TKR The Knee Team journey begins!

[Josephine]

One week postop TKR, of course my knee is swollen, but I have an area on the exterior side of knee, just above the compression hose line. It is between the incision area & flesh that goes to back of knee. What causes this to swell & become extremely hard?

a) read the articles Jamie left for you and b) especially read this one Swollen and stiff knee: what causes it?.

 

[Josephine]

SmartChoice
I also merged your threads. Please read this One thread for your recovery please

 

[referee54]

One week postop TKR, of course my knee is swollen, but I have an area on the exterior side of knee, just above the compression hose line. It is between the incision area & flesh that goes to back of knee. What causes this to swell & become extremely hard?

Your leg has suffered serious surgical trauma. That swelling and stiffness is caused by the fact the the knee is inflamed and the fluid has no where to go.

If you follow the Bonesmart manta, your swelling and stiffness will slowly subside, ever so slowly.

 

[SmartChoice]

There are dozens of different aches, pains, complaints, experiences, and whatnot during recovery that trouble or concern us that are of no significance and which time takes care of. In one sense your knee got "fixed," and in another it has just been through a train wreck! As a result, as most of us observe, orthos practically turn a deaf ear to us in the first few months.

There are issues that really do need attention, though. It doesn't sound like this is one of them. But let me include a knee drawing here so you can describe the areas you're talking about, just to be sure:

The HARD area is L1, C. Swelling decreasing in other areas, but the specific area is still tight, makes it vey uncomfortable to do heel slides very far. It has improved today. I finally slept thru the night other than med times.

 

[SmartChoice]

Thanks to all of you, you're a blessing! Dr's office & PT pushing me to do more, thinking that it will help that hardened area diminish and avoid adhesions/manipulation. Geez, really, they're putting me on a cane already 9 days post-op. They say I'm doing well, while I worry about continual aggravation of the swollen area. I guess only time & experience will tell..
Happy Thanksgiving!

 

[referee54]

The happiest of Thanksgivings to you, as well!

One of the toughest things that we have to do in TKR recovery is back off.

We have been instilled with an attitude of "If I work really hard, good things will follow" type of attitude.

Unfortunately, with a TKR recovery, if you work hard, you will slow down your progress---or, your recovery will freeze up altogether.

It is tough to do, but, sometimes the best thing for a recovery is to back of some of the exercises (or to take a break entirely) and let the knee rest.

You will be amazed at how much better the knee will feel---and therefore, how much better you will feel.

Remember---it is not how hard you work---it is how smart you work.

 

[Jamie]

Tim's right. I don't know why so many medical professionals seem to think pushing is a great plan for recovery from this very major surgical procedure. You have every right to insist that things progress at YOUR pace, though. If it seems too soon to do something, then don't. And don't feel guilty about it. You are the one who knows your body best. Listen to what it's telling you and you'll know when to move to a little more activity or from one walking aid to another. It doesn't hurt to take things slow....and in most cases, it actually HELPS!

 

[SmartChoice]

Well PT moving right along....damned if you do, don't mentality here. I'm listening to everyone, body aches/relief areas, and trying to choose wisely. Dr. Office said you want to push through & avoid manipulation!!!!

I am now walking with a cane at 10 days post op. (Mixed feelings, but some freedom) We shall see.

 

[SmartChoice]

Josephine @Jaime. Anyone who knows..

Is it sometimes smart to go it alone without home PT once you have learned the exercises?

I know the mantra, and the thoughts on not letting PT push you to pain and beyond. Last Friday I felt a setback from PT pushing too much, and today I had PT first thing in the morning when I was stiff after little sleep over night. PT and dr's office say I must push through to avoid manipulation. Hmm...I look at it this way, my SWOLLEN fluid filled knee is like an unbendable cast, albeit I do have good ROM, but that left side that so hard does NOT want to be pushed!!!!! After a full, demanding session, sweating through pain this a.m., I'm considering maybe I don't want PT coming in and pushing me. (in pain and frustrated...)

 

[Josephine]

PT and dr's office say I must push through to avoid manipulation. Hmm...I look at it this way, my SWOLLEN fluid filled knee is like an unbendable cast

EXACTLY!

Is it sometimes smart to go it alone without home PT once you have learned the exercises?

Well I did. And none of my surgeon's patients have PT like you all do. In fact most UK patients are just given a crib sheet and left to get on with it. They have 3 weekly assessment from the PT to see how they are doing but that's all. If they are having problems, then they might get some gym type work under supervision but not a lot. And we all seem to do just fine!

 

[referee54]

Dr. Office said you want to push through & avoid manipulation!!!!

This is not the first time that I have heard of this threat.

There is no window of opportunity when ROM is concerned---take a look at this article:
ROM: it's worth the wait for ROM

I am not sure why they make these threats, but they seem to forget (or not understand) that everybody recovers at different pace, and in their own different way.

Do not allow yourself to be threatened or cajoled into listening to the threats---you have quite a ways to go yet, as you are very, very early in the grand scheme of recovery!

 

[SmartChoice]

I know the past two PT Fridays have left me feeling VERY sore and a brief bit of depression. I know I am not taking the easy way out, I am very motivated to succeed. My poor knee knows what it feels, and I look at it this way, as they say let your conscience be your guide...I am letting my knee be it's guide, I listened to it enough to schedule TKR, I need to respect what it's telling me now. The PT seemed to show some concern about meds, but we're monitoring as using as directed. Thanks for the wonderful support here!

Food for thought..the medical field warns about adhesions = manipulation. But IF we allow ourselves to be exerted to the max and in pain when it feels like the stiffness is tearing, aren't we then more likely to cause damage, tears = adhesions??

 

[amackness]

Smartchoice, glad to hear you are on the other side. Sorry about the pain you're experiencing. I go in on Monday, and have really appreciated your positive attitude AND your honesty in sharing your recovery "realities." Take care of yourself!

 

[referee54]

I had adhesions; I was one of the few folks that gets them. I talked to my OS and my PT's about the; they said that it is just more or less a genetic thing---it is not about how hard one works or whatever---it is just the luck of the draw.

According to my OS and my PT's the lack of work does not cause adhesions. Overwork causes swelling, inflammation, and stiffness.

I know the past two PT Fridays have left me feeling VERY sore and a brief bit of depression.

If this is the case, I would strongly suggest that yo are doing too much.

I know I am not taking the easy way out, I am very motivated to succeed.

It is not how hard you work, it is all about how smart you work. Working hard does not equal success, as your knee is in charge of recovery and the schedule. If you overwork your knee, you will hurt, you will get stiff and sore, and then you will be tempted to work harder in order to accomplish something that is not up to you.

It is difficult to understand, as we have this mindset that if we work hard, good things will come to us. This is not the case with PT /recovery from a TKR.

You can be determined, dedicated, disciplined, etc, but, in the end, you have to realize that the surgical knee is in charge and that you need to keep it happy. Keep the PT in the envelope; it sounds like you are doing too much, too soon.

You cannot rush perfecion. This recovery may take (and usually does) longer than we would like it to. Once we come to terms with that, and once we come to terms with the idea that it is acceptable to be gentle with our surgical knee, recovery becomes much easier and much less frustrating.

 

[SmartChoice]

I call heel slides "hell slides" I detest being pushed!!!!!

 

[referee54]

I call heel slides "hell slides" I detest being pushed!!!!!

Then fight back and set your limits. Do not allow yourself to be pushed to the point of pain.

PT should only go to the point of discomfort, and no further.

 

[SmartChoice]

Ok not to discourage those who are pre-op phase..there are ups & downs, the pain is worse than I had anticipated, but keep in mind my nerve block wore off early, so yours may not.
- Take your meds as dr. Prescribes. Others will speak to you before leaving hospital & at home, and will disagree with amount being taken/not taken. YOUR OS knows what he feels his patient needs!
- hospital here did not elevate leg, nor mention elevation at home, but BoneSmart knows it is indeed necessary, I use it frequently as well as icing.
- I built up a line of fluid just above the tight compression hose. This fluid built over time, and causes great discomfort, minimal flexibility.
I am sharing what I did to relieve it....not recommending you do, just sharing..we chose to gently fold the compression hose down below it about 2 inches, to provide some relief, and gently massage it upward. Lots of ice & elevation is slowly helping to relieve.
- use ice on leg every time you use CPM!
- gently force yourself to do more when exercising. It seems I have a military PT, demanding and hurting. I am glad to have two days off, I am talking to my body and it responds so well to my gentle pushes, but those pushes are getting me from point A to C on OUR time.
- Walk when you can, walking relieves and builds.
- Senokot S is your friend as well as prunes.
- eat protein! Watch your dark green veggies, any food high in vitamin K, it interferes with your blood thinner.

Best wishes!!!

 

[GimpyGal]

I'm nearly 5 weeks post op, and my leg is definitely hot. I'm pretty sure that's normal - I've no worries about infection. Ice is still my best friend.

 

[Jamie]

Yes, it's very normal to feel warmth at the surgical site. It's a sign that healing is going on in there!!!

 

[NetballKnees]

Hi Smartchoice ... I agree with GimpyGal. I am 6 weeks post-op and the outside of the incision where it is still very swollen and hard gets hot still from time to time. Sometimes I think it depends on my activity level. I notice you had a "demanding and hurting" PT. Please have a good think about that. Although my progress is slow, I do have a fantastic PT who massages, treats little hard spots and gives me gentle exercise to do at home. I have never been hurt in any way at physio. She also gets me on my side and really massages my hamstrings and ITB for relief and to ease the tightness.

If at any time you notice a temp, then by all means follow up further, but getting hot from time to time on its own, I think does not mean too much - just one of those things that happen in TKR recovery.

I hope your recovery goes smoothly and with no little road bumps along the way

Take Care ...
Ellen