MUA Susie2023's TKR Recovery

[Susie2023]

Hello all. I'm glad to have found this site. I had TKR in left knee 12/27/22, it was out patient. A home PT came out the day after and a couple of days later. Very disappointing, he measured ROM, which was 81 I think. I was very, very swollen. He showed me a couple of exercises, pointing them out of the home exercises I received from the hospital. He never did the exercises with me, nor helped me with proper elevation. He did "tell" me on the 2nd visit how to elevate. I am not placing blame but realized I was not receiving good home PT like I did when my hip was replaced. Then he called out sick the next visit but it was me reaching out to him that I learned that. I finally contacted the agency, they wanted to send someone else but I declined. I continued to do the home exercises best I could meanwhile requesting out patient pt, my husband said he'd drive me. I wish I had been more aware of this 2 week post op time frame, I'm afraid it may have brought me to this point. When I was evaluated at out patient pt, my ROM was 76. I have stiff knee. At one point during pt, I got 95 ROM. But then I started having a lot of nerve pain, so bad. Started gabapentin which has been helping. But the swelling and pain set me back. We reduced our sessions to 2xweekly from 3xweekly to give my knee time to recover. At my last f/u, the PA was surprised at the amount of pain/sensitivity I was experiencing, said it was unexpected. She pushed my leg back under the chair, said it moved back more than 90. She was pressing on the joint I think. Anyway, said I needed to push myself, gave me new pt orders in case I wanted to switch, and pain meds. I spoke with my current practice and of course they will oblige. My husband is driving me in as I'm taking the pain meds before my appt (these are stronger). The pt has been great doing a lot of manual work on the muscles and tissues, stops pushing for rom when I yell Uncle. We got 93 this past week. I'm to see my orthopedic doctor mid March.

I've been trying to stay positive, totally experienced the "I should've never had this done", crying, feeling like I'll never be able to do the things I loved, but never stopped trying.

My husband, bless his heart, wants me to push harder and I wish it was as simple as that. I can't seem to explain the swelling that prevents me to walk properly, and the pain it causes.

It is hard not to compare yourself to other people I know whose surgeries have been more successful, even those at pt. I don't want a MUA, who does? I just don't understand why this is happening. My ROM was great prior to surgery, and outside the home health blip, I've been doing everything I should be doing. I guess I have the next appt to discuss my progress and MUA. My pt feels it won't come to that.

 

[Layla]

Hello Susie and Welcome to BoneSmart and recovery!
Too much PT is the biggest single cause of low ROM in early recovery, because it causes excessive swelling and swelling acts like a plaster cast, actively blocking any flexion or extension.
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.

You really need to have patience and allow time for your ROM to increase through walking, gentle stretches and the ordinary activities of daily living. Give it a try. It will be less stressful with a better result. I believe you will find confirmation of this thorough others's personal accounts here on the forum.

I wish you comfort as you continue healing and hope you'll stop back with updates on your progress.
Thanks for joining us!

KNEE RECOVERY GUIDELINES

As you begin healing, please keep in mind that each recovery is unique. While the BoneSmart philosophy successfully works for many, there will be exceptions. Between the recommendations found here, your surgeon's recovery protocol and any physical therapy you may engage in, the key is to find what works best for you.

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​

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 a 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 history before providing advice.
@Susie2023

 

[donnag1108]

Hi Susie.

Welcome! I am 3 weeks post op from my second knee replacement. I had the first done in 2018 with wonderful results but this is a very tough recovery. I am sorry the struggle you have been having with PT and you will get some excellent information on that subject here. I am NOT where I want to be right now but I am also trying to remember this knee was totally different and really a hot mess! The days and nights are tough as you know. Hang in there lots of support here!

 

[Susie2023]

A couple of areas I'm concerned about.

At 8 weeks, I'm still unable to cycle a full revolution on the Recumbent Bike we bought for recovery. Should I be concerned?

Next is developing scar tissue and/or adhesions by not having or gaining ROM. If this is part of of what is causing stiff knee and I wait too long, I won't be able to get an MUA, if that's what I decide to do.

Oh, there are 3 concerns. When I or the pt stretch for ROM, there is an area to the right of the knee cap (medial) and goes lengthwise following the incision. The PA explained the stitching underneath the incision is there, trying to heal. When I stretch and it's painful, does that mean there is scar tissue I need to work through?

Does anyone have some thoughts or experience with this? Thank you!

 

[Flashlight]

Hi, I would read volLady post. She just went through a MUA. My OS wasn't so concerned about ROM at 8weeks, but he was concerned about extension. Everyone's recovery is different depending on how damaged your knee is and where and if you have bowed legs. My inner (medial) side of my knee was damaged, and this area was painful. As long as you are pushing the exercises and keeping your knee swollen the longer it will take for you to have a good ROM. Your knee is still healing and when you stretch it is causing pain from you overworking your swollen knee. When you get your swelling down you will be able to do the bike set at 0 for a few minutes.

 

[Jockette]

At 8 weeks, I'm still unable to cycle a full revolution on the Recumbent Bike we bought for recovery. Should I be concerned?

Lots of our members take longer than 8 weeks to do a full revolution, so no, you should not be concerned.

Next is developing scar tissue and/or adhesions by not having or gaining ROM.

Please don’t get stressed about “scar tissue.” There are so many myths surrounding that subject. Yes, you have scar tissue, but what you have is the normal amount that is closing your surgical wounds and healing them. Without it, you would always have an open wound that wouldn't heal.

Stiffness/Tightness is a normal occurrence after this kind of major surgery. Your surgeon did major carpentry work and disturbed every millimeter of soft tissue in this area. You aren't tight because your muscle is underused and needs to be stretched and rehabbed. You're tight because your tissue has been disturbed and is healing...and full healing takes a full year or more.

You are having trouble bending your knee because of the swelling, and the normal stiffness that results from this surgery. As you heal, the swelling will decrease, and your bend will be better. I promise! 8 weeks seems like a long time, but it’s still very early in this 52 week (one year) recovery. And, just so you know, I had a tough first year, but my ROM continued to improve well into my second, and even my third year!

When I stretch and it's painful, does that mean there is scar tissue I need to work through?

Its painful because of all I’ve written above.

Regaining our ROM does not require forceful bending or painful exercises.
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.

 

[beachy]

It sounds like you're doing ok.
I was told at PT (take that fwiw) that a recumbent bike is more difficult then the kind with a high seat for tkr. Its harder to stretch the leg and pedal on a recumbent. Maybe try rocking the upright bike pedals when your swelling goes down.

 

[WillB]

Hi Susie! I’m now at almost 7 weeks and certainly not where I hoped I would be. My knee is still pretty swollen and stiff. Got my flex to 105 at last PT but extension still a little short. The swelling is the biggest problem as I see it. And I’m not as diligent as I should be. But hey, I’m 75 and need my naps. The mental part of these TKR’s is huge and I struggle with how tough this has been. But I keep telling myself, as this forum confirms, recovery is long, difficult with small successes along the way.
I am having a 60 minute lymphatic drainage massage Friday afternoon which I hope will help with my swelling. I have heard good things. Hang in there Suzie!! We’re all in this together.

PS! At 7 weeks I am having a really hard time making a revolution on the recumbant bike! Shying away from the pain I think

 

[InkedMarie]

You are doing just fine. Please share the info above with your husband. There is no need to push yourself.

Marie

 

[EalingGran]

My ROM was great prior to surgery, and outside the home health blip, I've been doing everything I should be doing

Agree with everything beachy, Jockette, WillB, and InkedMarie, say above.
From what I have read if you had great ROM pre-surgery then that is a good predictor of good ROM post-surgery. So I am sure it will come back with patience and not overdoing it.
I found pilates much more helpful than tough physio. My pilates teacher never forced me to do anything and showed me gentle exercises that helped with strength and flexibility. When I saw a physio recently in hospital he was very impressed- but I have had no formal physio apart from a couple of sessions immediately post-op.

 

[Susie2023]

You are doing just fine. Please share the info above with your husband. There is no need to push yourself.

Marie

Thank you! I wish it was as simple as showing him all of this information. He will only listen to the OS and PA advise as far as pushing goes. But he did witness the results of that, which I will share below.

 

[Susie2023]

I am encouraged by this forum, everyone's experiences, and your replies. I've been very worried about not regaining ROM, seeing what my future will be like that without it. I have a horse I enjoy riding, and am ok knowing it will take time to get back in the saddle, garden, etc. But w/o good ROM, I see those activities may not happen. Sorry to sound gloomy, it's a process for sure.

So I did a bad thing. Before coming into this forum, I was still going by what I was told about pushing more, my husband echoing my OS and PA, and then I hear it from PT's telling their patients. I mustered what courage I had, took a couple of pain pills, and set out to conquer the stationery bike. After 1/2 hour, I was able to do a backwards revolution, not with much finesse. I could do a forward one by taking my foot out of the non surgical leg pedal. The next morning, my husband drove me to pt since the plan was to take pain pill prior. This was the morning I reached 93 ROM (though last month I got 95). I had also taken a prescribed muscle relaxer. I don't feel my pt pushed me too far, I think it was me. Needless to say, yesterday morning I could barely walk, it was almost like the day after surgery. Lots of swelling, pain, and couldn't bend whatsoever. I also ran out of gabapentin (I thought I had already renewed the prescription) and the nerve pain on top of what I was experiencing was excruciating!!! When my hubby came home and I told him I pushed it too much, his response was "well, it's what you need to do". I was so upset. But he witnessed my reaction to the pain, how I couldn't bend or walk. I told him today that if the swelling doesn't subside noonish I was going to cancel my pt session for tomorrow. I was in tears all day yesterday. I keep telling myself it's temporary.

 

[EalingGran]

You need to get your husband to read some of this forum to get him to understand that exercising a painful swollen joint is dangerous.
I was recently on almost complete bed rest in hospital for 6 days with severe sepsis.
I didn't lose any ROM and the small amount of pain and swelling I sometimes have disappeared completely.
If I were you I would ditch the PT and find a good pilates teacher and take a more gentle holistic approach to your healing.
My pilates teacher has loads of great free videos on YouTube- just look up Katja pilates on YouTube. I do her 20 minute glutes strengthening class most days.

 

[WillB]

Susie2023! Its really incredible what a fine line exists feom doing too much and doing too little. And how quickly a knee can swell and stiffen after a little too much pushing. I’ve been taking Gabapentin for several weeks prior to bedtime but haven’t felt it’s been helping. Getting a good nights sleep has been the most frustrating part of this TKR! All this requires an incredible amount of patience, patience, patience! R

 

[Susie2023]

If I were you I would ditch the PT and find a good pilates teacher and take a more gentle holistic approach to your healing.
My pilates teacher has loads of great free videos on YouTube- just look up Katja pilates on YouTube. I do her 20 minute glutes strengthening class most days.

I was going to look at chair yoga. I had been doing yoga for almost a year before surgery and enjoyed the benefits. I tried pilates before but it wasn't a good fit for my back issue. But I will look at the glute exercises! Thank you.

I also read here about lymphatic draining. I have a massage scheduled 4/5. She also does lymphatic draining.

 

[sistersinhim]

When my hubby came home and I told him I pushed it too much, his response was "well, it's what you need to do"

Boy, is he ever wrong! So many people think this is what you do to rehab a joint replacement. Not true! All it does is cause setbacks and prolonged swelling and pain.

After almost 20 years of reading joint replacement members' experiences, Bonesmart's staff knows that gentle, non-painful movements are the key to having a better recovery time. All these ignorant, well-meaning people just don't have a clue. It is so frustrating to read how so many members are pushed, both physically and mentally, to do more so they can have a successful recovery when it's the opposite that is true for the vast majority.

 

[beachy]

You didn't do a bad thing. You did a painful thing. Trying to follow docs orders, pt and husband.
You're 2 1/2 weeks ahead of me. Try to rest that knee and you'll see a big improvement.

 

[Susie2023]

I cancelled tomorrow's pt session. Still trying to get swelling down. Next pt appointment is 3/7.

 

[InkedMarie]

Think of it this way, @Susie2023 . You push too hard, your knee swells. How can you move something swollen? Kind of like a hose. You can bend it until you fill it with water, then you barely can. Water=swelling.

Marie

 

[JusticeRider]

I have a horse I enjoy riding, and am ok knowing it will take time to get back in the saddle, garden, etc. But w/o good ROM, I see those activities may not happen

Hi @Susie2023 I also ride and have big gardens on my farm. I’m sorry everyone is pushing you so hard. It sounds like you have been doing your best but only earning more pain and swelling for all your efforts.

I am one whose knee is slow to bend, and the pressure from the OS, PA, and PT was brutal. My husband also believed the docs at first and tried to convince me to push past the pain, until he saw the results of my efforts to do that. All that pushing just caused my knee to swell, did not help my ROM, and harmed my mental health.

I just want you to know, you will ride again and you will regain your ROM. I started riding bareback pretty soon (too soon, but it all worked out fine!) after surgery. If you have a high spot like a porch where you can place a mounting block, you can just slip right on with very little stress on your knee. Definitely have someone with you to hold your horse while you carefully mount. I only recommend doing this if your horse is very steady and calm. The saddle and putting pressure on the stirrups can come later, when your knee is ready.

As for your ROM, if you are patient and have faith in your body and the wealth of knowledge here at BoneSmart, it can improve slowly and gently in its own time. Progress can happen up to a year or two after surgery. Mine didn’t start improving much until I finally got my swelling down, and now it is slowly but surely improving. Some people improve quickly, others (like me) slowly. But if you are willing to let your knee take it’s time, you can get there without all the pain and stress.

Edit to add: YES to the lymphatic drainage massage! Also, I refused a MUA and you can too, if it comes to that and IF you personally believe that it’s the right choice for your knee not to do it.