TKR Recovery Road

[Celle]

I think my wife is a little upset that I'm not elevating the way the PT instructed. He said to just place a pillow under the ankle ( for extension). The PT measured my flex at 90, but didn't measure extension. I know you could stick a fist under my knee before surgery, so I know that needs a lot of work.

What your PT showed you both is not elevating. It is a practice some people use for increasing extension. It's totally unnecessary at this early stage and should only be done for short periods later in your recovery. Keep on elevating as shown in this article - Elevation is the key to controlling pain and swelling - because you are aiming to decrease the swelling in your knee and leg. Get rid of some of that swelling and your knee will both bend and straighten more easily.

It sounds as if your knee was already bent before your surgery, so the muscles and tendons at the back of your knee will have shrunk a bit. It will take time, patience and gentle treatment to stretch those tissues again.
Don't let anyone hassle you about that or try to force your knee to straighten. You have plenty of time, because ROM, both flexion and extension, can continue to improve for a year or longer after a TKR. You don't have to meet any deadline.

One more thing: This is your knee and you are the only one who has the right to say what will happen to it. You are in charge of your recovery, not your surgeon, your PT therapist, or your wife.

 

[sistersinhim]

Your most important job to do now is to take your pain meds as prescribed, ice and elevation toes above your nose. That will help to get the swelling to come down, which will help with any pain that will come. Follow the Bonesmart way and you'll have a quicker and less painful recovery!

 

[microwv]

The PT just left. Very nice and not aggressive at all. He actually had my wife come into the room and he explained that the way I was elevating (the BoneSmart way) was correct. He explained that what she was referring to was an exercise for extension. Made me feel better . Unfortunately starting next week I go to the hospital for therapy.

He also measured my extension at 20 and flexion at 86. Both unassisted.

 

[Celle]

Remember when you go for therapy that you are in charge. You can set the rules and the limits.
You don't have to please your therapists. They have to please you.
Saying no to therapy - am I allowed to?

 

[sistersinhim]

The therapists work for you. You can say 'no' or 'don't do that'! Don't let them push or pull your leg. And if anything hurts, stop it immediately. Pain in therapy or while exercising just sets your recovery behind.

 

[microwv]

So begins day 2. Woke up in the middle of the night with quite a bit of pain. Then it dawned on me that since the "On-Q" is gravity fed, it's not doing any good at night (catheter is in the thigh area). No wonder the bulb hasn't gotten any smaller. I proved my theory out by walking around (using my walker) while having the bulb attached high on the walker. Low and behold, a short time later the pain diminished. Unfortunately, the way the catheter is inserted in my leg I'm not sure I can figure out something for bedtime.

I'm more swollen today, even though I iced and elevated all night and this morning. I hope it starts going down soon. The therapist yesterday said he has seen a lot worse, so I guess that is somewhat comforting. My guesstimate at ROM today is about 60 .

 

[sistersinhim]

Is there any way possible you can raise the bulb enough to feed your catheter at night. Night time pain is usually the worse and trying to play catch up is not good. Sleep is so important. You actually heal more while you're sleeping.

Today is only day 2 of your infant knee. You had PT yesterday and that's probably why your knee is more swollen today. Continue to take your meds and ice and elevate above your nose as much as possible. It will get better. Just do not overdo. You'll pay for it with increased swelling and pain. Bathroom trips and a little walking to the kitchen or around the room is enough exercise for the next week or so. I wouldn't even take PT until that swelling comes way down. You need to heal first before working on ROM. Your ROM will naturally come in when your swelling comes down. Exercise will not increase your ROM. It will do the opposite by causing swelling. Can you bend a water hose full of water? Your knee is the same way.

 

[microwv]

@sistersinhim - Thanks for the encouragement. Even my therapist yesterday said you can't do exercises if you're swollen. He said that fluid needs to go somewhere and it would most likely be through the incision.

I'm going to try to figure a way to hang the bulb.


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[sistersinhim]

Do you have any side effects from your on Q system? Does it keep you off of narcotics? I will really be interested in this for my next knee replacement.

 

[microwv]

I haven't had any side effects. When it's working, my pain level is about a 1. I am taking
5mg of oxycodone in preparation for when it doesn't work.


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[sistersinhim]

That is fantastic! I'm going to study up on it. I wonder why more doctors don't use it.

 

[microwv]

I'm not sure. My doctor uses it instead of the femoral block. The paperwork that came with it says it lasts 3 to 5 days. Depends on the setting.


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[microwv]

Day 3 is now underway. The last couple of nights I've been waking up, itching like crazy. There is no rash or irritation. Goes away after about an hour. Never experienced that before.

I can already tell that I'm gonna like my new knee. The arthritis pain is gone. I'm just dealing with the surgical pain.

The plan today is to Rest, Ice, Medicate, and Elevate. RIME for short. I want to continue to get the swelling down and see where my ROM is really at.


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[kneeper]

I got itchy like that from the pain meds.

 

[microwv]

That's what I was kind of wondering .


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[dsteff22]

Sounds like you're doing great! I had BTKR on 24 Apr - tomorrow I get my bandages off and I'm excited to see my scars. I have the disposable stitches.
I also suffer from the itchies!! I'm on oxycodone, acetaminophen and Celebrex for pain. I read itchiness was a side effect of the oxycodone. I've been using Benadryl cream during the day and a Benadryl tablet at night - which also happens to help with sleep.
During the procedure I had an epidural and a nerve block immediately following, which lasted around 12 hours. I've been very fortunate with pain management and swelling. Thanks to a lot of the advice on here!
I'm also taking the blood thinner injections Lovenox. They have me doing it once a day for 30 days. I haven't had any issues with them, have you?
I'm grateful for all the advice I've read on here. I think it really helped put me in the right frame of mind. Good luck and keep up with slow and steady progress!


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[microwv]

@dsteff22 - You seem to be doing good, as well. I probably have about 1 day left with the "On-Q", going by it's size. I hope I can manage the pain with the oxycodone they gave me.

I haven't had any side effects with the Lovenox. Just bruising at the injection site. Guess I don't have to worry about giving a shot in the same place. I only have to do 10 shots. Guess I'll try Benadryl for the itches. I forgot I had bought some in advance.


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[microwv]

Well, here it is day 5. Had a couple milestones. Had my first BM since the surgery. I was getting a little concerned. Also managed to take my first real shower since the surgery. It sure felt good! It took me awhile to figure how to get in the tub safely. I bought a "AquaSense Multi-Adjust Bathtub Safety Rail" for the tub which was a big help.

The "On-Q" pump finally ran dry so I removed that as well. It lasted 4 days. My pain meds seem to be working nicely. No real issues with pain.

Tomorrow S/B fun. It will be my first real outpatient PT session. Curious to see where my extension and flexion are at. Probably not good since I still have a fair amount of swelling.

 

[KarriB]

They'll probably do,an evaluation tomorrow. Decide how you want to approach PT and set guidelines from th beginning.

 

[sistersinhim]

Remember to NOT let them hurt you. It is counter productive and will set you back in your recovery.