TKR Left TKR 9/23/19 My Journey

[Carole4815]

IMHO there's far too much emphasis on numbers and not enough on functionality.

Putting on shoes and cutting toenails is a breeze.

Same here. I put on and tied my shoes in the hospital with a ROM of 68, not by bending my knee, but with my leg out straight in front of me on the bed. My PT said probably my shoe tying success had to do with hip flexibility and length of legs vs arms.

Two days after surgery I clipped my toenails the same way, and had about 6" of leeway had my legs been half a foot longer, or my arms half a foot shorter.

Now, I can do everything I need or want to do in life. The highest ROM that was ever measured for me was 101 degrees, about a month ago. I haven't had my ROM measured lately but I think it is probably increasing with time as my swelling decreases and my daily activities increase. Like the forum advisors often remind us, we need time to heal.

 

[Thatbpguy]

So here's my question of the day. I have always had stiff joints. Even as a kid. I have never been able to just bend my knees and cut my toenails. So what if I don't get back more than, say, 115 degrees? All I want to do is put shoes on and walk. Nothing else. Is there any leeway in how much rom I eventually have?

IMHO there's far too much emphasis on numbers and not enough on functionality. I, too, have never been a very flexible person. I'm now 20 months post-operation and have about 120 degrees of range. However, I'm fully functional: can walk and run, can compete in agility with my dog, can hike on very rough terrain and on moderate hills for long distances (10 miles), can run upstairs two steps at a time, can do all exterior maintenance on my house, including jobs requiring ladders, etc. Putting on shoes and cutting toenails is a breeze. If you search for my recovery thread ("Ceegee's recovery", https://bonesmart.org/forum/threads/ceegees-recovery.47021/), I've posted videos. You will see that I'm very mobile.

If I look at the numbers, my recovery is disappointing. But if I look at functionality, it's amazing. Life is much better now than I expected it would be, and I can do far more than I expected. My ROM is still improving and I expect to get another few degrees over time. But I don't need them to function well. If this is all I get, I'll be very happy indeed.

Thank you. I am going to go back and read your blog.

 

[Thatbpguy]

Two weeks today was my surgery. Still beb bound, but I can put about 70% weight on the knee. Fired my pt and start Thursday with new one. I also have my post op apt with surgeon Thursday. My rom is about 70%. I'm pretty much off oxy. The swelling is gone above and below the knee, but the knee center is 1" swollen. Incision looks great. All I need is for knee pain to subside so I can walk and for rom to improve.

 

[Thatbpguy]

I CAN WALK, I CAN WALK!! Ok, barely, but I moved around unaided a few ateps.

 

[Carole4815]

...

I CAN WALK, I CAN WALK!! Ok, barely, but I moved around unaided a few ateps.

YAY!!!! I am so genuinely happy for you!


(Now don't over-do! )

 

[luvcats]

The little steps make such a huge difference! Woohoo!

 

[Thatbpguy]

Dr apt today. Not good. ROM at 70. They will wait about 5 weeks and then perform a manipulation under anesthesia followed by 3 weeks of daily intensive, painful pt. We discussed just a lengthy healing process and we chatted about the 2 opposing POV's. His point is that if the scar tissue goes too long without being broken up then it often becomes a full blown revision surgery and the MUA is by far the easier route to go. Well, hell.

 

[sistersinhim]

They will wait about 5 weeks and then perform a manipulation under anesthesia followed by 3 weeks of daily intensive, painful pt

70 is not bad for a brand new infant knee. You need to tell your doctor that you would rather wait and let your knee heal some more before abusing it even more. Most OSs don't expect 90 degrees until the knee is 6 weeks old. As your swelling goes down, your bend will naturally get better. All it needs is time. This is the time for patience.

His point is that if the scar tissue goes too long without being broken up then it often becomes a full blown revision surgery and the MUA is by far the easier route

This isn't true. There is no time limit on getting a successful MUA. What's a shame is that the vast majority of patients are getting them when they don't need them. All they need is time to heal from a major surgery. Intense, painful exercise slows down that healing and keeps the knee inflamed. That means it stays swollen. Get that swelling down. An MUA sets recovery way back, almost to the beginning again. Please take the time that your knee needs!

 

[Jockette]

You are less than 3 weeks out of surgery, I’m shocked they are already talking MUA. I would have to be way worse than 70, and for months, before I would even consider a discussion of an MUA.

followed by 3 weeks of daily intensive, painful pt.

This is not good for an upset, swollen knee. It will not enhance ROM, but will create swelling all over again.

I don’t understand surgeons who just won’t allow the knee the privilege of sorting itself out.

@Jamie what do you think?

 

[Jamie]

@Thatbpguy .... I'm sorry your surgeon felt the need to alarm you with the thread of an MUA, but at least he gave you 5 weeks. In the coming weeks, it will be critical for you to ensure that your pain and swelling is minimized. Your knee has been angry and irritated since your surgery and it will take some time to calm down and stay there. Your knee is in charge of this healing process and not you, your therapist or your surgeon.

I'm happy to hear that you've progressed to the point that you can walk. This is a good start to your successful recovery. For at least the next week or two, all you need to do for exercise are gentle bends and stretches several times a day and some brief walking about the house (about 5 minutes every hour or so). If you have a stationary bicycle, that is also good as a brief exercise. Don't pedal. Just raise the seat high and rock your leg back and forth gently. Doing this over time will eventually allow you to do a full rotation.

Be sure you are icing and elevating as much as possible. As long as you keep a towel between you and your ice source, it's just fine to ice even as you sleep. Be sure and ice the sides and back of your knee as well as the front.

If you choose to see a therapist, ask for lots of soft tissue massage and maybe some time on the bicycle as I suggested above - just rocking back and forth. Do NOT allow them to "work" your knee beyond just mild discomfort in anything you do. No pushing or pulling and no weights on a leg press.

Once your knee has calmed down and the swelling is reduced, you should begin to see improvements in your ROM. Once that starts, you can let your surgeon know you're making progress and you prefer to do this on your own rather than have an MUA.

Formation of "scar tissue" that needs to be broken up is rare. Your body normally makes scar tissue; that's how it heals. What the surgeon is talking about is termed adhesions. Actually adhesions are more likely to be a problem when your tissues are hot and dry from irritation and overworking. Those dry soft tissues tend to stick together in places where they shouldn't which can restrict movement. This isn't the normal healing process and it's why we tell people not to overdo their activity and exercise in the early weeks of recovery. You are much better off to keep tissues cool with ice and allow swelling to go down.

Just put that MUA out of your mind for now. You get to decide whether you have it done or not. The surgeon only suggests options for you. I think if you let your knee relax and recover, you'll begin to see the improvements you're looking for.

Please continue to let us know how you're progressing. If you need to ask me a specific question, just tag me so I see it quickly.

 

[Rather]

With my first TKR, I had LOTS of swelling which meant that I couldn't bend my knee without lots of pain. I found a therapist who focused on the lymphatic system. She was able to get fluid in my leg moving much better with a combination of lymphatic massage and carefully placed kinesiology tape. As the swelling decreased, I was able to get much better ROM.

 

[Thatbpguy]

My MD is adding a strong anti inflammatory medicine. I have also started working with a specialized pt with purely one on one sessions. We started this afternoon and I was encouraged. Very personable, focusing in on muscle and tissue. I do have hope. He seems very sharp and not going to drive me into intense pain.

 

[Thatbpguy]

I also wanted to add all swelling is gone aside from just over the knee center. The swelling there is 1.5", per the pt.

 

[Jockette]

Interesting, no one ever measured my swelling.

 

[Thatbpguy]

Interesting, no one ever measured my swelling.

That seems really odd.

 

[Jockette]

After I found Bonesmart I learned there are many different opinions and protocols between surgeons and PTs. It comes down to how they were trained and what their opinions are.

When I learned that my surgeon and PTs pushed my knee to where they wanted it, to measure, which caused me pain, all because of an opinion, I was a bit outraged. How dare they hurt me like that, “just because.”

That was when I started to realize that if it was all about opinions, then my opinion counted also, and I could choose for myself, how I was going to recover.

My whole first year was so stressful, worrying about everyone else’s opinion. Things will go much differently next time.

 

[Thatbpguy]

Three weeks out. The good news is I have a pt I have confidence in.

The downside:

* Still unable to walk unaided.
* Leg pain at night leads me to an oxy just to get a couple hours of sleep.
* Stll only able to muster 3 or so hours of sleep every 24 hours, leaving me weak and fits of delirium during days and nights.
* ROM stuck at 65 for 2 weeks and I amdiligently doing my exercises.
* Still unable to sleep on my side due to knee pain and no end in sight.

Odds and ends....

* It feels as if there is a tight band around my left foot. Really strange.
* Left foot usually very cold and I never get cold feet.
* Since I got home 3 weeks ago I have zero color in my face. Literally white as a sheet. It almost scares me. I think I'll be a ghost for Halloween.

 

[lovetocookandsew]

ROM stuck at 65 for 2 weeks and I am diligently doing my exercises.

My suggestion is to do little to no exercise for a bit, plus ice and elevate as much as possible, and see if your ROM improves. Doing your ADLs at 3 weeks is plenty. Forcing your knee to do exercises it's not ready for at three weeks can cause more swelling and thus less bending.
https://bonesmart.org/forum/threads/activity-progression-for-tkrs.14334/

As for your cold foot, I might send a message to my surgeon just to get his viewpoint on it. I used a walker and cane for a total of around 6 weeks, so needing to use an aid at three weeks seems normal to me. Sleep deprivation is part of the recovery with this surgery and will improve with time.
https://bonesmart.org/forum/threads...tty-much-inevitable-but-what-causes-it.13344/

 

[Jockette]

* Still unable to walk unaided.

This is pretty common.

Leg pain at night leads me to an oxy just to get a couple hours of sleep

This is often a sign of over activity during the day.

* Stll only able to muster 3 or so hours of sleep every 24 hours, leaving me weak and fits of delirium during days and nights.

Lack of sleep is very common.

I amdiligently doing my exercises.

Like lovetocookandsew said, stop trying so hard. Instead, be diligent with your rest, ice and elevation.

* Still unable to sleep on my side due to knee pain and no end in sight

This is also quite normal for 3 weeks out. Most people do eventually return to sleeping on their side.

Try to relax. You are 3 weeks into a 52 week (on average) recovery.

 

[Thatbpguy]

My daily routine is to do my exercises twice per day, walk up and down a short hallway every 2 hours (up & back 5 times), and the rest I am elevating and icing.