not in training. There is no reason to use weights. Be very firm - it's your PT session and he works for you the way you dictate.

 

[Nivea]

I've decided to speak with my physical therapist on Monday. He has me using a weight to do leg lifts and the inside of my knee hurts for 2 days after he does this. I'm going to dictate the pace more. I've tried it his way and don't sleep Monday nights and am miserable for 2 days. My husband and I went for a pleasant walk this morning. No pain. My whole point of knee replacement was to enjoy retirement with my husband and go for regular walks( I was unable to enjoy walks for the 2 years preceding my replacement). Thank you for encouraging me. The more I learn the more I realize I have a say in my rehab.

Good for you. My OS does not prescribe any PT at all. Just doing everyday life, is more than enough. I am doing very well and going for my other knee 10/23!

 

[sistersinhim]

The more I learn the more I realize I have a say in my rehab.

Yes, you do. You are the employer, not the employee. What you say has to go!

Good for you. My OS does not prescribe any PT at all. Just doing everyday life, is more than enough. I am doing very well and going for my other knee 10/23!

We are seeing more of these types of recoveries. So many of us never took PT, just did our daily activities as our knees allowed us to do without extra pain or swelling.

 

[Axx72]

My whole point of knee replacement was to enjoy retirement with my husband and go for regular walks( I was unable to enjoy walks for the 2 years preceding my replacement).

Enjoy walks with your husband that’s the priority. ADLs are the way to go. Little by little you will have longer walks and be enjoying life the way it should be enjoyed. Don’t worry about crazy PTs

 

[Katt]

So why is there such a huge variation in how knee replacement is treated? Some drs don't advise PT. Some patients are having MUAs at 6 and 8 weeks long before swelling goes down. With every healing journey being different, I'm surprised at so many different philosophies. And I'm also surprised at the lack of information for patients. A former coworker of my husband's wife had a knee replacement 6 weeks ago and made an appointment to see her Dr because she isn't healing like she thinks she should be. If it weren't for this forum, I would be in the same place. I'm continuing at my slow pace with good and bad days and nights. I wish I had a 120 ROM at 6 weeks, but it is good to know many of us take longer and that it more normal than we are led to believe.

 

[KFTCS]

I've decided to speak with my physical therapist on Monday. He has me using a weight to do leg lifts and the inside of my knee hurts for 2 days after he does this. I'm going to dictate the pace more. I've tried it his way and don't sleep Monday nights and am miserable for 2 days. My husband and I went for a pleasant walk this morning. No pain. My whole point of knee replacement was to enjoy retirement with my husband and go for regular walks( I was unable to enjoy walks for the 2 years preceding my replacement). Thank you for encouraging me. The more I learn the more I realize I have a say in my rehab.

Yes, this! My surgeon uses an app associated with the joint manufacturer. They give you a couple of exercises a day to do as you can, not mandatory. I followed them every day, and PT started two weeks post surgery once a week. Other PTs, I’ve taken have always been multiple times a week so I questioned him. He and his PA both said to walk, walk, walk. my surgery was done as same day surgery and I went home and climbed a total of 20 stairs to get to my bed. I came down the next day, and I got up every hour on the hour to walk. It was the second or third day when I walked to the end of our block and back. As a matter fact, my insurance company pays for a lot of PT so I went for extra and my doctor yelled at me. His feeling was that I know when my knee is healing and I know how much I can do and he felt that anyone who goes for an excessive amount of PT starts to rely on that rather than their recovery,. He told me to do whatever I can. I was lucky enough to have no pain with either of my two replacements, October 22, and April 23. But I still have some exterior numbness and some internal swelling. I’ve reached 120 RM but I can still feel that it’s not 100%. But when I tell you that it is 500% better than it was when I went in for that surgery,best thing I ever did! Trust your body. That’s not the first time I’ve heard that from one of my doctors, either. He said that our bodies know what we need.

 

[sistersinhim]

I wish I had a 120 ROM at 6 weeks

120 at 6 weeks isn't even reasonable. There is still way too much swelling and pain at that early stage. Think of a water hose that is full of water with the nozzle cut off so the water can't go anywhere. Now, try to roll that up tightly. You can't do it. Open up that nozzle and let the water out and the hose will roll right up. The knee is the same way. For you to be able to 'roll up' the knee, (bend), the fluid has to get out of the way. How do you get the fluid out of the way? By gentle movements, walking around taking care of your daily needs, icing, and elevating. Too much activity too soon causes more inflammation, which causes more swelling. That means the ROM will be affected negatively. To me, it's common sense.

OSs concentrate on the hardware being correctly placed inside the knee. Then they don't see the patient anymore for 4-6 weeks. They know the knee will bend correctly or they wouldn't have closed up the incision after the implant's placement. The soft tissues aren't foremost on their minds, the operation of the implant is. It's the soft tissue swelling that keeps the knee from bending better. Most of the newer trained, OSs know that too much activity is bad after a joint replacement. The same is true with the PTs. Those trained in the later ways to rehab a joint replacement concentrate mostly on balance, stride, and ridding the knee of swelling. They know the ROM will improve as the knee heals.

 

[Katt]

I talked to my physical therapist and he was great. Said he wished I had spoken up sooner. We cut back on anything that causes pain, but still did exercises. He worked on both the top and bottom of my fibula. That is where my pain is. I asked if he thought I need an x-ray and he said no. I have a lot of inflammation due to SIBO so I wonder if my continued swelling is being affected by that. I'm doing more ice and elevating and am not in nearly as much pain after PT today. My ROM has decreased which doesn't surprise me so I guess I'm one of the slower healers. I'm only 2 months into a 12 month journey. He said drs do a poor job of preparing patients for just how hard this surgery is. I agree.

 

[Axx72]

Sounds like your PT is adopting the same mindset as you. Great to hear that he is working with you to gently improve and promote healing in your leg. Mentally, having caregiver's support goes a long way in recovery. When we are in a comfortable frame of mind with a common goal, wonderful things happen. Looks like one more victory in your journey

 

[Susie-Q]

So glad you talked to your PT and are slowing things down. Your knee will thank you! It really, truly is a 12 month recovery. I am betting it will feel more like "your" knee at about 6 months post-op. Yes, using weights at 2 months post-op is not a good idea. Your bones are still healing around those implants and weights will stress that area unnecessarily.

 

[MichiganGal]

Glad you talked to your PT - wish I would have done that too. I am grateful for all of their help and encouragement but should have been firmer about easing back on the exercises.