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TKR Lizzie's Recovery Thread

Liztlag

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I know I'm late posting this. I've been reading other's posts, which has been really helpful, and figured I'd post my own.
I had a left TKR on August 6th. I came home the same day since it was done at a surgical center.
The first two weeks were a blur - nausea, pain meds fog, and lack of sleep. At 7+ weeks post-op, the pain is manageable with anti-inflammatory and Advil/Tylenol. My biggest issues are the fatigue and poor extension.
I've been doing PT three times a week and I like the center I'm going to. The PT is gentle and supportive, but he's been stressing me out about my lack of extension, telling me that once the scar tissue builds up I won't be able to get it back. My knee is still very swollen and I believe that is impeding my flexing and extension.
My other issue is the fatigue. I can't seem to get through the simplest tasks - like making the bed - without needing to rest. I'm scheduled to go back to work at 10 weeks and I worry that I won't be able to get thru the day.
Any advice would be greatly appreciated.
 

Jockette

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Hi and Welcome!

I’m glad your therapist is gentle, but he is not correct about your extension. It can take quite a while to straighten but it will in time as you heal. Scar tissue does not continue to build and build and build. A certain amount of scar tissue is necessary or your wound would not heal.

You are correct that it is swelling that is not allowing your extension to progress. Spend a lot of time resting and icing to help the swelling go down. Always be sure to have a cloth between your skin and the ice, gel pack, or whatever you choose to use.

There is no window of opportunity, give your knee time it needs to heal. My ROM (both flexion and extension) have continued to improve past the 2 year post op mark!

I will leave you our Recovery Guidelines. Each article is short but very informative. Following these guidelines will help you have a less painful recovery.

Read through the articles as they will answer a lot of your questions.

You are fatigued because your body is using almost all it’s energy to heal this surgical wound. We call it the Energy Drain.

Knee Recovery: The Guidelines
1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now, they are almost certainly temporary
2. Control discomfort:
rest
elevate
ice
take your pain meds by prescription schedule (not when pain starts!)
don't overwork.
3. Do what you want to do BUT
a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you
b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.​
4. PT or exercise can be useful BUT take note of these
5. At week 4 and after you should follow this
6. Access to these pages on the website

The Recovery articles:
The importance of managing pain after a TKR and the pain chart
Swollen and stiff knee: what causes it?

Energy drain for TKRs

Elevation is the key

Ice to control pain and swelling

Heel slides and how to do them properly

Chart representation of TKR recovery

Healing: how long does it take?

Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

There are also some cautionary articles here
Myth busting: no pain, no gain
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds

We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery.

While members may create as many threads as they like in the 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 the member’s history before providing advice, so please post any updates or questions you have right here in this thread.
 

Pumpkln

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I'm scheduled to go back to work at 10 weeks and I worry that I won't be able to get thru the day.
We usually recommend 12 weeks before going back to work with a Phased return to work. You may want to ask if you can arrange a few weeks longer, and/or a phased return to work.

My knee is still very swollen and I believe that is impeding my flexing and extension.
Let your PT know you want to address your swelling and inflammation, they can use retrograde massage, and electrical stimulation, and Ice to control pain and swelling .
 

Celle

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The PT is gentle and supportive, but he's been stressing me out about my lack of extension, telling me that once the scar tissue builds up I won't be able to get it back. My knee is still very swollen and I believe that is impeding my flexing and extension.
My other issue is the fatigue. I can't seem to get through the simplest tasks - like making the bed - without needing to rest.
I'm glad your PT is gentle, but you're correct. It is swelling that's impeding your flexion and extension.

It's not at all unusual for extension to take longer to achieve than flexion. It will come, though. It takes longer because of the strong muscles and tendons at the back of your leg that have to be stretched slowly and gently.

There's no need to rush to get ROM (Range of Motion) because it can continue to improve for a year, or even much longer, after a knee replacement. There isn't any deadline you have to meet:
Myth busting: the "window of opportunity" in TKR

It's not exercising that gets you your ROM - it's time. Time to recover, time for swelling and pain to settle, and time to heal. Your knee is capable of achieving good ROM right from the start and its ROM will increase naturally, as your knee heals and the internal and external swelling decrease.

As for the fatigue, that's normal. Almost all your body's energy is being directed towards healing your knee, and there isn't much energy left for anything else.
Energy drain for TKRs

I'm scheduled to go back to work at 10 weeks and I worry that I won't be able to get thru the day.
Where you are now is not where you'll be at 10 weeks post-op. You'll be feeling much better by then, and capable of doing a lot more than you can now.
 
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Liztlag

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I haven't posted in a while, mostly because there's been no real change. 17 weeks after surgery and I feel like I'm stuck in the same spot. Lack of progress with my ROM led to an MUA at 13 weeks. The OS was able to get me to 120 - I've maintained 110 - but I'm still struggling with my extension. I'm using a CPM to keep my flex going and a Dynasplint for the extension.
After some internet searching and a discussion with my PT I realize that I probably have arthrofibrosis. It makes perfect sense, considering my symptoms - weak ROM, continued swelling, warm knee and continued pain plus the fact that I've always had issues with scarring. I feel a lot better knowing that there's a reason for my lack of progress. Now I just have to work out how to move on.
I'm scheduled to continue PT through the holidays, but after that I'm not sure there's much more he can do.
From what I've read there's differing opinions about surgically removing the scar tissue, that in some cases it actually gets worse after.
I'm wondering what experience others have had with arthrofibrosis.
 

Jockette

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A ROM of 110 at 17 weeks is not “weak.” Regaining our ROM takes different timeframes that are unique to each of us. And, many things influence that, how much swelling we have, and what our activities are, and how hard we work on it.

Ironic as it seems, the harder we work, the less ROM we get sometimes. It causes more swelling and tightness that prevents the improvement.

Mine was not good until well after my one year anniversary. By then my leg had had a lot more time to heal and relax, giving me a better ROM.

At 17 weeks you are only 1/3 the way healed in this year long, on average, recovery. My ROM even improved after my second anniversary, and I didn’t “work on it,” my daily activities were my “PT.”

Some surgeons and PTs want us to recover right away and they don’t take into account our individual body, and they make us feel we are not improving.

There s no rush to regain our ROM, which was proved in my case, as it can continue to improve for a very long time.
 

sistersinhim

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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 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. As I healed I was able to do more. Icing and elevation was a huge part of my recovery.

Listen to your knee. It will tell you if you're doing too much by increased pain and swelling. When that happens, I found that resting, icing and elevating helped.
 

Celle

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Jockette is right - a flexion of 110 is not 'weak'. It's about what is to be expected.

ROM can continue to improve for a year, or even longer, after a knee replacement.
Extension (straightening) often takes a lot longer to achieve than flexion does.
That's because those big muscles and tendons at the back of your leg need to be stretched slowly and gently. That's going to happen, so don't let anyone tell you that it needs to happen faster.

I'm pretty sure you don't have arthrofibrosis, because a) it usually doesn't happen this early in recovery and b) If you did, you wouldn't be able to bend your knee as far as you already can.

What you do have is an impatient PT therapist and surgeon, who expect quick results, and so have you all worried.

Your knee is only a third of the way through this year-long recovery . Give it time to heal and recover on its own schedule, not on some artificial, one-size-fits-all schedule.

good things take time.jpg
 

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