TKR PCL release post TKR<<

[IronGirl6]

So... two days ago I woke up and did NOT want to go to PT. I was achy. Then I looked at my leg - two red infection points AND discoloration stripes - overnight! I called my doc frantically - they Rx’ed me Bactrim and had me come in. I’m ok thank God! Apparently my skin doesn’t like the interior stitches and has been steadily pushing them up and out! I hadn’t realized the White I was seeing was stitch material. So the surfaced pieces were removed, and I’m on antibiotics, peroxide clean ups and band aids for 10 days. Fun! Gave me quite a scare I’ll tell you that.

Also - I’ve been afraid to ask anyone - is it normal to feel a bit of movement in the knee? Like an occasional materials rub? I notice this more when barefoot, if I pick up my leg and move it the feeling disappears. There’s no pain - just want to make sure I’m normal. Ish.

Perhaps this is “week 7, then the paranoia sets in”...

 

[sistersinhim]

Thank God it wasn't an infection! We have all been paranoid about these knees! Always wondering if this is normal. And the 'what ifs' just about drove me crazy and still is at times!

 

[IronGirl6]

@sistersinhim - what about feeling a small rub while walking? Is that normal? Hoping it’s inflammation related and will go away later.

 

[sistersinhim]

what about feeling a small rub while walking? Is that normal? Hoping it’s inflammation related and will go away later.

Sorry, but I don't understand what you mean by a small rub.

 

[Celle]

Also - I’ve been afraid to ask anyone - is it normal to feel a bit of movement in the knee? Like an occasional materials rub?

Yes, I think it's normal. It's probably one of the metal components moving over the plastic spacer. As you continue to heal and your tendons tighten up and your muscles regain more strength it should stop.

 

[IronGirl6]

Happy to report after a session of e-stim and ice, l felt a shift as I laid down that night and the rub sensation is gone! Doc said it was normal - been seeing him a lot as we monitor my skin rejecting the deep stictches. Boy is my body tired of antibiotics! It’s been a rather unpleasant cleanse lol. Working on helping my normal flora with kombucha and goat yogurt...

I’ve been doing so well, knee has been feeling good mostly and my walk is almost normal now... then yesterday, hubby and I went to the gym (2nd time post surgery) and I did my gentile Pt routine and some light upper body... but I was overconfident in deciding to tackle the stairs going up... then on the landing decided to work on walking down one stair and my flexion. Some kid came flying up the stairs - and I’m still nervous like an injured gazelle that can’t get out of the way fast enough... I fumbled, bent it more than it wanted to, and my knee was screaming. This morning it’s super sensitive / hard to walk normally again. So I guess it’s another rest / ice / e-stim kinda day. Anyone else ever do something like this?

Also, I’m 8 weeks post surgery - still can’t get the pedal to go all the way around on the bike. Normal? I can use the elliptical but the bike is still my nemesis. Wondering if I had scar tissue from the 3 meniscus clean ups that’s making this harder - or if it’s just normal and eventually it’ll loosen up?

Oh one possibly helpful thing I discovered - my gym has a stretching cage, which is an awesome tool I learned to use in one of my zillions of days in PT with all the ortho surgery I’ve had. I found that going into flexion *backwards* - in a hurdler stretch - is SO much easier than pushing forward into it. Hubby said I got to about 100 degrees the other day, hurrah! Most of the time anything past 90 or so feels like an impossibility.

Hope everyone is well, happy new year!

 

[sistersinhim]

Wondering if I had scar tissue from the 3 meniscus clean ups that’s making this harder - or if it’s just normal and eventually it’ll loosen up?

I would say it's normal. I've had 5 clean outs before my tkr and my knee eventually loosened up. It just takes time. Your knee is only 1/6 of the way through this year-long surgery. It's swelling that keeping your knee from bending more. As that goes down, your knee will bend more.

 

[IronGirl6]

Elusive ROM...

Saw my doc yesterday, today I’m 9 weeks post. It’s still seemingly impossible to get much past 90. Got close to 100 once in the stretch cage / approaching backward as hurdler stretch... then had a fumble and a few pain days and now back to 94 or so. (Architect hubby measures when I ask).

The topic of MUA was broached, I came home with a 6 day corticosteroid pack and instructions to try kneeling in a chair until I can get more motion. I read several articles (including on this site), it seems like muscle relaxers are used. I have some leftover Soma from my spine procedures - wondering if I should try some on my own THEN get on the bike? I really dislike the MUA idea. Not a fan of corticosteroids either but rather that than more anesthesia and cranking. Oy vey.

Is it normal to not be able to get the bike all the way around yet? Overall, my pain levels have decreased significantly. While I had some zingers whilst sitting in a car for 3 hours over the weekend, I haven’t had as much as an aspirin today, which is pretty much my dream after years of injuries and surgeries. Do I keep going slow? Or let this doc who I do like and respect dictate this? I’m scared and nervous. Don’t want to take a successful surgery and allow a negative. Also don’t want to have limited ROM forever. Sigh.

@sistersinhim @Josephine @Celle

 

[Josephine]

Got close to 100 once in the stretch cage / approaching backward as hurdler stretch

You should not, ever, use force to get a measurement. The only number that counts is that which you can achieve on your own.

The topic of MUA was broached

At 9 weeks out? Tell him you politely decline!

I came home with a 6 day corticosteroid pack and instructions to try kneeling in a chair until I can get more motion.

I wouldn't take this. It provides a false result.

I read several articles (including on this site), it seems like muscle relaxers are used.

On this site? Not in my knowledge. Using such medications is the same as using steroids, it provides a false result.

Do I keep going slow?

Absolutely!


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?

 

[IronGirl6]

Hi @Josephine - yes ask away. Thanks so much.

 

[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.

 

[IronGirl6]

answered within your message

1. off and on, 1-7 depending on situation. Activity feels fine, sleeping I get stabbing pain, zingers have been frightening, but last 2 days I’ve noticed significant pain improvement. But stiffness is ever preset - I miss stationary cycling successfully.

2. I’ve been taking ½ of a 10/325 Percocet 2x day, Celebrex 200mg 1x day. Today nothing so far (at 3pm) due to stomach virus. Might be a contributing factor to how tight it feels today.

3. Slight - it’s far less swollen than before surgery, which has been shocking to me.

4. Flex 94 give or take and ext 4

5. 2x day 20-30m each along with estim/tens unit, also use heat 20m before my little workouts

6. 2x day 30m +

7. Pretty good most days - housework some days (cleaning, cooking, laundry), have

8. ome
Daily
Stretching (gently)
Bike back and forth 5 frustrating minutes
Elliptical 5-10m depending on how I feel
Pilates reformer - gentle stretches and bends with 1 spring 10m
Clams 20 each side yellow band
Balance work at bar/proprioception 90sec total
Sit stands - 20 reps
More stretching
Leg slides - 3x day or more, 10r or so as tolerated, no force

Gym
Same + add upper body machines/no heavy lifting
Step ups 40 (step aerobics bench)
Walking UP 2 flights of stairs

been back to gym 2x, can do elliptical with no pain at regular speed now, trying to listen to my body and see how it feels so this varies by day. Also doing my nice PT - sit/stands, balance, clams, and sitting on bikes going back and forth ad infinitum lol. Hardest thing for me is sitting in the car too long (2+ hours).

PT
Haven’t been in 2 weeks since my body rejected stitches and the opened the wound got infected. Leg is better, looking to return Thursday.

Additional
I seem to walk ½ - 2 miles depending on the day and how I feel as well. No pain, feel more Mobile after walking for sure.

While it’s not swollen, I get varying degrees of tightness. Haven’t felt well today (probably terror of MUA affecting my stomach ha) - inactivity makes it feel very tight like there are huge bands inside that are very angry.

 

[Kiwigirl62]

Is it normal to not be able to get the bike all the way around yet?

@IronGirl6 no such thing as normal with tkr.... .i found trying the rotation on bike a little easier first thing in morning... after leg was rested and swelling was down

 

[beachy]

You're doing a lot for 9 weeks out. I know you're young, but that's still a lot for a healing knee. IMHO. Only because I've been there, done that. Not as much as you, but I did too much and paid the price.

 

[IronGirl6]

I’ve had a few days where I didn’t do everything - just stretch bike and slides along with a few paces around the house... but compared to before surgery & before knee took its worst turn early 2018 it feels like I’m doing nothing. If I’m not active, it tightens up, I get restless legs, and it hurts more. I’ve monitored swelling and pain, only thing in 2 weeks that hurt was a fumble on the stairs at the gym when some kid scared me...

I’ll try to do less if y’all think that’s my issue - but there is seriously and shockingly less pain and swelling now than I’ve had for a decade! Definitely tells the story of how much I needed this procedure. The fact that I can get up and walk - with 2m of warmup after sleeping 8 hours - without limping and without needing a pill and waiting 30m... it’s AMAZING. It’s also great that my leg feels stable again. After a bunch of muscle atrophy from years of imbalance, it now somehow feels like the stronger side.

I definetely don’t want an MUA, nor do I like the idea of this box of corticosteroids I haven’t opened yet.

Interestingly - I have an anti aging doctor who studies and practices cutting edge medicine, and I asked him - he said peptides are a solution! I’m still researching it, but it looks fascinating! I’ll report back when I know more.

Thanks so much - and I await Josephine’s input as well.

 

[sistersinhim]

I definetely don’t want an MUA

You have the final say-so about that. You are still early in this recovery and your bend will improve in time.

 

[Josephine]

1. off and on, 1-7 depending on situation. Activity feels fine, sleeping I get stabbing pain, zingers have been frightening, but last 2 days I’ve noticed significant pain improvement. But stiffness is ever preset

Hm, interesting

2. I’ve been taking ½ of a 10/325 Percocet 2x day, Celebrex 200mg 1x day. Today nothing so far (at 3pm) due to stomach virus. Might be a contributing factor to how tight it feels today.

I suggest you take more Percs because you're clearly not taking enough.

3. Slight - it’s far less swollen than before surgery, which has been shocking to me.

Okay

4. Flex 94 give or take and ext 4

That would be 94/+4 then

5. icing x2 day 20-30m each along with estim/tens unit, also use heat 20m before my little workouts
6. elevating 2x day 30m +

You accomplish little or nothing in 20/30 minutes. Ice for at least 40-60mins and more than 4 times a day.

7. Pretty good most days - housework some days (cleaning, cooking, laundry)

Okay

Home, daily
Stretching (gently) - okay
Bike back and forth 5 frustrating minutes - okay
Elliptical 5-10mins depending on how I feel - NO elliptical
Pilates reformer - gentle stretches and bends with 1 spring 10m - nor this
Clams 20 each side yellow band - definitely NO clamshells
Balance work at bar 90sec total - no balance work
Sit stands - 20 reps - none of these
Leg slides - 3x day or more, 10r or so as tolerated, no force - I presume here you mean heel slides. This is not a good way to do them. Did you read the Recovery Guidelines left you in post #2 of this thread? Because this article is listed in there so you clearly never read them! Heel slides and how to do them properly

Gym
Same + add upper body machines/no heavy lifting - none of these
Step ups 40 (step aerobics bench) - no step-ups
Walking UP 2 flights of stairs - okay but never to the point of pain

Been back to gym 2x,
can do elliptical with no pain at regular speed now
trying to listen to my body and see how it feels so this varies by day.
Also doing my nice PT - sit/stands, balance, clams, and sitting on bikes going back and forth ad infinitum lol. Hardest thing for me is sitting in the car too long (2+ hours)

In summary, I think you are doing far too much. You need to cut back as indicated. If you are concerned about refusing to do therapy, you need to read this Saying no to therapy - am I allowed to?

PT
Haven’t been in 2 weeks since my body rejected stitches and the opened the wound got infected. Leg is better, looking to return Thursday.

Additional
I seem to walk ½ - 2 miles depending on the day and how I feel as well. No pain, feel more Mobile after walking for sure.

While it’s not swollen, I get varying degrees of tightness. Haven’t felt well today (probably terror of MUA affecting my stomach ha) - inactivity makes it feel very tight like there are huge bands inside that are very angry.

 

[Josephine]

@IronGirl6 I have caught up with your answers but I'm not feeling too good so am going to check out for a while. Sorry about that but I'll be back later or tomorrow.

 

[IronGirl6]

@IronGirl6 I have caught up with your answers but I'm not feeling too good so am going to check out for a while. Sorry about that but I'll be back later or tomorrow.

Hope you feel better! My blah day was yesterday!

As another note on my status - yesterday I didn’t do much at all, except heel slides in bed and some minimal walking. Lots of elevation and ice time. Today I hurt like crazy when I got going... 10m on elliptical and 10m stretching and I was better again. Then was faced with some steep stairs while out - up was fine, was cautious down both feet per step.

 

[Celle]

Also, I’m 8 weeks post surgery - still can’t get the pedal to go all the way around on the bike. Normal? I can use the elliptical but the bike is still my nemesis. Wondering if I had scar tissue from the 3 meniscus clean ups that’s making this harder - or if it’s just normal and eventually it’ll loosen up?

Oh one possibly helpful thing I discovered - my gym has a stretching cage, which is an awesome tool I learned to use in one of my zillions of days in PT with all the ortho surgery I’ve had. I found that going into flexion *backwards* - in a hurdler stretch - is SO much easier than pushing forward into it. Hubby said I got to about 100 degrees the other day, hurrah! Most of the time anything past 90 or so feels like an impossibility.

today I’m 9 weeks post. It’s still seemingly impossible to get much past 90. Got close to 100 once in the stretch cage / approaching backward as hurdler stretch... then had a fumble and a few pain days and now back to 94 or so. (Architect hubby measures when I ask).

The topic of MUA was broached, I came home with a 6 day corticosteroid pack and instructions to try kneeling in a chair until I can get more motion. I read several articles (including on this site), it seems like muscle relaxers are used. I have some leftover Soma from my spine procedures - wondering if I should try some on my own THEN get on the bike? I really dislike the MUA idea. Not a fan of corticosteroids either but rather that than more anesthesia and cranking. Oy vey.

Is it normal to not be able to get the bike all the way around yet?

I can see that you're under a lot of pressure to achieve ROM quickly, but there's no need to worry.

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

We've had many people here on BoneSmart whose ROM continued to improve, even after a year had passed.

Stop trying to force your knee to bend - that will only irritate it and make bending even harder. You're past 90 degrees, which is the most important thing. you have plenty of time for your flexion to improve.
Essence of time is what's needed, not exercise and worry.

It's not exercising that gets you your ROM - it's time. Time to recover, time for swelling and pain to settle, and time to heal. Your ROM is there right from the start, just waiting for all that to happen, so it can show itself.

If your surgeon mentions an MUA again, tell him you'd like to wait a while. There's no critical time for doing an MUA either.

TKR: work “smarter” and not “harder”
Life in the slow lane
ROM: it's worth the wait for ROM
ROM: it's never too late to get more ROM!