TKR One year later and all is well

[Josephine]

Here y'go then!

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)

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.

 

[Celle]

The inability to move without painful repercussions is really getting me down.

It's only 3 months since you had major surgery that caused a lot of trauma. Complete recovery of all your knee and surrounding tissues will take a full year. It takes all that time, whether you are young and fit, or elderly and frail. There is absolutely nothing you can do to speed it up, but consistently overdoing the exercise could increase inflammation and actually slow down your recovery.

Your knee needs all that time and when you do more than it likes, it tells you so, by giving you more pain. Listen to your knee and try to do what keeps it happy.

This recovery is a marathon, not a sprint. You need to pace yourself.
I know it's hard, but being patient really is a wise investment.

 

[sistersinhim]

That pain is telling you that you are doing way too much. Slow down and follow the Bonesmart guidelines. You will find relief then. Be sure and answer Josephine's questions. She is a huge help!

 

[KarriB]

I'm sorry you're experiencing more pain, but I agree with Celle and Paula. As you said yourself it's probably due to the exercises. I've come to the personal conclusion that walking is a really good exercise at 2-3-4 months post op and wish I had done more early in my recovery. Walking is what we want our new knees to do first and foremost. Starting slow and adding 5 minutes a week helped me to walk longer without pain and stand longer without pain. The strength building can come much later when your knee is totally healed. My PTs started some strength work later and I had no pain at all.

 

[Minstrel]

Josephine,

1. My pain level while at rest is 0. Whenever my knee tries to bend beyond its limit, however, the pain increases. It isn't intense and it's not ever long lasting because it's the pain associated with stiffness - when my knee just does not go any further.

2. I have not taken the oxycodone I was prescribed for several weeks (8?). Now I take 2 X 200 mg of ibuprofen once or twice a day. Less frequently I take 1 or 2 X 500mg of acetominaphen (rather irregularly).

3. Swelling is moderate.

4. Flexion is -6 (6 degrees shy of straight) and extension is 96; last measured June 6.

5. Icing is at least once a day using a gel pack till it warms - 40 minutes, or so. I also take a gel pack to bed a couple of times a week.

6. Elevation usually occurs in the evenings in conjunction with icing. I also elevate any time I am just reading or watching TV while not at my desk or a table - 2 to 3 hours per day?

7. I now do all the activities of daily living - preparing meals and cleaning up afterwards, housework, laundry, grocery shopping and other errands. I live in a 2 storey house with my office on the second level; I must go up and down stairs 20 to 25 times a day. I have not been doing any yard work.

8. During the first 5 weeks post-op, I pretty much followed the exercise regime prescribed in the 40 page booklet I received prior to my surgery. By the end of that period I was doing 900+ conscious contractions of either my quadriceps or my hamstrings every day (10 different exercise X 30 reps X 3 times daily). After a miserable physio appointment on April 13 where I had had no improvement in my measurements for 10 days, I turned to the Internet and that's how I found Bonesmart. I have not had a physio appointment since then. And I have not followed an exercise routine since, either.

From that time till 11 weeks post-op, my exercises consisted of more of the activities of daily living as i was able to do them and walking outside for about 10-12 minutes at a time - first with 2 crutches, then with just 1, then with a cane.

In the days leading up to my 3 month check-up with my surgeon on June 6, I participated in 2 aquafit classes and used a recumbent bike for the first time (15 minutes at level 0; seat as far from the pedals as possible to allow for leg extension). Since then, at the urging of my surgeon to start re-building the strength in my quadriceps, I have added 10 minutes on an upright bike (level 0; seat very high - greatest extension of my operated leg), and leg presses (2 -3 X 25 reps with seat allowing only a 90 degree knee bend at level 0). In the pool, I have been flutter kicking up to 30 lengths of a 25 metre pool with my scuba fins on - again, as suggested by my surgeon to re-build strength.

So, I have waffled between intense exercise, almost no exercise, and the re-introduction of exercise and physical activities. It was 2 days ago that I was last in the pool/at the gym. Seems I'm back to no exercise because my knee is very stiff again.

 

[newlybionic]

I just caught up to your thread. I'm sorry you are experiencing problems with stiffness in your knee. I'll just make a few comments on what I read from your answers.

Your ROM is 6(extension) to 96 (flexion) as of June 6th. I found that it took me almost a full year to get extension in my left knee. My question to you is was that knee fully straight before surgery? If not that can take a bit extra time to get there during recovery.

If you have moderate swelling you should ice as frequently as possible during the day and to make sure you are elevating your knee correctly. (Toes above knee and knee above hip). That way the fluid that had accumulated there can move back into your circulation and be eliminated. If you leave your leg level the fluid will just stay where it is and it will take much longer to finally get rid of the swelling.

I would stop exercising now especially in light of the fact you are doing so many stairs. You might want to try to see if you can limit it a bit if possible. I truly think if you just concentrate on taking full strides when walking and relaxing a bit more you will get pass this stiffness faster. I learned this the hard way myself. After my revision on my left knee I did little in the way of exercising. I never did anything that caused me pain (discomfort, yes but no pain). I surpassed my OS expectations after that total revision. My ROM at last check was 0, 130. I gave my knee time to heal and all of the swelling to come down. I went back to full time nursing at 13 weeks and never worried about exercising again.

 

[Josephine]

1. My pain level while at rest is 0. Whenever my knee tries to bend beyond its limit, however, the pain increases. It isn't intense and it's not ever long lasting because it's the pain associated with stiffness - when my knee just does not go any further.

Increases to what?

2. I have not taken the oxycodone I was prescribed for several weeks (8?). Now I take 2 X 200 mg of ibuprofen once or twice a day. Less frequently I take 1 or 2 X 500mg of acetaminophen (rather irregularly).

I suggest you stop taking NSAIDs (ibuprofen) as a) it is a notoriously poor pain med, b) it has no effect on this kind of swelling and c) has some serious side effects - read this acetaminophen (Tylenol, paracetamol) and NSAIDs, differences and dangers
I suggest that instead you try 1,000mg Tylenol 3-4 times a day.

3. Swelling is moderate.

Since swelling is also a manifestation of pain, would I be correct in assuming you didn't factor this in when answering Q1?

4. Flexion is -6 (6 degrees shy of straight) and extension is 96; last measured June 6.

I think you have your numbers a bit mixed up! Flexion is the higher number and extension is the lower which may also be a plus or minus situation.Therefore your ROM is 96/-6 which is actually pretty good for 16 weeks.

5. Icing is at least once a day using a gel pack till it warms - 40 minutes, or so. I also take a gel pack to bed a couple of times a week.

Do you feel you really need the ice? Does it make your knee feel better? If so, in what way?

6. Elevation usually occurs in the evenings in conjunction with icing. I also elevate any time I am just reading or watching TV while not at my desk or a table - 2 to 3 hours per day?

Jolly good but are you elevating with a dead straight leg?

7. I now do all the activities of daily living - preparing meals and cleaning up afterwards, housework, laundry, grocery shopping and other errands. I live in a 2 storey house with my office on the second level; I must go up and down stairs 20 to 25 times a day. I have not been doing any yard work.

Good.

8. During the first 5 weeks post-op, I pretty much followed the exercise regime prescribed in the 40 page booklet I received prior to my surgery. By the end of that period I was doing 900+ conscious contractions of either my quadriceps or my hamstrings every day (10 different exercise X 30 reps X 3 times daily). After a miserable physio appointment on April 13 where I had had no improvement in my measurements for 10 days, I turned to the Internet and that's how I found Bonesmart. I have not had a physio appointment since then. And I have not followed an exercise routine since, either. From that time till 11 weeks post-op, my exercises consisted of more of the activities of daily living as I was able to do them and walking outside for about 10-12 minutes at a time - first with 2 crutches, then with just 1, then with a cane.

900???? Ye Gods!

In the days leading up to my 3 month check-up with my surgeon on June 6, I participated in 2 aquafit classes and used a recumbent bike for the first time (15 minutes at level 0; seat as far from the pedals as possible to allow for leg extension). Since then, at the urging of my surgeon to start re-building the strength in my quadriceps, I have added 10 minutes on an upright bike (level 0; seat very high - greatest extension of my operated leg), and leg presses (2 -3 X 25 reps with seat allowing only a 90 degree knee bend at level 0). In the pool, I have been flutter kicking up to 30 lengths of a 25 metre pool with my scuba fins on.

My dear, let me tell you that with all those stairs and doing all your housework, you really DON'T NEED any exercises at all! And the very last thing you should use is a leg press! Very bad for the knee. Read this BoneSmart philosophy for sensible post op therapy

So, I have waffled between intense exercise, almost no exercise, and the re-introduction of exercise and physical activities. It was 2 days ago that I was last in the pool/at the gym. Seems I'm back to no exercise because my knee is very stiff again.

I am not at all surprised! To say you've been overdoing it would be a monumental understatement!

From what you told me, you appear to be vacillating between none, some and stupid amounts of exercise! You're only 15 weeks out so please take my advice and just stick with daily activities and nothing more. Your ROM will carry on improving - as will your muscle strength - over the next few months. Just try and be normal!

 

[kneeper]

All those stairs jumped out at me too. That's exercise in and of itself. I was still working to minimize trips up and down stairs once I was back to work at 3 months, especially because I was on my feet a lot at work. But by the time my knee(s) was recovered I was doing stairs without a second thought.

IMHO so long as the knee is swelling and this painful, you should be easing into exercises slowly. You'll get there, it just takes time. For my first knee I let them talk me into doing some things too soon and the payoff was needless long range pain. For knee #2 I took it slow and steady and I recovered much less painfully and a bit more quickly.

 

[katdog]

Minstrel - I am sorry you have had to go through all this, but glad you found Bonesmart and are taking more control of your healing. I am at day 21. I found this site before surgery and have, except on my stubborn days, followed the protocols. I hope to do as well as you have, because, really, your ROM is great!

 

[kayak59]

@Minstrel From another kayaker, you'll get there! And yes, it is so wonderful to be out on the water and as good as any one else! Last year did not go as planned and I just thank God I could at least get in my kayak.

Prior to my knee surgeries, the way I would get into my kayaks was I would straddle them, plop my rear down in the seat and then bend my knees and slide them into the cockpit. When I got in the kayak the first time at around 2 months I think, I sat on the back of the cockpit and put my legs in first, then slid in. A little bit difficult with the high seat back of my Tsunami but I managed. Friends were holding the kayak level for me. I was able to bend my right knee enough to get in the "old" way maybe 9 months after the TKR and 12 months after my left TKR, I was getting in my kayak "normally". (And by the way, got in normally one month after my THR too.) Now, getting out of the kayak was fun in the early months but I managed, getting wetter in the process than I normally would, but at the expense of my dignity, I did it. (Or got help -- never let my pride stand in the way.) If I land on an uphill incline, I usually get help -- still -- but so do a lot of people younger than me who haven't had TKRs. Last year I went on several overnights and long paddles without any major problems. Sometimes my knees would hurt a bit if I was pressing them against the kayak sides for a long time but I would straighten and shake my legs out often and that never lasted.

Recovering now from a THR and thumb "replacement" and I'll be back in my boat on a regular basis as soon as I can load it myself. Hopefully I'll be back in friends' boats much sooner. I anticipate being fully back to normal by fall -- both flat water and white water. While I was recovering from the knees, I concentrated on doing upper body and abdominal workouts and gentle lower body, increasing the latter slowly. Going to be more interesting this time around with a splinted right arm but I'll figure it out. Best of luck!

 

[PolarBear60]

It took me almost two years to be able to do stairs "normally" and sometimes I still one leg them if I'm tired, carrying something, or feel unstable for other reasons. At least now I have minimal to no pain no matter how I do them.

 

[Minstrel]

Over the past couple of days I have taken the opportunity to read and digest the many comments since my last post. And I have also read a couple of new threads.

And I would like to thank everyone for their words of support.

I have also curtailed my activity considerably and feeling better for it. I'm learning to listen to my body, especially my knee joint.

Josephine: Of course, my numbers for flexion and extension were mixed up - my mistake. I'm understanding now that stiffness is pain and when I feel that stiffness, my pain level increases to at least 5. Icing for me does not seem to be reducing the swelling as there is no appreciable reduction in the size of my knee no matter how often I ice. I have not been able to fully extend my leg for decades; nonetheless, elevation is done while my leg is as straight as I can get it. Believe it! Those hundreds of exercises are prescribed according to the 40 page booklet all knee replacement patients are given where I live.



Marian: Prior to my TKR my extension was -23, so my leg was perpetually bent. Now it's -6, so of the 19 degrees of ROM I have gained post-surgery, 17 of them have been in extension. Was not aware that this circumstance could lead to a longer time to achieve full extension (just another thing I was never told at any time). Thanks for the suggestion to concentrate on taking full strides while walking; lately I have been 'waddling' side to side when I walk - I guess it's limping. Sometimes i go back to walking with a cane because my gait is so "off".


It's very, very difficult for me to not compare myself to other patients, especially those who have terrific ROMs. Tomorrow is 15 weeks post-op and I'm so discouraged at my lack of flexion. Patience and near complete rest would be so much easier if I had 130 degrees of flexion, but I'm stuck at 94. This has been such an emotionally draining journey.

Tomorrow we're departing for our first camping trip of the season where the focus will be on kayaking. Lookinfg forward to a change in scenery and daily opportunities to move without stressing my knee.

 

[sistersinhim]

Getting out and away from your knee worries will be so good for you. I, too, love to kayak and am looking forward to getting back in the water!

Enjoy your trip!

 

[Josephine]

my pain level increases to at least 5

And more I'll bet!

Icing for me does not seem to be reducing the swelling as there is no appreciable reduction in the size

Actually the intention is for it to reduce pain rather than swelling though the two are interconnected.

I have not been able to fully extend my leg for decades; nonetheless, elevation is done while my leg is as straight as I can get it.

Well that accounts for a lot! That being the case, you're unlikely to see a great increase in ROM until a year is out.

Those hundreds of exercises are prescribed according to the 40 page booklet all knee replacement patients are given where I live.

I don't disbelieve it but it's still a ridiculous amount of exercising. I doubt Olympic athletes do that much except when they are in training! And given you history of limited ROM, they really are only going to cause more pain, stiffness and lack of ROM.

 

[kneeper]

Most of my pain was what I call "achy stiffness" and like you, I'm glad you're "hearing" your knee and figuring out what works for you.
Have fun on your trip and keep listening to the knee.

 

[Minstrel]

It has been 4 months . . . shouldn't I be able to go downstairs normally by now? Usually I take the steps one at a time, or I turn sideways so as not to bend my knee beyond its capabilities.

And I waddle when I walk - I guess that's akin to a limp. Is this what is making my glutes and my lower back sore?

Short of trying to go about my days as normally as possible, I have not been undertaking any intentional exercise. I miss moving.

I feel like I'm setting the record for the slowest recovery on the forum.

 

[sistersinhim]

You are only 1/3 of the way of at least a year long recovery. Going down those steps normally will come. I found my biggest problem was the fear. My rails are on both sides, so I could grab both of them and then attempt to step down normally. It took a while for me to be able to do it. It had been about 20 years since I had stepped down normally, but I did at about 5 or 6 months! If you can use both hands to hang on to the rails, then try to step down when your knee is ready. You'll find you will eventually be able to do it, too!

 

[kneeper]

Can you step down stairs at all? I would just try doing a couple of steps down a day at first and gradually it got easier. I can tell you I was doing them very gingerly and not a full flight at a time at 3-4 months with my first knee.

 

[KarriB]

I used a cane until my gait was normal and still can't go downstairs normally, but that's due to my gimpy left knee. The RTKR does all the stair work.

 

[Minstrel]

Can anyone advise if the ROM I had pre-surgery will have a bearing on the ROM I can expect by the time a year has passed? Pre-surgery ROM was 71 degrees.