TKR Ten weeks later . . .<<'

[Cratchit]

Exactly that @little red canoe - the body seems to know what it`s doing and then we mess it up! How did your recovery go without the ice?

 

[Red's Mom]

Interesting information. I love my ice for comfort though!

 

[Cratchit]

Or maybe I was just so used to them being loose that the tightness they were supposed to was not comfortable for me.

I`m wondering if that is the case with me and I just have to get used to it and when I do, the pain will lessen.

How can you go back to work on a busy ward if you really need a stick? You wouldn't be much use to patients and your manager might actually see you as a risk (sorry!). I bet they could find you some office type work. Is there any research you could help out on?

She probably sees me as that anyway! I`m going to give it another week or two, see how I go. There is a piece of research I was working on; might pick that up again.

You and I have about the same dates of surgery

So we have, I hadn`t noticed that! How are you doing? Hubby bought me two walking poles and I`m definitely better with those - they`d defo freak out if I brought those onto the ward!

I was concerned about dropping to one stick at first and was concerned about torqueing but now it seems to 'remind' me to straighten up and not lean. It also takes some of the pressure off the (R) leg as well as the (L) TKR leg. Tis a slow process this mending lark, to be sure!

 

[Josephine]

I read the articles but noted that both were actually based upon injuries rather than surgery. That might be an arguable point but I really don't think so. Besides which, my main reason for using ice was for pain relief.

Article one

If you are injured, stop exercising immediately.

Unsurprisingly, I fully agree with this!

The authors of one study used two groups of mice

But would you really want to amend your treatment based on a study using mice?!!!

Article two

I will be sharing with you the crazy idea that ice is not only ineffective, but may even be counter-productive to proper natural healing following acute soft tissue injuries.

I would agree with this when it's an ankle or hand injury as putting ice on these places can cause nerve and circulation because these structures are so superficial and so small.

I have always been puzzled by the proposal that when an injury occurs, we must immediately act to reduce and eliminate inflammation. I just have one question to ask: why?

Obviously this guy has never had a knee replacement otherwise he wouldn't be asking that!

Sorry, Crachit but I shan't be using those articles for the Library!

Shame you couldn't rub some Codeine ointment straight on to your knee (if such exists!)

Interestingly enough, there was a documentary on BBC2 some weeks ago where they investigated the efficacy of topical gels such are Volteren or Ibuleve. The present (a doctor) had a painful joint (knee, I think) and in laboratory environment, he applied gel and the scientist managed to test his tissues are various levels to see how well it penetrated. The answer was that it didn't penetrate at all below the subcutaneous fat and even then, that fat got a very mild amount of the drug. They also showed that the drug in the gels never every got far enough to give the patient any relief whatsoever!

But I still use it on my shoulders occasionally!

I read on one of the threads that ice might not be the universal saviour it was once thought to be. It seemed to help me.

Me too! I couldn't have coped without my Cryocuff for either knee.Did squat for my shoulder though - only ice packs helped there.

I have been icing intermittently for a while but not consistently as I didn't find any real benefit from it.

This is the puzzlement about ice. Some people cannot bear to use ice on there bodies for any reason. My sister is like this. She just cannot tolerate it. Strange.

 

[Josephine]

@Cratchit you will notice I have merged your threads.

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.

 

[Cratchit]

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.

It is for this reason that I started a separate thread as it was a general topic rather than part of my recovery thread which may sink out of sight therefore the information, which may help to make an informed choice, is lost.

Did you read any other research/articles surrounding the subject of icing and current evidence or just the two links I posted? There`s a lot out there!

 

[newlybionic]

I've read different articles on line concerning icing vs not icing. For me it came down to earth me thought. If my knee was swollen it's not going to bend very well at all. I have found one sure way (IMO) is to apply ice to the area. I've also have told patients ( and of course everyone who calls me for medical advice) to ice any injury for after least the first 48 hours. I can't remember however where I picked up that piece of info. It could have been a PT I knew years ago or when I did my nurse's training in the 90s. I've used ice for many years going back to my late 30s after my tennis matches or practices. I packed both knees in ice before I would leave the clubhouse.

 

[Jamie]

The icing issue is one that comes up here periodically, so believe me we've read LOTS of the information that's out on the internet, both scientific studies and articles like yours by doctors. Not everyone agrees with our recommendation of copious icing for knees and you'll see conflicting information on the web. But....we base our recommendation on members' (and our own) personal experience, input from our medical advisors and observation of the good outcomes we've seen here in almost 10 years of working with BoneSmarties. I can tell you that never once have I heard of someone's recovery being compromised by the use of ice for extended periods (providing they keep a towel between their knee and the ice source to prevent over-chilling of skin). But I can tell you many, many people find great relief with the cold therapy.

 

[little red canoe]

Crachit I am doing well. Since Feb 5 I have been camping. I have not iced nor can I find ice easily nor elevate.. not so easy while camping..
Ice did relieve pain for me and reduce swelling.. But now I try to vary activitiy between putting extension forces on the knee and flexing.. Paddling is like doing 1500 quad sets per mile. Today we did ten miles. My knee says.. uh tomorrow I would like ROM.. So we will bike.
I am not missing the ice.. And can sleep quite well with no meds at all.

I think a balance of cold therapy to reduce swelling and pain and also letting the tissues heal naturally is the way that worked for me in the early months. Now five months out the key is using the knee all day everyday for me in a variety of ways. I am finding sitting in the car ( which I have had to do as we have traveled 5000 miles in three weeks) aggravates the knee more than anything

I am reticent to post that I am doing well despite not elevating and icing as clearly that is not appropriate for all.And that I really don't have any awareness of an artificial knee unless still for long periods. I do use hiking sticks for hiking.. Everyone in my area does.. its rocky trails with 1000 ft vertical per mile. If people dont have bad knees they use sticks to avoid them.. And those with artificial knees use them

Did you know my mind was made up for surgery by a BTKR person bounding down the trail who stopped for a brief chat?

 

[Want2hike]

I have to admit, I went easy on the ice too (and I usually only elevated above my hips or chest....almost never above my nose). Even wrapped in an electric blanket, icing more than 30-45 mins 1x/day was all the cold I could tolerate once I was off pain meds.

 

[Spex10]

I've noticed recently that the heat has gone out of my knee. It used to be quite pronounced in some parts of it. My OS told me before I was discharged from hospital that I wasn't to worry if my knee got hot. He said it was just blood rushing to the area to heal it. I wasn't given ice when in hospital unless I asked for it. I was lucky in that I didn't seem to experience the pain that others do (or maybe I'm Scottish and am used to it!!) so ice didn't make much difference to me. I did ice and elevate but found that my leg was quite stiff afterwards. Whatever! I'm OK now. Just got to concentrate on my gait so I don't hurt my other knee and hip. Onwards!!

 

[KarriB]

I saw on another thread that you made a decision to retire on July 4th! Congratulations! The freedom and lack of stress is palpable. I did a little tutoring this year, just one student, but it was just enough to keep me busy and happy.

 

[Cratchit]

@KarriB Thanks Karri! Yes, I have just this very day submitted the last piece of paperwork pertinent to my retirement on the 4th July - my very own Independence Day! Can`t wait! Whether I`ll opt for flexi retirement/bank work I`m not sure as a lot depends on how my knee behaves and at the moment it still isn`t marvellous, plus the other one has now joined in and is waking me up at night. Aaargh!

 

[KarriB]

I'm sorry the other knee is bothering you. My left knee keeps me from walking too much, but it's not waking me up at night or hurting when I'm sitting. I'm not sure what flexi-retirement/bank work is. You may go to work in a bank?

For the 38 years I taught school a percentage of money was deposited in a retirement account which will give me a monthly allowance for the rest of my life. It won't get larger or smaller, however in two years I'll be old enough to collect Social Security from the government (which I also paid into from the age of 18). So at that point I'll begin receiving more per month. Some US citizens choose to hold off on SS until the age of 67.

 

[Cratchit]

I had a physio assessment on Monday. I still lack power in my quads and hamstrings and this is contributing to the pain and swelling l am still experiencing. He was very straight with me, said l was too young to be stuck at this stage and that in order to progress l had to push through and build up power and strength. It would hurt, he said, but explained that whilst initially I may experience increased pain and swelling, l would soon build up toned muscle which in itself is able to support the structures of the knee and therefor improve my gait and level of pain/discomfort while at the same time is able to shift fluid more effectively. Quite unexpectedly, l sobbed. I felt ashamed and disappointed.

I hadn't fully appreciated the extent of the pre-operative atrophy, damage and deformity of my leg and knee, developed as a result of traumatic injury. My rehab starting point was way down the track. I therefore had more work to do to build up good power and effective muscle than others may have had. The message was clear; if l want to get the best out of this implant - and out of life - then l must work for it. I had blithely believed that what l was doing was enough. It wasn't. I am 'too young' to remain as limited as this. The ADL may be sufficient for some but it cannot always be enough. Once the acute postoperative stage has passed, the work has to begin, not to the point of causing damage but certainly to the point of improving outcome. I have learned a salutary lesson. Incidentally, my ROM is good, it's muscle and power that l still lack, all these months later.

@highlander and @little red canoe you inspire me. You have both worked hard to regain an active life and to not accept a status quo. Thank you.

 

[Spex10]

Interesting to hear this @Cratchit. It makes sense. Not sense that a lazy person wants to hear though!! I definitely feel that my operated knee needs to work now. Its healed and strong. I'm held back so much by my other knee. I can't 'push' myself exercise wise without hurting it more. I think that after our big hols I might have to bite the bullet and go for a TKR for my other knee.
Good luck with your exercising. You'll need to be fit for your retirement!

 

[Rainbow27]

No physio or no Knee Replacement Exercises = No Full benefits of a knee replacement. Just noticed you said no physio or no set exercises. Everything I have read and everything I have done I am positive that only IF you do the exercises that you will have the true benefits of a total knee replacement. I hate the exercises at 5 weeks since my surgery but I do them 3 x a day! I also go to physio 2 x a week. The exercises will keep the scar tissue moving and expand your range of motion so that you can walk, live life normally and be without pain someday!
It is a slow process and a painful journey but the EXERCISES are the key! Without them then you might as well have not had the surgery done. After 4 weeks I still have pain & swelling but I can walk with just a cane, do stairs with no pain now and I am at about 104 degrees range of motion. I have given myself a challenge to do better each day as I do my exercises. This is the biggest gift you can give yourself! Good luck!

 

[Mireille]

@Cratchit Sorry to hear you're experiencing pain and swelling. At least you are being proactive and looking for ways to improve. I think exercise is good for us, we just have to find the right balance and what works for us. Best of luck to you! You will be "running" around in no time! Hugs!

 

[little red canoe]

No physio or no Knee Replacement Exercises = No Full benefits of a knee replacement. Just noticed you said no physio or no set exercises. Everything I have read and everything I have done I am positive that only IF you do the exercises that you will have the true benefits of a total knee replacement. I hate the exercises at 5 weeks since my surgery but I do them 3 x a day! I also go to physio 2 x a week. The exercises will keep the scar tissue moving and expand your range of motion so that you can walk, live life normally and be without pain someday!
It is a slow process and a painful journey but the EXERCISES are the key! Without them then you might as well have not had the surgery done. After 4 weeks I still have pain & swelling but I can walk with just a cane, do stairs with no pain now and I am at about 104 degrees range of motion. I have given myself a challenge to do better each day as I do my exercises. This is the biggest gift you can give yourself! Good luck!

Couldn't disagree more. After four weeks I stopped knee exercises and physio.. Now I can kneel on my heels and my ROM matches my good knee ( which is genuinely good and not in need)

Might as well not had the surgery done? What? My muscles were fine though not well used and the bone on bone issue is gone.. Sorry but saying not having the surgery done makes no sense. Post surgery with no pain and better alignment I can get on with life.

And not in a rocking chair.

Gotta go, We got two feet of snow and a shovel is my next friend.. Oh that is exercise.. and life.

 

[Cratchit]

Just to clarify, I did exercise. In the UK we do not have physio sessions such as you do in the US but we do have set exercises. I use the cross trainer, steps, walk, as well as housework, shopping etc. In general I am very active. And that`s the thing - it wasn`t enough. It wasn`t targeting specific muscle groups. It is generally not enough to simply get on with living without doing specific exercises with the degree of damage I had. It is not enough to simply rely upon the Activities of Daily Living unless you`re happy with a more sedentary life. Maybe without damage or atrophy, perhaps.

You are right @Rainbow27, I am not yet reaping the full benefits of my TKR. But you are wrong, without the TKR the deterioration and pain would have increased so I have gained immensely from the procedure already.

Thanks @ Mireille And @little red canoe, thank you - getting on with life is what I am doing but now with a little more targeted support.