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[TKR] PJohnson Recovery'

Discussion in 'Knee Replacement Recovery Area' started by PJohnson, Feb 9, 2019.

  1. PJohnson

    PJohnson new member
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    Here I am. I had a deformity that caused my knee caps to track to the outside. When I was a teenager they suggested surgery to stop my kneecaps from going out of joint. I decided against it due to the size of the scar. Pure vanity. I managed OK but as I got older the pain became worse. Then my excuse was that I couldn't take the time off work. Now retired, I decided to take the plunge. I was supposed to have a partial but when the surgeon got in there, the damage was more extensive so he did a TKR. O.K......that's the history.

    Surgery was Jan 15, 2019, three weeks ago. Incision is healing fine. I am having trouble with ROM. PT and surgeon are very aggressive when bending my knee. It hurts like crazy. They tell me I am at 80 deg but the pain starts at about 60 deg. I also have a lot of trouble with swelling. I elevate at night but about 45 min after getting up, the swelling comes back and my leg gets very tired. I am so glad I found this site. Please tell me if what I am experiencing is normal. I was beginning to feel like such a failure.
     

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  2. Jockette

    Jockette FORUM ADVISOR Forum Advisor

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    Hi, again, we’re so glad you joined us!

    Unfortunately, that pain is “normal” however, we can affect that “normal” by doing things to either increase or decrease it.

    The fact that your surgeon and PT are aggressive when bending your knee is one of those things that increases our pain. Mine both did the same thing.

    I’ve since learned from Bonesmart that it is not necessary for them to do that. You can tell them not to bend your knee at all, that you will do it yourself. It’s a matter of consent, and it is your knee, and you do have a right to say what you will allow them to do.

    At 3 weeks it is way too early to worry about ROM. All that swelling you have is what is preventing you from bending your knee. As your swelling goes down, and as you heal, you will be able up bend again.

    And, contrary to many medical experts opinions, ROM can continue for more than a year, as mine has, so there is no “window if opportunity” that many of us are told about.

    I will leave you our Recovery Guidelines. Each article is short but very informative. Following these guidelines will help you have a less painful recovery.

    Knee Recovery: 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
    5. Here is a week-by-week guide for

    The 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 the 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 the member’s history before providing advice, so please post any updates or questions you have right here in this thread.
     
  3. Jockette

    Jockette FORUM ADVISOR Forum Advisor

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

    grandma chris graduate

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    Hi fellow Canadian! Your bend at 3 weeks is much the same as mine was then. Too bad about the aggressive bending , that can only make things worse. At three weeks I was pretty much icing and elevating any time I was not up and walking around - thus most of the time. I refused to do vigorous pt to the extent that the therapists were quite disgusted with me and gave up on me, thankfully! In the end they would just let me do whatever exercises I wanted to do, which was rocking the pedals on a bike and walking around the perimeter of the room. I am approaching 12 weeks now and I can take the steps foot over foot and I was able to get in and out of my bath last week. I have no idea what my number is but when sitting in a straight back chair I can bend my leg so that my heel is behind my knee. I have pretty good function and it's getting better all the time. Welcome to Bonesmart and good luck.
     
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  5. NavyGunns

    NavyGunns FORUM ADVISOR Forum Advisor

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    @PJohnson, you need to take charge and control of your recovery. If your OS and PT are overly aggressive, you need to tell them both to “back off”! Don’t be afraid of making them mad. Tell them you are mad! You hurt and what they are doing just makes you hurt more and you want it to stop, NOW. PT should never be painful. Uncomfortable yes. Challenging, yes. Never painful. Here is an article on saying no to PT:
    https://bonesmart.org/forum/threads/saying-no-to-therapy-am-i-allowed-to.36688/

    At three weeks, primary focus should be on reducing swelling, aiding healing, gentle stretches but never forced bending. You don’t need to be worrying about ROM at only 3 weeks. In fact ROM will gradually improve over time anyway, especially as your swelling goes down and internal healing progresses. Here some examples from other past members:
    Bertschb says:

    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.

    And this one:

    (Thank you, @Campervan ) As you can see, her flexion continued to improve for a long time.
    "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

    Feel free to read up on my recovery thread or that of any advisor to see what has worked and not worked. A link to mine is in my signature below.
     
  6. PJohnson

    PJohnson new member
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    Thank you for your support. I have another question. How do I know when I can walk, inside my house, without my cane?
     
  7. Jaycey

    Jaycey SUPER MODERATOR Moderator

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    You will know when you start leaving your cane behind. As you build up strength and balance this just happens. Meanwhile use that cane and don't feel rushed to ditch it.
     
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  8. CAdesgirl

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    I'm 5 days ahead of you so I don't have a lot of experience to share. I just wanted to echo what everyone else said. Your OS and PT should not be hurting you by forcing you to bend. The recovery from a TKR is tough enough without going through that.

    I, too, had an underlying issue causing my knee cap to track to the outside. Mine is a genetic condition called Nail Patella Syndrome. It's fairly rare so I wasn't diagnosed until I was in my 20's although I'd already had 2 knee surgeries (on my left knee) prior to that. Except for when I have overdone it (knowing full well that I was probably doing too much), my recovery has been almost what I expected. What I underestimated was how I would respond to the mind-numbing boredom. That's been the toughest part. When I had major surgery in the past, I think the doctors did a better job of preparing me for how limited I was going to be.

    I bet if you lay down the law to the OS and PT and allow your body to recover before you worry about your ROM, you'll get better ROM and be in much less pain. Oh, I also hope you're icing ALOT. I love, love, love my ice machine which is weird because I have always hated icing.

    Anyway, good luck and don't be a stranger!
     
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  9. NavyGunns

    NavyGunns FORUM ADVISOR Forum Advisor

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    I have to echo @Jaycey. When you find yourself thinking of the cane as a nuisance rather than a help is when you’ll be ready to give it up. I never used one. I used two crutches for the first three days home (went home on a Tuesday following my Monday morning surgery). By Saturday I was using only one crutch, more like a cane, and by Sunday found myself leaving it on the floor next to my chair most times. Exception was when I went upstairs. Having the crutch gave me extra stability. By two weeks they were both back in the basement. However, some people find they need the extra support and stability longer. It’s all a personal preference thing.
     
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  10. PJohnson

    PJohnson new member
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    Thx to all for the info re: cane
     
  11. CAdesgirl

    CAdesgirl member

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    I was in a walker for my first 2 weeks before I transitioned to a cane. I only used it for a few days around the house. I still use it when I take my walks or go out in public. I find it helps going up and down curbs, for going over uneven ground or if I get tired.
     
  12. PJohnson

    PJohnson new member
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    I find that I get tired very quickly.
     
  13. Didot

    Didot junior member

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    I’m nearly 4 weeks post op and cannot imagine walking without support. I use a walker and am trying to not lean on it as much .... but it’s essential for me when getting up, etc... I’d definitely fall I reckon.


    Sent from my iPad using Tapatalk
     
  14. grandma chris

    grandma chris graduate

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    I used my walker for five or six weeks and now still use a cane outside and when I first stand up. I am almost 12 weeks out.
     
  15. sistersinhim

    sistersinhim FORUM ADVISOR Forum Advisor

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    I had the same thing and I went through 5 surgeries on each knee before my right tkr. But, they ended up removing both kneecaps because of their being worn down so much.

    You should never let anyone push or pull on your leg. Going farther than you can do on your own doesn't count at all. Even worse than that is it causes more inflammation, swelling and pain. This sets back your recovery. Read the articles left for you. These were created from thousands of recovering patients through the years and we know what works!
     
  16. Lindylee

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    You'll know when you suddenly realise you've gone a short distance indoors and forgotten to pick up your cane.That's what happened to me. Now I alternate depending on how long I'm going to up on my feet, what pain level is like and whether I'm walking correctly and without limping. I was advised to use my cane until I could walk without a limp.
     
  17. PJohnson

    PJohnson new member
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    Burning sensation in the incision today. Anyone else get this?
     
  18. NavyGunns

    NavyGunns FORUM ADVISOR Forum Advisor

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    @PJohnson, yep, I remember those. Unless the incision is hot and red, it’s most likely just the healing process. In fact, your entire knee will be warm to the touch for quite a while as it heals.

    However, if you see signs of infection, best to get it checked by your OS or PCP.
     
  19. Jockette

    Jockette FORUM ADVISOR Forum Advisor

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    I think most of us did. Lots of pains, big and small will come and go over the next weeks. Most are temporary. If anything remains or concerns you, you can always check with your surgeon.
     
  20. PJohnson

    PJohnson new member
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    Nope, no sign of infection. There is just a burning sensation and the burning part seems to be wider than it was. Lower part of incision is together nicely, top part seems to be getting wider. Keloid maybe??
     

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