TKR Recovery Week 7 - June 9.2021

[Moone]

So glad to find this group! Such good advice. I worked hard in early weeks and have good range of movement and flexibility. But my knee and foot still swell, my knee buckles and it totally freaks me out! Feels unsteady and am challenged to walk, it clicks/ catches though am told it is a strength issue (have had xray and check with surgeon). Walking with 2 crutches, was trying to use 1 but then my other knee acts up!
I was hoping to be more mobile and return to work in September. Thinking now it will be longer and harder.
I can ride my exercise bike, physio telling me to do 3-4 times a week. Push till I'm tired?
Still not sleeping great.
Hard going but take comfort from sharing stories and advice.
Thank you all

 

[Jockette]

Hi and Welcome!

Everything you describe is normal for your stage of recovery. Riding an exercise bike is good, but no need to keep going until you are tired. You are only weeks out from major surgery and your body is sending most of its energy to heal. You can recover very well without “working hard.”

I will leave you our Recovery Guidelines. Each article is short but very informative. Following these guidelines will help you have a less painful recovery.

Here is an article about Sleep.

Sleep deprivation is pretty much inevitable - but what causes it?

Time and again members complain about not being able to sleep and after a while, that it gets to making them feel frustrated, despairing, depressed and even ill. I thought perhaps a short treatise on the reasons for disturbance of sleep patterns was long overdue. It won't help you to sleep but...

bonesmart.org

Just keep in mind all people are different, as are the approaches to this recovery and rehab. The key is, “Find what works for you.“ Your doctors, PTs and BoneSmart are available to help, but you are the final judge as to the recovery approach you choose.

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

​

the BoneSmart view on exercise​

BoneSmart philosophy for sensible post op therapy​

5. At week 4 and after you should follow this

Activity progression for TKRs​

6. Access to these pages on the website

​

Oral And Intravenous Pain Medications​

Wound Closure​

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 the 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 the member’s history before providing advice, so please post any updates or questions you have right here in this thread.

 

[Jockette]

Please tell us which knee it is and we’ll add that to your signature.

 

[Sisterpat]

Moone! Yes, very early days for you! This is, on average, a full year’s recovery, so you are still in the infant stages! Do not overwork that new knee or your swelling will persist. There is plenty of time for strengthening - for now, concentrate on healing - ice, elevate, medicate as needed.

 

[kneeper]

I was hoping to be more mobile and return to work in September. Thinking now it will be longer and harder.

In recovery terms, it's a long way until September. You won't be 100% but a return at 3 months generally works out. Some people have very steady progress but a lot of us hit a plateau or two but then seem to make a little jump ahead.
I found the exercise bike helpful (but didn't do a lot of minutes). Listen to the knee. It's ok to challenge yourself a little but if it feels like too much, scale back a little. Then try again in a day or two and see where you are.

 

[Moone]

Thank you so much, great to have the support and I love the information. It is my left knee and I fear have been pushing too hard. Am now plagued by anxiety and find myself panicking- not able to do what I was. I was using 1 crutch around the house but now back to 2. I can't walk on my own at all. My leg swollen ok and then gets worse - surely I need to be doing some walking on it? I do end up with ice on the couch in afternoon, I have only taken short walks outside, very slow, it catches and does not bend well. Again, thank you for the positive feedback and information

 

[Jockette]

I worked hard in early weeks and have good range of movement and flexibility.

I fear have been pushing too hard.

Since you have good range of motion and flexibility, you can stop working so hard on all that exercise. ROM is important, but so are other areas of recovery. I think if you take some time off from the exercise and rest and ice and elevate your leg, it will give your knee time to actually recover. There are articles in the guidelines that will show good ways to elevate. Keep us posted on how that works out for you.

 

[Moone]

Thank you. Will heed advice and do less for awhile. Feel shaky and unstable, have small step into our house yesterday I couldn't manage it at all. Today I did but when I step down it feels like it pulls apart - sorry not a great description- then I have issue standing. I did wonder if it was me panicking (which I kinda am) but even with help, I struggled not only with step but first few steps as it feels it is not fitting correctly and won't hold me. Does anyone else have trouble or advice for down steps? My other knee not great so this hasn't helped... trying to be calm as I have been able to do this daily (or more ) since I came home. Used to feel 'weird' but now feels looser and unstable. Has been a very hard week...

 

[Jockette]

trying to be calm as I have been able to do this daily (or more ) since I came home. Used to feel 'weird' but now feels looser and unstable. Has been a very hard week...

I’m sorry things are not going better as time goes on. Have you had a follow up with your surgeon since surgery? Have you told him/her about this looser and unstable feeling?

 

[Moone]

Yes I met with surgeon at 6 weeks, had xray and ultra sound. He said everything looked fine and that he suspected it to be a strength related issue. When muscles build back it will be more stable. One of the reasons I have been doing so much. Physio agrees, hence the exercises, the biking. I am not really sure what to do? Should I just walk less and still do exercises and biking? Still have swelling but with buckling I am very afraid I will fall. I am doing less and less but not really improving...

 

[Moone]

Maybe I should clarify. I am improving, on pain levels, exercises like leg lifts, biking easier. Most things bt walking....

 

[kneeper]

Going down steps normally takes longer than going up for most people. My PT said different muscles engage going down.
In general, I improved steps by doing them. But a little bit at a time. I have steps in my house so I'd start by doing one flight almost every day. But I'd only attempt a couple of steps the "normal" way.

I'm not sure I was attempting down steps while I still had the random buckling. That gradually went away without me "working on it."

I found that my muscle strength improved pretty naturally. I did a few exercises and would take short walks even using the cane. [Like many people in the US I started on a walker (you may call it a frame?) and then moved to a cane. ] I used the exercise bike for a bit too, just to loosen up.
A little goes a long way early in the recovery process.

There are some general principles but things are also very individual--your always reassessing what's working. A little more of this a little less of that--and permission to take a "day off" sometimes if you overdo.

 

[Moone]

Thank you am thrilled to hear you talk of buckling and how it went away! I find this the worst, very scary and stops me walking with one crutch. I have always used crutches, rather than a walker, and have only managed one or two steps solo.
Will try rejuggling and doing a little less, adding things in slowly. Appreciate the support.

 

[Atkinson8]

Moone - I had right knee replacement a week before your surgery, and it's really this last week that I feel sort of normal. I was told by PT to back off walking until about 6 weeks or so, as my gait wasn't "normal" yet, and walking with a compromised step was leading to swelling, pain, heat, and back-sliding. Now I'm working on strength, very gradually, and getting out and walking more - which feels good, but I have to ice afterward. Downstairs is really hard and awkward, upstairs using my right leg as lead is coming a long, but I need to hold on. If I walk too jauntily, I feel that buckle, and need to pay attention. You're doing well, just don't overdo it - things will come - it's a process. (This has been said to me about 100 times on the forum.

 

[Moone]

Thank you @Atkinson8 for commenting. Yes walking is the real struggle so will aim to do less - try and do what I can - and just wait. Pushing too much has certainly given me added issues- anxiety the worst. I only have one step to master in and out of the house so it could be worse. Will check in with your progress too. These last couple of weeks are the only that I haven't felt improvement, patience is hard!

 

[Jockette]

These last couple of weeks are the only that I haven't felt improvement, patience is hard!

As recovery moves along the improvements seem to come slower, but they do come. And, this is not an “always moving forward” recovery, there are a lot of times we plateau, or seem to go back a step. We call this recovery a rollercoaster, because of all its ups and downs.

 

[Moone]

Yes definitely a roller coaster- it is helpful to me to know there are others out there along for the ride! Appreciate your words...

 

[Atkinson8]

Patience IS hard! Especially if one is impatient. I think though that it's more important to walk correctly (heel, toe, bend (perhaps exaggerate the bend for a while), while we're healing then just to count steps. The goal is to eventually walk (shall I say glide?) as if there never was a problem, or surgery.

 

[Moone]

Yes can see that, I still have clicking and it buckles and sticks when I walk. Fine without pressure though can bend though with limited strength. I am overly cautious to bend as when I lock it in place I am more secure, though hopefully some of this will resolve when swelling goes down.
Patience hard and I have stressed myself out with thoughts of work, was hoping to do that in September but am thinking it won't be possible- I work with preschool children... was hoping to walk to enjoy more time with my own children, it is hard for them too. Thanks again for replies! Definitely a work in progress! My goal today is to make it down our front step for physio. While she prescribes exercises she has gentle approach - I am shocked by some of the manhandling othershave had to endure!

 

[Atkinson8]

Ah, a gentle approach to PT - nice! I thought mine was torture until about 2 weeks ago, now things are a bit more manageable (and gentle). Preschool: I'm thinking of all those small, low chairs, that you probably sat on to be down on the kids' level. You might need a more "grown up" seat, and use it more often than usual. I teach high school, and tend to stand all day, moving around and attempting to pull the energy and enthusiasm from my students. I'm going to keep an ice pack or two somewhere to use when I can. Walking will come, I'm a week ahead of you and it's quite recently (this week) I'm strolling about for 20 or 30 minutes (then ice!). You'll be in good shape by September.