TKR Thank Goodness I Only have Two Knees!

[MSuki]

My PT put 3 sets of all kinds of things early on. At home with no supervision, I was lucky to get one set of everything. But she always just assumed I did them all and I always progressed just due to healing. Lucky for me she rarely asks!

 

[selketine]

I woke up last night with uncontrollable chills. It was so bad and lasted maybe 45 mins - woke me up from sleeping and I couldn't figure out what was happening for a bit. I woke my husband up because I couldn't get it to stop and I thought I was going to throw up. It's cold outside here but the house is warm and I sleep with a heated blanket. I had him take the ice machine off my leg. I had it set fairly low (only 10 min. intervals). I seem to be very sensitive to cold and it's the only thing I can think of that triggered this. I won't use it at night going forward. I don't feel sick or have a fever, etc. I've been try to cut back on the pain pills as the doctor refilled them but only to take every 8 hours. It's really tough cutting back cause my leg makes me miserable and the ice machine is making me miserable as well. I don't even want to look at anything cold right now lol.

I looked at the paper the PT left me, and there are 14 exercises I'm supposed to do 3x a day with 20 reps each time. Looking at that - I can't even figure out how a person would schedule all this into their day. I wonder if some are more important than others (helpful). I think I will be like @MSuki and just do them once a day and go from there.

 

[benne68]

@selketine That terrible feeling of cold and chills is not uncommon during the first month of recovery.

While part of it is likely due to the icing, some of it is simply that your body is expending most of its energy on healing -- rather than on heating your body. It may seem like you are doing "nothing," but your body's energy stores are busy making and restoring lost blood, repairing soft tissue damage, and beginning the process of producing the important building blocks to insuring proper bone growth into your new prosthesis so it can be solid and not loosen. It's the same reason we fatigue so easily during the first month post-op.

It does get better as the weeks progress and your knee draws less of that energy for healing.

Make sure you are getting enough protein in your diet. You might want to take a look at our articles about nutrition: https://bonesmart.org/nutrition/dietary-tips/

 

[mendogal]

That's an absurd amount of exercise!!!!!

I'd knock off the list "strengthening" exercises like squats and long arc quads because until the muscles have had 6-8 weeks to heal it's just too easy to injure them. PTs intellectually know that but some get overly eager when they see a patient get good early ROM.

I believe quad sets are among the most valuable exercises because they do such a good job of activating the quads without stressing the joint. I started them on day 1 and never did count out 30 at a time - anytime I was relaxing with my leg up I'd do a bunch until my quads said "that's good!" and probably did that a half dozen times a day. They do prepare the body for more exercise later on in recovery.

Activating and working glutes is another excellent exercise to start as early as possible to help normalize gait. But it's too early in your recovery for squats or clamshells, so simply locating them and doing cycles of tensing and relaxing while lying down or sitting up is easy and safe.

Heel slides (which nobody really enjoys, but I never found nasty if done sitting up) are good as long as they are a slight stretch and not painful.

 

[Susie-Q]

but I never found nasty if done sitting up

Yes, so true, why is that? I hated doing heel slides while lying on the bed but didn't mind doing them in a chair, gently using my other ankle to get a nice stretch.

 

[CatieViv]

I looked at the exercise sheet the PT gave me once when she handed it to me and once at home. That's it. I didn't do any of the exercises because they hurt. I focused on gentle moments, walking heel toe and resting in between. My activities of daily living have been my exercises. And the quad sets while resting. When you drink lots of water, you make lots of trips down the hall!

 

[sistersinhim]

I looked at the paper the PT left me, and there are 14 exercises I'm supposed to do 3x a day with 20 reps each time.

Your knee is less than 10 days old. These are way too much at this early stage. These exercises sound like you are in training, not healing. I'm afraid they will only keep your knee inflamed, swollen, and painful. Please don't do all these and just do your gentle daily activities.

 

[MSuki]

I recently had my PT write me a new list to narrow down for me a reasonable number of exercises. She gave me 5 exercises and said I should do 3 sets of 10. So far I have never done more than 1 set of any of them. But I do ride my recumbent bike every morning, it helps me loosen up. I started back on it when I was ready, and worked my way up from 5-10 minutes to now about 30 minutes every morning. I ride at a slow pace and read the news, email, or a book, or play a game on my ipad so I enjoy it.

I also do some stretching, I think my PT assumes that I know those although they aren’t listed.

 

[selketine]

Just to be clear, I haven't been doing all these exercises. I've done some here and there but not in any systematic way. @sistersinhim I just thought - wow even if I wanted to do them all, I'm not sure I could organize myself to do 14 different ones, 20 reps each, 3x a day. I'd need a spreadsheet and a secretary to remind me what's next lol! The PT told me when I transition to going in to see a PT at my HMO to be sure to have them do things like weights on my legs and stuff. ack.

@mendogal what are the quad sets and glutes exercises that are good vs. the bad ones for this stage of recovery?

@benne68 thanks for the link! I have a protein shake drink I've been trying to have once a day but I haven't been good about drinking it cause my stomach doesn't always feel so good and the taste is kind of a turn off.

@MSuki I wish I had a bike - that is a tempting investment!

 

[MSuki]

I love my bike. We got it a few ago for about $130 at Academy. The screen has given out and the pedals make a little noise, but it has a tablet holder, a coke holder, and I can pedal either forward or backward.

I think when they talk about quad sets it’s the one where you squeeze your quad and push down, but someone can correct me if I’m wrong. For extension. At your stage the keys are to move and do gentle motions. You might also benefit from stretching if you are as tight as I was. My calf on the operated leg was the worst.

I don’t do mine every day, but when I do I claim victory after doing one set!

 

[mendogal]

@selketine

"Quad sets" is a very specific exercise. In the days post op, doing them while touching the thigh with fingertips helps wake up the quads. After that it starts really activating and toning them. Here's a link Though they are pictured sitting up, it's even easier to do them while relaxing in a recliner or lying down with your leg supported on a pillow.

For the glutes, the safest bet for now is tightening and relaxing them, again while sitting or reclining. After 2 - 3 months, when you're very comfortable sidelying, you can ask PT to show you the correct position for clamshells. I wouldn't do squats until later on due to the pressure the put on the knee.

 

[mendogal]

The PT told me when I transition to going in to see a PT at my HMO to be sure to have them do things like weights on my legs and stuff. ack.

Oh dear. I sincerely hope that's a typo because it should read "DON'T do things like weights on my legs."

I am personally a fan of strength training. However, having been through both minor and major athletic injuries, I understand the physiology of soft tissue healing and bone healing....

Even a minor sprain needs 6-8 weeks to heal. A knee replacement is a major injury and needs SLOW rehab.

It simply isn't safe for our new knees to start any kind of stregthening regimen until at least 6-8 weeks post op. And then, weights run the risk of really overdoing it as we try to please our PTs!!!!

Until then, walking, light stretching, a little no resistance biking IF tolerated just to regain ROM, and if desired the toning exercises to stimulate muscle action are fine... and many BoneSmarties simply use the activities of daily living to regain strength.

So please proceed with caution with your outpatient PT. No weights are needed unless, many months post op, it's a form of exercise that you happen to value - as I do. At seven months postop, I have just added a light ankle weight to my R knee work out.

 

[benne68]

I have a protein shake drink I've been trying to have once a day but I haven't been good about drinking it cause my stomach doesn't always feel so good and the taste is kind of a turn off.

I'm sorry you are dealing with stomach issues. I had that problem with my first recovery; I felt queasy for weeks. Turns out it was the medication causing it. My home health nurse advised me to always have some food 5-10 minutes before taking my pills. I found that yogurt or pudding were the easiest thing to eat. I did help.

 

[selketine]

I have a protein shake drink I've been trying to have once a day but I haven't been good about drinking it cause my stomach doesn't always feel so good and the taste is kind of a turn off.

I'm sorry you are dealing with stomach issues. I had that problem with my first recovery; I felt queasy for weeks. Turns out it was the medication causing it. My home health nurse advised me to always have some food 5-10 minutes before taking my pills. I found that yogurt or pudding were the easiest thing to eat. I did help.

I've been taking meds after eating and the nausea has mostly backed off. I'm hungry for food I like but - like when I was pregnant - some things just turn my stomach lol! (Def. not pregnant).

My doc refilled my pain meds and had cut back on them (to one every 8 hours vs. every 6) and I've tried to cut back on taking them even more...and it's probably a bad idea. I tried taking 1.5 yesterday and was miserable all afternoon/evening. I can usually sleep just fine though - apparently just very blessed with being able to sleep about 6-7 hours a night. Probably cause I have a wonderful adjustable bed and I'm ok with sleeping on my back & had gotten used to being awakened all night long pre-surgery with painful knees.

If I don't take the pain meds in the day I don't want to exercise my knee at all so obviously that's not a good idea plus I'm miserable and feel very frustrated with myself.

@mendogal I think my quads are completely awake - I can lift my leg onto the bed or whatever (hurts a bit to do it but nothing awful). I feel like I get nowhere with the heel slides but I am doing some every time I get up and move around. What about the exercise like putting a rolled up towel under the knee while lying down and then lifting the leg up to straighten it - is that bad? Or an exercise also lying down where you slide your leg out to the side keeping knee straight then slide it back? I wish I could just show you all the exercises she gave me and get your opinion on ones to avoid for now. What about exercises that involve bending the knee while standing - either back behind me or in front of me? She did have one exercise where I'm lying on the bed and I lift up the entire leg and move my leg in an arc to the side and back. That one hurts the top of my leg quite a bit.

Two days ago, my ROM was 0 (pretty much) and like 88 (just a hair short of 90 she said). She made it sound like I should be at 90 by two weeks post op ideally. She also said getting the staples out and bandage off may help. My knee feels really tight and just doesn't want to bend. I feel like overall I'm in more pain now than I was last week all up and down my leg. Not horrendous but sometimes enough that I can't focus on other things. I'm 10 days post-op today!

 

[sistersinhim]

If I don't take the pain meds in the day I don't want to exercise my knee at all so obviously that's not a good idea

Actually, not exercising your infant knee at this early stage is a good thing. Just walking around the house, doing your own daily activities is enough exercise for it for the first month or so. Many of us never took formal PT or did exercises and recovered quite well. I believe that too much emphasis is put on exercising a new knee. Doing too much too soon just slows down your recovery because your knee stays inflamed, painful, and swollen.

 

[mendogal]

My ortho team's goal, and that of the outpatient surgery center, was 90 degrees at six weeks. And goals are "aspirational," not commandments.

PTs absolutely don't get to set our goals.

Lying on your back with a rolled towel under your knee and lifting the leg to straighten it is called a "short arc quad." It runs a real risk of irritating your new knee.
Also at your early stage, I wouldn't put a towel under my knee with any weight or pressure on it (basic blood clot prevention!) and I would stick to quad sets instead - they provide a good quad work out without irritating the joint.

When I *much later on* progressed to short arc quads, the roll wasn't a towel under my knee but a slightly larger roll under my lower thigh, so there was still no direct pressure on the back of my knee. And no ankle weights!

Lying down and moving your extended leg outward is an ok range of motion as long as it's done slowly and not done to where it's bothersome.

Lying down and moving your leg around in the air or doing the knee bend things while standing are a problem - in my opinion - because you're doing all these repetitions in a short period of time. If you're at home going about your life, it's natural to incorporate a couple here and there, and the knee says "ok." For many of us it's the concentrated repetition of exercises in a PT session that put us into the Over Did It Club causing pain, swelling, and setting us back

 

[selketine]

If you're at home going about your life, it's natural to incorporate a couple here and there, and the knee says "ok." For many of us it's the concentrated repetition of exercises in a PT session that put us into the Over Did It Club causing pain, swelling, and setting us back

Thanks for the info - I'm going to be careful. I do naturally just bend my knee this way or that while standing up just as a stretch but I'm not standing there doing it 20x in a row. I noticed my swelling is down in my ankle today which is surprising and maybe cause I haven't been exercising.

@sistersinhim I'm trying to take it easy and do gentle stretches - things that feel good and not repetitive exercises. My knees are very knock-knee'd and the one operated on was worse than the one that's still to go. Without some pain med during the day I don't want to get up and it gets uncomfortable just sitting or doing anything still. I get a lot of pain down my entire leg and it's just the knee. I get up and walk every hour, get some water, bathroom, find a cat to pet, or something haha! My walking before surgery was bad - sure wasn't normal heel to toe walking - and so I think I'm going to be with the walker awhile just strengthening my walking muscles so I'm more balanced. The operated leg also feels taller than the other one now (which is still bent) which could be in my mind.

 

[selketine]

My knee was doing well but I tripped and twisted it yesterday afternoon and the pain brought tears (it was significant). I rested/elevated it and got the ice machine going for it yesterday as much as I could tolerate the cold. No issues with weight bearing but it feels a bit odd on the outside of the knee and sometimes with a feeling of a string being thrummed like a guitar when I walk. I'm guessing it's fine. It hurt more yesterday than today. I was so mad at myself. Tomorrow I have an appointment to get the staples out and an x-ray was ordered anyway so I'll tell them then about the incident. Hopefully I didn't mess anything up in there.

I'm in a battle Royale with myself trying not to request a pain med refill. I've consistently tried to take less than what was prescribed - and I've done ok - but I don't think I can stop them completely. I had them prescribed for 3x daily and took them mostly 2x. I think I will still need one or two a day in the coming week. I've had the same pain meds before and zero issue tapering off of them (they just have no happy effect on me - only pain relief). I just feel bad asking for more. I also have PT tomorrow for the first time in-patient at my HMO center. Oh boy!

 

[sistersinhim]

How scary tripping on that new knee. I imagine your soft tissues are even more angry now. The implant should be fine. If I were you I would ask for more pain meds. Just because you have them doesn't mean you have to take them. But, just in case you need one, you'll have them. It's better to be safe than sorry!

Be sure and not let PT hurt you tomorrow, especially after your twist.

 

[Layla]

I just feel bad asking for more

Please don't feel bad and take the meds for as long as you need to so you're able to remain comfortably mobile.
You're only two weeks post op, selketine. Take it slow / easy in PT, especially if your leg is bothering you. If it hurts STOP and don't allow anyone to forcefully manipulate your leg. Best Wishes! Let us know how it goes.