TKR Patella Clunk

[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. And don't forget to factor in other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness).

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.

 

[Scouseman]

1. 7

2. Codeine Phosphate 30 mg
Paracetamol 500mg Up to four times a day
Pregabalin 75 mg Twice a day

3. Moderate

4. Flexion 90 Degrees
Extension + 10 Degrees

5. Icing my knee every two hours during the day for 20 minutes each time

6. I was elevating my leg extensively during my stay in hospital for up to one hour at a time. I have reclining sofas at home and elevate regularly for thirty minutes a time.

7. Activity level minimal. I am employed full time as a Teacher. I occasionally assist with shopping.

8. Just been discharged.

Only just commenced my exercises at home.
So far leg flexions 4 x 10 repetitions 4 times a day.
Leg extensions 4 x 10 repetitions 4 times a day.
Leg raises 4 x 10 repetitions 4 times a day
Leg raises with towel under knee 4 x repetitions 4 times a day.
PT commences next Friday.

 

[Scouseman]

Day 4 Sunday 25 November 2018
Slept relatively well and able to manoeuvre my leg quite well during the night. Toilet break during the night posed no problems. Pain levels generally OK, although did need to take some pain killers at 02.45 this morning.

Some knee pain this morning. Injections administered and pain relief taken. My calf still presents a challenge. When initially attempting to move around on my crutches, it takes some time to be able to plant my foot fully on the floor due to the pain. Once mobile, I can feel the calf easing, but I am finding this frustrating!

Commenced some gentle exercises, following the guidelines provided by Bonesmart. Listening to my body rather than adhering to the ‘no pain no gain philosophy.’

Attempted a shower (walk in one) with a pre purchased waterproof thigh length leg sheet, which did a terrific job in keeping my leg dry! Think that I overdid it, as knee pain has increased as a result!

Managing to walk around living room on crutches and engaging in some gentle exercises but knee is very painful this evening.

Still taking the painkillers and self injecting. Feeling a tad low this evening but I do appreciate that there will be many days like this along the way to recovery!

 

[Jaycey]

Early days @Scouseman ! Please don't feel down. You have been through major trauma. Ice like crazy and get some rest. Tomorrow is another day. What seems really difficult one day will be easy the next. Be sure and stay ahead of your pain with your meds.

Hope you get some rest tonight.

 

[Scouseman]

Many thanks Jacey!

I am just so pleased to have discovered this Forum in time for my own procedure.

The support available to me from people like your good self is invaluable!

Thanks to everyone for their support!

 

[Scouseman]

Can any member provide advise with regards to pain and stiffness? I am engaging in gently leg bends, leg raises and leg extensions. Obviously, range of movement is not that of a normal knee!

Stiffness and pain eases off afterwards but is quick to return. It feels like one step forward and two steps back at the moment!

 

[Jaycey]

The pain and stiffness is all post op pain. However the exercises that you are doing several times per day are not helping this situation. Are you icing for at least 45-60 minutes several times per day? Elevating that op leg?

 

[Scouseman]

Hi Jacey,
I am maintaining a strict and regular icing regime of the knee.

How would you advise that I proceed with regard to the exercises?

I have a mental perception that if I do not do some kind of exercises, then no progress will be made. I know that this is something that I need to address for the benefit of my mental and physical health.

Should I concentrate on letting things settle, continuing with the ice routine?

 

[Jaycey]

Should I concentrate on letting things settle, continuing with the ice routine?

If it were me I would focus on getting the internal and external swelling under control. The swelling is what is making that knee feel stiff. Once things are settled a very gentle approach to any exercises works best. No need for constant repetition. Slow and steady. Many of our members did little or no exercise post TKR and recovered very well.

I'll tag a couple of my colleagues on the knee side to come and give you some input on their experiences. @Celle @SusieShoes

 

[Scouseman]

Many thanks Jacey!

Much appreciated. Your advice makes sense. I wish that the Physios would not put people under so much pressure to commence the exercises only hours after surgery!

Best wishes!

 

[Jockette]

You are only days out of surgery, your knee needs to heal. Just move it gently. Like Jaycey said, you don’t need constant repetition.

Also, don’t let your therapist bend your knee for you. Many of them feel they have to push it to bend further. That is not true. Not only does it cause you pain, but it will keep upsetting your knee making it swell, and swelling is why you can’t bend it right now.

Keep in mind, it’s not exercising that gets our range of motion back, it’s Time:

Time to recover.
Time for pain and swelling to settle.
Time to heal.

Our range of motion is right there all
along just waiting for that to happen so it can show itself.

In the general run of things, it doesn't need to be fought for, worked hard for or worried about. It will happen. Exercise as in strength training is counter-productive and in the early weeks does more harm than good. Normal activity is the key to success.

 

[Scouseman]

Many thanks Jockette!
Wonderful advice which has genuinely lifted my spirits! I seem to forget the trauma that my knee has been through - as evidenced by the stiffness, swelling and bruising that has started to reveal itself!

One thing that I should have asked my Surgeon that perhaps someone using this Forum has the answer to. A cyst was identified at the top of my tibia which needed to be removed and a bone graft performed to plug the resulting hole. Where would the bone graft be harvested from?

Just had a telephone consultation with my GP (who knows me well and is brilliant) and he advised that the bone graft procedure will extend the absence from my employment. He has just authorised a medical certificate that takes me up until the end of January and he will review me then.

This gives me plenty of time to focus on my new knee!

 

[Jockette]

I am going to tag @Josephine
our forum administrator and nurse director to address your concerns.

That’s great that you have at least until the end of January before you go back to work. We recommend taking 12 weeks off, then a phased return rather than going back full time right away. We realize that not everyone can do this, but it’s good if you can.

 

[Jockette]

Here’s our article on returning to work:
https://bonesmart.org/forum/threads/phased-return-to-work.5696/

 

[SusieShoes]

You are not even a full week out of surgery. You can give your knee some not-much-exercise TLC and not push it just yet. Move as you feel inclined. Walk when the urge strikes, just don’t overdo it. Bend the knee if you feel like doing that. I would bend my knees whenever the spirit moved me. A new TKR can become unhappy with being immobile and it will tell you as much: At that point, do a few bends and stretches, or take a short walk. Your knee will thank you.

It’s a temptation to think we have to do “more.” That if we do more, we will get through this healing stage faster. That’s just not the case. Doing less actually works better because it allows the knee to heal. Once the knee has healed, that’s the time to do more.

You’ve gotten good advice about therapy and exercise. Exercise is only good if it is helping. If it’s not helping, dial it back for a few days or weeks. Once exercise starts helping, you’ll know and can then get back to doing your favorites.

Josephine can best tell you about orthopaedic bone grafts. I had a cyst in my jaw and needed a bone graft for a dental implant. My dentist used cow bone as a matrix through which my own bone cells eventually grew to form new bone in my jaw. I got the implant and it works perfectly. But orthopaedic grafts are a whole different category! It’s rather amazing what medical science can do these days.

 

[Jaycey]

Where would the bone graft be harvested from?

A bone bank. When I had my right hip replaced they asked if I wanted to donate the femoral head to a bone bank. Here's an article from our Library on this process - pretty amazing!

 

[Scouseman]

Great responses guys! Thank you so much!

Medical Science is really amazing these days!

My employers are supportive of the time required to rehabilitate before I return to work, so one less worry there!

I will abide by the advise of the experts on this forum!

 

[Josephine]

A cyst was identified at the top of my tibia which needed to be removed and a bone graft performed to plug the resulting hole. Where would the bone graft be harvested from? (My GP) advised that the bone graft procedure will extend the absence from my employment.

Well I think you would know if it was harvested from you! So I would assume you had bone from the bone bank which is very commonly done. In that case, it most certainly won't affect your recovery but I'd stick with the extra time off, if I were you!

Now to you answers - sorry it's been so long but I've not been well!

1. 7

Okay

2. Codeine 30 mg
Paracetamol 500mg Up to four times a day
Pregabalin 75 mg Twice a day

Codeine is not adequate for a knee, not by a long shot. And certainly not just 30mg. That's almost the dose for a headache! I suggest you contact your GP and tell him that the codeine isn't 'doing it' for you and can you have something else (then suggest) perhaps like Tramadol (as you've heard it is better for knees). If he agrees, he should prescribe you 50-100mg every 6hrs which you can take with the paracetamol.
I would have thought that pregalbin is not appropriate for this stage of your recovery because it's for nerve pain which is unlikely yet. If your GP is insistent to keep you one it, then you need more than 75mg twice daily. It should be 100-200mg twice daily as a minimum.

3. Moderate

Okay but did you note that swelling is a form of pain also?

4. 90/+10

For 4 days out, that's pretty good. But don't be upset if it goes down as the swelling may well increase with activity.

5. Icing my knee every two hours during the day for 20 minutes each time

You accomplish little or nothing in 20 minutes. Ice for at least 40-60mins and more than 4 times a day.

6. I was elevating my leg extensively during my stay in hospital for up to one hour at a time. I have reclining sofas at home and elevate regularly for thirty minutes a time.

You accomplish little or nothing in 30 minutes. Elevate for at least 40-60mins and more than 4 times a day and elevate when you ice.

7. Activity level minimal. I am employed full time as a Teacher. I occasionally assist with shopping.

Not yet you shouldn't! Did you read the recovery articles in the second post of this thread? In it was this article Activity progression for TKRs which clearly states

Week 1
Just walking around the house - trips to the bathroom and kitchen are included!
Be up on your feet several times a day as you need to but don't get obsessive about it
A 5-6 minute walk every 3-4 hours is plenty
Spend most of your time resting and elevating

So shopping is clearly forbidden! Read the rest of the article.

Only just commenced my exercises at home - okay
So far leg flexions 4 x 10 repetitions 4 times a day - absolutely not! This is the last thing you should be doing right now. Your knee requires rest, not exercises and certainly not that many!
Leg extensions 4 x 10 repetitions 4 times a day -again don't do these now. Swelling makes extension very difficult but exercises will make swelling worse so don't do them now.
Leg raises 4 x 10 repetitions 4 times a day - a tip: once you can do a straight leg raise, you don't have to do them any more!
Leg raises with towel under knee 4 x repetitions 4 times a day - this is okay but don't overdo it
PT commences next Friday - I strongly suggest that you resist any other exercises or extremes of them. Read this article to see what I'm talking about.

It might also interest you to note that lots of BoneSmart members have now adopted the "BoneSmart way" of not doing any exercises at all after a TKR. I was one of them. I recommend you read my recovery thread to see how little exercising I did for either knee! Knee recoveries UK style Parts I & II (Josephine)

If you are concerned about refusing to do therapy, you need to read this Saying no to therapy - am I allowed to?

 

[Scouseman]

Many thanks Josephine!
Sorry to hear that you have not been well.

An extremely useful insight from a knowledgeable person who has successfully completed this journey herself.

I very much look forward to reading your personal journey. I have no doubt that it will be extremely useful to me!

Thank you for helping and encouraging me!

 

[NavyGunns]

@Scouseman, from one guy to another, it’s important to get a change in our “macho” mindsets regarding recovery from TKR. As all of the others have said, there is time for healing and reducing swelling and then there is time for exercise and overall rehabilitation. With TKR, they are NOT one and the same. In fact, because of how the knee is structured, the more you do now in terms of exercise, the more swelling you induce. The more swelling, the more tight and stiff the knee feels and the less it will bend. The more you try, the worse it gets!

As hard as it sometimes seems, accept the fact that the easier and gentler you are with your knee, the better your recovery will be. Feel free to review my recovery thread or that of @Roy Gardiner to get some perspective from a guys point of view.