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TKR May 28, 2014. Springsmom83

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Josephine

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You need some reading. With out collective wisdom, we can tell you far more about swelling than any PT!

First are the BoneSmart mantras ....
- rest, elevate, ice and take your pain meds by the clock
- if it hurts, don't do it and don't allow anyone - especially a physiotherapist - to do it to you
- if your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again
- if you won't die if it's not done, don't do it
- never stand when you can sit, never sit when you can lie down, never stay awake when you can go to sleep!
- be active as much as you need to be but not more than is necessary, meaning so much that you end up being in pain, exhausted or desperate to sit down or lay down!

Next is a FAQ (Frequently Asked Questions) thread.

And here are some very crucial articles
The importance of managing pain after a TKR and the pain chart
Myth busting: no pain, no gain
Swollen and stiff knee: what causes it?
Activity progression for TKRs

Healing: how long does it take?
Chart representation of TKR recovery
Energy drain for TKRs
Elevation is the key
Ice to control pain and swelling

Home physio (PT) and activity progress: suggestions
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds
Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

And then some wise words from members who have shared their experiences ...
Where are you in recovery?? (TKR)
Five “P’s” of knee recovery
TKR: work “smarter” and not “harder”
Recovering a knee - from one who knows!
It's never too late to get more ROM!
It's worth the wait for ROM
 

Josephine

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therapists are fussing about my flexion. At present it is 63-65 degrees. The knee feels tight and warm, I ice as much as possible. Should I be at 90 degrees already?
Not necessarily

I'm going to ask you some questions and it would be very helpful if you would answer each one individually 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 compare this with the bone-on-bone pain you had before surgery!
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)


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

3. how often are you icing your knee and for how long?

4. are you elevating your leg, how often and for how long?

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

6. what kind of PT/exercises are you doing? How much and how often? (and detailed details would be appreciated, please! Reps, sets and session and all that)
 
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Springsmom83

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1. My pain level is generally a 1-2. It bothers me more at night.

2. I am prescribed oxycodone/Tylenol, 5/325. I may take 1-2 every 4 hours. I take 1 at bedtime and 1 when I wake up during the night. Otherwise I take 400-600 mg. Ibuprofen when I think about it, usually about 1200 mg in 24 hours.

3. I ice 3-5 times daily for 30 minutes minimum.

4. I elevate my leg while icing, otherwise I am not as good about it.

5. Activity level. Um, there is the problem. I just got an update from my fitness monitor, the last 7 days I logged 45,000 steps and about 15 miles. I use no assistive device.

6. For PT at home I am only supposed to do seated leg lifts, firing the quads, 3 sets of 10. Leg lifts while lying down on back with right leg bent, 3 sets of 10. Extension by firing the quads to press the back of my knee flat. Hamstring/calf stretches with leg as straight as possible, 3 times holding stretch for 30 seconds. Bent knee stretch same as hams 3 for 30 seconds.
At therapy most of the same plus one where I stand on a raised platform on left foot with knee slightly bent, straighten the knee to lift the right foot up to the left 3 sets of 10, light weight on left ankle which hangs off table to increase stretch in back of knee.
I go to therapy 3 times a week.
 

Josephine

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1. My pain level is generally a 1-2. It bothers me more at night.
So what is it at night then? And are you including soreness, burning, stabbing, throbbing, aching, swelling and stiffness? All these are types of pain.
2. I am prescribed oxycodone/Tylenol, 5/325. I may take 1-2 every 4 hours. I take 1 at bedtime and 1 when I wake up during the night. Otherwise I take 400-600 mg. Ibuprofen when I think about it, usually about 1200 mg in 24 hours.
Well, ibuprofen is not the most effective of pain meds. You would be better taking 2 oxycodone last thing at night. If you add up the amount of Tylenol you have taken during the day then subtract that from 4,000, the remainder is how much extra Tylenol you can take at a time of your choosing, preferably during the night. The best and most effective dose is 1,000mg but I doubt you'd have that much left.
3. I ice 3-5 times daily for 30 minutes minimum.
4. I elevate my leg while icing, otherwise I am not as good about it.
You cannot accomplish much in 30 minutes. Much better to ice for at least an hour and more if you can. Same with elevating.
5. Activity level. Um, there is the problem. I just got an update from my fitness monitor, the last 7 days I logged 45,000 steps and about 15 miles. I use no assistive device.
You do 15 miles at only 3 weeks out? That's crazy! Did you not read the a rticles left for you previously? Especially this one Progression of activity for TKRs. In there is says quite specifically that at three weeks you should going for walks of 15 minutes a day. That is NOT 15 miles!

So I am guessing that your leg is swollen and stiff, yes?

My comments are in bold
6. For PT at home I am only supposed to do
seated leg lifts, firing the quads, 3 sets of 10 - forget the firing of quads, there's nothing wrong with your quads, they are just INJURED! The last thing they need is to be geed up with exercises before they have healed
Leg lifts while lying down on back with right leg bent, 3 sets of 10 - do 5 only in the morning
Extension by firing the quads to press the back of my knee flat - forget the firing of quads and just do 5 a day
Hamstring/calf stretches with leg as straight as possible, 3 times holding stretch for 30 seconds - that's okay but whatever you do, don't cause yourself any pain
Bent knee stretch same as hams 3 for 30 seconds - one exercise like this is quite enough

I go to therapy 3 times a week - At therapy most of the same plus one where I
stand on a raised platform on left foot with knee slightly bent - a bit early for this. I'd leave it till at least week 6
straighten the knee to lift the right foot up to the left 3 sets of 10 - is this with you laying in on side? These are called side lifts. I suggest you refuse to do more than 5 of these in each set
light weight on left ankle which hangs off table to increase stretch in back of knee - NO WEIGHTS! Much too early. Leave that till week 6 at the earliest.

I realise you might have some problems with your PTs about my suggestions but they are working you far too hard for 3 weeks out. Best routine is laid out in the article I gave above. 3 weeks of NO exercising except heel slides, leg lifts and walks to the bathroom but heaps of icing and elevating by which time the pain and swelling will have abated considerably. THEN one can start in with gentle exercises and gradually, very gradually, build them up. But personally I never found it necessary to go further than the heels slides (which I note you haven't mentioned - why not?!), straight leg raises and walks. Doing more only makes the swelling stay around or even get worse and that is why you cannot get a good bend in your knee. You should read this article Swollen and stiff knee: what causes it?. Fact is that your ROM is already there in your knee, just waiting to be allowed to show itself. All that's stopping it is pain and swelling which = stiffness. It's simple logic, really.

You might also like to read the potted version of my recovery to see how little exercising I did! Knee recovery - UK style
 
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Springsmom83

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I was doing heel slides, therapist asked me to basically do nothing but stretch at home, I would be doing plenty with him. Yes, it does get stiff and swollen, that is improving every day. Pain MAY hit a 2 in the middle of the night, otherwise I may notice a mild ache and go back to think when I last took anything. Ibuprofen does help me with inflammation, I was in pain and took Tylenol, did nothing. For whatever reason I do not respond well to it. I can take aspirin in limited doses but I took too much aspirin when I originally messed up my knee in 1975. Luckily, 30-45 minutes of ice and serious elevation on a wedge pillow will clear out all swelling. I am guessing on "miles". My monitor calculates steps and translates them to miles. Up until the last 4-5 days I was walking about 1,500 steps in 24 hours, none were my usual length. Over the last few days I have noticed the number of steps creeping up, I am a teacher and had to go in to clear out my room (with help). I will consider your suggestions, thank you so much.
 
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Springsmom83

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I did talk honestly with my PT today. He said "I TOLD you that, for the next 2 weeks ALL of your activity would come from physical therapy. Outside of therapy, SIT, ELEVATE YOUR LEG, AND ICE ". So I have myself to blame for being unable (unwilling) to wait. But it doesn't hurt, it just gets stiff and swells. It is getting much easier to get the swelling down again. Thank you again for advice and support.
 

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Hi @Springsmom83

I'm glad you are cutting back on some of your activity. Truly, your job at this stage is just to rest, ice and elevate as much as you can.

Josephine often says that stiffness is one of the many ways that we feel pain, so you should keep on taking your pain medications regularly.
 

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Celle is exactly right. Most of my "pain" for both my knees has been in the form of stiffness--and pain meds help it. (along with ice and elevation)
 
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Wonderful day! I can go upstairs like normal (but slowly) as of today and I hit 91 degrees. I gained almost 30 degrees in a week. Improvement has come quickly for the last couple of days. Thanks to all for your support and advice.

Josephine, I can take 1000 mgs and I cannot tell any difference in pain level. After discussing it with my family doctor and OS, I am one of those people that do not react to Tylenol. Biggest problem was when I was 7 months pregnant, had a double ear infection with a fever of 102.8, and Tylenol did not relieve pain nor reduce fever. After 12 hours I was told to take 400 mg. Ibuprofen (at that point the fever was considered a bigger risk to the baby than the ibuprofen) and fever broke in about 45 minutes and finally got relief from the pain.
 
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Relax. Don't force things. This is time to take care of yourself. I am 8.5 weeks out. I love stretches. They feel good. I can easily lift my leg now (PTs adamant I do 20 a day. I didn't. That just hurt. My quads were in rebellion. My kneecap carrying the load.). When my quads woke up, they did their job. I love the recumbent bike. It feels good. I start easy and may move the seat 4-6 times a sitting when ROM wants to be increased. I like heel slides now. I practice sitting with knee bent for 30 seconds at a time. As far as light bleeding, I experienced that several times. No infection. Some seeping through scar areas not fully closed. My OS said leave it open to dry. Do keep an eye out for redness, heat and color of discharge that may indicate infection. One more note, my PTs moved me to two days instead of three per week. They want more resting time for my knee. I am at 0 for extension and btwn 115 and 120 for flexion. It will come. Be encouraged! No stress zone. Just little successes will bring you through!


Sent from my iPhone using BoneSmart Forum caloparker4/21/14
 
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Springsmom83

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Interesting conversation with my doctor. He said ice no more than 15 minutes out of every hour. Any more and you are running the risk of frostbite and tissue damage. Any thoughts?
 

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He said ice no more than 15 minutes out of every hour. Any more and you are running the risk of frostbite and tissue damage. Any thoughts?
I disagree---if you use appropriate covering for your skin, you should be able to ice your knee for much longer than that. I iced for sometimes an hour and never suffered from frostbite.
 

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Interesting conversation with my doctor. He said ice no more than 15 minutes out of every hour. Any more and you are running the risk of frostbite and tissue damage. Any thoughts?
What I think can't be written here! Does he really think we are stupid enough to put ice-packs on our legs without a protective covering?
 
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Springsmom83

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I went in for my 6 week check today, my doctor was very happy. So much so that he told me he wished he could bottle some of my desire to recover to give to other patients that are weeks to months behind me because of their fear of trying. My extension is 0 (actually I can hyperextend much to my doctor's dismay). I was complaining about flexion, he asked what could I do sitting in a chair. He looked, estimated it at 115 to 120 and said not to worry. As I "go about living" increased flexion will come. The real problem is a 3/4 inch spot along the incision that still has not totally closed and I would like to start doing exercise in a pool, not to mention that my son is coming for a visit and wants to go to a water park. The doctor said "let's put a couple of staples in for 2 weeks. You can swim in pools, just clean it with an alcohol swab every hour or two and give it a chance to dry periodically". Has anybody else had any problems like this?
 

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@Springsmom83 I don't know if I would go in a public pool with an open incision! I would cringe at all the stuff that may be in the pool. Your ROM seems very good. I think at 6 week your incision should be healed, I will tag the forum nurse for you to get her opinion @Josephine.
 

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Yes, I would wait to go in a pool until that completely closes. Why take a chance?
Sounds like you're doing great otherwise.
 
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Springsmom83

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Biggest reason is my son. I have not seen him for a year, he will be here 3 days, and going to a water park is what he wants to do. The place that has not totally closed is at a spot where it takes a lot of stress from bending. The reason he put staples in was to take the stress off. He said that it is not draining, and appears to be mostly healed anyway, this is precautionary due to stress from bending. He does not think that the staples will do anything else.
 

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@Springsmom83 but the staples just made new holes. If you are going anyway, please find a way to cover it, maybe a bandage with one of those clear big bandages over it.
 
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