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TKR One year after surgery

This phase of the recovery is different from what I expected because I don't feel bad enough to "be sick" but not good enough to feel close to "normal" either. Also expected to be depressed but it's not even that bad - just sort of indifferent to a lot of things. Not being able to read is a real bummer and for some reason, I can't get into all the movies I was hoping to watch. Maybe feeling relatively useless is difficult for most of us and just takes some getting used to. Anyway, enough whining about all that. We're having weird weather here and my mid-season daffodils have started blooming - before the early ones. It's hard to be grumpy when you can look outside and see daffodils.

Newlife - for some reason, we have a lot of pillows and those have been a godsend. Have you tried sleeping almost sitting up with a lot of support behind and a pillow on each side of you? For some reason, that works for me until I have to go to the bathroom, the pillows fall down and have to be re-arranged again. *sigh* I actually managed to hoist myself onto my right side this morning which was comfortable for about 10 minutes but then I got stuck. It's so embarrassing to have to constantly ask my husband to keep coming in and rearranging body parts. :)

Celle - hadn't considered cataracts and it's been a while since the old eyes have been checked. Thanks - will have to make sure to add that to my list of things to check once I get out of the house.

All of you are right; this will all pass and we're lucky we're only dealing with knee replacement problems; there are a lot of other things which are worse!




 
@Laurenkate i hope the darkness has lifted a bit, yeah for the first signs of spring!!! There are so many ins and outs no one tells us about. Your Hubby sounds like a great guy, your blessed. Enjoy your strange dreams and keep those meds on a schedule for awhile longer. Soon you will see the light at the end of your tunnel!

Have you tried TV shows vs movies? I was able to enjoy many series in the early days. The Crown, Vikings, Good Girls Revolt, orange is the new black. 30-60 minutes was my max attention span!
 
It's the post-op brain fog that stops you from being able to concentrate.

I am an avid reader and yet I couldn't read a book for about 2 months. A short magazine article was all I could manage.
 
Thanks again for kind words.

We decided to go out to brunch yesterday - and it was like an episode of the Three Stooges. Got stuck trying to get my foot out of the car, couldn't get comfortable in the restaurant, etc. The idea of going out was more fun that the actual doing and made me realize it's going to take some planning in the future. One good thing about using crutches is that most people are very nice and helpful and they come in handy when trying to prop a leg up under the table. I think i'm going to continue to use them even after I don't need them when we travel; it'll make it very clear at rest stops on the NJ turnpike that I get the next available handicapped stall. :)

My in home therapist came today; she's going to release me to outpatient therapy starting next week. She mentioned something about kneecap manipulation. What in the world is that and why is it "necessary"? *sigh*
 
It's not necessary to have a therapist 'move' your knee cap.when you walk your kneecap is mobilized with each step you take.
 
My PT did that at my last session and my knee blew up!!! It is not going to happen again.
 
As hard as it was I waited until 4-6 weeks post op to go out to eat. Even then it was difficult and tiring but did help me to feel a bit of normalcy. I went out about once a week after a dr appointment and always propped my leg up on the booth beside me. A handicap placard is very helpful in getting parking spaces that allow your door to open the whole way. If you don't have one have hubby or "chauffeur" help you get out at the entrance then pick you up at the same place.

My kneecap was never manipulated and I was in an imbolizer brace for a month. I wouldn't let anyone but the dr touch my knee at first. My PT did massage my whole leg, but not until I was 4 months post op.
 
It's been 3 weeks since my surgery and it's been a challenging/interesting/surprising few days. Several random thoughts....

Today was the last visit from the in home physical therapist. She seems to think I'm doing well considering my leg is still fairly swollen. It's almost completely straight but I've only managed to get to 82 when trying to flex my leg under the chair - and that's with the good leg pushing it. Really pushed yesterday at flexing so the swelling was worse last night and very stiff this morning. The therapist commented that the only patients she ever had who never had swelling were all patients of one os who insisted that they spend 1½ hour elevating and icing, ½ hour walking around, going to the bathroom, etc. and then repeat all day until bedtime for 4 weeks. Then they started therapy. Sound familiar? :yes!:

See the OS tomorrow and am dreading setting up out-patient physical therapy. My insurance only allows 30 PT sessions a year so it'll be interesting to see how many sessions he requires. I'm not going to use all my sessions for this one situation because who knows what is down the road. By the way, the webbing on my glued incisions will supposedly come off tomorrow - is it just pulled off like a Band-Aid? Yowsa.

What does this sound like to you? It was a pretty, sunny warm day on Monday; had therapy in the morning and was up most of the day just puttering around, reading the newspaper, etc. My husband took me to the library, went in, returned a book, checked out the new book shelf for about 10 minutes and then came home. At 6 pm, the headache from hell started in and within 15 minutes, I was shivering and absolutely ice cold; thought I was going to vomit but didn't. Got into warm pj's, my husband tucked me into bed with a couple of down comforters and it took several hours to warm up. Felt listless but better Tuesday morning. Any ideas? Was it my body telling me I'd done too much? Or just a fleeting brush with whatever is going around town?

One more bit of information which may be useful or too much information. After trying all the usual methods with no results, I ate some home-made apple sauce with cinnamon on Thursday afternoon; perhaps it was a coincidence but it helped "move" things along in the plumbing department. Thank goodness.

Enough babbling - just wanted to jot this down for people who might be trying to make a decision about surgery. The first week was a little rough but after that, it's been much better than expected. Certainly feel better than I did before the surgery and at this point, so glad to have had it. Of course, who knows what next week will bring? Will probably be singing a different tune:censored: after my first "real" p.t.
 
It's ok to hold off your PT sessions until you really feel you need them. 82 at 3 weeks post op is just fine and will get better once the swelling goes down. If you feel the need to schedule PT just do one a week after all, you only get 30. :yes:
 
@KarriB - Well, that didn't work! Can you change title of my thread to LaurenK's recovery under "promise" of MUA? I can't change my thread title for some reason.

*sigh* Went to the doctor's yesterday. I really like and trust him and his physician's assistant. They were quite pleased that my leg is as straight as it is, but concerned about the ROM. The good news is the physical therapy department was booked for another week so my evaluation isn't until February 27 which gives me a week to elevate and ice to get swelling down.

The bad news is they said they have a limited amount of time to get the ROM to 125, blah, blah, blah. I told them my insurance limited p.t. visits but they indicated not to worry about that because I'd have to have an MUA within 2 months if my ROM wasn't where it should be.

We're obviously going to have another serious discussion about this before that little procedure. My ROM didn't get to 125 until 11 months after the meniscus surgery. So many of you have said you didn't do the p.t. or have a manipulation and your ROM was fine after a year. Those are the pros for not having an MUA; are there any cons for not having one? For instance, is it possible for your knee to get "stuck" and just not ever go further back than, say, 90 or 100 degrees?
 
I was in an imbolizer brace for a month after my infection surgery. A straight leg for a month. I was very worried whether my knee would ever bend again. I saw a future of walking around like a peg legged pirate, but with each visit and each question my OS said the knee would bend when we told it to bend. When I was finally allowed to bend and weaned off the brace my OS showed me how he wanted me to do heel slides by moving my foot 2 inches with his foot. The OS said he'd be happy if I got to 90. That was on Dec. 26, by Jan. 29 I was driving and back to teaching. No MUA was needed. I gained ROM well after a year.

Just last week the PA at my ortho's office was impressed with my ROM (I was getting shots in my left knee). My TKR does stairs just fine, I ride my recumbent bike 5-10 miles a day, can swim 15 laps and can squat in the water. I cannot sit with my TKR leg underneath me (I'm not sure that feasible for anyone), sit cross legged on the floor and I find kneeling odd and somewhat painful.

Here is an article from the BS library about MUA.

https://bonesmart.org/forum/threads/mua-manipulation-under-anaesthetic-and-adhesions.3656/
 
Just how swollen is your leg, Lauren? Compared to these?

[Bonesmart.org] One year after surgery
 
KarriB, thanks; I'd just read the article again and wondered how you did because I knew you'd been in a brace for a month. Your story makes me feel a bit more optimistic this morning.

I'm going to do those heel slides, various stretches, and walk a couple of times a day. We tried something the other day which might help too. I put my foot on my husband's hip and then he leans into me which really bends the knee. Told him this was his big chance to really inflict pain "accidentally" in case he was annoyed with me about anything. :heehee: He hasn't taken me up on it so far but we'll see how that goes once he goes back to work next week and still has to do some household chores at night.

Thanks again; hope you have a good weekend.
 
But with your husband pushing on the knee you're still pushing beyond what your knee seems ready for. You don't want to do anything that causes pain. Gentle stretches are all you need at not a month post op. 125 at a month is unrealistic and even 2 months is pushing things.

Which picture above is most like your leg?
 
Hi, @Laurenkate! You are so very early in recovery for the surgeons to start talking about MUA... There honestly is only one other person that I have read on this forum who thought she had to have 120 flexion at 6 weeks per her surgeon. Most surgeons don't seem to be that strict. If you had my surgeon, he only requires 90 degrees at 6 weeks - you'd have already passed!

Swelling makes a big difference. I took an anti-inflammatory which helped me immensely - once the swelling went down, the ROM just happened. As my therapist would say, weeks 1-4 are the swelling and pain phase where you just try to get those two things under control. After that, you start working on the exercises, etc.

All that being said, there are a few people on this board who *have* had a MUA... And who said it wasn't bad, and really helped. That being said, I don't think their surgeons were on your surgeon's "rush" schedule! I don't think it would be inappropriate to do a "Google scholar" search for Manipulation under anesthesia - there are a bunch of peer reviewed articles on the effectiveness of early vs late MUA. Arm yourself for your next visit! Lol

I think you will also find that a LOT will change between where you are now vs where you will be at 8 weeks. I know it has for me! At 3 weeks out, I would swell just by walking to the bathroom. I felt sick and would get nauseous I'd I stood more than 15 minutes. A 30 minute car ride would make me relatively ill. I had no energy, and couldn't keep my leg bent more than 30 degrees for an extended time. Now, at 8 weeks, I can comfortably keep my leg bent at about 120 degrees for as long as I like. I'm not nauseous, I can stand for an hour to an hour and a half, I can even finally sit like a normal human without swelling like crazy.

I'm hyper flexible, so my ROM was good out of the gate. But to give you an example of how much 5 weeks makes a difference.... I was just at 120 when I went for my 3 week check up. Not sure what my exact measurement is now (around 140? ), but I can sit cross-legged with my new knee. So there has been a great amount of improvement in that time.

I only did PT when the home health people came or the 2 times a week I had outpatient. I would do a flexion stretch every day just to make sure I didn't have a trend of going backwards.

So, for now, let your knee decide what will work for you. Try to control the swelling, and make sure you get a good PT who will work *with* you and not force anything. In the meantime, don't let what your surgeon said get in your head - it's unfair of them to set that bar so early. As if TKR isn't stressful enough!

Good luck to you!
 
I only had 95 degree flexion before my revision. I did just some easy PT consisting of stretches and massage and I eventually got to 130. I did not allow anyone to push on my knee at all. Since you said it took you a bit of time to get your flexion back after arthroscopic surgery you know that sometimes knees will get better on their own schedule. So ice and elevate as much as possible. Once the swelling goes down your ROM will improve.
 
HI @Laurenkate
Expecting 125 within such a short time after this major surgery is completely unrealistic. My surgeon only expects 90 degrees by about 6 weeks.

In any case, it simply isn't true that you only have a limited amount of time to get to 125. That's an old myth that should have died long, long ago. ROM can continue to improve for a year, or even longer, after a knee replacement. Myth busting: the "window of opportunity" in TKR

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. At the moment, the swelling is what makes your knee stiff and unable to bend. So, instead of exercising to try and get more ROM, concentrate on relieving that swelling, with lots of this - rest, elevate, ice .

Above all, stop putting your foot on your husband's hip and having him push on your knee. That's more likely to do harm than it is to help. It will inflame and irritate your soft tissues, which will increase swelling.

You have all the time in the world for your ROM to increase, so disregard the threat of an MUA.
In any case, it is your knee and you are the only one who has the right to say what will happen to it. Your surgeon can advise an MUA, but you have the right to say "Not yet. I need a little more time." And he won't be able to make you have an MUA.
Saying no to therapy - am I allowed to?
 
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Josephine - my leg is moderately swollen all the time - and has been for the past year. Unless I spend the majority of the day with my leg elevated and iced, my "new" knee measures 3-4 inches bigger each evening than in the morning just after getting out of bed. Yesterday the doctor seemed a little more concerned about the swelling in my ankle and indicated if that didn't get better, it would eventually become very tender and painful.
 
Are you on an anti-inflammatory? I agree with everyone that you should cut down on the activity for now - esp since you have a bit before your next PT. Pushing your knee beyond what is comfortable is also likely contributing to swelling, as the other have mentioned. I think this is a good time to binge watch some TV shows! :snork:

PS-listen to the ladies above... They've watched thousands of us all go through the same thing :wink:
 
My OS said he expected 90 degrees in 3 months. After my revision, even with good ROM I gained 5 degrees after 18 months.
You are still very early in recovery, your soft tissues are still very angry from having been cut, pulled apart, and otherwise manipulated. Given time to heal your ROM will be fine.

Here are the amounts or ROM you need for functional activities.
"These degrees of flexion are required for the following activities:
- 65° to walk,
- 70° to lift an object from the floor,
- 85° for stair climbing,
- 95° for comfortable sitting and standing
- 105° for tying shoelaces."
 
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