TKR Twelve days post op for my second TKR: left side this time

[Josephine]

my knee is so uncomfortable thanks to my "yard marching" yesterday, should I exercise or not exercise today before therapy? I

No you shouldn't and you'd probably be better not attending PT either.

I just took my noontime Norco and for the first time in about 18 hours, my knee is not moaning and chirping with discomfort.

QED!!
[quod erat demonstrandum meaning 'that which has been demonstrated']

I don't want to set myself up for more aggravation later today but also don't want to become complacent with exercise and lose the gains I'd made (I feel like I won't get the good ROM back if I don't exercise).

It's not the exercising that gets you your ROM, it's time. Time to heal, time for swelling and pain to settle and time to heal.

One thing that seems to be missing from all the PT's protocols is that all your ROM is there right from the start, just waiting for all that to happen so it can show itself. In the general run of things, it doesn't need to be fought for, worked hard for or worried about. It will happen. As Roy has also said, exercise as in strength training, is counter-productive and does more harm than good. Normal mobility and stretches are the key.

You'll be fine, I promise!

 

[susanlondon]

Came from PT where I had 102 ROM. Very stiff afterwards but the stiffness was alleviated as I walked and moved (a friend drove me to and from PT, taking the scenic - and long - route home) once I got out of the car. PT mentioned keeping knee bent slightly with a towel or pillow under when icing, as icing will stiffen the knee and after all the work at PT to gain ROM, a straighter knee is not the goal.

He also mentioned using ice only a few times a day as too much ice will! as previously mentioned! make the knee stiff. I got home and promptly iced, even after a good fifteen minutes of ice at the end of my PT session. Any suggestions or opinions? I am three weeks out today...three weeks ago, I was in surgery at the same time I was on the exercise bike and doing ball rolls today!See how far we've come!

 

[Josephine]

He also mentioned using ice only a few times a day as too much ice will! as previously mentioned make the knee stiff. I got home and promptly iced, even after a good fifteen minutes of ice at the end of my PT session.

I don't agree with him. It's NOT icing that causes stiffness. Stiffness is a combination of swelling and pain. Ice not only reduces swelling it's also nature's natural pain killer. And 15 minutes will achieve little or nothing in terms of improvement. You should ice for at least an hour at a time, more is even better.

In fact I actually agree with his 'icing only a few times a day' as long as each session is a minimum of an hour!

 

[susanlondon]

I find myself quite conflicted with the advice offered by so many people connected with KRs. What one person says, another refutes; what one refutes another revises. It drives me somewhat batty.i guess the best thing to do is to listen to all and choose the advice that sounds the best for my particular situation.

New issue: my PT has explained that my leg needs to relearn how to walk normally, bending my knee as I take each step (I'm walking quite stiff legged). I've added a walk to my daily at home exercise routine. The road on which I live is a smooth and level macadam road, with hardly any traffic except for the folks that live on this little road, so I'm using it as my "track." I bring one crutch with me, as it seems I have more confidence bending my knee when I have the crutch to take some of the weight off (from to,e to time, I feel like my leg is going to give out when I'm walking-it hasn't, but it sometimes fells like it will). My first couple of walks were .25 miles (3 weeks and 3 days post surgery). It certainly was not a race. (I think it took about 20 mins.) Then, last night, after waiting for the sun to set, I walked a bit further (.426 mi., maybe). Again, not fast, but taking my time and trying to slightly bend with every step.

Of course, that turned out to be too much, as once I got into bed (I do ice immediately after walking), a new "ouchy" moment was apparent. Instead of in the same medial spot alongside my knee, where my PT explained that the tendon is adapting to being stretched after so many years of being shortened due to no cartilage and being bowlegged, this ache was, though still on the medial medial side, more toward the place that might be described as behind my knee. Spent the night tossing and turning, but not crying, as I figured that my own overzealous nature was responsible for my discomfort. Spending this morning with my knee up.

Here's another concern: someone told me that tendons don't like ice, they prefer heat. I've noticed that my knee feels better after a shower, but I also remember how in my hot tub, after my last tkr incision healed, caused aches.

Again, I'm confused about what is best for different parts of the healing knee. My head feels like a ping pong ball trying to cipher out all the suggestions and advice.

Going to put ice on now. Thank you for any kind and gentle advice you can offer.

 

[Josephine]

You're getting conflicting advice on here?

 

[susanlondon]

No, conflicting advice between BS and my PT.

 

[Josephine]

Gotcha! Let me explain why that is. All of us here, including me, have had knee replacements and we have put together a collective wisdom in the best way to rehab a knee. Almost no PT I ever heard of has had one and they generally work on a lot of half understood protocols, old fashioned notions and even myths like the "six week window of opportunity" one. It's entirely your call whom you think might have a better understanding of it all.

 

[susanlondon]

I am feeling quite blue today...5 weeks post op and although the pain is not quite so "ouchy," it is still prevalent. My PT suggests that with PT 3X a week, I may be doing too much on the off days (exercising 2X a day-5-10 mins of not quite full rotations on the bike, calf raises, knee bends with exercise ball against the wall, straight leg extensions on my back and side, quad sets, which I hate but feel better after doing, calf stretches, bending knee to place foot on step (not quite 7" from floor). I also pushed "it" by taking a step up on the stairs using my KR leg 20X yesterday. My PT started some of that with a very low step on Monday but said nothing to me about doing that at home. All he suggested was "motion" exercises.

I also spent some time (40 mins) walking around my backyard yesterday, pulling, from a standing position, the weeds which have, in some cases, taken over the flower beds and last fall's new shrub plantings. I felt "fine" at the time, by nighttime and this morning woke up stiff and uncomfortable. PT has been reminding me to bend when I walk which is hard to remember, and I'm conflicted about working out the stiffness and maintaining a working knee.

I am worried that my recovery from this TKR will not be as successful as the last (I know I've said that in this forum at least 100 times so far this month). I reached 108 ROM last week and am back to 90-100 this week. I know BS says the ROM will not "disappear," but I do want the same bendability to my knee with this KR as I have with my right KR.

When I called the doc's office to leave a list of some things I wanted to talk to the nurse supervisor about earlier today, all I could get out was a sobbing message asking them to call me back. I'm trying not to be "such a baby" this time around, but my worry and the discomfort make it challenging to be more positive. I also know that we reap what we sow, and the negative vibes are likely to produce negative outcomes.

I just can't seem to shake the blues today, as I'm eager to be up and about but don't have the freedom to do that yet. Feeling , which I know is temporary. Thank you, BS, for being there for "days like this," my mama says.

 

[kneeper]

Sounds like a case of joining the ODIC (overdid it club) with all that backyard activity. It's often hard to know you're overdoing until it's too late, but remember you aren't very far out in this long recovery road and you need to pace yourself. I'd say take a nice knee break of icing and elevating and very gentle motion today.

 

[susanlondon]

I spent Friday resting after a pretty strenuous PT session with some new exercises that weren't impossible, just different (strengthening) from my former sessions, which focused on flexion. I was advised to rest for the remainder of the day and only take what has become an almost daily ritual of walking down the road and back, a quarter mile stroll. It actually looks more like a crawl, I guess, to my neighbors, who are probably wondering why this formerly active individual is now limping along.

I woke up on Saturday feeling knee stiffness, and although on Friday my PT thought my bend when walking had improved (he's had me on the treadmill, both forward and backward at a gentle speed for the past two sessions, just to practice walking), I was once again lurching around from room to room on Saturday morning. I rode my exercise bike (which I've only been able to make a full revolution with the pedals on in the past few days-formerly sitting on it and "rocking" the pedals back and forth), but the stiffness stayed with me.

My son's girlfriend came over, and we went strawberry picking. I brought a hiking pole and picked berries from a standing position. There's no way I could figure out how to sit down on the ground between the rows. We were probably out in the fields for a little over an hour. My knee stiffness did not abate and was probably more pronounced. After a one hour lunch break (I iced the whole time), we made 2 batches of jam. All together, between picking and jam making, I was on my feet for at least 4 hours during Saturday.

It doesn't seem like a lot, but apparently it was. My knee was throbbing by 5 pm, and I spent the rest of the night with my knee elevated, ice on it until I fell asleep. I slept with my knee elevated, as I know the fluid will drain better that way. I woke up feeling much better and will soon attempt my PT's new exercise routine. It includes squats, extensions, some gentle stepping up on a four inch step. His suggestion is to do the exercises once a day, except for fpglute stretches, and take two walks.

I am forty days post op today and feel impatient, more with my flexion, which was 102 on Friday (with my exertion) and 110 (with my therapist's help), than with my progress. This TLKR is very different from my TRKR, and I worry about not reaching the same degree of flexion as I have with my right knee (127).

As I looked back at my BS posts from two + years ago, it seemed like I was much further along in my recovery. I wonder how age factors into recovery? Is my overall stamina not as strong as it was 2 1/2 years ago? Might the damage to my left knee have been more significant, making recovery less productive? Could the remaining pin in my left femur from ACL reconstruction in 2007 (the 2 pins in the tibia were removed during my TLKR surgery) be compromising my recovery now? I thought I'd be on my road bike by now (I recorded on BS that at ten weeks I was riding 6+ miles!) I thought my knee would be stronger by now. I thought many things that are just not there yet. I worry that I might be left with a minimally useful leg, which would send me over the edge. I'm heading to exercise now and hope some one can offer some words of encouragement for what is otherwise a gorgeous day on this side of the pond.

Thank you for your ongoing support and help.

 

[patient 99]

There is an awful lot of `worry' in your posts. The `what if' game is counter-productive. If your right and left knee were children would you be so quick to tell left knee it was poor compared to right knee. Believe me now is not the time to be worrying about anything - its far too early. You are no novice. This is your second TKR. Stop worrying and practice what you know works - PTs no less than you. They are relying on theory. You on the other hand have experience - and there is no substitute.

Best wishes. Carol

 

[ladymax]

Sorry to hear you're experiencing the blues. I know that feeling well - we wish we were farther ahead than we are, the pain levels seem higher than they should be, watching the world go by without us.....etc. All I know is that if I use the thought that I'm doing what I can, doing the best I can, and it will all be worth it in the end - that helps some with the blues. You are doing the best you can! Time will bring the other rewards of having the new knee I'll be thinking of you and sending positive thoughts!

 

[kneeper]

4 hours on your feet? I can see why the knee was Your recovery was probably remarkably quick last time and this one is more normal.

 

[susanlondon]

My post today is to inquire about ROM. At eight weeks post surgery, I am at 113 on my own. My muscles feel too tight, both quads and hamstrings, to get a better bend (or is that permanently formed scar tissue?) My PT will assist, if I let him, to get more ROM, but I am too sensitive to his stretching and have backed away from that at most costs. My question: will my ROM improve? I'm worried sick about this, as I am hoping for the same or better ROM with my new Conformis knee. Looking back over my posts from two years ago, when I had my TRKR, I don't see any mention of ROM which leads me to believe that it was better at the same point in time than it is on my new left knee. I have 127 ROM on my right knee, a Smith and Nephew. My OS said I might have even better ROM with the Conformis knee (my eight week old new knee) over time. If anyone has any wise words or suggestions for improvement to share, I would greatly appreciate this today. I'm worried that scar tissue will keep me at 113 forever. For me, that is not satisfactory for long term recovery. Thank you.

 

[patient 99]

My post today is to inquire about ROM.

One of the best people to speak to about ROM is @referee54. I've tagged him for you. You are 8 weeks post op with flexion of 113. I am 17 months out with flexion of 115 (on a good day). I think you are doing really well. Carol

 

[tiredwife]

@susanlondon You are only a few months from surgery, from what I have read on other threads your ROM can improve up to a year or more.

 

[susanlondon]

Thank you, patient 99 and tired wife. I will await a reply from referee. I have been back on my road bike for mini rides for the past two days. Last night, I rode 1+ mile; this morning, just shy of 2 1/2 miles. A little more each day will hopefully bring me back to my former ride (14-16m) 3X/week and more. I'm wondering if ROM will improve with biking, especially as I increase distance and keep lowering the seat incrementally to get more of a bend while riding. I'm not convinced that, despite everyone's assurances that this recovery will be as good as tHe last or better, that it will be. Call me worrywart. I know the danger on being negative Nancy, but as summer is slipping by and I'm still limited in my activities, I'm growing increasingly impatient. I've even lost my enthusiasm for hanging out for long periods of time in my pool lately. What is up,with that???

 

[tiredwife]

@susanlondon I believe a little depression is a common thing with TKR. Maybe you are comparing your two knees, and no two knee are the same.

 

[susanlondon]

Wow! How are things going? I live alone, so no one to really count on to do stuff around the house. Friends and family were wonderful, but others have a life of their own and they need to live them. I often thought about how having a partner/spouse, etc, would make things so much easier, especially after major surgery. He's fortunate to have your help.

Thank you for the reminder. You sound like someone who really understands the way it works, as does my surgeon, the nurse supervisor, the PT, etc, except that they've never had a TKR. I always keep that in mind. That's one reason I so appreciate this site. It certainly gives me another perspective...from those who've been there and done that!

I'm off to attempt picking blueberries now. I picked strawberries several weeks ago and bending over, rather than squatting (who can squat yet? Not me.) was a challenge. It was another episode of overdoing it. Blueberries, however, are easier as you can stand up and pick. I know it'll be a stretch (or, rather I'll need a good one after that, I suppose) but it's a gorgeous day and the berries are ripe.

Thank you so much for replying. I'll keep in mind the mantra that no two knees heal the same way.

 

[tiredwife]

@susanlondon If I had left it up to my husband he would not have known what to expect with a TKR. I did a lot of research on a lot of different sites. I think he was afraid of what he might find. This way I could tell him what he needed to know without making him nervous. To me it sounds as if you might be prone to overdoing it. I think it is easier if you have someone to help, but many make it on their own. You sound like a strong woman, too hard on yourself.