MUA Keep on plodding on

[mendogal]

Hello! I have a couple of suggestions based on my two TKAs this year....
For sleeping: try elevating on a stack of four pillows, as shown on a Bonesmart post I can't easily find .... @Jockette ????
For movement: I had probably the same standard handout of post op exercises BUT my ortho team was united in giving me the direction "Less is better" the first weeks! What I found most valuable was
-short walks as tolerated, every hour while awake; don't worry about the gait and use your walker or crutches
-ankle circles and up-and-downs to promote circulation every hour
-quad sets, just a few several times a day, NOT to "strengthen", just to start activating the quads. Placing a few fingers on the muscle while doing them will help
-no stretching yet! Damaged inactivated muscles really don't need microtears that can come from stretching cold muscles.

 

[sistersinhim]

I'm one of those who never took formal PT. Due to birth defects, I've 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 along with the necessary house and yard work. As I healed I was able to do more. Icing and elevation were a huge part of my recovery.

Listen to your knee. It will tell you if you're doing too much by increasing 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 or forced to do. Doing too much too soon causes setbacks because your knee has to heal from the inflammation caused by the exercises before it can get back to its normal, after-surgery healing.

 

[Layla]

Hi Mutley, Happy Wednesday!

had such a horrible time with my RTKR nearly 11 years ago now that I’m desperate for everything to be ‘perfect’ this time round & not fall into that awful depressive state like I did then

Aww, I am sorry for this. Please keep in mind how it all turns out after the pain is finally gone and your mobility has returned. It will happen again! It takes time and patience and we will be here to support, encourage and cheer you on whenever you need it.

Have you tried the nifty little trick with the heel slides where you place a plastic bag under your heel, removing any friction between your foot and whatever you're attempting to slide it across? Works like a charm!

Back sleeping is difficult for many! Something that helped me obtain a measure of comfort was pillows. Bed pillows, multiples. Gather them up and surround yourself with them. It can be comforting to rest an arm on one, a leg on another, whatever brings you comfort. I have faith all will fall into place, you need to give it time.
I hope today is a good day!

 

[Jockette]

For sleeping: try elevating on a stack of four pillows, as shown on a Bonesmart post I can't easily find .... @Jockette ????

It’s in the following article, found in our Recovery Guidleines:

Elevation: Doing It the Right Way

Updated June 11, 2024 by Jockette Proper elevation is one of the best ways to help with pain and swelling following either hip, knee, or ankle surgery. Many people elevate improperly, which can dramatically lower the effectiveness. In the weeks following your surgery, make sure you elevate...

bonesmart.org

 

[Mutley]

Good morning!
Day 10 post op for me. I’m doing ok even managing a little bit of sleep during the night. Had a good walk round the block yesterday as well as keeping up with the exercise regime. I wanted to know how long before I might stop walking with a limp? I put the heel down 1st but can’t bend the knee to encourage a ‘normal’ gait Any suggestions? Also when is ‘too early’ to try the stationary bike? I’ve tried just gently going backwards & forwards with my foot on the pedal but no way near enough to do a rotation yet. Just checking I wasn’t doing any damage in the process? Still little progress with heel slides but just trying to hold the heel where it is for a few seconds before straightening the leg out again… Still battling massive swelling in the knee & all round my ankle so lots of icing & elevation. Think I’m still in the ‘very impatient’ club…

 

[sistersinhim]

10 days out is a drop in a bucket for this yearlong recovery. Right now, less activity is more healing. Your knee is a newborn baby and needs to be treated as such.

I wanted to know how long before I might stop walking with a limp?

If you are still walking with a limp then you should be using your walker or cane until you walk without a limp. Without doing so, your limp could become permanent. I used my walker for at least 6 weeks when out of the house and a cane for about 4 months. I figure it is better to be safe than sorry and ending up on the floor or worse!

Take a look at a live TKR on youtube. You will understand why you hurt so much and why it takes so long to heal. Would you exercise a broken leg while it's still broken? You have two bones that were sawed off and had foreign objects pounded into them. Add to that all those muscles, tendons, nerves, and skin that were pulled apart so that the implant could be inserted in that small space. There is a reason for all the pain and swelling!

 

[Jockette]

Had a good walk round the block yesterday as well as keeping up with the exercise regime.

Still battling massive swelling in the knee & all round my ankle so lots of icing & elevation. Think I’m still in the ‘very impatient’ club…

10 days post op is a bit early for a good walk around the block, since you have massive swelling.

10 days out is a drop in a bucket for this yearlong recovery. Right now, less activity is more healing. Your knee is a newborn baby and needs to be treated as such.

I agree. Try to curb that impatience and allow your knee the privilege of sorting itself out.

 

[Jaycey]

@Mutley Read the articles I left for you in post 2 on this thread - especially this one Activity progression for TKRs.

 

[mendogal]

I have had what is considered better than average post op recoveries on both my knees. On neither did I consider myself safe for community walking until way further post op - with my second, more confident, my first solo community walk was post op day 33. I didn't walk further than I'd already walked nonstop on a mapped route within the house.

 

[Mutley]

@Mutley Read the articles I left for you in post 2 on this thread - especially this one Activity progression for TKRs.

Hi Jaycey,
I did read & have re-read the articles but can’t get out of my head what my surgeon said about doing ‘Appaulingly’ I’m so frightened this knee doesn’t/won’t bend like the other one I’m all over the place. Today has been a bit of a downer…

 

[benne68]

What an outrageous thing for a surgeon to say to you just days out of surgery. He's a jerk, who clearly missed the classes on bedside manner when he was in med school.

Please don't let his bad manners impact your view of your recovery. As others have said, you are very, very early in this year-long recovery. It took me MONTHS to get to the point where I could bend my knee "normally." But, now two years out, my knee is great and I'm getting ready to have the other one done.

Be patient. You cannot bully your knee into bending. Your flexion will come back -- it just takes time!

 

[dotski]

What an outrageous thing for a surgeon to say to you just days out of surgery. He's a jerk, who clearly missed the classes on bedside manner when he was in med school

 

[dotski]

Still battling massive swelling in the knee & all round my ankle so lots of icing & elevation. Think I’m still in the ‘very impatient’ club…

I’m not sure if you have them, but I highly recommend compression socks. Minimum 20-30 mmHg strength to give adequate compression to the veins and lymph vessels. If concerned about them contacting incision, then thigh highs are more comfortable on the knees…or a mid calf height might be a good way to help the fluid out of your ankles. Remember that fluid down there has to travel up through the knee. So the more compression you have at the ankles, the more efficiently the vessels will work higher up, regardless of whether or not the compression goes all the way up the leg. They also help immensely with leg fatigue. Most drugstores have certified fitters - it can be a bit of trial and error. Or you can find good deals on sites like Amazon to try them without the cost of the big brands that pharmacies carry. The company “CEP” makes a mid calf height one that I wear in the summer when cycling. You veins will love you for it years down the road if you take care now to not let them get overstretched full of fluid now (like a garden hose that develops a bulge and loses pressure further down the hose).

 

[Layla]

I was trying to do some leg slides on a board & asked him how he thought I was doing? His reply…’Appaulingly’ Said I needed to ‘bully’ the knee more…

Try to let go of this and view it as your surgeon may be adept in joint replacement, but not so much in verbal communication / bedside manner. Possibly he felt his words would serve as motivation? At a later date, you may want to share with him how it made you feel. He could learn and grow from it.

I like, Jaycey's idea of referencing the Activity Progression for TKR. I used that as a rough gauge in my recovery and it kept me reasonably active without overdoing it. No ODIC.
Relax and take it one day at a time. You're only ten days post op and I'm sure you'll do great.
Have a nice week!

 

[CricketHip]

I think you might benefit from some gentle Manual Lymphatic Drainage (MLD) techniques. I put together a help list for the THR side but can easily modify this to help you with your TKR.
The key to this is to do deep breathing. As in taking your time to breathe deeply and slowly.
The second key to focus on is the groin area.. you have many lymph nodes in your abdominal area and then the lymph nodes in your inguinal areas are the second important area to help release.
Our lymph nodes are responsible for clearing the swelling and inflammation away from your surgery site. But they can get overwhelmed with so much to do and they kind of go into shock. Then add in the numbing agents and pain meds that they inject in the area and imagine how that slows down those nodes!
So simple, light to moderate massaging over the nodes in your groin can be beneficial AFTER you do the abdominal breathing and compressions.
I will leave you the article that I put together and for you, the best thing would be to lie on your back, elevate your surgical leg and then do the routine, then most importantly, stay elevated and try to nap and see if things begin to move..

I hope this helps.. it will help you to relax, too!!

****
Take deep breaths.. deep, as in breathing in to a count of 3 or 4, whatever is best for you. hold it for another count of 3-4, then blow out completely, still using the count that's comfortable for you. A series of at least 6 of these could help get your excess swelling to move. To ensure you are taking proper deep breaths, place your hand on your naval and watch while taking in your breath, if doing this properly you should see your hand move up.

Then, as you slowly breath out, to the same count of either 3, 4 or 5 gently press down and slightly upwards with the palm of your hand.
Do this whenever you feel up to it during the day or night. The more supine that you can get in the recliner or bed, the more effective this can be.. you have lymph nodes located in your groin and sitting up too much can cause a restriction of the lymph flow.

You can, after the breathing, place your hands lightly on your upper thigh, right where the crease is in your groin and lightly stroke upwards towards your naval.
I did this quite a bit post op and while it takes a while for the body to wake up and respond, it will and it will help get the swelling moving.
The reason this can help is because many of our lymph nodes are located in our abdomen. Our breathing combined with moderate pressure over our naval can help to "prime" our lymph system.

***********

Additional notes: you can reach down to your knee and lightly stroke upwards your groin after doing the steps above. Then lastly, gently pump the back of your knee in a rolling, upward motion towards the trunk of your body, using all 4 fingers of your hand and NO fingertips pressing in..

This can be effective if done daily.. use light pressure, no deep pushing. This isn't a no pain no gain thing.

I hope this helps!!

****

 

[Mutley]

18 days PO. ‘Keanu’ as I call my new knee is still being very stroppy on the bending front ROM is about 73. Everyday I go from thinking, don’t worry, it will get there TO OMG this is terrible…HELP! I think the reason im stressing is because I’m still not walking ‘properly’ but with a limp or a tin leg This then causes the back to ache etc, etc. My stamina has improved & I can spend more time on my feet seeing to dinner, little jobs. It seems my knee is best as soon as I get out of bed & do my exercises but then it gets more solid & log like as the day goes on. This is even though I still ice & elevate frequently or use a hot water bottle on my thigh, back of knee & below the knee. Still don’t get to see a physio until NEXT Monday. I’m so thankful for virtually no pain but would just like to progress on the walking & bending front.
Any thoughts would be appreciated

 

[Layla]

Hello and Happy Monday Mutley,
Stick with the "don't worry" and have patience, it's only Day 18, which is extremely early in the entire scheme of things. While your range of motion is currently limited, it will naturally increase as the swelling subsides and the pain eases. Give it time. Be nice to Keanu and Keanu will be nice to you.
Have a good one!
@Mutley

 

[sistersinhim]

I think the reason im stressing is because I’m still not walking ‘properly’ but with a limp or a tin leg

As long as you are still limping you should be using a walker, cane, etc. until you can walk without that limp. This will help you to 'teach' your knee to walk properly while using that device. You don't want to develop that limping habit! Don't forget the heel-to-toe gait.

It seems my knee is best as soon as I get out of bed & do my exercises but then it gets more solid & log like as the day goes on.

For a week or so leave off those morning exercises and use your knee just walking around doing your normal activities. Since you feel better in the morning, adding those exercises might be inflamming your knee causing it to swell. The log-like feeling you are experiencing is swelling. Concentrate on keeping the swelling down and your knee will not be as tight.

 

[mendogal]

Hmmmm.... If you do best first thing and do your exercises... and things get worse as the day progresses....
Maybe back off on those early day exercises and instead just walk around and do some normal activities of daily life?
At 18 days, my morning wash up at the sink, feeding the cats, scooping their litter, and making my first mug of tea was enough - recliner and ice for 45 minutes.

Then up to prepare my breakfast and second mug of tea, sit up at the table to eat breakfast...and time to ice and elevate again!

Later on I made my simple lunch; after a rest I *might* put up laundry (after MDH carried the basket) or sweep the kitchen floor (which I found useful body movement) IF I felt up to it; I'd make our supper after MDH fetched all the pans and ingredients for me, sitting on a tall stool to chop the veg, unless I were tired and we would eat more simply or he'd fetch take out!

The only "exercise" I was doing was quad sets, to activate the quads, periodically throughout the day. Plus walking in the house five to ten minutes every hour.

 

[Mutley]

WEEK 4 EXPECTATIONS…….(Sorry, this might be long!)
Good morning everyone from a very wet & windy UK! Just after some advice or words of wisdom! I will be 4 weeks PO tomorrow. Progress I feel is very, very slow I should have had my 1st physio appointment on Monday…it got cancelled I was then told another appt had been made but that wasn’t until 17th November. I was so upset as I really need some assurance as to how I’m doing. Rang the appts department & promptly burst into tears so the receptionist, feeling sympathetic managed to book me into another hospital tomorrow I feel my ROM has barely moved since discharge when it was roughly 70 degrees. Walking is a daily battle as despite all the advice received here & taking on board the chart of heel, toe etc this leg & knee is so stiff it’s like carrying a heavy log around with me. Feeling I over did it a bit yesterday ( and certainly paid for it last night ) I decided No exercises today. Literally popped to the supermarket to get some essentials & could feel my knee just getting tighter & tighter. I’m really getting fed up now as I (stupidly) thought that I would see/feel small increments on an almost daily basis …wrong.
So my question is and I understand that EVERYONE is different on their individual journey of recovery, what would be a realistic expectation at the 4 week mark? My brain is so willing but alas my knee isn’t….
As much as I can’t wait to see the physio tomorrow I’m also dreading it in case he confirms it’s as bad as I’m thinking it is
Sorry for the long post but just needed to get that out there