TKR Kneeling after TKR<
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fishy
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I’m sorry, you all are going to get sick of hearing from me but I have one more question I’d like your opinions on. As mentioned, I’m two months into this recovery. I’ve struggled with pain control this time and have tried all kinds of medications. A couple of weeks following surgery I found that ibuprophen was the most helpful but I was taking the maximum amount I could and it was really hurting my stomach so I had to stop it. I haven’t really taken Rx meds much since about week 3 or 4. Now having been off of the ibuprophen long enough to allow my stomach to recover I find that if I take two (otc) Advil in the morning and then two in the evening plus 1 oxycodone just before bed I get the best results. I’m just wondering if you think it’s a problem that two months out I’m relying on an oxycodone at night. That’s the only time I take it but I sure don’t want to develop a dependence on it. I tried not taking one the other night and had a horrible night of no sleep!
Denny39
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I can’t give you medical advice per se. But I can tell you that at 10 weeks, I still occasionally take 1 or 2 Hydromorphone (spaced at least 4 hours), mostly for sleep. My surgeon renewed my prescription without hesitation. Many initially had some fear, as did I, of becoming addicted. My surgeon told me I would have to be taking those regularly for much longer than needed to risk any addiction. I’ve also been told that if you have a concern about becoming addicted, and you are taking them because you really need them, you have very little cause for concern, especially at this early stage. Some stay on their pain meds for a few months.
If you are really concerned, ask your Surgeon. But from everything I have learned, your occasional use is not any problem at all. Keep your pain under control.
If you are really concerned, ask your Surgeon. But from everything I have learned, your occasional use is not any problem at all. Keep your pain under control.
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fishy
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Thank you Denny. My surgeon did write the prescription for me, so I guess he thinks its ok. I just hope I can get this sleep/pain thing under control before they run out. I should probably try cutting them in half and see if that works.
SnowHare
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Wow! I'm so impressed that you went for the second knee so soon! I understand that this was a financial decision, but I think it must take a lot of bravery to do this.
My surgeon said he would do my second knee once the first had healed, but he did not define healed. That, and I would be put back in the surgery queue. Last spring, it was about 6 weeks, but I had underlying conditions that had to be cleared.
My surgeon said he would do my second knee once the first had healed, but he did not define healed. That, and I would be put back in the surgery queue. Last spring, it was about 6 weeks, but I had underlying conditions that had to be cleared.
Denny39
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Have you asked your surgeon how long you can safely take these, and in what doseage? You really need to manage your pain. If I read it right, you are 2 1/2 weeks behind me. That is still very early in the process. “Short-term” recovery is considered 8 - 12 weeks. Don’t let unfounded worries and concerns cause you to endure more misery than this whole process automatically subjects you to.
susan11763
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@fishy I had the same issue as you with the pins & needles in foot after knee replacement. Try to find my thread. I just updated it (click on the number 5 next to messages under my pic). I'm almost 7 month post op and still have the issue except the pins & needles sensation is now numbness & pain. I'm told maybe it will go away and maybe it wont. I wish I had answers for you but 7 different doc/specialists had no answers for me. I know how frustrating it is.
Josephine
NURSE DIRECTOR EMERITA
@Denny39 and @fishy You should read this article which explains about the suturing in fine detail Closing surgical wounds: how is it done?
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?
fishy
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Susan, I am so, so sorry to hear this...for you as well as for me! I did find your update. It is so very frustrating!
Before I joined this forum I had read a couple of others who had mentioned this problem as well quite some time ago... I’d love to hear updates from them. It seems like we are few and far between, lucky us!
My surgeon, who is very, very good and in high demand told me he’d never had this happen before. The ‘post surgical neuropathy‘ is so interesting and something I’m going to read more about. I don’t know what state you live in but I’d be interested to know where they do try this possible IV treatment for it. Please keep me updated on anything you hear and how you are doing.
Before I joined this forum I had read a couple of others who had mentioned this problem as well quite some time ago... I’d love to hear updates from them. It seems like we are few and far between, lucky us!
My surgeon, who is very, very good and in high demand told me he’d never had this happen before. The ‘post surgical neuropathy‘ is so interesting and something I’m going to read more about. I don’t know what state you live in but I’d be interested to know where they do try this possible IV treatment for it. Please keep me updated on anything you hear and how you are doing.
Josephine
NURSE DIRECTOR EMERITA
Here y'go then!
It would be very helpful if you would answer each one individually - numbered as I have done - in as much detail as you can then I'll come back as see where you are ....
1. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine. And don't forget to factor in other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness).
2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?
3. how swollen is your leg compared to these?
![[Bonesmart.org] Kneeling after TKR<](https://bonesmart.org/forum/attachments/ai63-tinypic-com_eta39s-jpg.71593/ "[Bonesmart.org] Kneeling after TKR<")
4. what is your ROM - that's flexion (bend) and extension (straightness)
5. are you icing your knee at all? If so, how often and for how long?
6. are you elevating your leg. If so how often and for how long?
7. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and
8. are you doing any exercises at home? If so what and how often?
This is the most crucial question so please help me by using the format I have left as an example
(which means please make a list and not an essay!)
Exercises done at home
- how many sessions you do each day
- enter exercise by name then number of repetitions of each
etc., etc.
Anything done at PT
- how many times a week
- enter exercise by name then number of repetitions of each
etc., etc.
It would be very helpful if you would answer each one individually - numbered as I have done - in as much detail as you can then I'll come back as see where you are ....
1. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine. And don't forget to factor in other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness).
2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?
3. how swollen is your leg compared to these?
4. what is your ROM - that's flexion (bend) and extension (straightness)
5. are you icing your knee at all? If so, how often and for how long?
6. are you elevating your leg. If so how often and for how long?
7. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and
8. are you doing any exercises at home? If so what and how often?
This is the most crucial question so please help me by using the format I have left as an example
(which means please make a list and not an essay!)
Exercises done at home
- how many sessions you do each day
- enter exercise by name then number of repetitions of each
etc., etc.
Anything done at PT
- how many times a week
- enter exercise by name then number of repetitions of each
etc., etc.
fishy
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1. The pain is variable as far as intensity goes. Right now, I'm feeling it's probably at a 4 or 5 and it is most usually a feeling of achiness, stiffness, maybe swelling inside, not so much on the outside.
2. 5 mg of Oxycodone that I have been taking 1 of at bedtime only. I have been taking two, otc Advil in the morning and two in the evening as well. I've only got about 10 more of the oxycodone's and since I was really hurting last night, I'm not sure they are doing much, or the advil for that matter. I thought I might try to wean off the Rx and cut them in half the next couple of nights and then try not taking it at all.
3. Probably slight maybe between slight and medium. I have larger legs so it's hard to say. My swelling feels more like its on the inside rather than the outside.
4. I 'graduated' from Physical therapy two weeks ago and my ROM was flexion 127 and extension, almost completely flat, not sure how that number is shown. Additional info: I haven't really had any pain with straightening my knee but with this most recent surgery, I do have a little 'popping' sound on the back of my knee when straightening. The physical therapist told me that it was my hamstring and it should get better with time. It's still doing it though at week 13. I do have some IT band pain as well that runs up my thigh thru my hip and try stretching that and using a roller to smooth it out.
5. Yes, I'm icing my knee at least a couple of times a day, sometimes more often than that, for at least 30 minutes or more each time. I am also using a heating pad, especially at night. It seems to bring more relief than ice these days.
6. Yes, elevating my leg in my recliner, several times a day... maybe 5 or 6 depending on my day. I am usually at home all day. Today I've been up and doing things so I've only elevated it once today.
7. I'm doing basic housework, not every day, but I do cook an evening meal (my good husband cleans up for me) dusting, vacuuming, laundry, etc. I'm not doing any heavy lifting or anything. Some days I'm out and about, grocery shopping, running (but not running, lol) errands. Whenever I've been sitting for a time, not even a long period of time, and I go to stand up, both knees are really stiff and it takes a couple of minutes for me to be able to walk without a lot of discomfort.
8. I haven't been really good about doing my exercises at home every single day. On days when I'm hurting the most, I skip a day. When I do them, which is more days than not, I ride my stationary bike for about 10 minutes, lay on my stomach and bend my legs up behind me, slowly and hold it for a few seconds before repeating it. I do that about 10 - 15 times. Sitting on a chair, I bend my legs back, under the chair as far as I can and hold for a few seconds and repeat that about 10-15 times as well. I have a total gym in my basement that I did use and did 100 reps on that, but haven't done that in about 10 days. I also try to do a hamstring stretch everyday a few times. Hope that wasn't considered an essay! ;)
2. 5 mg of Oxycodone that I have been taking 1 of at bedtime only. I have been taking two, otc Advil in the morning and two in the evening as well. I've only got about 10 more of the oxycodone's and since I was really hurting last night, I'm not sure they are doing much, or the advil for that matter. I thought I might try to wean off the Rx and cut them in half the next couple of nights and then try not taking it at all.
3. Probably slight maybe between slight and medium. I have larger legs so it's hard to say. My swelling feels more like its on the inside rather than the outside.
4. I 'graduated' from Physical therapy two weeks ago and my ROM was flexion 127 and extension, almost completely flat, not sure how that number is shown. Additional info: I haven't really had any pain with straightening my knee but with this most recent surgery, I do have a little 'popping' sound on the back of my knee when straightening. The physical therapist told me that it was my hamstring and it should get better with time. It's still doing it though at week 13. I do have some IT band pain as well that runs up my thigh thru my hip and try stretching that and using a roller to smooth it out.
5. Yes, I'm icing my knee at least a couple of times a day, sometimes more often than that, for at least 30 minutes or more each time. I am also using a heating pad, especially at night. It seems to bring more relief than ice these days.
6. Yes, elevating my leg in my recliner, several times a day... maybe 5 or 6 depending on my day. I am usually at home all day. Today I've been up and doing things so I've only elevated it once today.
7. I'm doing basic housework, not every day, but I do cook an evening meal (my good husband cleans up for me) dusting, vacuuming, laundry, etc. I'm not doing any heavy lifting or anything. Some days I'm out and about, grocery shopping, running (but not running, lol) errands. Whenever I've been sitting for a time, not even a long period of time, and I go to stand up, both knees are really stiff and it takes a couple of minutes for me to be able to walk without a lot of discomfort.
8. I haven't been really good about doing my exercises at home every single day. On days when I'm hurting the most, I skip a day. When I do them, which is more days than not, I ride my stationary bike for about 10 minutes, lay on my stomach and bend my legs up behind me, slowly and hold it for a few seconds before repeating it. I do that about 10 - 15 times. Sitting on a chair, I bend my legs back, under the chair as far as I can and hold for a few seconds and repeat that about 10-15 times as well. I have a total gym in my basement that I did use and did 100 reps on that, but haven't done that in about 10 days. I also try to do a hamstring stretch everyday a few times. Hope that wasn't considered an essay! ;)
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Josephine
NURSE DIRECTOR EMERITA
Okay
I think your medication is inadequate. At two months you should be taking more than this. Or are you being denied by your surgeon?
Either way, you should be taking the oxycodone at least 3 times a day and, assuming there is no acetaminophen in the tablet, also take 1,000mg Tylenol 4 times a day as well.
You can take the Aleve (naproxen) as well.
Okay
Good
You accomplish little or nothing in 30 minutes. Ice for at least 40-60mins and more than 4 times a day.
Don't ever use heat on a swollen knee. Makes matters much worse.
That's not the right way to elevate. The protocol is "toes above nose"! And read this Elevation: the do's and dont's
Okay but do read this, also in the Guidelines Activity progression for TKRs
BTW, did you read the Recovery Guidelines left in post #2 of this thread? (Feb 20, 2019). If not, or if it was too long ago to remember, I suggest you go back and read them again!
Stationary bike 10 minutes once or twice most days - okay
laying on my stomach and bending at my knees behind me 10-15 times once a day - since your flexion is 127, you have no need to do these.
Knee bends while sitting on a chair - 10 -15 times once a day - same here
Leg presses on total gym - 100 reps two or three times a week - and here but another point, don't use gym machines, especially this one. It can demand a rotating motion in your knee which could result in an implant loosening
Hamstring stretch - 5 reps once a day - assuming you actually HAVE hamstring pain then these are okay. But if you don't, then don't do them!
You could also read this BoneSmart philosophy for sensible post op therapy another gem from the Guidelines!
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susan11763
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@fishy I'm in NY, the study I mentioned with the IV treatment is in Minnesota. I'll keep you updated & will also be interested in anything you learn.
fishy
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Josephine,
"my ROM was flexion 127 and extension, almost completely flat"
My flexion was 127 while being 'forced' at my last physical therapy appointment. My previous knee at my last appointment for it, while being pushed by them, was 137. When I was there for my current knee, they measured my other knee just to see where it was and it was at 125 with them pushing on it. So obviously, I lost some of my flexion over time. I'm concerned that since this knee only got to 127, I may lose too much over the next few months.
I have no idea what my bend measures without being 'helped' by a physical therapist. I just don't know how big of a deal this is.
Regarding your comments on my exercises, it sounds like other than the bike, you don't think I should be doing any of the other things. Are there things you do suggest?
"my ROM was flexion 127 and extension, almost completely flat"
My flexion was 127 while being 'forced' at my last physical therapy appointment. My previous knee at my last appointment for it, while being pushed by them, was 137. When I was there for my current knee, they measured my other knee just to see where it was and it was at 125 with them pushing on it. So obviously, I lost some of my flexion over time. I'm concerned that since this knee only got to 127, I may lose too much over the next few months.
I have no idea what my bend measures without being 'helped' by a physical therapist. I just don't know how big of a deal this is.
Regarding your comments on my exercises, it sounds like other than the bike, you don't think I should be doing any of the other things. Are there things you do suggest?
Josephine
NURSE DIRECTOR EMERITA
One thing you should always bear in mind is that the only number that matters is that which you can achieve on your own. 'Assisted' flexion is false and doesn't count!
Absolutely! 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.
Many of us never took formal PT or did exercises. I am one of them. I had 11 knee surgeries, 2 of them kneecap removals and 1 tkr. Even after those I never took PT. But, I didn't just sit around and do nothing. I took care of myself, my house and yard as my knee allowed me to do. As I healed, I did more. But, my knee was always in control 
. This was enough therapy for me and would be for any tkr patient. All the awful pain of PT is so unnecessary.
All you have to do is use it in your daily living. Your knee knows how to rehab itself and doesn't need anyone telling it how. Just use it and it will come back like new
. You have to be patient, though, it doesn't happen quickly. ADL,(activities of daily living), going to the bathroom, brushing your teeth and bathing, fixing a light meal, getting something to drink and or a snack, those kinds of things will be all the exercise your knee needs. If you just use it daily in your living, you can have a less painful recovery. We know what works, we've been there
.
. This was enough therapy for me and would be for any tkr patient. All the awful pain of PT is so unnecessary.All you have to do is use it in your daily living. Your knee knows how to rehab itself and doesn't need anyone telling it how. Just use it and it will come back like new
. You have to be patient, though, it doesn't happen quickly. ADL,(activities of daily living), going to the bathroom, brushing your teeth and bathing, fixing a light meal, getting something to drink and or a snack, those kinds of things will be all the exercise your knee needs. If you just use it daily in your living, you can have a less painful recovery. We know what works, we've been there.fishy
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Thank you so much for your reply! I am kind of a 'rule follower' and have tried to be the model patient following the Dr's orders, and doing what I have always assumed was the best thing, since they are all professionals and do this every day.
I know some of my PT people personally and admire and respect them so it's hard for me to accept that what they are telling me is all wrong! I'm not saying that you are not correct in your experience though. I just feel torn as to what I should do. I've read the articles referred to here and I know that many others believe that the pain of PT and the exercises are futile. I would love that to be the case because I am SO TIRED of hurting! I have actually really slacked off on doing any exercises at all over the past couple of weeks.
Since I did two knees so close together, (4 months apart) this feels like it's been going on FOREVER! I have lived a pretty pain free (physically) life and I am so grateful for that.
This has certainly given me a whole new appreciation for those that suffer with chronic pain for years and years. I don't know how they do it! I am just over the 6 month mark from my first knee replacement and I still have some stiffness and discomfort with it. I still can't bend it close to where I could prior to surgery without some pain. It is better than my second knee (10 weeks out today) so I am hopeful that it will continue to improve but neither of them feel normal or without any pain.
From previous surgeries I've had, I do know that my body likes to form adhesions and scar tissue and from what I was told by PT, that is the concern if you don't do exercises. Scar tissue will form and prevent the bend from advancing where you want it to be.
I am doing all of the things you mentioned just taking care of 'life', shopping, laundry, housekeeping, meal prep, but I do find that after I've been up walking around for more than about 20 or 30 minutes. I need to sit down and rest my legs. That just feels so unnatural for me and it's been going on now for so long that I have this fear that I will NEVER get my old life back again where I can go all day without needing to sit down and rest! I guess I'm just feeling more like I'm 93 than 63 and I'm not liking it at all! lol!
I so appreciate you sharing your experience with me. It really helps to hear that all of this is normal and it will get better. Honestly, your support means so much to me.
Thank you.
I know some of my PT people personally and admire and respect them so it's hard for me to accept that what they are telling me is all wrong! I'm not saying that you are not correct in your experience though. I just feel torn as to what I should do. I've read the articles referred to here and I know that many others believe that the pain of PT and the exercises are futile. I would love that to be the case because I am SO TIRED of hurting! I have actually really slacked off on doing any exercises at all over the past couple of weeks.
Since I did two knees so close together, (4 months apart) this feels like it's been going on FOREVER! I have lived a pretty pain free (physically) life and I am so grateful for that.
This has certainly given me a whole new appreciation for those that suffer with chronic pain for years and years. I don't know how they do it! I am just over the 6 month mark from my first knee replacement and I still have some stiffness and discomfort with it. I still can't bend it close to where I could prior to surgery without some pain. It is better than my second knee (10 weeks out today) so I am hopeful that it will continue to improve but neither of them feel normal or without any pain.
From previous surgeries I've had, I do know that my body likes to form adhesions and scar tissue and from what I was told by PT, that is the concern if you don't do exercises. Scar tissue will form and prevent the bend from advancing where you want it to be.
I am doing all of the things you mentioned just taking care of 'life', shopping, laundry, housekeeping, meal prep, but I do find that after I've been up walking around for more than about 20 or 30 minutes. I need to sit down and rest my legs. That just feels so unnatural for me and it's been going on now for so long that I have this fear that I will NEVER get my old life back again where I can go all day without needing to sit down and rest! I guess I'm just feeling more like I'm 93 than 63 and I'm not liking it at all! lol!
I so appreciate you sharing your experience with me. It really helps to hear that all of this is normal and it will get better. Honestly, your support means so much to me.
Thank you.
Bonesmart’s gentle approach to recovery does seem radical to most of us, but it didn’t take me long to forsake my surgeon’s and PT’s advice and go with the Bonesmart approach.
I had too many set backs from PT. I did try it their way, I tried everything they said and pushed to do things, but the final straw for me was my first (and last) pool session, at 4 weeks post op, that lasted for 50 minutes. It took 3 days to recover from that experience, as well as other sessions. I was fed up.
I started googling “stopping therapy” and found Bonesmart. My husband was very leary of my stopping PT, so I cancelled some sessions and only had a couple more before they discharged me.
I’ve been on Bonesmart for almost 2 years now and the more I read about how many exercises our members are told to do, the more thankful I am that I found Bonesmart and I’ve seen that this gentler recovery works. Next time around I will not go to PT and I will recover better than I did this time, with less additional pain.
I had too many set backs from PT. I did try it their way, I tried everything they said and pushed to do things, but the final straw for me was my first (and last) pool session, at 4 weeks post op, that lasted for 50 minutes. It took 3 days to recover from that experience, as well as other sessions. I was fed up.
I started googling “stopping therapy” and found Bonesmart. My husband was very leary of my stopping PT, so I cancelled some sessions and only had a couple more before they discharged me.
I’ve been on Bonesmart for almost 2 years now and the more I read about how many exercises our members are told to do, the more thankful I am that I found Bonesmart and I’ve seen that this gentler recovery works. Next time around I will not go to PT and I will recover better than I did this time, with less additional pain.
