TKR Thank Goodness I Only have Two Knees!

[selketine]

My leg is still wrapped with a bandage and I have thick pajama pants on - and I added a dish towel - too much?

Yes, this is too much. You can put the ice pack right on your bandage. With all these other things, none of the cool is getting to your knee.

I've made the adjustments. I think once the wrap is off and I can touch the skin to see how cold it is getting, that will help me know.

 

[selketine]

The surgeon said he had to do extra "something" cause I was so knock-knee'd so there's more in there to heal.

I had the opposite- my leg had bowed out. I was told that the tendons and muscles gradually adjust when your leg is off kilter, but when they are suddenly straightened they don’t have time so it can cause problems. So don’t be surprised if you get pains in odd places. The first two weeks after surgery my foot hurt worse than my knee, and it was probably more swollen too. No one really knew why but they attributed it to the leg straightening.

My leg does hurt all over but that could be from the tourniquet. Right now my feet and ankles are normal sized so I hope it stays that way!

 

[selketine]

The wrap came off yesterday and my leg looks good - not too much bruising either. I've had a PT at the house every day since I got home (Wed, Thur and Fri). She mostly wants me to do exercises that practice bending my knee (for example marching when I walk with the walker, act like I'm stepping up a step, using the other leg to nudge my surgical leg back under the chair - doesn't bend that far yet tho). Seems fine? She is very "we want you at this flexion by this date" but she isn't forcing my leg to do it. These exercises seem fine right? When I get up I do a few. My knee is swollen and feels tight. I think if the swelling went down I could bend it more.

What I really like is straightening my knee and it feels very good to do that...compared to bending it. Seems pretty straight to me. She's never measured the straightening only the bending. She was surprised my bend on the non-surgical knee is not super awesome so she backed off the expectations for the surgical knee a bit.

So far (knock on wood) I have been able to sleep just fine in the bed. We had an adjustable bed frame so I can get comfortable and get my knee up a bit. I'm kind of surprised I've slept so well considering many struggle with this. I've gotten a solid 6 hours at least. I hope that keeps up. The pain level (also knock on wood) has been surprisingly ok for me and well controlled so far with the meds I got.

 

[MSuki]

Moving your knee is good, and as long as it doesn’t hurt or cause your knee to swell, bending your knee is good. Just not to the point of pain - I haven’t had a PT forcibly bend my knee, but I’ve overbent my knee myself either by accident or because I was just trying a little too hard to get a better number. Then I paid for it with an extra couple of days of pain. In the early days my easy chair had some seams on the foot rest, and they happened to be at a point where I was getting a stretch but not pain. I would rest my heels on that seam (where it would hold them) for short periods of time. I then considered that my bending and didn’t do my heel slides. When I got to the point where I could pedal my exercise bike, I counted that as heel slides….starting to think heel slides aren’t my favorite !

So glad you are sleeping well, I think that will help your healing, your outlook, and overall quality of life!

 

[Jockette]

These exercises seem fine right? When I get up I do a few.

As long as they are done gently and don’t cause additional pain, then they are ok. I think only doing a few at a time is a good idea. Personally, I think stepping higher than normal when walking, this early in recovery, is not necessary. None of my PTs asked me to do that.

Here are some examples of exercises that are not in your best interest.

BoneSmart philosophy for sensible post op therapy

You will have noticed there is a significant opinion here about the potential hazards of PT. You may feel that your therapists are experts and know what you should be doing. However, over the last several years I've been here, I have observed that the more intensive the regimen of exercising...

bonesmart.org

 

[sistersinhim]

She is very "we want you at this flexion by this date"

You don't have a cookie-cutter knee, you have your very own special knee that is different than anyone else's knee. It will heal on its schedule, not the PT's. The vast majority of members have found that the Bonesmart way has worked well for them and had less pain and swelling than those using the aggressive therapy.

 

[mendogal]

The thing about "this amount of flexion/extension by this date".... it's aspirational! It seems to me in my time on this forum that a few are ahead of it, some hit the arbitrary target, and many lag behind... causing needless worry.

I was actually warned against doing that high stepping walk early on. Practicing a normal gait, which is hard to attain until the swelling recedes and ROM improves, is more important to resetting our overall structure.

My focus was quad sets while icing and relaxing in the recliner from day 1, in order to activate my sleepy quads, then addedd very slow gentle heel slides while seated.

 

[Jockette]

I was actually warned against doing that high stepping walk early on. Practicing a normal gait, which is hard to attain until the swelling recedes and ROM improves, is more important to resetting our overall structure.

Well said!

 

[Susie-Q]

starting to think heel slides aren’t my favorite

Heel slides were definitely the exercises I disliked the most!

 

[selketine]

@MSuki yes I think I am paying for it tonight with doing too much earlier today.

Thanks to everyone for the advice on those exercises. This PT is the third one I've seen - and the one that will be at the house next week as well. After next week I go to my HMO for PT and that's another person I haven't met yet. I think I overdid it today - in any case my knee is quite unhappy with me. I think I will focus on normal walking for the times I'm up and walking to the bathroom. I'm ok with the gentle heel slides that I do sitting on the chair. It's very interesting how even the nurses in the recovery area told me things that contradict what the PT has told me (like about how much to put my weight on the walker vs. my knee at first). Even the instructions the doctor sent home with me said just rest for 24 hours but I had PT at my house the next morning.

 

[Layla]

Ice, ice, then ice some more. It will help with the pain and any swelling.
A peaceful evening and relaxing weekend to you!
@selketine

 

[Jockette]

There are so many opinions from all the different medical people on our team that it can get frustrating and confusing, as to who to listen to. I’ve been here on Bonesmart for over 6 years and what I’ve learned in all this time is, after you listen to all the suggestions that you’ve been given, just do the ones you like. Sometimes this recovery/rehab is made out to be more complicated than it really is. Remember this from the Recovery Guidelines:

People are all 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.

 

[selketine]

Ok now I get the anxiety over the PT exercises and fear that you're not doing enough! I am just muddling through here doing what feels like I should be and not doing the rest lol. I'm having that anxiety of the PT chastising me for not doing enough when I see her today.

My "upper leg" is working now and I can lift my leg much better. I also have this really strong feeling of wanting to bend my TKR knee when I sit in the recliner like I was going to sit "criss cross apple sauce" style. I sit with it bent as much as comfortable for a little bit then stretch it out. Why does this feel better than when I do it seated or lying down? Is it bad for it?

I know the ice machine can help but I'm getting a bit tired of it cause it makes me so cold all over (I have the heat up in the house and a heated blanket but I'm still miserable with it). It also triggers Reynaud's in my hands and feet it seems. Still trying to figure out the best way to make it work. If it was summer and hot out no problem. Next knee it will be warm outside!

I'm kind of restless and want to get up more so that's a good thing I think! Still very much need the walker. I was very knock knee'd and I think my new knee leg feels a bit taller than the other leg (still need to get the other leg TKR in a few months) so my gait feels off. Working on just walking heel/toe rather than fast.

Please tell me what I'm screwing up - I just have this impending doom feeling of not doing something right!

 

[Layla]

Hi there selketine,
Please don't allow any PT to cause you anxiety. Ultimately, you are the boss, you are the one that will be forced to deal with the pain of an overly aggressive PT, not the therapist. You can say, No, or, STOP, if you're uncomfortable or in pain. Be brave, be bold, r-e-l-a-x. You've got this!

I don't have an answer for your question, but the PT likely will.

Maybe using the ice machine more frequently, for shorter periods of time will still bring you relief? You can try that and see. There is certainly no shame in using a walker at only 6 days post op. Concentrating on heel-toe walking is good and will assist in establishing proper gait.

Please tell me what I'm screwing up - I just have this impending doom feeling of not doing something right!

You're not screwing up anything. Healing is a long process and full recovery can take up to a year for some. Many continue to enjoy improvement into their second and even third years post op. So wrangle up some patience and enjoy the ride. We're here for you always!

 

[benne68]

I'm having that anxiety of the PT chastising me for not doing enough

The PT works for you -- and you don't have to please her.

At this very early stage of recovery, it's important not to do anything that causes pain. Only you know what hurts, so you have to tell her how it feels or she won't know.

I had a home PT during my first TKR recovery who tried to push me. After she hurt me once, I found the courage to say "no". She told me I was making a mistake by not pushing through pain. I asked her if she'd ever had a knee replacement. She had not, so I never let her push me again.

By the way, we have some good articles in the library about this subject:

Myth busting: No pain, no gain

With rather blatant snitching from a couple of other sites, I give you the lie to this saying! Wikipedia No pain, no gain (or "No gain without pain") is an exercise motto that promises greater value rewards for the price of hard and even painful work. Under this concept, competitive...

bonesmart.org

Activity progression for TKRs

Activities of Daily Living are assessed in hospital as a means of assessing your fitness to be discharged home. Your domestic circumstances will be taken into account as in if you are living alone, etc. ADLs include: ~ Personal hygiene and grooming ~ Dressing and undressing ~ Functional...

bonesmart.org

 

[mendogal]

You're FINE with the physical restlessness and testing out different positions!!!! It's incredibly hard to get comfortable, and personally unless I was napping with the Lounge Doctor I was moving that new knee/leg every five minutes because no position "worked" longer than that!

As long as you don't have direct pressure from the chair, pillow, other knee, etc behind your knee (early in recovery, it's a no-no for reducing the risk of blood clots), and you're not skewing a lot, just relaxing the leg within comfortable ROM limits, you're ok.

With my first TKA I was sure that if I stepped "wrong" I would break my implant. Um... nope!

 

[Susie-Q]

If it was summer and hot out no problem.

I had my second TKR in late Aug and even with the warm temps I was still cold! It's more than just the constant icing you are doing, there's something about having had surgery too and healing that just saps your core temp and makes you cold. I was reclining on the couch, watching tv, wearing a heavy robe and blankets and was still a bit chilled. I can imagine in winter it would be even worse.

Don't worry, you are doing everything right! You are not screwing up. Just take it one day at a time and the only muscle you need to worry about working the one called Patience!

 

[selketine]

The PT was fine and nothing she does really hurts when she is here but boy it hurt after. She has a schedule of like 10 reps 3x a day for each thing or something. I just do some of the exercises every bit here and there trying different ones for awhile. I had my worst night since coming home last night with pain - surprisingly! I managed to get back to sleep and not take another pain med I think because I'm so used to sleeping with painful knees anyway...but ouch. I like the exercises but I need to work my way up to them. I can't imagine doing as many reps as she has asked me to do.

I've asked for a refill on the pain meds as I'm almost out. I've tried stretching them out but haven't been able to very much. Overall I'm happy with my progress. I can get my knee straight it looks to me - and have been able to do so since the beginning - and it feels good to do that actually. Just the bend is hard because of the swelling and probably the staples still in there as well contributing to the tight feeling.

Thanks for all of the reassurance!

 

[Layla]

The PT was fine and nothing she does really hurts when she is here but boy it hurt after

Then it's too aggressive for only one week post op and you're struggling with possibly additional and
unnecessary pain. The reps are excessive, especially given they are for multiple exercises. Please contemplate the controlled trauma your leg endured and allow yourself time to heal through the TLC you deserve and need right now. Many, but not all PT's use the same therapy for each patient, ticking off the boxes on their standard list of exercises. Recovery is not a one size fit all situation, selketine, and it's difficult to imagine you engaging in this ambitious PT so early on and suffering with pain afterward. Please allow your body time to heal first. You're best bet right now is lots of rest, ice, elevation and meds on schedule. I hope you find relief from the pain today and get some restorative sleep. Best Wishes!

 

[mendogal]

I want to add.... from a physiological point of view, the series of three sets with brief rests in between (that is the standard PT regimen) makes NO SENSE.

If you are in the early stages of rehabbing from surgery, the initial few weeks where my surgical team insisted "less is better!", rather than counting out long sets it's easier and safer to select two or three things and just do a half dozen light repetitions at a time throughout the day. I literally never, not once, overdid it keeping to this regimen.

Even many months later, when working to get more functional capability, taking those rests in between doesn't let you adequately monitor the workout's effect on your target muscle. Slow controlled movements until the target muscle feels tired, then stopping, and then letting it have a couple of rest days to rebuild on a cellular level is a sensible approach. I was taught this by an incredibly good PT.