TKR knee stiffness two years post-op

[winemama]

I’m having so much trouble going down stairs. With the swelling behind my knee, there is just not enough bend

 

[kneeper]

What kind of shows or movies do you normally like? I know everyone here has a favorite. lol. I think I'm planning to start with re-watching my favorite Stargate SG1 show, when it won't matter if I can't focus.

I did a lot of SG-1 watching, myself. It was fun to do a re-watch; though I did more rewatching (or should I say re-starting) than I thought I would given that I'd often mid episode and have to start again and see where I had left off.

 

[cathyn518]

thank you, I will not push it. A question for those who are more knowledgeable than me. If time and healing is most important, what is the value of physical therapy if it causes pain and inflamation? I know some, including my (surgeon) believe that you must push through pain so that scar tissue does not build up and interfere with range of motion?

 

[lovetocookandsew]

I had a conversation with my OS after my revision. When I mentioned I don't go to any physical therapist for knee recovery, and asked him if he knew why, he kind of quietly said, "Because they make things worse". When I asked him why, since he believes that, he still prescribes PT for his patients, he said it's hard to tell if a patient will move around enough on their own, or will just lie around instead. I then asked why doesn't he just prescribe a kind of PT where they assist with walking only? I forget his exact answer, but I think it has a lot to do with PTs and their beliefs, which I also think are outdated and can be harmful to knee patients.

IMHO, a lot of what doctors believe and prescribe for knee recovery is also outdated and my guess is things are beginning to change there also. Doctors prescribe the PT, but many therapists have their own protocols and follow them strictly. I think the whole relationship between doctors, PTs and knee patients needs a drastic overhaul, and hopefully it is happening, albeit slooooowly. But in the end, it's up to the patients to draw the line in the sand and make the decisions about what they will and will not do for their recoveries. If a patient wishes to do PT and thinks it's working for them, great. If a patient thinks PT is more harmful than helpful so decides not to do any formal PT, great. And anything in between is also great, as long as it's what an informed patient decides. That's the key here-patients need detailed and truthful information and the doctors and staff need to either fully inform patients, or recommend classes where patients are told the truth about knee recovery, or send them to this website, or all of the above.

It really bothers me when patients are still told untruths such as they only have six weeks to get all their ROM, and after that their knee will be forever stuck where it is at that point in time so they'd better work their tails off to get it by then or it's too late! In the case of this surgery, no pain IS gain. Hurting an already painful knee that has just been drilled, sawed, sliced and diced, is in no way helpful; rather allowing it to heal while gradually increasing your ADLs makes total sense to me.

As for your question about scar tissue, doctors and PTs misuse that too much and it's past time to put it to rest. If your knee is trying to heal from the assault that is a TKR, and you keep re-injuring it by doing heavy duty PT, how does that help? Ice, rest and gentle, gradual ADLs are all it needs to recover in the early weeks and months. At some point in the future you can begin to add more activities, but let the knee recover from the trauma first.

 

[Celle]

question for those who are more knowledgeable than me. If time and healing is most important, what is the value of physical therapy if it causes pain and inflamation? I know some, including my (surgeon) believe that you must push through pain so that scar tissue does not build up and interfere with range of motion?

If you are fortunate enough to get a good PT therapist, they can help with massage, reduction of swelling, gentle exercises, balance, and correction of gait. They will be supportive and reassuring - and let's face it, going through recovery after a joint replacement, we do need a lot of reassuring that we are progressing normally.

If you get a PT therapist who is all about the ROM numbers, who preaches about a "window of opportunity," who frightens you about scar tissue, who says you have to push through the pain, who gives you lots of aggressive exercises, and who threatens their patient with a manipulation if their ROM doesn't increase fast enough, you have a bad therapist.

What that sort of therapist practices is bad PT - and no PT at all is better than bad PT.

My surgeon doesn't allow any formal PT at all for the first month after a knee replacement. He says your knee needs that time, to start on its journey of healing. For that month, we rest, ice and elevate our leg, and walk around the house. The walking is our exercise and we increase it a little each week.

After that month, we just go to PT once every 2 weeks, where we are shown a few new exercises to do at home each day.

His patients all do well and achieve good ROM, as I did, and he hasn't had to do a manipulation to help with ROM for the past 4 years. I think that speaks for itself.

Personally, I feel that going to PT to improve balance and gait at about 3 months post-op would have helped me.

 

[cathyn518]

thank you for these detailed and intelligent responses. I am considering up and quiting PT as I do think my second session made things worse. I know how my body feels and I know that I need to listen to it. I am afraid that I will catch hell from my Doctor but I have to trust myself My PT did correct my gait (heel/toe) which I find awkard but I am trying to do.

 

[sistersinhim]

I am afraid that I will catch hell from my Doctor

Why would he do that? As long as your function is good, that's what he should care about, not numbers. I am also one that never took PT, even after all 11 knee surgeries. I did my daily activities and increased them as my knee allowed. I firmly believe that the body knows how to rehab itself if we use it the way it was intended to be used. My OS gave me a prescription for PT, but I never went. He didn't say a word about it. He was happy with my results.

 

[Jockette]

It took a while before my gait was good. It certainly wasn’t at 9 days post op. At that point it was all I could do just to navigate with a swollen painful leg. My gait was the last thing on my mind. It all worked out as I healed and my gait is fine today. My PT never had me work on it. (Their main focus was always ROM)

 

[klinkmcbear]

@cathyn518 - I live in upstate New York, in the 518 too.

Regarding getting some pain medications, I know someone suggested a pain management doctor, which sounds like a good idea. Another thought is that maybe your primary care physician could prescribe you something. When I was having my pre-op physical, my PCP made it a point to review my drug allergies with me, in case she needed to prescribe me something for pain. Since you already have an established relationship, you might be able to go that route.

 

[cathyn518]

A question about CBD oil? Has anyone used it and found it effective? It seems to be advertised everywhere lately and at anywhere from $100-

 

[cathyn518]

Thank you for the Gentleman Jack recommendation! I watched 5 episodes yesterday (1 hr plus each) Ann Lister reminds me of Katherine Hepburn. One of those women who just knew what they knew and refused to be put in her place!!

 

[Rockgirl4]

Regarding PT....

My surgeon definitely uses the Bonesmart philosophy, but he DOES initially send everyone to PT. Depending on the patient and how those first few PT sessions go, he has a lot of people quit at 4wks post-op. He wants to be sure one is getting the benefits if possible, but he also insists on making people quit if it's harmful or useless. In his words, he's tired of fixing the problems they create.

For me personally, we tailored my PT to my specific recovery problems of severe swelling and super--high pain levels. Luckily, my PT has no ego and was supportive of my views on recovery and my surgeon's wishes. We DID have a hiccup last week that had to be clarified, but communication took care of it, and I'm glad I am still going to her. I'll be 6wks post-op in 2 days, and I JUST got around forward on a stationary bike a couple of days ago. She is NOT pushing things and is about form/function instead of numbers. We don't count the weeks for our goals, and she reminds me she works for ME, not the surgeon.

My secret to success was finding her and interviewing her before my surgery, as I've had a major knee surgery before (mixed in with all the others for 11 total now). That was brutal PT before---absolute torture with the PT forcing it to bend over and over for 2 hrs, 3X a week, even when I begged him to stop. I swore I'd never let anyone do that to me again, and there HAD to be a better way. So yes----if bad PT is what you're going to get, you're better off without it. I had setback after setback with bad PT, but they always blame it on YOU, and use the threats of scar tissue and manipulation to keep you in-line. It should be outlawed, but unfortunately, it's a PT philosophy that is very prevalent in America.

 

[cathyn518]

Staples came out yesterday. (2 weeks TKR today) Surgeon very pleased with knee, x-ray and flex. Don't know what my ROM is as I never asked but I cancelled all future PT sessions. Only went twice, first was ok, she was mostly evaluating. Second caused pain and swelling. I do believe in the Bonesmart philosophy so thank you so much to all of you for sharing your advice with me. I will do gentle PT on my own, I obviously am not losing ground not going last week. Biggest problem for me remains sleeping but I can deal with that.

 

[Josephine]

@cathyn518 you will notice that I have merged your new post into this thread as we prefer that members in recovery only have one thread.

This is for three reasons
1. if you keep starting new threads, you miss the posts others have left you in the old threads
2. it often ends up that information is unnecessarily repeated
3. it's best if we can keep all your recovery story in one place so it's easily accessed if necessary

There was also this notice in the post that Celle left earlier with the recovery guidelines
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.

Thanks so much for complying with this.

 

[Jockette]

You’ll be fine doing gentle PT on your own.

 

[cathyn518]

oh sorry, I couldn't find my thread this morning. I tried a search under my name but was unable to locate it. What am I missing?

 

[Jockette]

oh sorry, I couldn't find my thread this morning. I tried a search under my name but was unable to locate it. What am I missing?

Hopefully this will help:
https://bonesmart.org/forum/threads/how-can-i-find-my-threads-and-posts.14732/

 

[cathyn518]

Tuesday I was practically doing cartwheels (ok, only in my dreams) after the staples came out and Dr. said flexion and x-rays looked great. I cancelled PT for good once I got home. Last night was sleepless and today found me teary as I realizied that it is not just my knee that had surgery, it is my life that is now missing parts. I had a real pity party, crying about my tomato plants (my poor husband is trying his best with them) my neglected dog (she is not) and the fact that it is the first fourth of July in memory that I did not make potato salad.(no one is starving here) The best part of my day was getting in the pool with my OS's blessing. All I did was slow walks around the shallow end but it felt great. Does anyone have any recommendations about pool exercises for someone in the beginning stages of recovery? I have adopted the bonesmart "if it hurts, don't do it" philosophy?

 

[Jockette]

I’m glad you enjoyed your walk in the pool, but I’m surprised your surgeon said you could go in. I suggest you wait a while before going in again. You should really wait until your incision is totally healed, no open spots or scabs.

Or, did you have a very good waterproof covering over it?

Is this pool yours in your yard?

I was sent to pool therapy at 4 weeks post op and my PT had me do 50 minutes of bending and walking. It took me 3 days of additional pain to recover.

 

[cathyn518]

Hi Jockette, yes, OS took staples out tuesday and told me 48 hours and then I could get in the pool. It is our pool, my son properly maintains the chemicals and we don't really have small children swimming in it anymore (who might have potty accidents) Nonetheless, I know there can still be bacteria and need to consider risks. My OS did clear me for this though, as long as it was a clorinated pool. I was suprised too, he wouldn't let me shower until staples were out. I will be careful in the pool, I think with the weightlessness it would be easy to over do. Since it has been 95-100 degrees here, it is the only way I can be outside, even for 10 minutes