TKR One year later and all is well

[sistersinhim]

@Caly hit it right on the head! It is your knee and you know how it reacts. Don't let any one cause you pain, not even yourself! When you feel pain, you are causing inflammation. That in turn causes swelling and more pain and less ROM. Don't do any exercises for a few weeks and you'll see a huge improvement in the way you knee will move. And it will be with less pain. We, on this site, are experienced knee replacement recipients. PT and OSs are not. They know what the books said years ago. That is outdated information. A tkr is not a sport injury and should not be treated as such. Would you exercise a broken leg shortly after it was set? Of course not. Watch a knee replacement on youtube in real time. It will shock you to see what your knee has been through. And you'll understand why it needs to heal before starting any kind of exercise program. We care and only want the best for you.

 

[KarriB]

If what you have been doing thus far isn't working, it's time to try something else. Take the next week or so to rest, ice and elevate your knee. Cancel PT for a week to get the swelling down in your knee. You will not lose the ability to bend your knee. I didn't bend my TKR for 4 weeks a month after my surgery and I can bend my knee just fine. Go about your day, no shopping, mowing, exercises, just rest/ice/elevate your knee and the swelling will diminish. Once the swelling is gone the pain will lessen and you'll be able to bend.

 

[Minstrel]

Thank you, KarriB for your advice. I have not exercised at all today and I'm going to ice, etc. one more time yet.

If we are all different, how will I know that I will be able to bend my knee like you did? Isn't there also the chance that I may not be able to bend my knee?

 

[Celle]

Your knee will bend perfectly. Just give it time. We're not that different!

 

[KarriB]

You're going to bend it in daily living right now, you're just not going to over exercise it. Do a few heel slides throughout the day, regular daily living actvities, walking around the house, but no undue pressure on your knee. One week off PT isn't going to keep your knee from bending. Do one of these stretches through the day for extention, but stop when it hurts. I let my leg stretch across the ottoman-chair and let gravity do the rest. It's all I did to get extention.
https://bonesmart.org/forum/threads/extension-how-to-estimate-it-and-ways-to-improve-it.9529/

Is something is hurting your knee, it's not good for it. Before my infection a PT had me do a squat, I looked at her like she was crazy because I couldn't squat before they cut my leg off and then put it back together 2 weeks prior. I did one squat, looked at her and said never again. I had my infection surgery 2 weeks later and didn't go back to therapy for a month and then it was with a different group who was gentle and never caused pain. My dr wrote a script for "non-aggressive PT". Whatever you do, don't let anyone hurt you.

 

[GingerP]

I'm sorry that you feel you are getting conflicting information to get your knee better, but I can tell you that these folks have seen the good, bad and ugly parts that go along with the knee replacement journey. I had my tkr in December yet I'm dealing with incision healing yet. One thing I can tell you about my 6 week dr visit - no number was discussed about my ROM or extension. He asked me to walk. Yes, walk. He watched to see how I was doing. My suggestion is, since you are concerned about walking is to use your crutches on each side to keep from leaning one way and the other if that is worrisome for your gait. Since I had one knee done and the other desperately needs done but can't be until I'm healed, I still often use the walker and/or 2 canes in each hand to keep my stride equal since I often limp or wobble side to side without support for the knee that needs replaced. Please do good things for yourself. This is time for you to seriously rest. Ice your knee as often as you can and elevate it. Less work on exercises and more basic living walking to the bathroom, couch, bed, and meals is going to help. Sending healing thoughts to you.

 

[skigirl]

Of course it is confusing to receive conflicting advice---and, at some point, you are going to make your own decisions about your rehab. Let's talk about common sense. Do you think it is advantageous to take pain meds so that you can bend your knee more than it wants to bend?

In reality, when you stress the knee---like bending it more that it will bend on its own---the knee reacts with More swelling--not less. Our muscles are weak after surgery and cannot support the leg. When you do a lot of weight bearing exercises, your new joint will have to bear most of the weight---which it does not want to do--and it tells you so with swelling.

Here is what I did: week one and two---laid in bed or on the couch for about 80% of the time. I had my leg iced and elevated with three pillows. At three weeks I began pt with a very well trained therapist. He had me do non weight bearing exercises at first---leg lifts, clam shells, quad sets. I also rode the bicycle. I could pedal around at three weeks with no problems. we began weight bearing exercises at week 4 and did not begin strength training until week 10-12. I skied at 5 months with no problems. My rom ?140

Now, back to you. Do you really think that doing something that causes pain to your knee all day long is the right way to go? I think you have consistently been doing too much for your poor knee. You cannot exercise yourself into rehab. First, you have to let the tissues heal, then you begin exercising very gently so that the leg can handle the exercises without swelling.

Right now, you are swollen and sore. What to do next? here is a suggestion. Take the next three days and do a lot of rest, ice and elevation with your knee. Just do gentle heel slides and quad sets, perhaps a few leg lifts---no more than 10 at a time. Rest, rest and more rest.

Then, see what happens? If your swelling is decreased at all, you have an answer to your query. We already know that the way you have chosen up to now is not working---what is the harm in trying a more gentle approach. NOT doing nothing, but doing nothing that causes pain. Being gentle with your leg and knee. non weight bearing exercises---a bike is a good thing now. I emailed all of my friends and asked if anyone had a bike they were currently using as a clothing rack, would they consider letting me borrow it for a month. I got three offers!!!

 

[agarrett]

It does get better. My progress was not at the pace I wanted. Each week gets better. I didn't think it would be this long, but am noticing improvements still. The last two weeks I skipped PT and just did life whatever I could and I think it helped my mental state a little. Still more ROM improvement to go, but at least the beginning of my mornings isn't as bad as it has been. Patience and more patience, that is my advise.


Sent from my iPhone using BoneSmart Forum

 

[Minstrel]

Many, many thanks to Celle, KarriB, GingerP, skigirl, and agarett for your responses to my latest post. I have been reading and re-reading a lot of the information contained on this website/forum and have started to incorporate the advice. My last PT appointment was 4 days ago and I have not 'exercised' since. Rather, I have been resting, icing, and elevating my leg and I am pleased to report that the swelling has been reduced. I have been measuring my leg in 4 places (above the incision, across the mid-knee, above the calf, and at the ankle) and have lost 1/8 to 3/4 of an inch in all 4 places. Too, I have measured my right leg in the same places for comparison's sake and I'm getting closer to 'equilibrium'.

And yesterday, I went outside and walked for about 15 minutes with both crutches - just up and down a patch of dry sidewalk (we've had spring snow here for the past couple of days). It felt so good to be outside; it felt just as good to MOVE.

My next PT appointment tomorrow will be cancelled. And in preparation for my 6 week check-up with my surgeon in 3 days, I will be watching a video of the operation I had and compiling a list of questions for him.

A concern that remains is that my knee is very, very STIFF. I am not feeling any pain, just an inability to bend my knee very much - like when I am crutching around the house (using 1 crutch). I know I have lost flexion because of this and it is still a big concern.

 

[sistersinhim]

You probably have swelling inside your knee still. That will keep your knee stiff. Stiffness was my last major complaint. But, it does go away in time. Your knee is still very young and stiffness, unfortunately, is part of the recovery process. Keep doing the recovery guidelines and that stiffness will go away. It sounds like you're on the right track and have already found that less exercising is more healing!

 

[Minstrel]

Thank you, sistersinhim, every piece of feedback I get is helping to calm and reassure me that I am doing the right thing.

My recovery has been influenced by the many people who said, upon hearing that I was getting my knee replaced, "oh, you're so young and so active - you'll just fly through this". So, my expectations for a quicker recovery were pretty high . . . and it just hasn't been the case.

 

[sistersinhim]

No, it's not. It's slow and easy! But, in the end, well worth it!

 

[KarriB]

It may take a whole week or longer to get that swelling down. Try to use the knee just walking through the house or outside. I remember saying it felt like I had a rubber band around my knee, that sensation lasted for a few months.

 

[skigirl]

I applaud you for making a decision that I think is well made. You are finding out that this is a long recovery---very little happens quickly. Patience, Grass Hopper!!!

Seriously though===think of this as an investment in your future. Right now you are taking things gently as you get rid of the swelling. Once the swelling is down, you will be able to begin gentle exercises. Swelling is your cue---if the swelling increases---back off. By three months, I could see normal on the horizon. These few months as important though---you cannot rush the recovery---the knee needs time right now to heal from the surgery.

At five months I was skiing---without pain for the first time in years. Those five months were rehab and it was worth all that time to get to my goal---skiing without knee pain.

 

[Minstrel]

KarriB - interesting that you should describe the stiffness you felt like a rubber band. That's more the case for me now, although a couple of days ago, I descibed the sensation as having a tourniquet on my knee (it was much tighter!).

skigirl - you are my inspiration! I, too, am a downhill skier (amongst several other demanding sports). I absolutely love to ski and look forward to the slopes next season. If it's going to take 3 months to see normal, then that puts me at early June and just in time to enjoy summer activities. My husband and I have already booked 35 days of camping and we are intent on putting our kayaks to good use (getting in and out of my kayak myself without having to have someone else stabilize the boat is one of my goals).

Another goal is to be able to ride my bike without leaning to the right to get my left leg around the pedals and perchance to lower my seat post? Our camping destinations are putting us in the middle of some great mountain biking trails and I would dearly love to take advantage of them.

I have just finished an hour of icing and elevation - a bonus is that I'm getting more reading done!

Again, sincerest thanks for the feedback. I feel a lot better about my decision to follow Bonesmart's advice and allow my knee - my knee that I will need to be able to return to my very active lifestyle - to heal.

 

[sistersinhim]

I don't know which I enjoy more, being able to go up and down the steps like a normal person, or being able to bike without my knee killing me! That is you future, too!

 

[Minstrel]

What is a CPM?

 

[sistersinhim]

CPM=continuous passive movement (machine).

 

[bertschb]

My recovery has been influenced by the many people who said, upon hearing that I was getting my knee replaced, "oh, you're so young and so active - you'll just fly through this". So, my expectations for a quicker recovery were pretty high . . . and it just hasn't been the case.

This is exactly my situation. I was riding my mountain bike 20+ miles every day prior to surgery. It was one of the last things I could do with my failing knee. I'm relatively young, not overweight and I was in great shape prior to surgery and figured recovery would be easier and faster for me than the "average" person. I was sooooooo wrong! I really struggled with my recovery because of this mindset. Still do.

 

[Celle]

My recovery has been influenced by the many people who said, upon hearing that I was getting my knee replaced, "oh, you're so young and so active - you'll just fly through this". So, my expectations for a quicker recovery were pretty high . . . and it just hasn't been the case.

The people who told you that haven't had knee replacements themselves and they set you up for unrealistic expectations!
Recovery from a TKR takes a lot longer than recovery from most surgeries and, no matter how young and fit you were before the surgery, the tissues of your knee take just as long to heal as they would if you were 80 years old. You just can't speed up this recovery.

KarriB - interesting that you should describe the stiffness you felt like a rubber band. That's more the case for me now, although a couple of days ago, I described the sensation as having a tourniquet on my knee (it was much tighter!).

Have you read this article?
"Tight band" feeling across the front of my knee