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[TKR] Macknit's recovery thread

Macknit

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Hello everyone, I had my RTKR on Tuesday, September 3rd and did pretty well for the first 10 days; I was so busy with adhering to short walks, gentle PT exercises and helping my dear husband be patient with me :heehee:, that I read everyone's postings...but forgot to start mine! Might be the pain medication?? I was really feeling pretty good, though I never felt like 10 mg Oxycodone had completely erased the pain, until the 5th day, I could finally feel complete relief!

Unfortunately, I then had my 4th PT session (I've been working with this clinic and only one PT for my back for the past 3.5 years) and for the first time ever my wonderful PT pushed a little too hard to get flexion. I told her and she backed off, but boy do I feel it today! I can tell you, like so many have said, that any pain does mean take a break!!! I have read through all the recovery information and most of my questions have been answered and number wise I'm not worried because my flexion is up to 101 (without pain...) I haven't been able to get 0 degrees extension though...is this fairly common, where one bend direction does fine and the other lags? I also have a few questions specifically about my R IT Band which is very, very tight (and was pre-surgery) but now sends zingers up to the R hip, which literally causes me to jump!! Is this part of the recovery also?

Lastly, I'm wondering about the Doctor Lounge cushion....so far I prop 3 pillows at night in my bed, but the slowly shift as the night goes on:groan:, that doesn't feel too good.... I'm wondering if the pillow (shown in the items list of things possibly needed) is worth the investment. This is my first joint replacement, and, most likely I can use it in the future!

Thanks everyone, I really have enjoyed reading through ALL of the recovery forums!
 

luvcats

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It's still very early days to worry too much about numbers. Much has to do with how much swelling you have and according to the info from my surgeon we are just now hitting the maximum on that. I'm one day behind you on my second knee.

I have a Lounge Doctor and I use it a lot. At night I just have a stack of 2 fluffy pillows, but I spend the rest of my day with my leg up on the LD. I have a terrible tendency to swell even under the best of circumstances. Since I have had both knees done, it was a no brainer investment for me.
 

Celle

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Unfortunately, I then had my 4th PT session (I've been working with this clinic and only one PT for my back for the past 3.5 years) and for the first time ever my wonderful PT pushed a little too hard to get flexion. I told her and she backed off, but boy do I feel it today!
PT should never hurt. If it hurts, it's bad PT and detrimental to your recovery. There's never any need for your therapist to push on your inee, so tell her to stop.
number wise I'm not worried because my flexion is up to 101 (without pain...) I haven't been able to get 0 degrees extension though...is this fairly common, where one bend direction does fine and the other lags?
Your flexion is excellent. It's not unusual for extension to take longer. That's because the large muscles and tendons at the back of your leg 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

I also have a few questions specifically about my R IT Band which is very, very tight (and was pre-surgery) but now sends zingers up to the R hip, which literally causes me to jump!! Is this part of the recovery also?
At the moment, treat your IT band very gently and don't do anything to irritate it. IT band problems are, unfortunately, quite common, but they usually resolve. Here's an article about them:
ITB (ilio-tibial band) issues and treatments


Lastly, I'm wondering about the Doctor Lounge cushion....so far I prop 3 pillows at night in my bed, but the slowly shift as the night goes on:groan:, that doesn't feel too good.... I'm wondering if the pillow (shown in the items list of things possibly needed) is worth the investment.
 

Celle

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Welcome to recovery, @Macknit .
Here's your copy of the recovery reading:
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 a 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 history before providing advice.
 

Bionic

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@Macknit
Re the lounge doctor. I didn't feel I could justify the cost so did as you have done and stacked 3 pillows up for the night. To keep them in place I made 2 'belts' with velcro fastening and it worked really well.
 

sistersinhim

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I had two Lounge Doctor type leg elevators, one for the recliner and one for my bed. Being single, it was too difficult to carry one back and forth, so I got two of them! I think they are worth the expense. There are other companies that sell the same basic thing at a slightly cheaper price. Just make sure, if you plan on buying one, that it's like the one shown on here.
 

Celle

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You could also pin the pillows together, like this:
 
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Macknit

Macknit

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Thanks everyone for the helpful insight :thankyou: (@Bionic - I love the belt idea). I am excited to say that I got 6 1/2 hours of sleep last night and only 1 bathroom trip. However, I do have a few pain questions...I'm at day 12 and my pain is literally all over the place! Sometimes the zingers to my hip, sometimes the deep bone ache, sometimes the knee cap, and sometimes the entire knee :sad:!? I'm taking my oxy at the prescribed times and acetaminophen/ibuprofen at in between intervals. I ice and elevate often (5-6X per day, 45 -90 minutes). I use the "Cold Rush" ice machine, which is helpful!! All of this helps some, but I still really struggle with complete pain relief. I'm thinking the PT aggravated things on Friday, so I really am resting everything this weekend.
  • Is this "as good as it gets?"
  • Does anyone have any other relief treatments that they use?
Thanks!!
 

Celle

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This is "as good as it gets" for now, but you're healing and everything is going to improve gradually.
It's quite common to have pains all over the place. Your whole body is traumatized and needs to recover, not just your knee.

It does sound as if the PT made things more uncomfortable for you, so tell your therapist that and say you want to cut back on the exercises next time. At this very early stage of recovery, all the exercise your knee needs is gained from just walking around your house and garden.

It's not exercising that gets you your ROM (Range of Motion) - 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. Your ROM will gradually increase as your knee heals and the internal and external swelling decrease.
 

Bionic

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I agree with Celle that this is as good as it gets for the time being. I have to admit feeling pretty miserable for the first few weeks. Thats not to say that I had pain all the time but just that I couldn't see a time when things would start to feel 'normal'.
Well, 6 and a bit months later I do feel 'normal' most of the time. I go to the gym twice a week and am pretty confident with most of the exercises and not in any pain. This operation is for the long haul but it will all come right in the end. Hang in there.
 
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Macknit

Macknit

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Thanks for this insight, and the reminder that I am healing!! I am really doing 'good enough' with this and just have to remind myself of the millions of people who have gone before me and certainly have been happy down the road with the decision to heal! (Whether it has been due to terrible accidents or, as in my case, they made the choice to have this surgery) . I'm praying to be patient and kind through this process, which definitely will contribute to strengthening my inner self :angel:while giving me compassion for others in their travels down this road. Thank you for using this format to help others, like me, on this little (huge?) journey of recovery!
 

luvcats

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The first 2, 2.5 weeks are generally just plain unpleasant. Even with plenty of good drugs. After that things will get better, slowly but surely. That's when you have to be super careful not to overdo. And overdo is a very small moving target!

Be kind and patient with yourself.
 

Didot

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The pain and discomfort does feel relentless for me too. I hate the way swelling gets in the way of mobility, and it’s so difficult to make any progress without set backs when you try to do things. So frustrating. I’m with you!!!


Sent from my iPad using Tapatalk
 

Celle

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I hate the way swelling gets in the way of mobility, and it’s so difficult to make any progress without set backs when you try to do things.
In a way, the swelling is protecting your knee. It prevents you from doing too much. A TKR is major surgery and your knee has been through a lot. It needs time and gentle treatment, so it can heal without being damaged further.

Your knee will heal well, but that healing does take time - lots of time.
 

Didot

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I went to PT today. No pressure to do anything that causes pain. However mid way through they measured my ROM - only 60 or so. When I left hospital it was 90, but now still swollen and tight. This then seemed to be the expectation for exercises from then on. Like standing from the chair and sitting again. They say there’s no excuse to not keep the 60 bend ( because my knee can do it) but it feels like putting constant force on my poor damaged soft tissues. Eventually I said I’d had enough. Am I copping out or should I force the knee to work within the measured range?


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Macknit

Macknit

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@Didot I've read through many of the recovery threads and answers on this forum and consistently I read:
"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."

I do not hear that you are copping out or any such thing....some of us move more slowly than others and we just are blessed to get to work on our patience:loveshwr:! Is this luck or what??? My recent experience in PT is that it aggravates sometimes, and sometimes it doesn't!
 
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Celle

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I went to PT today. No pressure to do anything that causes pain. However mid way through they measured my ROM - only 60 or so. When I left hospital it was 90, but now still swollen and tight. This then seemed to be the expectation for exercises from then on. Like standing from the chair and sitting again. They say there’s no excuse to not keep the 60 bend ( because my knee can do it) but it feels like putting constant force on my poor damaged soft tissues. Eventually I said I’d had enough. Am I copping out or should I force the knee to work within the measured range?
It's not unusual for your knee to lose some of its flexion after you come home from hospital. It happens because, no matter how hard you try not to, you usually end up being more active than you were in hospital. Your knee swells more internally, which decreases its flexion temporarily.

Your instincts are correct. There's no point in forcing your knee to keep bending to 60 degrees or more. Forcing will just increase the swelling, which could further limit flexion. You know your knee has the ability to bend to 90 degrees, because its done it before, but there's no need to rush to get there again.

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

And 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. Its ROM will gradually increase as your knee heals and the internal and external swelling decrease.

Remember what we told you in the recovery guidelines:
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.
 

Didot

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@Celle. Thank you for confirming my thoughts again. It’s so difficult when confronted by “professionals” who insist otherwise. I don’t think I ‘m going to go back. I’ve had an awful day after being there yesterday.


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Celle

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It’s so difficult when confronted by “professionals” who insist otherwise. I don’t think I ‘m going to go back. I’ve had an awful day after being there yesterday.
I know how difficult it can be when you get conflicting advice.

Just remember that it's your knee, you have the right to say what happens to it, and you know your body best. People can advise you, but you also have the right to decide whether or not to accept that advice.

Another thing is that most of these "professionals" may well have been trained to believe there is only one way to recover, but very few of them have actually had a knee replacement. You've already had one knee replacement, so you are ahead of them in experience.
 

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