TKR mikb314159's recovery thread<

[Denny39]

@Celle, My surgeon checked the first one prior to this surgery, and told me, “you’re going to be real happy with this after a year, but even more so after 2 years”.

 

[mikb314159]

@mikb314159 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?

Yes

 

[Josephine]

Sorry I was tardy. 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.

 

[mikb314159]

Update.
Doing ok with PT 2x's a day. Pain in knee at 5 to 7. With Hydrocodone
But I have developed cellulitis in my lower leg. On Keflex but a lot of pain in shin and calf.
Not sure if I'm supposed ice or heat on my cellulitis.

 

[Spex10]

Oh what bad luck! I don't know what to say about heat/cold for cellulitis but I hope one of the mods can suggest the best thing.
A day at a time - as ever!

 

[sistersinhim]

But i have developed Cellulitis in my lower leg. On Keflex, but a lot of pain in shin and calve.
Not sure if I'm supposed Ice or Heat on my cellulitis.

I am going to tag @Josephine, our forum director and nurse, to address your questions.

 

[Josephine]

But I have developed cellulitis in my lower leg. Doing ok with PT 2x's a day. Not sure if I'm supposed ice or heat on my cellulitis.

For a start I would strongly suggest you do NO PT or exercising because that will irritate the areas where you have the cellulitis. And you don't want that! And for the very same reason, it's ice on any inflamed area.

 

[mikb314159]

1. Range from 4 to 9.

2. Hydrocodone 5 mg-325 Tylenol: 6x's a day

3. Moderate

4. Bend: 55 Straightness: 5

5. icing 4 x's a day

6. elevating all night and at least 30 minutes an hour.

7. Doing doing very little activity. Just getting up to change clothes get cleaned up and go to the bathroom and walk around the house about five times a day.

8.
2 times a day.
Heel slide 15
Hip abduction 15
Straight leg raise 15
CPM machine to 52°
Ankle Pump 15
Towel roll under heel. Five minutes
Standing exercises.
Sidekick 15
Back kick 15
Heel toe raise 15

Listed above in number eight
Anything done at PT

Three times per week. All of the same exercises I listed before


My main problem that I am not doing very well with is ROM bend. If I push it too hard for too long it causes me problems for the rest of the day. And then the next day I could not go as far as the previous day if I push it too hard.

 

[Josephine]

5. icing 4 x's a day

@mikb314159 my question was "how often and for how long?"

 

[mikb314159]

Ok. 3 to 4 tines a day. 30 minutes each tine.
Sorry for the missing details.
Thank you,
Michael

 

[Josephine]

1. Range from 4 to 9.

At two weeks out, that's about par for the course.

2. Hydrocodone 5 mg-325 Tylenol: 6x's a day

That's not very much. I think you should see about increasing your meds a bit.

3. Moderate

Moderate swelling - swelling is a form or pain and moderate swelling adds about 4 points to your pain score, making it about 8-13.

4. Bend: 55 Straightness: 5

Also par for the course and largely due to the swelling and pain.

5. Icing 3 to 4 times a day. 30 minutes each tine

But you accomplish little or nothing in 30 minutes. Ice for at least 40-60mins and more than 4 times a day.

6. elevating all night and at least 30 minutes an hour.

Apply the same as for icing.

7. Doing doing very little activity. Just getting up to change clothes get cleaned up and go to the bathroom and walk around the house about five times a day.

Good.

2 times a day
Ankle Pump 15 - you only need to do these the first few days while you're not very mobile
Heel slides x15 - you don't need this. Read this Heel slides and how to do them properly
Hip abduction 15 - you certainly don't need this - it's a hip exercise!
Straight leg raise 15 - once you can do these you don't need to do them any more
Towel roll under heel. Five minutes - this is a half leg lift and not needed now
Standing exercises Sidekick 15, Back kick 15, Heel toe raise 15 - you don't need these. Totally unnecessary

CPM machine to 52° - the use of this is largely discredited. I suggest you stop using it. It will only increase your swelling and pain and therefore increase your swelling and pain

Anything done at PT
Three times per week. All of the same exercises I listed before - don't go to PT. You don't need it.

In summary:
1. remember you are only 2 weeks out, very, very early out
2. see about changing your pain medication
3. adjust the amount of time you spend icing and elevating
4. stop all the exercises I've crossed out
5. cancel the PT sessions: there are many members on here who did their TKR recovery doing no exercising whatsoever. But, do remember this No exercising: what does that really mean?.
6. If you are concerned about refusing to do therapy, you need to read this Saying no to therapy - am I allowed to?

 

[mikb314159]

Wow! Thank you so much. I really thought the CPM was not helping me. I refer to it as the torture machine. I will adjust all of my routine as you have suggested.

 

[mikb314159]

Hello,
One follow-up question. What should I be doing for our ROM -bent for my knee?
One of the therapist mentioned scar tissue development if I don't get good motion.

Thank you, Michael

 

[Celle]

One follow-up question. What should I be doing for our ROM -bent for my knee?
One of the therapist mentioned scar tissue development if I don't get good motion.

Your therapist is just scare-mongering and perpetuating a myth. There is no such thing as scar tissue developing if you don't get good motion at this early stage. Myth busting: the "window of opportunity" in TKR

Your new knee is only two weeks old and it's far too early to be worrying about flexion (bending), because both flexion and extension can continue to improve for a year, or even longer.
Right now, your knee can't bend further because it's swollen and the swelling is a physical barrier to flexion. Your knee will bend more as the swelling goes down. For now, walking around the house is all the exercise your knee needs to help it with flexion.

 

[Poctdb]

@mikb314159
Once the swelling goes down, the ROM will follow quickly. I have been experiencing leaps in ROM....but I ice 6 hours a day usually. For the first 10 days, icing was pretty close to 24/7. My job is to kill swelling so the knee can show me what it’s got.

We are surgery buddies.....same knee same day.

 

[Josephine]

I really thought the CPM was not helping me. I refer to it as the torture machine.

A lot of people do!

One follow-up question. What should I be doing for our ROM -bend for my knee?

You don't need to do anything except your ADLs. No exercising: what does that really mean?

One of the therapist mentioned scar tissue development if I don't get good motion.

Yes, they do that in order to scare people into complying with their daft ideas. Scar tissue (more correctly known as adhesions) are actually pretty uncommon. Mostly what compromises ROM is simply swelling and pain.

 

[kneeper]

I was skeptical of the cpm but my OS prescribed it. I used it much less than they tell you too for the reason you say as well @mikb314159 . I found that just gently bending my knee periodically during the day was plenty; along with walking around a bit doing ADLs, but starting that slowly.
Listen to the knee and you'll figure out how much to do or not do.

 

[mikb314159]

Thank You

 

[Poctdb]

@mikb314159 how is my surgery buddy doing?

 

[mikb314159]

Hello surgery buddy,
I am doing much better in the last couple of days. Doing a lot of walking around the house with the walker and even got to go out to dinner. Pain is staying closer to a 4 or under. Got my staples out on Wednesday. ROM is getting better at 60 degrees. And I am getting more sleep. Overall happy with where I am at. The cellulitis is getting better also. Doctor extended my Keflex for another week.
How are you?