TKR Michele's RTKR recovery journey

[Cheleigh]

Hi! I've been lurking this sight and hope I can start a recovery journal and get some support and help. I think I'm doing this right, if not, please let me know.

10/12/2022 - I'm in my 6th week of recovery as of today. My ROM was 80 on Monday with perfect straightening (can't remember what the straighten flat is called by mine is better than perfect, go figure). I feel pretty good over all and the past 6 weeks have mostly had pain in right shin area, side of knee and occasionally back of knee. I had glue to close my incision and it has healed so well it looks like I will barely even have a scar. I was released to drive last week. Am doing minor house chores and getting around slowly but surely.

I am 48, was very active weight training and hiking almost daily til the last 16 mos of being diagnosed with bone on bone osteoarthritis and needing knee replacement surgery. I've never had any surgeries so I didn't know how I'd respond to pain meds. I had a hard time starting out after surgery because I believe the discharge PT let me do too much while still under pain block and it set me back with pain and progression. I did not respond to oxycodone and had to be changed to morphine. I also got sick first two weeks with a UTI and was unable to start PT well, so my ROM has been "bad" per by ortho's timeframe.

I have been extremely unsatisfied with aftercare from my ortho as it is nearly nonexistent and when it is provided, it's confusing, condescending and doesn't make common sense. Anyway, I am sticking it out with them because I don't want to start this all over. My PA has already said they will want to do an MUA by week 10 if my ROM isn't better. I am very much against this as I feel in my gut that I am progressing fine, just slow and not in the "one size fits all" timeframe they bully me about. I initially suffered from depression and anxiety during recovery over the aggressive ROM schedule and them making me feel like a failure for not meeting the metrics. My PT had me doing exercises at home every hour all day for two weeks. I kept saying I am overdoing it, I stayed inflamed and in pain. I'd explain that I am doing everything you say and still ROM isn't improving. I know now that I was absolutely over doing it and have cut back to walking and regular chores around the house. As of Monday, I measured an 80 at PT office. I had been stuck at 70-75 for a couple of weeks. I am still pretty swollen and it hurts to bend farther than I can, and I've told them all along, 'when the swelling goes down I'll be able to bend', but they warn about scar tissue and losing this window of ROM timeframe and if I don't get to 120 now I'll never get there and then warn about an MUA.

As of last week, my PT has begun me on weight training. I weight trained regularly before surgery, but again, not for the last 6 mos on legs simply because of my bad knee. So my legs have lost a lot of strength. I was excited about weight training, but now after reading the forums I believe it may be too soon and may cause more harm than good. I just don't know what to do. You guys say to go slow and easy - heal first. They say to get to perfect ROM and movement right out the gate or you never will. The PA told me to take oxycodone before PT exercises at home and before I go in for PT to get through the pain - but to me, that's counterproductive because pain is my body's warning system. He also told me to just focus on ROM and not strength training because I can always work on Strength training while my PT has begun strength training. See what I mean about conflicting advice and care? I have 90 days of PT and have used about 20. I am considering stopping PT now and returning in a month when I've healed more. Any thoughts or feedback on any of this is so very helpful and appreciated. I'm so confused. Thank you!!

 

[Jockette]

Hi and Welcome!

Please tell us the date of your surgery and which knee it s and we’ll make a signature for you.

I’m sorry you have a medical team that is aggressive and condescending, and are bullying you. All this is counterproductive to your healing.

Your gut feelings about this recovery are correct. Stopping formal PT at this point would probably benefit you. As long as you move around on your own, your knee will heal fine.

There is no window of opportunity, my ROM continued to improve well into my third year. I am now 5 and a half years post op, and it is still improving, I got up out of a low beach chair for the first time, just this past weekend. (see my post on my thread, the link is in my signature) I was thrilled!

I will leave you our Recovery Guidelines. Each article is short but very informative. Following these guidelines will help you have a less painful recovery.

Just keep in mind all people are 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: 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

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​

6. Access to these pages on the website

​

Oral And Intravenous Pain Medications​

Wound Closure​

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 the 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 the member’s history before providing advice, so please post any updates or questions you have right here in this thread.

 

[FCBayern]

I agree, your gut instincts are correct @MichelePrevette, masking pain before PT is a sure way to over do PT and be worse afterwards. You cant get ROM when you knee is swollen, it needs time to heal first.

Prior to my TKR I was aware of the BoneSmart gentle approach to recovery as opposed to rigorous PT. I was lucky enough to find the site before my TKR. Even though I knew about the BoneSmart approach my OS was all about PT and "whatever ROM you have when your scar turns silver is all the ROM you will ever have." He was the trained surgeon that has done many, many replacements, he must know what he's talking about right? So off I went to my first visit to PT, about 2 weeks out from TKR. The next day when my knee was more swollen and I was in much more pain I opted for a BoneSmart recovery. I never went to another PT session. That was one of the best decisions of my life. Not only did I suffer less pain, but my ROM has continued to improve over two years. It took me a full year to reach 120 degrees of flexion, and I was still 4 degrees from straight. By the end of the second year I was over 140 and past straight. I've been hiking over rough terrain for miles, scuba diving, and just living a happy active pain free life with more ROM than I ever thought I would have again after many painful years. I've now had a hip replacement with equal success following a BoneSmart approach. You don't have to suffer needlessly to have an amazing recovery.

 

[Cheleigh]

Thank you so much! I will definitely look a these links. My surgery was on my right knee and date was 8/31/2022.

 

[Cheleigh]

Thank you so much! I have tried for a while this afternoon to figure out how to reply. I hope you see this. Is quoting the only way to reply to a comment?

 

[benne68]

@MichelePrevette I'm so sorry to read what you've been through! But, I'm glad you found us.

Six weeks is still very early days in this year-long recovery. I'm just nearly 13 months post-op and am still improving.

As the others have said, all of that exercise you've been forced to do is probably the reason your flexion is limited. When you have swelling or inflammation inside the knee, it isn't going to bend. It's like trying to bend a hose full of water.

If it was me, I'd drop the PT and give that poor knee a break from all the exercise, elevating and icing until the inflammation goes down. It may take a couple of weeks, but I'm bet your flexion will improve a lot.

You'll find lots of great information in the articles @Jockette shared with you. The knowledge will also help you take control of your recovery. Remember, it's your knee and you don't have to please the surgeon, the PT or anyone else -- only yourself!

 

[Jockette]

When you want to reply, rather than quoting the whole message, just go down to the reply box and type your reply. No need to quote if you are replying to the post directly above your reply. You can also mention the member you want to address by using the @ sign in front of their username (no space) and type your reply. Not quoting whole messages saves a lot of space on the page, and also saves duplicate reading.

If you want to quote just a line in a post, highlight that line.

At the bottom of the post you will see:

Like/ +Quote/ Quote this message.

Click the +Quote

When you get to the reply box, you will see where it says “insert quotes” Click that and it will put your highlighted area into your reply.

Happy Posting!

 

[Cheleigh]

@FCBayern
I’m so sorry for not finishing… I hope you see this.‍ I meant to say- That is so great that you listened to your body and have seen such great results. Was it slow and steady? Does it ever feel like you have a cinder block on your leg?

 

[Cheleigh]

This is so encouraging to hear! I have an appointment Friday and will talk about cutting back. They do massages and cupping too and I will opt for that Friday instead of weight training. Thank you so much!

 

[Cheleigh]

Thank you so much for showing me the Reply box. ☺️ How I missed that is beyond me. ‍

 

[Jockette]

You did good with the reply box, now, don’t quote anything, just scroll down to the reply box and type.

 

[Cheleigh]

I saw that after. I don’t think I’m doing it now. I guess I’ll find out when I hit Post reply. So sorry for being slow. ‍

 

[Jockette]

No problem, you‘ve got it right, now!

A lot of members do quote the whole posts, but it’s not necessary.

Enjoy!

 

[JusticeRider]

Welcome Michele! You’ve come to the right place…these BoneSmarties are full of wisdom, knowledge, and encouragement. I’m in my 40’s as well, 9 weeks out from surgery. I’ll be interested to see how your recovery goes! Keep us posted!

 

[FCBayern]

That is so great that you listened to your body and have seen such great results. Was it slow and steady? Does it ever feel like you have a cinder block on your leg?

Early days are rough. At your stage of recovery I was using my ice machine 24/7, I only unhooked the hoses when I needed to use the bathroom, get food etc. Healing progress was slow but relatively steady, but there are days where you take one step forward and two steps back. This really is a 12-18 month recovery so progress can seem slow, some members have kept a journal of how they we feeling and when it didn't feel like they were progressing they could look back and see how much more they could do, or how much less it hurt to do things.

 

[Cheleigh]

Thank you all so much! I measured 82 ROM yesterday at PT. I have been so stiff this week and sore. I had PT Monday and he started me on strength training. I didn’t do any PT at home the rest of the week and just did regular activities around the house. It was rainy here in NC two days and my knee seems to hurt more when it rains. Anyway, I have a follow up Tuesday to check ROM with the surgeon. It was originally with the PA that I don’t like and I changed it to the surgeon. I haven’t seen him since surgery. They turned all my care over to a PA and he is the confusing one who gives bad and conflicting info and is threatening and MUA. So I rescheduled the appointment from him back to the surgeon I saw in the first place. I will decline an MUA at this point. Like my PT said yesterday, I am improving little by little and having no issues other than “slow” ROM progression. So we’ll see how it goes. I am so grateful for this forum.

 

[Cheleigh]

In the TKR recovery Facebook group I’m in, I regularly see people whose surgeons are recommending MUAs as early as 4 weeks. After reading on BoneSmart and understanding more about this healing process, I don’t understand this logic at all. A lady today said that she woke up screaming uncontrollably in pain after her MUA. Poor people speak of being so inflamed that they can’t get a bend, and then they get an MUA (and naturally duh I don’t get it…) are more inflamed etc etc. but they got that extra five degrees.

Why are MUAs so popular? They don’t seem to make that much difference in ROM, they put you under anesthesia again and you go back to PT more. If so many people don’t respond well to MUAs, if they set people back and cause problems, why is that the go to when we are slow to progress with the obsessive ROM? I can’t compute.

 

[Jaycey]

@MichelePrevette Well, we have been asking the same question for literally years. There are many, many surgeons who impose a very strict timeline for recovery. But it just doesn't work that way. No two TKR recoveries are the same - even on the same person.

Then there is this obsession with adhesions. But truth be told, adhesions are very rare - especially in the early days.

There are some people who benefit from MUA. But for many, it is suggested too early in the recovery process. And then all that results is a very frustrating and often painful setback.

Over the years we found that the slow and steady approach to increasing ROM just works for most of our members. Giving the knee time to heal and settle means ROM comes naturally.

 

[sistersinhim]

Why are MUAs so popular?

My personal feeling, unfortunately, is that sometimes it is a quick and easy money maker for all involved except for the patient. Also, many surgeons don't see their patients except for 2-3 times after the replacement and don't see the progress each person is making on a weekly or even monthly basis. As long as there is an improvement, even if it's slowly, then you don't have adhesions.

 

[sistersinhim]

Hello @MichelePrevette,
You'll notice that I have merged your two threads together as it's best if members in recovery only have one thread. We find it much easier for everyone.
This is because:

• That way, you have all your information in one place. This makes it easier for others to go back and review your history before providing advice.
• If you start 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.

Please keep all your questions and updates on this thread. We won't miss your new question as, between us, the staff read all new posts each day.
If you need an urgent response to a question, tag a member of staff.
Tagging other members and answering tags

If you prefer a different thread title, just post what you want and we'll get it changed for you.

Here are the instructions on finding your thread, How can I find my threads and posts?

A helpful hint - Many members have found it useful to bookmark their thread so they don't lose it.