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[TKR] Verwoodian's recovery thread<

Discussion in 'Knee Replacement Recovery Area' started by Verwoodian, Jul 2, 2019.

  1. Verwoodian

    Verwoodian new member
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    :chinstroke:Hi everyone I had my op on 25 March. To say I was not prepared for how painful this procedure would be is an understatement. Those first few weeks were really tough and I don’t think I’ve cried so much but thankfully those days are behind me now.

    I am so thankful that I found this wonderful site, it has been a life saver, both in terms of my mental health (during the post op blues) and for all the hints and tips - I don’t feel like I’m on my own.

    Now at 14 weeks I feel stronger but my patience is wearing thin. I just want to feel normal! My knee constantly feels tight under the knee cap and on some days the muscles above and below my knee are really sore. I am managing to walk 2½ miles but that’s about it at the moment. At night it feels really heavy and I am aware of it when I try to move around.

    I’m only taking paracetamol and ibuprofen when needed and massage and cream my scar everyday and the hypersensitivity is nearly gone thank goodness. I’m hoping that the knee pain will eventually go over the coming months and I’m trying not to worry about improving my ROM 115/0. Am I expecting too much at this point in time to want my knee back to normal?
     
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  2. Jockette

    Jockette FORUM ADVISOR Forum Advisor

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    Hi and Welcome to Bonesmart!
    The short answer is yes.

    You’re coming along very well but it does take a long time. A full year, on average, for complete healing. None of us are happy about 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
    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
    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.
     
  3. possum65

    possum65 junior member

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    @Verwoodian I think at around 14 weeks progress seems slower, at least it does for me! I had my bilateral knee replacement surgery on March 4th, and a lot of progress happened in the first 12 weeks. Great, I got excited and started walking more, biking more - so far so good. Two weeks ago I started yoga practice again, daily for 45 minutes. All good until today - knees are Sooooo tight, and butt muscles too! Had both hips done just before last Xmas too, so I need to put the brakes on again! I get your frustration and expectation that things should be getting back to normal. Well, they are, look at how far we've come since surgery. It does seem slower now, because the gains are smaller and less dramatic. This is the time for patience (talking to myself here!) Just can't hurry this process. Honestly, my hip surgeries (I have had both hips replaced. twice) were just a breeze compared to these knee recoveries. And I have been fortunate enough to recover really well, and I am so grateful for that.
     
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  4. Roy Gardiner

    Roy Gardiner FORUM ADVISOR Forum Advisor

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    As has been said, yes you are. Please, take it easy. You really don't need to walk so far, just relax and let your body heal. You can't speed it up, however you try. Take the pressure off yourself, please!
     
  5. kneeper

    kneeper FORUM ADVISOR Forum Advisor

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    I returned to work at 12 weeks and certainly wasn't completely healed yet. Even though my OS told me I'd still be healing and wouldn't feel "normal" for many months it was still a bit frustrating. I understand the desire to just want to be done with the recovering.
    I just kept pacing myself. It's a bit of a game of doing something and then saying "oops, don't do quite that much next time."
    With being on my feet at work a good chunk of the day I wasn't also walking much in addition for several more weeks.

    I'd say that just because you "can" walk 2.5 miles, doesn't mean you "should." Often taking it a bit easier helps get the swelling down--it's the swelling that holds back the bend. So maybe go ahead and walk a bit every day but don't go so far.

    You might try a day where you really "under-do"--do much less than you think you can and see how the knee feels. If it feels good, add a little bit of distance.

    Due to my other arthritis I took tylenol on a regular schedule and I think that helped the knee as well.
     
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  6. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    I'd really like to offer you some structured advice but in order to do that, I also need to ask you some questions. Are you willing for me to do that?
     
  7. Verwoodian

    Verwoodian new member
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    Thank you all so much, your posts have been so helpful and made me realise I just need to take it one step at a time (pardon the pun) stay as patient as I can and I will eventually get there.
     
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  8. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    You don't want me to post my questions?
     
  9. Verwoodian

    Verwoodian new member
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    Sorry Josephine, forgot to say yes please very happy for questions.
     
  10. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    Here y'go then!

    It would be very helpful if you would answer each one individually - numbered as I have done - in as much detail as you can then I'll come back as see where you are ....

    1. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine. And don't forget to factor in other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness).

    2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?

    3. how swollen is your leg compared to these?
    ai63.tinypic.com_eta39s.jpg

    4. what is your ROM - that's flexion (bend) and extension (straightness)

    5. are you icing your knee at all? If so, how often and for how long?

    6. are you elevating your leg. If so how often and for how long?

    7. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and

    8. are you doing any exercises at home? If so what and how often?
    This is the most crucial question so please help me by using the format I have left as an example
    (which means please make a list and not an essay!)

    Exercises done at home
    - how many sessions you do each day
    - enter exercise by name then number of repetitions of each
    etc., etc.

    Anything done at PT
    - how many times a week
    - enter exercise by name then number of repetitions of each
    etc., etc.
     
  11. Verwoodian

    Verwoodian new member
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    Hi Josephine, answers to your questions below:

    1. Pain levels 6-7

    2. 2 x 500mg paracetamol. I can’t take ibuprofen as I have kidney disease or Tramadol. Can combine with codeine if need to, I take this for my fibromyalgia when required.
    I tend to take in the morning and at night.

    3. Swelling is moderate

    4. ROM was 115 and extension 0 when saw physio at hospital in June. Due for check up again in September

    5. I am icing after any exercise for at least 20 mins

    6. I also try to elevate once every couple of days for 20 mins

    7. I can do all the housework, shopping etc at my own pace, having rests in between. Can’t stand for too long when ironing. Try to get out everyday for a walk

    8. I do my bending, my leg back x10 reps
    leg extension for 6½ mins but also stretch leg out straight with toes pointed every night and morning holding to the count of 10
    mini squats x10
    Getting to a standing position from a chair x10
    bridge x10

    I do this set once during the day, usually morning 2 to 3 times a week, more than this seems to aggravate. I don’t have any PT sessions as they felt I was doing ok on my own
     
  12. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    Since swelling is a form of pain, moderate swelling adds at least 4 more points to your overall pain score.
    Swelling/pain comparisons
    Why can't you take Tramadol?
    And I'm glad you can't take ibuprofen as it's a pernicious drug!
    Medications: acetaminophen (Tylenol, paracetamol) and NSAIDs, differences and dangers
    NSAIDs Diclofenac. ibuprofen increase risk of heart problems: new study


    The abbreviation "ROM" is not just applicable to flexion, it means both flexion and extension.
    So you have a ROM of 115/0 which is excellent !
    You accomplish little or nothing in 20 minutes. Ice for at least 40-60mins and more than 4 times a day.
    That's good


    1 set per day, usually morning 2 to 3 times a week
    - too many!
    bending, my leg /knees x10 reps - more commonly known as heel slides. This article was left among the list of recovery articles left for you in the second post of this thread Heel slides and how to do them properly. Did you ever read them? (be honest now!)
    leg extension: stretch leg out straight for 6½ mins. hold to the count of 10 - don't recommend these
    mini squats x10 - or these
    Getting to a standing position from a chair x10 - I would imagine you do enough of these in your daily life without doing extra!
    bridges x10 - don't do bridges, not ever!
    I don’t have any PT sessions as they felt I was doing ok on my own - jolly good! Many members on here never did any exercises/physio for their TKRs. I was one of them and never did any for either knee. AND I got excellent outcomes! But don't misunderstand what I mean - read this No exercising: what does that really mean?

    If you are concerned about refusing to do therapy, you need to read this Saying no to therapy - am I allowed to?
     
  13. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    Why can't you take Tramadol?
     
  14. Verwoodian

    Verwoodian new member
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    Thanks for your reply Josephine really appreciated. I can’t take tramadol as it gives me really bad heart palpitations and sickness.
    Yes I did read heel slides, I do them with a piece of tinfoil so that my foot moves back gently.
    I was really interested in the article about no exercise - I will be kinder to myself and I am being sensible about having rest days when we have had a few days where walking has been involved.
    With regard to the icing I was told by the OTs at the hospital not to ice for more than 20mins, I will increase and see how I get on.
    Do you have any suggestions for sensitivity of the scar, it’s better than it was and I do massage it, but there are 2 areas at the top and bottom (I had 42 staples so quite a long scar) which are painful when clothing touches it.

    Thanks again for your response Josephine.
     
  15. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    That's why it's sensitive! If you really must massage it, I suggest you use our Active Scar Shield which you can order through this advert but at the top of the page. But don't rub it!

    upload_2019-7-11_22-16-16.png
     
  16. marieltha

    marieltha senior

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    Hi, Verwoodian, our knee surgeries were the same week.

    When I take Tramadol, I have to cut the 50mg in half, take it with food, and stay still for a while. If I do that I do not get negative side effects.

    It is very interesting learning all the theories about icing. First OS liked 10 min on 10 min off for an hour, several times a day. Present OS says 20 on and 20 off several times a day. I did it more often in the 72 hrs after the surgery.

    Now? I end up icing 4 times a day (late am, mid afternoon, after dinner, & bedtime) and once in the night. I do my shoulder (May22RCR) for the 20, and usually do 10, sometimes 20, on each knee. Left knee is the March 27 PKR; right is a recovering ligament sprain.

    For the first time last night, I forgot to leave the Aircast CryoCuff cannister out for my husband to refill before bed. He was tired and went to bed early and forgot it. Because of the shoulder, I cannot do it myself yet (I can fill the cuffs now and get them on and off myself - what denny39 I think calls “little victories”). My husband was already asleep, and I hated to wake him (my 24/7 caretaker for 4 surgeries in 16 mos), so I just used icepacks and gelpacks. Yikes! I really missed the cryocuffs.

    I lightly massage my calf and thigh, but I don’t touch the scar or implant.

    Hope you feel better soon.
     
    Last edited: Jul 11, 2019
  17. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    I sincerely hope you DON'T touch the implant! :yikes:
     
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  18. Verwoodian

    Verwoodian new member
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    Boy that would be something! I get what you mean Marieltha. I was told by the physio at hospital to touch my scar as much as possible to try and de-sensitise it. It has helped a bit but I have two areas that are still really bothersome.

    I tried to kneel on a pillow on my bed today (again physio asked me to try this before I see them at the hospital again in September). I won’t be doing that again in a hurry - horrible feeling and shooting needles up through my leg.

    Have started icing for 40mins as Josephine suggested and it is helping.

    Thank you Josephine So glad I found this site. Have a good day everyone.
     
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  19. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    Yes, and it will. I don't recommend this as a treatment. Not at all.
     
  20. marieltha

    marieltha senior

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    How are you doing?
     

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