TKR More front tightness after 18 months

[tashia]

How are you doing? Is the swelling down. Its take time but it does go down. Remember to rest, ice, elevate, and take medican as needed. Try to stay postive. Take care, tashia

 

[keith55]

Hi Tashia,

Thanks for thinking of me. The swelling has come down from the max but it's still swollen or you could say misshapen. I still have that unnatural feeling that the knee is full of wet concrete - I think this is the worst part of this business . I'm gradually doing more each day. Single stick walking inside and I'm starting to do it outside now: increasing my walking distance outside. I've got my iterations up to 10 (3X per day) on the NHS recommended exercises - knee bend and straighten on step, PC plod knee bends, assisted knee bend seated and push knee down to get extension. I'm also doing one leg balancing on both legs in the kitchen while waiting for kettles to boil, microwaves etc. I can get about 30 secs and find that the affected leg is as good as the unaffected for this. I'm starting with some strengthening exercises: quad sets and leg raises (both legs).

The affected knee doesn't like going down slopes and I'm still single stepping up and down stairs and I wear my freezer gel packs just about all the time because of the heat from the knee: the best painkiller. GP said feelings of instability was due to muscle weakness and is common.

I'm icing and elevating about 3X per day for 1-2hrs each. See surgeon again on July 11 <3 weeks!

What does the forum think of Brugioni/Falkel book: "TKR + rehab". It says at week 4 I should be sleeping through the night but I'm still getting up 3/4 times to get new gel packs etc.

 

[soSuesew]

Keith, I don't know the book so this comment isn't aimed directly at it but I say 'very big raspberry' to most of the published stuff (except BoneSmart, of course). Although there are good sources of information, they deal in 'average' and 'typical' and many of us aren't average and typical. Comparing myself to others was nearly my undoing as my recovery has been very slow and I felt I was failing!

Seems to me you are doing very well and if you need ice packs, you need ice packs. It was weeks and weeks and weeks before I got near sleeping through the night.

Sue

 

[keith55]

Good advice Sue. I've decided that the main thing is to try to keep on an upward curve and not worry about the gradient. The trolley someone on this forum advised me to get has been the difference between coping and not coping on my own. I couldn't have done this without this forum.

 

[maryo52]

What gets us post-TKRers into trouble the most is our expectations. I think owning a new knee is a lot like having a new baby. You have described several expectations and are worried that your experience is not matching up to them.

I remember reading Dr. Spock's book on parenting. My baby boy woke several times a night. Dr. Spock said once he weighed 11 pounds he would sleep through the night. He reached 11 pounds and then some, still waking just as much. So I burned that book! (Dr. Spock later renounced his own book!!)

Burn your expectations and listen to your new baby knee. Don't have a schedule. If your knee was done properly, and most likely it was, then your job is to let things take their natural course. Most of all, do not rush your knee.

 

[lavender]

Hi Keith hope you are doing well. I agree with Mary the knee needs time to heal and your body needs time to adjust to the feelng of the new knee. Both of my knees needed replaced lots of artritis and no cartiledge.I developed a way of walking to compensate and for the lack of stability and pain and my body seems to not understand thatthe damaged knee is gone. I am in my 7th week going into my 8th and have started to find it easier to sleep.I am taking physio and having difficulty making me new knee bend to the degree expected . My pain level is lower and tolerable but finding it hard to walk with confidence on the cane told to put the weight on my right but my leg is still not comfortable. I think the books should be wrote by someone who has actually had this experience as only a person who has had a replacement can fully understand the ups and downs of this surgery. The bonesmart forum has helped me alot advice from people who have been where we are and offer support not demands for better results. Never thought this bending thing would be an issue figured after surgery it would all come into place but some times it takes a little longer for some of us and this is frustrating. I wish I had of found this site before surgery and I would have been educated on what to expect and asked questions before. Wishing you a painfree day and may your days get better and better. Holly

 

[Roy Gardiner]

GP said feelings of instability was due to muscle weakness and is common.

Also it's possible that having bone spurs cut away during surgery opens up range of movement and the knee can now 'wibble-wobble' where it couldn't before. I had this -- most disconcerting at first but I soon got used to it. It, in fact, is normal and I'd got used to abnormal before surgery.

 

[keith55]

Well I was planning to do some single stick walking outside in the nice flat even tarmac car park this afternoon but it was so cold I fled back inside. So I thought I'd give the exercise bike a go - not expecting to be able to rotate fully. Well I got a backwards full rotation straightaway! Woohoo! as people on this forum say. I only did a few as experience has taught me to be wary of doing too much and paying for it later. It wasn't easy of course.

 

[skigirl]

Keith it sounds like you are doing great. At one week, I could bike for five minutes--then at 2 weeks for 10 min, etc!! Eventually I got to 30 min and have stayed there--I bike 30 min every day no matter what else happens!! it is good for the knees.

It is amazing that it is still cold in late June--but we have had a late summer as well. Oh well, I do so hate to be hot!!

 

[Josephine]

​

One thread for your recovery please?​

 

[Josephine]

I can see progress in bend in exercises, but the knees natural angle is still roughly 70 deg and not budging. By natural angle I mean the angle of bend before which I don't have to push to get more bend.

You're only 5 weeks out - far too early to be worrying about all this. You still need rest and lots of it. Remember the mantra
- 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!

I'm less active than before op and walking very slowly so I've just realised I need to do some extra strengthening exercises for both legs to avoid muscle atrophy.

No you don't need that. Your muscles aren't weak they are injured and need time to heal and recover.

I managed my first unassisted straight leg raise yesterday in the operated leg

increasing my walking distance outside. I've got my iterations up to 10 (3X per day) on the NHS recommended exercises - knee bend and straighten on step, PC plod knee bends, assisted knee bend seated and push knee down to get extension. I'm also doing one leg balancing on both legs in the kitchen while waiting for kettles to boil, microwaves etc. I can get about 30 secs and find that the affected leg is as good as the unaffected for this. I'm starting with some strengthening exercises: quad sets and leg raises (both legs).

Sorry, but this is the reason you are still swollen, unable to get improvement in ROM and all that. Too much, too much. It's causing MORE swelling and therefore stiffness. Read this again Swollen and stiff knee: what causes it?.

I still have that unnatural feeling that the knee is full of wet concrete

That's swelling and pain; slow down, cut back on the activity. As long as you are experiencing this, you will not get your ROM.

 

[keith55]

Thanks for all your messages recently and for merging my threads. For some reason I didn't get the email alert for the last message and Wimbledon does take priority! The swelling is beginning to go down! There is a definite dent on the outside of the knee and I'm not always looking for the next cold pack now - but still using them of course. I managed a 20 min walk on pavements (2 sticks) near my home on Sunday - it wasn't very far and would have taken me 5 mins pre op but it's progress. I'm using one stick in the flat tarmac car park now.

ROM is improving. I can put socks on the affected leg without the useful sock aid now and the natural bend is more like 90 degrees. The knee bend when seated exercise now has the knee going much further back. It still doesn't bend like the unoperated leg though.

I'm having occasional home help with hoovering and laundry though I've been taking the laundry out of the washer/dryer and hanging it up - using the useful trolley to aid that. I was watching the tennis yesterday and got so into the Lisicki/Williams match that I thumped an arm of my armchair when Lisicki won. Cue shower of dust. Whoops I haven't hoovered that for a while so I decided to use my trolley to manoeuvre the hoover to deal with it - ok! But I won't be doing full hovering for a while.

 

[keith55]

I have my 6 week check up with the surgeon, or one of his team, tomorrow.
I guess the issues will be:
1. How is my bend and extension and how much more I can expect and how to achieve it e.g. do I need physio help or not?
2. It's still swollen so I'll ask them how to get it down. I know this forum says ice and elevate but I'd like to hear what they say.
3. I've managed to get in and out of my car unaided (using one stick) and have just moved the car around in the car park. So I'll ask if I can start driving. I'll start driving short distances at first.
4. I have some orthotics made by a private podiatrist but there is a podiatry section in the hospital. My needs may well have changed so I was going to ask if I could see an NHS podiatrist.
5. How should I vary my activity level through recovery?

Any other things I should be asking e.g. x-ray to check prosthetic? (was xrayed after op)

 

[kneeper]

Good idea to ask about the podiatrist. Your orthotic needs may have changed.
There may be a standard policy about follow-up xrays. I want to say they did xray the knee at my 6 weeks checkup.

 

[keith55]

Hello all,
I thought I would put out an update.
I saw one of the surgeon's team on 11 July. Surgeon was there but was seeing someone in a wheelchair. Quite a few of those being seen were the ones operated on the same day as mine.

I have ROM of 120 degrees (extension wasn't measured) which is up with the leading group and he thought the swelling was well down. I asked him about greater heat and redness at night - was this caused by doing too much? He said "you can't do too much" which is not the message of this forum. He was concerned about my balance and sent me off to p/t for further exercises. He said that patients can start to think about driving at 6-8 weeks. I started driving after that - small trips at first - in fact driving is already easier than before op.

I'm walking outside with 1 stick now and inside without. My walking speed is a grand 1 mph! and its much easier on smooth level surfaces. I walked round to a friend's house last night c30 mins for 1/2 mile. I've just noticed some clicking in the knee: not painful. Sleep and being tired much of the time is still an issue. I've reined back the tramadol to 1 at night and 1 in the morning from 6 a day. I still get some occasional sharp pain in the kneecap after activity

 

[keith55]

Well I've passed the three month mark. I'm much better than immediately post op of course. I'm doing all the housework now and beginning to walk further. Speed of walking is still slow but getting slowly better. Knee is still swollen from normal but the swelling has gone down. It does go clickety-clack - I'll just have to get used to that.

But I'm still worse off as far as walking is concerned than pre-op. I can't keep up with "normal" people. Down slopes are a problem and stairs is still single stepping. I wonder really if the next three months will in fact be harder. After all this time I just want to get on with normal life, go on holidays etc. The rate of improvement has slowed so at the back of my mind I wonder if this is going to be as good as it gets. I sincerely hope not! (Yes I know about the recovery diagram but that doesn't stop me getting frustrated)

I went walking on a nearby nature reserve today. Quite hilly so had to edge my way downhill. Later in the evening I had severe pain at the back of my knee in the nick of the knee. Is that usual? I also sometimes get a feeling like a vice gripping the sides of my knee while weight bearing. Is that usual?

 

[kneeper]

Down slopes will improve gradually. I had an area at work that was stairs or a handicapped slope and the slope was hard at first--I was just about at your point in recovering. Just keep trying.

The pain could be from the activity. Do you still ice and elevate sometimes? I was at this point--especially after work or if I was particularly active and it helped.

 

[bottomshollow]

Please keep in mind that you are ONLY 3 months post op---just 1/4 of the way through recovery. The rubber band around the knee feeling is very common and is usually gone by 6 months. Your ability to walk as fast as "normal" people will continue to improve over time, as will going down ramps and steps. This early out, you can expect your knee to make you pay when you do more than it is ready for.

The secret of success with joint replacements is TIME & PATIENCE. We have to have (or find) the PATIENCE to give our knees TIME to heal at their own pace. Nothing else works like these two things and nothing can take their place. But it is a very hard truth to absorb in the beginning of our recoveries.

Recovery is what it is, and it's going to take as long as it's going to take. So be PATIENT and let TIME take care of things with some assistance from you.

Take care and keep us posted. We care.

 

[keith55]

Thanks for these two encouraging posts. Yes I still ice and elevate but not as much as at first. I also ice when I can when I can't elevate e.g. driving and listening to church sermons (horizontal rather than raised). With autumn and winter coming on I won't feel that I'm missing out so much. Hopefully by next spring I'll feel normal and can make the most of the joys of spring migration etc. ... and go on the group nature holidays I have planned and won't feel I can't keep up.
I've got another hospital physio session in late September.

 

[Elliemae]

Hello Keith, it sounds like you are doing very well. Your ROM is really good, and I can relate to the down slope walk, not easy but getting better. I had a little stall pattern with my recovery, I could not get beyond 65-70 degrees and at just past 8 weeks had an MUA. For me it was exactly what I needed, I had a ton of scar tissue above my knee. My best measurement in flexion has been 112 and was happy to get that. I am still in PT but now just two days a week. For additonal exercise, my husband, stepson and I have gone on a hike the past three weeks, nothing too strenuous, but the last one was 2.5 miles and I was so glad when it was over.... Each day is a little easier.

Keep up the hard work!!!!