Revision TKR Mamie's Recovery Thread

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Mamie

Mamie

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Hello again,

revision lefty I am so happy you are with good care and speaking up. Today my therapist came and had me sit in a car and tried to do quads. I yelled out and she stepped back apologizing for my tears. She took me back to bed and had me rest but ask to try again but I couldn’t. She assured me gentle was the way we had to go and I was within target of where I should be.

My swelling took me out for the entire day. I pray for everyone here they don't go through what I have so far. No does not hold hold for long.

Mamie
 
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Jamie, I do not understand why the brace.
My blood pressures have been today between 189 to 209 over 78 to 91.

My foot has not resolved as yet due to swelling. I increased my blood pressure meds today. Metaproprol, Imdur and Bumex. I think it’s helping but has a long waus to go. What concerns me at this time is with the heel slide I cannot get much. The area right next to the inside of the knee isn’t wanting to give way. It’s very tight and I have no idea why or how to get it relaxed. Is it a sign it has frozen up? The brace adjustment knob sits about there. The brace is set to move to 90 degrees but there is no way with or without I can get half way there. I’m hoping the swelling once gone will help this ROM they want from me but I am not willing to be traumatized even if it means my leg freezes up. The ted hose are not available to me until Tuesday and cannot be bought anywhere that we live. That’s on my surgeon as it should have been put on me in surgery I seemed to have slipped through the cracks as many errors have been made. The surgeon knows about the swelling, no Ted hose and my blood pressure issues.
Thank you again for your caring manner,
Mamie
 
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Hello Kneeper, By the time I get to where I am going my leg is throbbing so badly I can barely stand up. I can’t get them to listen about it even though they can see the swelling and see no shoe fits my foot. I think my appointment on Tuesdsy is to remove the staples. It looks like about 200. Is it painful to have them removed?

Well, one day at a time!

you take care of you too,

Mamie
 

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It’s very tight and I have no idea why or how to get it relaxed. Is it a sign it has frozen up
It is very tight because it has been extremely traumatized by this surgery and now it has swelled, a normal body reaction to the trauma it has been through barely more than a week ago. Your knee will not freeze, so don’t listen to anyone who tells you it will. That is old school thinking that wasn’t true in the first place.

Your knee is very upset right now, as is your whole body, as after effects from this surgery. It also doesn’t sound like you are getting decent care. Try to relax, rest as much as you can, just take short walks every hour or two. Ice and elevate as much as you are comfortable with, just be sure to have some type of cloth or towel between your skin and the ice source, to protect your skin.

I’m so very sorry about the type of experience you are having. :console2:
 

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The area right next to the inside of the knee isn’t wanting to give way. It’s very tight and I have no idea why or how to get it relaxed.
It's very possible that you had a medial release during surgery. I had the same thing. I had heard others on here saying that they had ordered their surgery report and found out things had happened during their surgery that were never told to them. I then ordered mine. That's when I found out I had had a medial release and that explained why I had this extra problem area.
 
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Listen to your sense of logic and don't push yourself with exercises while you're still swollen. You do need to do gentle bends and stretches throughout each day. That will keep your knee mobile. It is not going to "freeze."

You probably will need to go to have the staples removed. Although a Home Health nurse can do this for you, your surgeon may want you to come to the office so he can check things out. You might try calling your Home Health services and see if they would do this for you you so you wouldn't have to make that trip. Given the state of your knee right now those long car trips are doing you more harm than good.

If you must go to the surgeon's office, that that time to ask him (call first and tell them you want a consultation with the surgeon as part of the visit) his plan for the brace and what is going on with your foot. You need to know that.

Then going forward, I'd say ask your therapist to provide you with printed copies of your exercises and then if you get to the point where Home Health can no longer come, use those as the basis for your post-op exercises. Once you have the printed sheets in hand, you can let us know what exercises they are recommending for you and we can possibly offer some additional help with what might work best for you. Don't feel like you have to make that torturous trip just to have therapy.
 
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Thank you Sisterinhim. I will look up what a medial release is and then ask exactly what he did. He told us that my knee was a mess and why it took 4 hours. The report he gave us was that every tendon, ligament, and muscle was either torn or damaged and there was an extreme bone loss. We do not feel I am getting care of any kind now. They know of my blood pressure, swelling, and pain but just ask I do not go to ER, but offer no help.

Jamie, I was given a copy of my exercise therapy provided and a link to my CareTeam exercises. Tomorrow, I will try to copy/paste my online exercises and the ones from therapy and see if they can be attached and sent to you. My blood pressure today at its resting highest was 189/119 HR 116. After exercise, it went quite higher. I only do gentle movements and walk several short distances. I do side to side slides, foot pump, pelvic tilts though its called something else, tightening of the tighs, and they ask me to do heel slides in bed and in a chair. Plus foot flat, knee bent, and push the knee forward. I do not do that one. I try to do the heel slide. I know we have to go have the staples removed and it will be a difficult trip Tuesday but, maybe the surgeon will see me with the PA. He informed me she was a team member and what she says will be. So, not much luck there. I wish I had seen this before surgery! I am worried about this appointment as I do plan to request pain meds of at least Tramadol for a few months during therapy. But, I am also concerned about all these staples being removed. My leg is so tender and swollen and she is rough.

Jockette, I have been told over and over that my knee will freeze as the first surgery. I was told that I throw scar tissue fast and when I went to surgery I only had a 60-degree movement. They tell me if I do not force it now, I may not get even that. I am horrified. Yet I can't do it. I would rather be stuck than be in that mush forced pain again. The first knee replacement, a wrong size was placed in the knee and when it was discovered, I did not want to have another surgery. I had to be medicated so much begore surgery just to deal with therapy, I can't do it again. I am doing my best. I am 8 days post-op and each day we see an improvement. I can lift my foot off the floor a bit higher, do the slides from side to side, get out of bed easier, walk and bend my knee when walking, more stable when walking, and do the gentle exercises. To us, it feels good at this stage but by Monday they are expecting 90 degrees ROM. It will not happen! I read that 90 degrees should be reached by 6 weeks. At 6 weeks my surgeon is hoping to get 110 degrees or more by pushing. I will be happy for 90 at any stage.

Thank you all for helping me walk this path.
 

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@Mamie.....I am so sorry that you are getting what appears from your description to be substandard post-op care from your surgeon. Based on your post above, here are some ideas I have for you:

They know of my blood pressure, swelling, and pain but just ask I do not go to ER, but offer no help.
Since you're not getting any help with these critical issues (especially your blood pressure), try contacting your GP and describe what is going on. It is dangerous for you to continue with those high readings and you shouldn't be adjusting your blood pressure medication on your own. Either your GP or whatever doctor prescribed your current medications can help. This needs to get under control as soon as possible. If you have these high readings along with any other problems like headaches, blurry vision, chest pain, or difficulty breathing ignore the surgeon's instructions and call 911. That's an emergency.

I am 8 days post-op and each day we see an improvement. I can lift my foot off the floor a bit higher, do the slides from side to side, get out of bed easier, walk and bend my knee when walking, more stable when walking, and do the gentle exercises. To us, it feels good at this stage
This is such a positive report, Mamie! It lets me know that we're on the right path with this recovery. Your knee has been through so much that it's expected that your recovery may be on the slower side of "normal." The fact that you see progress every day (sometimes it's only weekly in these cases), means you're doing just the right mix of exercise and resting. What we want to see now is a reduction in that swelling. It can take time, so patience is important. Be sure you're drinking at least 60 ounces of water each day....more if you can. That helps to flush out the excess fluid. Use ice as much as you can. Once you get your pain under control, that will help reduce the swelling too.

by Monday they are expecting 90 degrees ROM.
Well, you know....they can "expect" all they want. But the reality is that you are in charge of your body and your recovery. As long as you're making progress, no one has any room to complain. Stand firm in your resolve to recover your way. The surgeon cannot dismiss you from care this early in your recovery no matter what you do or don't do. If that PA gets too pushy with you, you can calmly tell her that you are not comfortable with the discussion and you'd like to speak with either the surgeon or a supervisor in the clinic. They don't have the right to bully you into doing something you feel is wrong for your health and well-being. You are a partner in this process and that means people should be willing to work with you on your treatment.

Hang in there, my friend. You'll get there. This obviously is not the perfect experience for you, but now that you're learning more about the knee replacement surgery and healing process, hopefully you'll be more comfortable to advocate for yourself when it's needed. We're always here to support you, talk about your concerns, and offer options for you.

One thing I suggest is that you register for our upcoming Ask the Expert Webinar on August 1st. If you click on the banner at the top of the page, you'll go to the registration page where you can enter a question about your post-op issues. We are selecting 4 BoneSmarties to be live during the webinar with Dr. Sinha and I believe your situation has a good chance of getting selected. That way, not only can you ask your question to Dr. Sinha directly, you'll be able to have a discussion with him about your knee and all that's going on. Sort of like an immediate second opinion without leaving home! I strongly encourage you to participate in the webinar.
 
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Jamie, I have found such comfort here. Thank you again for your advice. My swelling refuses to get started in the right direction which in turn keeps me in pain and with not a huge success in movement. I believe I am improving every day with most exercises but for ROM.

When I had my original knee replacement they pushed me so hard and drugged me up to push harder. Then at this stage, they wanted to take me back to surgery and manipulate my knee to “break adhesions” to start over, but I refused. I’ve heard this is the same technique my surgeon may suggest. I can’t go through that.

I went to registration but before signing up, do you have any suggestions which of my concerns/questions I should ask? There are a few. The freezing up is one...how much ROM should I expect at this stage of recovery? I did not swell to this degree or was I like this before nor did my pain or blood pressure become so severe. Why now? Can I do anything about my issues so my knee will recover? Do I just believe in my joint bending while resting it doing my exercises but not pushing it?

I think I am only at 45 degrees at 9 days and maybe not that yet. BP down yesterday some as I slept and rested, iced more. This evening high again now because I’ve been trying hard to get more bend.

I was told that since sitting in a chair and pushing for a good bend degree was too painful to try it differently. So I stood facing the side of my bed and bent my knee as though pushing off for a race. It was not as painful as sitting in a chair but hurt badly after doing it for ten minutes. I had to ice and it was too soon for pain meds. BP spiked and I still have not not stopped hurting. I am so afraid of what they will say about my progress. I know they will blame it on my therapy at home or me not trying hard enough but they can’t do much with a swollen knee/foot and BP so high. Other than refusing, if he suggest putting me to sleep to force my knee into better range, any suggestions as to how I should respond?

I am curious about this brace. I don’t remember wearing one before. Are they something standard used after revisions? It seems cumbersome and more difficult to exercise with it though set for 90 degrees. I also believe it adds to my pain.

I hate taking up so much of Your or anyone’s time but really need help understanding why things are as they are now. I promise I am working at it each day. I am resting in bed a lot as I am so tired. But I am constantly moving my knee in some exercise. I am determined but not winning.


Many thanks,
MAmie
 
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I just saw your reply to my positive results. I wanted you to also know another. I am not sure it is that big of a deal but it was to us. Our bed sits high off tge floor and I have not been able to lift it on my own getting into or out of bed. I still can’t alone but I am able to get it about one third of the distance coming straight up so my husband does not have to bend clear to tge floor to pick it up. I’m excited!

Mamie
 

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I still can’t alone but I am able to get it about one third of the distance coming straight up so my husband does not have to bend clear to tge floor to pick it up. I’m excited!
I can completely relate! :heehee:
 

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It was a couple of weeks before I could get my leg on the bed, or even just the height of an ottoman, so my husband did that for me. :roseshwr:

I think you are trying too hard with your exercises. This is increasing your pain. I also think the worry you have about ROM is a factor in increasing your blood pressure.

Please believe us when we say you honestly don’t have to work on your ROM. You are fresh out of a surgery that causes a lot of trauma to your body. Your surgeon did major carpentry work and disturbed every millimeter of soft tissue in this area. You aren't tight because your muscle is underused and needs to be stretched and rehabbed. You're tight because your tissue is healing...and full healing takes a full year or more.


Regaining our ROM is more about Time than repetitions of a list of exercises.

Time to recover.
Time for pain and swelling to settle.
Time to heal.

Our range of motion is right there all
along just waiting for that to happen so it can show itself.

In the general run of things, it doesn't need to be fought for, worked hard for or worried about. It will happen. Normal activity is the key to success.
 

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@Mamie ....the question that is most important for you to ask when you register for Ask the Expert would be something like this:

Revision TKR July 16. Severe pain and swelling causing consistently high blood pressure. Resting highest was 189/119 HR 116. Low ROM. What should I do?


I can tell from your posts that you are trying and that you're fearful of what might lie ahead. But I believe you still are approaching your recovery with the idea that you need to work hard at recovery or something bad will happen. It won't. You are trying too hard and that's contributing to your pain and swelling.

When I've suggested that you need to do gentle bends and stretches several times a day, I mean that literally. No pushing beyond just the mildest of discomfort. And never for 10 minutes at at time.

I recommend that you pick the most comfortable position to do these bends - whether it is lying in bed and doing heel slides, sitting in a chair or on the toilet (that's when I did mine), or standing and leaning into your leg to encourage a bend - and do the GENTLE bends for no more than five minutes three times a day. Rest a majority of the day with ice and elevation. Get up from your resting every hour or two and walk slowly around the house for 5 minutes.

If you have an exercise bike, instead of the 5 minute walk you could do some turns on the bike for 5 minutes or less slowly at no resistance. If you cannot make a full rotation, just rock the pedals back and forth. Eventually you'll be able to go all the way around. An exercise bike used this way is one of the best ways to gently provide motion for your knee. This is it for exercise for now until you have swelling relief.

As you can see, any more causes you to swell again and have pain. You need to keep this low level of exercise up until the swelling has reduced and stays that way. It may be a week. It could be a month or more. It's whatever time your body needs to settle down and no one is going to make it happen any faster by "doing" something. In fact, the more you "do" the more you'll swell and the whole process will take longer.

Contact your GP immediately about your increased blood pressure levels. Only your doctor should be making adjustments in your medication if that's needed to try and keep your BP at reasonable levels. It is not healthy for you to have blood pressure levels and heart rates like you're describing. It could be caused by pain or anxiety or a combination of both, but it is harmful for you to have this going on for days at a time.

I was told that since sitting in a chair and pushing for a good bend degree was too painful to try it differently. So I stood facing the side of my bed and bent my knee as though pushing off for a race. It was not as painful as sitting in a chair but hurt badly after doing it for ten minutes. I had to ice and it was too soon for pain meds. BP spiked and I still have not not stopped hurting.
The type of scarring your surgeon and his PA are talking about breaking up with a Manipulation Under Anesthetic (MUA) does occur, but it is not common. However, studies have shown that a person is more likely to have problems with adhesions if they are exercising too hard and causing inflammation in the knee. The inflammation generates heat in the tissues. Hot tissues become dry and are more likely to stick together instead of sliding freely against each other as they do normally when moist. This is the reason we are focusing on getting your swelling down as soon as possible. Trying too hard with pushing your knee could actually cause you to get the adhesions that you are worried about. Please stop trying so hard.

I am so afraid of what they will say about my progress. I know they will blame it on my therapy at home or me not trying hard enough but they can’t do much with a swollen knee/foot and BP so high. Other than refusing, if he suggest putting me to sleep to force my knee into better range, any suggestions as to how I should respond?
I know it's easier said than done, but try to not worry about things that might happen. You cannot control what your doctor and his staff may say or do. You can only control your reaction to their recommendations. And whatever they say to you is just that - a recommendation. They cannot make you do anything. You are in control of your care and your health. If an MUA is suggested, politely look the person in the eye and say you're not ready for that at this point, you're seeing gradual improvement with the way you are approaching your recovery, and you want to continue working with it on your own for now.

I am curious about this brace. I don’t remember wearing one before. Are they something standard used after revisions? It seems cumbersome and more difficult to exercise with it though set for 90 degrees. I also believe it adds to my pain.
I'm curious about the reason for the brace as well. It is not something that is normally done after a knee replacement or revision, so I encourage to ask questions about it to find out why it has been prescribed, what improvements are expected with your wearing it, and how long it must be worn. You can either call and ask these questions or wait until an appointment.

I am constantly moving my knee in some exercise. I am determined but not winning.
As mentioned above, stop trying to "constantly" work your knee. This is setting you back, not helping. Just do the movements I recommended above and then let your knee rest with ice and elevation.

Our bed sits high off tge floor and I have not been able to lift it on my own getting into or out of bed. I still can’t alone but I am able to get it about one third of the distance coming straight up so my husband does not have to bend clear to tge floor to pick it up. I’m excited!
This is indeed wonderful progress! You need to celebrate. Even these small advances prove that your knee is going to be fine if you can just slow down the "trying" to make it heal. Your body is in charge here and you need to let it heal itself. No amount of working at it will make things happen any faster.

Please don't worry about the time involved. Our main goal is to see you have a successful recovery. We are dedicated to that for all our BoneSmarties and we're always here to listen to your concerns and support you.
 

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Hi, @Mamie Here are several things I did/learned after my many surgeries. First, to get into bed, I used my leg lifter until my quads woke up and I could do it on my own. I would sit on the side of my bed, loop my leg lifter around the arch of my foot and lift it up onto the bed. (I used a long soft cloth provided by my hospital; you can use whatever you have such as a scarf, lifter, etc. Use whatever works best for you) As for the brace, if my doctor had prescribed one after surgery, it would have come off at home and been relegated to the garage. What you do is your choice.

As for ROM, I never, ever allowed anyone to measure me after the surgery as I never cared about numbers; only what I could do as time went on. As long as your knee remains swollen, whether inside where you can't see it, or outside, or both, your knee won't bend as much as it will when the swelling goes down. There's no way to change that, and trying to force that swollen knee to bend before it's ready will only cause pain, more swelling and less bend. Take my word for it, the new implant is sitting in there ready and willing to bend as soon as the swelling dissipates. I guarantee you your surgeon checked the implant thoroughly before putting it in, to make sure it works properly, so your job now is to be PATIENT, stop trying to force your ROM and allow that knee to heal.

We don't want you to become a couch potato, we want you to move around regularly in between icing and elevating, adding more and more distance to your walking around as time goes on and your knee tolerates it.

I also used to do small stretches of my calf by occasionally gently moving my toes upward when I was icing, and I'd also wiggle my toes, and move my ankles some while icing. If I was not up walking, I was icing and elevating for long periods of time during the day, and all night long.

My best advice to you is to message your GP just to let him/her know about your blood pressure; back off the heavy PT and follow the activity progression article in the guidelines you were given above. Relax and have patience-this is a long recovery and you're just at the beginning.
 

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Hello Kneeper, By the time I get to where I am going my leg is throbbing so badly I can barely stand up. I can’t get them to listen about it even though they can see the swelling and see no shoe fits my foot. I think my appointment on Tuesdsy is to remove the staples. It looks like about 200. Is it painful to have them removed?

Well, one day at a time!

you take care of you too,

Mamie
Yes, the "railroad tracks" of staples look like a lot. It will pinch to have them removed but with a good technique it shouldn't hurt much and it passes fairly quickly.

As for your swelling, I can tell you when I went back to have staples removed and have an xray I was so swollen I could maybe bend to 60 degrees. Heel slides felt like a joke--slide to where? It felt like if I got an inch that was a lot. But gradually, with lots of ice and elevating almost 24/7 the swelling did come down. I didn't get to 90 until 6 weeks. But the swelling did come down and I'm very pleased with my knees.
Oh, and after my PT with knee #1 gave me all the scare talk about the doc not being happy if I wasn't at 90 by 6 weeks "you might need an MUA" and all that, my OS didn't even measure me at 6 weeks. He had me show him how I could bend and said--keep up the good work and told me I'd continue to progress.

Keep those legs elevated. I found the best for getting my "toes above nose" was to lie on top of the bed with a pillow ramp for my leg.
 
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Hello Jockett and Jamie,

Today my PT person came and was upset. My BP was 219/99 HR 97. She told me I was going to stroke out after I told her I was having a headache. She said after seeing what I could and could not do that I needed to go to a facility where my knee could be cranked and shoved and it would really hurt but needed. I refused. I told her that if it's in the cards to be crippled, I'd rather get that way naturally than be tortured to get there. I just cannot do it. I believe all of you and following your suggestions to the letter. The only reason I am constantly worried is they (everyone I am in the care of) tells me my knee is going to freeze and that it needs to be forced. I will not ever allow that to happen again. It did after my first knee replacement and its why I am afraid. I know I am the captain of my own ship but they sit here making such vivid arguments to the logic of why to push. I, in turn, tell them with a swollen knee it made no sense to aggravate things. Here is the kicker.

I woke this morning with a high BP again. BUT, my swelling appeared to be better. Ankle up but hurt internally. I felt that if allowed to rest with ice and easy movements, maybe the interior would get better too. My PT saw the outside and said let's take it easy today based on this BP. So, I relaxed. She had me sit on the edge of our bed with my legs dangling for a stretch and then supported the left knee. Soon she was massaging it and it hurt but felt good. She then gently pushed my knee back towards the bed and kept the pressure up until it became outright painful. She stopped after doing it again. We then placed my leg back in the brace and we went into my writing room which had a few office chairs. She backed one into the wall for stability and had me sit back. Again, she pressed my knee backward towards the chair and I said enough. She explained to my husband that he needed to do that daily but more each day. He did not like the idea. Tonight you cannot see my ankle and my knee is outwardly swollen and very hot along with higher blood pressure. So, again, icing from a bad place and not to just help a healing knee. If fear tactics are what everyone is using, it's working. But I will not allow them to do what they said I needed to do in the few days laying ahead.

I feel vulnerable and it is why I suddenly find myself running from confrontation instead of drawing a line again and again in the sand. If my surgeon walks away from me for my refusal, what do I do then?

I will register tonight, and thank you for the suggested question.

Hello, Love tocookandsew!

Thank you for sharing your journey to recovery. First, I want you to know I did not see a progression article above and just now looked again. Jamie has been sharing so much but it seems I overlooked that one. Thank you for pointing it out to me. I do believe you and sincerely believe this way is best. I try to explain that I am doing my best but do not agree with pushing my know in directions it is not ready to go. They say it is like a child who needs to be taught what is best.

I will try to keep explaining but people in health care believe it is their way or no way. It is sort of like being told to do it their way or hit the highway. In my professional life many years ago, I worked with stroke patients and know part of what they say is correct but the source is where we disagree. I tell them that without the swelling, good pain control with rest, and ice my BP will come down. Trying to frighten me is not helping. Even though I know logic is telling me they are very wrong, being told over and over the same thing, it grows difficult to just discount them. But I WILL!!

Howdy Kneeper!

The nurse told me there were over 200 staples and it would hurt like hell to remove them. Quietly, I was thinking, only if someone with no experience removes them! It provided me with a good internal laugh which is rare these days! LOL

THANK YOU and GOD BLESS TO EVERYONE IN THIS GROUP
 
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Jamie, here is my submitted question. I had to shorten it-it would not take it otherwise.

Thank you
Mamie


Rev. TKR 07-16. Severe pain, Swelling/Heat-causing high BP. Highest BP 205/79 HR 103. Low 151/58 HR 71. How do I help myself?
 

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IMHO, your PT is doing you a lot of harm and no good. Remember, it's YOUR knee, YOUR life and YOUR decision! Tell that PT that you're the boss and she can do it your way or she's fired. Just because your surgeon operated on your knee doesn't mean he now owns it. You can see what the PT is doing to your knee by all the swelling she's causing, so why allow it?

Plus you don't have to tell your doctor you're not doing PT anymore-it's your choice and your decision. The PT will probably threaten to go tattle to your doctor-but she likely is giving you empty threats. Even if she really followed through, all you have to do is either not defend your decision to your doctor, or tell him she's torturing you and you decided against the torture. If he doesn't agree, that's his right, just as it's your right to chart your own recovery path.
https://bonesmart.org/forum/threads/saying-no-to-therapy-am-i-allowed-to.36688/
 

lovetocookandsew

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I can't believe you really have over 200 staples! But however many you have, it may sting or it may not to have them removed.

Btw, your knee knows what's best for it; not your PT, not your doctor, your husband or anyone else. If it isn't irritated, pained or swollen from an activity, then it tolerated that activity. But if it does any of those, then it's not ready for the activity so it's best to stop it now, and either don't do it again, or wait until a later date to try it again.
 

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