TKR Moving forward.

[Cycle-Path]

30 days post-op:

I've really been focused on stretching my hamstring, calf, IT band, and hip flexors this week as best as I can without putting adverse pressure on my new knee. Of course the IT band is a pain in the butt and hasn't gotten much better, but the others have responded pretty well.

Point:
- Today at PT I reached 135° of flexion and 0° extension without pain!
- I also learned today that I can go up/down the six stairs at my front porch normally! I do hold the handrail or use my cane (or both), but the operative leg can do it comfortably.

With that said, I don't want to mislead folks that read this. I am not moving my leg to 135° in any manner similar to how the nonoperative leg just bends back. It is slow, intentional movement with absolute control and it takes five repetitions to get it there. The same can be said with the stairs; they are focused and intentionally done. I am nowhere near moving around "naturally".

The end of this fourth week has been fruitful with progress. I am thankful and hopeful.

 

[Layla]

Nice update! You're doing well and slowly but surely you're getting there.
Keep the faith, brighter days are on the way!
@Cycle-Path

 

[Cycle-Path]

---Day 33---

I have a couple questions concerning pain med's at the bottom.

Situation - I've been using oxy with tylenol (7.5/325) since discharge.
The initial dosage was one pill every 4 hrs as needed. currently I've been getting by with one every 12hrs just fine.

This morning I tried not taking a dose and alternating tylenol and ibuprofen. Well, I got pretty uncomfortable about an hour ago and it has been 20hrs since my last percocet. I took one and it has helped bring things back to what I would consider as comfortable functioning.

Questions - Have I been using opiods too long? Is there something that may better fit my current situation? I will speak to my OS, but I just wanted to know what to expect.

Thanks for your opinions,
CP

 

[mendogal]

A slow taper is fine!

Some lucky folks are off prescription pain meds like Oxy within a week or two. Most of us take a few weeks or even a few months, and yes the final stage of the taper is from every 12 hours to once or twice daily only as needed.

It sounds like you would be fine taking acetaminophen (Tylenol) and ibuprofen on a daily schedule, and plan on a once a day Percocet until you're comfortable skipping it.

Be aware that you need to account for the 325 mg of acetaminophen in the Percocet when computing your over the counter med schedule. Guidelines say we shouldn't be taking more than 4,000 mg of acetaminophen per 24 hours.

If you take 2 extra strength acetaminophen every 8 hours, that equals 3,000 mg/24 hours, so you're within the recommended dosage with one or even two Percocets.

 

[Cycle-Path]

Regarding my last post I just had an afterthought:

- Today at PT I did some new exercises. I stepped up onto a stair leading with my new knee first and the good leg following, then stepped down backwards leading with the good leg x 20 times. After that, I did the same thing from the side x 20 times. Basically I loaded the new knee a lot; that's 40 ups & 40 downs on my new hardware!

I'm betting that this newly introduced exercise caused increased pain for me today three hours after completion. I've been controlling swelling all day. Granted I had been doing mini squats and a lot of straight leg raises (front, side, and back) in parallel bars, but nothing like the stairs.

I've been sitting here since I had to take a percocet this afternoon wondering how I could have so grossly misunderstood my own pain management plan. Now I'm pretty sure that I would have been just fine with my plan to drop to one percocet a day at night and get through the day with tylenol and motrin if my therapy hadn't just increased. At PT it didn't seem like a big deal. Just some easy steps that would have never caused second thought in my life, but in hindsight 40 up/down stairs is a pretty significant increase considering my quad has only been working for two weeks.

In my opinion this is a case of too much too soon and I may be pretty sore for it tomorrow. This is a perfect example of how I can easily get myself into trouble at PT. I love challenging myself and have always pushed for more. I'm a dork and can be my own worst enemy sometimes.

 

[mendogal]

Yes that is wayyyy too many reps.

Some are overly eager to make the PT happy, and some are going to try to rise to any challenge. Neither are productive.

Handy Tip number 1: don't do more than 6 - 8 reps of ANY new exercise. Then reevaluate in two days.

Handy Tip number 2: if a PT wants you to do any exercise (or stretch) with weights, say No. A few months of good healing are needed for our tendons and ligaments to handle that (they are slower than muscles to heal).

 

[Cycle-Path]

@mendogal

After reading your last post I have been doing far too much at PT for at least two weeks. Not only regarding rep's, but with ankle wieghts and strengthening exercises.

 

[mendogal]

Oh!
A handy reminder is the healing chart! Look especially at #2, 4, and 10....

Simple athletic strains need a good 6 weeks, but our support structures have been much more severely traumatized than a twisted ankle!

 

[Jockette]

Reread this from the Recovery Guidelines:

BoneSmart philosophy for sensible post op therapy

You will have noticed there is a significant opinion here about the potential hazards of PT. You may feel that your therapists are experts and know what you should be doing. However, over the last several years I've been here, I have observed that the more intensive the regimen of exercising...

bonesmart.org

 

[Jockette]

Yes, you want to get back to the activity of your choice, and you will, but you have to heal first. Too much PT, too soon, does not allow for that healing.

 

[Jockette]

I'm 33 days post-op and kinda stuck at -1/-2 extension. If I work at it I can get to 0, but the knee defaults right back to the bend. For me quad sets, leg extensions, and normal calf/hamstring stretches seem to loosen it up.

I actually think you might mean +1 and +2, because - is more than straight, since straight is zero. If you realy are the minus, you're there! If you’re +1 or +2, it’s still awesome for so early in recovery, and time, not lots of work, will get you to zero. Time, for your whole leg to continue to heal and relax.

 

[Cycle-Path]

@Jockette You are correct, I had it backwards. Thank you for pointing that out, so I can make that adjustment.

 

[Jockette]

You’re doing amazingly well with those numbers. Many take way longer to get what you have. Your recovery is going great!

 

[Cycle-Path]

Five weeks post-op:

As I typed the above it seemed kind of strange. I distinctly recall the first roughly ten days post-op when I felt like I was living hour to hour. Here in the forums I would read people's progress at the five and six week points and felt like it was forever away from where I was at. Let me reassure you all that looking back ot has gone fast.

Anyway, still a little sore from overdoing it Monday, but all is well. Today at PT we dialed it back some, but I'm sure they'll try to ramp it up again quickly. I'll be applying a little more discernment as we go.

 

[Cycle-Path]

To brace or not to brace?

I'm still dealing with swelling at week five. I never really had much knee swelling pre-op with exception to the month before my tkr. I knew I had some OA, but tearing my cartilage and meniscus is what triggered me to go back to the OS and ultimately the tkr.

Is it okay to wear a compression sleave or brace to help out at this point? I still haven't seen my new knee without any swelling regardless of how much I elevate and ice.

 

[Jockette]

Many of our members like wearing some compression for swelling but I didn’t want anything snug on my knee at all, so I never wore a sleeve or brace. It’s a personal choice. Swelling is very common for the first few months. My PT told me I could have swelling for a year.

 

[Layla]

Consider phoning your surgeons office to see what a member of your OS’s care team recommends in regard to compression socks.

My surgeon once mentioned swelling can last a full year, normally easing over time.

It is our lymph system that rids the body of fluid (swelling). So you want to get the fluid to the lymph nodes in your torso area so your body can more quickly process it. The lymph system works rather slowly on its own and much more efficiently with the assistance of gravity. The fluid isn’t draining into the hips, but contained with the lymph system and moving to the torso and lymph nodes located there.

BoneSmart FA, CricketHip, is involved in Therapeutic Massage and has shared this exercise to assist in manual lymph drainage. This gentle, yet effective therapy will help prime your lymphatic system to move fluid and inflammation away from your leg, which in turn will help your range of motion and pain - you may want to give it a try and tag her if you have any questions.

While lying supine, take deep breaths...deep, as in breathing in to a count of 5, 4, or 3 seconds, whatever is most comfortable for you. Hold that breath for another count of 5, 4, 3 then blow out completely, still using the count that's comfortable for you. A series of at least 6 reps may help get the excess swelling to move. To ensure you are taking proper deep breaths, place your hand on your naval and watch while taking in your breath, if doing this properly you should see your hand move up. Repeat this whenever you feel up to it during the day or night. Lying flat (supine) is best as the lymph nodes seated in your groin are less restricted, allowing for better lymph flow.

In addition, after the breathing exercise, place your hands lightly on your upper thigh, at the crease in your groin and lightly stroke upwards towards your naval.
Be patient because it can take the body time to respond.

Give it a try!
@Cycle-Path

 

[Cycle-Path]

I'm nearing the six week mark. There has been a few days that I could walk with a normal gait. On the other hand when those few days came around I overdo it and end up sore for two days with a limp using a cane. Overdoing it can be as easy as something like a 1/4 mile walk at the grocery store.

Swelling is still present and quickly increases with any activity which impacts range of motion. Icing and reduced activity brings down the swelling. Range of motion is around 135° of flexion and 1° to 2° of extension with some work. Extension is stubborn and defaults to around 3° or 4° unless I loosen up. Same with flexion it seems okay to about 125° and I have to loosen up for more than that.

I can sleep in most positions except on my stomach. That tends to give me a stretchy feeling regarding extension that gets uncomfortable rather quickly.

Still attending PT and it's going well. It is still uncomfortable. Then again anything I do still feels uncomfortable. The knee feels very stiff, slow, and weak.

I guess I still have a long way to go and there will be a lot of ups and downs along the way. Hopefully this week I'll get the okay to drive again.

 

[Cycle-Path]

Sorry, I've got a case of the Monday's. Lol.

 

[mendogal]

Sorry, I've got a case of the Monday's. Lol.

I hear ya!!! It really can be a slooooow slog.

Your numbers are great (needing to loosen up each time to gain extension took me quite a while), and 1/4 mile all at once at less than six weeks is good! I encourage you either use the cane or use a shopping cart as a big walker during grocery trips; it really helps.

A caution on driving: your R hip and R knee really need to flex to handle getting in and out of the drivers seat, so ease into it, plus make sure you've got the oomph in the leg in case you need to brake suddenly.

We like to hear from you whatever your mood!