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Bilateral TKR Look Mom, No Crutches!

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Mrs. Ciz

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@leejaa Yes, I’m icing and elevating right now as I type this. I’m not icing as much as I was in the beginning, but I’m still doing it twice a day for an hour at a time. Is this enough? I’m not sure. Someone in another thread asked earlier this week how often we should be icing and elevating during the 6 to 8 week post op range, but I never saw the answer.
 

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but I’m still doing it twice a day for an hour at a time. Is this enough
Only you can decide if this is enough. If you still get stiffness and swelling then do try and ice as often as you can.
 

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If I had pain or swelling I iced and elevated the whole time I was sitting or laying down. You can't over-ice as long as you have a cloth between you and the ice pack. I used a thin dish towel.
 
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Yesterday at PT I asked my therapist why my flexion has stalled out. He said it actually hadn’t. He can get a better range of motion measurement when I’m sitting with my legs dangling off the treatment table. He said he can move my lower legs much farther back without it hurting when I’m in that position. He’s right! Each of my lower legs goes pretty far back without pain. He can’t match that flexion measurement when he tries to measure when I’m laying flat on my back with my knee bent as far as I (with a bit of his help) can bend it. So I have way more measurable flexion one way (dangling legs) than I do the other (flat on back with leg bent).

He has stopped cranking my leg back when he tries to measure when I’m flat on my back and is much more gentle now bc if it hurts, I involuntarily shoot my body up and away from the pain, so he can’t get a good measurement. And he knows I HATE it!!! Thankfully he’s a good therapist!
 
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My husband really wants to know when I can start driving again. I think he’s getting tired of taking me to PT. Ha! I’m off the narcotics now, so that is one hurdle crossed. I have an automatic shifting car, not a manual stick shift. I just don’t know when bilateral TKR folks go back to driving. Please share your experiences.
 

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My husband really wants to know when I can start driving again.
Well in the good old days (pre-covid) you would have a followup with your surgeon and they would release you to drive. Have you had a followup?

You will need to be able to do an emergency stop and since you have had bilateral surgery you need to be certain you can do this. Many of our members go to an empty parking lot to practice before venturing out on their own.
 

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I also had a much better bend when sitting on a chair than when laying down, though I don’t know why.
 
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I do have another follow up appointment with my OS in a few weeks. At that point I’ll be 10 weeks post op. I think I will practice in a parking lot. I don’t want any accidents!!!
 

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You can try out braking with the car not running. If that feels ok it's not a bad idea to try in an empty parking lot. I was able to drive (short trips) at 6 weeks.
The getting in and out of the car will probably be more challenging with a bilat than a single knee.
 

Roy Gardiner

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I told my therapist that the 8 min bike warm up last week kicked my butt for 2 days following PT. So we backed it down to 5 minutes today.
But I’ve stalled out the last 3 weeks with flexion. I’m still 105L and 100R. I’m really ready for these numbers to start moving again!
Can you get a static bike for home, or a static trainer to mount a normal road bike on? If you can, using a bike to gain ROM is pretty simple:
  • Set the bike to zero resistance
  • Set the saddle low enough so that a single rotation is a challenge; difficult but not painful. When a rotation becomes easy right from the start, lower the saddle a max of 1cm.
  • Gently turn the pedals, through discomfort but without pain.
  • Continue until the knee is 'warmed up' and the rotation is now easy, or for 2 minutes, whichever is the shorter time.
  • Repeat several/many times a day, but don't go mad. Diminishing returns will apply; my guess is that half a dozen reps would be enough
  • Do not pedal fast or for more than 2 minutes, this is a stretching exercise, not training.
  • And if you get any pain or swelling in the 24 hours after doing this, cut it down until you don't
Here is a bit more chat and some pix and how 'healing' and 'training' are different
 

leejaa

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The thing that helped me gain flexion at home was my platform rocker. I would use it a few times a day sitting to watch television or read and rock. The rocking motion is soothing to the brain and body and the knee follows the motion as it relaxes a bit. It really helped me. Again, do not force it just rock to a comfortable angle and increase in slight amounts if it relaxes.
 
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I do have a rocking chair, but the seat is really really low. I’m afraid if I sit in it, I won’t be able to get up. I may pile up some pillow to raise the seat and give it a try. Rocking was also recommended by another therapist at my clinic.

I have a bike, but I don’t have the contraption needed to convert it to an exercise bike. At PT I moved from one recumbent bike with additional arm pedals to the other harder recumbent bike. I could not pedal on the harder one two weeks ago, but this week I could! Progress!

I spent the last couple of days going over all the insurance explanation of benefits and doctors’ bills. Fun fun fun! I paid all the small bills and set up a payment plan for the big one. I‘m still waiting on a couple more small bills to roll in. One is from an out of network hospital pathologist (that I didn’t know about and didn’t get to choose) who managed all my in hospital pre op testing. Hopefully he will bill me as in network or I’ll be able to negotiate what I owe since I had the testing done at an in network hospital. We’ll see. All in all, my insurance did a pretty good job with coverage. The only big surprise was being required by both the hospital and my surgeon to make a big down payment before surgery. I’ve never had to do that with any prior surgeries and was not prepared. Fortunately, I’m going to get most of the surgeon’s down payment back because I hit my deductible and my out of pocket max.
 

pamsknees

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My husband really wants to know when I can start driving again. I think he’s getting tired of taking me to PT. Ha! I’m off the narcotics now, so that is one hurdle crossed. I have an automatic shifting car, not a manual stick shift. I just don’t know when bilateral TKR folks go back to driving. Please share your experiences.
At my 6 week post op visit, my surgeon told me I had no need for physical therapy( it had shut down the day after my bilateral TKR on Mar 16) & that I was fine to drive. I’d been off narcotics for a few weeks at that point.
 

leejaa

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Yes, insurance is so much fun. When I had my first replacement I had to leave a deposit at the hospital on day of surgery equal to my deductible ($3000). I did know about it so at least it was not a surprise. I actually got some of the money back (not much) in a few months. That is why I did my other knee in the same year since it was hurting and needing doing. I figured since I had met the deductible for the year I might as well reap some benefit from it instead of being in pain and postponing the surgery to the following year.
 
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Same with me - I had to do both in the same calendar year due to the high deductible. If I did them one at a time, I’d have missed half the school year. I didn’t want to miss that much time with my students, so bilateral TKR was the solution. But boy, was I unprepared for how hard it was going to be!!!!
 
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Ever since surgery, I’ve been getting a lot of cold sores. Usually I may get one or two a year unless I get sick, sunburned or super stressed. But now I seem to be getting them almost weekly. This week I got 2!!!

I know recovery really taxes the body, so maybe that’s why I’m getting them. Maybe my immune system is down. Or maybe it’s the mask wearing. My skin underneath the mask is a mess - broken out and very chapped. I’ve tried acne cream, antibiotic ointment and lotion. Now I’m putting hydrocortisone on the chapped area to get it to heal up. That seems to be working the best.

Anyone else struggle with cold sores during recovery?
 

leejaa

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Surgery and recovery is very stressful for the body plus living in the time of pandemic does not help with decreasing this. Sounds like your body is reacting. I hope you have a peaceful evening. What kind of masks are you using as you said your face was broken out and chapped. If cloth, could it be laundry detergent? I hope you have a peaceful evening/night.
 

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Hey there! I don't know how I missed your recovery thread! Sounds like you're doing pretty well for your bilateral tkr! I haven't had any cold sore issues but I do wonder if they are from the masks. Make sure you are washing in between or use the disposables. I like the cotton ones better than disposable, and I have like 15 lol because I will have to use them at work too very soon.

I too also measure better when sitting upright than laying down. It's just a different and more normal position, so not sure why that isn't what they want to do, esp when you're several weeks out! I hope you continue to improve and I will be sure to check back in on your thread!
 
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@leejaa
I’ve been wearing the disposable paper masks. I’m not really going anywhere but PT where I sweat up a storm. My skin does not like that damp sweaty environment under the mask. I also haven’t been wearing make up at home, so I haven’t been doing my full pre make up skin care routine. I think that’s a big part of the breakouts and chapping too. I need to be more consistent. Maybe the skin around my chin and mouth being angry plus the surgical impact on my body and immune system is the perfect cold sore storm.

Hi @SpaceGirl
I’ve been keeping up with your recovery thread. I’m glad I’m not the only one who measures better with legs hanging off the treatment table versus flat on my back with knees bent. It doesn’t help that I have big legs! I asked my therapist if that was part of it. He said big legs may account for 2 to 3 degrees but that’s it. I’m stuck at 105 after 8.5 weeks. I’m hoping as the swelling goes down over the next few months that I get to 120. That’s my goal.
 

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