TKR Patella Clunk

[Celle]

@Scouseman - I agree with the advice the others have given you.
Your knee has been through a major operation that caused a lot of trauma. It needs gentle treatment and time to rest and heal.

As for the PT, your knee will get all the exercise it needs this early in recovery if you just walk around the house a bit.

I have had three knee replacements, and only done minimal formal PT.
My surgeon doesn't allow any PT at all for the first month after a knee replacement. He says your knee needs that time, to start on its journey of healing. For that month, we rest, ice and elevate our leg, and walk around the house.
After that month, we just go to PT once every 2 weeks, where we are shown a few new exercises to do at home.
His patients all do well and achieve good ROM, as I did, and he hasn't had to do a manipulation to help with ROM for the past 4 years. I think that speaks for itself.

 

[Scouseman]

Many thanks NavyGunns!

Point taken! I appreciate you taking the time out to reassure me - it really has helped!

Best wishes!

 

[Scouseman]

Celle,
Your thoughts and experience are invaluable and do make so much sense. The mindset of UK based Physiotherapists opposes this, to a degree, but in my heart I realise now that the body requires time to heal.

I am so glad that I found this Forum. Without it, my recovery may have been significantly affected!

God bless you all!

 

[Celle]

@Scouseman - The important thing to remember when dealing with PT is that this is your body and your knee. You are the only one who has the right to say what will happen to it. You can set limits on what you will do in PT. You can say you won't do any exercises that cause increased pain or swelling, at the time or later. You can tell your therapist that you will not allow any forcing of your knee - no forced bending or straightening.
Your therapist has to abide by your wishes, because you're the boss.
Saying no to therapy - am I allowed to?
CONSENT: what it means and how it can be used

 

[Scouseman]

Interesting advice Celle!

Thank you!

 

[Celle]

Yes - Interesting, but true!
Your knee is the boss and you are the one who speaks up for your knee.
Your PT therapist works for you, not the other way round.

You don't have to please her/him - she/he has to please you.

 

[Josephine]

The mindset of UK based Physiotherapists opposes this

Actually it's much the same the world over. But we must endeavour to be our own advocates and see that it doesn't happen to us!

 

[Scouseman]

Day 5 Monday 26 November 2018
My worst day so far. Incredible pain and swelling of the knee and my calf still continues to be problematic.

I went to bed early morning to rest.

I had a telephone consult with my GP and he has declared me medically unfit for work until the end of January.

I have utilised the experience and expertise of the BoneSmart Forum, with some incredibly invaluable advice and suggestions. This has really helped me and I am extremely appreciative of their input.

I have been elevating and icing my leg and walking around my living room on crutches.

Wish my calf would settle down!

 

[NavyGunns]

@Scouseman, here is another “guy’s” perspective regarding PT. My OS does not prescribe PT until after his patients have their first follow up post op. Mine was just over 2 weeks after surgery. He asked if I thought I was ready. I had already become aware of BS and shared my concerns regarding aggressive pt and therapists who try to force bending of the knee to achieve ROM numbers. My OS firmly stated that there is absolutely no reason for anyone to be pushing on my knee. He agreed with me that the primary focus of pt should be to promote reduction in swelling, gently massage, gentle stretching, etc. When tolerated, gentle exercises to help muscles re-engage to help promote proper walking gait.

I selected my own Therapy Center. During my first visit, I laid down the ground rules with my PT. I told him if he wasn’t “on board” I’d find someone else. Lucky for me, he was not only supportive but fully advocated the same approach. At the start of every session he would ask how my knee tolerated the prior session and if there were any specific complaints. My response set the direction for that session.

 

[Jockette]

@NavyGunns I wish all surgeons and PTs were like yours.

 

[NavyGunns]

@Jockette, that would be nice! We can only hope and try to educate them! Of course, I might have had a completely different outcome if I had not spoken up and had my conversation with both my OS and PT. Medical professionals are not perfect, they are definitely not God (although some might argue to the contrary), and if they are smart, they will recognize that they can still learn new things, sometimes from their own patients!

 

[Scouseman]

Many thanks NavyGunns,
That is a positive and reassuring rehab journey. Would you regard your TKR as a success?

Last night, the biggest side effect post my surgery lay with my calf. The pain is a 10 and if kept me awake all night. The pain initially prevents me from placing my foot fully on the ground when I engage in gentle moment around my house. I painfully manage to do so and am able to stretch it off.

I would have hoped that this would have settled by now?

Does anyone have an opinion if an infrared heat lamp would assist with the healing of my calf?

 

[Scouseman]

Guys,
I am really, really struggling today with my calf pain, which has elevated to an unbearable pain level. I can barely move my leg or put my foot fully on the floor.

Due to my previous DVT’s (all in the same calf) I do have PTS - Post Thrombotic Syndrome.

Post surgery, I had a Doppler Scan to investigate a possible DVT and this was negative. I was receiving the same treatment if I had a DVT whilst in Hospital and upon discharge at home via Fragmin injections to my stomach.

This morning, I reverted to my normal Anticoagulation therapy of Apixaban, 2.5 mg twice a day.

An assessment for Compartment Syndrome was undertaken whilst in Hospital but this was ruled out.

Medical explanation was that the nerves, veins and vessels in my calf area were starved of a blood supply for approaching 2 hours due to a Tourniquet applied to the top of my leg and that the calf will repair itself in due course.

Calf is getting worse, rather than improving so does anyone have any idea as to what might be causing this? I am extremely worried!

 

[Jockette]

I’ll tag @Josephine for you.

 

[Jaycey]

Have you talked to your GP? Please call your surgery. Pain at that level needs to be addressed!

 

[Scouseman]

Thanks Jockette, Jacey,
I did consider doing so but given the medical assessment in Hospital, I held off.

However, I am happy to advise that I have just managed to have a deep, uninterrupted sleep on my sofa for a solid two hours! Feel so much better for that and I awoke to a much reduced pain level in my calf. Yet to attempt to put my foot down yet though so watch this space!

Wow!
However, I do have a slight temperature and if the pain level does get to that level again, I will certainly call the Hospital!

Could it be an infection? The wound is covered and does not appear to be infected. For some reason, I am unable to upload photos from my iPhone 7 Plus!

 

[Jaycey]

I do have a slight temperature

How high is your temperature? Many people experience a low level temperature just out of surgery.

For some reason, I am unable to upload photos from my iPhone 7 Plus!

Make sure the image is not too large. Most iPhones take high resolution images creating very large files. Try reducing the image size a bit.

 

[Scouseman]

I do not have a thermometer so cannot provide a temperature reading. My face is quite red and I feel hot and uncomfortable, using a portable fan to cool my face down.

I will try to resize the photographs.

 

[Josephine]

@Scouseman did you ever get your pain meds changed? Excessive pain can give you a fever.

 

[NavyGunns]

@Scouseman, during the first two - three weeks of my recovery I would run a low grade fever (under 100). My OS said as long as it didn’t go over, not to worry. During recovery it’s also common for your knee to feel warm, but it shouldn’t feel hot. That’s another potential sign of infection. Things to keep in mind.