TKR Recovering tschrade RTKR March 25

[skigirl]

This is not a "fairly common occurrence" in TKA patients---I have been a moderator on this forum for over six years and I have never heard of this!!! I think I would get a second opinion from another doctor not connected to this practice. do you have pain from this bone fragment? Do you like your "aggressive therapy"? You are about 7 months out on the first knee and about 3 months out on the second knee---I think, anyway, so you can exercise like this if you are feeling well otherwise and you are not having knee pain.

It will help us if you put your second surgery in your signature too, so that we can keep track! You have not talked about knee pain---do you have any?

 

[tschrade]

Thanks for the advice.

My second surgery was June 3. (Not sure how to place that as you suggested). I still have pain and swelling in both knees, but mild enough to not be medicated and much less than pre surgery days. I do ice and elevate still. I can do the therapy without real discomfort but it really pushes me. At this point the knees seem to be pretty equal excepting a small strength lag in the left. Extension is good, ROM in right 105, left at 100.

Have a great day.


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[kneeper]

I think it's fine to continue doing exercises if they're not causing you pain, but I don't know that you need to be aggressive about it.

 

[Josephine]

The piece that broke off is below the knee cap in line with the tendon. He said that this is a fairly common occurrence in TKA patients.

Absolutely NOT! I've been in orthopaedics for 50+ years and never seen nor even heard of this happening! I think it's very poor of him to pass it off like that.

My instructions from OS was to forget about it, continue aggressive therapy

Again, this is poor advice. I think the most likely reason this bit broke off int he fiorst place was because of "aggressive therapy"! A lady here actually tore her quads tendon because of that and added many weeks to her recovery.

Does this little piece eventually disappear, and does the bone it broke away from " fill in" over time?

Maybe, maybe not. It depends how big it is. It will very likely just stay there for years causing no trouble.

I'm going to ask you some questions and 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 compare this with the bone-on-bone pain you had before surgery!

)

2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?

3. how often are you icing your knee and for how long?

4. are you elevating your leg, how often and for how long?

5. What is your ROM - that's flexion (bend) and extension (straightness)

6. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and

7. what kind of PT/exercises are you doing? How much and how often? (and detailed details would be appreciated, please! Reps, sets and session and all that)

Note:
If you're not familiar with this, it goes like so:
1 lift of a 500kg bell bar = 1 rep or repetition.
Doing 5 reps and then a brief rest = 1 set of 5.
And doing 5 sets and finishing = a session.

 

[tschrade]

Thanks for your insight.

Here are my answers to your questions.


Pain is at 1 to 3 when going down stairs, bicycle, getting up out of a chair, getting into and out of the car and doing squats. Otherwise pain is minimal.

No Meds for pain on a regular basis. I take an aleeve once in a while and only 1 in a 24 hour period.

Ice once a day each knee for 2 hours in the evening.

Elevate 4-5 hours in the evening.

Extension full both legs. ROM left 100 right 110

Activity level

Household chores pretty much back to normal
Gardening is at about 25% of my normal.
Working part time.

PT
Walk 1 mile minimum
Stationary bike 20 minutes after rocking back and forth for enough time to loosen knees to perform forward rotation.
Total gym squats 100
Stand on one leg and bend that knee as far as possible 20x each knee
Rolling stool lowest setting "walk" sitting on stool 40 feet forward and backward 6x
Put both feet in rubber band loop walk sideways 40 feet up and back 6 times
Step up 20 x each leg
Straight leg lifts with 4lb weights 30x each leg
With roller under knee, 7lbs weight each ankle lift foot to straight leg position 30x each leg
Put all weight forward over knee then opposite leg extend behind and bend as far as possible 20 x each leg

Extension is full in both legs.
ROM 100 left 110 right.



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[Josephine]

Pain is at 1 to 3 when going down stairs, bicycle, getting up out of a chair, getting into and out of the car and doing squats. Otherwise pain is minimal.

Okay .......

No Meds for pain on a regular basis. I take an Aleve once in a while and only 1 in a 24 hour period.

I suggest you take Tylenol 1,000mg 3-4 times a day instead of the Aleve. Much safer and more effective. NSAIDs, acetaminophen (Tylenol, paracetamol) differences and dangers

Ice once a day each knee for 2 hours in the evening.
Elevate 4-5 hours in the evening.

Try icing all the time you are elevating.

Extension full both legs. ROM left 100 right 110

Jolly good!

Household chores pretty much back to normal
Gardening is at about 25% of my normal.
Working part time.

Okay

Your exercises - my comments in bold
I trust these are only done ONCE a day?
Walk 1 mile minimum - okay as long as it's 1 mile total meaning ½mile there and ½mile back!
Stationary bike 20 minutes after rocking back and forth for enough time to loosen knees to perform forward rotation - cut it to 15 minutes
Rolling stool lowest setting "walk" sitting on stool 40 feet forward and backward 6x - novel but okay as long as you only do it 2 or 3 times

these are ill advised and I recommend you stop doing them:
squats 100 - a hundred? That's ridiculous! And squats are not good for knees, not good at all.
Stand on one leg and bend that knee as far as possible 20x each knee - this exercise is also too hard on your knee
Put both feet in rubber band loop walk sideways 40 feet up and back 6 times - these are really not helpful except to cause you pain!
Step up 20 x each leg - not necessary
Straight leg lifts with 4lb weights 30x each leg - absolutely not! You shouldn't need to do SLR now anyway
With roller under knee, 7lbs weight each ankle lift foot to straight leg position 30x each leg - absolutely not on these also
Put all weight forward over knee then opposite leg extend behind and bend as far as possible 20 x each leg - this is a most peculiar exercise and one that produces nothing much but swelling and pain! And it stresses the knee.

Additional and less stressful exercises are the simplest ones:
1. heel slides, gentle: sit in a chair with your foot forward and slide it back until it is under the chair. Only do this to the point of discomfort and then lean forward slightly to put pressure on the bend. NEVER cause yourself pain doing this.

2. lunges:
type 1 - stand straight, step forward and gently go down on the knee to the point of discomfort and then a tiny bit more. Hold it for 10-15 seconds. You may need to hold on to something while doing this
type 2 - on stairs: put a foot on a stair or a stool, then lean forward until the point of discomfort and then a tiny bit more. Hold it for 10-15 seconds.
NEVER cause yourself pain doing these

 

[tschrade]

Thanks very much. I thought what I was doing at therapy was a bit much and now you have confirmed my suspicions. I will alter my exercises as you suggest.



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[Josephine]

 

[skigirl]

Boy, I think Josephine is on the money. I am a ski instructor and getting ready to ski with two months of "Pre ski conditiioning"--most of us in the class are fairly athletic. We are old, but in pretty good shape and there are some younger folks too. There are about 20 of us we work out twice a week for one hour fifteen minutes---and I will tell you again that I am very strong.

I would NEVER do 100 squats. Yikes--doesn't that pt have any other exercises to give you?!! Among other things, I would die of boredom. Our workouts are different every week!!!

We do the rolling stool, which is a hamstring exercise---I do it three times a night at most.
Step ups---again for quads and hamstrings: we do three sets of one minute----most of the time, we have fun workouts, we have stations and do them three times. So, one one we might do step ups, an arm exercise and maybe the rubber band around our ankles. The pt times the minute at the end, we move on to something else. Your pt is what ? training you for the army?

We do lunges--but again, it might be one minute to the front, one minute to the side and one minute to the rear. I think 20 is too much and you must be in pretty good shape yourself after all of this.

My pt got rid of the machine with the roller under the knee and the weight on the front of the ankle--he said that people with bad knees shoudl NEVER do that machine.

Most of all your pt is pretty unimamaginative at best. Doing the same thing over and over with 20 reps each time, week after week will cause repetitive stress injuries.

 

[tschrade]

Wow. I am no where near your level of fitness. So I am certainly going to dial back. I can only think that the bone came loose because of overdoing the pt, and the fact that I'm not any kind of poster child for a physically fit person. Thanks for your response.



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[Josephine]

I can only think that the bone came loose because of overdoing the pt

You are referring to that bone fragment, I trust? I haven't missed anything else have I?

 

[tschrade]

Yes, I was referring to the fragment. Thanks


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[Josephine]

Well, in that case the answer is no, it's most unlikely to be connected with PT.

 

[tschrade]

Hmm. Then one wonders the cause?


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[Josephine]

Well, there are two reasons for it
a) the fragment of cement was left in that position during the operation - the most likely and most common cause
b) a bit broke off for some reason and settled in that position - most unlikely as I can promise you that bone cement does NOT break easily! I have tried over the years and used metal hammers, chisels, pliers and, in moments of sheer frustration, simply throwing it at the wall. It doesn't break. You need a circular saw to get through it!