TKR Total knee replacement - despairing

[Dolphin5]

Thank you everyone for your input which is really appreciated.

To clarify a few things....I can't take ibuprofen as I'm on Apixaban blood thinners for another 4/5 months. Regarding the driving, with only being able to lift my foot about 4 inches off the ground, my query really was regarding the length of time before I'm unstiff enough to drive, not anything else. I'm a very confident driver, so once I'm able to sit comfortably in the car and in control of my legs/feet then I'll drive. Currently, with very long legs, it is with extreme difficulty that I can even get into the passenger seat In my car. In taxis I get into the back seat by sitting on a silky, slippery, piece of material I take with me, sit on it and have to haul myself backwards to almost the entire back seat before being able to get my feet in. I then sit askew. Not great for my back of course but I have no choice.

I cannot do elevation whilst sitting. It hurts my back and hips. I'm doing elevation lying flat on the bed. Ice pack on, minimum 45 minutes, twice a day. In the evening I sit in my chair and have my legs straight in front of me on a stool. Preferable to having my feet on the floor. I don't sit longer than an hour before getting up and moving around a bit.

I rang the clinic yesterday to book to see another physio. I explained I didn't want to see the previous physio again or even speak to her. Was told a senior physio would ring me. Guess who rung? The original physio. She said that any other physio would be the same as her. I told her how her hurting me a week ago caused my knee to swell and be so painful that I couldn't do anything for several days. No apology of course. I then decided not to bother seeing another physio. I know what I need to do now.

I actually haven't done any of the exercises since seeing her a week ago but I am beginning again today with stretches and perhaps a few GENTLE heel slides. Walking as and when. I'll try and gauge my knee's reaction to the exercises to decide whether to increase or decrease them.

 

[beralc]

I cannot do elevation whilst sitting. It hurts my back and hips. I'm doing elevation lying flat on the bed. Ice pack on, minimum 45 minutes, twice a day. In the evening I sit in my chair and have my legs straight in front of me on a stool. Preferable to having my feet on the floor. I don't sit longer than an hour before getting up and moving around a bit.’

I’m glad you’ve worked out your own approach now to PT. I’ve only seen a physio once in 9 weeks and I’ve only done the exercises I mentioned in my last post to you, not the ones they recommended.
I know you said you can’t sit and elevate but could you be in a semi recumbent position. Getting swelling down is really going to be key at this point after you’ve been active/exercised, so if you need to lie down a few more times during the day, would that impact your day adversely, because it may be worth just investing that time while you’re finding things out and progressing.

I think the other consideration with driving is reaction time. So physically I’m probably nearly there in term of being physically able to drive, but I’m delaying it because I know my reaction time isn’t that it was because of tiredness. It’s Indy important to you as a means of independence but you have to get that decision right.

So start your weekend gently some nice soft exercises with activity, elevate as much as possible, with regular pain relief and things will start to move.

 

[Jamie]

@Dolphin5 … if you’re asking when the stiffness in your knee will lessen enough to allow you to drive, that’s difficult to answer. Normally surgeons will tell their patients they can drive at 6 weeks. But, as you noted, a person has to be able to react in an emergency and be able to safely use the gas and brake pedals. The difficulties you’re describing are more related to swelling than to actual healing. And it’s impossible for anyone to say when your swelling will reduce enough for you to feel in control when driving.

I know it’s probably not what you want to hear, but I think you would be wise just to allow one of your sons to transport you to and from the party. Even under the best conditions, you’re still going to be less than 3 months out from your surgery. What you’re planning is a pretty long car trip even if you’re not trying to drive yourself. Sitting that long and the vibration of the car impact a tender new knee. Then you will have all the activity of the party itself. Even if you sit most of the time, gravity will ensure that your swelling will likely increase. At then end of the party (or the next day, if you’re staying over), you’d have to drive yourself back home again. This is not a recipe for a good and memorable experience for you.

This is a time to allow yourself to be pampered. Your sons sound wonderful and the offer to get you to and from the party is perfect. It would guarantee a much less stressful trip. That way if your knee is acting up, you could lie in the rear seat of the car with ice to be more comfortable. Let your boys pamper you. You deserve the royal treatment! There will be other days when you can drive to and fro. Let this be a very special event for you. I wish you the best as you make your decisions and plan for this important event.

 

[Layla]

HAPPY TWO MONTH ANNIVERSARY!

I rang the clinic yesterday to book to see another physio. I explained I didn't want to see the previous physio again or even speak to her. Was told a senior physio would ring me. Guess who rung? The original physio. She said that any other physio would be the same as her. I told her how her hurting me a week ago caused my knee to swell and be so painful that I couldn't do anything for several days. No apology of course

Right there, in bold type.

Another PT may be warmer, more empathetic and capable of building a rapport with you making a great difference. The physio you met with doesn't sound very approachable or supportive. Different tones of voice and ability to listen can also affect how we perceive the PT. Some people simply struggle relating with others and have a poor delivery which can make all the difference in how we feel about them personally. When you feel more comfortable with your PT you're more likely to follow their recommendations. You need someone to help boost your confidence while healing, not an aggressive authoritarian type of personality. If you feel you need PT, or want it, please don't let her words stop you from making an appointment with a different PT.
Happy Saturday! I hope you have a nice day, Dolphin.

 

[Jamie]

Layla is right. Since you were told that you’d be called by a senior therapist and you got this person again, my guess is that she intercepted the notice to call to avoid being “on report.” At any rate, you only have her word that “all therapists would be the same.” At some point you could call the therapy clinic and ask to speak with the person in charge. Tell them what happened and ask if they have therapists who would work with you. Then make an appointment with that person. Therapy isn’t absolutely required, but it can be very helpful with the right person.

 

[Dolphin5]

Hi All. Again, thank you for all your helpful comments and encouragement. And so speedily

The physio also told me I'd have to wait 4 weeks to see someone. On reflection it was wrong, after saying specifically that I'd didn't want to speak to this physio, Dawn, for her to then ring me. I'm going to ring the clinic again on Monday, ask to speak to somebody senior and request seeing a different PT. Even if it's 4 weeks time. I can then always cancel if I decide at that point I don't need to see someone.

My party weekend. You may think that because of my age it'll be an afternoon party. Nah. 6pm to 12am with a singer booked singing 60's songs. Big dance floor. I'm a party animal. Always has been, always will be. I'm going up on the Thursday, my actual birthday is on the Friday, party on the Saturday, and then my son is doing a BBQ on the Sunday with a different singer booked. Home on the Monday. So yes, you're right, I need to be driven.

In the evening I watch TV with a dog and a cat on my lap. If I recline in order to elevate I can't watch the TV. I'll try and do more elevation during the day. I'll ice pack continuously during the evening and can do ankle pumps and static gluts (squeezing the buttocks).

Thanks again everyone.

 

[eaglemom]

I have nothing helpful to add here. But I just love your birthday weekend and all that is involved. It's great your a party animal - keep it up.

Do try to ice so the knee behaves for you.

 

[JWS]

I had my TKR seven and a half weeks ago. Despite doing all the required exercises, and the past few weeks doing a total of 40 minutes walking around my bungalow every day, my knee still feels like a block .

As others will tell you are really over doing it at less than two months. IMO never push into the extreme pain zone it well cause swelling and cause pain witch well set your healing progress back.

 

[Jockette]

I truly hope you enjoy your party weekend. You’ve been through a lot in your recovery and hopefully this will take your mind off your recovery. It will be nice seeing your friends and family, enjoying the music.

I can almost guarantee that you will pay a price with increased pain and swelling. BUT, if you know that ahead of time, and accept that, and take steps to lessen that, you’ll be able to cope with it.

I know this by experience, and in my case, due to lack of experience, I did not take appropriate steps to take care of myself.

I was 5 months post op when my son got married. The wedding took place 90 minutes from where I live. The evening of the rehearsal dinner, my husband and I drove there and back home the same day. I managed well enough that day. The next day, the wedding, we again drove that 90 minutes there. This day didn’t go as well for me. There was a lot of standing, which even at 5 months was painful. The only option to elevate was with my leg on a pew in the back of the church, before the ceremony. This wasn’t even remotely comfortable, due to spine issues, so I didn’t do it for long.

There was a long time between the wedding and the reception, hardly anywhere to sit until we could actually go into the room where we ate dinner. So, I was either standing, or sitting, with my feet down on the floor. I was in a lot of pain.

We did not go home that night but stayed with friends, hoping that would be good for me, especially since the evening went very late (dinner didn’t even start until 8pm) However, in all the busyness of the occasion, I forgot to take my ice packs with me, and my friends didn’t have anything suitable for me to use, so, no icing. But I did take my foam elevating wedge with me, so at least I was able to elevate overnight.

The next morning we had breakfast with family, then the 90 minute drive home. By this time my whole leg was very upset, with pain and swelling.

This whole weekend caused me quite a setback, and again, this was at 5 months post op. There really wasn’t much I could have done different, other than have my ice packs with me.

So, my advice is, have a place for you to sit and comfortably put your leg up. Have ice packs with you at all times, and don’t be embarrassed to use these options.

If/when you have the increased swelling from this weekend, realize that it will be from “cause and effect.” Give the swelling lots of time to go back down. Don’t listen to people (especially medical) who might tell you that you’ll never get your ROM back. Any decrease in ROM will be due to swelling. All will settle down in time, but it will take time.

Enjoy the party, and definitely take steps so that you can enjoy it. Life doesn’t stop just because we had a knee replacement. (Like birthday’s and weddings) And then, give yourself lots and lots of time to recover from any repercussions.

 

[Jamie]

During the times you want to be resting, watching television, icing and elevating, do you have have access to a tablet? I’m thinking if you or your sons have a tablet and internet access you could use a streaming service instead of actual television to entertain yourself. It might be worth checking with them even if you don’t have a tablet and streaming service. At least here in the US, the younger generation is used to watching television on their phones or tablets. While on vacation, I’ve also done streaming on my laptop computer, so that works as well. You could position it so you could watch while reclining.

 

[Dolphin5]

Hi All. Thank you for your comments and suggestions.

I won't use a tablet for my entertainment. I have a large TV screen and record everything so I always have a choice of watching a documentary, drama, comedy etc. it's my down time so I'll carry on with this BUT doing almost continuous icing and ankle pumps with getting up about every 45 minutes.

Yes, with my party weekend I'll definitely take my ice packs. My elevation is on a suitcase!! It's actually very comfortable with 3 cushions on it so I will do this at my son's as and when I can. I've already said I don't want to be decorating the room on the Saturday afternoon as I want to keep my feet up and rest. There will be enough of them to do all this. I'm not even sure we'll go out on my birthday on the Friday due to the busy next two days so it'll probably be a ,ot easier than your wedding experience Jockette.

I just want to see even a miniscule of improvement by the end of the next 7 days. Even half an inch extra movement would be incredible. Trying and experimenting to get the balance right. Such a beautiful day today and normally I'd be going for a 2 mile walk by the sea and perhaps having a coffee in one of the seaside cafes. Be patient woman!!! My dogs are such wonderful companions. When I got home feeling upset and exhausted last Tuesday from seeing the consultant and the long trip, my dogs being overjoyed to see me was such a comfort.

Think of this....if a man put his wife and dog in the boot of his car and left them there for half an hour, which of them will be pleased to see him later

 

[Layla]

Good Afternoon and Happy Sunday, Dolphin!
I hope your day has been good so far. BoneSmart member, Shea, posted the ice pack below on her thread and it made me think of you! With a skirt below the knees you could get by with wearing this at your upcoming events and no one would be the wiser. Just a thought...

@Dolphin5

 

[Dolphin5]

Hi Layla

Thank you for that. It does look very good and also that it would stay on as it wraps around very well. The only thing is that it would probably need changing about every 20 minutes which is about as long as ice packs seem to stay cold. I'd probably just forget and wear it all evening! But thank you. And a happy Sunday to you too!

 

[Dolphin5]

With much brighter days now I noticed this morning getting out of the shower that, apart from my scar being very purple, the rest of the going leg going down including my foot is also a purple tinge. I've googled this and it says this can be due to trauma, circulation, not enough oxygen in the blood. Any thoughts on this please? Should I ring my surgery? Thank you.

 

[Jamie]

This could be from the hot shower. If it has disappeared by now, I wouldn’t worry. But if the discoloration has lasted a couple of hours, I would contact your surgeon or your GP.

 

[Dolphin5]

Woke up about 4am with my knee hurting and a feeling of a tight band round it. Yesterday I did 2 X one hour elevating, 10 mins walk round the bungalow, 10-12 icing and a few quad exercises. Why the pain? Unless I inadvertently moved awkwardly during the night.

Spoke to my previous physio yesterday. Again she rang me after I'd left a message saying I wanted to make an appt for a physio and also to speak to a manager to make a complaint. She said her colleagues were busy and since I'd said I wanted to speak to somebody immediately, she'd rung me. I told her I hadn't asked to speak to somebody immediately. She apologised profusely if she'd upset me. Anyway, after initially trying to get me to travel 10 miles to another clinic since apparently she's the only one who deals with knees, she got me an appt with a senior PT this morning. Taxi booked. Open mind as to whether this person will be able to help me.

Opened my curtains to a beautiful day which made me want to cry as I want to be out there walking my dogs...... I've only been doing the new regime with the elevations and icing for 6 days so I guess I need to be more patient. Longing for the merest sign of improvement with mobility but my knee is stiffer than ever.

 

[beralc]

Opened my curtains to a beautiful day which made me want to cry as I want to be out there walking my dogs...... I've only been doing the new regime with the elevations and icing for 6 days so I guess I need to be more patient. Longing for the merest sign of improvement with mobility but my knee is stiffer than ever.

This. It’s extremely hard especially for those who are normally very active, but it’s the greatest truism. There’s nothing else for it, but to accept the situation and move with it. Six days is such a short time in the great scheme of things.

The tight band is extremely common and can remain for months sometimes. Just keep doing what you’re doing and know that even though you can’t see it, healing and therefore progress is being made every hour of every day.

 

[mendogal]

Yes to what @beralc wrote.

The tight band feeling is one of the top complaints from our members after TKR. It can easily persist for three to six months and in itself is NOT a reflection of having overdone activity or moved badly.

Josephine, our Nurse Director Emeritus, explained:

"That tight band is caused by scar tissue but not the adhesions type of scar tissue. When the surgeon opens up the knee, he has to undercut the skin and superficial structures from that centre line to each side of the knee in order to get good access all round the bones. Part of the healing process is when those flaps reattach themselves to the main body of the leg. This healing creates a thin layer of scar tissue across the front and sides of the knee. But scar tissue isn't anywhere near as flexible as normal tissue so it feels like a tether or a clamp across the knee if there is any swelling and during later normal activity.

It will gradually reduce in size and thickness over the following months until it reaches a point where it's not substantial enough to cause this sensation, same way as does the incisional scar in the skin. But be warned that this can take several months to dissipate completely and sometimes or every time, lots of walking or standing can make it worse. It differs greatly for every individual."

 

[Jamie]

@Dolphin5 …. If you’re not doing some gentle bends and stretches each hour or two in addition to what you wrote in your post, I suggest you try doing that. You only need to do 5-6 of each of the stretches and bends, but this is sometimes beneficial when you’re spending large amounts of time icing and elevating. It helps keep the joint lubricated and more mobile without stressing the joint and soft tissues. You want to do each of the bends and stretches to the point of mild discomfort and hold for about 5 seconds.

 

[EalingGran]

this morning getting out of the shower that, apart from my scar being very purple, the rest of the going leg going down including my foot is also a purple tinge

Agree with @Jamie that if there is more long-lasting severe discolouration- then report it.
But if it is fairly transient, I wouldn't worry.
I have generally rather poor circulation with legs that can get mottled purplish when cold. I have noticed that even two years out- that my operated leg tends to be a bit more purplish in the mornings and my chilblains are worse on that side.
I think that some small blood vessels are cut and that does affect circulation longer term.