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[PARTIAL KR] Patello-femoral March 13<

Discussion in 'Knee Replacement Recovery Area' started by Jockette, Aug 29, 2017.

  1. Jockette

    Jockette Senior BoneSmartie Forum Advisor
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    Hello to everyone! I found this forum about 4 weeks post op when PT was becoming too difficult for me. I cannot thank you all enough for sharing your experiences, knowledge and support for this most difficult recovery.

    My surgery was Monday, March 13, 2017, and my hospital experience was excellent, I don't have one complaint! Nurses and PT were very caring and supportive. PT consisted only of walking and doing their "bridge of steps" and the day after my surgery the PT actually stopped the session because he was concerned about my blood pressure, which he took mid session, it was 90 over something and he said, we're done here, and asked if I still wanted to walk back to my room or be wheeled there in the recliner I was sitting in. I honestly didn't feel bad so opted to walk, but his assistant was right behind me with said recliner. I walked back to my room fine.

    I was discharged later in the evening on the day after surgery, which was Tuesday.

    I went to my first out patient PT the next day, 2 days after surgery. Just getting into the car, out of the car and into the building and then the reverse to go home was beyond difficult as I'm sure you all understand. I will say that the session was fine, basically just an introduction and assessment and the therapist was gentle and had a very calm voice, so that was nice. So far so good. But I wish I had known then what I know now, that it was not necessary for me to have that appointment at 2 days post op!

    From then on I went to out patient PT Monday Wednesday and Friday for the next 4 weeks. In general it was not aggressive, definitely no where near as bad as some experiences on here that I've read about, however after reading here there were some aggressive moments, every appointment they pushed my knee to a painful place to measure. The exercises were not painful and all 4 therapists were pleasant and caring. (as they gently moved my knee to a painful place get the highest measurement but I thought then that was the way it had to be, and they "only" did that once per appointment.)

    At 3.5 weeks post op they introduced the bike. The PT told me to just rock back and forth and only try a full rotation if I felt ready. Well, at that point in time I knew one had to work hard, so I somehow did manage a couple of rotations, especially since the first time you can do that they ring a bell to celebrate and stupid me wanted them to ring the bell for me, and they did, but I cried the entire time I was on the bike ( as well as other times in the previous weeks when they pushed my knee too far) My poor husband stood helplessly next to me holding my purse and handing me tissues, since we both thought this was how it should be. I recovered "pretty well" within 24 hours, so when I went to PT again 2 days later, Friday,

    I rode the bike again and tried even harder, did more rotations and cried less. At the time I thought that was success. However, this time it took 3 days to recover. I was supposed to start pool therapy on Monday, 4 weeks post op, but I was still hurting and thought I'd damaged the joint so I called Monday morning and told them this experience so they had me come to the office instead of the pool and assured me I was fine and by then I did feel better. I refused the bike after that and they were ok with my decision.

    My next appointment was 2 days later, on Wednesday and I did go to the pool. Oh my! I am now 4 weeks and 2 days post op and they had me in the pool for 50 minutes! I don't even know how many exercises I did that required me to bend my knee, as well as walking frontwards, sidewards and even backwards! I was so scared, I was not steady on my feet yet on land, let alone in a crowded YMCA pool with water moving a bit since there were at least 20 people or more in the pool. When they finally let me out I had to walk foot over foot ( like normal) up the steps to get out, probably at least twice per foot, I don't remember

    This took another 3 days to recover from so I started googling stopping therapy which eventually led me here. I spoke on the phone with the pool instructor and she agreed that it might be too much for me at this point, so I was back to office. The best part at this point is that they are a busy office and it's hard to schedule appointments if they are not in advance, so for the next month I was only scheduled on Friday's and thanks to Bonesmart I cancelled some of them.

    Back in the office the exercises were fine, I only did as many as I wanted but still let them push my knee which at this point didn't hurt as much as it had earlier, and I guess still tied into their thinking, I wanted that higher number.

    I have never been measured on my own so I have no idea what my actual rom is. Early on common sense told me it wasn't a true measurement if I couldn't do it myself.

    Anyway, I am now 5.5 months out, stopped PT on May 5, with their approval, so I got an "honorable discharge". I am not doing any exercises, just my normal activity.

    It is still a challenge, as I'm still not halfway through, but that's the way it is. I have not had any complications for which I am thankful. Any time I have had a concern I google whatever the issue then add post op tkr Bonesmart and it brings me here to someone who's had a similar experience.

    I will write later, as I've probably already written a book here, but wanted to introduce myself and tell about my beginning.

    Thanks again to everyone who posts on this forum, I don't know what I would have done without you all!!!
     
    Last edited: Oct 11, 2017
  2. kmak81230

    kmak81230 post-grad

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    Welcome!!! Better late than never for finding Bone Smart. I didn't find it until about a month after surgery and I was really overdoing the exercises. But all is good now 4 months in . . . As you have already noticed there is a wealth of information here and lots of support for whatever you are wondering about or feeling bad (or good) about. Glad you were able to back off on the exercises and PT -- that was a good thing for your recovery. :flwrysmile:
     
  3. Jockette

    Jockette Senior BoneSmartie Forum Advisor
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    Thanks for the welcome!

    I forgot to mention, it's my left knee.

    So excited to finally have joined!
     
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  4. crissyP

    crissyP member

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    @Jockette....Welcome to Bonesmart !! This is absolutely the best place for info and empathy. We're all here for you as most of us have been through a knee replacement. There are wonderful moderators who can and will give you great advice. Take it easy and be good to yourself. It's a long journey but worth it !!
     
  5. Jockette

    Jockette Senior BoneSmartie Forum Advisor
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    This is indeed a wonderful site full of encouragement and empathy! I live in a 55+ community and at 61 I am one of the youngest ones here! Quite a few in our community have had TKRs but I've found if they didn't have a slower recovery even they don't understand. When I mentioned to one person that I didn't do well in the pool I got a surprised, almost disapproving expression from that person. Two of my friends have had TKRs since me and are well ahead of me. I know we should not compare ourselves to others but it's so hard not to.
     
  6. crissyP

    crissyP member

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    Oh boy.......I know that feeling. We all progress at a different speed that's for sure. I was one of those who wondered what I was doing wrong and why wasn't I further ahead like others?? Now I just go with the flow.....otherwise I'd drive myself crazy with all the "What ifs". I'm slow but I'm getting there and that's all that counts. I still have days when things hurt, swell, zap and pinch. But, I also have days where things are going smoothly. I'll get there one day and you will too. Listen to your body and don't listen to nay-sayers. You're the one walking in your shoes....not them !!!!!!
     
  7. kmak81230

    kmak81230 post-grad

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    :SUNsmile:We do have a slow bender and slow straightener's club here and the initiation dues are minimal! We are always looking for new members and we promise not to give dispproving looks or shaking of heads - only support and congratulations
     
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  8. Jockette

    Jockette Senior BoneSmartie Forum Advisor
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    I'm glad there is a slow benders club open to new membership! I was not always a slow bender. I have never been measured by what I can do on my own. Not only did my PT push, not hard but still the same result, but my OS is a fan of that technique also. Here are the measurements he got:
    2 weeks post op-97 flex
    6 weeks post op-116 flex
    10 weeks post op-128 flex
    I didn't overly mind him pushing when I got these numbers and it wasn't overly painful.

    It is worthy to note here that I had basically stopped the flex exercises at about 4 weeks post op after reading Bonesmart. I did an occasional exercise 2 or 3 times so that if asked I could say, yes, I'm doing my exercises. He was thrilled with the 128 at 10 weeks, smiled at me and said, don't stop what you're doing. I had trouble not laughing as I knew if he knew how little I was doing he would not approve.

    My extension was still not what he wanted, so once a day I would do the push the back of my knee down on the couch while I sat with my feet on the ottoman, usually one rep of about 20.
    The further away from my 10 week check the less I did them.

    Then came my 18 week check up. This time when he pushed my bend it really hurt. I told him twice, that's too far. I guess what I should have said was put my leg back down but on the spur of the moment that's not what I said. He held it there and I was beginning to breath rapidly, from pain and I was getting angry. He "only" measured 124. When he checked my records he was concerned that was less than it had been 8 weeks earlier. Then he bent my knee again and called it 128 but I don't think it was.

    Is this cause for concern?

    Before that appointment I was doing so well and I was so mad that it hurt so much. I know we should not let anyone push our bend and PT had ended 10 weeks earlier, so it had been a while since anyone had done that.

    So does the no one also apply to my OS? The check ups consist of x rays and measuring flex. That's about all. I am already dreading my next appointment in October for my 7 month check. I hope I will have the courage to tell him he does not have permission to touch my leg. But he's the surgeon. How can I tell him that?

    But now I do qualify for the slow benders club because towards the end of July, 3 days after this last check up. we went away for the weekend to visit friends. Their house only had the lower standard toilets, and I had an awful time with them the whole weekend. By the time I got home my rom was shot. Not much outward swelling but obviously inner swelling. It took almost 4 weeks of less activity rest and ice to feel better and then about a week ago my son got married and my knee was stressed again, but this time from a lot of standing and lack of being able to elevate my leg, and now my rom seems very bad again.

    I have tried to be really careful with my activities all along but some times life happens. The wedding was an hour and a half away and so was the rehearsal day, but I did the best I could.

    So I am back to icing more, resting and elevating and am trusting all will eventually be well.

    Since I was "able" to get those high roms the potential is there for it to come on my own power, right? I am so worried it won't.
     
  9. kmak81230

    kmak81230 post-grad

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    I think the advisors will have more to say but you have already achieved great ROM - and I'm sure it will come back if you let the swelling go down. My flexion hovers around 110 at 4 months, less if I have overdone it at all, and I'm not worried. I think you have the right to say no to your surgeon - he works for you! Everyone heals differently and ROM can improve a year or more after surgery. Try not to stress out about it - you are doing the right thing if you are gentle with your knee as much as you can be.
     
  10. Josephine

    Josephine FORUM ADMIN, DIRECTOR Administrator

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    When he reaches for your leg, just move it away and say "Thanks but I'll do that" and bend it yourself. Actually the number that's obtained when they push on your leg doesn't really count. The only number that does count is the one you get on your own efforts!

    I'd really like to offer you some structured advice but in order to do that, I also need to ask you some questions. Are you willing for me to do that?
     
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  11. Jockette

    Jockette Senior BoneSmartie Forum Advisor
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    Sure you can ask the questions, thanks.
     
  12. Josephine

    Josephine FORUM ADMIN, DIRECTOR Administrator

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    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?
    [​IMG]

    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.
     
  13. Jockette

    Jockette Senior BoneSmartie Forum Advisor
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    1. Pain level- Pain that makes me think "Ow!" is 0-1 and not that often.
    Since stiffness is a form of pain I would rate the stiffness at maybe a 5.
    No stabbing or throbbing, achy maybe 2-3 if I've stood in line for 20-30 minutes after grocery shopping for 45 minutes or so.
    No burning any more.

    2. Pain medication-
    I came home from the hospital on the day after surgery with Dilaudid but that was almost 6 months ago so I'm not sure I remember the dosage, I think it was 4 mg and when I finished that bottle I had Dilaudid 2 mg, I took them every 4 hours, I think. I did finish the first bottle, started the second lower dosage but it didn't help so I was allowed to take 2 of them to equal the 4 mg.

    My vision changed quite a bit the day after surgery, I could no longer read my cell phone which I was able to do just fine the day before surgery so when I told my surgeon on post op day 10 that my vision was still blurry he took me off the Dilaudid and switched me to something else, it may have been Tramadol and maybe 50 mg, I'm sorry I can't remember these details. I only took it 4 times and then stopped the prescription medications totally hoping my vision would return to normal. I also no longer have the bottles so I can't check them.

    So on Day 11 post op I started taking Tylenol, but only 500mg 4 times a day and prescription ibuprofen 800 mg 3 times a day. A week or two later I finally had the presence of mind to read the Tylenol bottle and realized I could take 1000 mg, 4 times a day, so since then I take 1000 mg of Tylenol 3-4 times a day, usually 4 times and every 6 hours so I'm usually taking one during the night just to keep it evenly spread out through the 24 hour period.

    I also currently take 800 mg of ibuprofen 3 times a day as that is the only thing that helps the arthritis I have in my other knee, spine and neck.

    3. The swelling I can see is slight and doesn't change much. It's in 2 spots on the outside of the knee, a bit above and a bit below. It's always been there since the surgery. I'm sure I also have the inner swelling, and that does change depending on activity and unfortunately the weather.

    4. I don't have an accurate ROM measurement since I've always been "helped", the highest was 128 at my 10 week check up. The last 5 weeks my ROM is very poor, we visited friends for the weekend on July 21-23 and I greatly struggled with the lower height toilet for the weekend, not only was it low but the was almost nothing to push against to help me get up. My flex has not been the same since. It took 4 weeks to begin to bend better and then about 2 weeks ago my son got married so I spent 2 days with wedding things and very little elevating and on my feet a lot. I did the best I could under the circumstances.

    I don't have a number for extension but my surgeon said he liked it at my 4 month check, I think at my 10 week check it was -1.

    5. I ice my knee for an hour, once or twice a day, usually in the evening.

    6. Elevation:
    I elevate toes above the nose all night, every night, about 7 hours.
    During the day any time I am sitting at home my feet are up on an ottoman, usually an hour at a time or more. 5 or 6 times a day.

    7. Activity level:
    I am trying to walk, about a ½ mile a few times a week. I do grocery shopping which usually takes 45-60 minutes about once a week. I make easy meals and clean up, load dishwasher and hand wash the rest. There's only my husband and I so not a lot of that! Very little house work, just cleaning up kitchen and bathrooms, no vacuuming yet.
    I started bowling a year and a half ago, 3 games twice or more a week. So, at 12 weeks post op I tried bowling one game. Other than both arms being a bit shakey, I did well, I don't remember any repercussions. My ball is only 8 pounds, which is very light for a bowling ball. I waited a week and went again and was able to bowl 2 games at 13 weeks. I did 2 games for about a month and then did 3 games at 17 weeks and handled it fine. It was great to be back with my friends doing what I enjoy.

    I did go in our pool several times a week the month of June, 12-16 weeks post op but found I continued to spend too long in the pool stretching most of the time so I stopped going because I was totally overdoing it. It's hard to stay still in a pool.

    8. Exercises at home:
    I rarely have done exercises since the first month.
    The first month I did:
    Half leg lift-10
    Toe raises-20
    Heel slides-10, and these were a sheet wrapped around my foot so I could use the sheet to pull my foot as close to me as I could, per PT.

    Exercises at PT
    Heel slides using sheet to pull foot close
    Half leg lift 10-20
    Up on toes 20
    Leg lift with roll under calf 10-15
    One time they had me stand and bend my knee up behind me, I did about 15.
    Bike at 3.5 weeks post op, 2 diffferent days, 10 min. Very painful! Didn't ride it again.

    4 weeks post op they put me in the pool
    for 50 minutes.
    Lots of walking, frontwards, sidewards and backwards
    Marching
    Many type of knee bend exercises 10 each. I lost track of how many.

    It took me 3 days to recover from the pool and I did not go back to the pool.

    I did OP PT 3 times a week for a total of 15 sessions over 8 weeks, starting 2 days after surgery. No home PT at all. My last PT appointment was 5-5-17.
     
  14. sistersinhim

    sistersinhim FORUM ADVISOR Forum Advisor

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    Welcome, Jockette! Just in case you haven't read these, here are some really good recovery articles.

    Knee Recovery: The Guidelines
    1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now, they are almost certainly temporary
    2. Control discomfort:
    rest
    elevate
    ice
    take your pain meds by prescription schedule (not when pain starts!)
    don't overwork.
    3. Do what you want to do BUT
    a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you
    b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.​
    4. PT or exercise can be useful BUT take note of these
    the BoneSmart view on exercise
    BoneSmart philosophy for sensible post op therapy
    5. At week 4 and after you should follow this
    Activity Progression for TKRs

    Recovery articles:
    The importance of managing pain after a TKR and the pain chart
    Swollen and stiff knee: what causes it?

    Energy drain for TKRs

    Elevation is the key

    Ice to control pain and swelling

    Heel slides and how to do them properly

    Chart representation of TKR recovery

    Healing: how long does it take?

    Post op blues is a reality - be prepared for it
    Sleep deprivation is pretty much inevitable - but what causes it?

    There are also some cautionary articles here
    Myth busting: no pain, no gain
    Myth busting: the "window of opportunity" in TKR
    Myth busting: on getting addicted to pain meds

    We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery. While members may create as many threads as they like in a majority of BoneSmart's forums, we ask that each member have only one recovery thread. This policy makes it easier to go back and review history before providing advice.
     
  15. Josephine

    Josephine FORUM ADMIN, DIRECTOR Administrator

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    Okay
    Well, I cannot improve on that!
    Okay
    You should remember that a number obtained whilst being 'helped' is invalid. The only number that counts is that which you get under your own power. If you'd like me to measure it, send me a photo with your leg like one of these but you need to be in shorts and from hip to foot inclusive!

    knee flexion photo-horz.jpg

    1. put your leg on a bench, seat, bed, floor or anything similar but preferably something fairly firm.
    2. with not too much pressure, press the back of your knee down - use your leg muscles, not your hand!
    3. slide your hand, palm down, under the back of your knee
    a) if you can get your entire hand under easily, it's probably about -10 degrees
    b) if you can get just your fingers under, it's about -5
    c) if you can get your fingers under but it's a push, it's 0
    d) if you can't get your fingers under at all, it's +5 or more


    Here's a graphic to explain the degrees involved
    knee ROM small.jpg

    if that's all your leg needs then it's fine.
    'On an ottoman' is not elevating! Not properly...
    Yes, you're making slow progress for 6 months out, bless you. I read the exercise regimen you were on and I wouldn't have recommended any of it! I don't wonder your knee got stiff! You're not doing any now are you?
     
  16. Jockette

    Jockette Senior BoneSmartie Forum Advisor
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    Thank you so much, Josephine. I do realize after lurking on this forum for a while that I was very under medicated early on. I was so afraid of the narcotics.

    My vision never did get better so about 6 weeks post op I saw an eye doctor and got new glasses. Since the surgery my distance vision got much better but my reading got much worse. I've had bifocals for years but only needed the reading part if I read some really tiny. Now I need them for everything. Something changed it overnight. I did have a patch behind my ear for nausea but I don't know what the medication was in it. It might have been scopolamine. Have you ever heard of that causing permanent vision changes?

    Another thing I'd like to ask about is the elevating wedge I was sent home from the hospital with. From the side it looks like the one on the picture with the red x that I have seen posted. My wedge has a cut out area for my leg to fit in, which drops my leg down a bit inside the wedge. At my 2 week check up my surgeon told me to keep using it. After getting used to it I like it. I sleep with my leg on it all night.

    My husband said it doesn't look like my leg is totally straight on it, but had a slight bend. Do you think I should stop using it? I do have an adjustable bed, so I can raise my feet up and I wonder if at this point that might be the better position as it would have more bend to it. Maybe my leg has been too almost straight all this time. I thought using it was good to manage the swelling.

    And no, I'm not doing any exercises. I'm so glad there's a very good reason not to do them and not just because I don't want to.
     
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  17. liam2015

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    hi jockette...you can maybe adjust the shape of the wedge by placing a pillow on it to elevate your leg a bit. if you like it and it feels good, helps you be comfy in bed, then i would just try to adjust it a little. i also sleep with mine every night as it keeps my legs comfy; it's a little different from yours. i have read about side effects from the patch you mentioned for nausea but i wonder if it would affect you so soon and in such a short time with your vision? a few members here have used that patch ~ maybe they can chime in with their experience. continue to ice and elevate when you can; hoping your recovery will be more comfortable with giving up p.t. and doing your regular ADL's (activities of daily living).:flwrysmile:
     
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  18. Jockette

    Jockette Senior BoneSmartie Forum Advisor
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    @liam2015 I did put something under my knee last night and used my wedge. It did give me more bend and it was very comfortable. I tried just raising the foot part of my bed but my knee didn't like that angle. At almost 6 months my knee is still very particular about the angle of my leg.
     
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  19. Jockette

    Jockette Senior BoneSmartie Forum Advisor
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    @Celle after reading your reply to another thread (I'm not sure how to quote it) I'd like your opinion, since patellofemorals tend to not have a good track record, what should I pay attention to regarding mine in the future? If my surgeon feels something is not right should I go with his suggestions or seek another opinion?

    I'm under the impression that second opinions are needed if one's current surgeon is not helping. But what if in the future my current surgeon feels it's time to revise to a total, should I let him do it or seek another opinion at that time? My surgeon did tell me before the surgery that once he got inside if he thought I needed a total it would be easy for him to do that instead.

    I like my surgeon as far as personality goes, but he does not promote the Bonesmart way, but then I guess many US surgeons don't.
     
  20. Josephine

    Josephine FORUM ADMIN, DIRECTOR Administrator

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    You should look in the Library - there are lots of "How To" articles in the index. But for the quoting, try this one How to use the quote feature

    Never! And we used to use it routinely years ago.
    How about a photo of it? That would help a lot Uploading a Picture in a Post
    Elevating is a good way to manage the swelling, elevating it completely straight is not!
    Just pain, that's all. Most issues make their presence known with pain.
    Yes, lots say that. I believe Jamie had that arrangement and ended up with a total!
     

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