TKR Slow recovery from TKR

[mendogal]

Welcome to the recovery side @westiemom !

My ortho team was 100% united in telling me that in the initial weeks Less is Better.

That translated to: elevating and icing while awake except for my prescribed hourly walk or attending to hygiene or food.

The only exercises I did were ankle movements for circulation and quad sets (to help wake up the quads to fire better, assist circulation, and provide gentle extension). I never counted reps or sets, just did them pretty often within my comfort level while icing and elevating.

When I could tolerate sitting up in a chair for 5 minutes I added very gentle heel slides. Again, not counting reps or sets, just doing a few very slowly to promote flexion.

Many of us found lying down heel slides quite difficult but did well with seated ones.

It's important to take your walks and not be a total couch potato... but right now your body's primary need is to heal.

I suggest you look closely at #5 in the above post, Activity Progression. And do share it with your husband! This wasn't an athletic strain. This was a major teardown and rebuild!

 

[Layla]

Hi again!
Congrats on your new knee and thanks for joining us again...on the healing side this time! I am sorry you were off to a rough start with the pain due to the low blood pressure. Thankfully you're home now.

You really don't need to be doing a lot in these early days, much more than taking a five minute walk every hour or two and that is normally accomplished by a trip to the bathroom, or to the kitchen for a drink or snack.

See if you find the ACTIVITY PROGRESSION FOR TKR useful. I followed the guidelines loosely so I was not overdoing it, but remained comfortably mobile. Also, if you don't feel your pain cocktail is effective, you can always contact the office of your OS and see if they're able to make any adjustments.

This is such early days for you and while pain is no fun, it is normal and we all experience pain to different degrees, so remind sweet hubs of that...gently. You don't want to bite the hand that feeds you in these early days I don't recall whether mine fed me in those early days, but he did toss Gummy Bears or a Lindor Truffle into my lap when I accomplished some silly task, like making it to the bathroom and back
Tell hubby to go easy on you - Orders From Headquarters!
Happy Sunday westiemom!

 

[benne68]

Welcome to the Healing Side, @westiemom.

Don't worry about not doing exercises this early in recovery. I've had both knees replaced and did not do any exercises for the first two weeks. My surgeon told me that my only job the first two weeks was to rest and recover from the trauma of surgery. He told me not to start PT until I was a full 3 weeks post op because it's important to let everything heal first.

During those first two weeks, I iced and elevated most of the day, getting up every hour or two for a short walk around the house for circulation. I also did gentle movements, like ankle circles. And when I was sitting in a chair, I would swing my leg back and forth a little.

Know that you are not alone. Most of struggle to manage the pain during the first week or two post-op. It does get better with time.

 

[Jockette]

I know you all say do the exercises but the "no pain, no gain" theory is not true. However, whenever I go to do the exercises, I hurt badly. In fact, I hurt just sitting in the recliner with my legs elevated and icing machine going.

Of course you’re in pain like this, so early out of this surgery that causes a lot of trauma to the body. All you really need in these early days and weeks is short walks, as in to and from the bathroom, or the kitchen and back, and just very gentle bends. There will be plenty of time for more rehab later, after you’ve healed a bit.

Regaining our ROM is more about Time than repetitions of a list of exercises.

Time to recover.
Time for pain and swelling to settle.
Time to heal.

Our range of motion is right there all along just waiting for that to happen so it can show itself.

In the general run of things, it doesn't need to be fought for, worked hard for or worried about. It will happen. Normal activity is the key to success.

DH (who has a really high pain tolerance) is starting to get upset about my not doing all the exercises prescribed by the PT.

My husband was a retired basketball coach and put a lot of stock in the exercises prescribed. Once I found Bonesmart at 4 weeks post op, after some pretty aggressive PT, I started listening to my body and I backed off the exercises. I would do one or two reps, here and there, so I could say “Yes, I’m doing my exercises” He wasn’t thrilled, but he did back off and let me make my own decision about my own recovery. And no, he’d never had knee replacement.

We are so bombarded by those around us who believe the exercises are essential, and the more the better, no matter how painful. However, we each have our own pain tolerances, and different rates of healing, that it only make sense to listen to our own body and recover accordingly. You have hardly had a chance to begin this healing process, that does take an average of a year. Take care of yourself and be gentle, and once you feel better, and your pain level drops, you’ll be able to do more, and find a rehab approach that works for you.

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.

 

[westiemom]

I did email my OS and he has prescribed more pain meds for me, but isn't too thrilled about it. He said they want me off all pain meds by 6 weeks and I reminded him it hasn't even been a week yet. I do get up and use the walker to go to the bathroom - which is a pretty nice walk - every couple hours. I do the ankle bendy things and the quads clench 3 times a day at least. It still hurts like fire to drop my leg down towards the floor. Everyone is being very encouraging; I'm just scared I'm not going to be able to drive to my post op appointment on the 25th. It's an hour long drive and then a rather long walk to the elevators and then into his office.

Unless a miracle takes place this week, I think I will be a TKR failure.

 

[Jockette]

Unless a miracle takes place this week, I think I will be a TKR failure.

Oh please don’t even let this thought enter your mind! You are so early in recovery, your body is in, what I like to call “shock mode” right now. Things are definitely going to improve, but it won’t happen over night.

I do get up and use the walker to go to the bathroom - which is a pretty nice walk - every couple hours. I do the ankle bendy things and the quads clench 3 times a day at least.

This is excellent and plenty of “rehab” at the moment.

It still hurts like fire to drop my leg down towards the floor.

I definitely remember this, I described it as liquid fire running down my leg!

I'm just scared I'm not going to be able to drive to my post op appointment on the 25th.

Do you mean drive yourself, or ride in the car? If you mean drive yourself, why do you want/need to do this? I certainly couldn’t have done it at 2 weeks post op, and even just riding in the car for an hour is a painful activity at this stage, for most of us.

 

[Jockette]

Hopefully this article from the Recovery Guidelines will be helpful to you:

Post op blues is a reality - be prepared for it

Post op blues is feeling depressed, weepy, nervy, shaky, fearful of the future, anxious, overwhelmed by what is happening to you, convinced it's never going to get any better and finally, uttering that most intense of all cries "I wish I never had this done!" It arises out of a variety of...

bonesmart.org

 

[mendogal]

Oh my goodness, you certainly aren't failing! You've just had major surgery. Your description of your activity is exactly fine for now.

It took me a few weeks to tolerate sitting on a chair at home for more than 10 minutes, which isn't at all unusual. It's a slow process, adapting to having the leg down. I think it was a good 6 to 7 weeks before I asked to be driven to a cafe to join a person for lunch. I was good, but did ice and elevate for an hour after being driven home!

I hope you mean that you'll ride or be driven to your Nov. 25th visit...you won't be able to drive anywhere in November; most of us aren't cleared to drive for 6 weeks, and not everyone feels ready then.

In terms of the car trip on the 25th: can you stretch on the back seat and bring an ice pack? If you are afraid the walking will be to far, there's no shame in letting the facility know you need a wheelchair - in my experience, most ortho practices will have one for transport.

 

[Layla]

Good Morning westiemom,
TKR is major surgery, a controlled trauma to the body. The body needs time to heal both internally and externally and that takes a full year for most, and even longer for some. Many notice improvements into their second and third years post op. Recovery time varies from person to person depending upon age, physical fitness before surgery, whether you have any pre-existing health conditions, struggle with a complication or how you're choosing to re-hab. There is no way you can consider your surgery a failure at this point. With that said, please let go of unrealistic timelines and goals. You'll stress yourself out unnecessarily and stress is not good for the healing process. Be as patient as possible, take it slow and easy and you will have a successful recovery.
I do hope your surgeon will work with you to get the pain relief you need and deserve at this early date.
Hang in there and know we' re here for you always.
Big hugs!
@westiemom

 

[westiemom]

Oh no, I'm not driving! DH will be driving me for quite a few things for the next couple months. I was not thinking yesterday evening and missed my pain med till 6.5 hours after the last one. That was an eye opener - took most of the night to get the pain under control enough to sleep. Today I have been watching the clock closer. The pain is somewhat better; DH says my walking looks better with the walker. At least I am walking with one foot in front of the other with both legs. He said when I first got home, I'd walk with my left leg, but my right one (my good one) was only coming even with my left leg. Now my gait is more normal.

I just read another thread about someone being on just a cane after a week. Yep, that throws me into a blue mood. My GP has called in an increase in my antidepressant for me. Hopefully that will help too.

Your encouragement is so very nice and helps me feel better about my progress. I've never been a patient person and I think impatience is NOT my friend right now.

I'm pretty tired tonite - didn't take as many naps today. Have a good night everyone!

 

[mendogal]

In case you missed it ( post #9 up just a bit on this page -from Jockette) it's super common to get downhearted after major surgery. I'm glad you reached out to your GP.
And we're here for you.

 

[westiemom]

Well, I made it over the pain hump. 12 days past surgery and I finally have the "normal" pain, not the kind that you can't function with. I've been doing my exercises and that hurts me more, but I do know that's to be expected. I'm still using my walker to get around.

It's just so dang nice to not be in pain 24/7 and not able to sleep. Thank you all for your advice and encouragement. I don't know where else I could have turned to get practical advice. And I did spend 2 whole days mostly just napping and icing. I swear that helped me more than anything else. Wednesday is my follow up visit so we shall see what he thinks.

Again, appreciation all around for your cheerleading and advice

 

[Layla]

And I did spend 2 whole days mostly just napping and icing.

Sleep is the best for you right now. It accelerates recovery as in tissue repair and is good for your overall health.
May you get all the restorative rest your body needs for a perfect healing.
We're glad you joined us and thankful for your willingness to share your journey here for the benefit of others.
If celebrating on Thursday, I hope you have a wonderful Thanksgiving!

 

[westiemom]

I guess I just want to vent here where no one knows me. I'm 3 weeks past LTKR. I had my first physical therapy appointment yesterday. I'm at 3 for straightness, but started at 52 for bending. At the end of the appointment, my bending was 70. I went home and iced. She gave me 3 exercises to do 4 times a day. Tried the first one today and could only go 2 times cause of the pain. OS moved my appointment up to 12/11 saying if I can't get to 90 degrees bend, he will do a MUA. My pain doing the exercises is usually at an 8 or 9. I am taking 5 mg oxycodone every 4-5 hours and 1000 mg tylenol every 6 hours. I am using my ice machine constantly.

I am so anxious about this upcoming appointment and the threat to do the MUA, his not prescribing more pain meds (he only gives me enough for 5 days at a time and thinks I'm taking too many) and the fear I will never recover that I just shake from anxiety. I know this is bad for me, I know the doctor cannot force me to have the MUA, and I can continue PT without his further authorization. Mentally I know all this, but I cannot seem to keep my anxiety under control. I absolutely dread doing the exercises cause I know how much pain I will be in. I just feel I made the biggest mistake of my life by having the surgery.

I just wanted to get this said in a safe place. , ,

 

[Layla]

I am so anxious about this upcoming appointment and the threat to do the MUA

You don't have to feel anxious. It is a threat, just as you said, and he can not force you to undergo a MUA. Please understand that.

I absolutely dread doing the exercises cause I know how much pain I will be in.

Then don't do them, NOW, but maybe later...or maybe not. Listen to your body and allow it to heal from the trauma of less than one month ago. You make the decisions, not your OS, or your PT. It is your body, you're the one dealing with the aftermath of exercises or therapy that is presently too aggressive for you.
Please refrain from engaging in movement that causes discomfort or pain. Do not allow anyone to forcefully manipulate your leg. While your range of motion is currently limited, it will naturally increase as the swelling subsides and the pain eases. Give it time.

This is a safe place! We're thankful you reached out and trust the membership. We're here for you always.
It is w-a-y too early to regret the surgery. You are currently in the throes of the worst part of recovery, you have to hang in there and know that your future looks bright. It takes patience and lots of it!

 

[Layla]

Read both of these accounts from recent / current members.

JusticeRider's post -
"I just want to add, for all those coming along, a note on ROM. I want to share this because nearly all of us have a tremendous amount pressure put on us to increase our ROM by certain deadlines, or else.

Mine has been extremely slow coming. First I had to wait out the swelling, which in my case took more than 5 months. Yes, months. At that point I began to see real progress. It has continued to this day. I have seen improvement in the last 2 weeks. It’s still going. A this point I think the limiting factor is tight muscles, ligaments, and tendons from 3 yrs of very limited ROM and actually about 25 yrs of somewhat limited ROM. Those tissues are slowly stretching.

I have had to be willing to let my flexion improve at a glacial pace, be very patient, and tune out the dire warnings of my surgeon, PA, previous PT, and some well meaning acquaintances. I refused painful PT and refused a MUA. I have absolutely no regrets. I know my body, and I believe those things would have caused a domino effect of swelling and pain that may have derailed my recovery long term and even possibly have torn soft tissue, etc. I now know I have the added challenges of hypermobility and an immune condition that causes an inflammatory reaction. I think a MUA would have been very harmful to me.

Instead of forcing it, I have relied on weekly massage and using my stationary bike as a stretching aid every single day. I have been very active, but I have ramped up really, really gradually. I have not measured my flexion, because honestly I feel almost a PTSD type of reaction around it. All I care about is function and what I can do. My knee is very functional now, and still improving. I love my new knee. I’m glad I let it heal on its own timeline even though it was so much longer than everyone (most of all me!) would have liked."

 

[Layla]

VolLady's post -

"I want to tell everyone that has went though TKR that it is a long journey to heal. I am going this spring to have my other knee replaced.

Please do not get discouraged and I know you will because I did with my first one and cried more than I had in a life time. Scared mostly.... Surgeons will not tell you everything that you will experience during your healing. It took me 7 months actually to feel more normal but not 100%.

For the ROM I only got to 112 at 4 months and still cannot bend it all the way back to reach 130. But I can drive, sit at a table, put my shoes and clothes on great without a ROM of 130 or 120. There is no swelling at all at 8 months but I still have some stiffness at times but I deal with it and walk. I also still ride my bike with no trouble.

I am telling everyone this because your body will heal without PT and pushing your limit beyond to the point there is more swelling and pain. I have decided when I have my other knee fixed this spring, that I will do my own PT since I have all the equipment and items that they use anyway.

I had a MUA at almost 6 wks., and regretted it from day one. Simply because it did not help me anymore with my ROM but it did set me back on healing. The swelling was awful. I will not have another MUA even if my ROM was 95 at the time.

I will go in with open eyes on this other knee comparing on what I went though with the first one. So, with all that said, I wish everyone a happy healing and let your body decide with healing than someone trying to push you until you scream with pain. Also don't worry about the ROM, it will come -- it might take a year or more, but it will come. I am 67 years old and I don't expect to get past 120, but I do what I want to do at 67. Oh! and I can even bend down with the knee need to kneel on it..... Best wishes everyone!"

 

[Jockette]

I just wanted to get this said in a safe place. , ,

This is indeed a safe place. I am so sorry to hear the stress and anxiety you are feeling right now. First, take a deep breath. You are going to recover just fine. However, you are going to have to take charge of your recovery, without guilt, for doing what you feel is best for you.

Saying no to therapy - am I allowed to? Yes, you are allowed to say no to any and all “therapy” that you don’t feel is in your best interest. You may feel that your medical team knows best, but you know your own body, and the pain you feel, better than anyone.

I'm at 3 for straightness, but started at 52 for bending. At the end of the appointment, my bending was 70.

These numbers are fine, for only 3 weeks post op, especially the straightness!

I hope there was not a lot of pushing and pulling on your leg to get you from 52 to 70. That is totally not necessary. Your bend will improve as your swelling goes down and you heal more.

She gave me 3 exercises to do 4 times a day. Tried the first one today and could only go 2 times cause of the pain.

My pain doing the exercises is usually at an 8 or 9.

I absolutely dread doing the exercises cause I know how much pain I will be in.

Don’t do any exercise that causes pain like this. Doing so only increases the pain and swelling, which reduces ROM, rather than improving it. Some of us did no exercises and had great outcomes, just using our knee as we went about our day. Our regular movements throughout the day give our knee all the healing mobility it needs.

OS moved my appointment up to 12/11 saying if I can't get to 90 degrees bend, he will do a MUA.

I know the doctor cannot force me to have the MUA

At only 3 weeks post op it is far too early to even think about an MUA. What your doctor needs is patience to let you recover on your body’s own timeframe.

 

[Jockette]

his not prescribing more pain meds

I am taking 5 mg oxycodone every 4-5 hours and 1000 mg tylenol every 6 hours.

Stop doing all these painful exercises and you won’t need as much pain medication. Yes, there’s plenty of pain just due to the surgery itself, but these painful exercises are increasing that pain, which increases your anxiety.

I was also afraid to stop doing the painful exercises, but I finally did take control of my recovery. If I ever have to do this again, I will do even less and formal PT won’t be part of my rehab. I’ve read time and time again how our members cut way back on the exercises and their knee/leg settled down, the pain and swelling went down, and they were able to relax and get on with their recovery.

This early in recovery, only 3 weeks since the trauma this surgery caused, we are very vulnerable. I’m so sorry you don’t have a more supportive medical team. That’s where Bonesmart comes in. We’re here for you!

 

[westiemom]

Thank you, thank you, thank you so much for your responses. You made me feel like I'm not a failure and I'm not going to ever be able to be normal again.

My DH gave me a xanax last night since I was so upset and crying so hard after getting an email from the PA insisting I come to the appointment on the 11th to discuss what the future holds if I can't get to 90 degrees by then.

I have always hated confrontation and telling the surgeon/PA that I will NOT be doing as well as they think just makes me shake inside. DH has said he will take the doctor and PA out of the room and let them know that I will NOT be following their advice on my goals and that he will not stand for their scare tactics like I'm a 4 year old kid refusing to eat all my veggies. Knowing I don't have to be part of that makes me feel very safe and cared for.

Just so you know, I had a total rotator cuff repair in the past and I handled all that horrible therapy just fine and got total ROM back. So I'm not a newbie at pain and PT.

Yesterday after therapy, they told me to not elevate my leg, to let it drop to the floor and leave it down. I did, but cheated with a small stool cause my legs are too short to reach the floor. Today my leg is so swollen I cannot even bend it.. Just getting up and walking is hard. The good news is that I managed to sleep all night without waking to need a pain pill!! I elevated and iced during the night. Even after that, my leg is swollen almost as badly as when I first came home.

I'm supposed to have PT today, but I'm going to call and cancel. With my leg this swollen, there's no way I can let it be manipulated without committing murder of the PT. LoL.

Whoever mentioned about feeling like having PTSD hit it on the nose! Just thinking of going to the doctor makes me literally shake and feel nauseous.

I am going to relax about my recovery and not worry (too much) about how long this takes and how much ROM I get back. Tomorrow I am going to go to a small shopping center 2 miles away to walk farther than I can at home. We live in the country and have a gravel driveway and really cannot walk there. I'm tired of making circles thru the house so going out and walking sounds exciting. I can also keep track of how far I walk each time. My DH is wonderful that he is willing to drop everything and be my chauffeur. He has certainly come around from his No Pain, No Gain attitude after I have read him all the responses here. Thank you all for that also! I don't know what I would have done if I didn't have this forum for support. You have no idea how appreciative I am to hear of all the stories of everyone.