Revision TKR Third and final surgery all done

[Celle]

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?

In my country, just as in the USA or the UK, there are different approaches to recovery, depending on the training the surgeon himself/herself received. One surgeon in my town advises aggressive exercise. The others don't.

No. I was never shown any strengthening exercises. They were just gentle exercises aimed at increasing ROM. And I confess, I seldom did even those exercises. I've never been a person who enjoyed going to the gym or doing set exercises. I'd rather take a walk.
My knees grew stronger as they healed, just from ordinary, everyday use.

I have no idea what my ROM was at those times, because it wasn't measured. The only time my ROM was measured for my first two knee replacements, eleven years apart, was on the day I was discharged from PT - I don't even know what it was then, because my PT said something like "Oh, you're well over 90 degrees. That's good."
I didn't go to PT at all for my last TKR, so it was never measured.
MY ROM visibly continued to increase as recovery progressed and I estimate both knees bend to about 125 degrees now.

I've had two different surgeons, one in 2000 and one for my last two TKRs. Neither surgeon was particularly interested in ROM. They both said that function was more important than the numbers. My current surgeon eyeballs the knee and says "Show me what you can do."

As for swelling, it wasn't minimal until about 3 months post-op. It decreased slowly, but still returned if I overdid my activity. I suffered the same tight band feeling that almost everyone does.

One thing I have to say about measuring ROM: I never had any concerns about my knees eventually being able to bend sufficiently. Everyone told me it would come, given time.
I truly feel that the constant, frequent measuring of ROM is a very bad thing. It makes people anxious and, if they don't achieve some theoretical number by a certain date, they also feel worried and inadequate.

Why worry your patient unnecessarily, when ROM almost always comes, given time, gentle treatment and patience?
There is no critical window of opportunity. That's an old myth that should have died long ago:
Myth busting: the "window of opportunity" in TKR
ROM: it's worth the wait for ROM
ROM: it's never too late to get more ROM!

 

[kayow11]

Thanks KarriB for the tip on where to find info in the LIBRARY. I did read a lot of the articles there just for my own info.

Overall, I am following the bone smart principles of lots of rest, elevation, and icing. It sure does get boring having to lay down and do this all the time I must say though. I would just like to sit on my deck and do some reading but my leg isn't elevated and I can tell it swells up even more when I do that, so I need to be laying down with my leg up when I am resting.

I have been learning over the past several weeks what aggravates my knees. Pretty much everything! But today is the two week mark on my newest knee, but today I started with some extremely gentle and doing maybe five comfortable heel slides, but the quad sets do seem to hurt some so I stop them. Lots of ankle pumps, and a little bit of straight leg raise which is not hard for me.

I did go to my second PT session yesterday and hardly did anything there, but noticed that since then my 13 week old knee replacement on the other side acted up some especially in the incision area. That knee is staying around 95° of flexion and still swollen. Even though it is resting a lot with my new knee, it still is holding onto the fluid.

I also did a 10 minute walk outside today with my walker and after that I could tell both of my knees felt more sore and swollen! Will I ever get out of this? 10 minutes doesn't seem like too much on a 13 week old knee replacement.

I can see that maybe the new knee doesn't like it but I was doing it in the house without a problem. I think my first knee 13 weeks ago is getting lazy and weak because of so much resting I have been doing. So I guess it's back to five minute walks.

 

[kayow11]

Thanks Celle for your response.
I know that I have to lose my exaggerated interest in my ROM.. It is just hard and discouraging for me to be at the end of the pack, or in that 20%. I know it happens enough, and you all are very familiar with it on this site since most people that read this forum have had problems.
I like exercise and exceeding goals, so a 13 week old knee that is still swollen and only 95 degrees flexion, and a 2 week old knee that is 65 degrees, (less than the other knee at this time), is a big defeat for me.
And doing everything that I possibly can to try to get that swelling down, without any apparent success, and everything I do aggravates them, well what else can I say?

 

[Dianna_WA]

Did some or any of you not do any exercises the first month, and then start PT one month later?

Hi Kayow11. My OS in Perth, Western Australia, is a well known doctor in orthopedics in this state, and he told me that all he wanted me to do after the surgery was a bit of walking around the house as necessary, and using a "slidy board thingy" just do some knee bends every day. After 4 weeks, increase walking and exercise a bit until about 3 months when I should be able to walk 1 kilometre - in stages. His approach is slow and gentle and he said only see a physio if any problems arise. I am now 4 weeks after BTKR and can bend both knees to 110, have hardly any discomfort and can walk quite easily using one crutch.

 

[kayow11]

Dianna, sounds like you are doing fabulous! That first month did you just rest, ice and elevate a lot as Bonesmart recommends, besides some walking and some bending with that device? I assume you didn't push the bending too much and just stayed within tolerance. It seems there are plenty of people that get good ROM without working at it much. Was that you?

 

[Dianna_WA]

Kayow11, Yes, lots of ice and elevation. Boring, boring!! I haven't pushed myself at all. I will go and see a physio later on to get an assessment, but not for a while yet.

 

[kayow11]

What would you compare that thing that you use to bend your knee with? A mini skateboard? I have just been doing very minimal or occasional heel slides for bending, and not getting anywhere near discomfort. I just seem to stay swollen no matter what.

 

[RadioGal]

@kayow11 When you say you just stay swollen no matter what, do you mean above and beyond what might be considered normal? We had our first TKR a couple days apart in June, though I'm making good progress I'm still quite swollen. Not like my knee looks like a cantaloupe or anything, but it's still noticeably swollen. I ice and elevate, sometimes wear the compression stocking, like it's the day after surgery. I still have those habits. It sounds like you're doing all the right things too, so I guess I'm trying to understand where the frustration comes in. You're walking just a few days after surgery, though not getting far, and that sounds encouraging.

Listen, I'm copping to be guilty of trying to rush things. I get frustrated some days just trying to walk my dog, or go down stairs foot over foot without saying "ouch" with each step, but perhaps I'm rushing it a bit. I think you need some good, deep breaths and a sprinkle of patience. Every time I get ahead of myself I go back and read a testimonial here from someone who did this a year, or longer, ago. They all say the same thing ... it will get better. I'm counting on it.

 

[Dianna_WA]

My husband made this for me to use as a leg slider. My OS recommended a mini skateboard, however, the wheels on a skateboard can tilt and the board can go at angles if you're not careful. This board that my husband made (copied from someone elses board), the wheels can only go straight up and down. My OS recommended when sitting, just gently slide up and down when you can. Works really well and requires not a lot of effort.

 

[kayow11]

RadioGal, thanks for your response.
I will try to summarize why I feel so frustrated. First of all, after my first knee and just before my second one at approximately three months later, I was able to walk 20 minutes and it seemed kind of OK. I could never walk down steps reciprocally though without pain and extreme stiffness. going upstairs wasn't too bad. My range of motion in flexion has consistently been about 95° for a couple months now. The swelling is probably moderate and possibly like yours but that is probably what is limiting the range of motion. It seems to be stuck there as far as swelling and never really changes except that it feels worse regarding swelling if I overdo something. It was feeling stronger and less painful though.
But then, since I had the second surgery two weeks ago., The first knee has had the privilege of resting along with the new knee. Its swelling still has not changed though. And yesterday, just taking a 10 minute walk outside, was too much for my new knee and even my first knee seem to get more swollen and stiff just from that. So it seems that it is going backwards even though I am not using it much.
What kind of exercises have you been doing, and are still doing for your knee? And what is your range of motion now? I must admit I have been spending much more time Icing the new knee than the old knee. 'I also wear compression stockings, thigh high, every day, on both legs. But I do spend time elevating both legs a lot of the day.
I don't know if it is normal to still be this swollen 13 weeks out. My old knee swelling seems to stay the same for the last six weeks at least, and can get a little worse if I do something it doesn't like. Most people I know that have had knees, are easily bending to 110° To 120 and more at this point. But I can see how It can't bend if it is still swollen. I am not doing exercises with my old knee either, since I am not doing them hardly with my new knee.
And now here I am with and another new knee to deal with that is very very swollen, and is only bending out 65° which is less than the other knee at this point. It feels less painful though due to not exercising out. But the swelling remains because it is so fresh I guess. I feel the old knee has regressed in strength and ability to handle much activity in the last two weeks since the new knee happened.
But maybe now you can get a better picture of why I feel like I do. Still curious though about your current state of motion and exercises though. Please respond to that. Thank you.

 

[Jockette]

I wonder if your first knee is reacting to the energy drain of the second surgery, and that's why it may seem as if it has regressed. It wasn't very old yet when you had your second surgery.

I am so sorry you are struggling so much with what to do and/or not to do.

It is so very hard not to compare ourselves to others who are doing better than we are. I have that problem myself. I live in a 55+ community so there have been tkr's before and after me. My friend had hers exactly 4 weeks after me, with the same surgeon. She is way ahead of me in activities. Another friend had his surgery on July 3, and even he is way ahead of me. To be honest, I feel a little embarrassed. But I do notice that both of them have a confidence that I don't have. And they have a better attitude than I do. So I am working on having a better attitude. Easier to do when things are going well.

I can't tell you how much I appreciated Celle's reply to you earlier in describing her recovery. I especially liked that she was not worried about regaining normal function because everyone told her it would happen, given time!

That is our problem. Not the pace of the recovery itself, but the unrealistic expectations so many of us face, by just about everyone we know. If everyone, especially, our doctors and therapists told us to relax and that it will get better, we would relax and worry would not even occur to us.

I am actually going to print out Celle's reply and put it on my refrigerator so I can see it all the time, as well as anyone coming to visit and tells me "I'm not where I "should" be".

I wish you well in your recovery.

 

[kayow11]

Thanks Jockette for your response. The thought about energy drain from the second surgery so close, could be a factor. Didn't even think about that. Is that common to happen?
You are right that CELLE's response was comforting but I just don't naturally have that kind of mindset, plus everyone around me including the therapist and family, coworkers, feel I should be able to do more, and why am I not healing faster? And that I definitely need to keep doing my exercises only possibly more vigorously to get ahead. I already tried that and it backfired.
Actually my surgeon is not that pushy but definitely does believe in regular exercises and therapy but not to push too hard, especially because I just seem to be going slower and can't handle aggressiveness at all. Even normal exercises that most people can do without a problem, aggravate me.
One of my biggest troublesome factors is that my work expects me to be back before December 18 or I will have to resign from my 20 year position. My short-term disability also Ends. It wouldn't be the end of the world if that happened but it wasn't our plan yet.
With as slow as I am going with the first knee, I don't see how I can be ready to go back to work at the three month mark past my second knee surgery, and of course there is the health insurance problem where as at work that is a non-issue because I have good coverage. Not old enough for Medicare so that puts me in a bad spot.

But after my experience with the first knee, I have to look back and remember how I responded with the regular routine. Am I likely to be this way on the second knee? It sure could Happen and it definitely more swollen right From the start.
I am thankful for the insurance I have had, and the ability to get my knees replaced. I just think I am one of these people that takes a lot longer to recover due to how my body rebels against trauma. I can do nothing about this. I just have to accept it and do what is best for my recovery, and try not to be influenced by the voices around me. My spouse is great though and listens to me and doesn't expect anything. He just wants me to get better.

 

[kayow11]

I should have added this to my last post just a moment ago, but have any of you tried massage for swollen legs, or lymphatic drainage massage for this problem? A friend mentioned it to me yesterday that it could possibly help some with my swelling problem. My insurance company said it could be part of a PT treatment as long as there was active exercise involved also. I don't think the two go together and at my PT clinic, they don't offer such a thing. Any thoughts out there?

 

[OJ2]

My therapist does a lot of massage, which I think helps a lot. It is not the relaxing, feel good kind of massage. It hurts as he digs in deep. He told me that the muscles, esp in the leg, all tighten up involuntarily because of the trauma done to the knee. They want to protect the part that is being traumatized. Part of the recovery is getting those muscles to relax and fire up again, like they are supposed to. (I know this is a dumbed down version of what really happens but I am not a medical person.) He feels that my tight hamstrings and quads are affecting my ROM. So besides his massage, I massage them with an old rolling pin I keep specifically for this purpose. I run the rolling pin over my legs ( not the knee) as heavily as I can without pain.

 

[SusieShoes]

The thought about energy drain from the second surgery so close, could be a factor. Didn't even think about that. Is that common to happen?

Yes. Many members who have undergone staged knee replacements have noted the way the second recovery piggybacks on the first, so they are more tired than expected. Your first knee isn't finished healing; it's still in the first third of a recovery that takes a year or more. Your body is directing much of your energy toward healing two serious surgical procedures.

One thing that helped me recover was acceptance. Acceptance that my knees were going to be painful for a while. Acceptance that my knees would be swollen and I would just have to sleep on my back until my knees let resume a normal sleeping pattern again. Acceptance that I would only be able to do very little for a while, until the day came when I could do a lot. Pushing the body to do things it's not yet capable of doing only leads to frustration and stress.

Massage might help because it also reduces stress. Among other things, muscles that are relaxed allow better blood flow -- and that's excellent for healing. I'm not going to say it sped my healing along, but Mr. Shoes gave frequent massages and they certainly improved my relaxation and outlook. A professional can surely do even better work, and I've heard good things about lymphatic massage. It well worth trying!

 

[OJ2]

I totally agree that relaxation massage is wonderful for our mental state, and sometimes that is exactly what we need. Helps us to relax and feel good. What my therapist did was to try to get the muscles to leave their tight state and get back to normal. Sometimes a force applied to the muscles gets them to relax by tightening a tiny bit first- sort of shocks them out of their tightened state.

 

[KarriB]

I think expecting to climb steps foot over foot at this early stage is too much. My OS warned me that full recovery would most likely take a whole year. If you take a look at threads of June TKRs I think you'll find many aren't going up/down steps naturally. I can't do them the "adult" way because of my natural left knee, but my TKR has no problem or pain with steps. Plus you were dealing with 2 bad knees.

A few members have had success with lymphatic massage, but I'd hold off on doing that with your September knee for a while. Chances are your knees are still feeling the trauma of surgery. My knee was still swelling at 10 weeks post op. I had received tickets to see Wicked (everyone thought I'd be fine by January) for Christmas, my niece drove me right to the restaurant and theater, I didn't have far to walk at all. But my knee was down for a whole evening for the drive, dinner and show. I could feel it swelling all night and by the time I got home had to peel my trousers off like a banana. My knee was so tight I elevated the best way I knew, laid flat on the sofa with my legs up on the sofa arm with ice on my knee. It was midnight, but I couldn't even sleep with my knee that swollen. If you take care of that knee the swelling will diminish, but it takes time for most everyone.

Also a 10 minute walk is probably fine for your June knee, but may be too much for your September knee. Remember, your September knee is just 2 weeks old. At 2 weeks all I did was walk to the bathroom and kitchen. If you don't overdo things it's very possible you'll be able to return to work by December, but my advice right now is to relax. Find a few things you can do that requires sitting with that knee up or tv shows you can enjoy and take your mind off things.

 

[kayow11]

Thanks Susieshoes, Oj2, and KarriB for your responses.
Well, the energy drain from my two knees so close together I guess can make sense. I must say I am surprised and disappointed that it seems to have lost 50% of its strength. Amazing how the body works so closely together with each of its parts isn't it?
And as far as massages goal, I do believe that a relaxing massage does feel good and helps the brain to. But as far as something more therapeutic or a lymphatic massage, my insurance company said it had to be combined with physical therapy active exercise or they would not pay for it. So I guess I am on my own if I pursue that route. I have seen recently some videos on how to do self massage for lymph Fattic drainage but well clear that with my doctor first.

 

[liam2015]

hi ~ i have had the same issue with swelling that seems to stay the same whether i rest, ice and elevate and do very little or if i was out and about, driving here and there, going to a play, exercising, etc. it's only been recently that i've noticed i have "pockets" of swelling rather than the whole entire knee of swelling. it still looks moderately bigger than the unoperated knee. i love getting the massage at physio and it probably helps but visibly, it looks the same. like KarriB said, above, it's probably too soon for your new knee to be massaged in the therapeutic way. i can't even imagine what it's like for you with 2 new knees, one newer than the other. i'm sure it's difficult at this point. i can say it does get better.

 

[kayow11]

Whoops! I didn't mean to send that last post yet so I will finish now. I do realize I have to accept my condition. But I fight with myself many times a day thinking about it. The work situation is probably the biggest factor.

I also agree that I just need to let my new knee recover a lot more before any massage is done on it I think. Especially the lymphatic drainage one. My husband can do a little bit of regular massage later I guess.

I could go up stairs alternating (not down) at 2 mo with my first knee, and walk 15-20 minutes without too much trouble. But now it can't. I also completely understand the terrible feeling your knee gets when it is down in a dependent position in sitting. It swells up a lot and feels just horrible, and it takes a long time for that to go down. So I can't even sit at the table except to eat and right back to the couch with my legs up.

And yes, my old knee is still swelling up and can even increase 13 weeks postop. It never did get back to normal yet and just stays in this Moderately swelled condition.

I know I am getting closer to accepting my slow progressing condition. All of you have helped a lot too. My expectations don't supersede the real facts I guess. I just have to do what has to be done and keep my mind right, even though I am often disappointed and disgusted at the littlest thing that aggravates. But again, I have to go with that. As many on this forum have mentioned, my knee is the new boss and answers to no one. But if I behave maybe I will start winning.!

I am trying to watch a bunch of movies on my iPad or portable DVD player. I love movies so it is a good distraction, but even with two weeks of this so far, I must say I am tired of laying down.