TKR Questions

[AprilM]

Thank you so much for the links!! Reading all of this has lifted a huge weight from my shoulders. My ortho surgeon says to me every time I see him "no pain, no gain" which of course leaves me in tears. My physical therapist says "push through the pain" which of course leaves me in tears. I knew that this surgery would not be a walk in the park but I didn't expect all the pushing from both my ortho and the physical therapist.

During my last appointment with my ortho, which was on January 26th, he told me I had 2 weeks to show improvement, to be bending my knee far more than 90 degrees, or he was going to be doing a MUA, which I do not want. I don't see him again until Feb 23rd, unless he calls me in sooner after the physical therapist reports to him about my progress. I know he's going to be ticked at me for canceling my PT appointments for this week but it is what it is.

I had mentioned to my physical therapist that I had come across 5 or 6 different websites while searching to see if anyone else had had the numb & tingling foot problem after surgery and on those sites they all said "90 degrees by 6-7 weeks and 110 degrees by 11 weeks". He chewed me up one side and down the other for "google searching" and "wanting to follow advise of the internet". Boy is he in for a surprise when I get around to telling him that I'm following advise given to me here ;)

I have been so upset and trying so hard to not get depressed because both my ortho and the physical therapist have left me feeling like I'm doing something wrong, doing things not enough, not pushing hard enough, etc, because I'm not where THEY want me to be on this. On Thursday, while on the NuStep, the gentleman next to me was bending a LOT more than I was able to. My therapist pointed to him and said "he's only 4 weeks post-op and doing BETTER than you are!" I started crying.

I am not a sensitive person but between the ortho and the physical therapist, I have been in tears more often than not. This board is an absolute blessing to have found. If I could hug every single one of you, I totally would... and I'm not a huggy person. So thank you. From the bottom of my heart, thank you.

 

[Celle]

Hugs for you, April, because I think you need them!

every time I see him "no pain, no gain" which of course leaves me in tears. My physical therapist says "push through the pain" which of course leaves me in tears. I

Well they're both wrong! Their advice is entirely inappropriate for recovery from a TKR. Our motto here is "No pain, More gain."
Myth busting: no pain, no gain

During my last appointment with my ortho, which was on January 26th, he told me I had 2 weeks to show improvement, to be bending my knee far more than 90 degrees, or he was going to be doing a MUA, which I do not want.

Well, that's what he says, but he can't do it without your permission, so keep saying no if you don't want it. What's he going to do? Shout at you? Well it seems he already does that, so what else is new? He can't drag you into hospital and do a MUA against your will because that would be committing an assault.
Just tell him something like "I hear what you're saying, but I'd like more time."

On Thursday, while on the NuStep, the gentleman next to me was bending a LOT more than I was able to. My therapist pointed to him and said "he's only 4 weeks post-op and doing BETTER than you are!" I started crying.

That's unforgivable and most unprofessional. He was trying to intimidate and frighten you into working harder. The man next to you might have had a knee that was less damaged than yours, and that required less intervention during the operation. Your PT can't know that. in any case, no two knees are alike. Your knee is on its own journey, on its own timetable, not a timetable dictated by someone else's knee or some pre-conceived idea of how it should be progressing.

Don't try to argue with your therapist - you won't convince him he's wrong. Just tell him that his way is not helping your knee and you won't do it any more. End of discussion. Walk away if he shouts at you - and never come back. There are other PT clinics out there that don't bully and hurt their patients.

 

[PegGar16]

Hi April,
Sorry things have gone so rough on you....Remember you are the consumer, paying customer. The Surgeon and PT work for you providing a service and you can always find an other if you are not happy. One of the best jobs I had was working in a Doctors office who believed in that philosophy. It is amazing how often Yelp was checked
I had the foot numbness/tingling after my TKR surgery. It was in the arch area and around the heel, I want to think it lasted 3-4 months. I also used my ice machine almost non-stop for the first 6- 8 weeks. I think I had it on more than off.
Things will get better.

 

[smarttoys]

I'm so glad you got some much needed rest. Hopefully you can find a way to get comfortable tonight for a good night sleep.
I'm also glad Kneeper and Celle were able to advise you and give you the reading list. There is a lot of great information. I wish you would have found this sight before your surgery so you would have been better armed to deal with pushy PT's right away. Good job for cancelling PT. It will be good for you to take a break and relax your mind and your body.

 

[AprilM]

Unfortunately, finding new doctors and physical therapists out here in my area isn't easy. It took me a couple of years before I found an ortho that would do the TKR surgery at all. Everyone else kept telling me to come back in 20 years when I was 60+ rather than wanting to do it on a 40 year old. I live in a small town. The other problem I run into is my insurance. I have Medicaid and Medicare. A lot of places out here won't take it at all. It's pretty frustrating. I wish we could just move but I promised my son we wouldn't move until after he graduates high school.

I, too, wish I'd have found this board before my surgery! It would have been a huge help. I'm just glad to have found it at all. Better late than never! Though if I'd have found this board first, I'd have gotten to learn about the ice machines and would probably have gotten one instead of using ice bags. It's okay though. If, and it's a huge if, I go through with having the right knee done eventually, I'll definitely be getting an ice machine well in advance!

I have chronic pain, so have never bought into the whole "no pain, no gain" garbage especially when it comes to surgeries.

 

[KarriB]

There's a recipe for ice packs that I used when my dad had a hip replacement two months ago. I think it's two cups water and one cup rubbing alcohol in zip lock bags (I double bagged them). It gets really cold, but stays pliable. You can make a few and switch them when out. My dad used his all the time.

 

[AprilM]

That's a good idea. Tomorrow I'll wander into the kitchen and make up a few so I can switch them out as well as have enough to go completely around my knee.

Oh! While I'm here... any suggestions for helping the tailbone not hurt so much from sitting a lot? The last couple of days, no matter what position I'm in, my tailbone has been hurting. I'm not used to sitting so much and I've been doing a lot of that the last almost 8 weeks.

 

[smarttoys]

There is a tutorial for making the zip lock ice packs that KarriB mentioned in the Library on the top of the site page in the index under "ice to control pain and swelling". At the bottom of the page.
https://bonesmart.org/forum/threads/ice-to-control-pain-and-swelling.5493/
I'm not sure how to post a smaller link to the articles

 

[AprilM]

Woke up this morning with my knee fairly swollen. Already have it elevated with ice on it. Was going to make the zip lock ice packs this morning but discovered we're actually out of rubbing alcohol. Will be having ex-husband pick up a bottle after he drops our son off at school this morning so that I can get them made.

 

[jarabas]

Hi April,
Just read your thread. You have been treated so badly by you OS and your PT--I'm really sorry and here's a hug. The people on this forum are a treasure and a blessing and hopefully you'll find things a bit easier now.
I have my two cents to chip in, small tho they may be.

I'm a side sleeper, tummy sleeper myself. It's been difficult to get to sleep for me but it does help propping myself up on two firm pillows so I'm a bit raised up from stomach to head. I also prop up my leg and ice it right as I'm trying to sleep. I tuck a soft pillow under one arm and sort of turn my upper body --it's a bit tricky to explain, but experiment and perhaps you'll find a more comfortable way to arrange yourself.

As to the tingling--just a thought here--you might call your GP and talk to her/him about gabepentin for nerve pain. I used it after my heart surgery and it was a miracle cure for me. I still take it now for restless leg syndrome and I'm thinking it has helped with this knee recovery.

If you get any guff from your OS, can you talk to the patient advocate at your hospital for support? Tell them how you feel. Perhaps an intercession from them will get your OS to realize that he's not treating patient's with the care and respect they have a right to.

Remember to

Jan

 

[AprilM]

I was just reading another thread and followed the link to the Scoring site to find your best surgeon - US. Went to the link there and this is what I found for my surgeon.

Here's the link to the full image if you can't read/see the above one: https://i.gyazo.com/a1e6f7f2dafdd8193a8abca984db7812.png

I'm not sure of how to read it though...

 

[Bullet]

Hello April sorry to hear about your double trouble with surgeon and PT. One thing I have learned being a nurse is to never share the great information you find on line with your doctor as it puts he or she on the defense and creates tension which you have already experienced with your surgeon. It is never okay for a doctor to blow off your concerns but many of us have experienced this too. I am now 9 weeks out for Right TKR and have a lot of my own struggles which the wonderful people on this great site have helped me deal with. My surgeon is aggressive and treated me very poorly while in the hosoital. He is nice in the office but continues to be upset with my progress. He recommended a manipulation and I refused and now have Dynasplints to aid in my recovery. I have suffered bouts of depression since my surgery which I strongly believe has affected my recovery. I love my PT she is attentive, compassionate and never pushes me to do things over my comfort level. When my numbers improve she is just as excited as I am. It is never okay to be treated the way you have been treated but with that said you at this point are trying to get through your recovery and as you said being in a small town with little resources makes getting a second opinion difficult but not impossible. I agree with everyone else the PT works for you and this recovery is yours not his. Being in a good state of mind helps your physical recovery. You have been given some great tools on this site which I believe will start to help in your recovery. Good Luck.

 

[jarabas]

I took a look at the surgeon scoring site. I think it's probably reasonable to notice that it is only Medicare data, with no input from other insurers/evaluators. It's a bit concerning, but if your surgeon is the only practitioner in a area it's likely he has to handle the very complicated and sickest patients along with everyone else. It's hard to tell how the statisticians control for this based on this little graph.

 

[AprilM]

He's the only one in the area that would do the TKR. Everyone else told me to "come back in 20 years".

 

[DJofNV]

April, lot of good advice here. I had my right knee done in July, it was no walk in the park, believe me. I too had second thoughts about the left but really had no choice. It was bone on bone, hurting my hips and I was afraid damage the new one. What a relief this one has been, gone so much smoother, I was walking that night, walking without the walker in the house within a day or two. So keep your chin up, even if this one goes a little slower, the next one can be totally different. It pisses me off that your therapist tries to compare your progress to someone else, we all heal differently. And I'm an example on how one leg was rough but the other one has been smooth.

Rest is very important, as well as ice. I used the alcohol made packs but they eventually leaked...I use a couple bags of frozen peas in a ziplock, works great. I have the machine for ice but it I couldn't keep enough ice in the house, went through it fast. No pain no gain? What a ridiculous statement from a supposed professional. I heard **** like that as a kid lifting weights, most will tell you to manage the pain to the least amount possible. I didn't even need pain meds to start on this one but my doc convinced me to take them, and, they do help. In a few months things will be so much better and this will be a nightmare of the past. I'm still rehabbing right leg 6 months later, but I'm glad I got them both done.

 

[Josephine]

Also don't forget to include other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness

I had been told no more than 5 minutes at a time

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

he told me I had 2 weeks to show improvement, to be bending my knee far more than 90 degrees, or he was going to be doing a MUA

Well, you know you can just say no! It's all a question of consent. If you don't give consent he cannot touch you. We are not mute and gelded mules for surgeons and PTs to order a round willy-nilly! You have a brain and can think for yourself.

I've been taking prescription strength Aleve for about a year now. 500mg twice a day. That's about all I've ever done for anything pain related.

I'd also say that you really must take your prescribed pain meds. It's as much a part of your healing as anything else. You see, pain also includes soreness, burning, stabbing, throbbing, aching, swelling and stiffness. So to take just Aleve, you might as well take vitamin pills! You need proper, adequate pain management else you risk ending up with a stiff knee.

Incidentally, have you any ideas what your ROM is? What the numbers are? It would help is to see where you are at.

 

[AprilM]

Also don't forget to include other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness

I definitely have soreness, throbbing, aching, swelling and stiffness. I don't really have any stabbing pain, but I do feel pinching behind my knee and a slight pinch in the front of my knee as well.

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

Yesterday, I iced for 60 minutes 6 times throughout the day. Holy **** I can't get over how much THAT alone helped relieve some of the pain!

Well, you know you can just say no! It's all a question of consent. If you don't give consent he cannot touch you. We are not mute and gelded mules for surgeons and PTs to order a round willy-nilly! You have a brain and can think for yourself.

I know. It's hard for me to stand up for myself though. I'm quite shy and rather timid :/ Standing up for myself is really, really hard for me.

I'd also say that you really must take your prescribed pain meds. It's as much a part of your healing as anything else. You see, pain also includes soreness, burning, stabbing, throbbing, aching, swelling and stiffness. So to take just Aleve, you might as well take vitamin pills! You need proper, adequate pain management else you risk ending up with a stiff knee.

I wasn't prescribed any because I told them I didn't want any >.> I'm realizing how much of a mistake that was, believe me.

Incidentally, have you any ideas what your ROM is? What the numbers are? It would help is to see where you are at.

The last ROM measurement that was taken was on Thursday and it was 90 degrees for bending and -2 degrees for straightening. Those are the numbers you're asking about, right?

 

[Josephine]

I definitely have soreness, throbbing, aching, swelling and stiffness. I don't really have any stabbing pain, but I do feel pinching behind my knee and a slight pinch in the front of my knee as well.

I didn't list those to ask if you were experiencing them, I listed them to show how you need to take everything into account when you are considering pain management. People often think that some of them don't count but they do. It's all PAIN!

I wasn't prescribed any because I told them I didn't want any >.> I'm realizing how much of a mistake that was, believe me.

Then contact your GP (PCP) and ask for some. Wait no longer.

The last ROM measurement that was taken was on Thursday and it was 90 degrees for bending and -2 degrees for straightening. Those are the numbers you're asking about, right?

You're about 8 weeks, right? So taking into account the lack of pain management and the swelling that you have because of this, and that you've not been icing or elevating properly, I'm not at all surprised with those numbers. See, pain killers help to reduce swelling (because swelling is part of the pain cycle, right?) and once you get that under control, you will see your swelling and stiffness reduce and your ROM increase! Right? You see, the one thing that seems to be missing from all the PT's protocols is that all your ROM is there right from the start, just waiting for all that to happen so it can show itself. In the general run of things, it doesn't need to be fought for, worked hard for or worried about. It will happen. But you need to do 4 things to help it along
- rest
- elevate
- ice
- TAKE YOUR PAIN MEDS!

Nuff said, I think!

 

[referee54]

On Thursday, while on the NuStep, the gentleman next to me was bending a LOT more than I was able to. My therapist pointed to him and said "he's only 4 weeks post-op and doing BETTER than you are!" I started crying.

It is important for you to remember that no one should compare you---nor should you compare yourself---to anybody else and their recovery.

We are all unique individuals and our recoveries reflect that.

As others have said, it is vitally important to ice and to elevate properly---your knee has undergone a tremendous amount of surgical trauma, and by icing and elevating, you will calm that knee down and let the swelling slowly subside.

Take the pain meds, as you need them, and do not try to work hard to gain ROM---ROM is not something that you work for---it is something that just happens. You cannot rush recovery, but there is plenty that you can do to slow things down and make recovery much more frustrating.

 

[AprilM]

Oooh! My bad! I thought you had listed those to see what was happening to me right now. Sorry *blush*

I am 8 weeks post-op as of today. I had been told to only keep my leg flat and straight and to only ice 5 minutes at a time a few times a day. Since I started elevating yesterday with staggered pillows and iced 60 minutes 6 times, I was already able to feel a difference this morning when I woke up. Today, I've got my leg elevated with the staggered pillows and have already iced my knee 60 minutes 4 times and can definitely tell the difference between even yesterday and today. The swelling between yesterday and today is quite noticeable as well; there's not as much today as there was yesterday.

I bit the bullet and called my PCP. He declined prescribing me pain meds, telling me to call the surgeon that did the surgery. So I called and left a message for the ortho's nurse. She called me back and said they called in a prescription for me that should be done in about an hour or so. I asked what he gave me. Norco is what I was told. I've never heard of that one before so don't have a clue how my body is going to react to it. We shall see I suppose.