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[TKR] TortiTabby's recovery

Discussion in 'Knee Replacement Recovery Area' started by TortiTabby, May 13, 2019.

  1. kneeper

    kneeper FORUM ADVISOR Forum Advisor

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    "Threats" and scare tactics are not very productive ways for doctors to "help" people. :(

    My OS was quite pleased when I made it to 90 at 6 weeks. Not coincidentally that was the point at which my swelling had decreased considerably. I did heel slides and so forth and it wasn't comfortable, but I didn't let any PT "crank" on my leg, nor did they try to.
    My approach was to use my common sense-- take the knee through its range a few times a day (to discomfort but not agony) and do a lot of icing and elevating. In my experience it's a daily balancing act. Use the knee but don't aggravate it. As I continued to heal over the months I would do more daily activities that required me to bend my knee and I continued to see progress. (My OS was ok with that approach, by the way).
     
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  2. lovetocookandsew

    lovetocookandsew FORUM ADVISOR Forum Advisor

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    That doctor fed you a load of malarky! Correction; he tried to feed you a load of malarky, but you were too smart to eat any of it! Every knee is different, and every knee recovers at a different rate, therefore your knee will recover at it's own pace, and not at anyone else's pace. Some people have their swelling dissipate at a relatively quick rate so have more flexion earlier than someone else. Some knees take longer to heal and thus continue with the swelling longer, hindering bending progress to some degree. There is no hard and fast rule on how long any given knee should take to bend to any specific degree. Granted, if your knee doesn't bend enough to live your life by a year after the surgery, then maybe there's a problem, but you're at just over a month! Your knee is still in shock over what happened to it and hasn't even had a chance to figure out how to process the assault that is a TKR. This recovery takes, on average, 52 weeks, and you're only at 6 weeks. By around 3 months most people begin to feel much better, but the healing is still going on inside your knee.

    Here's my silly attempt at an anology...we had a new roof put on our house a couple of weeks ago. The first 2 days there were 7 men on my roof removing the THREE layers of our old roof, replacing any wood that needed replacing, and so on. The next day and a half there were only 2 men on the roof at any given time, nailing on the paper, finishing up the wood replacement, putting on the shingles, and so on. The first two days were the hardest work, so there were many more men on the job, the last day and a half was still busy, but only needed two men to complete the job. By the same token, my next door neighbor, who has the same sized house, had a roof done just a couple of months before mine, but her roof took over a week to complete, as she had much more damage up there and needed a lot more wood replaced, even though she only had one layer of old roof that needed removing. We also used different roofing companies, so their methods were likely a bit different. But, in the end, we both have beautiful new roofs that will not leak for years and years to come! And that's the goal-to have a knee that functions well for years and years to come, so, if one knee takes longer to reach that point than another knee it doesn't matter-what matters is the end result.

    At first, your knee has a ton of healing to do so a great deal of your body's resources are sent to that knee to begin the healing. As time goes on, the acute phase of healing is behind you, but you still have healing taking place, you just need less of your body's resources sent there to do the work. But it still sends some to your knee while you are still healing. At some point the job will be finished, and your knee will be done healing, but no one can tell you exactly when that will be, they can only give you estimates based on what was done, and how bad the damage was. After the surgery, your knee takes over and repairs the damage in it's own time.

    Doctors sometimes say they'd "like" to see 90 degrees at 6 weeks, but any doctor who threatens a patient with an MUA or they'll have a semi-frozen knee for life needs to have a very large penalty flag thrown right at his feet! I don't know what gets into some of them, but whatever the reason, he is totally wrong. I don't care how good he may be as a surgeon, as someone giving recovery advice, he needs to move into the new century. While I agree you need a new doctor, I can't help but wonder what would happen if you saw him again and stood up to his bullying. I've always hated bullies, and a doctor, someone who took a vow to "first, do no harm", bullying his patient, is doing great harm and needs to be called out on his behavior!

    Let your knee recover and help it all you can by icing, elevating and resting in between your daily activities, and it will reward you by doing what it needs to do to heal at it's own pace. I also suggest reading the activity progression article more than once to remind you not to do too much, or too little, at any given point in your recovery. Good luck and keep us posted!
     
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  3. TortiTabby

    TortiTabby junior member
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    I'm really confused. After reading my own thread again from the beginning I do see that my flexion has improved from 75 to almost 90, but it feels like it's stuck at the 90 point. I have no swelling anymore and very little pain. Why isn't the flexion getting better? It feels like it just physically stopped at the 90 degree point. It's hard to imagine it improving much more... I just don't know what to do. For those of you who have said that your flexion improved over a year or so, how much did it improve? I'd hate to go a year and end up with only 100 degrees or so - that would still limit what I can do. I used to kayak and I'd like to be able to get in and out of a kayak again. I've read a bunch of studies that do seem to agree that if you are going to do a MUA it really does do better if done within the first 12 weeks. I really don't want one but I also don't want to be limited in flexion the rest of my life. :sad:
     
  4. Jockette

    Jockette FORUM ADVISOR Forum Advisor

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    I just counted the weeks from your surgery, and it will be 7 weeks this Friday. Still very early days in this year long recovery.

    I have no idea what my real numbers were at 7 weeks, as I was always measured by the measure-er pushing my bend. But, I had much less ROM at home.

    My leg seriously relaxed more as I got closer to the one year mark and I had a better bend. I’m now more than 2 years post op and recently realized I can bend further and more comfortably.

    Please don’t worry at this early date, it is not worth all the stress. Your ROM will improve over time. There is no rush and no “window of opportunity.” (articles about that in your recovery guidelines )

    One of our members, Bertschb, kept a record of his ROM process. He agreed for us to post it for those of you that are afraid you're stuck. The key is to have patience! Bertschb says:

    “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.”
     
  5. Jockette

    Jockette FORUM ADVISOR Forum Advisor

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  6. Benay

    Benay graduate

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    If I knew then what I know now I would have done a lot more in depth quizzing of my surgeon pre op. My numbers at the 4 week follow up (120 and 0) have made him happy and I don't have to see him again for 3 months but I'm sensing his philosophy on the healing process isn't in line with ours. I'm just lucky and very pleased I'm part of this forum and that I didn't have to deal with what you are. Tough, thinking of you - the situation makes you feel so vulnerable.
     
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  7. Jockette

    Jockette FORUM ADVISOR Forum Advisor

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    I agree with how vulnerable we are with this surgery and recovery. We get so much conflicting information from absolutely everyone we come in contact with. And we get that information at a time when we are hurting, struggling, exhausted, unsure, and trying to do “what’s right” and that can be so hard to figure out.
     
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  8. TortiTabby

    TortiTabby junior member
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    Here's an interesting thing I noticed today. I have been having quite a time trying to get my flexion past 90 degrees, well, today I was using the wall to stretch my side a bit (right side to the wall, right arm up, right TKR leg in front of the other, then leaning toward the wall with my right hip). Anyhow, it felt really good all the way down my side and leg and when I finished my knee felt really flexible. I was able to easily get it to 95 degrees and was able to walk better. :dancy: I overdid it a bit with a bunch of walking and now I'm kind of sore, but it did help me to see that tension in the rest of my body may be affecting the flexibility of my knee's joint and therefore ROM. Does that make sense?
     
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  9. Jockette

    Jockette FORUM ADVISOR Forum Advisor

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    I definitely found as the months went by my whole leg seemed to relax and my ROM improved. This continued especially after the one year mark for me. It made me realize struggling to get increased ROM in the early months isn’t worth it, it will come as we heal.

    And I had a very tough first year, ROM-wise. I had a major set back at 4 months and again at 5 months. I don’t know what my numbers were at that point, but it didn’t seem to be much. I was always stressed that first year about my ROM, but my surgeon made a big deal about it.

    Now my ROM is in a decent place and I fail to see why they cause us so much stress early in about the ROM that will come, given time.
     
  10. winemama

    winemama senior

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    My PT stretched and massaged my thigh and knee, ROM started at 92 and with out pushing made it to 97. We are going to try for 100 tomorrow. No pain involved. Thank you Bone Smart
     
  11. TortiTabby

    TortiTabby junior member
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    Nine weeks and a few days since the RTKR and I'm still hovering around 90 degrees flexion. I feel like I can do more, like, get out of a chair with minimal arm help and go up stairs one foot after the other - even down stairs one foot after the other delicately. I push my knee to bend more throughout the day gently since I'm at work at a desk. There's no swelling but I do still have bruising toward the inside part of the knee.

    One of my co-workers who is athletic and has had ACL work on her much younger knee keeps commenting on my lack of flexion. She insists that I need to aggressively push it at PT (I stopped going and do my own gentle pushing). How do I get people to stop "caring" about how well and quickly I recover! :oyvey: I don't want to be mean but I'd like to say, "Leave me alone! It's my leg!". I'm avoiding seeing the OS because I know he's the same way.

    I know you all say that the ROM will come in time but I'm really only seeing one or two examples on the site... how can I be sure? It's so frustrating hearing two completely different viewpoints about recovery. :gaah: Is there anyone on this site who didn't gain ROM over a year's time - and I don't mean people who didn't move at all, but people who just did daily activities and gentle stretching? I'm not expecting to be able to squat down completely again, but 120 degrees would be so welcome.:sad:
     
  12. lovetocookandsew

    lovetocookandsew FORUM ADVISOR Forum Advisor

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    I would, at first, gently say to the co-worker that while you know they're trying to help, you would rather not discuss your knee any longer. Then change the subject. If she gets the hint, great. If not, every time she opens her mouth to talk about your knee, stop her more firmly, and tell her you already asked her to not discuss your knee any longer, so the subject is closed. Get firmer if needed, but remain polite and change the subject, or walk away if that's what it takes. Unless she's completely thick-headed she'll get it and stop.

    As to your flexion, it will get better with time. Even though you don't see any obvious swelling, it's likely you still have internal swelling, which is why your bend isn't fully available yet. But the knee implant is there waiting to bend, it just has to wait until your tissues, etc, fully heal. It takes a lot of patience to get through this year long recovery, and you're only two months in. I know it's hard when you mostly feel recovered, or at least think you should be back to "normal", but your knee really does need that year or so to finish it's healing. Where you are today is not where you'll be 10 months from now, you just have to dig deep and find that patience. If you look back to where you were a month ago, and project that healing forward, you'll see that you are healing and progressing.
     
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  13. Jockette

    Jockette FORUM ADVISOR Forum Advisor

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    It really is tough when people force their opinions us. I agree with what @lovetocookandsew suggested about telling her you don’t want to discuss it. I think sometimes we are too polite and do not get our point across, that’s how I am. Then I just grit my teeth and fume inside while waiting for them to stop talking. Or worse, I try to defend myself and they don’t agree with my Bonesmart approach.

    My numbers were “great the first few months,” but they were all forced when measured, so I have no idea what they really were. For my whole first year I did not have the function those “numbers” should have given me.

    I had a major set back at 4 months post op and my ROM went way down. It took a month to start improving and then I had another unavoidable set back a month later. My ROM was bad for months. I doubt it was even 100. I was well past 6 months by this time.

    My ROM at my one year check up was around 125, but still wasn’t comfortable and it improved after that and still improved even more after my 2 year anniversary. It was well past the one year mark that I actually had comfortable function to go along with the number.

    So it honestly is true that where you are now at 9 weeks is most likely not where you will end up.
     
  14. alexthecat

    alexthecat MODERATOR Administrator

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    Establishing interpersonal boundaries is not "mean". It's a way of trying to find a way to continue to interact with someone, even after their behavior has been inappropriate. You're doing them a favor, whether or not they appreciate it.

    I would just say something like, "I appreciate your concern, but I'm not interested in discussing my knee." Then, every time she brings it up, just say that, politely but firmly. She'll get the message or she won't. That's on her though.



    Sent from my SM-S327VL using Tapatalk
     
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  15. newpartial

    newpartial junior member

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    Hi there I have only just had my knee done so cannot coment on flexion but I did ha e my ACL done 20 years ag. When I mentioned to my OS ahead of surgery that I sort of knew what to expect as had my acl done before he said to me that the recovery protocol is totally and utterly different so not to expect or treat it the same... maybe worth mentioning to your co worker :)
     
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  16. Jockette

    Jockette FORUM ADVISOR Forum Advisor

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    Very well said. I needed to hear this also.
     
  17. TortiTabby

    TortiTabby junior member
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    Thank you all for the responses. :flwrysmile:
     
  18. TortiTabby

    TortiTabby junior member
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    Yesterday after work I went to my fantastic massage therapist who is very knowledgeable about anatomy. She said that the brain's pain response can be part of the limited flexion I have. I'm always trying so hard to "protect" my knee that I'm just clenching my muscles in my legs and glutes. She say my brain needs to know it's ok to let go. She had me lay on my stomach and bend my surgery leg as far as I could then she ever so gently made small circles with it. She had me press downward against her hand and then relax and then more small circles to loosen it up. We got several more degrees of flexion doing that. :happydance: She said, although better than last time, I still have a small amount of swelling behind my knee too. Feeling so much more optimistic today. :yes:
     
  19. kneeper

    kneeper FORUM ADVISOR Forum Advisor

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    Great report on the massage! Loosening up your muscles can only help the situation. :thumb:
     
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  20. Rockgirl4

    Rockgirl4 senior

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    I am glad the massage helped. I really think it comes down to "how" we help the knee calm down, heal, and bend. I had severe muscle guarding up through Post-op week 4 or 5, and just now my PT can tell how much more relaxed my knee/hamstrings/calf is. I think some of us just need more time, more help, and other non-traditional approaches. I don't see why many PTs and surgeons can't grasp that we're not all alike.
     
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