Bilateral TKR Oregon Mom's recovery journey

[Murphy2013]

Hi Oregon Mom, oh my gosh I thought I was the only one who had that symptom. (i named it the Grandpa from the Real McCoys hitch;
right in the middle of a walk/stride it would feel like a little knuckleball in mid-knee). I had an MUA 9/3 and it went away with the nuclear solution. It is a relief to have it gone but....Never really understood what it was.
Anyway, I love reading your thread. At 3.5 months I have good days then (wait for it) I do something too much and ouch again. Am using this time to try to process a sense of humility because I was so attached to my athlete self and now I am slowest walker in community and not back to the pool yet. It is hard no doubt but shared community is everything.

 

[Mrs. Ciz]

I also had a twang behind my left knee that happened every time I did heel slides. I was really worried about it for a while, but it went away after a couple of months. I have not felt it in several weeks now. My left knee is doing really well with strength and ROM - so much better than my right knee. Obviously my twang was just something that needed time to heal. Maybe yours does too?

I’m much more concerned about the lingering behind the knee pain in my right knee. At 13 weeks, it’s still a huge issue, and it really contributes swelling and stiffness in that leg. I’m so ready for it to resolve.

 

[Oregon mom]

(i named it the Grandpa from the Real McCoys hitch;
right in the middle of a walk/stride it would feel like a little knuckleball in mid-knee)

Oh no that's so funny! I actually laughed out loud reading that. Oh boy ack! Please don't tell me I have to have an MUA to make Grandpa go away!
People tell me I was brave to have a bilateral, but I think the MUA and revision folks are the brave ones.

 

[Oregon mom]

I’m much more concerned about the lingering behind the knee pain in my right knee. At 13 weeks, it’s still a huge issue, and it really contributes swelling and stiffness in that leg. I’m so ready for it to resolve.

I'm so sorry this is still bothering you! Sending prayers and hugs.

 

[Oregon mom]

Man, these steri strips... They are slowly peeling away, and I'm trimming them back. But there's a residue of medical glue, dried blood and lint and it's just not easy to look at. My poor 7 year old son is so disgusted and freaked out. There are a couple exciting tiny spots of pristine pink scar tissue that give me hope. Even trimming the strips back, I worry I'll catch them on a blanket or something and then my knee will pop open and my patella will roll under the bed. If I look at them, the sutures ache. So I try not to look but kinda hard when they are right in my face all day. I wish I could cover them up but I can't think of any feasible way to do that. I want them in the air. Draping even a light cloth, like hospital gowns I've taken to wearing, would be irritating.
So I just walk around with flaky chunks for knees?
Speaking of flakes, I discovered that what I thought was very dry skin, was actually a thin layer of medical glue peeling away. I guess they painted the whole knee and really slathered it on to adhere the steri strips.
I wonder when this part is over?

 

[Fran55]

Hi @Oregon mom - I came over to your thread to see how you are going. Thank you so much for the laugh. I am sitting here in my recliner with my knees dutifully elevated waiting to be able to pop a sleeping pill and try for my first good night's sleep. I am visualising the patella rolling under the bed.

My steri strips just slowly peeled off - no glue. That's another thing I find fascinating. There are so many different ways our procedures have been done, medications we have been given, how much medication we are given, therapy that we do, how long we are in hospital.....

You still have your sense of humour - well done !

 

[Oregon mom]

So discouraging!
It can be really hard to stay positive sometimes.
Went to see the PA yesterday to check my incision. It looked uneven, but she said that it is ok and is healing fine.
She commented on how well my legs were bending while I was sitting on the table and asked about my ROM. I had ordered a goniometer for myself and I told her I'd measured 110° on the right and 100° on the left. She replied "Oh, you measured yourself," in a tone that sounded mildly dismissive. She asked what my ROM had been previously, and I told her I could easily pull both heels right to my butt. Then her eyes got big and with some urgency, she told me that I really needed to bump up my PT and get to pushing my knees soon before I hit that dreaded 6 week mark. I'm at 4 weeks now. She suggested I ask for in-person PT so the therapist could force my knee ROM. She told me it is painful, but that often its easier for us to have someone else push us than to do it ourselves.
I don't understand why the information is so varied. Why is this professional in modern times telling me that I need to have someone push me into pain, while exactly the opposite is stressed here on BoneSmart? It seems so counterintuitive to cause pain, yet it is pushed by the PA, therapists and all over the internet.
Even if it makes logical sense to avoid pushing into pain, I cannot help but start to doubt myself all over again after a conversation like that.

 

[sistersinhim]

Why is this professional in modern times telling me that I need to have someone push me into pain, while exactly the opposite is stressed here on BoneSmart? It seems so counterintuitive to cause pain, yet it is pushed by the PA, therapists and all over the internet.
Even if it makes logical sense to avoid pushing into pain, I cannot help but start to doubt myself all over again after a conversation like that.

These might be modern times, but that PT of yours is doing it the old fashioned way. PTs years ago were trained this way. Newer training is that the gentle way is the best way to rehab a joint replacement. You will find just as many, if not more, PTs rehabbing a joint replacement this newer gentler way.

Bonesmart was started in 2004. In these 16 plus years, Bonesmart has had tens of thousands of joint replacement patients. We have learned from these patients what works best for the vast majority, that the gentle way to rehab has better long term results. Gentle therapy doesn't cause increased pain or swelling and allowed the joints to heal from an extremely traumatic surgery. Less swelling means better ROM.

Can you bend a water hose that is full of water? Nope. Run out that water and the hose will roll right up. Your knee is the same way. Get the fluid out and it will have a better ROM.

 

[Oregon mom]

PTs years ago were trained this way. Newer training is that the gentle way is the best way to rehab a joint replacement.

This wasn't a PT, it was Physicians Assistant, just one step down from an MD. That's what makes it even more confusing. I'd gone in to have my incision checked and a medical professional with prescriptive power is telling me this.
My other question is, if my swelling has gone down am I expected to push further? It seemed like she was addressing my not - as-swollen-anymore knees and suggesting it was time to start forcing the joints to move further before I hit 6 weeks.

 

[sistersinhim]

This wasn't a PT, it was Physicians Assistant, just one step down from an MD.

The handling from her is the same thing. No one should touch your knee or force it.

if my swelling has gone down am I expected to push further?

There is never a reason to push beyond what your knee allows without pain or causing extra swelling. Even if you don't see swelling on the outside the inside of your knee is probably still very swollen. Your knee is less than 5 weeks old. It still needs to be treated gently. Listen to it. You have already found out that the PA pushing it caused increased pain and swelling. Remember, this is at least a year-long recovery that you have going on there. There is lots of time for ROM to improve.

 

[Oregon mom]

Remember, this is at least a year-long recovery that you have going on there. There is lots of time for ROM to improve.

Thank you... It can be so hard to stay on the right track when you get mixed messages. There's the fear of "What if."
I started walking around the 1/10 mile track at the elementary school behind our house. Also trying to stretch more. It is exhausting.
I am 47 years old and was in excellent shape prior to surgery, and I have literally been brought to my knees with this recovery. I went in rather smugly, thinking I'd have it mastered in no time due to my age and fitness level. This has been humbling to say the least.

 

[Jockette]

Why is this professional in modern times telling me that I need to have someone push me into pain, while exactly the opposite is stressed here on BoneSmart? It seems so counterintuitive to cause pain, yet it is pushed by the PA, therapists and all over the internet.

The biggest thing I’ve learned in my joint replacement journey is that there are many opinions on how to recover, contradicting each other. That tells me that there is not only one way to recover. And, since there are so many contradicting opinions, your opinion is the most important of all. Decide for yourself how you will recover.

In my recovery I was so worried about what literally everyone else thought, that I was a nervous wreck the whole first year. Well, I’ve come a long way since then (I’m 3.5 years post op) and if I do this again, it will totally be on my terms. I have a lot more knowledge now than I did then and I know what to do and not do, to recover well.

 

[sistersinhim]

I went in rather smugly, thinking of have it mastered in no time due to my age and fitness level. This has been humbling to say the least.

Sometimes younger patients have a harder time with patience! I'm sure being in good shape before your surgery will be an advantage. But, you have more muscle mass than most older people. Maybe that means more to heal. You'll get there when your knee is ready to get there. You can not speed up healing but you can slow it down by doing too much.

 

[Oregon mom]

A couple of things I've found to be useful.
FURNITURE GLIDES - These are incredibly inexpensive products meant to be placed under furniture that sits on a carpeted surface. They come in a wide variety of sizes, even as large as a big human foot. They are a great way to do slides with legs and arms on carpet.
GETTING ON AND OFF THE FLOOR after BTKR - There is a great post on BoneSmart by a woman who posted step by step how to accomplish this. I lost the link. But also, for those who are limber and familiar with yoga moves, the Downward Dog and Plank can also be a great sequence to get to the floor and back up without other supports. Downward Dog slowly into Plank. Gently lower to belly keeping quads strong. Gently roll to back. You are on the floor. This can be accomplished without pressure on the knees of the feet are flexed and arms are strong. Not for everyone.

 

[Oregon mom]

(I’m 3.5 years post op) and if I do this again, it will totally be on my terms.

Do you feel like you have your range of motion back? I know these new knees are never really the same as our native knees and may have limitations on movement, but do you feel as if they are integrated into your form?
I'm looking forward to one day not thinking about my knees at all.

 

[sistersinhim]

I can give you my opinion. The only difference in my new knee before its surgery is that it has no arthritis. My ROM is the same as is my strength. My old knee crunched every time I bent it and this one clunks. The crunch hurt but the clunks don't. I do not regret my new knee at all and love not have that arthritis pain. I can do things now that I had been unable to do for over 25 years. It was well worth the TKR!

 

[Jockette]

Well, I’ve not had the best outcome, so, no, my knee is not normal. I had a partial, in a somewhat small town, and I seriously wonder now how many partials my surgeon has done. I regret trusting the first and only surgeon I saw to know what was best for me. One of the things I’ve learned since is that the experience of your surgeon, with your particular procedure, is key to a good outcome. He has great reviews on his totals.

My PT was fairly aggressive, and even my surgeon was a fan of force bending my knee at each appointment, to get the highest ROM number he could. It took me until my 7 month check up to refuse to let him do that, because I was afraid to stand up to him. I won’t allow either of those things next time.

I backed way off PT when I found Bonesmart at 4 weeks post op, after suffering so much in my recovery.

However, even with a generally poor outcome, my knee is way better now than it was that whole first year of recovery. It continued to heal and relax over the next year. My ROM has improved in my second year, and even in my third, proving there is no window of opportunity.

My actual ROM is good, however, I have poor function. I still can hardly do stairs foot over foot, either up or down, and I can’t bend my knee and put weight onto it, like to lean down and reach into a lower cabinet, or to pick anything up off the floor. I have to bend at the waist, which wreaks havoc with my back.

Ive had 2 second opinions and neither found anything to fix, though they never looked past my good X-ray to find a reason for my limitations. After the second, second opinion, I got fed up with it all and decided no more second opinions and just accepted what I have, though I actually have more issues now than I did before my replacement. I’m doing ok with what I have so I try to be content with that.

 

[Oregon mom]

Wow those are two very different individual stories! It really shines a light on just how different the experience can be. And even between the two knees.
I knew going in that this would be a long process. And I understand that I'm only just beginning. But there's the intellectual understanding of something and then the rubber hitting the road side.

 

[leejaa]

At 4 weeks I did not force my knees to do anything they did not want to do. No one forced them to do anything either. My OS did not push on them just looked to see how I was doing and my PT did not push. I did minimal exercises that felt good but not too much to cause pain.

The one thing that really worked for me was my platform rocking chair ( I am sure a regular rocking chair would work also). Rocking is meditative and it bends your knee naturally without thinking as you relax and how much you let it bend. I would start out with my knee further out so minimal bend and slowly bring the foot back closer to the chair and continue rocking as I watched TV or read. I did not force it and I actually kept ice on it (I had a wrap with ice packs provided by the hospital) as I rocked. Motion without pain.

I can do more with my replaced knees than my originals since there is no pain. I have full flexion and extension and I have had now for years. I am so thankful to be able to go walking or hiking or ride the bike without pain. I can grocery shop without pain or clean the house (not my favorite things to do).

You are doing excellent for 4 weeks. I am sorry the PA was being so old fashioned in her outlook.

 

[Oregon mom]

@leejaa Thank you so much for the reassurance. I was adhering to that line of thinking and feeling peaceful. Sometimes it takes just one person to make you question yourself all over again.
I have another question about flexion. I'm starting to experience a really pleasant sensation now when I can get the swelling down and flex. Its a strong, all over the front, top and just above the knee feeling of.. all I can think to describe it is like superficial fascia breaking up, stretching, letting go. It's less intense each time I flex. My knee is tight, but this feeling is kind of fun actually.
What's worrying me is the deeper feelings I'm getting that feel like tendons catching, or things deep in the joint that seem like they will just never stretch out. These feelings can be sharp pain, extreme tightness, catching. They don't feel like the temporary, superficial tightness over the top of my knees.
Two very different sensations.