TKR TKR concerns

[Layla]

I can even handle the pain while at PT, but it’s later that night and the next day that is so bad

Please do ICE. Icing will help with the pain and swelling after PT.
Icing for up to twenty minutes only is what most of us have heard or been advised to do following an injury. Following joint replacement, ice is a critical part of pain management and should be used not only on the joint, but any surrounding areas of discomfort for as often and as long as you're comfortable doing so, always placing fabric between your skin and the ice source. Icing helps bring relief from the soft tissue trauma and internal swelling. Icing is a great natural pain reliever and best of all, it's free. While some care providers do put a maximum time on icing, others suggest you ice as often as you see fit.

Icing after therapy, exercises, or prolonged activity that challenge ROM and endurance should help ease any discomfort, or preventively keep pain at bay. You may find relief through icing for weeks to months post op.

Following is an article on ICING from the Recovery Guidelines -> ICE

 

[Layla]

My first post op was with my surgeon's PA. This is not uncommon. Try to take a breather from all of this and see what your surgeon has to say on Monday. I will leave a couple of posts from other members for you to read regarding ROM.


Justice Rider's post -
"I just want to add, for all those coming along, a note on ROM. I want to share this because nearly all of us have a tremendous amount pressure put on us to increase our ROM by certain deadlines, or else.

Mine has been extremely slow coming. First I had to wait out the swelling, which in my case took more than 5 months. Yes, months. At that point I began to see real progress. It has continued to this day. I have seen improvement in the last 2 weeks. It’s still going. A this point I think the limiting factor is tight muscles, ligaments, and tendons from 3 yrs of very limited ROM and actually about 25 yrs of somewhat limited ROM. Those tissues are slowly stretching.

I have had to be willing to let my flexion improve at a glacial pace, be very patient, and tune out the dire warnings of my surgeon, PA, previous PT, and some well meaning acquaintances. I refused painful PT and refused a MUA. I have absolutely no regrets. I know my body, and I believe those things would have caused a domino effect of swelling and pain that may have derailed my recovery long term and even possibly have torn soft tissue, etc. I now know I have the added challenges of hypermobility and an immune condition that causes an inflammatory reaction. I think a MUA would have been very harmful to me.

Instead of forcing it, I have relied on weekly massage and using my stationary bike as a stretching aid every single day. I have been very active, but I have ramped up really, really gradually. I have not measured my flexion, because honestly I feel almost a PTSD type of reaction around it. All I care about is function and what I can do. My knee is very functional now, and still improving. I love my new knee. I’m glad I let it heal on its own timeline even though it was so much longer than everyone (most of all me!) would have liked."


VolLady's post -
"I want to tell everyone that has went though TKR that it is a long journey to heal. I am going this spring to have my other knee replaced.

Please do not get discouraged and I know you will because I did with my first one and cried more than I had in a life time. Scared mostly.... Surgeons will not tell you everything that you will experience during your healing. It took me 7 months actually to feel more normal but not 100%.

For the ROM I only got to 112 at 4 months and still cannot bend it all the way back to reach 130. But I can drive, sit at a table, put my shoes and clothes on great without a ROM of 130 or 120. There is no swelling at all at 8 months but I still have some stiffness at times but I deal with it and walk. I also still ride my bike with no trouble.

I am telling everyone this because your body will heal without PT and pushing your limit beyond to the point there is more swelling and pain. I have decided when I have my other knee fixed this spring, that I will do my own PT since I have all the equipment and items that they use anyway.

I had a MUA at almost 6 wks., and regretted it from day one. Simply because it did not help me anymore with my ROM but it did set me back on healing. The swelling was awful. I will not have another MUA even if my ROM was 95 at the time.

I will go in with open eyes on this other knee comparing on what I went though with the first one. So, with all that said, I wish everyone a happy healing and let your body decide with healing than someone trying to push you until you scream with pain. Also don't worry about the ROM, it will come -- it might take a year or more, but it will come. I am 67 years old and I don't expect to get past 120, but I do what I want to do at 67. Oh! and I can even bend down with the knee need to kneel on it..... Best wishes everyone!"

@emmakk

 

[emmakk]

Thank you for the encouragement!!

 

[Jockette]

After my surgery I always, only saw my surgeon. But many members here often just see the PA.

 

[Layla]

You'll find a lot of encouragement as part of the BoneSmart community. We're glad you're here and hope you'll continue sharing your journey. I believe through the support you receive here, you'll get back on track and it will hopefully be smooth sailing. Keep in mind it is very early days for you.
I hope you sleep well tonight!
@emmakk

 

[EalingGran]

Continued to say if I don’t push, that the pain doesn’t hurt anyone that I would need an MUA. He said that he had a hip replaced and he would push it til he almost cried!

This seems bizarre to me. I would seriously consider looking for another physio/ PT practice. This physio regime seems very aggressive. In the UK things seem much more relaxed with less physio overall and much more emphasis on just following exercises at home. I have a close friend who is about 10 weeks from her THR. She is walking fine without crutches and said her pain levels were moderate throughout. I quizzed her carefully, because I may need a THR at some point.
I haven’t heard of anyone here who has been pushed to pain. There also isn't the focus on ROM numbers. The only time my orthopaedic surgeon mentioned my bend was in passing in a letter to my GP at about a year, when he was reviewing my knee and hips. He just watched me walk and move and agreed it was all very good. MUA rates also seem much lower overall, yet results from surgical review papers are equally good.

 

[sistersinhim]

If we can trust a 2 year old to rehab himself with great results, we adults can do the same.

No truer words about needing any PT.

Continued to say if I don’t push, that the pain doesn’t hurt anyone that I would need an MUA.

Ridiculous. A MUA is a decision that is totally up to you and no one else. Your knee just needs time to heal and reduce its swelling. It is swelling that is reducing your bend. Get that swelling down and you knee will natually bend more. Can you bend a water hose full of water with the nozzle shut off? Nope. You knee is the same way, let the water out of it!

I can even handle the pain while at PT, but it’s later that night and the next day that is so bad

Nighttime pain is a sign that you are doing too much during the day, doing things that you knee isn't healed enough to do. Cut back on the intensity of your movements, and your sleep should improve.

 

[benne68]

Continued to say if I don’t push, that the pain doesn’t hurt anyone that I would need an MUA.

He said there is no reason I should not gain 10 degrees in a day

These are ridiculous statements. He is just trying to scare you into compliance. From what you've reported, these therapists have not been trained in helping someone recover from a TKR because they are applying sports injury techniques! They clearly haven't read any of the recent (past 5 years) studies on this.

Are there any PT people out there that actually believe in a gentler approach.

Yes, absolutely! Therapists who have actually taken training in how to approach TKR recovery. My therapist took the gentle approach for both of my TKRs and my knees are great. He advocates for the gentle approach during the first 3 months of recovery because it takes that long for the soft tissues to heal from the trauma of surgery and trying to push the knee any earlier simply delays recovery.

If you allow these "therapists" to continue to push you into pain and inflammation, that's going to delay your recovery. I encourage you to drop them, take a few weeks off and just do some gentle exercises yourself at home to give that poor knee time to recover from the damage they have done to it. As the internal inflammation goes down, your knee with regain bend all on its own.

 

[Layla]

Hello and a Happy Saturday to you, emmakk!
How have you been over the past couple of days?
@emmakk

 

[Jamie]

There can be a correlation between painful, inflamed soft tissues in your knee and a tendency to develop adhestions which might result in the need for an MUA. Please try to avoid any exercises or pushing that take you beyond mild discomfort. You should do bends and stretches for 5-10 minutes every couple of hours throughout the day and ice as much as you can to lessen irritation and swelling.

When you have pain and swelling, the tissues are warmer as part of the healing process and they can tend to dry out. This is what you want to avoid so that drier tissues don’t stick together in places where they were meant to glide across one another.

If you can, I agree with the idea of finding a different therapy clinic. Interview with one or more therapists there to see if they will practice a more gentle approach to your recovery. As for the surgeon or his staff telling you that you need to push to the painful point, just smile sweetly and follow your own body signals. Don’t let anyone threaten you with an MUA if you don’t push hard enough. The gentle movements from bending and stretching, normal walking around the house, and your activities of daily living will keep your knee loosened up. Your ROM will improve once you get pain and swelling under control. You are in the very early days of your recovery and there is plenty of time to see improvement.

 

[emmakk]

Hello everyone!!
A lot has been going on. My heart rate has gotten very high (180’s) a couple of times. I went to see my dr at my heart and lung hospital. A few years back I had open heart for the replacement of my aortic valve. Have not had any issues in over 2 years. They said they believe that it was from all my body is going through and the pain.(although I was not really in pain when the heart rate was rising). They have me on a monitor for 2 weeks. I have continued to do walking and stretches on my own at home. I will not be going back to the PT place but will put out phone calls on Monday for a new place. Have 2 places in mind. I see the PA tomorrow afternoon.

 

[EalingGran]

Sorry to hear what you are going through. I know that physical and mental stress can raise pulse rate. I dont have the history of valve issues that you have- but I have POTS ( postural tachycardia) since my teens. It is fundamentally benign but I know how unpleasant tachycardia feels. My pulse has been as high as 160 when I was physically unwell. It definitely ran high after my PKR and low grade inflammation and pain pushed it up. I feel very stirred up, anxious and physically unwell when my pulse is really high.
I have a Fitbit which I use to keep tabs on my pulse.
Tachycardia is definitely a sign to take it easier and look after yourself. Walking and gentle stretches are good.

 

[Layla]

Hi emmak,
I am sorry to read about the elevated heart rate episodes you mentioned. It has to feel scary and physically uncomfortable. Thankfully you're being monitored and they suspect they know the cause.
Good luck for your appointment with the PA today. Let us know how it goes, if you care to share. I wish you success in your search for a good match in a PT.
Happy Monday!
@emmakk

 

[eaglemom]

Goodness a high heart rate is nothing to ignore. I'm glad that your taking it seriously. Having said that why not just give yourself a break from 'formal' PT? See if you can't do the same exercises at home, or better yet, rest more, elevate and ice more & see how you feel and your knee. Taking small walks where you live and just daily ADL's might be enough for you to recover.

If your knee is swollen and your in pain then your bp gets elevated that's a combination that isn't working. That baby knee needs rest and it seems like your body is telling you the same thing.

We are here to support you, whatever your decision.

 

[emmakk]

Hello everyone,

Well I went for my follow up and the PA thinks my knee looks very good and was not concerned about my bend. He thought I was a little behind but nothing to be concerned about. I also went to my regular physician. She sent me for an US of the leg because I have been having so much pain. It’s hard for me to sit in any kind of regular chair or in the car. Everything hits the back of my knee. So that ended up being clear for blood clots but the report did say that I had a Bakers cyst on the back of that knee. Nobody has spoken to me about it yet, I just read it on the report. She also has me scheduled for a CT of the chest cause I’ve been so tired and get very person. That will be tomorrow. All in all I really thought I would be feeling stronger by now but looking forward to gaining strength each day

 

[emmakk]

Oh also I will be going to a new PT place starting the 15th. I stopped going to other place and doing very gentle stretches at home

 

[Layla]

Well there's some good news in your post, emmak! I hope the visit with your surgeon's PA put your mind at ease. Great to read there are no blood clots! I will leave an article for you to read on Baker's Cyst from the BoneSmart Library - HERE

I wish you the best for your chest X-ray tomorrow. Please know that feeling tired post op, especially at not even a full month yet is completely normal. Our body's energy supply isn't limitless. So when we're in healing mode after major surgery our energy will be used for healing first, not leaving a great reserve for all the other activity of daily life. It is completely normal to feel tired for quite some time. How long....most likely relates to your body's rate of healing. Making our best effort to get adequate sleep and rest is beneficial. Our body does it's best healing while we're sleeping.

I hope the new PT is a good match and if not, you may find that through your gentle stretches at home coupled with the activities of daily living, you can go without PT all together. Keep us posted, we're here for you and we care!
@emmakk

 

[sistersinhim]

I have been having so much pain. It’s hard for me to sit in any kind of regular chair or in the car. Everything hits the back of my knee. So that ended up being clear for blood clots but the report did say that I had a Bakers cyst on the back of that knee.

Thank God you don't have any clots. That has to ease your mind. At your early stage of recovery, your pain is pretty normal. It was about 3 months before I could sit with my legs down for any length of time. I suggest you try and elevate the best you can. Doing so should help your pain.

I have Baker's Cysts behind both knees. When I am extra active, they fill up and are painful. When I rest a few days, they go back down on their own. Ice also helps them. You can try that.

 

[Layla]

Hi emmakk,
I hope all went well with your chest xray last Friday. Noticing you hit a milestone on Saturday.
A belated Happy One Month Anniversary to you! I hope you have a great rest of the week.
@emmakk

 

[benne68]

Hi @emmakk. It's been a few weeks since you last posted and we're wondering how you are doing. Are you happy with your new PT? Any more on the Baker's Cyst?

Please do post an update when you have a chance. We are here to help and really want to know how you are.