TKR TKR feeling a bit lost at sea.

[Minik]

Hi everyone.
Looking for some guidance as not sure if I am doing the best I can for my recovery.

Quick background.
55 years old, total knee replacement 21st March so 18 days post op.
Had staples removed today, wound good, seems to be healing well.
Live in Turkey.

So it's this last part that kind of leaves me feeling unsure of the right way to go. My surgeon, I am happy with his skills, experience etc, but things can get difficult to balance at times given the cultural differences. By this I mean 3rd day post op surgeon wanted me to have 120 flex, he said to push and force back, and that screaming was ok and to be expected. He did say later that he hadn't taken into account the difference in how we from Europe use our bodies in comparison to Turkish people for example when Turkish people pray they use a lot of standing to kneeling done repetitively and therefore the legs muscle are used to being used in a different

Spent 6 days at physio rehab they did no more than heal slides x 10, rolled up towel under my knee and to press down x 10, ankle stretches and leg lifts x10 all this once a day. Plus use electronic machine to help break down edema, this did ease the swelling and loosened up the stiffness a little.

Home now 6 days and have continued with these exercises as told by physio but did up it to twice a day. Elevating and icing a lot of the day/evening, slowly more mobile, walking around the house for about 2 hours a day, not all at once.

But don't see any difference from when I left the rehab unit.
I am also worried that my knee is quite bent, funny it feels straight inside but it's not. Have started doing the resting on the chair and let gravity do it's thing but still not seeing any improvement.

Saw surgeon today, he wasn't happy either with this, plus says I should have 120 flextion which I don't have, think I have assisted 90 flextion.

At my knee it is rock solid, swelling yes but i dont think to badly swollen, it's the solidness which is restricting me straightening and bending.
Is this normal?
What is the best way to loosen this?
Surgeon put me on heparin today I think to help with this.

Will try to upload a photo of my knee taken today.

Sorry for this being a long post and hope I have sense.

Thank you.

 

[FCBayern]

@Minik Yikes! Screaming is OK? You should not reach past a level of discomfort working on you range of motion. Your knee is very swollen inside making it feel hard. The moderators will be along soon to offer lots of good advise and articles for you to read. For now I would suggest ice, elevation and reading those articles when you get the links.

 

[Zommom]

Rehab resulting in screaming is not ok! Like other posts the moderators will be contacting you with a lot of good advice and ice ice ice!

 

[jboles]

I think we are all cringing when we read screaming is ok. I bet if it was your doctors knee, screaming wouldn’t be ok!

 

[eaglemom]

Oh no no no no no, NO screaming. That turns my stomach even reading that, I can't imagine. Personally I'd take a rest from everything except elevation, ice and medication. Your poor knee has been through too much to do anything else.

 

[Pumpkin]

@Minik ,
Sorry you have had such a rough start, with cultural expectations you cannot be expected to meet.
Most surgeons in the US would be very happy with 90 degrees this early in recovery. My surgeon expected 90 degrees at 90 days.

What gets you ROM is time, time to heal, time for swelling to go down, time for your muscles to recover.
Pushing for ROM will cause increased swelling, pain, and inflammation, setting back your recovery.

We have many members who never took PT and have had great recoveries and ROM. Your knee knows how to heal itself and recover.
Be sure to read all the articles I have left you below, your recovery will go smoother.
Saying no to therapy - am I allowed to?

Here is your copy of the Knee Recovery Guidelines, the articles are short and will not take long to read.

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

the BoneSmart view on exercise
BoneSmart philosophy for sensible post op therapy​

5. At week 4 and after you should follow this

Activity progression for TKRs​

6. Access these pages on the website

Oral And Intravenous Pain Medications
Wound Closure​

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


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.

 

[Pumpkin]

Here is a copy of one of our members posts, his ROM was slow in coming. He did finally get there.

@bertschb said:
I'm 12 months out from my surgery and have some advice based on my experience:
1. Stop going to PT - all it will do is make your knee swell and reduce ROM
2. Don't worry about your ROM
3. Be patient - VERY patient!!!

Here is my ROM history (more or less):
1 month - 60 degrees
2 months - 80 degrees
3 months - 85 degrees
4 months - 90 degrees
5 months - 90 degrees
6 months - 110 degrees
7 months - 120 degrees
8 months - 125 degrees
9 months - 130 degrees
10 months - 135 degrees
11 months - 140 degrees
12 months - 140 degrees

I spent waaaaay too much time worrying about ROM. I thought I'd be riding my bike a couple months after surgery but it took SIX months!

Looking back on my surgery, if I knew then what I know now, I wouldn't have wasted my time with PT and I wouldn't have worried about ROM.

Here's a post from @Campervan .

92 - 8 weeks post op
105 - 10 weeks
107 - 5 months
110 - 6 months
112 - 7 months
116 - 9 months
119 - 11 months
118 - 1 yr
120 - 1yr 2 months
125 - 1 yr 8 months and still this now at 1yr 10 months

So, please don't let anyone tell you that you MUST obtain your ROM by a specific date or the "window of opportunity" will be lost! It just isn't so.

 

[Celle]

I'm sorry you've had such a painful start to your recovery, @Minik .

In spite of what your surgeon says, you really don't have to try to achieve good Range of Motion (ROM) so quickly.
There's no need to rush to get ROM (Range of Motion) because it can continue to improve for a year, or even much longer, after a knee replacement. There isn't any deadline you have to meet:
Myth busting: the "window of opportunity" in TKR

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.

I suspect that the hardness around your knee is swelling, even if your knee doesn't look swollen. You've been through a very major surgery and your knee needs time and gentle treatment, so it can start to heal.

Your poor knee isn't lazy or unfit. It's wounded. So treat it gently and don't do any exercises that are painful. IT's your inee, so take charge of its recovery. You have the absolute right to say what will happen to it. Your surgeon can advise, but you have th right to choose whether or not to accept all his advice.
Saying no to therapy - am I allowed to?
CONSENT: what it means and how it can be used

My surgeon has a completely different approach to recovery from a knee replacement.
He doesn't allow any PT at all for the first month post-op. 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.

 

[Lilli215]

@Minik, you poor soul, I felt sick reading your post and what they put you through. In Scotland my surgeon said 75 was the number to achieve to get discharged from hospital. At my six week check up I had got to 101 and zero. She was delighted and said the rest would come with time and normal day to day movement. I thank god I didn’thave your surgeon, I would probably have punched him if he’d put me through what you’ve been through. Take your guidance from on here and you will soon see improving results.

 

[Jodingers]

Oh no, poor you... I had my tkr the day before u, I tried to do lots of exercises initially ( off my own back thx to good old google- thinking I could speed things up) with awful results + thankfully followed the advice here + haven't looked back.
Now I just walk, potter about, flex and extend as I walk, gradually increasing my distances. My physio today is really pleased, my flex is 105° , my extension isn't great, she advised me not to push tbe knee down but to massage the back of my knee in an upwards direction + it helps massively already, my knee feels much looser. Her advice echoed the advice on here- listen to ur body, discomfort is expected but not pushing to the point of screaming.
I really hope u can follow what the guys on here advise u to do, u won't look back.

 

[Minik]

Thank you for your replies, it does help hearing from others.
Also seeing other people's experience reinforces the face that everyone's healing is different. @pumpkin the list showing the time line was really helpful thank you.

I was feeling that following surgery that you are sort of thrown out there on your own with no real guidance and I wasn't sure if that was typical or just how things are done here in Turkey. Having found this site makes me feel less like that now.

So new day, with new beginning for me and hopefully I can stop panicking about my progress or lack of it and relax a bit more and listen to my body.

I have lost quite a bit of weight and have felt very weak, concentrating on getting a good diet going to give me the vitamins, carbohydrates and proteins I need to get my strength back. Feel this is also important for my recovery as I did need blood following my operation as platelets very low, and my TKR was only 7 weeks following a second key hole surgery to remove meniscus tears, and feel I was still recovering from that. Plus having anaesthesia and all the meds from that then this so soon after I believe has had an impact on my strength.

 

[Minik]

This is a picture taken yesterday.

 

[Lilli215]

@Minik you are correct in following ahealthy diet, my surgeon advocates eating a healthy nutritionally balanced diet with lots of protein to aid in the recovery process, every patient she does is given a booklet about six weeks prior to the op with lots of info in it including the importance of eating properly. Your body needs huge amounts of energy to heal the knee and eating properly provides that energy.

 

[henrietta]

@Minik, like you I'm in a foreign country, and so this site has been so helpful in supporting me in understanding what to expect, and what is 'normal'. Good luck with your journey.

 

[Irish471]

@Minik , I had surgery the same week as you and I am right around where you're at. My physical therapist measured me at 75 degrees flexion (unassisted) and I've been stuck there for 2 weeks. The surgeon would have liked me to be at 90 degrees at 2 weeks post op, but I also had a complication (hematoma) that caused more swelling. I made the mistake of doing the today on accident (came down the stairs wrong) and I do NOT recommend it.

I had problems getting my flexion back quickly with a previous surgery, too, but it came back eventually. I'm not too worried about it. I think it's just the way I heal. Regarding the hardness feeling in the knee, I have some of the, too. I was told by my home physical therapist that it was due to swelling, but I wondered if the implant (being that it's metal) is part of that hard feeling?

Every day in this recovery process is different. Today, I am having a not-so-good day and didn't do any of my exercises. Hoping tomorrow will be better. Hang in there, I think you're right where you should be