TKR Suggestions needed for “tight band” feeling

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@Jockette: Thanks for your comments and, esp, sharing the woman's story.

After my replacement, I had painful PT 3x/week for THREE months. Even then it seemed excessive.

I would LOVE not to go to PT nearly as much this time around. I'm scheduled this time 3x/week for 2 weeks, then 2x/week for 3 weeks. (I'm going to a different OS and PT, btw).

It was the PA who said that they wanted me at 90 degrees by 10 days post-op. I'm assuming the OS wants this milestone then, too. I'd love to just do ADL and 2 weeks of PT. That would be my dream. We won't know til they get in there but I think I have a bunch of scar tissue...and it does make me wonder if excessive/painful PT and 6 hrs/day for 5 weeks on a CPM machine contributed to this. (No CPM this time, thankfully). They were NEVER happy with my ROM and flexion, which is demoralizing bc I did all my at-home exercises AND all that PT. I want/need a different outcome than last time!

I appreciate all the feedback/info!
 
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@Jockette: I see the "Lounge Doctor" displayed in the info you shared with me. I think I would benefit from one. Is there a particular one that Bonesmart recommends (leg rest light? leg rest LD?). Is there a Bonesmart link? Thanks!
 

Jockette

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Just click on the Lounge Doctor banner at the top of the page and you can order it there. It does cost more than some others, but it is well designed and members here really like it. Rather than “expensive” most members feel it is “priceless” and well worth the money.

It is very possible that your aggressive PT last time did create problems for you. Remember, you are in charge of your recovery, not your doctor and not your PT. This is not your first time, so you have lots of experience and are well educated to choose the rehab approach that works for you. You don’t have to be locked into a cookie cutter, one size fits all rehab. Yes, you want to give the new joint movement, but gentle works just fine, especially in the early weeks. Your knee needs to heal before being stressed with a list of reps of exercises.
 

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@Stiff knee NC .... you've been getting some good advice. Number one thing to remember is that you know your body better than anyone and YOU are in charge of your recovery. If you are more comfortable in a recliner, then use it. Having the angled pillows or a Lounge Doctor on the footrest will the fine. You do need some additional elevation more than just the foot rest to get your leg high enough. But frankly, most people cannot elevate using a towel under the heel to keep your leg straight for very long without it causing pain. That's a good exercise to do during the day, but a person usually has to start with just a few minutes (or less even) and work up to longer times as the swelling goes down and you are able to gain extension.

The Lounge Doctor is an excellent product as it is scientifically designed to place your leg in the best position for both comfort and elevation. This is why it comes in several sizes - to correspond with your height. It's handy to use even when you're not in recovery if you've been on your feet a lot.

After surgery, you could meet with your therapist when you're ready and go from there. If you prefer to see them two days a week, just ask for that schedule. And if you prefer to have a few days or a week at home, either request home health or just advise the therapist that you want to start on a specific day. Any time someone tells you that you HAVE to be at a particular point by a certain day, just smile and nod. The world will not end if you don't meet these arbitrary deadlines some people seem to want to impose. Your body will heal at it's own pace. Granted, you must not just lie around. It's important to do gentle bends and stretches every couple of hours during the day for 5 minutes or so. Turns on an exercise bike are good. So is walking around the house several times. Just listen to your body and it will tell you when it's ready to do a bit more or when you've overdone things and need to scale back a bit.

All the best to you with your surgery. You've got this!!
 
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@Jamie: THANKS so much for all your thoughts and encouragement!! Will post when I can AFTER surgery! (and let you know what the surgeon finds in there!)
 

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I would LOVE not to go to PT nearly as much this time around.
You really don't have to go if you don't want to. I'm one of those who never took formal PT. I've had 12 knee surgeries, 2 of them kneecap removals, and 1 tkr. Even after those I never took formal PT. But, I didn't just sit around and do nothing, I used my knee as it was intended to be used by walking around to take care of my daily needs along with the necessary house and yard work. As I healed I was able to do more. Icing and elevation were a huge part of my recovery.

Listen to your knee. It will tell you if you're doing too much by increased pain and swelling. When that happened to me, I found that resting, icing, and elevating helped. Your knee knows how to rehab itself without being told what to do.
 

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@Stiff knee NC Wow. Just read your entire story. Am at 4 months and my recovery so far pretty much mirrors yours. I am hoping that I am just a slow healer but it’s hard to accept the constant pain and swelling in my knee after I absolutely aced a hip replacement. Good luck with your upcoming procedure.
 
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Hello all, not sure if I should post here (adding on to an existing thread) or start a new post. Could someone please put in my signature that I had a revision to my TKR on April 11, 2022. Got through my surgery just fine! Really glad that that’s over. OS says the surgery went as expected and there were no surprises. Quite a lot of scar tissue, which he cleaned up. Put in the patellar button and went from an 11 mm to a 10 mm on the spacer. Will report more over the weekend. Deciding to have this surgery was the hardest decision of my life… and fingers crossed it will help. I feel I’m off to a good start… and so does my PT!
 

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Welcome to recovery again! You can continue to post here, it’s a continuation of this knee’s history.

Here’s a refresher course for you, each article is short but very informative. Following these guidelines will help you have a less painful recovery.

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
ice
take your pain meds by prescription schedule (not when pain starts!)​

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. At week 4 and after you should follow this

6. Access to these pages on the website

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.
 

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So glad this is behind you now and I hope it does the trick for you. Things sound promising.
 
OP
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Hello all, again… well, the medicine the OS put in before he closed me up has worn off so now I’m getting a very healthy dose of pain. i take the Dilaudid, but it makes me sleepy and I’m napping like crazy! I alternate w/Tylenol, too.

Here’s my question re scarring: my dr, when talking about a low, moderate or high level of scarring he found inside my knee, said i was at the top of moderate-bottom of high. Said scar tissue forms two ways: being genetically predisposed to scarring (nothing I can do about that) and being INACTIVE after surgery, which I definitely was NOT after my TKR (6 hrs/day on the CPM machine for 5 weeks , PT 3x/week for 3 months, ADL, etc). I believe BS advocates NOT overdoing things to prevent drying out of tissues/scarring. Soooo… should I take it easy, elevate/ice, do my at-home exercises, etc.? I am very worried about creating scar tissue all over again.

Would appreciate any thoughts! Thanks in advance!
 
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Oh and one other thing…I developed this bad bruising on the back of my knee about 2 days post-op. PT says this is common (Altho I did not have it with my TKR). Is it anything to be concerned with? I could send this pic to my OS or wait til thurs to show him when I get my staples out.
 

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Jamie

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Yep, I agree with the above posts about the bruising. It's blood from the surgery that can pool at the back of the knee. It should go away within a couple of weeks. I bet you'll start to see it changing color here soon. You'll be quite a work of art for a while!

As for the level of activity following surgery, this is a decision you're going to have to make for yourself. Not all surgeons agree with what we have seen in our members who do a lot of aggressive exercise and therapy following knee surgery and we'll stick by our advice that you need to try and keep inflammation down in your knee while you are recovering. You absolutely do need to move your knee frequently during the day either by walking for 5 minutes or so every hour or by doing some gentle bends and stretches with your knee. The exercises should challenge your knee but not cause serious pain.....discomfort is good, but actual pain will usually lead to more swelling and inflammation.

You know how much activity and therapy you did with your last surgery and if you would like to try something different (like our approach) this time around, you certainly could. Which ever approach to recovery you take, you need to keep your pain levels as low as possible. Usually this is accomplished by taking whatever pain medication you're using on a regular schedule and not waiting for pain to build up....especially during the first few weeks after surgery. It actually takes more pain meds to "catch up" once you're actually in pain than it does to just keep the medication in your system. Listen to your body's signals. It will tell you when you have overdone things and sometimes it will even signal that it's ready to do a little more. I suggest you read our section on wound healing so you know just what will be taking place in the coming weeks. It's in the blue toolbar at the top of the page under PostOp Care.

Your surgeon is right that "inactivity" after surgery is not good. But there is a huge difference between being inactive and doing so much activity and therapy that you keep your knee irritated and hot. By moving around and doing the bends and stretches every hour or two throughout the day, you are keeping your knee moving. Exercises don't have to be painful to get the job done.
 
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I foolishly overdid it yesterday and ever since my leg has been warm, VERY warm. Doesn’t warmth=inflammation=greater chance of scarring? Could someone pls direct me to BS info on warm knees/inflammation? Add to this I will get my 33 staples out tomorrow :gaah:feel like I hit a wall today. Trying to stay ahead of pain but don’t feel like I’m being successful. PT cautioned me against elevating/icing for 1.5-2 hrs at a time…he thinks that’s keeping it “inactive” too long. Sigh.
 

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We don't have a specific area on the forum that discusses a relationship between inflammation and the potential to develop adhesions. Try not to worry to much about this. Everyone overdoes things now and then. The fact that you recognize it is good. Now you need to just scale things back, rest and ice until things settle down in your knee. If you're having pain, take some type of medication for it on a regular schedule throughout the day and night in addition to the icing. Your therapist is right that you shouldn't be totally inactive for hours on end. But you only need to do some gentle bending and stretching exercises and maybe a short walk around the house for 5 minutes every hour or two to keep things loose. You don't have to do extensive exercises.
 

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I foolishly overdid it yesterday and ever since my leg has been warm, VERY warm.
Hi @Stiff knee NC , welcome to the club of foolish overdoers!! Like you, whenever I overdo things, my knee(s) would either swell up and/or swell up and heat up. It never crossed my mind that internal scarring could occur as a result, so I was spared that worry. Maybe that's because a lot of PTs push patients to, oftentimes, engage in exercises harder than appropriate, using the scare tactic of internal scar formation if one didn't push oneself.

Hopefully you'll be able to discuss this tomorrow as your staples are being removed.

All the best for a smooth staples removal and recovery/rehab!
 

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