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TKR Total Left Knee Replacement CaredFL

caredFL

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I had my knee replacement 10/28 so it will be 1 week tomorrow morning. I went in at 5a.m and was home by noon the same day. Felt pretty good as I had the nerve block still in place. The first evening the nurse came to check on me followed by PT for an evaluation. Not a lot of pain just uncomfortable muscle stiffness. Day 2 the nurse came back to remove the drain. PT came and I had my first gentle session. We did a few exercises but nothing too difficult. Day 3 no nurse or PT and that was the day the nerve block started wearing off. I'm taking meds as directed and Ice and elevation. Pain is manageable. Had PT sessions again on day 4 and 5. Again nothing too difficult at this point. I'm able to sleep pretty good and able to get my leg up on the bed without assistance. Good thing as my Sister was with me for the first week but she went home yesterday. So, I am by myself with help from neighbors and friends as needed. My Doctor also uses the CPM machine and I find it more painful than anything. In fact, I am only doing it as I can and not nearly as much as is prescribed. I have a follow-up with OS on Wed and will discuss it at that point. Anyone else use the CPM? I know it's not used a lot anymore.
 

Jockette

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Welcome to Recovery! It sounds like things are coming along well.

I have not used a CPM machine but I know there are mixed reviews, both from the medical side and from the patient side. Definitely tell your doctor it is causing you pain. We do not recommend “working through pain” as that just keeps your knee upset and swollen. I would take a break from it and see if your pain settles down. Just continue gentle knee movements and short walks. Being alone will give you all the walks you need right now, since there’s no one to get things for you. Are you able to adjust the setting to a more comfortable level? Maybe try that.


I will leave you our Recovery Guidelines. Each article is short but very informative. Following these guidelines will help you have a less painful recovery.

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
ice
take your pain meds by prescription schedule (not when pain starts!)​

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

5. At week 4 and after you should follow this

6. Access to these pages on the website

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 the 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 the member’s history before providing advice, so please post any updates or questions you have right here in this thread.
 

Sara61

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I use the cpm machine at the PT facility twice a week then it is only for max 30 minutes and a very gentle movement - no pain whatsoever actually it is quite relaxing. For me it has helped :)
If it is painful then you are not benefiting in some cases it could do more harm than good.
Talk to your PT or Doctor maybe the setting is on too high.
Good luck with your recovery xx
 

Celle

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My Doctor also uses the CPM machine and I find it more painful than anything. In fact, I am only doing it as I can and not nearly as much as is prescribed. I have a follow-up with OS on Wed and will discuss it at that point.
If the CPM machine is causing you pain, it's doing more harm than good.

Your knee isn't ready yet for the degree of bending that the machine is set for. Can you adjust the degree of flexion (bend) to a lower number, one that causes discomfort but not pain? If so, do that and try again - just so that you can assure your surgeon that you have been trying.

If that doesn't work, the forget about the CPM machine. It isn't essential and whether you use it or not will make no difference to you eventual ROM (Range of Motion).

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 knee is capable of achieving good ROM right from the start. Its ROM will gradually increase as your knee heals and the internal and external swelling decrease.
 

tlfiore

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@caredFL your post is great news! Sounds like you are on your way to recovery. The CPM is an interesting concept and something I was hoping my OS would prescribe. Seems like even here in the USA, post-surgical protocols vary greatly. If the flexion movements with the CPM cause pain, I too would see about discontinuation.

Please keep us posted. I hope you are feeling better with each passing day.
 
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caredFL

caredFL

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Are you able to adjust the setting to a more comfortable level? Maybe try that.
Yes, I can control it and have been only increasing as I can without pain.
 
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caredFL

caredFL

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Seems like even here in the USA, post-surgical protocols vary greatly.
Yes, so different. My sister had a TKR 4 years ago and a completely different protocol and she did great. My nephew is a new Physical Therapist and he said not many Drs use the CPM at this point and was surprised mine was using it.
 

tlfiore

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@caredFL Yes, the trend seems to be moving toward utilizing the CPM less 'n less, as your nephew cited. This is what I was told by my OS. Ah, I guess things change frequently in this orthopaedic field-smile.

How are you feeling today? Thinking about you!
 

LindaO

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I used the CPM for my first two TKRs and found them quite helpful in getting my ROM back. I started gently and slowly increased the flexion as my swelling went down. Unfortunately, my insurance at the time didn't cover the CPM and I had to pay a large sum out of pocket for it.

For my revision, I actually went onto ebay and bought a used CPM machine. My pain has not been as bad this time around and although I have used it, it hasn't been as much as I previously used it.

Moderation in all things will help you the most.
 
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caredFL

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Moderation in all things will help you the most.
Yes, I think that is the key. When the machine was delivered the instructions were to increase 5 degrees each day and that is just too much for me. I am using it with a much more gradual increase. I believe Medicare pays for 3 weeks.
 
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caredFL

caredFL

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How are you feeling today? Thinking about you!
Feeling good this a.m. but not as good after PT. I started 'in home' PT the day of surgery and today was my last day of 'in home'. Started getting those 'zingers' everyone speaks of and I know why they call them zingers. I will be getting set up as an out-patient for the remainder after my OS appointment tomorrow. I don't have stitches or staples on the outside, glue instead. So, I haven't been able to shower and am looking forward to getting okay for a shower!
 
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caredFL

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So, I had my post op follow-up yesterday which was 9 days post surgery. All looks good and my OS is pleased with progress. Finally was able to shower yesterday! I had not seen incision since day 2 so was anxious to see it and surprised it wasn't all that bruised. I had more bruising where the femoral block went in. Anyway, I have been released to out patient PT which will start next Tuesday. Frankly, glad to have a few days break from formal PT. My bend was 94 and extension -2 so I was told not to be too concerned at this point with the bend as it will come as swelling goes down. That was good to hear from OS. Was up a lot yesterday so more swelling this a.m. so I have been elevating and icing all day and it seems better tonight. Pain is manageable with Tylenol and Tramadol. Walking with a cane but really feels stable enough to not use it from time to time. Being careful with that for now.
 

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My bend was 94 and extension -2 so I was told not to be too concerned at this point with the bend as it will come as swelling goes down.
That ROM at a little over a week out is outstanding. You have nothing to worry about.
Pain is manageable with Tylenol and Tramadol.
This is also outstanding!
Walking with a cane but really feels stable enough to not use it from time to time. Being careful with that for now.
Be sure and use something to keep you stable until you are sure that you won't fall. I used a cane for months while I was out in a crowd or on uneven land.
 

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Welcome! You sound like you are progressing nicely.
I was not sent to PT, but my OS gave me exercises and closely monitored how I did them.
I never even heard of a CPM machine before reading about it here. I lose muscle strength so quickly that I like the concept, though.
It is just my opinion, and I am sure there are many other threads that describe their PT, but @luvcats ‘s thread describes her positive experiences and @Carole4815 ‘s thread is a precautionary tale.
You certainly have beautiful Nurse Cats. They will get you through.
 

flacie1

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Wow you are doing great. I just got home from therapy and I’m on day 8 post op. My bend was 58. I know OS wants to see 90. That gives me 11 days to get even better. I’m not going to push myself but I’m going to work harder.
 
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caredFL

caredFL

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Be sure and use something to keep you stable until you are sure that you won't fall. I used a cane for months while I was out in a crowd or on uneven land.
Yes, I am cautious as I live alone and best to keep that cane with me for a while!
 
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caredFL

caredFL

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Welcome! You sound like you are progressing nicely.
I was not sent to PT, but my OS gave me exercises and closely monitored how I did them.
I never even heard of a CPM machine before reading about it here. I lose muscle strength so quickly that I like the concept, though.
It is just my opinion, and I am sure there are many other threads that describe their PT, but @luvcats ‘s thread describes her positive experiences and @Carole4815 ‘s thread is a precautionary tale.
You certainly have beautiful Nurse Cats. They will get you through.
Yes, I have read their threads and I also have a nephew who is a new Physical Therapist and we have had those discussions. My kitties are the sweetest but they are a little baffled about what all is going on with mom and all her visitors and machines. It has all rocked their little world!:spin:
 

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@caredFL Oh I am so happy to hear about your better day! WoW you are doing so well, IMHO!...you really are. I had a home-based PT session today (Friday) and my therapist focused on numbers, as I know they must. And while Rachael (my therapist's name...I thought it was Jennifer) said, "I'm good and on track," my flexion only managed to get to 83 today.

I guess the PT gold standard is approximately 90 degree flexion 2 weeks post surgery. I told Jennifer, "I do not even care to hear the numbers, as long as all indications show I'm moving in a positive direction."

Keep up the good work!
 
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caredFL

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I guess the PT gold standard is approximately 90 degree flexion 2 weeks post surgery. I told Jennifer, "I do not even care to hear the numbers, as long as all indications show I'm moving in a positive direction."
Thanks and Yes, I think you are right about the Home PT and 90 before you return to OS. Hang in there and I know it will get better.
 

Motherbone

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I was put on the CPM after my TKR last year but after 20 minutes they had to stop it because my foot went completely numb. Apparently it was aggravating swelling and circulation was compromised. I won't agree to it in the future when it's time to do my left knee.
 

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