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[TKR] Need suggestions to improve knee extension ROM

Discussion in 'Knee Replacement Recovery Area' started by HappyCatTX, Mar 10, 2018.

  1. HappyCatTX

    HappyCatTX new member
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    Had surgery Monday, March 5. Things went very well (guess). Did not feel anything or was aware of anything. Glad for that. In the afternoon they got me out of bed to walk a few steps to the door of the hospital room. (In the hospital they provided every TKR patient with an “ice machine” to take home. Works very well. Is like a cooler with ice, water, a pump and a hose that goes to an ice pad that you place over your knee.)

    Tuesday, day 2, some classes of exercises to do, a few walking trips around the hospital floor and discharged to go home. My support group drove me home. I was able to seat in the car passenger seat. (No need for an ambulance or large car! – Suggestion 1)

    Once discharged from the hospital they gave me a written prescription for the occi’s, the pain medication pills. Had to take to the pharmacy that works with my insurance, but they were out of stock and I was not going to wait for a couple of days. Therefore, started hunting for other pharmacies that could fulfill the prescription. That took time, and the pain went up, UP. (Before you leave the hospital with a prescription, suggest you call your pharmacy to be sure they have it. – Suggestion 2)

    Wednesday, day 3, at home. They called to arrange for PT at home. They visited at home and completed the necessary paperwork to start PT next day. (Subject to insurance approval.) In the hospital they mentioned the occi’s are opioids and can produce constipation. They gave some stuff at the hospital and at home they suggested to drink prune juice, which I did.

    Thursday, day 4, at home. Started PT. But that thing about constipation is very true. Wish I would have taken more prune juice and other stuff. Therefore, be ready for when it strikes. (Prepare for constipation – Suggestion 3).

    Friday, day 5, at home. Second day of light PT. But at the end of the day swelling was getting very bad. They say ice, elevate and rest. But how can I elevate if they say don’t put a pillow or something under the knee. Sitting in a recliner with ice machine and ice pads didn’t help. Swelling getting work and worst. Finally figure out how to elevate the legs with cushions and wedges while laying down at bed and not in a recliner seat. Therefore, figure out how to elevate and get Very strong suggestion 4)

    Saturday, day 6, at home. Swelling went down, but still some stiffness and pain from previous day swelling. Things going fine so far. Missed how to proper elevate the knees to prevent the swelling and pain. Hope these suggestions will help you.

    In short suggest you read the Elevation: the do's and dont's in BoneSmart website.
     
  2. MSgirl

    MSgirl senior

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    @HappyCatTX, congratulations on having your surgery done. Some of the moderators will be along to help you with suggestions. I'll give you a couple of mine. First. About constipation: it is bad and can get a lot worse if you don't address it quickly! I didn't on knee #1 and needed a visit from home health. For knee #2 in January, I started taking Miralax as soon as I got home. Also took the stool softener (colace) my dr. recommended and ate prunes. And also at as much fiber as I could. Although "things" slowed down, I didn't have nearly as much trouble.

    After reading Bonesmart, I learned about the Lounge Doctor pillow. Never heard of it. I searched and found one online for around $85.00. Not cheap at all but has probably ended up costing me around 1/4th of a cent/use. I am on it every time I sit down. It just feels so good. I lay down a hand towel on it, put my Chattanooga Colpac on top, lay another thin towel to prevent frostbite on that followed by my knee, then wrap the hand towel around all of it. Bliss! The pillow keeps your legs and toes up high enough to help with the swelling. And I still have room for my laptop on my lap.

    Good luck! You are on the way!
     
  3. Celle

    Celle FORUM ADVISOR Forum Advisor

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    Hello @HappyCatTX - and :welome: to recovery.

    It sounds as if things are going well for you.
    When they say don't put a pillow under the knee, they mean don't put one behind the bend of your knee. It's OK to elevate using pillows - you'll see how if you read the article in the reading list, below:
    Knee Recovery: The Guidelines
    1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now; they are almost certainly temporary
    2. Control discomfort:
    rest
    elevate
    ice
    take your pain meds by prescription schedule (not when pain starts!)
    don't overwork.
    3. Do what you want to do BUT
    a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you
    b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.​
    4. PT or exercise can be useful BUT take note of these
    5. Here is a week-by-week guide for Activity progression for TKRs


    The Recovery articles:
    The importance of managing pain after a TKR and the pain chart
    Swollen and stiff knee: what causes it?

    Energy drain for TKRs
    Elevation is the key

    Ice to control pain and swelling
    Heel slides and how to do them properly

    Chart representation of TKR recovery
    Healing: how long does it take?

    Post op blues is a reality - be prepared for it
    Sleep deprivation is pretty much inevitable - but what causes it?

    There are also some cautionary articles here
    Myth busting: no pain, no gain
    Myth busting: the "window of opportunity" in TKR
    Myth busting: on getting addicted to pain meds

    Please don't be overwhelmed by the list. The articles are not long and they and contain information that will answer many questions and help you make your recovery much easier on your knee and on you.

    We are here to help in any way we can: answering questions and concerns; supporting and encouraging you from start to finish.

    We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery. While members may create as many threads as they like in a majority of BoneSmart's forums, we ask that each member have only one recovery thread. This policy makes it easier to go back and review history before providing advice.
     
  4. JG464

    JG464 junior member

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    Congratulations on your surgery! I had mine done on same day! Your suggestions are spot on! Still waiting for miralax and Colace to kick in. Ususing wslker but have s severe pain in one hip which is making things harder. I have same ice machine and think it is helpful. Am facing my biggest fear and that is steps. Guess sooner or later I will really need a shower or sleep in my bed!!! I see the mechanics behind it but my brain dies not want to process!
     
  5. HappyCatTX

    HappyCatTX new member
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    Monday, day 8. After applying elevation, ice, meds, rest, the swelling went down on Saturday. But today missed elevation for a long time and swelling came back. So back again to elevation, ice, med, rest. It really helps with the swelling a pain. This is a very good suggestion from BoneSmart.org
     
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  6. sistersinhim

    sistersinhim FORUM ADVISOR Forum Advisor

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    Oh yes, the icing and elevating is a tried and true thing on this recovery!
     
  7. katchmo

    katchmo member

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    It took me six weeks to get an elevation wedge I could use. Like you I was told not to use pillows (WHY?) After 3 weeks of misery I found bonesmart and ordered a lounge doctor which took a week to get here. But it just didn't work for me and I couldn't get to the PO to return. Hubby finally returned it and it took a week to be returned and credited. Then I ordered a Milliard, it finally got here last week and it is perfect. So finally, at 7 weeks post op, I am elevating like I should and it is great!
     
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  8. Beckadeez

    Beckadeez senior

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    I was told not to use pillows under the bend of my knee for a while, as it can cause the tendons and ligaments to tighten. I do it now, with no ill effects.
     
  9. SusieShoes

    SusieShoes FORUM ADVISOR Forum Advisor

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    Elevation, and lots of it, is one of the three cornerstones of TKR recovery, at least in my book. I think I elevated 90% of the time for the first two months of my recovery. Yes, I slept with my legs up. :umm: Anyway, it really helped!
     
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  10. HappyCatTX

    HappyCatTX new member
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    :wave:A month after surgery everything going very well. Pain level is around 1, still in physical therapy, trying to regain ROM, but things went very well and fast. Plan to visit the doctor in 4 weeks and plan for the next TKR. In short, not all is bad after surgery. Glad I had the TKR, also this website helped a lot with their advice elevate, ice, meds and rest. Good luck to all of you.
     
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  11. SusieShoes

    SusieShoes FORUM ADVISOR Forum Advisor

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    Great to hear from you! Glad to hear you’re happy with your new knee. At one month out from surgery, not everyone is there yet. And you’re planning to replace the other, too! (It’s pretty amazing to have two brand new good knees.)
     
  12. kayow11

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    I am kind of an old pro with this knee stuff. Had 2 TKRs and 1 revision in the past 9 months.

    For constipation, I found that eating beans (i.e. Kidney, black, pinto etc. ). two times a day really really helped with the fiber intake. Also, they have a lot of nutrients. One half cup or a little more seemed sufficient.

    Some of those other remedies such as Senna, or Colace, caused me to have some leaking and messy stuff. The beans kept things moving at least. I have to use a digestive enzyme first before eating them, so I don't have other problems.
     
  13. HappyCatTX

    HappyCatTX new member
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    Need suggestions to improve knee extension ROM after TKR. Bending (flextion) is good, but the extension part is progressing slowly. How long should it take to get knee straight (0 deg) ?
     
  14. Celle

    Celle FORUM ADVISOR Forum Advisor

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    Hi @HappyCatTX
    You'll notice that I have merged your newest thread with your original recovery thread.
    For several reasons, we prefer that you only have one recovery thread:
    • That way, we have all your information in one place. This makes it easier to go back and review your history before providing advice.
    • If you keep starting new threads, you miss the posts and advice others have left for you in the old threads, and some information may be unnecessarily repeated
    • Having only one thread will act as a diary of your progress that you can look back on.
    So please post any updates, questions or concerns about your recovery here.
    Don't worry that we won't see your question because, between us, the staff read all new posts every day.
    If you need an urgent response to a question, just tag a member of staff.
    How to tag another member; how to answer when someone tags you

    If you prefer a different thread title, just post what you want and we'll get it changed for you.

    Here are the instructions on finding your thread, How can I find my threads and posts? . Many members bookmark their thread, so they can find it when they log on.
     
  15. Celle

    Celle FORUM ADVISOR Forum Advisor

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    What is your ROM now- both flexion and extension?

    It's only 6 weeks since you had this major surgery and you have all the time in the world to get good ROM.
    There's no need to rush to get ROM because it can continue to improve for a year, or even much longer, after a knee replacement. There isn't any deadline you have to meet and there's no time by which you should achieve extension, or all is lost.
    Myth busting: the "window of opportunity" in TKR
    The "window of opportunity" is a hoary old myth that should have died long ago.

    It's not exercising that gets you your ROM - it's time. Time to recover, time for swelling and pain to settle, and time to heal. Your ROM is there right from the start, just waiting for all that to happen, so it can show itself.

    It's not at all unusual for extension to take longer to achieve than flexion. That's because you have large muscles and tendons at the back of your leg that have to be stretched slowly and gently. Try to do it too fast, and they will just shorten again, as elastic does when you've stretched it.

    Thus article does give some ideas about how to help with extension. Just choose a couple of exercises that you like, and do them a couple of times a day, only to discomfort, and never to the point of pain:
    Extension: how to estimate it and ways to improve it
    Walking is one of the best ways, especially if you lengthen your stride a bit.
     

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