Revision TKR Third and final surgery all done

[kayow11]

I am so glad I consulted with all of you on my surgeon options.
To go with a revision specialist, was the right choice. I could have gone the other way, and who knows what I would have ended up with. Thanks Jamie, for the MD name.
Sometimes we don't think correctly in these situations. I will be relieved when this first month is completed, and I am past the most vulnerable time for healing.
I am amazed that I have so little pain, so far. Before, I could hardly wait 4 hours so I could take another pain med.
Less work done in there, plus using the hemovac which removed a lot of the excess blood, seems to have greatly decreased the swelling, bruising and pain.
Thanks all, for your info. Caring and encouragement. It has been invaluable.

 

[kayow11]

Do any of you have ideas regarding using a CPM? I have not used one before, and the recommendation is to use it 2-4 hours per day.
I used it 2 hours each of the past 2 days, plus some typical post knee exercises that do not cause pain, plus ice 4 times a day with elevation.
My knee does not hurt more, but seems to be stiffer. It doesn't look more swollen, but possibly could be some just from this activity.
Am I doing too much again too early?

 

[Babushelen]

Wonderful news. Praying for a great recovery. Take care and give that knee lots of TLC. Hugs

 

[Jordon6]

@kayow11 i used a CPM after my revision and I liked it. I used it about 2 hours a day while I had it. Unfortunately after I stopped( my ins only allowed 12 weeks) I stiffened back up. I wish I’d had it longer!

Many people and surgeons don’t agree about its effectiveness but if you like then use it!

I’ll probably have to get more scar tissue removed this summer and I plan to ask for it again!

Best wishes!

 

[kayow11]

Thanks @Jordon6 for your input and experience with a CPM. I can't say my range of motion is more at this point. It seems the same or maybe even slightly less by the end of the day. Sure does seem stiffer and feels a little more swollen.
Anybody else out there have some opinions about this and exercises now, regarding my last couple of posts?
I want to have better success with range of motion this time, but I don't want it to be flared up. At six months before my revision, I was only at 95°. My nine-month-old knee is still only at 97° and still seems like it has pockets of swelling.
I have so much less pain, already I am cutting my oxycodone in half. I don't have much bruising at all on my thigh or knee area either. That is so different from my last two surgeries. I really think that the hemovac played a very important role in decreasing this.
But yet, it is very stiff, but not noticing increased swelling it seems. I fear I still may be doing too much possibly? It is only five days post surgery.
When my surgeon did the revision, he told my husband that there was moderate scar tissue, I guess that means normal right? I have not seen him since surgery but will in a few weeks. We'll see his PA in less than two weeks.

 

[Jordon6]

@kayow11 my ROM at 9 months is on 75
I left PT at 12 weeks and it was about 85ish and have since lost it. I’m struggling with excessive scar tissue. Moderate scar tissue does something like normal to me too. My surgeon said that I had extensive scarring and that he had to do “a lot of work” in my knee before he could even put in my new implant.

Be sure to ice and elevate often especially after using the CPM.

One more tip- I was so focused on working on my straightness that I probably kept my leg too straight while elevating. Check the bone smart way of correct elevation. I have a very straight leg now that cannot bend!

Live and learn!

 

[gertie]

@kayow11 I used a CPM in the hospital for 2 hours a day--don't think it did much for me. But I live alone and it's hard to set up so I did not take one home with me (the hospital was pushing it but my OS doesn't think they do much good).

 

[sistersinhim]

You are only 5 days out from a revision. You shouldn't be worried about anything but healing right now. You ADL will be enough for at least a month. This gives your knee time to get some good healing in. Exercises too soon slows down healing, causes inflammation and swelling and less ROM. Just relax and heal!

My OS doesn't order the CPM either, so I can't comment on how it did for me, but there are different opinions on it's helpfulness.

 

[Celle]

Don't worry about your ROM yet, @kayow11 . It's far too early. Your knee has been through a big operation that caused a lot of trauma. It needs rest, gentle treatment and time, so it can heal.
At this very early stage, your knee needs very little exercise. Just walking to the bathroom and back s is enough.

My surgeon didn't want me to use a CPM. They make no difference to your ROM in the long run.
In fact, he doesn't allow any formal exercise at all for the first month after a knee replacement. He says your knee needs that time, to start on its journey of healing. For that month, we rest, ice and elevate our leg, and walk around the house.
After that month, we just go to PT once every 2 weeks, where we are shown a few new exercises to do at home.
His patients all do well and achieve good ROM, as I did, and he hasn't had to do a manipulation to help with ROM for the past 4 years. I think that speaks for itself.

If you like the CPM, keep using it, but only to move your knee gently. Don't worry about the numbers and don't try to increase them too soon. Since your knee seems more swollen by the end of the day, cut back on the other exercises.

Remember this:
- if it hurts, don't do it and don't allow anyone - especially a physiotherapist (PT) - to do it to you. Exercise only gently
- if your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again

 

[kayow11]

Thanks @sistersinhim, and @Celle, for your Reminders and what I should be focusing on this first month.
I am thankful several of you have been patient with me when I should know what to do at this point. It is crazy how we forget and go ahead with the same old plan.
I have noticed now since using the CPM five times, that I feel I am getting more swollen afterwards. I am realizing that I need to stop doing this as frequently. I only have it up to 60°. I was up to 70 yesterday but now I can tell that is too much so that tells me I am swollen, found it actually feels more swollen too.
I am going to skip my exercises today too and just focus on ice and elevation to get the symptoms down.
I am supposed to start PT next week and I am sure I will have a battle on my hands dealing with them and their recommendations, along with the doctor and his PA, when I see them soon.
I suppose I will be labeled as stubborn, non-compliant and ignorant. I did follow less exercise and less stressing of my last joint that was crooked, And it felt better as far as swelling and pain goes but I still never got past 95° out six months postop. That is what I am the most concerned about is not achieving decent range of motion even many many months out. My first knee which is nine months old is still only at 97°. It is limiting with many functions, to have this decreased flexion.
I also had, and believe I still have the problem of pain from both of my knees going up and down my leg when I try to stand or walk more than 10-15 minutes.
I know it has been mentioned on this site that some people even gained more range of motion after one year, but I know that is rare. I don't know how to increase the range at this point with my Old knee because it still has swelling and is too painful to push.
Do any of you out there have any experiences to share regarding this increased range of motion after so long such as one year?

 

[Celle]

My last TKR is 3 years old now. I know that its ROM increased after a year. I didn't do anything to try and help it, but just used it in my everyday life.
About 6 months ago, I went to a ball game and I found, to my surprise, that my knees would bend enough to let me sit on a low step. I couldn't do that the previous time I went.

I'm convinced that ROM can continue to improve, but because it isn't measured, we sometimes don't realise it.

Have you seen this latest update from Campervan?
https://bonesmart.org/forum/threads/rom-at-6-years.46765/#post-1141743

 

[Jockette]

I was one year post op on March 13, and I know my bend continues to improve.

At my one year check up I was about 120. I was able to bend to that myself, but to be very honest, it would be very uncomfortable for me to keep my leg in that position. I no longer care what the number is.

I can tell it’s better than it was a few months ago. I get in and out of the car better than I used to.

Also, I like to sew. It took months to be able to sit comfortably at the little table my sewing machine sits on. My chair rolls and swivels. It is much easier now for me to sit down and then swivel my chair to face the sewing machine and clear the leg of the table which requires a decent bend. I can do it well now. But it took months and months to accomplish it.

Yes, ROM continues to improve over time.

 

[kayow11]

Thanks @Celle, and @Jockette, for sharing your personal stories.
It was encouraging to me, and I believe I will be one of those people that it will be very slow going, and hopefully continue to get better even for two years.
I just know that I'll be in trouble with the PTs and Dr.'s. But it is my leg, and I have the final say.
It doesn't take much to aggravate my knees, so I have to listen to them since they are the boss. I've tried many times to over rule them but I never win
And yet on the other hand, my knees don't like too much icing either. I can't believe how stubborn they are

 

[Celle]

I just know that I'll be in trouble with the PTs and Dr.'s. But it is my leg, and I have the final say.

Try not to worry about what your doctors and PTs say. It's not your job to keep them happy.
They can advise, but you have the right to choose whether or not to accept their advice.

It's your body and your knee and you have the ultimate say in what happens to it - except that, really, your knee is in charge, so do whatever you can to keep The Knee happy.

 

[kayow11]

Thanks @Celle for supporting me, and helping me to muster up the courage to "stick up for my knee" against common and persistent advice on how to take care of my joint.

 

[kayow11]

Did several of you, besides Celle, not do any exercises or PT for the first month?
And did you feel that was the best start for your knee to heal?

I have done it both ways more or less with my first 2 surgeries. I definitely had less pain and suffering waiting, but both results were, and still are, significantly less ROM at the 6 and 9 month point.

Even the CPM and the simple exercises from the hospital rehab, seem to increase my pain, stiffness and swelling.

Could this time possibly be different, or is this likely how my body responds after TKR?

I am supposed to have a PT evaluation tomorrow, but I honestly feel I would like to put it off for 2 weeks.

Anyone have an opinion or thought about this? I love your input and ideas.

 

[liam2015]

kayow ~ i did no p.t. until 6 weeks post op and very few exercises partly due to feeling nauseous for the first 5 weeks. i started p.t. at the 6 week point, but it was only treatments i received and print outs for home exercises, which i wasn't very dedicated at. i knew that my knee would not bend any further no matter what exercise i would be asked to do and it would only cause pain; there was just no benefit for me in pushing further with pain. my knee was not going to budge until it was ready. however, i did walk, went up and down the stairs carefully holding onto the rail (laundry room downstairs) and did chores around the house, took the dog out our backyard and walked all over, up and down the ravine.

for me, i think this was the best start to recovery, even though my r.o.m. was slow to improve. i've heard about others going to p.t., doing strenuous exercises, and afterwards suffering from pain and swelling and then there's others that thrive on it and improve. i have no idea what my flexion or extension is but i can go up and down stairs easily with no pain, ride my bicycle and walk for hours, coming up to 1 year post op. i noticed the biggest improvement at 7 months post op when i could finally ride my bike. these are just my opinions based on my experiences. listen to your body and do what feels right to you. wishing you all the best in a better and complete recovery this time around. whatever you do, keep moving.

 

[kayow11]

@liam2015, thanks for sharing your experience, and details regarding specifics. It really helps me to hear of other people's journeys.

My first knee is 9 months old, and still only about 95 degrees. It's not just a low number, but it still has pockets of visible swelling that I can also feel. This was the knee I was the most aggressive with for exercise and PT even early on. Functionally, I have enough limitations too.
I also had the complication of the other leg being crooked, and pain there.

I have often heard here that walking is a great and effective therapy, even though it doesn't bend the knee much. I still can't do much of that yet either, mostly due to winter weather, and not safe.
But it's possible I still will gain ROM.

Is a revision more sensitive if pushed too hard, due to 2 recent traumas? Who knows?

 

[kayow11]

@Celle , Thanks for sharing Campervan's ROM story and history.
It is remarkable and encouraging, even though my ROM is much worse, and so far, has not changed in months.

 

[sistersinhim]

Many of us never took formal 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 as my knee allowed me to do. As I healed, I did more. But, my knee was always in control! This was enough therapy for me 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! You have to be patient, though, it doesn't happen quickly! ADL,(activities of daily living), going to the bathroom, brushing your teeth and bathing, fixing a light meal, getting something to drink and or a snack, those kinds of things will be all the exercise your knee needs. If you just use it daily in your living, you will have a quicker and less painful recovery. We know what works, we've been there!