TKR The Knee Team journey begins!

[Josephine]

How do you know that it is this activity that is causing the problem? Or is it just that it becomes more evident when you do it?

The OS said he did the undercutting on the inside side of knee & that's where the drain tube came out, "that side is all fine." It's the opposite side which is so troubling

I just noticed this which I missed before and tells me a bit more. How to explain this, though ....
When a surgeon undercuts - which is fairly normal practice, btw - the consequences aren't confined to the area of the incision. The surgeon can reach far into the joint and also either cut or stretch structures on the other side, as you can see here ...

So I take you back to my previous statement that you are only 6 weeks out and that this is common or garden post-op pain

So now I have some questions to ask you ....

1. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine. And don't compare this with the bone-on-bone pain you had before surgery!

)

2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?

3. how often are you icing your hip and for how long?

4. are you elevating your leg, how often and for how long?

5. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and

6. what kind of PT/exercises are you doing? How much and how often? (details would be appreciated!)

 

[SmartChoice]

How do you know that it is this activity that is causing the problem? Or is it just that it becomes more evident when you do it?

It is obviously a SNUG type feeling, when forcing the knee to bend correctly/normal gait..it feels awful & like it's tearing.

I just noticed this which I missed before and tells me a bit more. How to explain this, though ....
When a surgeon undercuts - which is fairly normal practice, btw - the consequences aren't confined to the area of the incision. The surgeon can reach far into the joint and also either cut or stretch structures on the other side, as you can see here ...

Thank you!

1. what are your pain levels right now?

Normal rest, inactivity, no pain or minimal 1-2 discomfort.

2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?

Only Flexerill for the muscle cramps I was having, I take the ibuprophen/Tylenol cocktail recommended by BS.

3. how often are you icing your hip and for how long?

It's the knee, I ice & elevate throughout the day when resting, and especially after exercising. I am not icing all day, due to increased activity of cooking some meals, and I drove for first time yesterday. I shopped for an hour, and elevated/iced upon arrival home.

4. are you elevating your leg, how often and for how long?

Yes as above......

5. what is your activity level?

I do minimal cleaning, as husband still helps, I do NOT use the basement steps!! I climb two steps to get into house upon entry, but most days that does not occur, still home 90% of time. I cook entrees, hubby assists with rest, and cleanup. Shopped first time yesterday, leg did well, pushing thru the nagging discomfort with normal gait, then knee/leg were very tired, noted gait becoming more of a limp, so I quit.

6. what kind of PT/exercises are you doing? How much and how often? (details would be appreciated!)

Normal routine twice a day, with walking throughout to try to maintain gait. Typical PT exercises for this stage, 20 reps, twice daily. I pedal my recumbent bike for about 5 minutes, I don't push it! It is extended all the way out, not at the position I normally used it. I began outpatient PT Thursday, and have appt'mt. Tomorrow. I used an elliptical type machine while sitting, did very well. She added walking sideways, backwards, suggesting hanging leg over side of bed to stretch that troubled area, stretching. She's going to massage the incision, and try to move the patella for some reason?? Going to use modalities, electronic machine tomorrow on troubled area. Thursday was first day, lots of questions, etc, will do more activities tomorrow.
ROM is 105

 

[claire61]

Isn't that your quad muscle? My os told me to massage the quad while letting gravity do it's work by sitting on a chair. Does that help? I had a tkr and a hto on Nov 25 and due to the hto, I was no weight bearing for 4weeks. I've just been given the green light to start pt some light weight bearing. My knee feels very wobbly due to atrophy!
Good luck with your issue and keep recovering well!

 

[SmartChoice]

Vastus Laterallis????

 

[Josephine]

It is obviously a SNUG type feeling, when forcing the knee to bend correctly/normal gait..it feels awful & like it's tearing.

No, it's not the VL. It's just internal swelling and quite common. Remember this article? Swollen and stiff knee.

I take the ibuprophen/Tylenol cocktail recommended by BS.

You take it regularly during the day? And the full doses suggested?

It's the knee, I ice & elevate throughout the day when resting, and especially after exercising. I am not icing all day, due to increased activity of cooking some meals, and I drove for first time yesterday. I shopped for an hour, and elevated/iced upon arrival home.

Sorry, yes of course it is! I have one of these saved and just edit them as I use them. I forgot to edit it this time! But that's good.

As for the exercises ...
PT exercises 20 reps, twice daily - only do 10 reps
- pedal my recumbent bike for about 5 minutes - okay
- used an elliptical type machine while sitting - but for how long?
- walking sideways and backwards - hum, okay, but never heard of that before!
- suggesting hanging leg over side of bed to stretch that troubled area - okay, but only for 5 minutes
- stretching - stretching what?
- she's going to massage the incision and try to move the patella - okay
- going to use modalities - meaning?
- electronic machine tomorrow on troubled area - what kind of machine?

ROM is 105

Well, you're still only 6 weeks and already over the 100 bench mark so don't worry about that.
But what's your extension (straight leg) like?

 

[SmartChoice]

You take it regularly during the day? And the full doses suggested?

Not always, but will.

- used an elliptical type machine while sitting - but for how long?

At outpatient PT (1 day) It was probably about 7 minutes

- stretching - stretching what?

On tiptoes, and heels

- going to use modalities - meaning?

Forgot meaning, but it's the machine with little electrical currents, feels like worms moving ;)

 

[Josephine]

Not always, but will.

Jolly good!

On tiptoes, and heels

Mind she doesn't make you do too much of that. 10 reps of each each visit should be plenty. And don't do them at home!

the machine with little electrical currents, feels like worms moving

Oh that's the TENS machine - and that's a very good description of it!

 

[SmartChoice]

Thank you! WHY does the PT want to move the patella?

 

[Josephine]

Normally a patella should be freely movable from side to side with your knee perfectly straight and relaxed. Failure to be able to do this yourself or by the PT (or doctor!) could indicate either swelling, adhesions or maltraking.

There is a thinking amongst some PTs that it's good to manipulate a patella to 'free it up' same as they say their massage is to 'break up scar tissue'. Don't buy it myself, I think it's just another 'thing' for them to do an justify the time they spend on you. Mostly it's totally unnecessary in my opinion!

 

[SmartChoice]

I wouldn't think it would feel very good to have PT manipulating my still tender incision area in order to move Patella!

 

[Josephine]

I couldn't agree more! If that ever needed doing to me, I'd much sooner do it myself!

 

[SmartChoice]

@Josephine moving & massaging t,he knee cap actually made me feel better, boy was I surprised! I have continued PT, exercises at home, more time ice/elevation, and the sore/stiff spot has improved this week. I actually am beginning to think maybe it will all go away after swelling is gone. Thanks for listening, having someone listen to you makes all the difference.

 

[Josephine]

That's good - but who did it? You or the PT?

 

[SmartChoice]

I allowed PT to try it, it felt fine, actually good.

 

[kneeper]

I remember my doc had me do the "kneecap mobilization" myself though the PT did check it.
They had me walking sideways I think to work on the outside thigh muscles which were pretty weak.

 

[SmartChoice]

The kneecap mobilization seemed to help with "that tugging feeling" I have complained about. I still have a tiny bit of it, but it's much better. I've almost completed my outpatient PT , I recommend it for those who have insurance coverage, it's that extra boost. My knee is doing very well, ROM/extension all good, swelling is minimal, I exercise most days, but not daily. I walked a 1/2 mile the other day, and go shopping, and I'm back to doing almost all household chores. I've reached a great point in my recovery.