Revision TKR Third and final surgery all done

[Josephine]

1 ranges from 2-5, 2 with sitting or resting, 3-5 with too much standing or walking or after exercises

Up to 5? That's concerning

2 no pain meds for several weeks.

So why are you not taking any pain meds, not even Tylenol? If your pain is at 5 then you need some

3 swelling is visibly between slight and moderate, closer to moderate.

And you did see that swelling is a manifestation of pain, didn't you? So did you factor that in to your overall pain score?

4 ROM is 4-94 degrees

So that's 94 flexion and 4 extension, yes? Is that a plus or a minus?

5 just iced last week 2 times on 2 separate days, otherwise have not been icing over past 3-4 weeks due to increased aching and severe stiffness for hours afterwards. Would ice for 20-30 min.

You have been covering your skin with a light cloth?

6 I elevate my leg usually 2 times per day for 30-60 minutes about.

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

7 moderate activity level but not like I usually am. I cook, do some shopping but standing can aggravate. I do some cleaning. Try not to shop much.

Okay. You are almost 12 weeks so time you were doing a bit more.


Exercises done 2 times a day usually: better to do them once a day and none at all at the weekends!
straight leg lifts with 2-3# weight 15 reps, 2 sets - NO weights, not ever! And once you can do straight leg lifts, you have no need to do them any more!
focusing on tightening my quads as much as possible - but why? I don't think this is helping you much
heel slides 15 reps, 2 sets with a hold of 10 sec. on each rep of the second set - you're not going to improve your flexion with heel slides or any other flexion exercise. Walking is the best therapy
Towel roll under ankle and stretch 5-10 minutes or as able. (this can really hurt so I break if that happens) - of course it can hurt! That's why I advise against so many of these exercises. All they do is cause pain and swelling and therefore block the ROM (they're called half leg lifts, btw)
green theraband (moderate strength) around bottom of thighs just above knees, and do sideways hip abduction on driveway both ways. (probably 30 steps each direction) - never ever use weights or bands when exercising. This is one of the activities that is causing you pain. Apart from which, 120 reps at a time is far too many!
walking once or twice a day for 15-20 minutes - this is the only one that's good!

PT 2 times per week exercises can vary
recumbent bike for 6 minutes
leg press with both legs and separately 2 sets of 15 reps
Leg curls same sets and reps
Using a machine where you sit with your foot on a platform and use a lever to self flex the knee. I had control over this and did get aggressive at times and hold it for 1-2 minutes and do it 3-4 times
I suggest you stop the PT sessions. They are only contributing to your pain and swelling and your inability to get better ROM.

 

[kayow11]

I had my Left TKR one week ago on 9/13. I was the one asking if I should have a MUA of my first knee which is 4 degrees ext. and 94 degrees flexion at 3 months. I asked the surgeon before surgery, and he said that as long as I wasn't in the 80's ROM, that he felt it would come along on it's own without MUA, even if slowly, due to the residual swelling.

I did do some PT during the 2 day hospital stay, and did a PT evaluation yesterday. It didn't hurt much doing it but felt somewhat flared up just after and more sore and swollen for the rest of the day. I am still very swollen just as I was in the hospital, 2 degrees ext. and 65 degrees flexion. I have not been doing much of the exercises at home. It is day 7 now.

Before my last surgery, Josephine wrote me a very lengthy and detailed message regarding all the issues I wrote about in my first thread. Overall, her recommendation was for me to not do PT at all. I was doing too much at home too. Thanks for your input Josephine

As most of you know that are Americans, it is highly recommended to do regular PT 2X week at the clinic, and 2X a day at home. They always preach (and truly believe) that scar tissue is a big issue if one doesn't stretch and exercise regularly.

I have mostly been doing a little walking around the house, and lots of elevate, rest, and icing. I know what many of you have said about exercise and the results of some of you that have not exercised. I just feel so weird and uncertain about not doing any exercises, and still getting good results. My big issue is swelling! And it doesn't seem like it's going to leave even with all this elevate and icing. It is going to take it's sweet time going down. I am 3 months out from the first one and still only have about 95 degrees and is still swollen some.

I also have a work issue that I am hoping is resolved by end of Nov. or I won't have a job to return to. I am 62 and didn't want to retire yet, and the health insurance issue is a big consideration., My short term disability ends Dec. 18. That is also a motivator to get well ASAP.

Did some of you do some PT either at home or at a clinic and still get good results? Did you cut down to 1X a week and maybe only do it one time a day at home too?

I am trying to listen to my leg to see how it responds to any exercise, but it is still very sore and swollen since it is only one week post-op.

 

[Celle]

Hello again, @kayow11
Welcome to recovery the second time around.

Although it's OK to have a different recovery thread for each knee, it can become a bit cumbersome, since you'll need to switch from thread to thread. We can combine both threads and give you the new thread's title, if you'd like. Just let us know and we'll do it for you.

Since your new knee is already bending to 65 degrees, I don't think you're going to have much of a problem with it. My knees didn't bend at all until about that time, but they now bend beautifully, after very little PT.

I agree that most US PT therapists are very hung up about the ROM numbers and the window of opportunity. You know it's a myth, don't you?
Myth busting: the "window of opportunity" in TKR

Knees all over the world share the same anatomy and almost all of them recover, regardless of how much, or how little, PT you do.
I think I prefer the gentle, kind way, rather than painful working hard.

It's not exercising that gets you your ROM anyway - it's time. Time to recover, time for swelling and pain to settle, and time to heal. Your ROM is there right from the start, just waiting for all that to happen, so it can show itself.

The swelling does take a long time to go away - often as long as 6 months - but as long as teh swelling is decreasing, your ROM will increase.

Here is your recovery reading:
Knee Recovery: The Guidelines
1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now; they are almost certainly temporary
2. Control discomfort:

rest
elevate
ice
take your pain meds by prescription schedule (not when pain starts!)
don't overwork.​

3. Do what you want to do BUT

a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you
b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.​

4. PT or exercise can be useful BUT take note of these

the BoneSmart view on exercise
BoneSmart philosophy for sensible post op therapy​

5. Here is a week-by-week guide for Activity progression for TKRs


The Recovery articles:
The importance of managing pain after a TKR and the pain chart
Swollen and stiff knee: what causes it?

Energy drain for TKRs
Elevation is the key

Ice to control pain and swelling
Heel slides and how to do them properly

Chart representation of TKR recovery
Healing: how long does it take?

Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

There are also some cautionary articles here
Myth busting: no pain, no gain
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds

We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery. While members may create as many threads as they like in a majority of BoneSmart's forums, we ask that each member have only one recovery thread. This policy makes it easier to go back and review history before providing advice.

 

[kayow11]

Thanks for the reminder Celle. Yes, please combine the two threads and keep the newest title. Thank you. Didn't and still don't know much about all this stuff but I am learning so thank you for the info.

I actually think that 65° at Day 7 is rather terrible. Everyone else in class was doing 90 and better. My other knee was even better at that point of two days postop.

How much should I rest elevate and ice? Ice for 45 minutes four times a day or even more ? I like to have specifics or at least some good guidelines to start with. I just think I am one that swells excessively. No matter what I do.

Thanks for your help. I will be very careful doing any exercises if at all. Did some of you out there Not do any exercises or PT at all? Or if you did, at what point did you start?

 

[DebM]

@kayow11 I was about 50 for my most of my 2 weeks in patient rehab post BTKR. It has taken its own sweet time but at 8 months I am now between 110-120, dependant on the day. I still get some swelling, especially after a busy day on my feet. My OS has never been concerned about my ROM saying it will come and may even take 18 months - 2 years to be as good as it gets.
I know that it is still slowly improving.

 

[SusieShoes]

You're doing fine and your surgeon thinks so, too. Your anxiety about "not doing enough" is fed by a mistaken application of the work ethic. In the work ethic, those who work harder get bigger rewards. But your body's healing process is not subject to your will, or anyone else's. What your body is doing inside your knee to heal itself doesn't have a work ethic; it works 100% hard all the time. Healing is your body's top priority right now.

That's why you're so tired, no matter how much or how little you do. Your body is commandeering all that energy for healing.

The way the body heals is why your knee swells when overworked... no matter that PT says about no pain, no gain, it's working against your body.

And swelling is why your knee won't bend... because that's a matter of physics, not a matter of will over an obstacle.

Those of us who do go ahead with PT handle it in different ways. I went to my PT session 2x a week. I did the exercises I thought useful -- heel slides, some extension stretches, balance exercises later on -- and I refused to do any exercise that involved weights or pushing on my joint. My therapist sometimes tried to push weights or leg presses on me, but I would just say no. I always got my way.

In between PT sessions... I did no exercises at all. Just a few heel slides here and there because my knees kind of liked them. I also walked. At first I couldn't walk far, and just did my daily activities. As my recovery progressed, I walked a little farther each day, and a little more often.

Other folks will come along with how they handled PT. Some have very BS-friendly therapists they can work with. That's one way to do PT and still be gentle: find a therapist with the same philosophy. They're out there.

Many of us have also done no PT at all. @sistersinhim comes to mind.

 

[Fire wolf]

Here are two suggestions for you.

The first is not to compare your knee to anyone else's or even to your first, as every knee heals differently.

The second is to ice and elevate a lot more. I would ice and elevate for hours at a time and during 1st month I would say at least 75% of my time, if not more, was spent icing and elevating, including overnight.

I started PT after 2 weeks of being home, went 2x a week, and did no exercises at home in between. PT was mainly just gentle stretching for the first few weeks.

I understand it's frustrating, but truly the "fastest" way to recover is to s l o w d o w n a lot.

 

[KarriB]

The best exercise you can do is the short walks around your house at first. We want these knees to walk and take us everywhere we want to go! Saying no to exercise doesn't mean doing nothing, check out the activity progression chart. That first month is a lot of resting, icing, elevating, but that's what your body needs right now.

Most orthos are in agreement with yours, no MUA after 90. I was at 109 around month 5-6 and continued to gain ROM well past a year post op. As someone above said, your body has its own time table.

 

[KitCat]

I agree, to try to learn not to compare your own recovery with anyone else. It just doesn't help. And it's the one thing that can send me into a downward spiral of discouragement more than anything. Tell your knees they are doing great!!! Because they are. They are working hard on your behalf to be well. Be their best friend. Respect all they are doing, and where they are at any given time. It's something we all need to learn to do, and I am still working on it.

 

[kayow11]

Thanks all of you who responded so far. It was very encouraging to me.
My surgeon who said no MUA right now, (and I don't plan to ever have one), is under the assumption that I will be doing regular PT at the clinic and at home. Pretty much every doctor in the US thinks it is the only way to success. Another I really appreciated was the info Fire Wolf sent on the specifics of exercises, and mostly the icing, rest and elevation with % of time doing this. I like details like this, so thank you. It will help me gauge time spent doing things.
And yes, you are all correct in that I should not compare my knee to any others, and especially to be thankful for all the years it has carried me around, and will continue to as long as I give it the tools to do so. Speaking life and health to them is good for my frame of mind. I know this first whole month will be lots of rest because that is what is required. I know how I can become discouraged since I love being the busy bee, and laying around seems so unproductive. I am also grateful that I live in a country and have health insurance that allows me the privilege of "repair" instead of immobility and pain.
For activity, I will focus on short walks, some daily self cares or tasks and maybe a few exercise movements if I feel the need to.
Did many of you ice and/or elevate during sleeping also?
Your insight sharing and experiences are very valuable to me

 

[sistersinhim]

Many of us never took PT or did exercises. I am one of them. I had 11 knee surgeries, 2 of them kneecap removals and 1 tkr. Even after those I never took PT. But, I didn't just sit around and do nothing. I took care of myself, my house and yard. This was enough therapy and would be for any tkr patient. All the awful pain of PT is so unnecessary. All you have to do is use it in your daily living! Your knee knows how to rehab itself and doesn't need anyone telling it how. Just use it and it will come back like new!

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 in the early weeks does more harm than good. Normal activity is the key to success.

The whole time I was sitting or sleeping I was icing. This went on for months, though the bedtime icing usually stopped after about 5 hours on my 2nd month. I don't think you can ice too much, unless you don't have a cloth between your leg and the ice. Icing is a great pain killer and inflammation and swelling reducer.

 

[Jockette]

At 6 months post op I still elevate all night. The hospital sent me home with a foam wedge for elevating, and while I didn't like it at first, I love it now. I think it's why my knee feels best first thing in the morning.

It depends on how my knee feels when I go to bed whether or not take ice to bed with me. Last night I did and I probably will tonight.

And yes, PT is the norm here, unfortunately. While mine was not overly aggressive, it did have agressive moments. Thankfully I found Bonesmart at 4 weeks post op and started saying no to things ( which they were fine with) and even cancelled some appointments and managed to get "an honorable" discharge, thereby making my surgeon happy.

I live in a 55+ community and there have been many tkr's before me here and even those who have been through it push the PT and exercises. I just grit my teeth and don't debate with them and follow Bonesmart. I'm not going to change their minds and they are not going to change mine. It's frustrating though when the Bonesmart way makes so much more sense! I don't understand why surgeons don't see it.

 

[Fire wolf]

I still ice most nights when I go to bed. I don't really elevate in bed anymore, but that is mostly due to the fact that I don't like sleeping on my back. I have great ice packs that will stay cold for several hours, so it works well for me.

 

[Aknee]

Kayow11
I am also in the US. I am scheduled for BLtkr in a few months and I share your concerns/confusion about the US approach, specifically PT and ROM exercising, compared to the recommendation of no PT or very little PT and exercise. My surgeon wants me to start PT soon after surgery and told me he will be keeping close tabs on it.

You may want to Google the Journal of Arthroplasty and read the articles. Sorry if this confuses you more but it is a respected peer-reviewed medical journal. I hope you find the information presented useful and helps you decide on the best course action for you. You will find research studies on exercise and PT and their impact on outcomes after TKRs.

 

[Fire wolf]

I'm in US and my OS did not put huge emphasis on PT, nor did he ever once try to measure my ROM at follow up appts. I agree that there is alot of conflicting information and ways to do things.

 

[kayow11]

Fire wolf, where do you find ice packs that stay cold for several hours? Can you give me a brand name or website that they could be ordered from? And also someone else mentioned a foam wedge that could be used for elevation in the day or night time. I just use several pillows and it is a pain trying to keep them organized . I looked at Lounge doctor but not sure about that. Please give me some info on this someone please. Thank you

 

[Jockette]

I have a picture on my thread of my wedge. My thread is called Patellofemoral March 13, and the picture is on page 2 of my thread.

 

[Fire wolf]

The brand is Cryomax, and I got them at Walmart, but they can be found online as well. They do take awhile to freeze up well, so I have 4 that I switch in and out.

 

[KarriB]

It does seem that recently the Mayo Clinic has taken a different approach to PT. We had a member last winter who had her TKR done there and she had no formal PT. In the hospital a therapist came to see her, went over the stretches she was to do and sent her home with a copy.

 

[Clipless]

Hi, I'm in the U.S. After participating in the whole nine yards of PT with my LTKR I decided to manage my RTKR recovery on my own. I barely did any formal PT, nobody hassled me about it, and I recovered quite well. A little online research helped me choose the useful home stretches. You can find them here on Bonesmart and a few other sites. My OS also gave me tips. From day 3 onward I pedaled the spin bike that I've had forever. As my saddle time increased I used music to keep it fun. After about 6 weeks I did attend 4 sessions of outpatient PT, which felt like such a patronizingly huge waste of time that I quit going. By 8 weeks post op I was back at the gym doing modified activities. At 12 weeks I eased back into cycling and hiking, and was back to work without restrictions at 18 weeks. My job, by the way, entails 12 hours of standing, bending, walking, pushing, and climbing stairs. I was not allowed a "phased return"- it was full duty or stay home.

Did my knee swell and ache periodically for months on end? Sure it did, and that's a normal recovery for most. Rest, ice, elevation, and time makes it better, not PT. But PT can definitely make it worse!