TKR May 12 L TKR

Bisbee

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Happy to have found this forum. I had robotic-assisted TKR Thursday, May 12 and will have to have my right knee done in the next year. I’m coming along OK, I guess. I would love advice on “elevation”. In the daytime, I’m on a recliner so my feet are about even with my hips. At night I just sleep flat. In reading the very helpful threads here and the info document, I wonder if I should be elevating higher and/or at night? Thanks. Speedy healing to all!
 
Welcome to BoneSmart and recovery! Congrats on your new knee.

I will leave the Recovery Guidelines below where you‘ll find an article on elevation.
“Toes Above Nose”, so the saying goes. Unless you have excessive swelling, I don’t know that I’d be concerned with elevating overnight.

We‘re happy you joined us here and hope you’ll continue to share progress. We’re here for support if you need us. Happy Healing and all the best to you!

Knee Recovery: The Guidelines

As you begin healing, please keep in mind that each recovery is unique. While the BoneSmart philosophy successfully works for many, there will be exceptions. Between the recommendations found here, your surgeon's recovery protocol and any physical therapy you may engage in, the key is to find what works best for you.


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
6. Access these pages on the website
Oral And Intravenous Pain Medications
Wound Care In Hospital


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.
 
Thank you. I will elevate it correctly now. Wish I’d found this a week ago.
 
Hi and Welcome !

I found elevating all night very helpful all through my recovery, and I still sleep like that.
 
Thanks, I’ll try elevating it at night.
 
Just to confuse you (sorry) I didn’t elevate at night at all and had no real problems with swelling after the first two weeks. I did ask my surgeon and he said “night time is for sleeping so sleep however you like”. But do what’s good for you. Best of luck.
 
Thanks. That seems like great advice, too! And sleeping well post-surgery is already a huge challenge. :sad: For now I’m kind of compromising- using a flattish pillow at night but really focusing a lot on sufficient icing and elevation during the day time.
 

This is what I use to elevate. I’m currently using it in my recliner: toes above nose! At the very beginning, I elevated, and used my ice machine, at night. I used the ice at night for a week & a half. My surgeon’s view is that sleep is important; get it however and whenever you can.

Marie
 
@InkedMarie Bonesmart has a partnership with the Lounge Doctor, so I switched your link with ours. Or, members can always use the link on the banner at the top of the page.
 
Well, I am six weeks out and my surgeon wants me to have MUA. I am happy to report I am pain-free for the most part. Sleeping is still a challenge, improving a bit, though overall fatigue level remains high. The main problem is stiffness. I got to 90° pretty quickly. Six weeks later, with PT twice a week, doing my heel slides faithfully, and walking around my house quite a bit every day, I am at…90°. No change at all.
 
I am six weeks out and my surgeon wants me to have MUA.
Too early! At only 6 weeks out 90 degrees is very good. I would hold off on any procedure - especially if your pain levels are low. MUA will only reset the clock on your recovery. Don't forget - it's your knee and you are in charge.

You might want to read these articles again:
Myth busting: no pain, no gain
Myth busting: the "window of opportunity" in TKR
I’m in a FB group where I’ve been shocked at people being told they need an MUA...some at a month!

Marie
 
Hi there. I was 90 at 6 weeks … at 12 weeks I am 115-120. Due what you are comfortable with! You know you body, but don’t feel pressure. My doctor wanted me at 130- I am not but I am also not pushing hard- just Bonesmart way ADL and stretching and things I want to do. I have cried and been depressed (esp around 6 weeks) over my progress… but you are only just beginning. Be gentle with yourself and follow your gut. Sometimes less is more. At my 12 week appt (Monday) doc said “wow- your swelling has really come down since 6 weeks!” (Of course I now know that correlates to better ROM.) Most importantly, don’t feel pressure to do anything you aren’t comfortable with, but if you think MUA will help, it’s good to have an option. From reading on here- it seems perfectly reasonable to give it some time before deciding on an MUA. Hang in there!
 
The majority of the surgeons don't expect 90* until 6 weeks. As your knee swells your bend will go down. As the swelling diminishes, your bend will go up. Can you bend a waterhose full of water with the nozzle shut off? Open up that nozzle and let the water out and the hose becomes flexible. It's the same thing with your knee. The swelling, (fluid), coming from inflamed tissues, will hold back your bend. Get that fluid out by icing, elevating, and resting, and your bend will improve. A MUA at 6 weeks and 90* is not needed. Time and healing is what your knee needs.
 
I was slow to regain ROM, probably partly because of how long my knee had been trash. I was only about 85 degrees at 6 weeks but I stayed patient and went at the pace my knee wanted. Managing my activity to not increase pain and swelling while still staying active led to my ROM increasing slowly but surely. I actually continued to increase my ROM throughout my second year of recovery until I'm above 140 degrees. No way I would have an MUA at your stage of recovery when I had 90 degrees ROM.
 
MUAs are generally appropriate only if you are truly stuck. It is possible to plateau for a week or two (I did) and then gain again as more of the swelling comes down. It took me a full 6 weeks to get to 90, but I gained about 10 more degrees within the next few weeks as the swelling began to really come down. How's your swelling?
 
@kneeper I saw my PT yesterday. He says that my knee is still swollen (more than it appears to be from the outside) and he was not onboard with a MUA at all- he agreed with all of you that six weeks is too soon. I think a got a good one!
 
I have to agree with everyone else on here. I got to 90° flexion one week and maintained it until my PT pulled my hamstrings and As I started to be more mobile the swelling kicked in. The thought of tearing apart the fascia and adhesions in one swift move I am certain only restarts the exact same process that built them & Ive heard horror stories that after the adhesions are stronger and thicker. Makes sense to me-all the material to build them is sitting there still!
Every PT session took me out for at least one sometimes two full days of increased pain&swelling.
I served myself a very needed slice of reality pie that I desperately needed and gave myself the gentleness and sound medical input I would give another; the same things that all of the bonesmart guides encourage.
Then I did the taboo thing & quit PT..for now. My swelling is no longer disabling and although at 6 weeks Im still dissappointed in how little I can do,I remember that I had been living on a 20° extension and only 115° flexion for 7 months waiting for surgery so not only was my PT&surgeon forgetting that-I was! Its been 2weeks off PT&Im at 5° extension & 100° flexion and whats better is that I have 6 hours a day I can spend up on my feet. Of course I have to do it 2 hour increments max... but accupressure & a crud load of self advocacy have proven more effective for ME.
The slice of reality pie was eaten with the fork of humilty slowly as I read through the blogs here and all the resource material. If you got this far that shows you have the hypothetical fork to eat the pie; the humility to be receptive & open minded to the input & experiences of others. The pie is this support group-full of validation, support and factual clinical articles you need to do what you know is right for your body! I am glad your PT is NOT on board with the MUA; not all PTs are aggressive-mine was. Ive worked along side ones Id rather go to because they believe the entire foundation of the bonesmart principles!
Good luck on next visit with surgeon...
 

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