TKR Recovering at home

Herewego77

junior member
Joined
Oct 31, 2017
Messages
27
Age
69
Country
United States United States
Gender
Female
Surgery was Monday and I came home last night around 7. Taking 50 mg Tramadol every 4 hours, doing the exercises physical therapy showed me at the hospital, and will have my first home visit tomorrow
Got up this morning and took a shower and have been able to make it to the kitchen and bathroom slowly and with minimal pain. I know the pain medication injections into the knee are helping tremendously but they only last about 3 days. I have Dilaudid for breakthrough pain and am wondering if I should take that before my physical therapy session tomorrow? I'm thinking if not, I made need it afterwards. Thank you for your support and input.☺
 
Hello @Herewego77 , and welcome to recovery.

No, don't take the Dilaudid so you can do PT tomorrow. Exercises should never hurt. If they hurt, that is a warning sign that you are doing too much for your knee, so stop doing it.
If you mask the pain by taking painkillers, you lose that valuable warning sign and may unwittingly do too much and slow down your progress.

At this very early stage, exercises are not really necessary anyway. All your knee needs is a walk around the house, or to the bathroom.
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.

Here is some post-op reading for you - lots of useful information here:
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. Here is a week-by-week guide for Activity progression for TKRs


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.
 
Sounds like you’re doing well. Congratulations
 
Welcome to the recovery side, Best Wishes to you!
 
Congratulations! Sounds like you are on the way and doing well.
:flwrysmile:
 
Many of us never took formal PT or did exercises. I am one of them. I had 11 knee surgeries, 2 of them kneecap removals and 1 tkr. Even after those I never took PT. But, I didn't just sit around and do nothing. I took care of myself, my house and yard as my knee allowed me to do. As I healed, I did more. But, my knee was always in control! This was enough therapy for me and would be for any tkr patient. All the awful pain of PT is so unnecessary.

All you have to do is use it in your daily living! Your knee knows how to rehab itself and doesn't need anyone telling it how. Just use it and it will come back like new! You have to be patient, though, it doesn't happen quickly! ADL,(activities of daily living), will be all the exercise your knee needs. If you just use it daily in your living, you will have a quicker and less painful recovery. We know what works, we've been there!

Be careful to not overdo. Sometimes PT can get carried away and end up causing a set back. You stay in control and not let them push or pull your knee. My PT at the hospital was sneaky and tried to push my foot with her foot and I strongly told her, "No!", and she stopped. You have that right, too. You can't force your knee to heal any faster by exercising, but you can sure set it back. If you follow the BoneSmart guidelines you'll have a quicker and a much less painful recovery! Trust all of us who have been through what you are going through! Experience knows!

Your knee is damaged requiring healing, not unfit needing training. Bending to the point of pain is not helping your recovery but compounding the damage done by the surgery. Your knee needs GENTLE stretches only, without pain. Taking painkillers before PT allows more harm to be done, so we do not recommend doing so. Taking them afterwards is a much better way!
 
I found the best way for pain control was to just stay on a schedule and not wait for the pain to get really bad before taking meds.
 
Thanks for your input. So far the only thing PT has done is put a belt under my foot and have me pull it up as far as I can...raised it to about 74 degrees. I've just been doing chores at home at a slower pace of course, no heavy lifting and using my walker. Shower, laundry, fix light meals and dressing myself. Pain is manageable with tramadol every 4 hours. Scar tissue seems to be a major concern of PT?
 
So far the only thing PT has done is put a belt under my foot and have me pull it up as far as I can.
You should never use anything to pull or push your leg to try and increase the bend or straighten it. You can do way too much harm doing that. Your knee knows how far it can bend and going farther than that can damage the healing tissues. You have layers of stitches that have to knit together. You don't want to pull those very delicate tissues apart.
https://bonesmart.org/forum/threads/closing-surgical-wounds-how-is-it-done.4286/#post-90691

Your knee needs to tell you when to stop so never take pain meds before doing any exercises or PT. You have had major surgery and your knee is extremely traumatized and needs to be treated like the newborn baby that it is!
 
So far the only thing PT has done is put a belt under my foot and have me pull it up as far as I can...raised it to about 74 degrees.
Don't do that exercise. In fact, don't do anything to assist with the bend. The only numbers that count are the ones you get when using your own leg muscles.
Scar tissue seems to be a major concern of PT?
Yes, the number-obsessed PTs will rattle on about it as if the big. bad "scar tissue" is just sitting there, waiting to pounce if you don't do enough exercise.

Actually, it's quite the reverse. The infamous scar tissue (which is more correctly called adhesions) is very rare, and one of the easiest ways to develop it is to work your knee too hard. Over-worked knees get inflamed and hot, and hot tissues become drier than normal and more likely to stick together and form adhesions.

This article explains the difference between scar tissue and adhesions:
MUA (Manipulation under Anaesthetic) and Adhesions

You need normal scar tissue. That's what holds your incision together, and it's part of the normal healing process. Without it, you'd always have an open wound.
 
Gosh this can all be confusing? PT returns next week.. what SHOULD I let them do? Is my showering, walking around, icing and elevating all I need which I can do on my own. Where does PT get their incorrect and somewhat dangerous info from? I can tolerate some degree of pain but not if it's going to damage or halt progress.
 
I can tell you that showering, walking to the bathroom and kitchen, icing and elevating (plus naps!) and a few heel slides was all I was doing 5 days out. They had me doing the cpm machine, but I am skeptical that it was particularly beneficial. I did it less than they said I should because I think using it too much made the pain and swelling worse.

The only use of a belt or the like I had was to help get my leg on and off the bed in the first few days. My quad was sore and weak right after the surgical trauma. No pulling or pushing on your leg to "make it bend." I think any exercises you do should be under your own power. But this early, the most important things are rest, ice and elevation.
 
I was resting on the sofa today trying to get comfortable and I felt and heard something pop in my knee...didn't really hurt but it got my attention. Anyone else have this happen? Hasn't happened again but I'm being real careful not to turn or rotate or move my leg too quickly.
 
I've not heard it, but I have felt it. It's painful for me. I'm glad yours isn't!
 
That my having a TKR last week is causing such tension between me, my boyfriend, and his mother. They live 3 hours away and she can't understand my hesitancy to travel this Saturday and return home next Monday evening. I keep telling him to go without me, my family is nearby if I need them and I would prefer being comfortable and close to home right now. His mother thinks I should come there for Christmas and do Christmas with my family later. Boyfriend says he feels stuck in the middle because he wants to travel too...ugghh!!!
 
@Herewego77
You'll notice that I have merged your newest thread with your original recovery thread. For several reasons, we prefer that you only have one recovery thread:
  • That way, we have all your information in one place. This makes it easier to go back and review your history before providing advice.
  • If you keep starting new threads, you miss the posts and advice others have left for you in the old threads, and some information may be unnecessarily repeated
  • Having only one thread will act as a diary of your progress that you can look back on.
So please post any updates, questions or concerns about your recovery here. If you prefer a different thread title, just post what you want and we'll get it changed for you.
If you need an urgent response to a question, just tag a member of staff.
How to tag another member; how to answer when someone tags you

Here are the instructions on finding your thread, How can I find my threads and posts? . Many members bookmark their thread, so they can find it when they log on.
 
I, too, had in-home PT the first couple of weeks after surgery. In my case, she worked on me with correct walking (I had developed a pretty bad gait from the damage to my knee) and some simple stretches to keep my hamstring and calf happy. They also worked with me on getting into and out of the shower safely, getting into and out of chairs, using the walker, and other things that would help me to get to the bathroom, get dressed, etc. They also gave me some wonderful massages. It was really very gentle... ROM wasn't a huge pressure thing -- they had already measured me at about 90 degrees in the hospital the day I was discharged and I could do that without a lot of discomfort. The big emphasis on the in-home PT was to get me up and walking, if only for a little bit. By the time I was ready for rehab (which began last week), I was able to walk with the four-point cane, and I had increased my ROM to 105 all on my own. My therapist taught me how to go "just so far", avoiding pain, even if it meant only a millimeter more every day or so. They were definitely NOT the "no pain, no gain" kind of people, and the surgeon has been very supportive of the laid-back, "let time do its thing" approach. We had a good chat about that yesterday, and as long as I am making progress under my own steam, he's pleased.

So, you DO control the message and the rate at which you can do things. This early in, as everyone else has said, your job is to rest, elevate, ice, and do only what you can achieve without pain.

I am not a doctor, but it seems to me that Dilaudid is a bit strong. They have me on Tramadol (50 mg every few hours as needed) and I found it has been fine. But, YMMV, so check with your docs about that.

Good luck!
 

BoneSmart #1 Best Blog

Staff online

  • Jaycey
    ADMINISTRATOR Staff member since February 2011

Members online

Forum statistics

Threads
65,167
Messages
1,596,864
BoneSmarties
39,356
Latest member
JanieMarie
Recent bookmarks
0
Back
Top Bottom