TKR + MUA first knee. One year post knee surgery

[KarriB]

Here is the activity progression chart, take a look at where you are. How much PT are you doing?

https://bonesmart.org/forum/threads/activity-progression-for-tkrs.14334/

 

[FlaGranny]

If your surgeon is pleased with your progress, don't worry about what the PT thinks?

 

[BBCG]

Hi CJM, I was in the same spot you're in, but not at 4 weeks! I was threatened with the dreaded MUA at 6 weeks when I was not yet at 90 degrees...I'm not there still, either, but it's due to my having to be on my feet a lot. My ROM is still increasing, but very slowly since I am not able to ice and elevate as much as my knee likes. My next appointment with my OS is in about a month from now, and I hope to be at 90 by then, but I'm not too worried yet. I also cannot get my foot around the bike pedal wheel, either, just going back and forth! But each time I get to work on it, I get a bit farther... My OS was happy when I was feeling my ROM was improving.

I know: it would be nice to be able to get the swelling to magically decrease fast, yeah, like in 10-15 minutes! The only thing that's done that was a Melt session with the roller under my hips, and that took an hour, so I try to do that each evening to decrease swelling before going to bed.

But, for your PT to be the ROM police is not fair... and telling you to get to 120 from 90 in a week is crazy! Not sensible, cruel and unusual punishment for your poor baby knee, as others here have said. Seriously, I would consider asking for a different PT or just find someone else as this person seems determined to make your knee heal slower not faster... Judging from the reading and the other experts here, you are doing fine, and the PT is out of line.

The glute strengthener that my PT gave me to try was NOT until I was at the 8 week mark, though, and if you do it too soon and your quads aren't really ready yet, you'll only cause more swelling and a decrease in ROM, just so you know... she has me hold on to the edge of my kitchen sink, arms stretched forward, scapulae pulled toward each other in the back, tight core abdominal muscles, stand tall, then stick my butt out and back, then down, as if to sit down, in a modified squat. Then, hold a teensy bit, and using my glutes, NOT my knees, etc. raise back up to standing tall. I was to only do 2-4 per session the first week, only every 2-3 days. No more than that. Then increase by 1-2 each week to 10 per session for a few weeks.

But, like I said, wait a few weeks to do this yet, since you could...and I did...overdo it the first time I did it. I need to slowly get my quads and glutes in better condition, not too fast or I end up losing ground! I'm sorry your PT isn't trustworthy in terms of asking if you are trying to do too much too soon...if they are pushing you more than is good too soon already!

 

[Josephine]

My ROM is at about 90 and my PT really wants me at 120 next week

Well poo to her! Never, ever allow anyone to set targets for you like that. You're doing fine for 4 weeks out which is slap bang in the middle of the 'angry tissue' stage when everything appears to be working against you!

She suggested taking Tramadol before exercising

Absolutely not! This is a most dangerous thing to do. Pain has a function which is to let you know when you are overdoing things. Masking this can cause damage to soft tissues so please don't do it!

I am tired of elevating, icing and heat pads!

Heating pads? Please tell me you're not using heating pads! Ice and only ice!

it is my understanding that I only have 6-7 weeks to get this knee to bend for the best results.

Quite wrong and Celle has left you the articles explaining it.

When I ride the bike my husband says I am turning my knee in.

That's because you are in pain and cannot bed your knee enough.

I'd like to ask you some questions if you don't mind, and 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)

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. what kind of PT exercises and exercises at home are you doing? How much 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 each day)
enter exercise then enter number of reps and sets
etc., etc.

At PT (how many times a week)
enter exercise then enter number of reps and sets
etc., etc.

 

[CJM]

I waited to respond until after my PT session yesterday. In answer to your questions...
1) pain is normally 1-3
2) I only take 1 50mg pill of Tramadol if pain is above 5 and that only seems to happen on therapy days
3) the swelling is moderate (PT saw a huge improvement since I spent the weekend mostly in bed elevating and icing)
4) My ROM was 93 with PT holding the leg to measure and the extension is close to normal
5) ice 3-4 times during the day for at least an hour and use the Ice Man every night
6) elevate almost all day and night
7) activity level low - trips to bathroom, and kitchen to get food or ice and trips to PT
8) soft massage down and up the leg for blood flow (2x day), foot pumps and circles (2-3x day 10 each), sit with leg down and good leg pushing for a gentle bend (2x day), recumbent bike for 5 minutes 2x/day and occasionally some foot slides

Also, I was taking 1 Aleve tablet twice a day but called my doctor to ask if instead I could go back to 800 mg Ibuprofen 3x a day which I was doing for my RA before the surgery and he said fine. So hopefully that will also help with the swelling. And I was able to get my leg to complete a circle on the bike 4 times yesterday at PT with a good lean to the right. This is probably why I'm a little more sore today. Oh, and I was wrong about the 120 ROM. Ideally if I can get to 110 by my doctor post op visit on the 27th that would be great. The PT just doesn't want me to have to get an MUA so she's working me hard but gentle to avoid that.

 

[Celle]

My ROM was 93 with PT holding the leg to measure and the extension is close to normal

The PT just doesn't want me to have to get an MUA so she's working me hard but gentle to avoid that.

I've got news for you. You don't have to have an MUA.
Even if your surgeon suggests one (which is unlikely, since you are already at over 90 degrees), you don't have to have it. You can always ask for more time. It's your knee and no one can do anything to it without your consent.
Saying no to therapy - am I allowed to?

PTs are often obsessive about measuring ROM. It's one way they can prove to the insurance companies that their ministrations are effective. That doesn't mean you have to get wrapped up in their numbers game.
At only a month after surgery, your ROM is actually very good.

 

[Josephine]

1) pain is normally 1-3

Okay

2) I only take 1 50mg pill of Tramadol if pain is above 5 and that only seems to happen on therapy days

And do you take Tylenol with it? 1,000mg will enhance the overall effect very nicely.

3) the swelling is moderate (PT saw a huge improvement since I spent the weekend mostly in bed elevating and icing)

Jolly good!

4) My ROM was 93 with PT holding the leg to measure and the extension is close to normal

Never ever allow your ROM to be measured while being 'encouraged'. It only counts if you are doing it under your own strength. Measurements while it's being forced or pushed don't count!

5) ice 3-4 times during the day for at least an hour and use the Ice Man every night
6) elevate almost all day and night

Jolly good!

7) activity level low - trips to bathroom, and kitchen to get food or ice and trips to PT

Even better!

My comments in bold
soft massage down and up the leg for blood flow (2x day) - why? and these are done by your PT, are they? I really don't see the point. I think if you want them, 2-3 times a week would be more than sufficient
foot pumps and circles (2-3x day 10 each) - these are only for the early days when you're not so mobile. You're 4 weeks out now and don't need them
sit with leg down and good leg pushing for a gentle bend (2x day) - a 'good pushing' by whom? If a PT then stop it. If by you, then you should read this Heel slides and how to do them properly.
recumbent bike for 5 minutes 2x/day - once a day is more than enough
occasionally some foot slides - do you mean heel slides? If so, read the article above

I'd strongly recommend you only do anything once a day and none at all at the weekends.
Read this BoneSmart philosophy for sensible post op therapy

Also, I was taking 1 Aleve tablet twice a day but called my doctor to ask if instead I could go back to 800 mg Ibuprofen 3x a day. So hopefully that will also help with the swelling.

I wouldn't if I were you. Medications: acetaminophen (Tylenol, paracetamol) and NSAIDs, differences and dangers. Also NSAIDs don't help much with this kind of swelling as it is trauma induced.

Ideally if I can get to 110 by my doctor post op visit on the 27th that would be great. The PT just doesn't want me to have to get an MUA so she's working me hard but gentle to avoid that.

Then stop her! 90 at 4 weeks is excellent and it's much better to allow your ROM to improve slowly and naturally. All this 'working hard' will just increase your swelling and thereby block your ROM. Remember this article which was left in the recovery articles in post #5? Swollen and stiff knee: what causes it? Did you ever actually read them? (not trying to be funny but some members, having been asked that, then say 'I will go and read them now!' so you get my reason for asking!)

 

[KarriB]

I'm glad you have less swelling after a weekend of elevating and icing. I see a pattern here...why not duplicate your weekend through the rest of the week and see what happens?

 

[CJM]

I'm curious about how the September TKR people's knees are feeling. Mine is still achy but with all the holiday work it's hard to stop moving! My ROM is good and I can do the recumbent bike without trouble.

 

[FlaGranny]

I had mine on Sept. 26. I'm doing well. Feel better than before surgery. Still a bit stiff and sore when flexing, otherwise good. I've been running around a bit too.

 

[wilsonma]

I was Sep 27 and doing well also. Back to the gym and up to 250lbs leg press. Like both of you, I've been busy also running around and take the odd Tylenol now and again. My ROM in the TKR is better than the "good" knee.
So far, so good...

 

[CJM]

But does your knee still hurt. Not like a pain level 7 and up; more like a 2-3. I mean I still haven't gotten to the point of a pain free day. I know it's a 6 mo. recovery. Just nervous because knee #2 will be done Jan. 31! Yikes!

 

[ACDCJen]

I had my LTKR ON September 14th. I'm doing well. I had my RTKR on November 28th, so my left knee has been bearing the brunt of the activity since then. It's not 100% pain free, but I'm never above a 1-2 or so. My movement is limited by my RTKR for right now, but I feel as though I was doing well at 10 weeks out for sure. It's still swollen at times, but I knew right from the moment I woke up in recovery that it was one of the best decisions I've made.

Jen

 

[Beckus]

I have been wondering the same thing. I had a LTKR on Sept 19. I still have discomfort everyday that is controlled with Tylenol and Advil. On occassion I still take Oxycontin at night if I have had a very active day (usually ends up being on the weekend). My ROM is only 105 and my insurance wont cover any more PT. I worry that I am not making the progress I should be.

 

[FlaGranny]

Sometimes I get a pain here and there, and have some soreness when flexing. There is very mild swelling. I wake up once or twice with knee bothering me, but most of the time I'm comfortable with no pain at all. There is a bit of a tight feeling around my kneecap area.

 

[Jaycey]

@CJM you will notice I merged your two threads into your existing recovery thread. Please keep all your updates and questions on recovery here so that we have a history of your situation and can advise if needed. Thanks!

 

[CJM]

Thanks Jaycee. I'm not tech savvy. Is there a quick way to follow my thread? I thought I could click on my initials on top but that didn't work. Otherwise I page back till I find me . That's why I started a new thread.

I guess after reading these responses that I could be doing better. I admit that I've slacked off my exercising for the last three weeks with all the decorating, cleaning and shopping. There aren't enough hours in the day. I guess that might be why my TKR still hurts . The right knee has been going downhill with all the extra effort it's had to make, but that makes sense.

 

[newlybionic]

If you are doing a lot of activities now you don't have to concentrate on exercising. Daily living should be enough exercise right now. If you are still swollen or stiff at the end of the day then icing activities during elevating would be the best for you to do.

 

[Red's Mom]

I had my LTKR ON September 14th. I'm doing well. I had my RTKR on November 28th, so my left knee has been bearing the brunt of the activity since then. It's not 100% pain free, but I'm never above a 1-2 or so. My movement is limited by my RTKR for right now, but I feel as though I was doing well at 10 weeks out for sure. It's still swollen at times, but I knew right from the moment I woke up in recovery that it was one of the best decisions I've made.

Jen

I'm with Jen. Even though the journey is difficult I already know these new knees are going to be so much better than the originals!


Sent from my iPad using broken link removed: https://r.tapatalk.com/byo?rid=75543

 

[Celle]

Thanks Jaycee. I'm not tech savvy. Is there a quick way to follow my thread? I thought I could click on my initials on top but that didn't work. Otherwise I page back till I find me . That's why I started a new thread.

How can I find my threads and posts?
You can also bookmark your thread, which is what I do.
The article above is in the section called How To Use This Forum
Lots of useful information there!

I guess after reading these responses that I could be doing better. I admit that I've slacked off my exercising for the last three weeks with all the decorating, cleaning and shopping. There aren't enough hours in the day. I guess that might be why my TKR still hurts . The right knee has been going downhill with all the extra effort it's had to make, but that makes sense.

I'm not surprised you slacked off the exercises - that was exactly the right thing to do. With everything else you've been doing, the exercises would have been far too much for your knees.
In fact, all the other activities could well have been too much, and that would explain why you seem to have taken a step backwards.

With plenty of rest, icing and elevating, you should start to move forward again.