Become an Insider

Revision TKR Third and final surgery all done

Status
Not open for further replies.
What is a quad set?

My PT told me I should press the back of my knee down against the table while sitting on the table with my legs straight out and on the table. Is that a quad set? They never pushed my knee down to get extension. They never put a weight on my knee to force extension. They did, however, push my knee to bend and then measure at every appointment.

I think I was also supposed to tighten my thigh when I pushed my knee down towards the table.
 
Yes, that is a quad set. You can even just be laying on your bed with a small towel roll under your knee and then pressing the back of your knee down as hard as you can against that towel roll. Then you are to hold that for 10 seconds or more and do 10 to 15 of those, and then do two sets of that. That is what I was instructed to do for my quad set. I was also instructed to do a quad set just before I did my straight leg raise so they were done together. Quad sets made my incision hurt and was painful each time. But I suppose for others, it wasn't that bad or didn't cause problems. I think it is Beneficial for strengthening the quadricep muscles in the front of the thigh but for me, it aggravated.
 
i still ice and elevate every night in bed until the ice pack slides off elevating on the lounge doctor all night long. i haven't been icing and elevating during the day for a couple months now but i do after a day out, ie. after the ball game on the weekend. i do lay my leg on a foam pillow on top of an ottoman, sometimes with an icepack, watching t.v. or just sitting reading on my laptop. i don't seem to need the icepack as much anymore as in the first couple of months. you are right, many of us do a combination of the Bone Smart philosophy and go to physiotherapy recovering on our own terms incorporating tips and recommendations from others here. we know our own knees and our own limitations and can speak up for what we want or don't want regarding physiotherapy.
 
No one assisted my knee on heel slides or ever pushed/pulled on my knee. If something hurt after I did it once I refused to do it again, not because of BoneSmart because I was unaware of BoneSmart, but because I don't like pain and believed if it hurt my knee it wasn't good for my knee. I never did a quad set with a towel either, my quad sets were just activating my quad muscle with a straight leg. I could do it while I was elevating. Straight leg raises were difficult and it was a few weeks before I could do one unassisted. But my assist came from my leg lifter. Since I couldn't lift my leg alone I practiced by using arm power with the leg lifter to get a straight leg lift and as time went on I used less arm power and more leg power until I could do one with no help from arms or leg lifters.

In the end we have to listen to our bodies and do what is best for ourselves. Pain isn't good for a bone that has been broken, shaved, pounded etc. so it made sense to me to allow things to heal before pushing too hard. For me and my circumstances, that meant nearly 2.5 months before doing much walking or any type of exercise. But at 2.5 months it only took a week or so of rocking pedals before I got a full rotation on a bike and good news, it didn't hurt at all.
 
Last edited:
KarriB. Yes, I think that is the key, to listen to what your body is telling you. I would listen and determined that it was rather angry or flared up some from the exercise, but it didn't tell me to stop. I am referring to my other leg, not the second surgical procedure two weeks ago on my other leg. I was under the assumption that was normal and I just had to work through it, and that it would get better eventually.
By the way, straight leg raises were probably the easiest for me. But quad sets definitely caused incision pain.
That was good info to share with me, that you waited until 2 1/2 months to do exercise or even much walking. I know you had some other complicating factors at the beginning though so that definitely set you back right away. But knowing that if you wait long enough and let things heal up, you will have much more success with the activity and exercise and then it is the right time too without negative consequences.
 
I'm glad that my experience gives you some peace of mind. It wasn't the best way to recover (not bending for a month), but because of that my knee was not swollen at all! To be honest I never had such a skinny leg or saw such defined knees as during that time. My friends and family even commented on it. So when I began to walk with a bend, do easy heel slides there was room for bend even though it was stiff. The stiffness worked itself out after about 2-3 weeks of beginning to bend and the turning point was being able to get a full rotation. After that I rode a bike every day for 5-10 minutes.

When I reflect back, my actvity level during the first month and the weeks after being in an immbolizer was close to the Activity progression for TKRs except I did do heel slides, straight leg raises and few other stretches in bed every day I didn't realize that once you can do a straight leg raise there's no reason to continue. But my quad got so strong I could even lift my leg with the immbolizer on!
 
I know that it is said on this forum that if you can do a straight leg raise, then you don't need to do anymore, with ankle weights or at all. But in my opinion, you can do a straight leg raise without contracting a lot of quad muscles. It is the hip flexor muscles that do most of the work unless you consciously do a quad set first and then lift the leg using the quads AND hip flexors to do this movement. Obviously, both sets of muscle groups are very important to get strong after the initial healing and rest period, but PT definitely focuses on waking up the quad muscles and maximizing their strength for ADLs. I do agree with this mind set.
So KarriB, did you not move your leg at all for one whole month? And then after that first four or five weeks, was that when you were able to do a little tiny bit of bending and walking and moving it.?
 
My first month post op was typical, but then I had a high fever and my closed incision began seeping a day later. My OS group had a revision specialist who operated, did a washout/spacer exchange and didn't want any bending for 2 weeks because my soft tissue was so compromised by the infection and the washout. But after 2 weeks the seeping had begun again even with oral and PICC line antibiotics, therefore no bending until that stopped. He was ready to do another surgery, possibly taking out the knee for a spacer when through the grace of God the seeping slowed and stopped over a few days.

There was no bending from Nov. 27-Dec. 26. I only took the immbolizer off to change clothes, sponge bath, change bandages and for the visiting nurse to check. I only walked around the inside of my small house to do ADLs, went to dr appointments and sometimes a restaurant after appts where I had to prop my leg up on the booth bench beside me. Even after Dec. 26th I phased out the immbolizer and wore it during part of the day because my leg had become very weak. I would walk around the house intentionally bending as I walked, doing a few heel slides with no assistance and didn't even start formal pt until 2 weeks later. My revision dr told me he hoped I could get a rom of 90 degrees, so a year later he was very happy! Last February when I saw a PA for my left knee he was amazed by my TKR and asked if he could play with it, moving it, bending it etc.
 
  • Funny
Reactions: OJ2
Did some or any of you not do any exercises the first month, and then start PT one month later?
 
My surgeon doesn't allow any PT 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.

For my last TKR, I didn't go to PT at all. I just let my Activities of Daily Living (ADLs) be my exercise.
Occasionally I tried a couple of heel slides when I was sitting on the toilet, just to assess my bend against the tile markings on the floor.

I had very good results.
 
Is that common in your country or just a few OS? And when you did start and went one time every 2 weeks, were they strengthening exercises and stretches and did you do them? Was your swelling minimal at that point? What was your Flexion ROM at 4 weeks, 2 months 4 months?
 
KarriB, how does such an infection occur when the scar is healed and that far out? Are you ever out of the woods as far as this goes? My surgeon said to take an antibiotic before any dental work, or a colonoscopy, but only for the first 2 years postop.
 
An infectious disease dr was involved from surgery on. That group studied/analyzed the cultures, prescribed the antibiotics and then wait for it...my body stopped making white cells as a reaction to all the antibiotics after 5-6 weeks. So I had to go off all of them and stay home until the white cell production kicked in, about 2 weeks. After that I went on 200 mg of doxycycline which was cut to 100mg 8 months later. I still take 100mg of doxycycline, see my ID once a year and she takes blood work to be sure everything is working the way it should. At the time my ID said I may take it forever, everything depends on my blood work. She also said there's no way of knowing how the infection started, but it was definitely in there and worked hard to come out. My fever started on a Monday (thought I had the flu) and the seeping began Tuesday through the night, enough to soak my sheets. Of course I've thought of this a lot and have my own ideas, but we'll never know.
 
KarriB, thanks for sharing your story of all of this infection nightmare. So glad you are healthy now and made it through the huge ordeal where you could have possibly lost your life.
This isn't the first time though I have heard of people getting infections in their knees months or years after their surgery. I just don't understand how that happens. Is that prosthesis and implant a magnet for foreign things other form dream this isn't the first time though I have heard of people getting infections in their knees months or years after their surgery. I just don't understand how that happens. Is that prosthesis and implant a magnet for viruses and diseases to attract to? I guess you don't hear of it all that often though so I need to stop worrying about it.
Does anyone else know of any precautions that can or should be taken after you have had a total knee replacement to avoid infection besides the antibiotic before dental work or colonoscopy for two years?
 
kayow11 said:
Did some or any of you not do any exercises the first month, and then start PT one month later?
Click to expand...
After RTKR hospital discharge I did not begin PT until 6+ weeks post op but I did simple exercises at home on my own. I won't detail them because I think I did so already, but they were gentle, felt good (to me) and moving my leg seemed to relieve/prevent muscle cramps. I'm long back to normal of course, but I still do my ankle pumps every morning and night. Ankle pumps are wonderful- no more charlie horses!
 
In most cases once your incision is healed and your OS gives you the ok to shower/bath there are no restrictions. My dad has had two TKRs and a THR with no issues, as well as pretty easy recoveries. Worrying will get you no where, so just take care of yourself, try to baby your knee and look forward to normal actvities in a few months. There are quite a few articles under the library tab about infections if you want to take a look.
 
I had 3 arthroscopic surgeries before my tkr. In each of those, the PT consisted of me doing all sorts of exercises, and the therapist never touched me.Now that I have had a tkr, I know that those arthroscopic surgeries were a piece of cake. Now fast forward to post tkr. I go to PT twice a week. The therapist does touch me, but only in a good way. He massages my leg and knee and it feels so good. He stretches out my hamstrings and I moan in delight. I still do some exercises, but he often limits me and says " no more". I come out of there tired and a little achy, but I go home and ice and then I am fine. I don't dread PT at all. But I told them up front that if they made me cry, I wasn't returning. And I told them that they were not to force my leg in any way. If they tell me what to do, I will do it to the best of my ability, but only to the point of pain and then I will back off. I find I can do movements more comfortably if I go slowly, relax, and then go a little farther. But when I hit that wall of pain, I stop.
Funny thing, the head of the PT told me "of course we won't make you cry. If we made people cry, we would not have any patients." But reading on BoneSmart, there are a lot of therapists who seem to feel the more the patient cries, the better the therapist is doing their job. My theory is that any fool can bend my new knee and make me cry. But it takes a skilled therapist to help my knee recover in a way that doesn't hurt me. I have told my therapist that I will make him earn his money, and I am pleased with how he is doing.
 
kayow11 said:
I just know that right now for me, my new knee seems to not be able to handle any real exercise. It easily gets aggravated and feels worse and more painful with anything except some walking for 5 minutes or so, frequently.
Click to expand...
Then listen to your knee! After all, it IS the boss!
 
Thanks! That's how I did them early on.
 
Status
Not open for further replies.
Active Antimicrobial Hydrogel
Corganics CBD

Members online

Total: 820 (members: 1, guests: 819)

Latest posts

Back
Top Bottom