TKR Two steps forward 10 steps back

[Amy h]

Hello everyone. I ha e been reading so many post and decided to reach out to you for guidance based off your experiences.
I am at 7 weeks.
Have been doing PT. It has been horrible.
I AM currently 94 flexion and 3 extension. My doctor is trying to get me do Manipulation under anesthesia (MUA) .
My Pt and doctor keep pushing me on flexion.
They push it to get to 105 and I spend 3 days with sweeling and unable to do anything and end up back at 85.
They have done this for the last month every week.
I refuse to let this happen anymore.
So my question is...
If I start doing the passive excerises stated on this site.
Can I do this on my own.
Just gaining a little at a time. Taking it slow at 1 or degree every other day or should I seek out a different doctor.
I am back at work pt desk work. Can't miss anymore work.
When is the proper time to consider MUA?
Would a CPM machine still be helpful at this point?
Any guidance would be appreciated.

 

[Jockette]

Hi and Welcome!

I am so sorry your medical team is treating you like this. It is not necessary, honestly.

My Pt and doctor keep pushing me on flexion.

I refuse to let this happen anymore.

Tell them ALL, not to touch your leg. It is your leg and you have the final say what happens to it.

You don’t need an MUA. They have already pushed you to 105, so the knee does work correctly. There’s nothing wrong that time and healing won’t fix. Your knee will come along fine if you stop allowing them to force the bend. Forcing the bend is maintaining, as well as enhancing, your pain and swelling.

With all your knee has been through I think you should stop all exercises. You are already back to work and the movements you get in your normal day are plenty of exercise for your healing knee. When you are home from work you need to rest, ice and elevate your leg as much as you can, so it can recover.

It’s not exercising that gets our range of motion back, it’s Time:

Time to recover.
Time for pain and swelling to settle.
Time to heal.

Our range of motion is right there all
along just waiting for 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. Exercise as in strength training is counter-productive and in the early weeks does more harm than good. Normal activity is the key to success.

 

[Jockette]

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
elevate
ice
take your pain meds by prescription schedule (not when pain starts!)
don't overwork.​

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

the BoneSmart view on exercise
BoneSmart philosophy for sensible post op therapy​

5. At week 4 and after you should follow this

Activity progression for TKRs​

6. Access to these pages on the website

Oral And Intravenous Pain Medications
Wound Closure​

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.

 

[Jockette]

Also, please tell us the date of your surgery and we’ll make a signature for you so we see it in n every post.

 

[kneeper]

90 was the "magic" number for my OS. Once I hit that he was unconcerned and said I would continue to gain. Like Jockette said, all that forcing of the knee just causes it to swell and a swollen knee isn't going to bend much.

Keep on with ice, elevation and gentle range of motion exercise. I did a few heel slides (maybe 5 at a time) 2-3 times a day (as it occurred to me). Personally, I think a cpm would just irritate the knee at this point.
I would avoid PT at this point, or if you feel the need to go, definitely don't let them push on your leg.

If you're back at work already, the desk work is probably adding to the swelling. Do what you can to ice and elevate at work and get the leg up and on ice first thing when you get home. Walk around for a minute or so every hour when you're at work to help loosen things up.

 

[Amy h]

My surgery date was July 16, 2019.
I so appreciate all your guidance. I am looking into another doctor and I really considering dropping pt. My husband is concerned if I drop pt my insurance could refuse any more coverage of care...
The swelling has gone down quite a bit today and I was able to bend to 96 with just light stretching. I am sure as I continue to care for my knee my flexion will improve as you all have kindly pointed out.

 

[InkedMarie]

Just say NO! Dont let anyone push your knee.

 

[Amy h]

Good morning everyone. I have been resting, icing and elevating my knee. My knee swelled back up Monday. The swelling just doesn't want to go down. I called out from work yesterday but today I need to go in for a couple of hours to do paper work. Going back to work has been rough. I have it so I can at least prop it up and have ice on it. But 3 to 4 hours is all I can take. I am lucky to be that I work for a company who is so kind. I am one of the big boss so I can just sit at a desk but on that note there is part of my job that other just can't cover.
I spent time on the phone yesterday with my insurance and contacting a new doctor office. I am waiting to hear back if that Doctor will take me as his patient.
My flexion has been horrible (85-88) with all the swelling but I am just letting it rest and lightly being it until the knee settles downs.

 

[sistersinhim]

Many of us never took formal PT or did exercises. I am one of them. I have had 11 knee surgeries, 2 of them kneecap removals and 1 tkr. Even after those I never took PT. But, I didn't just sit around and do nothing. I took care of myself, my house and yard as my knee allowed me to do. As I healed, I did more. But, my knee was always in control. This was enough therapy for me and would be for any tkr patient. All the awful pain of PT is so unnecessary.

All you have to do is use it in your daily living. Your knee knows how to rehab itself and doesn't need anyone telling it how. Just use it and it will come back like new. You have to be patient, though, it doesn't happen quickly. ADL,(activities of daily living), going to the bathroom, brushing your teeth and bathing, fixing a light meal, getting something to drink and or a snack, those kinds of things will be all the exercise your knee needs. If you just use it daily in your living, you can have a less painful recovery. We know what works, we've been there.

You are already doing PT just going to work. You have to get up and get yourself ready for work, get there, do your job, then get back home and do everything there you have to do before bed. This is all your knee needs to do. Your knee is swelling because it's inflamed from all that pushing and exercising. Stop PT all together. You do not need it. I would think your insurance company would love for you to quit since they wouldn't have to pay out anymore money for it.

 

[Amy h]

Hi everyone..
I just heard back from that other doctor. He won't take me due to knowing the other doctor and doesn't want to step on his toes.
I really don't want to see my current doctor. He seem completely focused in on doing a mua as mentioned before. I will be using the word NO a lot with him.
Thank you all for all the threads they are very helpful..

 

[Amy h]

Thank you Sisterinhim for your reply. I really needed that. I just got done praying and then saw your reply.

 

[sistersinhim]

I am also a praying woman and I know that prayer works! HE has sustained me all through the years. I pray that God leads you the way He wants you to go.

 

[Jockette]

It wasn't intended to be funny

I bet she tapped funny by mistake. I have often done that on my phone.

For anyone reading this, if you miss the icon you want, there is also an “undo rating” that you can tap so it can be changed.

 

[Rockgirl4]

@Amy h It sounds to me like you have a surgeon who only does things one way and is not open minded at all.

I'm going to agree with everyone else and say that when you rest the knee or and back off of the PT, your swelling will go down with time.

I had my right TKR on May 21st, and at 6 wks I was only at 92 degrees. By 8 wks, I was at 98, and at 10 wks, my flexion was 104. My PT was very gentle with mostly massage and stretching. My surgeon was adamant that no one ever force my need to bend or straighten. He only allowed me to do one session of bending the knee each day for 5 minutes.... that was on a stationary bike once I could pedal all the way around. I managed that once I got about 94ﾟ of flexion.

I saw him at 9 weeks and was only bending to 103-ish, and he was thoroughly pleased.

Something else I wanted to mention about insurance not..... I hope you didn't read that in the Facebook group regarding knee replacements as it is commonly used to scare people. I spoke with 2 physical therapists about this earlier in my recovery. Both of them have been PTs for almost 20 years and have never had a patient dropped by insurance for refusing to do their knee physical therapy. Both said it probably only happens with workman's comp situations, as those are handled completely differently in the United States. So I really don't think you should use that is a way of making your decision.

Lastly, you can still go to PT… just set the rules and do NOT allow them to push your knee. You are in charge of your PT, and no one is allowed to hurt you or assault you. Most people never need to know this though, so it's rarely brought up.

I wish you the best with the rest of your recovery and please know that many of us were considered slow benders and still recovered just fine and got our range of motion back. I'm a perfect example of someone who was very hopeless at 4 weeks post op and am now literally doing most everything that I want to do at 15 weeks post op.

 

[tabbykit]

Sounds like you are doing well, and should continue to improve if you stop the aggressive PT and rest, ice and elevate. You can go to PT but tell them no more forcing. There are other ways they can help you. I am at 11 weeks postop (revision) with flexion of 70, not great but it is improving very gradually. If it improves by only one degree a week I will be happy! There is so much good advice on here.

 

[Amy h]

Thank you rockgirl4. Your right I did hit funny icon mistake.
Thank you for share you rom numbers and time lines. It has giving my the most peace I have had in months.

 

[Amy h]

Does anyone have information on driving with a stick shift with left knee replacement.
I have been borrowing a car but I will have to start using my this weekend:(.
Will this cause me more problems?

 

[kneeper]

It took me 6 weeks to get to 90. The only thing that worked was lots of ice and elevation and very gently using the knee. Even my PT with my left knee said to focus on icing. She'd put the GameReady on in my PT sessions for about 20 minutes and could see a measurable difference in the swelling (centimeters? millimeters? I'm not sure) but the point was that my ROM was a little better after icing than before. It didn't necessarily "hold" but it really illustrated that it was the swelling holding me back.
With you being at work I'm sure you have more swelling again. Take a major knee vacation this weekend and that should help a bit.

 

[Celle]

Does anyone have information on driving with a stick shift with left knee replacement.
I have been borrowing a car but I will have to start using my this weekend:(.
Will this cause me more problems?

I drive a stick shift car.

Before driving it, I used to sit in it with the engine turned off and practice moving my feet quickly from one pedal to another, until I was certain I could do it accurately and co-ordinate one foot with the other. I also practiced doing emergency stops.
Then I tried a slow drive down our little lane and back before going on the open road.
I think it was about 6 weeks post-op before I could drive my car.

You may find that, until you can bend your knee well, you need to park with plenty of room on the driver's side, so you can open the door wide enough to get your foot into the car.

 

[Amy h]

Thank you Calle. I have been nervous about driving my stick shift. I tried a short drive at week 4 and it made my knee super sore. So I gave up on that idea a few. Lucky I work close to home so I won't have to drive it very far.
Did you notice any extra swelling from it?