Revision TKR Partial Revision Failure

[lovetocookandsew]

I just tried some crooked leg lifts (instead of straight) and managed 20. It was hard, also, tried some very unsuccessful heel slides, maybe 15.

Just wondering WHY?????!!!!!! Do you feel guilty if you don't? Or obligated? JUST SAY NO!

20 lifts and 15 slides at two weeks is too much. Heck, I'm at four months and have yet to do a lift or a slide............ Give that baby time to recover from the assault it just suffered.

Go back and read the activity progression guide and

 

[Cementless]

Yes.. guilt!!! What if the PA is right and I go back in 4 weeks without a good bend and extension...he will say, told you do the exercises!

 

[lovetocookandsew]

Or......you could just keep moving around at home as per the activity progression and what if that works?

 

[Pumpkin]

Cementless,
Here are two gentle exercises you can do 1 to 2x a day.
Heel slides and how to do them and Extension: how to estimate it and ways to improve it .
You will be able to say yes if asked about exercise.

You can also follow the:
Activity progression for TKRs

 

[Jockette]

I believe in the Bonesmart approach.

But so many of us are bombarded with being told “do your exercises” by absolutely everyone who is not on Bonesmart.

I have not had a good outcome. Every now and then an evil thought comes to my mind telling me I didn’t do my exercises. (I did the first month, until I found Bonesmart at that point.)

I know in reality none of those exercises would have improved my particular outcome, but it’s hard when that thought comes, because that is the mindset of most people.

If I have to do this over again, I will follow Bonesmart’s approach all the way. I will not go back to the PT/exercise way of doing things.

 

[Josephine]

I just tried some crooked leg lifts (instead of straight) and managed 20.

I was going to leave you a link to the heel slides article but I see Pumpkln has beaten me to it! But do read it because it will explain to you why this approach is mightily WRONG!!

What if the PA is right and I go back in 4 weeks without a good bend and extension...he will say, told you do the exercises!

You know what? I bet we've dealt with more knee patients on this forum in the last 11 years than he has in his entire career! So you could say the same thing about us. What if you just took longer than usual to get a good ROM and then WE would say "we told you NOT to do the exercises"! Who are you going to believe? That PT who has dealt with a few hundred patients or us who have dealt with thousands?

 

[Cementless]

@Josephine, I didn't know I just had internal sutures that will dissolve (plus the steri strips)….could that be another reason my knee doesn't like to bend besides all the internal swelling and trauma? Now my husband is on my case to exercise more! I feel like I could scream!!! Sometimes if I am resting I can go, 8 hours without Norco 7.5 mg. but when I need it, I need it! Becoming agitated. I feel like I need to get in the shower and let the warm water soak off the bloody dried steri strips.

@lovetocookandsew , @Jockette ,@Pumpkln, @sistersinhim: thank you all so much!!! I am at the point where I feel like crying and feel frustrated. I guess it is the opioids?

 

[Cementless]

I did want to mention that the nurse that took my dressing off yesterday before the PA came in was impressed with how little exterior swelling and bruising I was having.

 

[Josephine]

I didn't know I just had internal sutures that will dissolve (plus the steri strips)….could that be another reason my knee doesn't like to bend besides all the internal swelling and trauma?

Of course you had internal sutures! How else can we hold the incision closed! But it has nothing to do with an flexion and all. It's just the swelling and pain that's the problem.

Now my husband is on my case to exercise more! I feel like I could scream!!!

Well don't let him bully you! You know that that would be very bad for your overall function.

I feel like I need to get in the shower and let the warm water soak off the bloody dried steri strips.

Yes do. In fact, just pull them off! They are serving no useful purpose. I can never figure why your surgeons always say to let them drop off. Bloomin' stupid in my opinion!

I am at the point where I feel like crying and feel frustrated. I guess it is the opioids?

Not wholly. You're likely to be depressed and anxious with all you have going on, plus your husband bullying you.

 

[Jockette]

Post op blues:
https://bonesmart.org/forum/threads/depression-post-op-blues.34456/

 

[SusieShoes]

All knees have those internal sutures (lots of layers to knit back together) and they are part of why we don’t like to bend our knees. I don’t know for sure about anyone else, but I could feel those sutures in there! Necessary things, of course, and I wanted them to be there, but I was aware of them. Being aware of something in one’s knee does not make bending it more pleasant. But bend we do.

My surgeon explained to me in detail (he knows I’m a researcher and pragmatic) how he did the sutures and he assured me the incision was strong, so I could trust it. Just bend as best I could, because those sutures weren’t going to break. They never did. Of course I was of the BoneSmart way: I didn’t push my bending to the point of agony, ever, and never let anyone force it.

You know your knee better than anyone. I’m sorry your husband is putting pressure on you. Mine didn’t and I’ll be forever grateful. It’s difficult enough to advocate for your OWN BODY when other people think their opinions matter more than yours. You’ve done the reading, researched, know the drill. You can manage this quite well, thank you.

 

[sistersinhim]

Here's a link to the layers of stitches inside your knee:
https://bonesmart.org/forum/threads/closing-surgical-wounds-how-is-it-done.4286/#post-90691

 

[Cementless]

@Josephine, I did know I would have layers of internal sutures but because I requested no staples, I was expecting sutures on the outside like I had before.

I would say I am doing week 5 of the ADL already.

Thanks for all the reassurance guys...it is so good to have the reading material at my fingertips!

 

[Cementless]

 

[lovetocookandsew]

Maybe I misunderstood, but are you saying you're doing the activities of week five on purpose, or without realizing you're overdoing? It's not a race to see how fast you can get through the list; rather a guideline as to what you should be doing so as to not overdo.

If your husband thinks you need to do more exercises, then tell him (ahem...calming pause and deep breath for a moment) you appreciate his concern, but you have to do what your knee tells you and what you think is best. I would personally be more succinct, but don't want to get into trouble here by saying what I'd actually say.......lol. If that doesn't work, then you might need to be more succinct. I have noticed many husbands who are caring for their wives after this surgery take that to mean they are also supposed to tell them what to do to recover faster or better, etc. Maybe it's a guy thing in that they like to fix everything; it's in their DNA. Who knows, but most are well-meaning and just need to understand the boundaries. I had my husband well-prepped this time around as to what I was going to do, or not do, and why, and where he was allowed to help and where he was not allowed. Last time he was inclined to follow the PT and kept nagging me to use the CPM more often and at higher numbers-I finally had to tell where he could put his (well-meant but wrong) advice.

My steri-strips took forever to fall off. I finally "helped" them meet their maker as I was sick of them. I don't know why they use them either, but many doctors do and they tell us to let them "fall off naturally". That may be fine for those whose strips fall off easily and quickly, but mine seemed gorilla-glued on and were't budging without some help.

 

[Cementless]

@lovetocookandsew, you are my kind of gal....love the way you think!!!
The ADL week 5 is just what happened, what I feel like doing..at times. Really not pushing it. Right now, I am mad at my husband and he better keep his distance! lol

I got in a warm shower and peeled the steri strips off. Then I used hydrogen peroxide to help loosen the dried blood.
Next I applied the Active Guard Shield. My knee feels so much better.

I am icing and elevating right now but added a layer of sterile gauze pad between my exposed incision and towels with the ice pack.



with Active Guard Shield.

 

[SusieShoes]

The ADL chart isn’t a guide at all; it’s a “here’s what you can expect to be doing at this point” chart to help people plan out their recovery. In other words, best not to count on going full-on grocery shopping until about five to six weeks out because, for most people, that’s not going to work out well. It’s ever so general, but a good way to tell spouses when you might be ready to assume some of your familiar activities, just in case they’re getting antsy.

I used it to keep expectations in line. “Will Susie be able to go with us to Kitchen Kettle on [date]?” Susie consults chart. “That doesn’t look great. How about two weeks later? I should be up to it then.” I actually did that. Maybe I could have gone on the original date, but by going with the averages I made it more likely the experience would be a positive one for all involved (me included!).

 

[Cementless]

@SusieShoes, thanks a lot! He is a really good husband but yesterday he bought into "I should be doing PT 2-3 times a week from the PA". He was scared I might have to have a manipulation. We live on 20 acres in the country, so I have not been out of the house much because our land is uneven in spots. You see that cute little doggie face on my avatar, well, we had been dividing potty duty up since we had her a little over a year ago (a rescue). She needs to go out frequently because of bladder issues and she is getting use to a new type of food. She was throwing up on the new food every night and I was up washing sheets and bedspreads/her doggie beds (before, during and after my knee revision).We take her out on a leash or she will go into the cow pasture or chase squirrels or whatever. This has almost been too much for him but he is finally adjusting. He makes our meals, goes grocery shopping (which he likes to do). He just rubbed me the wrong way this morning.

 

[Cementless]

Just logged on to my OS website about yesterdays visit:
"The patient returns 2 weeks after revision left total knee replacement. She reports that her pain has improved since prior to surgery. I recommended that she perform outpatient physical therapy to work on range of motion. She does not want to do physical therapy for another few months. I emphasized the importance of gaining early motion to ensure an optimal outcome. I provided her with a prescription today and encouraged her to attend physical therapy. I answered all of her questions today regarding the surgical procedure and her recovery. She is currently taking Norco which she can continue. She will follow-up in 4 weeks."

 

[Celle]

I emphasized the importance of gaining early motion to ensure an optimal outcome.

Well, he's misinformed there.
There's no need to rush to get ROM (Range of Motion) because it can continue to improve for a year, or even much longer, after a knee replacement. There isn't any deadline you have to meet:
Myth busting: the "window of opportunity" in TKR

Look at these two examples from people who gained ROM slowly - and look where they ended up.

"I had a slow recovery. Here's my flex measurements at various points:
92 - 8 weeks post op
105 - 10 weeks
107 - 5 months
110 - 6 months
112 - 7 months
116 - 9 months
119 - 11 months
118 - 1 yr
120 - 1yr 2 months
125 - 1 yr 8 months
128 – 6 years "​

"I'm 12 months out from my surgery and have some advice based on my experience:
1- Stop going to PT (all it will do is make your knee swell and reduce ROM)
2- Don't worry about your ROM
3- Be patient - VERY patient!!!

Here is my ROM history (more or less):
1 month - 60 degrees
2 months - 80 degrees
3 months - 85 degrees
4 months - 90 degrees
5 months - 90 degrees
6 months - 110 degrees
7 months - 120 degrees
8 months - 125 degrees
9 months - 130 degrees
10 months - 135 degrees
11 months - 140 degrees
12 months - 140 degrees

I spent waaaaay too much time worrying about ROM. I thought I'd be riding my bike a couple months after surgery but it took SIX months! Looking back on my surgery, if I knew then what I know now, I wouldn't have wasted my time with PT and I wouldn't have worried about ROM."​