TKR March 7, home same day

[sadenhup01]

Good afternoon Bonesmart Friends! Sorry for not posting earlier. No ones fault but mine.
Here’s my story: I had a TKA on the left knee March 7, 2024 and came home later that afternoon. They say everything went according to plan. Now I’m a veteran and my surgery was at a VA facility which uses Duke orthopedic providers. My surgeon is there Chief of Orthopedics, I was in good hands!
I had my right knee replaced 8 years earlier, same facility, same providers. With that knee, the VA had home therapy at my house the day after I got home.
With this knee, there was a mix up in paperwork (government) authorization and I had no PT till day 6! I tried to remember from 8 years ago. My knee was still by the time PT started. It took everything I had, including a Biodex machine to get me to 90. At six weeks I was 4/91.
My DPT said don’t worry will get there.
This past Monday (7 1/2 weeks out) I was at 1/97 - 1/101 using strap.
My knee seems to go backwards after going forward. My DPT says he has a few tricks to break up the scar tissue.
BTW, I’m a 72 year old male.
I think I should be at 110 or more by now, am I wrong?

 

[benne68]

Welcome to BoneSmart, @sadenhup01. Glad you found us while you are still early days in recovery.

You are not "going backwards" at all - in fact, you aredoing absolutely fine in terms of flexion! Most surgeons want us at 90 degrees by 6-weeks post-op and you are past that point. Please do NOT let your PT force your knee to "break up scar tissue." That will only set your recovery back.

I will leave you our recovery guidelines below, which will help answer your questions in more detail.

Again, welcome!

 

[benne68]

@sadenhup01

Follow are BoneSmart's Recovery Guidelines. Each article is short but very informative. Following these guidelines will help you have a less painful recovery.

Just keep in mind we are all different, as are the approaches to this recovery and rehab. The key is, “Find what works for you.“ Your doctors, PTs and BoneSmart are available to help, but you are the final judge as to the recovery approach you choose.

KNEE RECOVERY 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.

If you want to use something to assist with healing and scar management, BoneSmart recommends hypochlorous solution. Members in the US can purchase ACTIVE Antimicrobial Hydrogel through BoneSmart at a discount. Similar products should be available in the UK and other countries.

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
the BoneSmart view on exercise
BoneSmart philosophy for sensible post op therapy
5. At week 4 and after you should follow this
Activity progression for TKRs
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

Good nutrition is very important during recovery:
Dietary Tips for Recovery
Nutrition Basics

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.

 

[sadenhup01]

I’ve read the recovery guidelines. I am trying to do everything they say. I even went and read about knee swelling and stiffness. There are times like right now or my knee feels like a brick.

 

[benne68]

Glad you read the article about stiffness and swelling! That was a big one for me during my first TKR recovery.

What you are experiencing ("knee feels like a brick") is normal at less than two months post-op. Your knee still has a lot of healing to do! Try to give it time and, remember, no two knees are alike -- even two knees in the same person.

 

[sadenhup01]

Thank you for reminding me no two knees are alike. My first knee was 8 years ago and me being 8 years younger.
Today at therapy (8 weeks & a day) my rom was 1/103.
I’m happy!

 

[Jockette]

My DPT says he has a few tricks to break up the scar tissue.

We all have some scar tissue after this surgery. It’s the body’s normal reaction to surgical cuts. Normal scar tissue does not need to be broken up. It will all settle down, in time, as we heal.

Regaining our ROM does not require forceful bending or painful exercises, or even a list of repititions of exercises.

Regaining our ROM is more about Time:

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.

 

[mendogal]

At two months postop, it's most likely swelling that is interfering with range of motion, not abnormal amounts of scar tissue.

We strongly recommend both elevating "toes above nose" and icing the knee at least 45 minutes to an hour. The shorter periods usually suggested for icing are great after an acute sprain or strain. But the extent of inflammation after joint replacement merits longer sessions to provide pain relief and avoid the potential of rebound swelling with shorter sessions. As long as there's fabric between you and the cold pack it's quite safe.

If your PT has indeed felt specific scar tissue (feel like nodules or thin cords under the skin) then he can let you feel them, and he can do therapeutic massage work on them as well as teach you how. However he shouldn't start actively manipulating or pushing on your knee "to break them up" - this will traumatize tissues that are just starting to heal.

 

[benne68]

Today at therapy (8 weeks & a day) my rom was 1/103.
I’m happy!

You should be happy. That's good ROM for two months.

What was the date of your first TKR (month and year)? We'll add it to your signature so others who read your posts will know you are a veteran of joint replacement surgery.

 

[sadenhup01]

My first replacement was my right knee. March 2016.

 

[Layla]

Happy Two Month Anniversary, sadenhup01.
I hope you're doing well and having a good week!
Stay in touch and let us know how it's going for you. Best wishes!
@sadenhup01

 

[sadenhup01]

Can someone recommend a good scar cream?

 

[Jockette]

This information is in the Recovery Guidelines in post #3:

If you want to use something to assist with healing and scar management, BoneSmart recommends hypochlorous solution. Members in the US can purchase ACTIVE Antimicrobial Hydrogel through BoneSmart at a discount. Similar products should be available in the UK and other countries.