TKR Please: Some advice for one week out..

[kneeper]

75 to 85--that's very encouraging!

 

[leslie01]

Very confusing...PT tells me that since I am past the surgery pain, I should be able to push thru the pain and get more mobility..therefore, I am on the recumbent bike trying to get past the painful part..when I get so that I cannot go anymore, I push and push..Could somebody please explain scar tissue to me..I am under the impression, that it is forming as we speak..when I am not moving it, it is forming. Therefore, I have to do these exercises every two hours until they really hurt so that more scar tissue does not form..Is this not true?
Extremely down today..I know I have lots to live for, but can't see it..Very scary..
Should I be taking pain meds day and night, even if I feel not needed? I know that I certainly need pain meds when the exercise time comes..maybe taking the pain meds would help with getting thru that..I have read the postings and am most grateful..also read the articles..it is hard when the PT is telling one thing and the articles are telling others..I just want to get better.
Going to see surgeon on March 7th where he will ex-ray and then talk to me..Have heard he does MUA for anybody under flexion of 95..I am soooo scared that I will not get there..

 

[Creeker13]

Fire your PT. They are giving you sports injury advice not joint replacement advice. You should not be in this much pain if you are taking your pain meds as prescribed, on time, and not over exercising. It takes months, not weeks to get past the sugery pain. Josephine was an osteo nurse and has been through knee and hip replacement herself. Her advice is golden. I hope your surgeon sends you to a different PT. It is obvious they have not had knee replacement surgery and do not understand the length of time it takes to get better.
From what I have read here MUA is not so bad. Not something to be terrified of.
If you have done the reading that has been recomended it will answer most of your questions. If you keep pushin your knee and not listen to your body it will take a lot longer to recover. I recomend stopping all exercise for 2 days and see how you feel.... remember any wandering around the house is also exercise.

 

[KneeAware]

leslie01 you have to give it time to heal, all that pushing and pushing through the pain is not correct!!! Give yourself a couple of days and let your knee rest, it will feel much better but don't jump right back into the exercises. My first PT used to give me lectures about trying to do too much and she had the motto 'no pain more gain', as she would say, it was major surgery and you HAVE to give it time to heal. So do yourself a big favour, slow down and let your knee dictate what you can and should be doing, you are the one suffering not your PT, when she pushes you too far!!!!

 

[bottomshollow]

Leslie, you are only 1 month post op---that's just 1/12th of the way through your 12 month journey to complete recovery. You are NOT past the surgical pain and won't be for several more months. This is a person who does not know what he/she is talking about. As long as your knee is swollen is it not going to bend properly. It doesn't mean that it can't or won't when the swelling is gone-----but you have to give the swelling a change to resolve itself. As long as you and the PT are punishing your knee in this manner, the swelling is not going away and you are going to be in pain and not get the flexion you want.

Please, please stop PT now. Find yourself someone who agrees with the BoneSmart way. Go back and read all the articles you were given earlier---and read them all carefully and take the info in. It is all good---the BoneSmart way works----I am living proof of that----I followed the mantra to the letter and had a wonderful recovery with very few bumps in the road.

Take care, sweetie, and keep us posted. We care.

 

[hhilltop]

Hi,

I'm new to Bonesmart. I wish I'd found it when I was 1 mo post TKR. I remember all to well how totally distraught I was when my PT first mention manipulation (MUA) to me. I went on line and made myself even more distraught about it. It isn't everyone who is so "lucky" to need an MUA, so the majority of patients don't ever learn about it. That aside, the research I did came up with an article of a study of nearly 700 TKR patients. Of them about 5% needed an MUA. Of these patients about 95% came through with great gains in their ROM - average flexion gain 22, average gain in extension 5. I'll try to locate a link to that study for you. (I found it and posted it below.) For now, take a deep breath and relax. Though they call it surgery, they don't open you up at all. They put you under anesthesia for just a few minutes while your surgeon twists and turns and breaks up scar tissue and adhesions. In my case, I was back in 25 minutes already alert. Yes, it will hurt for awhile thereafter, but you should see gains. If you haven't heard this enough, you eventually will - everyone is different. You can't make predictions on your progress based on someone else's progress.

If you need an MUA, you need an MUA, though not everyone does. My OS said the research shows the results are best if it is done before 2 months post op. It takes a bit of time from the time you decide it is needed until it can be scheduled. At 1 mo. my OS gave me 2 weeks to try my darndest with PT and I did!!! Didn't budge. It was done at 2 mo. I had (5,75) for my ROM before MUA. In the procedure my OS got it to 130.

I'll be watching for you. I was able to locate the article. Here is the link. broken link removed: https://www.healio.com/orthopedics/journals/ortho/%7B77c72630-cd5b-4e4e-a1cc-fe5750e0d693%7D/closed-manipulation-after-total-knee-arthroplasty-outcome-and-affecting-variables

Martha

 

[leslie01]

Thank you so much..I think I will get a different opinion from a different PT. What you are saying here at bonesmart makes so much sense..I cant seem that I will get much ROM with it being this swollen..I tried to rest it today more keeping it elevated more.
Is it true that some people, thru no fault of their own, lay down more scar tissue faster and there is nothing that can be done for those people? That they won't ever get a good range of motion - that they have to have a MUA no matter what? I seem to have it in my head that I am this person..don't know why I do..I suppose just negative thinking..
I will do my exercises but not to the point of great pain..I will go to my limit and that is it..I will not do them every two hours as told..I will rest my body more - ice and elevate more. I will take my pain meds as prescribed..
My PT told me that they will not give me any more pain meds after another week..Is this true? I was trying to save some just in case I needed it past next week..

 

[leslie01]

Thank you Martha...I do have myself worked up over the MUA and it might all be for nothing..I will check the article out..

 

[referee54]

Is it true that some people, thru no fault of their own, lay down more scar tissue faster and there is nothing that can be done for those people?

I am not sure that it is the way you say it is---but I had adhesions in both knees after a BTKR---I took care of them myself, though. I guess some may be somewhat predisposed than others,; perhaps Josephine can answer that. Josephine

My PT told me that they will not give me any more pain meds after another week..Is this true?

I would have a talk with my OS, if I were you. Others have been on pain meds much longer than you---if you need the pain meds, then you need the pain meds. You are taking them for a valid reason.

 

[leslie01]

I am hoping that Josephine will answer that question about scar tissue..
How did you take care of them yourself referee54?
True about the pain meds..I won't feel like I should not be asking for them, when they are needed...

 

[referee54]

How did you take care of them yourself referee54?

My PT had me use ankle weights and exer-bands to break them up. I would hang the knees over the edge of either the bed or the couch and add more weights to the ankle weight belt through the ensuing days. I would also use the exer-bands to pull the leg into position to pop the adhesions.

 

[hhilltop]

You sure know more than I did one month out. Yes, it seems there are a few "lucky" ones that have bodies that like to slap down the scar tissue. There's a few others I've found here that know about this, too. Do check out the article. It has lots of graphs and charts included. It shows us to be among the lucky few. Please hear me when I say - it really isn't the end of the world. I know when you're coming out of TKR and your leg is nothing like it was before the procedure and it is still very swollen at 1 mo. The last thing you want to hear is any thoughts about another surgery. Believe me. An MUA is not a big surgical ordeal.

Just make sure that you don't have to navigate any stairs into your house after it is done unless you have a team to help lift you in. You won't be ready to do any stairs. Go home, lay down, ice, ice, and more ice while elevated. Take the meds like clockwork. Keep doing lots of ice and elevation along with some EASY movement. Don't let anyone - be aggressive with it - PT's included. If your body threw down a lot of scar tissue after the TKR, it may want to again.

Hope you hear from others, too.

 

[referee54]

If your body threw down a lot of scar tissue after the TKR, it may want to again.

My understanding is that adhesions come from surgery---not from an MUA---when the tissue is cut, some people, for certain reasons, produce adhesions---many do not. Since an MUA is not surgery, the adhseions do not "reproduce."

 

[hhilltop]

From what I'm being told it depends on your body chemistry. Scar tissue can form whenever you feel a warmth to your swollen knee. Thus, ice, ice, ice. Now my therapist early on in my injury will tell, you, I did not heed this advice. But, I've lived and learned. Ice is good!

 

[leslie01]

Well, my ROM was 83 or so last time I was at physio . I am going to be a bit easier on myself..do the exercises, but not to the point of extreme pain, ice and elevate more and hope that the ROM comes as the swelling goes down. I hope to heck I am not one of THOSE that lays down the scar tissue, or the adhesions..Pray for me

 

[Josephine]

PT tells me that since I am past the surgery pain, I should be able to push thru the pain and get more mobility

In no way are you 'past the surgery pain' at one month out! That doesn't come until about 10-14 weeks out and probably even longer than that. Never EVER 'push through the pain'.

Could somebody please explain scar tissue to me..I am under the impression, that it is forming as we speak..when I am not moving it, it is forming. Therefore, I have to do these exercises every two hours until they really hurt so that more scar tissue does not form..Is this not true?

There is a lot of misunderstanding about scar tissue. In fact, you need scar tissue to heal/seal the incisions your surgeon made. This is perfectly normal and mostly doesn't cause any problems whatsoever. What is really meant when PTs and others say this is adhesions. These are a totally different phenomena which I explain here MUA (Manipulation under Anaesthetic) and Adhesions. To go over a couple of points from this article

All the structures in the body, muscles, tendons, ligaments, even gut and lungs, need to be able to glide over one another smoothly to let our bodies work. To enable this ‘glide-ability’, the body produces a special viscous fluid, approximately the consistence of egg white, which lubricates everything with great efficiency.This gets interfered with when surgery or injury takes place

a) skin generally makes itself a nice thin little line of fibrous tissue which will fade and disappear over time. This is a scar.

b) where split apart muscles come back together, they usually 'resume normal relations' in terms of being close together but with glide-ability. But sometimes they fail to restore the lovely moistness that allows this and get stuck together resulting in adhesions. Mostly this process isn't too aggressive so the moisture eventually develops and the normal 'glide-ability' of the structures ultimately gets back to normal anyway. But problems occur when the fluid isn’t produced quickly enough and the structures get stuck fast. These are adhesions

However, if you do too much and cause the tissues to become hot, inflamed and painful, then the production of the natural moistness in the muscles is likely to be inhibited so making adhesions more likely. This is where rest, elevation and icing is more likely to prevent adhesions.

Should I be taking pain meds day and night, even if I feel not needed?

It's a balance than you have to work out for yourself by trial and error. Did you read the articles Jamie left for you earlier in this thread? The very first one was about pain management. I suggest you go back and read it again as it's all explained in there.

Have heard he does MUA for anybody under flexion of 95..I am soooo scared that I will not get there..

There is one immutable fact in this - neither he nor your surgeon can do anything of this kind without your consent. Secondly that a lot of people don't get to 100 for some weeks after surgery. That doesn't mean you will never get there. Again in those articles was one on "the window of opportunity" - go back and read it. No-one needs an MUA before at least 12 weeks has expired and some haven't had it until months later, even a year. There's no rush. Read the article.

Is it true that some people, thru no fault of their own, lay down more scar tissue faster and there is nothing that can be done for those people? That they won't ever get a good range of motion - that they have to have a MUA no matter what? I seem to have it in my head that I am this person..don't know why I do..I suppose just negative thinking..

People who have a tendency to develop adhesions are very rare. In the first few weeks, the thing that prevents good flexion being obtained is swelling and pain and that is caused by being too aggressive with PT and exercising. I suggest three actions:
1. fire your PT and either get a new one or do the exercising yourself
2. stop listening to all these doom laden prophecies of doom!
3. apply the BoneSmart mantra

From what I'm being told it depends on your body chemistry. Scar tissue can form whenever you feel a warmth to your swollen knee.

I'd love to know who told you this and where they got it from. As far as I know, nobody knows exactly how or why adhesions form. We know under what circumstances they tend to occur but why it happens in one person and not another - that's still one of life's great mysteries!As for the second sentence, warmth is not the scenario - that's a normal sign og healing. It's when the muscles are HOT!

 

[kneeper]

If you have a variety of exercises, spread them out over the day. You can be doing *something* every few hours, just not *everything* so many times a day.

 

[referee54]

Recovery can take a while---and it is best to not rush things, anyway. As has been pointed out, there is no "magic window" for ROM---it can take a year--and longer---to achieve.

I also agree---stay away from all of the folks who espouse the negative points---you are still very, very early in the grand scheme of recovery and you have to be patient.

apply the BoneSmart mantra

Ice/elevate/rest---and do the exercises gently, and never to the level of pain---only to the point of discomfort. I will bet yo will see some progress.

As for progress, in a TKR or BTKR recovery---it is not measured in leaps and in bounds---it is most often measured in the tiny, little successes that allow us to realize that we are making progress.

 

[referee54]

I was lucky---the PT center that I went to had two sets of PTs---one for joint replacement patients and one set for the "athletic" type injuries and rehabs. The two sets never crossed paths with patients.

My PTs were great at making sure that I was not overworking the knees and would also tell me when to cut back---they never expressed concern about "you had better get your game face on and increase that ROM." They never threatened anything, and they made sure that I understood that ROM was something that could take some time to acquire.

 

[leslie01]

Thank you Josephine..I went back and re-read the articles..I guess it is just the worrier in me...forgetting what I have read...needing some "boost"...I have changed my attitude..doing my exercises faithfully, but not to the point of extreme pain..swelling is still quite bad..if icing and elevating is not working, anything else to do..or am I just rushing it..People have talked about putting somekind of cuff on lower part of leg and pulses to get rid of swelling, or get a tissue massage around the knee for swelling..Any truth to that??