Bilateral TKR Massage?

[Jayla]

So I am 9 days post op from a bilateral TKA. Ice, ice ice, yuck. I hate the ice. Before icing my knees are flexible and the pain is easily tolerable. Then I ice both knees using the double cryo cuff cuff. When the cryo cuff is removed, my knees are very stiff and it is so hard to walk and so painful. It takes quite awhile for my knees to “warm up” so I can move around. Is that normal?

 

[Jaycey]

@Jayla Welcome to BoneSmart and the other side of surgery. Can you tell me the exact date of your op and I'll pop the information in your signature for you.

It takes quite awhile for my knees to “warm up” so I can move around. Is that normal?

I think the answer to your question is yes - for you. Some people can tolerate icing. Unfortunately sounds like you are one who can't. Still early days for you however. As you move around more you might start to notice swelling. This is when icing is really needed.

I'll leave your reading list here for you to refer to:

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

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

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.

 

[Jayla]

My date of surgery was December 18 2018. How do I get the little “bilateral TKR” symbol to come up in the little info section next to my name?

 

[Celle]

I think that Jaycey did the "Bilateral TKR" prefix for you
I've also made a signature for you, so we can see your surgery date at the bottom of every post you make.

 

[Josephine]

When the cryo cuff is removed, my knees are very stiff and it is so hard to walk and so painful.

I trust you are using a light cloth or towel between your skin and the wrap? Sounds to me like you're not. You must have some protection against just this kind of reaction. We don't want you getting freezer burn!


I'd really like to offer you some structured advice but in order to do that, I also need to ask you some questions. Are you willing for me to do that?

 

[Dickybird]

My knees are stiff 8 weeks post op and the prediction is they will be stiff for months still (though less and less) as my healing process continues. I think we have to accept the stiffness goes on for an extended time and believe it will go away.

 

[Jayla]

Hi Josephine,
I would be happy to answer any questions.
I would like to reassure you, though, that I am not attaching the cryocuffs directly to my knees. I have on fluffy pajamas in between. Also I know my husband is adding ice and water to the tank in the correct proportions. I am running the ice for about 40 minutes at a time. I have some but little swelling in my knees.

 

[Josephine]

Here y'go then!

It would be very helpful if you would answer each one individually - numbered as I have done - in as much detail as you can then I'll come back as see where you are ....

1. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine. And don't forget to factor in other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness).

2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?

3. how swollen is your leg compared to these?

4. what is your ROM - that's flexion (bend) and extension (straightness)

5. are you icing your knee at all? If so, how often and for how long?

6. are you elevating your leg. If so how often and for how long?

7. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and

8. are you doing any exercises at home? If so what and how often?
This is the most crucial question so please help me by using the format I have left as an example
(which means please make a list and not an essay!)

Exercises done at home
- how many sessions you do each day
- enter exercise by name then number of repetitions of each
etc., etc.

Anything done at PT
- how many times a week
- enter exercise by name then number of repetitions of each
etc., etc.

I am not attaching the cryocuffs directly to my knees. I have on fluffy pajamas in between.

Then that's probably not enough. I suggest you try a good towel.

 

[Jayla]

1. Pain levels : lowest pain level = 2. Highest pain level = 6
The worst pain occurs either when I have been inactive for a period and then start to move around, or after I have been moving around like walking the hallway for awhile.

2. I had to drop the dilaudid and the tramadol because of this terrible aggravating rash that manifested on the entirety of my legs and back. The stupid rash takes up a great deal of my energy and willpower not to scratch.
Meds I am taking:
Oxycodone 5 mg 4xday
Gabapentin 300 mg 4xday
Tylenol 1000 mg 2xday
Benadryl 25mg 4xday ( for the rash)

3. Swelling : moderate to slight

4. ROM: extension=0 flexion=78 as measured last Thursday however I believe it has now improved and I dare say it would be 85-90 if measured today.

5. Icing: I use the cryocuff 2-3 times per day at 40-60 minutes each time. I also use a small freezer pack for the back of my knees 2x day for 30 minutes. (I really hate the ice.)

6. Geez. Should I be doing that stuff now? I am lucky to have my husband get me through a shower every few days. So to answer: no cooking, cleaning, shopping or housework. I pretty much stay in my bedroom and alternate sitting in the rocking chair and my bed and walking the long hallway. We have a set of 18 stairs to get down stairs and I manage to go down on my butt using my arms and back up again on my butt using my arms every 3 days or so.

7. Shame. I am not on a routine. I do the following at random:
Ankle pumps
Pressing knees down straight to increase extension and holding
Sitting in glider rocker and gradually pulling my knees towards the chair to excercise the knee and increase flexion (can you picture this) it works very well
Walking up and down the hallway working on heel to toe movement and standing straight
Ankle slides - none - the hamstring tendons behind my knee are so tight they pop with significant pain whenever I try to do ankle slides. My doctor said once the swelling back there resolves this will go away.
Dangling legs and swinging legs - whenever I get on or off the bed which has to be 10 times a day

Formal PT
She has come to the house twice so far and will probably be here twice next week. After that I will be released to go to the formal PT center at the hospital.
She has shown me the exercises I should be doing but because of the tight tendon problem and the rash that’s eating me alive, we did not do much this week. Sigh.

I hope I did this right. Thank you.

 

[Josephine]

Some detail left out!

Ankle pumps
Pressing knees down straight to increase extension and holding
Sitting in glider rocker and gradually pulling my knees towards the chair to exercise the knee and increase flexion (can you picture this) it works very well
Walking up and down the hallway working on heel to toe movement and standing straight
Ankle slides - none - the hamstring tendons behind my knee are so tight they pop with significant pain whenever I try to do ankle slides. My doctor said once the swelling back there resolves this will go away.
Dangling legs and swinging legs - whenever I get on or off the bed which has to be 10 times a day

You've not said how many or how often. I need to know that

She has shown me the exercises I should be doing

She showed you, now please tell me!

 

[Roy Gardiner]

Jayla it looks to me like you're pretty much doing it right. Not too much activity, no training exercises and just a few mobility ones.

Just wait, ROM will come and pain will go

 

[Jayla]

ok. I don’t write it down so this is best guess. I will create myself a chart going forward.
Ankle pumps- 20 each leg, 10x day
Pressing knees down- hold for 20 seconds, 5 x day
Rocking chair knee flexes - 10 minutes, 5 x day
Hallway walk with walker - 2 loops, 3 x day (40 yards per loop)
Dangling/ swinging legs - 5 minutes, 5x day
Leg elevation above heart, 20 minutes, 2x day

These are the exercises she showed me to do.

 

[Jayla]

My leg muscles feel pretty stiff which doesn’t help when I am trying to improve the ROM of my knees as it pulls on the stitches/staples. I have an electronic muscle massager that I have tried using a couple of times lightly on all the muscles of my legs. It really seems to help to loosen things up but then I wondered if there is any reason why I should not be doing this. I keep the massager on the lowest setting and gently move the oscillating balls across my muscles without pushing into them. Any thoughts on this?

 

[Pumpkin]

@Jayla,
You'll notice that I have merged your newest thread with your original recovery thread. For several reasons, we prefer that you only have one recovery thread:

• That way, we have all your information in one place. This makes it easier to go back and review your history before providing advice.
• If you keep starting new threads, you miss the posts and advice others have left for you in the old threads, and some information may be unnecessarily repeated
• Having only one thread will act as a diary of your progress that you can look back on.

So please post any updates, questions or concerns about your recovery here. If you prefer a different thread title, just post what you want and we'll get it changed for you.
If you need an urgent response to a question, just tag a member of staff.
How to tag another member; how to answer when someone tags you

Here are the instructions on finding your thread, How can I find my threads and posts? . Many members bookmark their thread, so they can find it when they log on.

 

[Pumpkin]

I wondered if there is any reason why I should not be doing this

If you have a history of blood clots or a family history of blood clots, using a vibrator is not recommended.
IMO would not use a vibrator this early in any case.

I will tag @Josephine to answer your question.

 

[Breadman]

Hi @Jayla. I am a month ahead of you. My knees did the same with the ice. I would wrap them with a blanket after to warm up and get loose. Try shorter times more frequently during the day. It gets better. Take you time don't push it. Rest is what you need to heal. It gets better before you know it.

 

[grandma chris]

@Jayla as time has progressed, I find that fully charging my ice machine results in much too cold. My solution for this is to put less ice in the machine. I use frozen 8oz bottles of ice along with the water needed. At the beginning I used four of the bottles plus ice cubes at night. Now I use 3 of the 8oz bottles and they sit overnight in the reservoir not being used until morning. By then they have melted somewhat and provide a very pleasant chilled but not freezing cold experience. Good luck!

 

[Josephine]

I think if you read the user manual (if it's a good, trustworthy make) it will say if you can use it on recent surgical sites but I think not. It can have the unfortunate effects of increasing swelling and stiffness.

 

[Jayla]

For some reason I have a green banner that says “bilateral PKR”. It should say “ bilateral TKR”. Not sure who fixes these things.

 

[Jockette]

We’ll get that changed for you!