TKR Newbie

1Seamer23

new member
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I just wanted to introduce myself. I just found this forum and it has been very uplifting. I had a TKR on my right knee on 1/10/23 and have been struggling big time in my PT. I should start by saying I suffer from high anxiety and depression. The prescribed pain meds sent me into the hospital with panic attack and I was unable to take. At 7 weeks post-op my extension is currently at 0 degrees and ROM is variable between 95-100 degrees. My PT therapist is VERY aggressive and during my last visit was so aggressive with forcing my knee that I screamed and cried, asking them to stop. They stopped when I finally said “Uncle”. They have emphasized they need to get me to 110 degrees within next couple of weeks. I cannot go back. Now I anticipate the pain and it makes me physically ill. I am enlightened to see there are other ways to proceed after reading over comments and now have hope. Thank you!!
 
Hi and Welcome!

It always shocks me to read how forceful PTs can push their patients, when they are crying and telling them to stop. Where is the common sense in this type of PT?

Yes, there are other ways to recover and rehab your knee:

As one of our staff members likes to say, this recovery is a long journey but if you stick with the BoneSmart approach the journey will be less painful and you will still reach the same final destination. Ultimately you get to choose the path, the tough rocky road through painful PT, or the BoneSmart path through the meadow with the pretty wild flowers. :flwrysmile:

I suggest you find another office with a better rehab approach, or, do your own rehab at home, on your own terms. Going to a formal office can be helpful, but many of our members did not do that, and they still had great outcomes.
Saying no to therapy - am I allowed to?

At 7 weeks post-op my extension is currently at 0 degrees and ROM is variable between 95-100 degrees.
This ROM is excellent.


I was discharged at 8 weeks and continued to rehab my knee on my terms at home, mostly by just doing my daily activities, and a few easy bends. You can do the same.

Regaining our ROM does not require forceful bending or painful exercises.
Regaining our ROM is more about Time than repetitions of a list of exercises.

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

Our range of motion is right there all along just waiting for that to happen so it can show itself.

In the general run of things, it doesn't need to be fought for, worked hard for or worried about. It will happen. Normal activity is the key to success.
 
I will leave you our Recovery Guidelines. Each article is short but very informative. Following these guidelines will help you have a less painful recovery.

Just keep in mind all people are different, as are the approaches to this recovery and rehab. The key is, “Find what works for you.“ Your doctors, PTs and BoneSmart are available to help, but you are the final judge as to the recovery approach you choose.

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
ice
take your pain meds by prescription schedule (not when pain starts!)​
If you want to use something to help heal the incision,
BoneSmart recommends hypochlorous solution. Members in the US can purchase ACTIVE Antimicrobial Hydrogel through BoneSmart at a discount. Similar products should be available in the UK and other countries.​

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. At week 4 and after you should follow this

6. Access to these pages on the website

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

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 the 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 the member’s history before providing advice, so please post any updates or questions you have right here in this thread.
 
You go, girl! You will not only be fine, but you feel much better, physically and emotionally, by doing a gentler rehab.

The prescribed pain meds sent me into the hospital with panic attack and I was unable to take.

Now I anticipate the pain and it makes me physically ill. I am enlightened to see there are other ways to proceed after reading over comments and now have hope.
I’m sorry you’ve had such a difficult experience. I’m glad that you are choosing what is in your best interest. We’ll be here to help you along the way.
 
My PT therapist is VERY aggressive and during my last visit was so aggressive with forcing my knee that I screamed and cried, asking them to stop. They stopped when I finally said “Uncle”. They have emphasized they need to get me to 110 degrees within next couple of weeks. I cannot go back.
This is awful. You definitely can't let this happen. I have had virtually no formal physio ( just a couple of sessions in hospital before discharge).
I have had private sessions with my pilates teacher instead. She has a great knowledge of anatomy and uses a totally gentle approach- no forcing whatsoever. Only now at 4 months are we working more on strength and starting to use a resistance band and tiny 1/2 kg weights.
My ROM is great and when I was in hospital recently for an unrelated issue the physio I saw was very impressed with my recovery.
So formal physio is definitely not a must.
Look for a good pilates teacher if you want more support and a different approach.
 
They have emphasized they need to get me to 110 degrees within next couple of weeks. I cannot go back. Now I anticipate the pain and it makes me physically ill. I am enlightened to see there are other ways to proceed after reading over comments and now have hope. Thank you!!
This is so incorrect. You have all your life that your bend can improve. It is not in a preset timeframe!
I have decided to take over my own recovery and take back my life.
Oh yes, now you're talking! You'll find that you will progress better and without all that extra pain and swelling. Just do the things you can do without hurting your knee and causing extra swelling. Your knee's reaction should be your guide. If it hurts or swells that night or the next day, then your knee isn't ready for that activity. Try it again in a couple of weeks.

I found that if I tried only one new thing a day, then just my previous activities the next day with added icing and elevating, that new activity could be tolerated as long as it wasn't something that was too aggressive. I had my days of pain and swelling, but I was in control and those days were managed very well by me!
 
Thank you! I feel so much better knowing I’m not alone in this. I am somewhat worried about my next appointment with my Surgeon so that will be a test for me on standing firm on my recovery. I’ve been so sore after my PT sessions that I could hardly move the next day and of course the Therapist said I’m too pain sensitive
So relieved not to return there!!
 
I am somewhat worried about my next appointment with my Surgeon
I was also very worried about appointments my surgeon. We see them as the top of the line of command in the medical team. He was very into the PT aspect, and I wasn’t doing what they told me to do. But, at the end of the day, it’s our knee, our recovery and how we rehab is our choice, not theirs.

People are all different, as are the approaches to this recovery and rehab. The key is, “Find what works for you.“ Your doctors, PTs and BoneSmart are available to help, but you are the final judge as to the recovery approach you choose.
 
This is so true. I am agonizing over an appointment I have next week with my oncologist. She wants me to change my medicine and I don't want to. I feel like I have worked through all of the side effects and don't want to start again. I think all we can do is be our own advocate and do our own research.
 
I’ve been so sore after my PT sessions that I could hardly move the next day and of course the Therapist said I’m too pain sensitive
This is so wrong! I'm very glad you are taking charge of your own PT. My wish is for this therapist to experience a TKR for themselves!
 
It’s so difficult. He’s a really nice guy but he says I need to be at 110 at minimum by the end of my 16 sessions that Kaiser has approved. There’s no way I will be even close. It’s really messing with my mental health. And he knows I have anxiety so I think he’s just pushing to see how far he can get to meet Kaiser standards. I only reached 100 last week because he and an assistant forced it. Normally by my own I’m an 85-90 but I’m no where close to that today. I’m tired and done with all of this stress.
 
I’m tired and done with all of this stress.
Then stop going to this PT. All this stress is not helping you.

You don’t have to be any ROM number by any certain date. Ever. Your knee will heal, and it will do so on its own timeframe, but it will take longer if you continue to let them keep forcing your knee to bend to their standard.
he says I need to be at 110 at minimum by the end of my 16 sessions that Kaiser has approved.
I seriously doubt your insurance company is demanding this protocol. @lovetocookandsew is familiar with Kaiser and she took charge of her recovery and did what was in her own best interest. You can, too.
Saying no to therapy - am I allowed to?
 
I've had Kaiser since 1976, and not only love it, I know how it works. No doctor or PT anywhere can tell you what to do. They can suggest or recommend, but in the end it's your body, your life and YOUR DECISION. This goes for the doctors, etc, at Kaiser also. There is no ROM that needs to be achieved by any random date. All patients are different and all recoveries are different. I never even allowed anyone to measure my ROM as I refused to follow any artificial timeline, although my doctor never gave me any numbers by dates, and also agreed with my choice to not go to PT. He would just eyeball my bend when I came in for app'ts , but never measured it. Instead I allowed my knee to heal at it's rate, and had a much easier recovery when I did that.

You don't have to go to any PT-that's your right to choose. Or you can continue PT if you choose, and you can also let the PT know exactly what you will and will not accept or allow. I allowed the PT to visit me in the hospital to help get me up and moving, but let them know in no uncertain terms that they were not to push or pull my leg, nor touch it unless they let me know why or I asked them to help me with something such as lifting it. The same went for any PT home visit I allowed, as Kaiser has their PTs also check on you and how you're doing at home, etc. But I told them up front I wasn't doing any formal exercises, I wasn't going to allow them to do any actual PT on me. They could watch my gait and help with that, and keep an eye on my vitals, but otherwise I refused PT. I had a call from the PT dep't one time about scheduling home visits and thanked them, but refused the service. They tried to push me by telling me they would inform my doctor as he had ordered PT (only because it's the usual practice, but he also agreed with me that I didn't need to follow through with it). I told her she was welcome to call him and thanked her for the call. That's the last I heard from them.....lol.

Just remember-just because your doctor fixed your knee does not mean that he now owns your knee. Yes, listen to his advice, and take the advice that works for you. Then ignore what doesn't work and there's no need to tell him if you have a doctor who likes to be in control.......lol. Of course, I avoid those kinds like the plague, so generally don't have a problem there.
 
Thanks for your shared Kaiser experiences. I will need to have my Left TKR done in the future and will definitely be more aware of my rights. I am definitely not going back to PT for sure. Thank you all for your support. ❤️
 
You don't have to go to any PT-that's your right to choose. Or you can continue PT if you choose, and you can also let the PT know exactly what you will and will not accept or allow. I allowed the PT to visit me in the hospital to help get me up and moving, but let them know in no uncertain terms that they were not to push or pull my leg, nor touch it unless they let me know why or I asked them to help me with something such as lifting it.
That's right. Know that you are not alone in this.

I'm a advocate for and have greatly benefited from PT but adamant about what I will allow and disallow. Even in the context of being fully engaged otherwise. My PTs were always good re. abiding by my rules about PT, my surgeon too.

This is YOUR knee, your life and your particular adjustment to and recovery from a major surgery.
 
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Thank you! I feel so much better knowing I’m not alone in this. I am somewhat worried about my next appointment with my Surgeon so that will be a test for me on standing firm on my recovery. I’ve been so sore after my PT sessions that I could hardly move the next day and of course the Therapist said I’m too pain sensitive
So relieved not to return there!!
I too had pain after even some of my reasonable PT sessions (especially early on) and rested a day or so and then we went forward. There was no commentary about me being 'too' anything. If anything my PT carefully explained to me that I might be sore and this is why I had two days in between PT sessions.

Good you switched to another Physical Therapist. I had two PT's this time as the initial one went out on a medical. That worked out as they both understood my boundaries and specifics of my case.

I'd look up the previous PT one of the many medical doctor and specialist websites online. Others may have noted their 'positive' commentary and style.
 
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I’ve considered going back and telling them no more forced bending etc but unfortunately my anxiety is so heightened just considering walking back in the door that it’s probably healthier for me to just go my own way and take over my own recovery. I did order a recumbent stationary bike to assist and I’m super active in the home. After reading a lot of other’s experiences here I believe I can control this. Biggest challenge for me is to slow down and rest more because I keep overdoing it and have lots of swelling and stiffness. It will take some awareness on my part to listen more closely to my knee lol.
 
When I get to my LTKR I plan to do it right from the beginning and not get to where I’m at now. But I plan not to do the surgery until I’m completely recovered so it might be a while
 
We indeed find our way...:ok:. The main thing I like(d) about PT is the firm table you lay on for extensions and other positions that helped me. IMO, hard to replicate in bed, especially mine which is too soft to give any real feel back needed to extend my leg fully. Now at two months I can get on the floor and pads and to it.

I liked the mini-steps w/ the railings in the early days as increasing my speed, etc. without worry of falling down a true flight of steps. Also loved the gentle but effective tissue pressure massage my PT provided at the end of each session. I continue to do them myself but it is not the same as having someone else do it (sniffles).
 
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