Revision TKR Third and final surgery all done

[kayow11]

@KarriB, I'm not walking outside today either because it is 97°. Low humidity, but still way too hot! I will use my elliptical for five minutes and see how my knees act or what they say about it.
Thanks for reminding me to be slow and steady. You would think I would have learned that by now.
You have always spoken right to my heart right from the start, too, as several have.

@SusieShoes, you always express yourself so diplomatically. I need that too. You also add a bit of humor, and seem so kind in how you say things. I know I am more pushy with my recommendations.
My biggest challenge is remembering that I have a two-month-old knee. I feel like a ping-pong ball being bounced back and forth from old almost 1-year-old knee, and a baby two month old knee. They are like fraternal twins both demanding mom at the same time.
Thanks for sharing your moms story. And thanks for the compliment of saying I am patient. I sure don't feel like a saint

I do feel as if I somewhat know many of you when I read your stories . I love seeing your photos on your posts , it helps me connect a face with the words. I should consider adding my mug shot to my post, but don't know how

 

[liam2015]

Or is it too soon to be working my eight week old me on a recombinant bike? That just occurred to me. I have been at this for so long that I keep forgetting about the newest baby.

hi ~ just catching up. it's hot and humid here in ontario too so i haven't been doing any walking, not even walking the dog (getting over a nasty head cold) ~ hubby loves this weather so he can walk the dog, i'll sit in the shade in the backyard with him lol!

i don't think there's any harm in trying out the recumbent bike at the gym ~ it might be more adjustable than your bike on trainers. just for comparison: i could not pedal a full rotation until i was 7 months and 1 week post op, so don't be surprised if your 9 week old knee doesn't cooperate. it's worth a try though; many others have accomplished that in a short time. i was also a slow bender! you've had a lot more work done than many of us...slow and steady is the way to go, you don't want to undo any of the good work your surgeon did. will you have a trainer to help you at the gym? just remember, you're the boss of you and only do what feels okay.

 

[kayow11]

@liam2015, Thanks for sharing your personal experience. I am maybe 80-85 degrees bend, at most, on my 9 week old. I need to be realistic about this, so glad to hear about you and how long it took to achieve a full rotation on the bike?
Just asked my hubby today to put the seat back on my bike, which is on a trainer downstairs. I honestly doubt I can do it, or even be comfortable enough to sit there. But I am still encouraged by you and your story, because it may also be my story in how long it took you to bend well, per your former posts.

I did call my gym today to get some info. though. I would not have a trainer at the gym. First I think I will use my elliptical a few times for short stints, and see what the knees say. I did so last night for only five minutes, but I did get some increased symptoms after. It might be way too early for me to be going to the gym.

I cancelled my PT today. I have no more scheduled. My strength is VERY SLOWLY returning, and their main focus is to work on the bend. I just get more flared up and swollen for 2 days, every time I go. Always a setback, so why? I know how to work on the bend myself, and I don't need motivation, just ability to do so, I.e. more time to heal.
Yes, I do get mad , at how slow they respond, and how temperamental they always are. But I have no choice but to listen, or SUFFER

I have taken some 15-20 minute walks outside, but lately it has been too hot, 90-100 degrees. I just can't take that heat!

But I do console myself with the knowledge of others, and the possibility that I can get this result too, in time. I am really looking very long term for this, 2-5 years.

 

[KarriB]

Ellipticals are hard on knees, much more so than a recumbent bike on 0 resistance. Chances are swelling is keeping your knee from bending and an elliptical will probably make swelling worse. Be careful...

 

[kayow11]

@KarriB, thanks for that info. I vaguely remember hearing that years ago, but I chose it then because it was easier for me than taking a walk, Or doing a treadmill, and I still could get a cardio workout.
I have had the continued problems of swelling and lack of bend, so I sure don't need more of that!
Do you know why it's hard on the knees, since there is no pounding on the joint?

 

[SusieShoes]

I also love the elliptical machine, so understand wanting to get back to it. I think the reason it's harder on the knees than a recumbent bike at 0 resistance is... there's more resistance. Even at the lowest setting, the knee has to work harder on an elliptical machine. Once a knee can deal with some resistance, the elliptical is a good workout.

 

[kayow11]

@SusieShoes, it makes sense that with an elliptical, the weight-bearing it's self of the body, can be a bit too much stress, but is it that much more than just regular walking? Seems that it would not be, but I do know people can complain about knee pain with an elliptical. Not sure of the biomechanics of all that.

I guess using a recumbent bike could make more sense right now, if I can even do it at all at nine weeks. It still might be too early for me. But I surely do, at some point in the future, want to get back to my elliptical which I really love.

 

[KarriB]

What Susie said! A recumbent bike gives you the ability to control resistance whereas the elliptical is your body weight and you’re right, quite a cardio workout. But honestly, once you get then swelling down you can ease back into cardio slowly. I still bike at 0 resistance because my left knee complains, but I can get that puppy going fast enough to work up a sweat. I actually find treadmills and ellipticals harder than plain old walking, but I don’t know why.

If you’re having trouble bending just concentrate on getting the swelling down. I found the
Activity progression for TKRs really followed by activity level during recovery.

 

[kayow11]

@KarriB, thanks for your answer andresponding to my last post. It makes much more sense now about walking versus elliptical versus recumbent bike.
My husband also reminded me that when you're on the elliptical, there is a little more torque on the back-and-forth movement of the knee, laterally. When you're walking, it is not the same and just straight forward without the extra knee strain.
I like to know how and why all this works together so I can understand, accept, and realize what's really happening. That is me. Details details details.
So I will probably stay off the elliptical for a while yet and concentrate more on Walking, and/or maybe start the gym, but I'm thinking the gym is probably too soon. I do need to increase my range of motion, but from past experience, I think I should wait a bit.
I have to fight that little voice in the back of my head that tells me my range of motion is getting more difficult to increase, and that I will just get stiffer and stiffer the longer I wait. That is the OS and PT mindset and belief.
Hopefully, I can prove them wrong, and report back to them or send a message to them in the future, even if it's one or two years down the road, about my increased motion after I've healed and swelling was eliminated, and all without exercises or PT.

 

[KarriB]

Well, now that you mention working in ROM...I was in an immbolizer for 4+ weeks (I eased myself slowly off the immbolizer due to leg weakness at the 4 week mark) after my infection surgery which was a month after TKR surgery. When my revision surgeon told me no bending for first 2 weeks and later 2 more, I was beside myself! For a whole month I had faithfully done heel slides etc. and now nothing, I was worried my knee would never bend and I’d walk like a peg leg Pirate the rest of my life. I saw my OS twice a week during that month and every vIsit I’d ask if the knee will bend when this was done, his reply was always the same, “the knee will bend when we tell it to bend”. And it did! My leg/knee wasn’t swollen at all because I’d had done NO exercises during that month, I only elevated and did very little else due to the immbolizer being so cumbersome. Yes, it was a little stiff at first and it took a full year + to gain full ROM, but the only thing I can’t do is sit with my leg under me. I went back to teaching half days at 12 weeks (I was still suffering from energy drain due to the infection and 2nd surgery) and full time 6 weeks later.

So with you being just 2 months, I think if you concentrate on getting the swelling down the ROM will come. You are moving about with ADLs, not just sitting and walking a bit as well. I did get an inexpensive recumbent bike for about $200 (Walmart) during my recovery and as I said, I use it every day while my treadmill just sits there. It was nice to not worry about going to a gym or even PT to use a bike.

 

[kayow11]

@KarriB, thanks so much for your timely response. You're always so practical, and yet kind and specific with your thoughts and what you think and recommend. I really love that. I totally understand everything you say and it gives me much more food for thought.
Could it possibly be that my swelling, and some others with the same problem, is from just too much movement or pushing it too much by doing too many things the first month or so? If that is the case, that may set the precedence to never gain full range of motion possibly, or at least greatly delay.
But I refuse to accept that now and will consider the recumbent bike. This problem, especially for me, just stems from all the advice given by doctors and PT people early on as if it is gospel truth, and that there are no other real options to progress. It is amazing though how many people really do benefit from this advice and come along really well. I'm just not one of them.
Did you say that you still use the recumbent bike? I may consider getting a cheap one like you did. I really don't feel like I need to go to the gym now just for that one main machine.
I am trying to be more serious about my walking though, even if I don't do it every day. I have been trying to do 20 minutes, but that is my current limit. I come home and ice right away. But it still is not working on my knee bend which is pretty skimpy. So maybe the bike could be the answer or at least help with that problem.
What would I do without you fine people helping me along? I really consider it a true blessing to have found all of you.

 

[KarriB]

Thank you for your kind words! I love helping here on BS!

I know people worry about the “window of opportunity”, but I clearly blow that theory out of the water. I don’t think I mentioned that my OS/revision dr ordered non-aggressive therapy when I came out of the immbolizer. So although I did go to PT, it was heel slides, the recumbent bike (I could only rock the pedals back and forth for 2 weeks), walking about 5-10 minutes for the PT to help with my gait and massage. I did have strength therapy, but not until I was 4-5 months post op. So I do believe 2 things; some people just swell more than others and pushing too hard, expecting too much from a new knee creates swelling which inhibits ROM.

When I went back to teaching I still iced and now elevated. Sometimes I’d ice while I drove home, but I always elevated, toes above nose when I got home because my knee felt tight still at 4-5 months post op.

 

[kayow11]

@KarriB, good to know all that additional info too. I even checked on craigslist today for a good used recumbent bike, and saw a couple brand-name ones for less than $200.
But my husband suggested I go to the gym for a one day pass, and try the recumbent bike there just to see how my knee reacts. The problem is I hate to spend $15 to get on a recumbent bike for five minutes and leave. I guess I am relying on wishful thinking that this would be an answer to some of my problems over here, and not give me The same trouble with increased swelling as other things like the elliptical.
I am mainly looking for the revolution or rotation of the foot pedals to be small and not large. I don't know if that's the case with most recumbent bikes. So I guess I need to check that out further.

I didn't realize that the word nonaggressive was even in an OS vocabulary, or PT vocabulary.

I guess I would like to know if many of you other Bonesmart people have successfully used a recumbent bike for part of your therapy? Either at home or at a gym? And did it help your range of motion for your knee without too much strain or stress?
KarriB, do you still use your recumbent bike or are you mostly just walking and other exercise to keep it flexible?

I do think I naturally swell more with any insults or trauma, and my year old still is tight and some swelling in there. Even if I sit for just 10 minutes or lay down and then get up to walk, my knees and even my old one, is still pretty stiff and takes several slow steady steps to get moving. And loosen up.
Range of motion has not increased since three months postop. I do think some of it is from the residual swelling, but I do wonder if it's just tight from whatever else is going on in there, the foreign parts, and that is how my knee reacts. I know it has been through a lot because of the crooked leg and two other surgeries there but I expected more at this point from that year old.

I have to admit that even though I am icing two or three times a day, I don't elevate much because I'm usually icing after a meal, and if I lay down with my legs up like that, I end up getting acid indigestion and bloating for the rest of the day. I typically am not thinking of elevating when my stomach is empty. But maybe I can try to do that once a day anyway. Do you think this is one of my main problems?

 

[Celle]

I have to admit that even though I am icing two or three times a day, I don't elevate much because I'm usually icing after a meal, and if I lay down with my legs up like that, I end up getting acid indigestion and bloating for the rest of the day. I typically am not thinking of elevating when my stomach is empty. But maybe I can try to do that once a day anyway. Do you think this is one of my main problems?

You don't always have to lie down flat to elevate your leg. You can still elevate when sitting up in a chair - like this:

Although "toes above the nose" is best, it isn't always comfortable.
As long as you get your toes above your hips, you will be doing OK.

 

[kneeper]

I have a recumbent or semi-recumbent exercise bike at home. I did use it in my recovery. First just to rock the pedals back and forth and then when I got a full revolution I started with 5-10 minutes on no resistance almost every day.

 

[kayow11]

@Celle, @kneeper, thanks for your advice and info on these two things. I will try to elevate more often knowing that it at least sitting with legs above hips has some benefit.
Glad to know the recumbent helped one or some of you also.
I suppose you can get a decent cardio workout from the recumbent bike also, but I know that I can't even think about that for a while. Just range of motion and limitations for me now. I have to keep reminding myself of that or I frequently overdue.

 

[Hood1980]

My DH got me a very good and inexpensive recumbent bike at Sears. I haven't used it as much as I would like, but i do think it keeps my knee more mobile and less stiff, thereby increasing the ROM. It does feel good to be able to move and wish I was up to a cardio workout, but you know my situation and I'm no where near that in my recovery.

 

[KarriB]

I actually never stopped riding my recumbent bike. During recovery I rode for 5-10 minutes, around 5-6 months post op I was riding 4 miles, now 4 years post op I ride 8-10 miles a day and intentionally walk 2-2.5 miles a day depending on the weather. But I built up to all that slowly. I’m far more active now than I was pre TKR.

I only elevated toes above nose after working because I was on my feet 3-4 hours at a time. During recovery I elevated like the picture Celle shared because I used a chair with ottoman every day. Try concentrating on elevating/getting that leg up every time you sit and see if that makes a difference.

 

[kayow11]

@KarriB, as I write this post, I am sitting in my recliner with ice on both legs, angled upward with my toes and feet above my hips. That is about all I can do right now. But I will try to consistently do this a couple times a day.

I am amazed at how much activity you're doing on the bike and walking. It must take hours to get all that accomplished. Good for you and I'm glad you are doing so well. For me, It is definitely worth taking the chance to try using a recumbent bike soon here, to see if I can gain some range of motion with my knees. That is a big sticking point for me, and has been for the past year.

I am very slowly improving with my tolerance for standing and walking. I notice it when I look back 2 to 3 weeks ago. But like many of you have said, it's a marathon. Slow and steady wins the race. That is now my motto. I am very careful and seldom take any chances where I could fall or hurt myself in anyway . It's just not worth the risk.

@Hood1980, good to know about a good recumbent bike at Sears, or at least what they used to have. I can check them out too.
I know what you mean about doing a good cardio workout at this point. You are only a month ahead of me in your last surgery, and I know how I still feel with activity. My endurance and stamina is still low, although sloooowly improving, and even five minutes on the elliptical makes me feel like I could fall off. Good thing I have handles to hang onto, but quite frankly, I have only been on it twice since my surgery, and it is too early for that machine. I think it's hard on the knees as KarriB said.
I feel like my knees and body a year before any surgery, was a lifetime ago. I so want to get back to being able to be busy and do everything I want to do. I am still hoping and praying for that and professing that, and it is my goal. I am not turning into an old lady who can't move much. I refuse. But I have to be smart about it.

 

[KarriB]

This makes me happy!