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TKR New Left Knee . . . Check!!

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Just returned from PT a little bit ago, so I'm icing at the moment. I did ask him about the patella movement and he said that is really typical that there is not much vertical movement. He worked on that quite a bit for me today. He was much more hands on today than during the first session earlier in the week. But he was great in really watching my reaction and knowing how far to go. Much to my surprise--I really like him and am liking PT!

When I was getting ready to leave though, he did say that he would measure me again at the end of next week, and if I haven't made much of an improvement in flexion, he wants to talk to my OS about getting some kind of device that I would use about 4 hours a day. He said it's kind of like a brace of some kind that works on flexion. Wondering if it's the JAS device I've read about here or something similar. He mentioned a couple of names, but I didn't recognize any. Anyway, I told him that sounded like medieval torture and asked how much I would need to improve to avoid that. He said if I haven't gained at least 5 to 10 degrees then he wants me to try that. 10 degrees?? That seems like a lot to me! He does think that I am definitely behind where I should be at 8 1/2 weeks out because of the whole fracture issue. He's hoping that once I can ditch the crutches and start walking that things will improve and I'll be able to quickly catch up. I can't start walking until Thursday and I think he will measure me on Friday--so not much of an opportunity to catch up!

Today I am making dinner for the first time in 8 1/2 weeks! I have always complained about having to cook (not something I love doing), but surprisingly I kind of miss it! Or maybe I just miss my own cooking! :th_heehee: My daughter-in-law has taken good care of us, but I kind of miss the things that I normally make. I am making something that I can put together really quickly and then it just cooks all day. So it will be minimal standing (which is still hard on one leg) and minimal walking (still with the walker) because I'll have my husband put everything on the counter for me.

Five days to go!!!! Niki
 
editor98 said:
I can't start walking until Thursday and I think he will measure me on Friday--so not much of an opportunity to catch up!
Click to expand...

I think I might just have a headache or something on Friday if I were you... :snork:

Congrats on making dinner though - another big milestone! I know what you mean about missing your own cooking. As much as I enjoyed not being overtired and doing all the work on Thanksgiving, I missed the food being made the way I make it! It was all good, but not the same. It is like that for the food my hubby has been making too. Oh well... :wink1:
 
Hi Niki
my best advice on "numbers" the more active you are (ie the new joys of walking) the more likely you are to have some swelling. swelling WILL reduce your flex!
so just be prepared.... I know you are going to be excited to walk but don't be disappointed if it impacts your flex. My best numbers were almost always a day after I REALLY took it easy <G>
My PT is now measuring me 1x per week. I really want to be in the best of the best LOL when it comes to numbers but I'm starting to get used to the fact that this knee has a mind of its own - pretty steady at 125 give or take.
the truth of the matter is that I could have sat on my "heels" prior to my RTKR - but I was in HORRIBLE pain. I am a person who LOVES numbers! but I'm on cloud nine right now because of FUNCTION not numbers.
so excited for your upcoming walking.
btw I'm also a person who LOVES PT -
also - I might add that my knee prior to surgery also hyper extended past zero 15 degrees - it is now very happy at "zero" extension.
 
Niki.....the fact that you DID have a fracture is precisely why it may take a little longer for you to achieve your full ROM. You should not be in a hurry and neither should your therapist! He is rushing you because he believes in that "window of opportunity."

You have dramatically increased your activity level from when you had in-home therapy. You more than likely have some swelling now that must be reduced before you can improve ROM. Putting your leg in a brace for 4 hours a day won't help with that. You need to follow the BoneSmart mantra of rest, ice, elevate and take pain meds on a schedule. If you're doing that and not pushing too hard in therapy, you'll get there. Don't worry! The key is that you continue to make progress....even if it's slow it is still a step forward to be celebrated.
 
The whole ROM thing is so frustrating. I know that the more active I am the more swelling I have. I definitely have swelling for the rest of the day after PT--and my PT is not really what I would call aggressive. He definitely believes in the magical "12-week window" though. My husband thinks my 12 weeks shouldn't start until Thursday when I get to walk for the first time! :hysterical: Maybe that's what I'll tell my PT on Friday. I kind of doubt that my ROM is going to be any better on Friday than it was this past Wednesday when he measured me for the first time at 92. I've been on the bike three times now and all three times there has been no improvement in how far I could get around. I get stuck at the same point every time.

But, the more I think about this brace/flexion device thingy, the more I think he has to realize that I am not your normal 9-week out patient. It seems logical to me that I would need more time than a person who has been walking since day one. And I don't think it's really reasonable to expect me to make up for the past 9 weeks in the next 3. Like I said, it's just all so frustrating...:sigh:
Niki
 
Don't let it frustrate you, Niki. Remember that you are in charge. He is your employee. You must sometimes be firm with therapists and tell them what you want them to do. You instinctively know what is working for you and what is not.

So tell him just what you wrote here. You are not a typical patient. You did have complications. You prefer to take things slowly and, as long as you are making forward progress each week (not daily), he should help you with gentle exercises.

You should not have a huge amount of swellilng after PT. If you do, I suggest you scale it back a bit for a while. Remember....at this early stage all you really need are gentle bends and stretches....plus a little time on the cycle maybe....like 5-10 minutes. You're getting stuck at that same point on the bike because that is when the swelling kicks in.

Remember that the knee compartment is very tight space-wise and it doesn't take much to constrict movement. You might not even see swelling that is present an impacting your ROM. That is why I'm telling you that if you ARE seeing swelling after PT, it means you're pushing too hard.
 
There is no "twelve-week window." You can continue to gain ROM upwards---and past a year. Don't be in a hurry---you realize that the more you do, the more the leg swells, and the more the ROM will drop. The idea is to keep the knee happy and be PATIENT with the outcome. The harder you work, the slower your recovery---and the development of ROM---will be.

There are also plateaus in this recovery---sometimes you will make great strides---sometimes, you will hover around the same point for a while. I would tell your PT that I continued to develop ROM throughout time to about 6-7 months, and it was about a year before I felt pretty much normal.

Don't sweat it, and, most importantly,
[Bonesmart.org] New Left Knee . . . Check!!

Patience, Grasshopper, Patience!
 
Thanks, Jamie, for that. And Tim, I know patience is key. It is so much easier to tell y'all what I'm feeling about all of this than it is to tell my PT who has a different mindset than I do about ROM and time. But you're right, Jamie. I can tell him just what I wrote here. I do think it is way too early to be giving me deadlines since I have yet to even take a step on my new knee.

Jamie, I can't really see any swelling after PT, but I know it's there cause I am very tight and stiff and uncomfortable afterward. Also pretty dang tired tonight. It doesn't feel like much when I'm doing it, but it does wear me out! Tomorrow is going to be a recovery day for me for sure! Church and then rest, ice, elevate! I'll worry about my PT next week....:snork:
 
Sounds like a plan!
 
Niki,

Don't let the PT "scare" you into doing more than you can handle. My thinking is this "window" they keep looking at is a bunch of bunk. My bad but I never really worked that hard at my pt and my ROM moved right along in its own time, also my PT did NOT measure me all the time, actually I had to ask her to meausre most of time so I could tell how I was doing. My ROM improved most when I would increased my walking (which you can not do yet) and when I would take a day off from all exercise (the day after PT apppointments). If you are having increased swelling (internal) from your exercises (which I also would have) of course your ROM will be less.

Just take your time, let it happen on its own, and before you know it it will be there. Keep reminding them that you had the fracture and you are not at the normal level yet. Sometimes it seems like they just want to impress the OS's with how far they get the patient. I went by what the OS said over wha the pt wanted.
 
Just some more thoughts. I've been reading almost every post that was posted since the very start of your recovery journey. It certainly has been a tedious one. I have learned many things from reading your posts & the replies from all the other wonderful, supportive people on Bonesmart. I appreciate your honesty & your openness regarding every stage of your recovery. By your sharing, those of us who are awaiting our own TKR, are much more informed as to how our bodies may react & heal. Progress is surely a slow process, but for every degree farther in your ROM & every step you take, know that there are others who are soon to be following in your footsteps & encouraging you.
 
the tightness is swelling
I think (for what it is worth) my guess is that the next few weeks will have ups and downs as you start to use that leg. But I think that it is the return to a more normal life that WILL help your flex. My left knee is now 10 months old and it feels just great. Better than it did at 9 weeks, better than 16 weeks and better than at 6 or 8 months. You WILL keep improving. You are on unique path for your TKR but you will get there. I echo's the rest of the comments from others. ALSO - you will be surprised at least I am regarding - how you can suddenly make a big gain in flex - I think it often has to do with doing "normal" daily life AND swelling going away. Keep the faith!
 
Niki,

You are getting great responses, imagine what it would be like if we were struggling without this incredible resource.

My son is a big believer in the kneecap manipulation for recovery and he got that from a PT / ATC with over 45 years experience. (ATC = athletic trainer certified).

I'm confident that you will find what works best for you and won't have to just blindly accept what the accepted criteria (window of opportunity....not so much, I'd rather open the door myself and walk in when my knee and I are ready)

Met someone yesterday who has gone through both knees about a year apart and is glad he did it.
 
Okay, first, I have to say how much I agree with Harry. I just could not even imagine going through this surgery and the ups and downs of recovery without having the incredible support and exceptional knowledge of everyone who posts on this forum! There is no one who knows what this is like except someone who has also walked this walk. I am so thankful for all of you and for your willingness to share your stories and offer your support. :ThankYou:

I planned on an easy icing and elevating day today to recover from PT yesterday. I was pretty stiff, tight, and uncomfortable for most of the day yesterday. But I have to say, that my knee has recovered pretty quickly--much to my amazement! It feels really good today! And last night was the first night since my surgery almost 9 weeks ago that I did not use the ice machine at all. I iced until about an hour before I went to bed, then went to sleep without the machine. I woke up at about 4:30 and almost put it on, but was feeling okay so went back to sleep without it. Woke up at 7:00 this morning--so I lasted about 10 hours with no ice, and woke up with my knee feeling good! That is progress!

I was going to take a day off from the exercises, but I think I will at least do the flexion/extension stretches. But I am going to skip the rest since I have PT again tomorrow. And I will do the moving the kneecap bit and scar massage. Speaking of that, I sent my husband to the store to get me some kind of vitamin E lotion or oil to use on my incision. He couldn't find that but came back with something called Bio-Oil. I had never heard of it before. It is made specifically for scars and contains something called PurCellin Oil that they are calling a "breakthrough ingredient." Have no idea what it actually is, but I have to say that I really like this oil! I've only been using it for a few days on my incision, and I can already see and feel a difference. My scar looks really good (if I say so myself), but I do have two small lumps. With this oil and massage, those lumps are looking so much better. It also just feels good to massage the oil into the whole area around my scar. Anyway, just thought I would pass that along.

Thank you all for your advice and comments on my PT situation. I feel so much more prepared about having a conversation with my PT about unrealistic expectations for my situation. Of course, I want to do all that I can to wind up with the most ROM I can get, but he has to realize that I'm going to need more time than the typical patient. Catherine, I think you are exactly right--there are many ups and downs ahead of me as I start using this leg later this week. (My 3-year-old granddaughter keeps saying that my boo-boo is going to be all better on Thursday! Hope the rest of my family isn't expecting that!) :hysterical:
Niki
 
Your granddaughter is your Lighthouse, "and a little child will lead them."

You are going to make it just fine!
 
Hi, Niki -

Thanks for the hint about Bio-Oil. I have seen it mentioned elsewhere on BoneSmart, so I'm going to try it out.

Sounds like things are getting a bit better for you! Good luck with the "full weight" day that's coming soon.
 
Like most things in life, Niki, you will find that as you progress, your knee slowly starts recovering more quickly from whatever you've given it during the day.

That's one of those :ideaIPB: moments when you know you're finally turning a corner! Congratulations!
 
Sounds like great progress during the past 24 hours - congratulations, and, as you already know, all of us here continue to wish you the best of luck as you progress through your recovery.
 
Hi Niki,

I use Bio-oil - it was recommended by a nurse when my husband had surgery. I use it twice a day and I like it too - very light, sinks in easily and doesn't leave an oily feel - I've no idea whether it really speeds up healing or not but it certainly feels and smells nice!

My scar looks good though.
 
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