TKR New knee newbie<<

[chicklet]

I think it’s only human to compare ourselves to others even when we know we shouldn’t.

I think I have some kind of quad issue going on, not sure. It could be my IT band. My knowledge of knee anatomy is not the best. My ROM is okay, and I can do a straight leg lift, but I still can just barely (and painfully!) do a bent leg lift (where you start lying flat, leg bent at the knee, foot flat on bed). I can’t do it any better if I have a bolster under my knee. Not that I do any kind of leg lift often, but I do try the bent lift every now and then to see if it has improved. I am considering some massage therapy to see if that will help. I mostly am just giving it more time.

I have found that when I let fear creep in, things go from bad to worse. Fear can drain me mentally. It can be paralyzing. But this I know to be true: it’s almost never as bad as I feared it would be. For me, it really is true that “the only thing we have to fear is fear itself.” It’s not the actual circumstance thats so bad, it’s the fear and worry about it beforehand!

 

[Jockette]

All through my recovery I tried to figure out what this was, what that was, should I try this, or that...

Time is what we need most!

Time to recover.
Time for pain and swelling to settle,
and Time to heal.

Our range of motion is right there all
along just waiting for that to happen.

Here’s what one of our members said:

One of our members, Bertschb, kept a record of his ROM process. He agreed for us to post it for those of you that are afraid you're stuck. The key is to have patience! Bertschb says:

“ I'm 12 months out from my surgery and have some advice based on my experience:
1- Stop going to PT (all it will do is make your knee swell and reduce ROM)
2- Don't worry about your ROM
3- Be patient - VERY patient!!!

Here is my ROM history (more or less):
1 month - 60 degrees
2 months - 80 degrees
3 months - 85 degrees
4 months - 90 degrees
5 months - 90 degrees
6 months - 110 degrees
7 months - 120 degrees
8 months - 125 degrees
9 months - 130 degrees
10 months - 135 degrees
11 months - 140 degrees
12 months - 140 degrees

I spent waaaaay too much time worrying about ROM. I thought I'd be riding my bike a couple months after surgery but it took SIX months! Looking back on my surgery, if I knew then what I know now, I wouldn't have wasted my time with PT and I wouldn't have worried about ROM “

Bert is right!

 

[MJ61]

So last Saturday I went to visit friends. I tried to spend most of my time sitting with my leg on the couch, but the small visit turned into a 7hr one. When I got up on Sunday morning my knee was really swollen it was hard to walk and the pain was bad. So I stayed off my feet and iced. I couldn't do any of my exercises because I just couldn't bend my leg. This morning it's just as bad. This is a set back I wasn't counting on. It's like I lost everything (what little I had) Did I over do???

 

[lovetocookandsew]

Welcome to the ODIC-and don't come back! You did overdo, and your knee is announcing it loudly and clearly. You'll get back to where you were as long as you keep up the I&E. I posted before and after pictures last night of my knee swollen, red and hurting on Friday and back to where it was by Sunday after a lot of I&E. Check it out on my thread.

 

[Josephine]

Well, you're only 8 weeks out so I'm going to ask you my questions again because I rather feel there is more going on here than you've said. Hope that's okay

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. And don't forget to factor in other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness).

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. are you doing any exercises at home? If so what 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 you do each day
- enter exercise by name then number of repetitions of each
etc., etc.

Anything done at PT
- how many times a week
- enter exercise by name then number of repetitions of each
etc., etc.

 

[MJ61]

No problem
1. what are your pain levels right now?
I'm back on the pain meds so with them I'm sitting at 5 when they wear off it goes to 7.

2. what pain medications have you been prescribed
Norco/ Acetamin 5-325mg every 8hrs but I usually take them at the 11hr mark that's when the pain kicks in.

3. how swollen is your leg compared to these?
I would say moderate but it feels like I have a ace bandage wrapped tightly around my leg all the time.

4. what is your ROM
As of 2wks ago it was 73. I'll get measured again on the 25th before my Dr apt.

5. are you icing your knee at all?
Yes several times a day for about an hour

6. are you elevating your leg
I do when in bed at night, but the only place I have to sit other than that is my reclining couch. I know that's a no no but that's the only place to sit. My dinning chairs I can only sit in for 10min before my back starts to hurt. I do have one of those Dr Lounges leg raiser coming soon.

7. what is your activity level
I try and get up every few hrs to walk. I'm using my cane which gives me a little more freedom to get around. I have done some dishes, used a Swiffer on the floor and dusting that I don't have to bend to far over. I can fix my breakfast & lunch. Shopping I just don't have the energy to do that.

8. are you doing any exercises at home?
Yes I try and do exercises x2 a day but sometimes its only x1.
I have PT x2 a week and depending on how I feel I might do exercises x1 on those days. Most of the time I don't.

recumbent bike to go around as far as my knee will allow 5min.
stretch calf hold 30sec 3x.
wall slides hold 15sec, 5x
lay down and dangle right leg off bed letting gravity work hold 30sec 3x
tighten thigh muscle hold 5sec 10x 3sets
place rolled towel under ankle try and push knee down hold 1min 3x
place rolled towel under knee try and lift leg 6inches. 10x 1set
Lay flat, hold leg in air, try and bend letting gravity work. My husband holds my heel so it doesn't fall fast.
Heel slides 10x 3sets

I think that's all.

My quad is kinda working the muscle is starting to feel like its being worked but only aches when I try and use it. No hurt, it feels like it's getting used. I know the Dr will probable recommend an MUA at the next visit unless I improve a lot. I haven't decided if I will go that way, all depends on my ROM. Right now I think I'm stuck. I need to go back to work on Aug 15 but as of right now I can't drive.

I also need to be off pain med's.

 

[Josephine]

I'm back on the pain meds so with them I'm sitting at 5 when they wear off it goes to 7.

Ikay

Norco/ Acetamin 5-325mg every 8hrs but I usually take them at the 11hr mark that's when the pain kicks in.

What made you take them even at 8hrs? For sure that's not how it is prescribed. They are usually at 4-6hrly intervals. At only 8 weeks and with the pain scores you've declared, you do need to be taking them that frequently. Certainly don't leave it till 11hrs when 'the pain kicks in'. Very bad way to take them! Did you read the articles left you in the second post of this thread? There was this one which is very pertinent to this point Pain management and the pain chart. You will note there that the way to good pain management is to pre-empt the pain by taking the meds on a schedule rather than waiting for it to 'kick in'.

I would say moderate but it feels like I have a ace bandage wrapped tightly around my leg all the time.

Yes, and that is a form of pain - did you understand that? So I trust you factored that in to your pain score because if you didn't, then I would imagine it is actually 7-9. You did notice my footnote that other forms of pain include soreness, burning, stabbing, throbbing, aching, swelling and stiffness

As of 2 wks ago it was 73. I'll get measured again on the 25th before my Dr apt.

I would imagine that much of that is due to swelling, pain and stiffness.

Yes icing several times a day for about an hour

Okay

I do elevate when in bed at night, but the only place I have to sit other than that is my recliner couch. I know that's a no-no but that's the only place to sit. My dinning chairs I can only sit in for 10min before my back starts to hurt. I do have one of those Lounge Doctor leg raiser coming soon.

Who told you it was a no-no? I spent night and day in my recliner for both knees for about 12 weeks and it was fine. I did add a cushion not unlike the Lounge Doctor though.

I try and get up every few hrs to walk. I'm using my cane which gives me a little more freedom to get around. I have done some dishes, used a Swiffer on the floor and dusting that I don't have to bend to far over. I can fix my breakfast & lunch. Shopping I just don't have the energy to do that.

Well, not too bad but don't be in too much of a hurry for the shopping though! When you go back and read those recovery articles, you will also notice this one was amongst them Activity progression for TKRs

Yes I try and do exercises x2 a day but sometimes its only x1.
I have PT x2 a week and depending on how I feel I might do exercises x1 on those days. Most of the time I don't.

Well, don't try and do them daily!

recumbent bike to go around as far as my knee will allow 5min - okay
stretch calf hold 30sec 3x - okay
wall slides hold 15sec, 5x - never liked wall slides, they are punishing on the quads
lay down and dangle right leg off bed letting gravity work hold 30sec 3x - these are similarly punishing
tighten thigh muscle hold 5sec 10x 3 - okay but only 5 times
place rolled towel under ankle try and push knee down hold 1min 3x - that's not a good thing to do
place rolled towel under knee try and lift leg 6inches. 10x 1set - this is a half leg lift and only necessary if you are unable to do a full leg lift
Lay flat, hold leg in air, try and bend letting gravity work. My husband holds my heel so it doesn't fall fast - this is a full leg lift and good idea getting hubby to help! However, once you can do these, you really don't need to do them any more!
Heel slides 10x 3sets - heel slides are an easy thing to do badly and this is badly! Read this Heel slides and how to do them properly. (This is in among the recovery articles btw!)

In summary,
1. please apply these recommendations to your PT sessions. In fact, you'd be better of not doing them at all!
2. note the recommendation about pain meds

I'd be interested to know what your ROM is when you get it checked. Do ask the doctor for the extension as well as the flexion.

 

[kneeper]

Sounds like your knee is protesting after that long visit. A few days of doing nothing much but icing and elevating should help.

When I did something similar at about 4 weeks in, having a long visit with my leg down and my knee swelling increased, I had to ice and elevate a lot more for than usual for a few days. As your knee swells it's hard to bend. So I'd say for now, focus on the swelling and don't worry if you're not doing all the "official" exercises.

 

[MJ61]

@Josephine
The 8hrs for the Norco was the way it was prescribed to me by my Dr. I thought the reclilner was a no no when I looked at the "how to elevate you let article. Maybe I misunderstood it.

Do ask the doctor for the extension as well as the flexion.

Not sure what that is?? if your asking with a straight leg what that degree is. It was a 3 my last visit. The leg lift I do and then try and bend my knee using gravity, I can't get the leg straight up by myself my husband has to help. But once its there I can hold it straight up myself.

On a side note today I had a bit of a scare. I had my hands on my knee and I noticed it felt warm to the touch so I felt my other knee it was cool. I called my Dr to ask about it and he wanted me to take a picture of my knee and send it to him then go get blood work done and made an appointment for tomorrow. They also ask if I was running a fever, I was not. I sent him the picture and he came back with it looked fine.

I got my blood work done at my local hospital (they are faster with the results) and got a call a few hrs later. He looked it over and found everything to be fine, but to keep an eye on my temp and if it goes up to call immediately. The only thing I can think of is after I ice my leg the blood rushes back in to warm it up. Just a guess I know very little about how the body works.

 

[Ellie@0318]

I am also around 8 weeks out and my knee gets red and warm many times during the day off and on. Sometimes when I’m resting and other times when I’ve been busy. I really don’t know why it gets so warm but i assume it’s part of the healing process. I just tell myself that my knee is letting me know it’s time to elevate and ice. I’m glad you didn’t have anything to worry about with your knee after contacting the doctor.

 

[sistersinhim]

A warm knee is nothing to worry about. It's a sign that it's healing! Mine was warmer than the other one at least 9-12 months.

 

[Josephine]

Do ask the doctor for the extension as well as the flexion.

Sorry, I forget that there are lots of people who don't understand all this medical jargon! You can read about it in here ROM (range of motion) information

 

[MJ61]

Tho I don't see my Dr til Wed. I'm pretty sure he'll recomend a MUA. No matter how hard I try my ROM just isn't happening.
My question is how long is the recovery for a MUA? Are we talking weeks? Do most Dr put you back on the CPM machine? I'm suppose to return to work Aug 15 I'm a Classroom Aid in 1st grade for only 1.5hrs a day I sit and walk around very little. Hoping I can go back the first day of school. I love my kids.

 

[Desertgal]

I had one at 6 weeks. Although it was not successful in helping with the ROM, it was a very short recovery. No pain, no additional discomfort. Just a day or 2 to let the anastisia get out of my system.

 

[sistersinhim]

What is your ROM? You have the right to say no to one, too. You said you are working hard at trying to increase your bend. That is probably your problem. By working hard, you are keeping your knee swollen and inflamed. Even if you don't see outside swelling, you're still having inside swelling. That swelling restricts movement and bend. You have to get the fluid out to be able to bend well. Why not stop working hard trying to bend and just use your knee as you normally would. Add to that lots of icing and elevating. That helps to reduce swelling, too.

 

[Sweettader]

MJ61 - Keep your chin up. The people on this board are wonderful and it really helped me reading the threads and experiences of others. The advise of listening to your knee and giving it time is golden!! Your knee will tell you when it is tired and needs to rest. It will heal it does take time. I was trying to rush things in the beginning and got really depressed when I could not do everything I thought I should be doing. Reading these posts helped me to realize I needed to slow down, listen to my body, and heal. Now I do as much as I can comfortably. When I am tired or over do, I rest. Healing is taking place and I can feel it every day. So I smile and keep positive. You CAN DO THIS!!!

 

[lovetocookandsew]

No matter how hard I try my ROM just isn't happening

I think you have the answer to your "ROM problem". Although at not quite two months, I don't think you should be worrying so much about that yet. You're still in early days and even if you don't see much swelling on the outside, you still have swelling on the inside, which is why your knee won't bend well yet. I'd not even consider an MUA this early on. IMHO, patients, surgeons and PTs are way too impatient to see results right away, and push too much to get them, to the patient's detriment. Patience is a virtue, and much needed with this surgery.

As for work, you'll be nearly three months by then, and may be able to make that date. But, an MUA would set you back some, and may not even help. If you spend a lot of time icing that knee, and keeping it elevated, instead of trying to force it to bend, you'll be doing what that knee needs, and it will thank you for it.

 

[MJ61]

I went to PT today and she check my ROM for me I was at 73 at 2½ weeks ago. Now I'm at 70. She did tell me my muscles are very tight and to try and massage them. I know about the icing and swelling but nothing right now seems to help. I'll see what the Dr says on Wed.

 

[kneeper]

It may or may not help your bend to massage your muscles but it should feel good. I had tight muscles too. My PT showed me some gentle stretches.

 

[MJ61]

Actually my Pt told me yesterday to maybe start massage my muscles. They are really tight.