TKR Lane 47, December 12, 2016 <

[Josephine]

Why did you say?:

I know to avoid the actual scar line with any lotion or oil.

Because it can cause infection in the early days. Massage post THR

 

[Lane47]

Mireille, I do not use gel. Don't even have any gel. My PT uses a TENS like unit on each visit, they do not use gel, but sometimes they clean my knee with alcohol swab. The electrodes last for several sessions, actually depends on how clean your knee is before use. At the PT, we have used 10 times, still using. At home, just started a few days ago, at about 5 uses.

 

[Lane47]

LTKR4Xmas
Hope you are doing well, thanks for the input and question. Your question regarding avoiding scar line was answered very well by a forum expert. My PT was the person that advised me to avoid the scar line to avoid infection.

 

[LTKR4Xmas]

Because it can cause infection in the early days. Massage post THR

Oay, I believe we simply have a semantics issue. In referring to a "scar", I'm assuming a "closed wound", not one which can become infected. Of course I wouldn't use any type of lotions or creams on an open wound, or incision!

What I am using on my scar (closed wound) is vitamin E. I puncture a hole in a vitamin E pill and squeeze the oil out into my knee and spread it around. I have done this successfully on other scars with great results!

 

[Josephine]

You missed the point of the article - it's not necessary! Wounds will heal well on their own without it.
Or did you not notice the photos in the article!

 

[Lane47]

Thanks Josephine, I totally understand, I don't even massage, nature will take care of this part!

 

[Lane47]

Visited doctor yesterday, he was pleased with my progress, and released me from further PT visits, unless I have a setback. My ROM is currently at 0 & 125. He advised that I should expect to feel Heat in my knee for a few more months, which if I understand, indicates healing.
What type of activities does the forum suggest I avoid, and what type of activities would be beneficial?

 

[Josephine]

I'm so glad your doctor has released you from PT. And yes, warmth is always a sign of healing.

Regarding activities beneficial and to be avoided, there if only one thing you need to apply and that is normal activities! But do take it easy to begin with. No heavy yardwork for instance. Gradually increase the load over the next few weeks until, but 12-14 weeks out, you are back to your preferred norm.

 

[Lane47]

What would anyone suggest to improve my sleep quality?
I wake up about every 2 hours, usually with pain in my knee. I can usually reduce the pain with either ice, massage, just walking around for a minute or two, and if all others fail, medication. Basically, when my knee is "still" for a couple of hours, it begins to hurt. Logical explanation for this? Concern?.
Why does my still knee hurt, what can I do to eliminate?

 

[Celle]

It's still very early in this year-long recovery and I'm afraid that sleep disturbance is still normal.
Sleep deprivation is pretty much inevitable - but what causes it?

You can help yourself a bit, though, by making sure taht you don't do too much activity during teh daytime. Sometimes you aren't aware that you are doing too much, but your knee says "I'll get you for this, later" and it hurts during the night.

The other thing is to take some pain relief just before you go to bed. It's not at all unusual to still need pain meds at night, even if you don't need them during the day.

 

[Lane47]

It's been two weeks since my doctor released me from visiting the PT. My knee therapy (other than ice and elevation) has been just my daily activities, only at a reduced pace. No exercises specific to my knee.
I still have a lot of soreness and stiffness in my knee, the pain is managed with tramadol, which I take for a chronic shoulder pain issue.
I don't think my knee is progressing, my ROM is less today than 2 weeks ago, nothing major, maybe 110 now, where it was at 125. My gait is still not smooth, down steps still one at a time. Up steps varies, I can step up normal, but prefer one at a time.
Should I be exercising my knee? If so, what would those of you with greater wisdom than I possess suggest?
My family is concerned, due to lack of progress, and "limping gait". They think I stopped PT too soon. I stopped PT mainly for one reason, along with all the positives of PT, there was the mindset that ROM should be increasing with time, if not, let us help you. Help by gently pushing / forcing me to do a little more, more than I could do alone. Should I have continued PT, and just said no to the ROM increase mindset? There were many positives, and only one negative.
Thanks for all your advice.

 

[Curiousnva]

Sounds like your doing awesome! I'm 9.5 weeks out. 10 degrees from straight. They are taking about the mua for me. My rom isn't too bad 100. Think I can get that better the extension worries me

 

[Curiousnva]

PT told me they can't do anything else for me. So told me not to come back. All I was doing there was the bike to warm up then leg press machine, hamstring machine, step ups, calf stretches and leg extensions. All that stuff is strength and I can do at my gym. Kinda made no sense to me. They are a huge rehab hospital. Looks like would of done more with my extension.

 

[newlybionic]

Stairs seem to take the longest to accomplish. You're just a bit more than 2 months out. That's only one sixth towards being fully recovered. If you are still limping you need to use a cane when possible to help with attaining a smooth gait. One more thing to consider is to check your shoes for wear. It is probably better to replace the shoes you are wearing with new ones. If you had orthotics in your shoes for any reason they need to be checked. Since you have been working for a few weeks (usually we recommend a phased return to work after 12weeks) the last thing your knee needs now is more exercising. Ice and elevate at night.

 

[Josephine]

I still have a lot of soreness and stiffness in my knee. My ROM is less today than 2 weeks ago, nothing major, maybe 110 now, where it was at 125. My gait is still not smooth, down steps still one at a time. Up steps varies, I can step up normal, but prefer one at a time. Should I be exercising my knee?

Absolutely not! It's possible your issues might be caused by a poor gait. I suggest you get a visit with a good PT (not the one you went to before!) and ask them to assess your gait and advise you on it.

I know when I had just had an arthroscopy, I was in a lot of pain for about 2 weeks after and my PT showed me that I was walking badly. She advised me there and then and I left the department fairly skipping! A limp can be very problematic.

 

[Lane47]

Absolutely not! It's possible your issues might be caused by a poor gait. I suggest you get a visit with a good PT (not the one you went to before!) and ask them to assess your gait and advise you on it.

Thanks for this advice.

I actually did this with the other PT, they gave me 6 exercises to do, using a band. All standing, with blue band around ankle. It had little impact on my knee. Should I expect something like this (exercises, not necessarily these exercises) from a good PT?

 

[highlander]

With your ROM being so good, do you think your lack of confidence in stairs could be caused my muscle weakness? I know many on here are opposed to muscle strengthening for some reason, but a "good PT" should be able to help you start the strength process. All this stuff about waiting months and months - I'm not going to subscribe to. As long as those exercises don't cause acute pain and swelling- then why not??

Some some people, and not a tiny few, exercise and movement specific stuff is GOOD. I know some of the Bonesmart advisors will argue this point and point to the old "time is all you need" mantra. I don't believe it, and maybe you should start a more focused strength and flexibility program with a great PT. Just sayin........

I'm one month out tomorrow- and most of what I am doing now- 3x per day is ROM stuff. I've gained 20 degrees in 10 days and am walking pain free, but still with a cane for insurance. The Bonesmart way is good for some, and probably good for all in the first few weeks- However.......

We also have started some easy strength things to activate my quads, and some flexibility things to help correct a lot of the shortening of the muscles and tendons. Does it not make sense to you that the more we lay around expecting "time" to do it all- that we have more atrophy, and more shortening of critical fibers- this equals stiffness and weakness. Be smart with it - step it up a notch and dial back and tune it if you get too much swelling etc....

I may get a lot of blowback with this advice- but Im cool with that ;)

 

[FlaGranny]

I don't think anyone is against muscle strengthening. It's just that it is not recommended too soon after surgery. I'm getting ready, as I write, to go to the gym for the first time to start strengthening exercises, but it has been over 4 months since my surgery. I was going to go last month, but then decided I wasn't quite ready.

P.S. Movement/activity is always recommended. In fact, the recommendation is to get up and move at least every hour and stay as active as pain pain allows.

It sounds sometimes like the site is recommending no activity, but what they are actually doing is trying to keep patients from overdoing the PT, causing themselves unnecessary pain and swelling and setting themselves back. Many have a horror story to tell about their PT. I did PT for a handful of sessions for each knee and none on my own and I'm fine.

 

[highlander]

I think maybe 4 months is to long to wait in general....but thats a difference in philosophy I have. And it is going to vary wildly between each person's knee. It seems as though @Lane47 has good ROM and is not doing anything specific for his knee, and is experiencing weakness and stiffness- why not try it? With the exception of this site, everyone else out there in the entire TKR world- OSs, nurses, PTs, etc...mainly come down on a different side and program. I do respect this forum and it is a tremendous online community- but come on- do we really think all those people are somehow way behind the times and ill informed- and that they don't see thousands of TKR patients daily and live in some sort of veiled world??

Bonesmart is a good way to start off for everyone- then you have to find what additionally works for you and add that to your program- and the sooner the better.

 

[Cratchit]

Bonesmart is a good way to start off for everyone- then you have to find what additionally works for you and add that to your program- and the sooner the better.

I totally agree with this. If you are able to build sufficient muscle power to support the structures of the knee and maintain a good gait through daily activities, walking etc then all well and good. However, I do think there is a case for targeted exercises where necessary which build up muscle strength without compromising the healing process.

In my own case, I tootled along thinking I was doing really well, albeit slowly. I had a physio assessment at around 13/14 weeks prior to a planned return to work and it was found that I lacked anywhere near enough muscle strength to maintain a good gait, even to walk unaided therefore I couldn`t be signed off fit for work (I`m a nurse so on my feet all day). I was gutted as I thought I was doing so well. I was given some specific exercises to strengthen the quads and hamstrings and it`s worked; my gait has improved, swelling has decreased and I am less and less dependent on my stick for walking. I do still need to use the stick sometimes and I do still get variable amounts of aches and pains and swelling but no more so than when I rested and elevated a lot.

No one size can ever fit all and I think there is wisdom in what highlander has said above as it takes into account invidual needs and circumstances. There will always be those who push beyond to the point of pain and further trauma but I think (hope!) most will heed the warning that pain always gives. All things in moderation and listening to The Knee is the key, in my opinion and personal experience.