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[PARTIAL KR] PKR Success - 1 yr out.

Discussion in 'Knee Replacement Recovery Area' started by NavyGunns, Apr 26, 2018.

  1. NavyGunns

    NavyGunns FORUM ADVISOR Forum Advisor
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    Good morning all! I’m a new member, 10 days post-op. Had Mako - PRK done to lateral compartment left knee to fix problems from a 40+ yr old injury. According to the surgeon, all went as planned. Went home next morning. My first follow up with the surgeon is 16 days post-op. PT has not been scheduled yet, surgeon likes to wait till after first follow up.

    My initial pain management was via a nerve block / pump attached to my left thigh which lasted for about 3 days post-op. Since then, pain has been managed with combination of Tylenol and narcotic pain killer. Keeping dosages to a minimum as long as pain is tolerable.

    I was up and walking with the aid of a walker within 6-8 hours of surgery. Within 24 hours was only using a single crutch. The past three days I’ve been able to walk (slowly) without aid of any crutch or cane. I was sent home with a daily exercise/stretch routine consisting of heel slides, long-arc leg lifts, and flexion stretches to be done two to three times a day. I was also provided a cooling compression therapy machine to use following exercises and whenever additional pain relief was needed.

    I have no idea what my current ROM is but guessing it might be from 3 or 4 degrees to roughly 90 degrees, maybe slightly more.

    Knee still shows quite a bit of swelling and is very stiff, especially as I approach 90 degrees. But each day seems to be a bit better than the previous.

    While I’m hoping my current progress is good/normal, I recognize that everyone’s situation is unique, so I’m not overly concerned if progress lags somewhat. So, I’m wondering what to expect from this point forward? What should I expect from PT? Are there any “watch outs” I should be aware of? I’m also wondering if I should consider applying some heat to my knee prior to my home stretches then followed by cooling therapy? I know that heat helps to loosen muscles, etc. so I was thinking it would help here too.

    Thanks all for your thoughts.
     
  2. VonnieN

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    Hello welcome there are plenty here who can provide you with good advice. what I have picked up is less is more...dont get convinced to do more before you are ready. Good luck
     
  3. NavyGunns

    NavyGunns FORUM ADVISOR Forum Advisor
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    Thanks Vonnie. That’s what I seem to be getting from the few other posts I’ve read. At first I was surprised when my surgeon didn’t prescribe PT right away, but now I’m glad he didn’t. Seems like those with issues started PT too soon after surgery.

    Thanks again. Looking forward to feedback from others.
     
  4. SusieShoes

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    Hi @NavyGunns and :welome: to BoneSmart. Our community of joint replacement recipients is happy you joined us!

    This is your recovery thread, so feel free to share your thoughts or concerns, ask questions, and just vent if you wish. We're here to help.

    I think some of the answers to your questions about what comes now in knee replacement recovery can be found in our reading for new members, so here you have it:

    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
    5. At week 4 and after you should follow this

    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 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.
     
  5. SusieShoes

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    The main thing to expect from PT is... no miracles. In fact, you really don't need PT. Lots of surgeons prescribe it, and its main use is that it at least gets people to move (some people need prodding), but... you could easily do all that's needed to rehab your knee on your own. You don't need special equipment or strenuous exercise. In fact, walking is the perfect knee rehabilitation exercise; it is what knees are designed to do, after all.

    Watch out for... PT. A good therapist will understand that the main need of a knee after replacement is rest and the chance to heal. The therapist would work on gentle movements like bends and stretches, and on things like balance and gait.

    Some therapists push training exercises, though. They work a knee hard with straps, machines, and too many repetitions. This kind of PT is what causes setbacks. Aggressive exercise causes more swelling, more pain, and less ROM. It can create a vicious circle that feeds on itself. Patients caught in this kind of situation get frustrated and you don't need that.

    It can be difficult to think of resting and letting the knee heal as an active process, but it is! You are doing the very best thing for your knee. So the thing to watch out for is the temptation to overdo the exercise part of recovery.

    We recommend NOT using heat on the knee at this point in recovery. Heat increases blood flow and therefore swelling (because of existing inflammation), so would likely just cause more pain and less ROM. You can use heat on your calves or on the thigh muscles above the knee if you wish, to relax them.

    Later on, after a couple to a few months, after the swelling has subsided, you can try using heat on your knee again.
     
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  6. NavyGunns

    NavyGunns FORUM ADVISOR Forum Advisor
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    Thanks @SusieShoes! Your comments regarding PT are very consistent with what I’ve been reading in this forum. Definitely something I need to discuss with my OS to get his thoughts. It’s been almost 20 yrs since I last had PT on the knee (following arthroscopic surgery to clean it out). I’m sure approaches have changed some, but I do remember it being quite aggressive at the time.

    Your comments regarding heat at this point in time make sense. I do know that if I massage my knee the the areas just above and below while doing my stretches, each repetition gains more ROM and less stiffness / pain. Figured warmth would also help, but too soon for that, I agree.

    Thanks again.

    NG
     
  7. SuperSnapper

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    I have a three and a half year old partial medial. It’s great. But I took recovery fairly slowly and gave my knee time to heal before I asked it to do too much. Now it can do most things. I walk a lot and can run on it if I want. I enjoy swimming and that’s been great. I am so glad it was done. I’d echo the warnings about too much PT. very over rated in the early weeks but more helpful when you’ve given your inflamed tissues a chance to heal and stop swelling up.
     
  8. Celle

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    Hello @NavyGunns - and :welome:

    It sounds as if you are doing well so far.
    SusieShoes warned you about doing too much PT, and she's right. A good PT therapist will help your recovery, but avoid anyone who insists that you have to meet deadlines for your knee, because your knee will heal on its own schedule.

    Complete recovery from a knee replacement takes a full year - it's a marathon, not a sprint - so pace yourself and be prepared for periods when you don't seem to be making much progress. You'll get impatient and frustrated, but it will be worth it in the end. This recovery takes a lot of patience.

    Be prepared for well-meaning friends and relatives to ask, "Aren't you better yet?" Or they might tell you of acquaintances who had lightning-fast recoveries - those recoveries are usually urban myth.
    No one who hasn't had a knee replacement understands how long recovery can take.

    It's not exercising that gets you your ROM (Range of Motion) - 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.

    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.

    I did minimal PT for my first two knee replacements and for my last one I did no PT at all. I just let my activities of daily living (ADLs) be my exercise.
    My knees are strong and reliable. They straighten fully and bend to over 125 degrees.
     
  9. NavyGunns

    NavyGunns FORUM ADVISOR Forum Advisor
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    Thanks everyone for your thoughts and support. You’ve all given me some great topics to discuss with my OS next Wednesday. I’ll update my post following with the plan forward. Your successes are encouraging. NG.
     
  10. kneeper

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    I did PT but I also listened to my knee. I learned that PT doesn't have to cause a lot of pain. In fact if it does, it's too much. Be wary of the "if 5 repetitions are good 20 are better" mindset.
     
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  11. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    I'd be very happy 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?
     
  12. NavyGunns

    NavyGunns FORUM ADVISOR Forum Advisor
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    Josephine, ask away. If I’m able to answer, I will. Thx. NG
     
  13. NavyGunns

    NavyGunns FORUM ADVISOR Forum Advisor
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    Good evening all. I’ve enjoyed reading many of the other member posts and found great information I can use to aid my own recovery.

    Tomorrow will be 2 weeks post op. I see my OS on Weds for my first post-op visit. Can’t wait to hear what he has to say. I’ve been walking without any aid since 7 days post op. Each day gets easier. Able to walk up stairs normally and somewhat normal going down (kind of sideways as I can’t quite get that much bend yet). Most of my restriction and tightness is right under the incision, not in the joint itself.

    Speaking of ROM, can’t believe how much improvement I’ve seen the past several days. Swelling is down quite a bit which helps. Prior to my stretching exercises, I spend about 5 minutes messaging all around my knee to loosen it up. I’m guessing I can bend it to roughly 90 - 92 degrees or so, maybe a bit more? The past couple of days I’ve also gone for short walks around the block which seem to help. Of course really look forward to icing the knee afterwards .

    I’ll post another update after my follow up with the doc.

    Thx. NG
     
  14. Josephine

    Josephine FORUM ADMIN, NURSE 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?

    swelling.jpg

    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.
     
  15. NavyGunns

    NavyGunns FORUM ADVISOR Forum Advisor
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    Josephine,

    Here are my responses:

    1) pain level on average is between 4-5. At times as low as 2, others as high as 7.

    2) prescribed Oxycodone 10mg; 1/2 to 1 pill every 4 hours or as needed and 1 Tylenol every 6 hours. Was originally sent home with a nerve block pump the first 3 days. Didn’t take the pain meds till block removed. Last three days have only taken pain meds at night. During the day been taking 2 Tylenol every 6 hours which seems to work fine.

    3). Swelling between slight and moderate, knee area only.

    4) ROM - guessing between 2 - 90

    5) icing the knee following all exercises and significant walking. Avg about 20-30 mins 5 to 7 times a day.

    6) elevate whenever I’m not on my feet. Figure 30 - 40 mins out of every hour or more.

    7) no major housework. General walking around the house. Can go up and down steps normal like with minimal problems

    8) Sitting heel slides, 5-6 repetitions, 3-4 times a day
    Long arc quad, 5-6 repetitions, 3-4 times a day
    Quad sets, 5-6 repetitions, 3-4 times a day
    Prolonged flexion stretch, 4-5 repetitions, 3-4 times a day

    No PT at this time yet. That may change after weds.
     
  16. Celle

    Celle FORUM ADVISOR Forum Advisor

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    Hello @NavyGunns
    Please will you tell us the date of your knee replacement, so we can add it to your signature? Thank you. :flwrysmile:
     
  17. NavyGunns

    NavyGunns FORUM ADVISOR Forum Advisor
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    Celle,

    It was 4/16/18. PKR left lateral.
     
  18. Celle

    Celle FORUM ADVISOR Forum Advisor

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    Thank you.
    :flwrysmile: I've done your signature now.
     
  19. NavyGunns

    NavyGunns FORUM ADVISOR Forum Advisor
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    Thanks.

    NG
     
  20. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    Interesting
    Yes, it's a very good pain med
    Okay
    Okay not bad for 2 weeks out
    Jolly good
    Very good!
    Good


    Sitting heel slides, 5-6 repetitions, 3-4 times a day - heel slides are an easy thing to do badly and these are badly! You should read this Heel slides and how to do them properly but more than that, leave them for a few weeks.
    Long arc quad, 5-6 repetitions, 3-4 times a day - also known as straight leg raises. I'll give you a tip, once you can do them you don't need to do them any more!
    Quad sets, 5-6 repetitions, 3-4 times a day - I think once a day is plenty for this
    Prolonged flexion stretch, 4-5 repetitions, 3-4 times a day - here again, too many. I suggest 2-3 once a day

    No PT at this time yet. That may change after Weds - well don't let them give you too much to start with and on no account allow anyone to push on your knee to get more flexion - very bad!
     

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