PKR partial knee replacement x2, swelling<<

[xyxex_kayn]

Did they show you how to use the cane?
I agree with you that it's important to feel stable, and if you can do it without the cane, go for it. You may tire easily though, so listen to the knee and your body.

I know how to use the cane i used it one day during the fifth week after the first surgery. Since it was the the left knee i used the cane in the right hand.

That being said, i used the cane in the left hand since the newest surgery was on the right knee and it is my weakest knee. But, was unsteady trying to walk with it and i rolled my left ankle. But was able to walk better without it so thats what im doing. I do really well, unless i get tired then i short step instead of taking strides

 

[xyxex_kayn]

I do have a question for the community to see if anyone else has this problem or not. I don't have the swelling in my legs and feet like I did right after the second surgery. But, I do have slight swelling because I can push on my lower legs and leave an impression in my leg.

Most of the time after I have PT, and I get home, a few hours later my feet start to feel swollen (like when they really got swollen to the point I couldn't wear shoes). A tightness in my feet, in the area of the toes. At its worst it will be painful. The pain will be a sharp pain, and if I hold my feet over the edge of the bed I get a bit of relief and can feel twitching in my feet like muscles loosening up or regaining blood flow after (falling asleep) not the tingling feeling just twitches.

If anyone has had something like this what did you do for relief or what may be causing it.

 

[Celle]

I think it's all part of the swelling you get after a knee replacement. After PT, you will get some swelling, as a result of the activity. That's normal.
For you, the swelling has most effect in your feet. I think that's gravity working.

When you get home from PT, spend some time resting, icing and elevating, being particularly careful to get your feet as high as you can. You can try icing your feet as well, to see if that helps the strange feeling in them.

 

[xyxex_kayn]

My Pt is at 11am when I have it, and if I have issues I do ice and elevate. The foot issues don't start till the evening hours, and I elevate when it starts, I'll even go to bed to elevate and it will get worse, making it hard to sleep, and then the sharp pain will occur. But eventually sleep wins over and by the time I get up the feet are fine or at least feeling better.

 

[Celle]

Then it may just be cumulative swelling at the end of the day. The fact that it feels better by morning, after a night of inactivity and elevating seems to suggest that.
However, I'm going to ask @Josephine if she has any suggestions for you. Josephine, the problem is explained in Post#162.

 

[Josephine]

But, I do have slight swelling because I can push on my lower legs and leave an impression in my leg.

later my feet start to feel swollen (like when they really got swollen to the point I couldn't wear shoes). A tightness in my feet, in the area of the toes. At its worst it will be painful. The pain will be a sharp pain, and if I hold my feet over the edge of the bed I get a bit of relief and can feel twitching in my feet like muscles loosening up or regaining blood flow after

Sounds like you've developed lympedema which is somewhat different to ordinary swelling. That does have this kind of 'worse in the evening' pattern, in my experience. But you're only 8 weeks out yet so it may be a bit early to jump to conclusions like that.

Nevertheless, I'm like to ask you some questions (again!!) if you don't mind, and 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. And don't compare this with the bone-on-bone pain you had before surgery! )

2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?

3. how often are you icing your knee and for how long?

4. are you elevating your leg, how often and for how long?

5. What is your ROM - that's flexion (bend) and extension (straightness)

6. how swollen is your leg?

7. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and

8. what kind of PT exercises and exercises at home are you doing? How much and how often?
This is the most crucial question so please help me by using the format I have left as an example

Exercises done at home: (enter number) of sessions each day
(enter exercise) x (enter number of reps and sets)
(enter exercise) x (enter number of reps and sets)
(enter exercise) x (enter number of reps and sets)

At PT
(enter exercise) x (enter number of reps and sets)
(enter exercise) x (enter number of reps and sets)
(enter exercise) x (enter number of reps and sets)

 

[xyxex_kayn]

1. I would say about 97% of the time my pain lvl at most 1 (or less, some pain, but if I'm busy with something I forget about the pain. (this last week, I don't know if the weather or not, its been as high as 3, after 2 days in a row of PT)

2. I'm no longer taking the Percoset or the Oxycodone. Still taking Meloxicam 7.5mg twice a day. Tramadol HCL 50 mg every 6 hours. (just received a 30 day supply, and appointment made with doctor to discuss weening me off them after close to 3.5 years because of arthritis). Also if suggestions for some pain meds im taking Warafrin, so limits what i can take.

3. I'm icing twice a day for about an hour. Once when I get home from rehab, than about an hour or two before I go to bed for a hour or two. An hour for each knee or 2 hours for right knee if its really hurting. Most of the pain I get is in the right Knee.

4. I elevate while icing, and if I'm in living room I elevate while in recliner. Helps with knee but will aggravate the feet. So anywhere from 3 to 5 hours aday

5. Haven't had a recent, measurement since I started PT, but this past Tuesday, while therapist was doing manual flexion, just bending heal to rear, he says I'm at full flexion because of the size of my leg and calf. Last measure but for number's sake, I was 109 left knee and 107 right knee 4 weeks ago and it does seem as though I'm doing a lot better on flexion. Extension I was -2 left knee (was at 0 before surgery on right knee and all the complications with it), -5 on right knee, the same time therapist was doing manual extension, he could barely put his fingers under left knee, but only a little bit more with the right knee

6. would be just a bit over slight, but no where near moderate.

7. My wife takes care of all of this, but she does have me drive to post office to get mail where I have to go in get the mail, and get in and out of vehicle. Otherwise she has me resting my knee. I also drive to rehab. Spent last weekend getting in and out of car visiting friends and family.

8. Exercises done at home:
I use exercise ball at home, with heel on ball, bring heel to rear and then extend leg. 2 sets of 20 each leg
straight leg raise 2 sets of 15 each leg.
walking 4 sets of 25 feet in house hallway

At PT
Exercise ball 2 sets of 20 each leg
straight leg raise 2 sets of 15 each leg 2 pound weight
Knee bend 2 sets of 15 each leg 2 pound weight, with something under knee to only raise to straight position
knee bend 2 sets of 15 each leg 2 pound weight, from seated position.
squats 3 sets of 5 from seated position to standing
Heel slide 2 sets of 15 with tension from rubber band held by therapist
Marchs 2 sets of 10
heel lifts 2 sets of 10
side steps 1 set of 10, 5 steps to the right and 5 steps to the left = 1 rep
8 inch step 2 sets of 5 each leg, lead with right leg, then lead with left (just started this height Friday)
Walk throughs 2 sets of 5 each leg, plant right foot, step forward then step back behind foot each leg
Toe raises 2 sets of 5, able to raise heel off ground
heel raises 2 sets of 5, able to raise toes of ground

did PT Tuesday and Wed did 6 inch steps, but right knee was hurting wed, and didn't do l two exercises nor was I able to do them on Friday because of pain in my right knee. Instead therapist iced my right knee both front and back side of knee

 

[xyxex_kayn]

I have been doing these exercises since the beginning just lower reps built up over time. and havent had a problem with pain till this past week. Only thing i can think of was because of the weather change we had or when doing the manual check of flexion and extension, the therapist used some pressure to help with extension, there was a tiny bit of pain done on left knee but not right knee. but the right knee is the one that is hurting since.

 

[Josephine]

1. I would say about 97% of the time my pain lvl at most 1 (or less, some pain, but if I'm busy with something I forget about the pain. (this last week, I don't know if the weather or not, its been as high as 3, after 2 days in a row of PT)

I'll speak about this later.

taking Meloxicam 7.5mg twice a day. Tramadol HCL 50 mg every 6 hours.

okay - not taking any Tylenol with it then? Don't you know that 1,000mgs Tylenol with each dose of Tramdol enhances the latter very well?

3. I'm icing twice a day for about an hour.
4. I elevate while icing, and if I'm in living room I elevate while in recliner. Helps with knee but will aggravate the feet. So anywhere from 3 to 5 hours a day

An hour twice a day is not enough. Why don't you ice while you are elevating? That would be good.

Extension I was -2 left knee (was at 0 before surgery on right knee and all the complications with it), -5 on right knee, the same time therapist was doing manual extension, he could barely put his fingers under left knee, but only a little bit more with the right knee

Never ever allow a PT to force bend your knee. It's a pretty good way to get inflamed tissues and aching. And your extension is absolutely fine so he has no need to do that. none whatsoever.

6. would be just a bit over slight, but no where near moderate.

Okay.

7. My wife takes care of all of this

My comments in bold
Exercises done at home: how many times a day?
exercise ball bring heel to rear/extend 2 sets x20 each leg - this is much like heel slides and is not a good idea to do 40 in one intense session. You're better of doing heel slides but properly! Heel slides and how to do them. Plus you should NEVER use weights. Jolly good way to get pain.
straight leg raise 2 sets x15 each leg - a tip about SLRs, once you can do them, you don't need to do them any more!
walking 4 sets of 25 feet in house hallway - you'd be better just walking when you need to - bathroom, kitchen, etc.

Exercise ball 2 sets of 20 each leg - not good as I said previously, don't do them
Knee bend 2 sets of 15 each leg 2 pound weight, with something under knee to only raise to straight position - NO weights - ever!
knee bend 2 sets of 15 each leg 2 pound weight, from seated position - NO weights - ever!
squats 3 sets of 5 from seated position to standing - squats are a very good way to get pain
Heel slide 2 sets of 15 with tension from rubber band held by therapist - NO resistance like this, it strains the muscles and ligaments around the knee
Plus these four above are all flexion exercises and it's not good to do so many in one intense session.

At PT - you've not said how many times a week you go to PT
straight leg raise 2 sets of 15 each leg 2 pound weight - no weights!
Marchs 2 sets of 10 - marching is punishing on the knee
heel lifts 2 sets of 10 - so is this
side steps 1 set of 10, 5 steps to the right and 5 steps to the left = 1 rep - so are these and largely unnecessary. Plus they are strengthening exercises which you don't need at less than 4 weeks out.
8 inch step 2 sets of 5 each leg, lead with right leg, then lead with left (just started this last Friday) well stop it this Friday!
Walk throughs 2 sets of 5 each leg, plant right foot, step forward then step back behind foot each leg - the same he
Toe raises 2 sets of 5, able to raise heel off ground, heel raises 2 sets of 5, able to raise toes of ground - these are also punishing on your knee.

did PT Tuesday and Wed did 6 inch steps, but right knee was hurting wed, and didn't do l two exercises nor was I able to do them on Friday because of pain in my right knee. Instead therapist iced my right knee both front and back side of knee - exactly so! You should cut your exercises of the ones that I have crossed out. Otherwise, this pain will just get worse!

I have been doing these exercises since the beginning just lower reps built up over time and haven't had a problem with pain till this past week. Only thing I can think of was because of the weather change we had or when doing the manual check of flexion and extension, the therapist used some pressure to help with extension

It has nothing to do with the weather! It has everything to do with the amount of exercising you are doing - I make it 130 reps per day at home and 120 reps per PT session which is HUGE! That plus the 'manual check' (which is a great bit no-no!) is what has sparked off your pain.

If you are worried about this advice, there are plenty of members who have followed it and that after a few weeks, found their ROM increased extremely well. I suggest you do the same.

 

[xyxex_kayn]

Unless I get approved for more days of PT, today was my last day.

Left knee measurements
First day 109 flexion -5 extension
Today 120 flexion -2 extension

Right Knee
Firsts day 109 flexion -15 extension
Today 119 flexion -5 extension

Because of my body size, I am heavy set, 120 flexion will probably be the best I will be able to do until I can get some weight off. Still have some work to do to get my extension better and I know it can get better, because at five weeks after first surgery on left knee I was at 0 extension and now I'm at -2 with all the complications with second surgery and the lack of rehab flexion and extension took a hit, but have made improvements so I will take what I can, and continue to work on getting it better. I will continue with extension exercises to get better even if I don't get more rehab dates.

Have a membership at a fitness center to continue with rehab on my own if need be. Therapist expects that I will get more days so will still talk to him about the fitness center and find out what equipment to use and which one to stay away from till I'm fully healed.

 

[Josephine]

Because of my body size, I am heavy set, 120 flexion will probably be the best I will be able to do until I can get some weight off.

That's not true! I am big - huge in fact - and I got 135 degrees of flexion in both knees.

Still have some work to do to get my extension better and I know it can get better, because at five weeks after first surgery on left knee I was at 0 extension and now I'm at -2

As for your extension, I think when you say -2, you really mean +2 which means you can't get your knee totally straight. Is that right?

But in any case, your extension is excellent and you shouldn't give it another thought. You're only 10 weeks (rt) and 15 weeks (lt) which is nothing in the overall scale of recovery. Your normal activity will see to any further improvement so please don't worry about it.

And the very last thing you need right now is more exercise!

 

[xyxex_kayn]

Well I got approved for 6 more days of physical rehab. Have 4 more days to do, Friday, Monday Weds and Friday of next week and that's it. And I will start back to work finally on April 23, 2016, I'm looking forward to this day. Went today to see how well I could walk on part of my mail route. I have a set of apartments that I have to walk, so I went to see how much of it I could walk without trouble, made it around the test section with no problems with walking it (no pain in my knee) but I did find out that I started some very heavy breathing, definitely out of shape and need to build up my stamina. All of which will come as I do it.

 

[referee54]

but i did find out that i started some very heavy breathing, definately out of shape and need to build up my stamina.

Pretty much normal! I, also, was horribly out of shape when I went back to the classroom.

Remember also that you body has been funneling large amounts of energy towards the healing process, and will continue to do so---stamina is one of the last aspects to return.

 

[xyxex_kayn]

Pretty much normal! I, also, was horribly out of shape when I went back to the classroom.

Remember also that you body has been funneling large amounts of energy towards the healing process, and will continue to do so---stamina is one of the last aspects to return.

yeah i know, the twenty pounds i gained doesnt help either lol, but today ane the three days of Physical therapy we are concentrating on excersises that help with stamina. but i expect it to take awhile to get back to where i was before the surgery, but it will still be without the pain that i had before the surgeries, yes i have some discomfort and swelling it doesnt compare to the pain i was in

 

[Celle]

You're doing very well. In terms of full recovery, it's still early days, so allow yourself a bit of slack.

 

[xyxex_kayn]

Today was my last day of physical therapy. Range of motion actually got worse in the last two weeks since the last measurement. But the physical therapist said not to worry about it, because i have been doing alot more the last two weeks to build up my strength. He says my mobility is more fluid and walking well and straight up. So next week i will start using my membership at "Anytime Fitness" and discussed with my physical therapist which machines to avoid as to not do damage to my knees and which will benefit my knee. To start off i will start with lowest settings and do 2 reps of each excersise and build up from there. Plus will also add the recumbant bike and also Aerodyne when i build up strength for that as well. Going to take it easy and build up as i go.

I also start the next chapter of my healing process as i go back to work after being off for 4 months. Wish me luck

 

[xyxex_kayn]

Survived my first day back to work as i figured walking around the apartments would be the hardest part of the day. Not because of knee pain, but because of shortness of breath. The part i wasnt expecting was how difficult getting in and out of my truck would be. There is alot of knee bending going on. Everything im having difficulties with, will get better over time as i continue to do them

 

[newlybionic]

I'm glad you made it through your first day of work. Now relax, elevate and ice your knee so you're ready for your next day at work. I had to always move the sat of my car back so I can get in and out of it a little easier.

 

[xyxex_kayn]

at

Im a rural carrier between packages and medical dismount(customers) im in and out of vehicle alot would take alot of extra time to do that. And i have to keep to a schedule. Even though they know that im going to be slower in certain aspects of my job (loading truck and wslking the apartments) i still have time constraints. And doesnt include customers who want to ask how im doing and some that are excited to see me back after 4 months

 

[newlybionic]

That definitely is a tough job. I hope it gets easier as time goes by.