Knee Infection* TKR Infection 2 Years Out

[TKRsharon]

Hi. I had my LTKR on Oct. 13th, 2020. I have had a very rough road with pain and swelling. I had the knee aspirated a couple of weeks ago. I believe my PT is way to vigorous. After Friday's session, I was in excruciating pain the entire weekend. I decided this week to go 2 times a week instead of 3, to have some rest and recovering time. I told the PT on Monday that she has to take it easy. I am afraid that they think they know more than I and not take me seriously. I wish I had found this forum earlier and understood about letting my body heal. ROM is about 105-110. I went to my GP today. He said the knee is very swollen and that I should not be in pain. I do not agree with him. From what I am reading, less that 2 months post op is still early, right? Oh, I can walk for about 10 minutes. It is so hard to know how I am doing.

 

[sistersinhim]

I believe my PT is way too vigorous. After Friday's session, I was in excruciating pain the entire weekend.

This kind of PT is bad PT and sets your recovery back. No PT is better than bad PT.

 

[TKRsharon]

Thank you. How do I convey my concerns and need for a more gentle approach?

 

[sistersinhim]

I started a new Recovery Thread for you. If you would like a different title, please let us know and we'll change it to what you would like it to be.

How do I convey my concerns and need for a more gentle approach?

Just remember that you are the boss. Tell the PTs "hands-off" and that you will do only what doesn't hurt. If your PT doesn't agree to this, then leave. You can do everything you need to do right at home.

Many of us never took formal PT or did any exercises. I am one of them. I had 12 knee surgeries, 2 of them kneecap removals, and 1 tkr. Even after those I never took formal PT. But, I didn't just sit around and do nothing. I used my knee as it was intended to be used by walking around to take care of my daily needs. As I healed I was able to do more. Icing and elevation were a huge part of my recovery.

Listen to your knee. It will tell you if you're doing too much by increased pain and swelling. When that happened to me, I found that resting, icing, and elevating helped. Your knee knows how to rehab itself without being told what to do.

 

[sistersinhim]

The following are our basic guidelines and should help get you started. As you read more on other members' recovery threads, you’ll get a better perspective of what to expect and what not to do, especially regarding PT.

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. 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

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.

 

[Jockette]

Thank you. How do I convey my concerns and need for a more gentle approach?

What I learned after having some aggressive PT is that it is my knee, not their’s, and I have the right to tell them what I will allow them do do to me, and what I will do at PT.

Increased pain and swelling that takes days to recover from, like I had, is counterproductive and does not give your knee a good chance to heal. If your PT won’t agree to your terms, find a different one, or do your own rehab at home. You really only need gentle bending movements and some walking, to have a good recovery.

 

[Nancan]

I agree with Jockette. After reading your post I had this lyric running thru my head “ Should I stay or should I go”( The Clash) .I had to switch PT offices for the exact reason you mentioned. I was is agonizing pain for days after first office. I decided I would “GO”! My new PT office is all about helping you get better. Nothing is pushed and they treat me like an adult and I truly appreciate that aspect . If I am instructed on a specific exercise I don’t need someone counting for me. I really hate that! I now complete as many of a specific exercise that I feel comfortable with and the PT or one of the assistants notes what I said I did in my chart. How adult, right? Anyway, I learned my lesson and found a PT office that meets ALL my needs. I wish you well in whatever decision you choose to make.

 

[TKRsharon]

Thank you so much for your support! I will have to buck up and advocate for myself! I go to PT tomorrow. Wish me luck. So often we are afraid to speak up for ourselves. In this case not doing so has caused me a lot of pain and regression. Again, thank you!

 

[TKRsharon]

So I went to PT this morning. I told them that they need to take it easier. I said no to weights. Seemed to be going well, then at the end, my PT said we need to increase the intensity of the exercises next time. She also said I need to do " a thousand" quad sets at home. I will try to stand my ground next week, and if I need to I will find another PT.
Again, thank you everyone for your support and for listening!

 

[Jaycey]

She also said I need to do " a thousand" quad sets at home.

My friend you are not in training - you are healing. One thousand of any exercise is absolutely not right. Please do not put yourself into the position of not being able to say no. Frankly, your PT isn't listening if they are asking you to do that much.

 

[Celle]

STand your ground with your PT therapist. It's your knee and you are in charge of its recovery - not your surgeon and not your PT.
Saying no to therapy - am I allowed to?

3 times a week is definitely too often for PT. Once a week is enough.

In spite of what you've probably been told, 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

In any case, 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 knee has the potential to achieve good ROM right from the start, but it's prevented from doing so by swelling and pain. As it heals and the swelling goes down, your ROM (both flexion and extension) will increase spontaneously, whether you do formal PT or just let your normal Activities of Daily Living (ADLs) be your exercise.

 

[Jockette]

I’m glad you said no to the weights, they are not appropriate this early in recovery. Stand your ground with your PT, it sounds like she may have humored you today but might hassle you next time. Her approach to this rehab is not the only approach. The intensity she wants you to do is not necessary to have a good outcome.

 

[sistersinhim]

I will try to stand my ground next week, and if I need to I will find another PT.

Please do. You will be much better off.

 

[TKRsharon]

Thank you all - for your advice and for helping me to heal myself. I will let you know how it goes.
I also think she was just humoring me and plans to amp it up next week. I will do what is best for me. I actually headed another PT with a client today talking about the importance of rigorous out patient therapy and it made my blood boil.

 

[TKRsharon]

Hello everyone. I have a question about KT tape. My knee is taped at the end of each PT session. Sometimes the tape is so annoying I take it off, but mostly I keep it on because I do not know if I must. It is more beneficial to leave it on for days? It it counter productive to take it off before the next sessions? I have done a lot of reading on the benefits of KT tape. My OS said it's a waste of time, but as I have said before, he is not a very positive person. He likes to do a lot of tests and does not even look at my knee. Thank you for your imput.

 

[TKRsharon]

input

 

[Jockette]

KT tape is an option, not a requirement. If you think it helps, and you want to use it, then use it. If you don’t like it, don’t use it.

I did not use it early in my recovery, but tried it at about a year. I thought it helped the nerve issue I was having but I had an allergic reaction to the tape, so that was the end of that! That reaction surprised me because my chiropractor had taped me many times for a back issue, and I never had a reaction to her tape.

 

[TKRsharon]

So you do not think it is counter productive if I take it off or do not use it at all? Sometimes it feels so itchy, but I think that may be the effect of the skin healing. Thanks

 

[Jockette]

No, I don’t think it’s counterproductive to to not use the tape. My PT never taped me at all, (I taped myself at one year to see if it would help the nerve issue I was having) so it’s only the opinion of your particular PT.

I understand your hesitation to not do what your PT says, I felt the same way, early in my recovery. But, I have since learned that there are lots of opinions and options of things to do and try in this recovery. Your medical team can advise you about what to do, but in the end it’s your knee, and you have the right to not accept the advice.
Saying no to therapy - am I allowed to?

 

[TinAB]

@TKRsharon
Hi. My right TKR was on 1st October so am 2 wks ahead of you. At nearly 4 weeks I went to PT and the week after and the week after that. I know my PT and like him but I was so sore afterwards I have stopped going. I do heel slides everyday just 5 or so at a time. Some other home exercises when I feel like it and go for 30 min walks when the weather is fine. Otherwise I put some music on and just walk around the house. At 9 weeks my flexion was 112 and my surgeon and his physio said all was really good. So I'm recent proof that no physio can be just fine. Yes it can still be sore and stiff and aches after a walk but it's improving every day.