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TKR Trailspud Recovery thread

What a gorgeous part of the world you live in, Trailspud! Just to clarify, those are HAND weights you've been using, right? Every day I was in rehab, I had OT in the afternoon--and in my case, that was dedicated to building upper body strength and practicing proper "neck hygiene." I started with 2-lb. "Smart Belles" and worked up to 4-pounders. All while seated, no stress on my knee whatsoever.

I'm a bit anxious after reading your story, as my left knee lacks an ACL after a nasty onstage fall. Have no idea what shape my PCL is in, since it hasn't been MRI'ed since 1994 (and with all the metal in my right leg & knee, it probably won't be again). AFAIK, only the condyles themselves are bone-on-bone trashed--had a successful medial meniscus repair (sutured) back when I ruptured the ACL which was debrided rather than reconstructed (no time to go through the rehab from an open reconstruction since I had to be in China 6 wks. later). No problems with ripping or tearing anything else--just that since 2005, every time I've asked my orthos whether my left knee was ready for a replacement, the reply I'd get was "You tell me." The current plan is to replace my left knee sometime either in late Dec.-early Jan. or (if my surgeon has time) early March, since I must fly to Toronto the last week of Feb. I'd prefer the earlier date so that my entire spring gigging schedule needn't be put on hold the way this summer's was--for a folkie, spring & summer are when the gigs and festivals are. (Fall is for conferences, winter for staying in town or holing up in the studio). But my surgeon's prime conference/convention season is Feb & early March--and he lectures and presents at most of them. Meanwhile, my PT today thinks that if I keep up with strengthening my left quad (I "graduate" from formal therapy tomorrow, starting on-my-own honor-system maintenance at a health club come Oct.), I should be able to postpone a left knee replacement for months if not years. But that bone-on-bone medial condyle's a real.......uh, "female canine."
 
Diva,

Yes, arm weights...10-25 lbs. I'm not a weight lifter, but it feels good to pump some blood through the whole system. I'm home now and weights are upstairs so maybe, I'll get someone to bring them downstairs tomorrow. Today was for some short walks down to the end of my street and back (short block).

Many implants have PCL-substituting options (if it's not in good shape). I don't think that's a real issue for most. The iTotal requires an intact PCL so that's why my doc had to change plans during surgery. Your surgeon will have options, too. I wish you well on the surgery timing and your writing and performing.

The American West is beautiful. My avatar is one of the 400 alpine lakes in Idaho's Sawtooth Mountains. The waterfalls photo is in Provo Canyon, Utah. I hope to make it to some alpine lakes next summer.
 
trailspud said:
I got home to SW Idaho last evening...doing some short walks and light stuff around the house when I'm not napping. I saw my doc yesterday morning...X-Rays looked great, knee looks like it should, but I probably do have a gout attack going on.
Click to expand...

Yes, there is no place like home. And napping isn't the same unless you are in your own bed.
I was a hiker before my knee issues and hope to be again; at least day hikes. There is something so unique and peaceful about being around nature, waterfalls, and animals. I'm giving myself to next spring and then will plan a few small hikes at first; perhaps on ocean trails.

Hopefully your gout is doing better now. Can you share with us what you have been doing for it so others, if they have the same issue, might know what works. Ha, ha I just reread my sentence and had written goat instead of gout. :heehee:

Nothing compares to good looking xrays! Let me tell ya! Congrats on those Xrays!
 
1ELISEA,

The gout, or what appears to be, is still a problem. My Utah surgeon gave me a prescription for Colchine (Colcrys). It's 2*day for 6 days w/ 1 refill. So far, it's not a cure. But, so far none of the possible nasty side effects have occurred either.

Mt foot and ankle are better today, but I think that is because after a half dozen short walks outside on Thurs. and just a couple of 125m walks yesterday morning...I decided to quit that for awhile and just move around the house w/o bearing any more than toe touch weight. If not resolved by Monday, I will probably go see my general doc. I also started a two week course of Celebrex and just took the 4th day's dose (1*200 per day). I'm hoping that will help reduce the ankle swelling in due time. I just have today's injection of Lovenox and that is the end of my DVT prevention therapy. I may add a couple of baby aspirin (81mg) once or twice a day although the 10 day series of Lovenox should have been sufficient.

My foot is less swollen this morning, but it's not back to normal and my ankle still has significant swelling. I'll just try staying off it for the rest of the weekend. I have a dumbbell bench nearby with some light weights to help me get a little exercise. I feel better after each short, easy session.

I left the post-surgery CPM machine in Utah, but by yesterday afternoon I felt like using CPM again would help. We rented a local unit. I had lost about 20 degrees of flexion in the two days since leaving Utah, but this morning I'm back to a bit over 90 flexion and near full extension. Moving my leg feels good...slow easy bending and straightening.

It's kind of crazy that my knee, which hurts and is swollen, has been the far lesser problem to deal with. I just hope I can start putting a bit of weight on it fairly soon. In the meantime, there is a lot of football to watch this weekend.
 
Today is three weeks.

A couple of things slowed me down in the first 2+ weeks...at least compared to what I had hoped for. First, I was not able to have the iTotal implanted. Although the traditional implant which was used is on the bone sparing side, about 1/3 more bone was resected than if my PCL had been intact and the iTotal could have been used. Next, and more impactful, was a nasty bout of gout which hit my right foot and ankle on about day 3 or 4. It worsened as I continued to walk on it...good for the implant, bad for the gout. I finally got wise and took a couple days off of weight bearing, started a 10-day course of meds, and finally got back on the recovery track somewhere near the 2-week mark.

At two weeks I tried 5 mts. on the elliptical machine at the gym, but my knee seemed to be slightly more swollen the next day so I took four (4) days before trying again. On Sunday, I did 12 mts. on the elliptical (along with some other light work). On Monday, I had slightly more flexion w/o any additional swelling. So, yesterday (Monday), I hit the gym for 20 mts. of lifting, 30 mts. on the arm cycle (pulse 130), and finished with 15 mts. on the elliptical (pulse 135). I came home, sat on the porch in the late summer afternoon sun, iced my knee, and finally felt something close to normal. I'm able to go up and down stairs now and in need of a cane rather than a walker. I am not sure how much the gout impacted my recovery, but looking back it was pretty nasty for awhile.

I was somewhere around 95 flexion yesterday. I am resting this morning, using the CPM, icing, and if my flexion is as good as yesterday, I will hit the gym again this afternoon. If not, I'll take the day off and just walk and do some slow circles on the stationary bike. My big challenge is going to be getting extension back. My right knee has not been straight, or close to straight, since somewhere around 2000. I was at -20 ish before surgery, maybe a little worse. I hope I can get to -10 and possible -5, but it will take a long time. I see my doc in Boise on Thursday. He is in town with BYU for the game vs. Boise State. I have not started PT, but I will after after I see my doc. Right now, I am just icing, elevating, using the CPM, stationary bike, hitting the gym for easy stuff, and doing a few basic exercises at home. I start back to work in six days, but thankfully have a job where I can sit as much as I need to and, at least partially, keep my knee somewhat elevated at times.
I'm taking a pain med (Percocet) every 8-9 hours plus one 200 mg Celebrex daily. The Celebrex was prescribed as a secondary aid to the gout now gone. I only have a couple days left of the Celebrex but I think I should be able to shift to a mix of ibuprofen and acetaminophen soon.

FH
 
Wow, are you sure you want to start working in six days? You will be at four weeks. That is pretty early to start to work--for one thing, you will still be tired after the surgery, for the other, your knee will swell if it is down too much. You cannot elevate properly if you are sitting. I would try for a few weeks more. Kelly
 
Kelly,

I probably could survive another week or so off, but I am mentally ready to get back to work. I teach 3*90 mts. blocks each day and have two senior classes and one junior class. My classes are fairly small this term (alternative high school). I've done this job for a long time so while I may not be at my best for awhile, I think I'll do fine. I'll be able to elevate my knee before my first class and at lunch...using a camping pad and a few books. Otherwise, I'll have the leg up as much as possible w/ice. I have a chair w/leg support. It's not proper elevating, but it should minimize additional swelling. Then, I'll have the rest of the day to maintain. If things should worsen, I can take some additional strategic days off.
 
trailspud said:
I probably could survive another week or so off, but I am mentally ready to get back to work. I teach 3*90 mts. blocks each day and have two senior classes and one junior class..
Click to expand...

Just give them all a surprise test and make it an open book. :heehee: Then leave for 90 minutes and hang someplace with your leg elevated and iced.

I started back last week and I was ready to go back mentally. But my knee has had other ideas. My whole leg was swollen by the end of the week and the knee muscles have been a hurtin'.

And your avatar is very cool!
 
trailspud, please check with your surgeon about using the elliptical at this early stage of your recovery. It puts some stress on that new joint that are usually not recommended this soon. A stationary bike is the best form of exercise right now and even that should not be done to the point of having pain or swelling afterwards. Watch any weight machines with that knee as well. You want to baby that knee in these early days and months.
 
1ELISEA, I have sort of a unique teaching situation which should help, but I would have no surprise if I need to take another few days off. The avatar is one of roughly 300 alpine lakes in Idaho's Sawtooth Mountains. It's been 10 years sisnce I have been up in that high country and I'm looking forward to getting back there soon.

Jaime, I see my surgeon tomorrow. Today, after 3 days in the gym, I'm resting except for a few short walks which are so much nicer now that I am using a cane rather than a walker. I'm going easy and short and making sure no additional swelling occurs. I can ride the stationary bike, but I'm still a little short of ROM to allow normal technique. I'm just doing about 100-200 revolutions slowly 2-3 times per day with very little resistance. I'm very much looking forward to cycling again normally. My surgeon is on the aggressive side, but I appreciate the heads up on the elliptical. I will make it a point to ask him directly about it. I am not lifting any weights with my legs...just some light upper body stuff including an upper body (arm) cycling machine for my much loved cardio exercise.
 
Good for you....sounds like you are on track then.
 
Jamie,

I ended up meeting with my surgeon this evening. He was in Boise for the BYU game tomorrow night. He thought my knee looked good and thought my range of motion is okay for now given that it was around 90 flexion pre-surgery, but he wants me to start pushing it now. I'm around 95 at weeks + 1 day and he wants me up around 110 by 6 weeks. He thought the elliptical was okay, but he prefers me to focus my efforts on ROM until I make more progress. I know there is some contention on this forum about ROM and how long it takes for progress to be made. But, I suppose I'll follow my doc's orders as best I can. I will be starting PT on Friday or Monday.
 
3 weeks + 3 days: First day of PT. I lined up PT with a friend whose daughter I coached in club soccer a few years back. I heard he was pretty good and today I found that to be true. I was very pleased that with his help I reached 107 degrees of flexion. I'm already close to my OS's goal for 6 weeks out (110). I've set 120 as a new goal at 6.5 weeks. My PT also helped my straighten my knee with some manipulation and stretching. We didn't measure extension, but I asked if it was better than 15 and he said "oh, yes" so I must be close to 10. My right knee has not been straight for so long that near full extension is going to be a challenge. A good first day of PT.
 
Great trailspud, you're doing well!:thumb:
 
"Pushing" is an ambiguous word and means different things to different people. The general interpretation of new members is that it has to be an extreme "no pain, no gain" kind of pushing but that's not appropriate in TKR recovery. We've long exploded that myth and converted it to no pain MORE gain Myth busting: no pain, no gain.

Then there's the old chestnut about the window of opportunity which has also been roundly debunked Myth busting: The "window of opportunity".

So at 3½ weeks you need to be conservative and take it gently. I know you know all this, just wanted to urge you not to over-interpret your surgeons advice. Follow it by all means but still stick with the mantra
- rest, elevate, ice and take your pain meds by the clock
- if it hurts, don't do it and don't allow anyone - especially a physiotherapist - to do it to you
- if your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again
- if you won't die if it's not done, don't do it
- never stand when you can sit, never sit when you can lie down, never stay awake when you can go to sleep!

Otherwise, well done you! And keep up the GOOD work, okay? :thumb:
 
Hi Trailspud!
Welcome to Bonesmart!
As I read through your posts, I am finding that you are like me.
I am also a dedicated hiker (live in New England), and I had my TKR in March2010.
I pushed myself hard because I had a vision of doing a planned backpacing trip in August. Needless to say, didn't make it.
All I can advise you is to please let your knee tell you how fast/slow you recover.
I had a ton of trouble with the elliptical. The best stuff was bicycle and weights to get the legs back. Good old walking works too!
I pushed myself through pain and swelling because I wanted my life back. Don't do it! (I have a different life now).
I also returned to work early which was very bad for my unhappy knee, though your job likely allows you to rest and elevate AND teach.
You sound like you are doing great! Just don't push your knee past it's limit. It will win in the long run.
Best,
Sandy
 
Thanks Sandy (Trainwreck) and Josephine for the words of advice.

One Month Today: 115 degrees Flexion and 6 degrees Extension. Both better than 2 days prior (111, 9). I'm very pleased with my progress at this point in time. My surgeon wanted me at 110+ flexion at 6 weeks so I'm ahead of that already. I was confident the flexion would come in due course. I'll keep shooting for more, slowly, but surely.

My PT has been awesome in helping me get better extension. I was somewhere around (probably over) 20 degrees at surgery. Getting to 6 today was good news. My (right) knee has not been straight since sometime between 1998 and 2003...really could say exactly when...so getting extension back as close to 0 as possible is a priority. I find working on flexion on my own is much easier (CPM and stationary bike both work well), but extension is tougher. I didn't ask, but it sure feels like a small bit of my quads were cut during surgery. Straight leg raises hurt a lot.

Going back to work did take plenty of energy...I crashed each day once back at home. Other than two PT sessions...no workouts this week. I hope to hit the gym this weekend.
 
Well, they do! But it's highly unlikely you had the cut you think you might have had. It's a very old fashioned procedure and went out of fashion years ago - except for especially complex revisions. You probably just need some good pain meds.
 
Josephine,

You are probably correct. I'm curious, however. My surgeon did have to expand his incision in switching from the iTotal (planned) halfway through surgery to a traditional implant. His incision, about 10 inches, does extend above the knee. I'll ask when I see him again in a few months.

One thing I will agree with you on, from our past conversations, is that the traditional implant used will be just fine and should function very well. The key is the skill of the surgeon and in that I am highly confident. I started PT at 3+ weeks and the first thing my PT said was your incision looks incredible. My sister, a nurse of 40 years, said the same thing. Although my knee is still stiff, swollen, and painful...it feels so, so "smooth" when I cycle or do the elliptical machine. No clicking, clunking, catching...just a smooth, smooth motion. I haven't had that for nearly 20 years.

Best of wishes on your 2nd one.
 
Sounds like you're doing really well, trailspud!
 
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