TKR My Recent TKR

[Snoosie]

@Slugger I, too, had the same expectation wanting aggressive PT (after a poor ROM and OS berating me one year after surgery for a previous knee injury - one of 3). Post TKR surgery complications but finally started PT at wk 3. I was aggressive. Four weeks of lunges, squats, hamstring weight machine, bike, stepper, treadmill and manipulation. Swelling and excruciating pain resulted, gradually lost ROM and general daily function and ended up with knee buckling and incredible muscle contractions across my knee. End of wk 7, physiotherapist told me to stop PT for 10-14 days to let things settle. Three wks later, no PT and gained flexion and daily function. My OS said no PT needed, use recumbent bike with little or no resistance, bend and stretch only to uncomfortable, but remain active through walking and use the knee in daily tasks. I now see the wisdom in this BoneSmart approach. My mind will always play games with this approach, but I am determined to stick with it.
Much to consider what is right for you. I wish you well.

 

[Beckadeez]

At my 4 week appointment, I had flexion of 115. No PT and no exercises of any kind.

 

[Slugger]

I aapreciate the feedback @Snoosie. I'm very happy with the way my PT is going. I feel Iam progressing well. I seem to get a lot of comments about the BoneSmart approach, but like I said previously, my OS, my PT, and I are all on the same page.

Im glad yours worked out for you.

 

[sistersinhim]

What you should do is what's working for you. You seem to be happy with it and aren't suffering too much. But, what's working for you is what the average person finds sets them back.

 

[Jamie]

1. Often when going to sleep I'll have knee jerks in my TKR leg which will give me a little pain. These seem to happen just as I fall asleep. I wonder if this is a side affect of the Oxy pain meds. Does anyone else experience this?

Slugger, those spasms are sometimes present in recovery and are not a side effect of medications. Your nerves were very traumatized in surgery and it can take a while for everything to settle. They also can come as a result of overdoing things, which is why you might tend to get them at the end of the day. They should go away with some time.

2. I often have involuntary muscle spasms in my foot of my TKR leg. Not painful, but often and annoying.

I'm thinking these could be similar to muscle cramps and will increase my potassium intake to see if that helps. Appreciate any feedback.

Same answer for this concern as well. It's just part of the recovery process for some people.

Im sitting here on the cpm machine set at 110º as I write this. I dont think 120º is that far off in the future.

Please know that the measurements on a CPM are not the same as the ROM measurements done when you're bending your knee on your own. So even though the machine is set to 110, you probably are not really at that point quite yet. Better than concentrating on numbers, try to focus on functionality of your knee. What can you do this week that you couldn't last week. It's a much better way to measure progress as even your therapist might make different measurements on different days.

Yesterday I got a pep talk from another patient. He was in his 70's. had his TKR the day after mine. He was moving better and had more ROM. He was telling me what he was doing in addition to PT.

Pep talks are good, but try not to compare your recovery with anyone else's. Yours is unique to you and based on many, many factors which may or may not be part of someone else's history.

What are others experience with TED hose?

Generally TED hose are not needed once a person is up and around on a daily basis. Compression is sometimes used to help with swelling, so I'm wondering if your surgeon saw swelling in your leg or he was anticipating it because of that aggressive therapy you both are pursuing. Wear them if you want, but you're not going to hurt your new knee if you don't. Unless you have some other medical issue, you should not be at risk for a blood clot.

 

[Slugger]

@Jamie , thank you for taking the time to respond to my questions.

You maybe right concerning my knee jerks and muscle spasms. I forgot to ask my OS last Friday but probably because the frequency and severity of these have lessened.

I understand the CPM machine setting a nd my actual measured ROM are two different things. My point was/is that I am continuing to make progress and feel i will reach 120 measured ROM in the not to distant future.

I understand not to compare TKR recoveries. Each recovery is different even on different knees for the same patient!. My point was that this gentleman was encouraging to me. He was not bragging or saying "look what I can do". He was encouraging me and sharing what worked for him and I thanked him for it. That's really the purpose of this forum right? To encourage each other and share experiences.

Thanks for the feedback on the TED hose. I have no previous experience with these. I do have some swelling in my left knee but not as bad as I thought it would be. Since my previous surgeries my left knee has always been bigger than my right and in last couple years would swell up with any level of walking so seeing my left knee swelled up a little seems "normal". I will revisit this with my OS. The TED hose on my left leg causes me more pain than when i have it off.

Finally, you say that all are free to express themselves. However I feel that it is continually pointed out to me that the approach I am taking for PT is not the Bonesmart generally accepted approach. That's fine. Each recovery is different right? But I don't need to be continually reminded as if what I'm doing is wrong. I am happy with the approach that my OS and PT have taken. Frankly, I'm going to trust an educated and trained OS who has 1000s of TKR and recovery experience and a PT who has 100s of TKR recovery experience. Know that it is not blind trust. If something doesn't feel right, i will call them out on it. I am a egineer and manage $100 million+ construction projects but I don't know beans about TKR. I will trust the experts.

After my QTR injury and surgery, I found a forum specific to that injury that was so helpful. I feel the mental side of these recoveries is as important as the physical side. That forum was a vital piece of me keeping a positive mental attitude. I am hoping for the same in this forum.

I'm not expecting a reply to this although I'm sure I will get a few. I really do appreciate the responses to my questions. They have been helpful and giving me food for thought. However, I don't need reminded that I am being too agressive with PT. I get it. We disagree. As I am still early in this recovery things may yet go bad, you can say I told you so.

 

[MSgirl]

@Slugger, you and I seem to be in the minority here. Maybe we just don't mind speaking up. Like your OS, my doctor recommended PT. I agree that we have to trust our doctors. Why else would I have chosen him to operate on me? Mine has also done several thousand knees and knows a lot more about knee recovery than I ever will. Because of his skills, I have always had a positive attitude with an expectation that the surgeries would be a success.

I followed through with his recommendation last year on knee #1. My result was extremely good. It wasn't all roses, and I did have some aches and pains but not so much that I needed pain meds, etc. I made great progress and was discharged with a flexion of 127. After beginning a walking program, 9 months after surgery, my flexion was 145. My knee was back to what it was 15 years ago. Aches now and then but no biggie. I'm not 25 years old.

Knee #2 was done 1/16 of this year. Once again, I had home PT for the first two weeks, then started outpatient PT on week 3. I was off narcotics and drove myself. I am going to the same place I went last year that gave me so much help. I had my first post-op Friday at six weeks and was measured at 135 flexion and 0 extension. He asked if I wanted to quit PT and I said no. I'm going to continue for awhile. And I continue to ice and elevate.

Were these numbers caused by my surgeon's skill or my PT? I don't know. Probably both. I do know that I wouldn't change a thing about what I have done. I respect my OS immensely and know that his patients all have similar outcomes to what I have had.

This forum has provided good suggestions to me. I've learned about supplies I'd never heard about for knee #1, such as the Lounge Doctor pillow and Chattanooga Colpacs. I've met some great people on here that I have enjoyed getting to know and admire. And I think it provides good support for those who are experiencing difficulties following surgery. I have had a problem with the constant preaching against PT. Just doing ADLs may be fine for some people. But it's not the only way. PT may be better than the Bonesmart way for some of us and shouldn't be discounted.

Good luck on your continued recovery. You have a great attitude and I know you will have a successful outcome!

 

[Jamie]

It sounds like you have your head on straight about all this recovery stuff. And I do mean it when I say that it's fine for you to talk about your experiences even if they aren't an approach that fits a majority of our members.

But please know there will be a lot of members and guests reading your posts and, when we talk about things not being appropriate for everyone, it is more for those who are reading than for you directly. I cannot tell you how many times people will read of someone who pushes the exercises in recovery and think they can and should do the same even though their situation is totally different.

The real key here is what you recognize - that everyone heals differently. As long as your approach is working for you, go for it.

 

[MSgirl]

One thought. We all know that PT stands for physical therapy. It doesn't stand for painful therapy. Or aggressive therapy. It should simply be therapy to help strengthen weak muscles, loosen tight muscles, increase ROM, work on gait, balance, etc. A way to teach the patient to use muscles that haven't been engaged for a long time. We aren't training for a marathon here. A good therapist will do all of those things. Good physical therapy can hasten recovery. It is our responsibility to find that good therapist. If one is bad, just quit and find another.

 

[skigirl]

I don't think it is necessary to spend a lot of time comparing PT experiences. I am an athlete (ski instructor) and used to the gym. My PT was very gentle in the first 4 weeks---mostly table exercises---leg lifts, clam shells, etc. At four weeks we began strength training when my quad was fully functioning and my soft tissues were healed. I was in pt for 4 months and skied at 5 months.

Pt is personal based on your own physical condition and functioning. However, you cannot strengthen a leg that does not have a fully functioning quad muscle. Until your quad is awake and working, strengthening exercises are futile and thus questionable. Also, I think the idea to take extra pain meds before PT is a great way to injure your leg. I think that the scheduled pain meds were enough to keep the pain at bay. When I had pain, I realized i was doing too much ( and yes, I did do too much at times!!) I took the scheduled pain meds for three weeks and then started using Tramadol, mostly at night.

I do disagree with the "no pain no gain" approach of exercise in general---however, a certain amount of muscle pain is part of recovering from surgery. Muscle pain is different from joint pain and I think it is critical not to aggravate the joint. When your quads and hamstrings are not fully functioning, they do not give the joint as much support as when they are working. Therefore when you are weightbearing in the early weeks, your joint itself is doing more to support the leg. It is important not to stress the joint too much and thus cause yourself extra pain. That is why my PT did very little in the way of weight bearing exercises until week 4.

My PT is awesome and he was a great part of my recovery team. However, I was in charge of my recovery and decided with the PT how we would handle it.l I respected his position, but I also am very familiar with my own body!!! All Pts are not alike---my husband always reminded me that someone graduated at the bottom of the class in all professions!!