TKR The continuing story of Justznu's knee surgery.....<

[newlybionic]

You are doing a lot for less than two weeks out. I ice my knee for at least an hour at a time and have it elevated whenever sitting down. While walking is good walking around a grocery store at this time is not something I'm prepared to do. The amount of exercising you are doing is quite a bit. I do some exercises when I have PT at home but other than that I do only occasional heel slides during the day. I would suggest stopping all that PT for a couple of days and only do them when PT is at your house. I've done this and my ROM has been steadily increasing. The first time around I exercised too much and had a slower increase in ROM and much more pain.

 

[referee54]

I have to believe that you are doing way too much, way too soon. You surgical knee has just sustained tremendous surgical trauma, and it needs time to recover and time to heal.

Ice for longer periods of time---at least 40- minutes to an hour while elevated---you can do this if you place a cloth between your knee and the ice. 20-30 minutes of icing is not enough time to get any relief.

Place a hold on doing house, work, laundry, or going to the store---again, let the knee calm down and let the tissues heal ---there is nothing you can do to speed up recovery---but the more you do at this stage of recovery, the more inflamed your knee will be, and the slower, more frustrating, and more painful your recovery will be. At this time in your recovery, you should be resting, sleeping, icing and elevating---and repeat. Let others take care of the housework and the shopping.

The key to recovering is understanding that recovery will probably take longer than we want it to and expect it to---we crave normalcy, and, after the surgery, we want to reclaim our lives. It will be some time, however, before the knee is able to accommodate us.

Fight the urge to do more---take it easy, take it slowly, and take it gently. Be patient.

 

[Josephine]

1. My pain levels swing from 8 when the pain meds are wearing off and I'm moving, to about a 2 when I'm properly medicated and walking

Try to keep it at the lower level.

2. Hydrocodone-Acetaminophen 5-325 which I take every 4 hours. My doctor's office has approved me taking an extra dose at bedtime.
also newly prescribed Flexeril 10 mg one at bedtime.

You don't really need Flexeril , it's just a muscle relaxant. If you were taking your pain meds to the hilt you shouldn't need them.

3. I ice my knee for about 20-30 minutes at a time at least 5-6 times during my waking time.
4. I elevate my leg each time I ice it - at least 5-6 times a day for at least 20-30 minutes at a time.

You accomplish little or nothing in 20 minutes. Ice and elevate for at least 40-60mins and more than 4 times a day.

5. I am using a CPM machine and the ROM is set at this point at 85 and -5. Each day I try to increase the bend - today I will be moving it up to 90.

I'm not a fan of CPM machines as they give a false sense of achievement. The clue is in the name Continuous passive motion. This means your muscles aren't doing any work and cannot get the ROM on their own.

6. My leg is mildly swollen at times during the day

Okay

7. I have stairs in my home, so I am up and down the stairs several times a day, laundry, dusting, dishes, going to grocery store occasionally.

This is way too much to be doing at 12 days out! Did you not read the articles Pumpkln left you earlier in this thread? One of them was Activity progression for TKRs. I suggest you go read it again.

My comments in bold
Exercises done at home: (2-3) sessions each day - you would be better doing only one session per day and none on the weekends
ankle pumps x 25 every hour (or more) - these are only clot prevention exercises and therefore no longer necessary
quadricep sets x 10 reps(or more) 2-3 times a day - do 5 reps once a day, that's plenty
gluteal sets x 10 reps 1-2 times a day - do 5 reps once a day, that's plenty
hamstring sets x 10 1-2 times a day - why are you doing these? Do you have tight hamstrings?
hip abduction x 10 reps 1-2 times a day - this is a hip exercise!
heel slides x 10 reps 1-2 times a day - heels slides are very easy to do badly and 10 twice a day is bad. You need to read this Heel slides and how to do them.
straight leg raise x 5-10 1-2 times a day - do 5 once a day, that's quite sufficient
CPM machine 3 times a day for at least 1 hour or more - I'm not a fan of CPMs but there'y go!

Fact is that you are doing FAR too much. You need to cut out all the house work, laundry and going to the store. Right now your only job is to rest and lots of it. You are fresh out of MAJOR surgery and your body needs to rest in order to heal. As for the exercises, I suggest you leave out all the ones I have crossed out and amend the others as suggested.

There is a fundamental thing about knee recovery which is that it's not the exercising that gets you your ROM, it's time. Time to recover, time for swelling and pain to settle and time to heal. One thing that seems to be missing from all the PT's protocols is that all your ROM is there right from the start, just waiting for all 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. Exercise as in strength training is counter-productive and does more harm than good. Normal activity is the key to success.

 

[justtznu]

Thanks so much for your suggestions and advice! I'm one of those impatient people who just want to 'get it done' as quickly as possible. While that is a good trait to have in some situations, you guys are right - I need to back off and let the natural healing process do its job.

Prior to surgery, I kept telling my friends that my knee pain was mostly coming from the Baker's Cyst I was told I had behind my knee. My surgeon told me that during surgery that area would be cleaned out really well and that I should not have problems with that afterwards. I am still having quite a bit of pain behind my knee and swelling. My home PT felt it and said to keep icing it. Does anyone else have this problem and does it eventually go away after the trauma of the surgery? I ice it and am taking my pain meds at designated times - but the pain behind the knee is pretty consistent.

Still dealing with leg cramps at night even though I am taking a muscle relaxer when getting ready to go to bed. I sure hope those fade away sooner rather than later.

I see my Ortho doc tomorrow for my first follow-up and staple removal. I'll be sure to tell her all of this as well.

I have enjoyed reading everyone's posts and learning from others' experience that we all seem to be sharing the (somewhat) same pains, frustrations and gains. This surgery is definitely tough, but having fellow knee replacement patients at this site to share their knowledge and tips for recovering is a blessing!

 

[Josephine]

Oh .... did you read my post? I somehow get the feeling you didn't. Sorry if I've got that wrong!

I am still having quite a bit of pain behind my knee and swelling.

It's unlikely to be the cyst but pain at the back of the knee is the most common site of post-op pain! If you haven't already, I suggest you read my previous, very long, post!

 

[newlybionic]

I have pain behind my knee too. I had it there after my first surgery too. It does go away after a few weeks. I usually put ice all the way around my knee and elevate it as much as possible 24 hours a day. In fact I'm doing it now and am bundled under a blanket to keep the rest of me warm! My PT does gentle massages on my muscles to help with the cramping. I have been doing the same for myself especially before its time to fall asleep. I can tell you that it does get better.

 

[justtznu]

Had my first post-surgical visit with my doctor today. She was very pleased with my progress! Gave me an A+
LOL I am starting outpatient physical therapy on Thursday and she has cleared me to return to work next week for 4 hours a day until I am up to working a whole day, which should be the following week. Happy Feet!
Good luck to all of you that just had or will be having your surgery soon. Best advice from this rookie is to follow your doctor's instructions and do your best - but be sure to take care of yourself through it all. Don't be afraid to ask questions and read about other patient's experiences on this site. You'll get a lot of good information which will help guide you in your recovery.

Blessings to all!

 

[Celle]

I am starting outpatient physical therapy on Thursday and she has cleared me to return to work next week for 4 hours a day until I am up to working a whole day, which should be the following week. Happy Feet!

I'm sorry, but that is just crazy!
Going back to work, even part time, at only 3 weeks after major surgery like a knee replacement is asking for trouble.
You have pain now from doing too much. Going back to work is going to increase both your pain and your swelling.

We usually recommend taking about 12 weeks off work, if possible, so that healing is well under way.
Have you read these article?
Activity progression for TKRs
Phased return to work

 

[Jaycey]

she has cleared me to return to work next week for 4 hours a day until I am up to working a whole day, which should be the following week.

What's the rush my friend? I have to agree with Celle - you are heading for chronic pain problems if you don't slow down and let that knee heal.

 

[Josephine]

And a third voice in dissent! 12 weeks is the recommended period of leave for a TKR and even then it should be followed by a Phased return to work. You are just entering the most acute angry tissue stage. Please don't do this but do take your own very excellent advice!

but be sure to take care of yourself through it all.
read about other patient's experiences on this site. You'll get a lot of good information which will help guide you in your recovery.

You won't find anyone else that is returning to work at 6 weeks never mind 3.

Let me ask you a couple of questions:
1. are you getting good night's sleep yet?
2. are you able to get out of bed and get going without any problems?
3. are you pain free throughout the day and night?
If none of these, then you won't be able to cope with work yet, not even 4 hours a day.
Read that article and remind yourself of everything else that "going to work" involves.

 

[justtznu]

I do have to return to work - after next week, I will have used up all my vacation and sick time and will receive no pay for my time off. Secondly, I work for a great company with totally wonderful people. My office is located a few feet from the restroom (which has a handicapped toilet) and on the other side of me is our kitchen area where I can keep my ice bags, etc. My co-workers will be helping me when and if I need it. The main focus of my job is working on a computer, so I'll be sitting and fairly immobile most of the time. I'm not really concerned about it. When I had my hip replaced 6 years ago, I also went back to work at 3½ weeks. I admit my hip recovery was a lot easier, but I'll take care of myself and if things get to be too much, I'll back off. My boss understands and will accommodate any of my needs during this recovery time. I'm lucky to have such a great group of people to work with!

 

[Josephine]

Well that's a relief! It sounds like you have a great deal of wiggle room and an understanding boss. Solid gold that.

The main focus of my job is working on a computer, so I'll be sitting and fairly immobile most of the time.

There is one thing that doesn't happen with a THR, and it's this Pain: Movie sign in TKR. I just tell you this to be forewarned.

 

[justtznu]

Thanks for that info Josephine. I sure am aware of the fact that sitting in a chair for long periods is not too comfortable. I've already discussed with my boss that I can't sit for long periods, so I'll be up and walking about in the office area frequently. The good part of that is that there is way more room in my office for me to walk about than there is in my house! Also, two of my managers have sofas in their offices which they have both made available to me if I need them. I should be fine - but if it gets to be too much I will back off on how much time I am spending at the office and know that I will have full support from my Managers. When I get home shortly after noon each day, I'll be resting, elevating and icing for the rest of the day. Should be good to go!

 

[sistersinhim]

You are really blessed having such a wonderful work environment. Everyone should be so lucky! Be sure and take some pillows so while you're icing you can also elevate on those sofas! You have it all worked out and you can do it! We all will be praying for you.

 

[newlybionic]

That's great that you have managers that are so willing to accommodate you through your recovery. While my boss is also great I can't even consider going back now since my job involves me to be on my feet the whole day and I have no place to ice and elevate. It's sounds like you have everything ready to go.

 

[justtznu]

Oh no...I couldn't do it if I had to stand on my feet all day. No way. I do work with and for wonderful people here in little old Montana and they have been so good and responsive to my needs during my build-up to surgery. They even installed a second handrail on the other side of the stairs that I may have to go up to be sure that I had that stability! They are great and I do consider myself wonderfully blessed to be working with them. Which is why I have not made any decision to retire yet. I would miss them terribly. LOL

 

[Glamg1979]

How fortunate to work for such a caring and supportive company! Love that the managers have couches to stretch out on!!
I'm sure you will be tired but it will be manageable.

 

[Celle]

You're very lucky to have such understanding and accommodating people at work. I do understand that taking the recommenced time off work is economically impossible for you.

Is there any way that you can elevate your leg while you are sitting at your desk? Even if it is only propped up on another chair or a waste basket, it will be better than having your foot down on the ground all the time.

The other important things is that on work days you try to nothing at all except for travelling to and from work, and working. No PT, no shopping, no housework. Just come home, grab an easy meal and then spend the remainder of your time resting, icing and elevating.
You will probably find that you experience an increase in pain and swelling, and temporary loss of ROM. Those will all sort themselves out, in time.

Do let us know how you get on.