TKR Beachinnc's recovery thread<

Beachinnc

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I've had 6 in home PT visits since my TKR and was using a CPM for the first 10 days. Had to stop that, when I got out of the machine I could hardly walk and at 10 plus level pain. I'm not a fan of the CPM, anyone else experiencing similar issues after CPM exercise?
 
Hello @Beachinnc - and :welome:

Which knee did you have replaced?

Many doctors no longer use the CPM and whether or not you use it doesn't make any difference to your eventual Range of Motion (ROM). So, as it seemed to be affecting your knee adversely, you were wise to stop using it.

Since the use, or not, of a CPM makes no difference in the long run, I think the long and short of it is this:
  • If your surgeon recommends it and you feel it is helpful, use it.
  • If your surgeon recommends it and you hate it, don't use it.
  • If your surgeon does not recommend it and you don't use it, your recovery will not be impeded.
Don't feel you need to do lots of exercises, to rehabilitate your knee.
It's not exercising that gets you your ROM - 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.

Here is the post-op reading we give to everyone with a new knee:
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
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

Please don't be overwhelmed by the list. The articles are not long and they and contain information that will answer many questions and help you make your recovery much easier on your knee and on you.

We are here to help in any way we can: answering questions and concerns; supporting and encouraging you from start to finish.

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.
 
Many OSs have gotten away from the CPM. I never had one for any of my surgeries. The pain it caused you was in no way helping your knee. You were smart to stop it.
 
Both need to be done due to service-connected disability/ arthritis, OS wanted to do both at once but I insisted start with the right knee first.
 
It's funny, I like the CPM. I put it on slow, start at a low ROM and work slowly up, no more than 45 minutes 2-3 times a day. I didn't start until after two weeks, and it's because of my prior history of adhesions and at my request. But everyone is different, and not being able to walk after using it is not a good sign, is it?
 
I feel much better just doing my stretching and exercises + walking without using the CPM. I had all the angles rechecked and everything was okay there. At 16 days post-op still using the Walker which is recommended and starting to get some okay sleep at night finally. My PT in the hospital was also not a fan of the CPM , my home PT wanted me to use it at my house but really didn't say anything good or bad about it. Research I've done on it was mostly inconclusive.
 
The research I've done on it has been far from inconclusive!

I'd really like to offer you some structured advice but in order to do that, I also need to ask you some questions. Are you willing for me to do that?
 
I only had a walker for one day then it was taken away and I was given 2 good sticks. I found walking was the best form of exercise and rehabbed myself by just doing that. Not overdoing it of course. Just about the house (I solemnly marched up and down the hallway, 30 paces one way then a return journey - boring but worth it) I then increased to walking round the grounds of our block then incorporated steps. All in my own time and I made a great recovery. I'm so glad I did it this way unlike my experience of doing it the PT s way for my first knee. Good luck on your recovery.
 
Thanks for posting your experience. Still using my walker and pretty much doing what you did, walking and doing a few exercises my PT left me with plus icing and elevation. Starting to sleep better at night also.
 
I used the cpm (OS prescribed it) for the first two weeks and thought it was ok in small doses and if I increased the bend very slowly. It felt like it helped me loosen up a bit. But I don't know that it had any longer term effect.
 
Here y'go then!

It would be very helpful if you would answer each one individually - numbered as I have done - in as much detail as you can then I'll come back as see where you are ....

1. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine. And don't forget to factor in other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness).

2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?

3. how swollen is your leg compared to these?
ai63.tinypic.com_eta39s.jpg


4. what is your ROM - that's flexion (bend) and extension (straightness)

5. are you icing your knee at all? If so, how often and for how long?

6. are you elevating your leg. If so how often and for how long?

7. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and

8. are you doing any exercises at home? If so what and how often?
This is the most crucial question so please help me by using the format I have left as an example
(which means please make a list and not an essay!)

Exercises done at home
- how many sessions you do each day
- enter exercise by name then number of repetitions of each
etc., etc.

Anything done at PT
- how many times a week
- enter exercise by name then number of repetitions of each
etc., etc.
 
1. 4-5, my knee mainly aches in the knee cap area, once in awhile sharp pain and or a popping noise/feel when I'm exercising

2. Oxycodone-acetaminophen 5-325, prescribed to take 1-2 every 4-6 hours as needed for pain. Tramadol 50mg, 1 tab every 6 hrs as needed. This is my second prescription of Oxycodone , was told would not refill, pain level has decreased so only take usually two pills overnight to help relieve knee ache for sleep. Have several refills of Tramadol so I take one every six hours

3. Slight swelling

4. 105 to 5 degrees of full extension

5. I ice my knee after self PT and when it is aching or is painful.

6. I Elevate almost always while I'm at rest lying down.

7. I feel I'm fairly active, I get out once or twice a week in a car with my wife driving to go to the store or run errands.

8. I exercise 2 or 3 times a day at home (nothing else to do lol)
Heel slides 2-3 sets x15 reps
Short quad arch 2 sets x15 reps
Straight leg raise 2-3 sets x10 reps
Quad set, 2 sets x15 reps
Long arc quad 2 sets x15 reps
Supine hip abduction 2 sets x10 reps
Heel raises 2 sets x10 reps
Standing hamstring curls, 2 sets x10 reps
Standing marching 2 sets x10 reps
Standing hip abduction 2 sets x10 reps
Hip extension standing 2 sets x10 reps
Squat supported with chair 2 sets x10 reps

I've had six in home PT visits (no additional in home visits authorized by ins co.) and my OS will not schedule any outpatient PT until my 6 week follow up (if deemed necessary) which is on February 28th.
 
Before I get started, I need a little bit more detail:
2. Oxycodone-acetaminophen 5-325, prescribed to take 1-2 every 4-6 hours as needed for pain. Tramadol 50mg, 1 tab every 6 hrs as needed.
At what times do you actually take these?
4. 105 to 5 degrees of full extension
What do you mean by "full extension" and is the 5 degrees plus or minus?
5. I ice my knee after self PT and when it is aching or is painful.
6. I Elevate almost always while I'm at rest lying down.
But how many times a day and for how long? Please be specific.
7. I feel I'm fairly active, I get out once or twice a week in a car with my wife driving to go to the store or run errands.
Did you read the articles Celle left you in post #2 of this thread? Specially the one Activity progression for TKRs
 
I take one Tramadol every 6 hours and oxycodone when needed, which is usually about 1 a.m. every night and I will take two pills. I go through the day without taking any oxycodone.

By full extension I mean stretching my leg straight out

I ice my leg after every self PT session for about an hour each time, after that I get up and go for a walk around the house, do a few activities then go back to rest and will ice again.

Yes, I did read her article, good information. I'm fairly certain I'm at the week 4 level as per the article.
 
Right knee, 22 days post-op.
 

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By full extension I mean stretching my leg straight out
That can't be. Straight out is zero. If it's 5 degrees it must be either plus - NOT straight out (red flag) - or minus - hyperextended (blue flag) which means you can lift your heel off the bed. This image will explain how this works

knee ROM small.jpg
 
Jan 29, 2019 Left Knee Replaced at Wake Med-Cary, NC.
My insurance does not help offset cost of a CPM machine or an Extensionator. I thought about renting a CPM machine but I've seen so many mixed reviews that I'm not sure what to do. So far I've had 3 visits from in-home PT and do the exercises as pain permits. The Breg icing system is my new best friend.
 
When I was in hospital there was a young girl who had surgery on a kneecap that kept dislocating. She was really struggling with any of the exercises so the physio brought in the CPM machine started it at 50 and increased it very gradually to 75 over 2 hours just to show the girl that it could be done and it did seem to help her and she didn't suffer afterwards. I guess it depends on how it's used and might be useful for someone with very restricted mobility.
 
Thanks for your posts soccercop and LindyLee. I will be 4 weeks post-op on February 11. My surgery was completed at Moore Regional in Southern Pines NC. I'm hoping to transition from my Walker to a cane by next week and was not offered the icing system option but I've heard good things about that. My home PT sessions are over but continue to do self PT two to three times a day plus walk ( with walker) around the house and have started walking outside in my driveway (paved.) I want to add that when I use my Walker I have been putting less weight on it and more on my legs, then Elevate and ice after every walk & pt. My CPM is still not in use and should be picked up next week. Still waiting for a decent night's sleep. I found this forum has excellent information and guidance from multiple people. My experience has been once you get into the third week you'll feel much much better.
 

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