TKR Ready for Recovery TKR Left (9 years since right)

[mendogal]

Happy to help @Dearjr !
1) There's a small percentage of PTs and orthos who advocate zero knee bend in order to promote extension. The fact is almost nobody actually tolerates full extension post op!!!!
With my first, pre Lounge Doctor knee, I used pillows. My PT, who had had a knee replacement, endorsed using pillow as it's impossible to sleep post op without them.
The Lounge Doctor provides a safe bend.
2) There's a legitimate concern about pressure being applied to the back of the knee as a risk factor for blood clots. A properly sized Lounge Doctor, and properly arranged pillows, support both the thigh and the calf, with zero pressure or even contact needed between pillow and the popliteal area.

 

[mendogal]

Re exercise: I have studied different modes of strength training and cannot find any physiological basis for the common pattern of "do a set - rest - another set -rest - another set." (deep dive for us exercise geeks: From a metabolic perspective, the rest actually allows the initially challenged muscle fibers to reset and resume activity, which means there are other fibers that are never challenged. )

I recommend selecting no more than two or three exercises, period, and only doing one set of each. And I also suggest doing each exercise a couple of hours apart, with rest and ice in between.

At this point you absolutely haven't healed enough for squats, half squats, repetitive steps up and down, or anything that would qualify as strengthening.

Doing those too early can acutely damage unhealed tendons.

@Dearjr

 

[Jockette]

The regular PT came today and gave me at least 6 new exercises.to do 3 x a day 2 sets each

I thought that was much to much
I'll take the less is better advice

You are correct, that's way too much for your stage of healing.

 

[selketine]

I thought that was much to much

I wish you could see the 10 page handout I got from the PT who came after my January surgery. So many exercises/reps/x times per day I would have needed a secretary to keep track. My PT told me today that the real important things early on are exercises that help with your extension and your bend - the strengthening stuff is gravy and can be done later. Regardless of what exercises you're doing - it worked well for me to spread them out over the day.

I had a ton of swelling with the January knee and trying to increase the bend was impossible until that started going down. The Sept. knee has much less swelling and I can tell it is more amendable to heel slides and such.

Glad to hear you are doing well so far!

 

[Dearjr]

Thanks so much @mendogal and @Jockette
Will do less

I use the lounge doctor as it says with the knee in the contoured bend
I'm just not sure if it's worth it to keep pillow under ankle or calf. It seems to make it more uncomfortable

 

[Dearjr]

had

I also have a lot of swelling but only d#4 post-op
I remember having swelling till 6 months with right one

 

[Toothfairy]

Very early days. Rest and heal.

 

[Jockette]

I use the lounge doctor as it says with the knee in the contoured bend
I'm just not sure if it's worth it to keep pillow under ankle or calf. It seems to make it more uncomfortable

Just do whatever makes your leg as comfortable as you can. What works for one person may not work for another. It’s really ok to experiment with positions.

 

[Dearjr]

Just went outside for.my first walk post op d#5
Swelling slightly down . Feels a little less stiff
Developed a row of clear blisters by calf on inner.side . Outside of bandage
Could that be from fluid buildup and swelling in calf . Doesn't hurt and is not warm or red

 

[mendogal]

They may be "fracture blisters" - not an infection, but a reaction to the trauma of surgery and yes related to inflammation and edema.

While the blisters are intact, they are a "natural bandage" and won't develop infection.
Protect them gently - when the blisters do break, infection becomes a risk because the raw skin layer underneath will be vulnerable.

A topical hydrogel spray is what I use at home on blisters that open, but you should notify your ortho team as they may have a protocol for both intact and broken blisters.

 

[Dearjr]

Thanks
So far so good
All closed

 

[Layla]

Another option -
ACTIVE Hydrogel

 

[Rockgirl4]

I had 25-30 fracture blisters of varying sizes after my first TKR in 2019. My home health nurse and surgeon said they're caused by extreme inflammation/swelling and tend to form where the skin is thinner----usually from traumatic bone breaks and less commonly after joint replacement surgery. It's a definite warning/sign not to overdo things, as your body is already dealing with higher-than-normal swelling. While Preparing for my recent TKR #2, due to my psoriatic arthritis and tendency to swell horribly, my surgeon and I made a plan for what happened if I had these again. My home health nurse in 2019 had only seen them 2-3 other times. I counted my blessings--Only 1 this time!! My swelling was initially well-controlled until Day 7-8 post-op when something else created a problem. Some of yours will probably open up. My surgeon wanted to know if they popped ASAP because of infection risk. Mostly they just wanted to give me the run-through of keeping them covered, etc.

You mentioned the pillow under your ankle, keeping your leg straight. It's advice I threw out 10+ years ago. It seems to be the #1 piece of advice everyone gets from the hospital/nurses though, with fears of never having a straight-leg again, etc. I found 3 areas in my pre-surgery packet and post-surgical packet where it was mentioned time and again, with photos of how they wanted you positioned.

This is (by far!!) the post-op advice that sets me off every time. I've had 11 knee surgeries before this recent TKR, 5 of which had lonnnng recoveries. I NEVER had trouble getting my extension back, in fact it came back fairly fast each time---even though I swell horribly (for months!!) and get loads of rebound swelling from exercise (for months!). I use what pillows I want. Since my last TKR though, I definitely swear by the Lounge Dr. I've had friends see it and warn me of what all the nurses say ((AGAIN!!)), and I just nod and smile, ignoring every word.

Funny enough, my mother-in-law asked me ((genuinely)) why I get so mad about this "no pillows, prop your ankle" advice, as a family friend just had TKR a week before me. He was following it to the letter of the law, and was miserable with his leg propped straight ALL NIGHT LONG---getting little to no sleep.I asked her if she would try a simple experiment, as it would mean more than any explanation. I told her to sit on the floor, prop her ankle on a rolled towel about 2 inches off the floor, and stay that way for 45 minutes (long enough to get the idea of being uncomfortable!!). She went home and did it, said she made it to the 25-30 minute mark, thought about quitting, made it to the 40 min mark, then quit!! She was so stiff it took awhile to walk normally, and as a perfectly healthy, mobile 75 year old woman, she was extremely uncomfortable. She asked how anyone could do that all night long or all day long??? My words were "EXACTLY!!!! Now do it all day/night with a leg that had been cut open and put back together, .every night for weeks, when you're having bad pain from the surgery itself!!!

She called it "barbaric" torture! Then I told her to go a step further and imagine a physical therapist pressing on it like that for minutes at a time, days after surgery, as a form of "helpful therapy". She said it's no wonder I've lost my trust for physical therapy and patient care. She agreed everyone should have to experience these things before handing out advice. She was glad I threw out the advice that just gave me more pain to deal with and simply let my body guide me.

I'm off of my PT/torture soapbox now.

 

[mendogal]

@Rockgirl4 I want to print out your post and hang it on my office wall. Oh, right, I'm retired! Well, anyhow, THAT'S how high my opinion of your post is!

 

[Rockgirl4]

@mendogal Thank you for that. I feel better, as I was a little worried I came across as (cough-cough) too opinionated.

 

[Toothfairy]

@Rockgirl4 brilliant post. Not opinionated but evidence based and knowledgeable!!

 

[EalingGran]

You mentioned the pillow under your ankle, keeping your leg straight. It's advice I threw out 10+ years ago. It seems to be the #1 piece of advice everyone gets from the hospital/nurses though, with fears of never having a straight-leg again, etc. I f

The hospital physio told me this. But my surgeon just laughed and said not to worry - just whatever was comfortable. I have full extension.

 

[selketine]

no pillows, prop your ankle

I only do this an an exercise for awhile until it bothers me. I cannot imagine sleeping that way. I have an adjustable bed frame and sleep with the feet part up and a pillow under the length of my leg. My leg is fairly straight but comfortable (well as comfortable as I can get it - this is an achey leg).

 

[Layla]

@Rockgirl4
Also like your touches of humor. We can use a bit of that around here.
I hope today is a good one for you!

 

[Layla]

@Dearjr
Good to hear the blisters haven't broken. Fingers crossed for you.
Have a great Thursday!