Knee Infection* My L T K R Diary 2020

[Lindylee]

I'm glad Jamie has suggested lymphatic drainage. I was thinking of it, but didn't know if it would be appropriate.

I think you're wise to delay further PT. You might find it's cancelled anyway. Mine has been and the hospital website says they're cancelling as many outpatient appointments as possible because of the virus, will conduct telephone appointments where appropriate and only seeing patients when it's really necessary. Hopefully plenty of rest and icing will help that swelling.

 

[Defender]

Many thanks for the replys
All I have been doing is elevating and icing 4 times a day.
I haven't been doing any exercises just waking as necessary because of the swelling.
My physio is at the same hostpital where my op was done it's a private hostpital which is one good thing as they are less likely to cancel.
What does lymphatic drainage involve and who would do this.
My knee feels warm but not that hot

 

[sistersinhim]

Some of us just swell worse than others. Your OS might have had to do more work on this knee so it's taking longer to heal it. I iced and elevated for hours at a time and the whole time I was in bed.

 

[Lindylee]

Lymphatic drainage can be various techniques, but usually some form of massage is part of it. You should ensure it's someone properly qualified to perform it for medical reasons.

I can't remember the initials they should have after their names, but they should be a qualified LMD therapist. The British Lymphology Society has a directory on its website or you could call Manual Lymphatic Drainage UK. Alternatively your private hospital might be able to put you in touch with someone. If you have medical insurance not all policies will cover it.

 

[Defender]

I doubt my physiotherapist knows how to dodo lymphatic drainage or even heard of lt.
He is too young I have no confidence in him.
After seeing how swollen my knee was on my last visit which was 2 weeks ago he wouldn't have given my those exercises.

 

[Lindylee]

You do seem to have started physio early. Apart from the basic exercises I was given when discharged I had assessments at 2, 4 and 6 weeks and was given advice and stretches to do at home, but didn't start formal physio until week 7.

I was talking to the physio who did 2 of my assessments and he said one of the problems is that they often have no idea how the patient was prior to surgery or exactly what the surgery entailed. All they are told is that it is a knee replacement and there can be a vast difference in the work that's carried out. He was far more understanding of my issues when I explained I had been knock kneed and that most of my wear and tear had been on the patella where I'd been told 3 years ago that there was no cartilage at all. Maybe there needs to be better or clearer communication between the different departments?

 

[Defender]

You do seem to have started physio early. Apart from the basic exercises I was given when discharged I had assessments at 2, 4 and 6 weeks and was given advice and stretches to do at home, but didn't start formal physio until week 7.

I was talking to the physio who did 2 of my assessments and he said one of the problems is that they often have no idea how the patient was prior to surgery or exactly what the surgery entailed. All they are told is that it is a knee replacement and there can be a vast difference in the work that's carried out. He was far more understanding of my issues when I explained I had been knock kneed and that most of my wear and tear had been on the patella where I'd been told 3 years ago that there was no cartilage at all. Maybe there needs to be better or clearer communication between the different departments?

Yes I believe they have a set of rules they go by and everyone who has a knee replacement is given exactly the same exercises.
My biggest problem now is when I try to bend my knee it feels like it's in a clamp.
Still very swollen and so tight.
At 5 weeks I would have hoped that the swelling would start to ease.
I have an appointment for Tuesday so am going to call them Monday to explain that any more expensive physio is only making it worse.

 

[loneshark64]

You are getting good advice on here. I am 8 weeks out and doing well. I would just reinforce the feedback you have received that (1) it won’t bend if there is a lot of fluid/swelling in there (2) activity, while necessary, can cause swelling, (3) ice reduces swelling, (4) days off reduces swelling.

I had a setback at 4 weeks and told my PT I wasn’t coming back until I felt like it. I went back after a week when it felt better and told them I thought I was good to go and they signed off and I am done. Now I do my own at home. Some days (yesterday) I do a little more and it tightens up and other days (today) I do very little and it calms down. Overall I experience very small average improvement each week but it is hard to see day to day. I am better since I forced myself to stop thinking about it every minute of the day but sometimes I fail at that.

 

[CricketHip]

Hi @Defender A Lymphatic Drainage session is a very gentle modality and can be very effective, especially since you are now at 5 weeks plus, post op.

The interesting thing with a MLD session is that usually the therapist begins by working on your neck and abdominal area, as the majority of our lymph nodes are located there. Lightly stimulating them will create a 'drawing' effect for your leg-then when the fluid is gently moved from around your knee it will more readily be assimilated into your system and left behind in the bathroom.

Sometimes, you can kick start some of this yourself with practicing some deep diaphragmatic breathing and I can leave you some directions in how to help ease that tight swelling.

A full session with a certified MLD or complete decongestive therapist is the most ideal option, but maybe this will help.
******

****
Take deep breaths.. deep, as in breathing in to a count of 3 or 4, whatever is best for you. hold it for another count of 3-4, then blow out completely, still using the count that's comfortable for you. A series of at least 6 of these could help get your 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.

Then, as you slowly breath out, to the same count of either 3, 4 or 5 gently press down and slightly upwards with the palm of your hand.
Do this whenever you feel up to it during the day or night. The more supine that you can get in the recliner or bed, the more effective this can be.. you have lymph nodes located in your groin and sitting up too much can cause a restriction of the lymph flow.

You can, after the breathing, place your hands lightly on your upper thigh, right where the crease is in your groin and lightly stroke upwards towards your naval.
I did this quite a bit post op and while it takes a while for the body to wake up and respond, it will and it will help get things moving.
The reason this can help is because our lymphatic system doesn't use our cardiovascular system to help lymph fluids move.. no assistance from the heart pumping. Our breathing and our physical (muscular) movements keep it flowing.
****

 

[Defender]

Thanks Loneshark64.​

Yes the advice I get on here does help a lot
When I had my other knee replacement in 2018 I didn't do much excercise just walking around as necessary with a stick.
It was swollen probably not quite as much as this one but I could see an improvement week by week.
But with this one I just seem to have got to a point where it's as though nothing is improving which is so frustrating.

 

[Defender]

Here is a side view taken this morning.

 

[sistersinhim]

With that much swelling, you need to do as little activity as possible. Spend all the time you're not doing your necessary daily activities icing and elevating. Make sure you ice the whole time you are down and have a cloth between your knee and the ice pack. You can also ice the back of the knee. Are you elevating high enough?

Try CricketHip's suggestions on massaging and getting that fluid moving.

 

[Lindylee]

That does look swollen and inflamed.

 

[Defender]

That does look swollen and inflamed.

Yes and the physiotherapist looked at how swollen it was he even compared it to my other knee yet he still went ahead to giving me exercises.
At one point he got me sitting on a chair got me to get as much bend as possible while he kept pushing his foot against mine.
As I said I have another appointment Tuesday and I am not allowing any excercises.
It's going to be an interesting session I have no confidence with my physiotherapist.

 

[Lovablenut]

That's such a shame, Defender. I think my husband has been very fortunate given his PT - she's not in any hurry to hasten the pace and us very careful not to push things beyond what he's comfortable with.

I hope the swelling eases for you and good wishes for Tuesday.

 

[_Annie_]

When I was in the hospital for my TKR, a nurse told me to elevate and ice as much as I can, just keep something between my skin and ice pad. She said I can ice day and night and it will really help with the pain. I was all about avoiding pain. So that’s what I did. The hospital gave a complimentary Breg’s Ice Machine when I went home, a real treasure! I had very little pain. With the Breg, it’s very easy to ice. We freeze water bottles (room for 4 at a time) so freeze 8. We also throw in some ice too, it stays cold almost all night or all day.

 

[sistersinhim]

Yes and the physiotherapist looked at how swollen it was he even compared it to my other knee yet he still went ahead to giving me exercises.
At one point he got me sitting on a chair got me to get as much bend as possible while he kept pushing his foot against mine.
As I said I have another appointment Tuesday and I am not allowing any exercises.

Never let anyone push your leg or foot. All this does is cause more swelling and pain. Find a different therapist. This one does not know how to rehab a joint replacement and is setting your recovery back. You need to stay home until that swelling goes down.

 

[Defender]

Yes and the physiotherapist looked at how swollen it was he even compared it to my other knee yet he still went ahead to giving me exercises.
At one point he got me sitting on a chair got me to get as much bend as possible while he kept pushing his foot against mine.
As I said I have another appointment Tuesday and I am not allowing any exercises.

Never let anyone push your leg or foot. All this does is cause more swelling and pain. Find a different therapist. This one does not know how to rehab a joint replacement and is setting your recovery back. You need to stay home until that swelling goes down.

Thanks don't worry he won't be having anything to do with my physio.
I think I should call them in the morning ahead of my appointment Tuesday
The physiotherapists are at the same hostpital that done my replacement and you are automatically given dates to attend.
But as I said in my previous posts they took me out of the group sessions and put me on a one to one.
When I asked why they said I was behind the others and would get more time dedicated to me.
Pity I got put with a young physiotherapist who obviously needs a lot more training in dealing with knee replacements.

 

[Celle]

Yes and the physiotherapist looked at how swollen it was he even compared it to my other knee yet he still went ahead to giving me exercises.
At one point he got me sitting on a chair got me to get as much bend as possible while he kept pushing his foot against mine.
As I said I have another appointment Tuesday and I am not allowing any exercises.
It's going to be an interesting session I have no confidence with my physiotherapist.

@Defender - While your knee is so swollen, there's no point at all in even going to PT. The swelling is physically preventing your knee from bending and your young therapist obviously doesn't understand that, so he is the wrong therapist for your knee.

Stop all PT for now, until your swelling is almost gone. your knee will still get exercise as you walk around your house.

In case you think you aren't allowed to stop PT, read these articles:
Saying no to therapy - am I allowed to?
CONSENT: what it means and how it can be used

Instead of going to PT or doing any exercises, spend as much time as you can resting, icing and elevating your knee.

Check that you're doing things correctly, by re-reading these articles:
Elevation: the do's and dont's
Ice to control pain and swelling

 

[Jewlz1]

Oh Defender-I'm so sorry you're dealing with such swelling. Are you bruised or are you inflamed?
Keeping positive thoughts for you!