Visit to my OS

[NLVCa]

I've enjoyed reading so many reports both good and bad, so I thought I would add my experience so far.

Yesterday I had a scheduled visit with my OS at 5 months, 2 weeks and 3 days after the operation. I arranged to advance the 6 month check up a bit because I am having trouble with flexion and pain. I am about 90 degrees cold and up to 98 degrees after warm-up and physio. I get some pain with each step I take, particularly at the start and end of the step.

The news wasn't particularly promising. The surgeon blames the flexion problem on poor physio during the first 6 weeks. It wasn't aggressive. No hands on; just heat up the knee and do various exercises. At my 6 week check-up the OS advised me to get more aggressive treatment, which I did. I asked that my primary clinic use more aggressive procedures and I also started going to a 2nd sports clinic in addition to the first one. I added a hydrotherapy class at our local YMCA and I continued to do exercises at home on days I didn't go to therapy.

Now the OS says that I probably won't get more than an extra 5 degrees. He doesn't want to scope the knee because of a whole list of possible complications such as infection, dislocation of the knee cap, breaking the femor, etc., etc. I also have a history of DVT & PE in previous knee scopes. He won't consider operating until after at least 1 year. He says MUA won't accomplish anything at this point.

The OS gave me a prescription for Percocet to be taken before therapy sessions. I had been taking a combination of extra strength Tylenol and extra strength Ibuprofen when the pain was severe, but not necessarily before therapy.

I chewed out the physio people and of course they do not agree with the OS's assessment on what additional bend I can get.

Obviously I'm discouraged by the report. I realize that everyone heals at a different rate but I thought I would be well on my way by 6 months.

Sorry for the rant. I know that many of you have gone through worse than this.

Vern

 

[ship4]

Vern,
Sorry you are having such a tough time. To me it sounds like the classic symptom of not enough pain medication before PT!!
In order to force yourself to move do the exercise to the fullest you need to be medicated to handle the pain.........
See if your OS or PCP will prescribe something to take at least 30 minutes before your PT........ JMO
Best,
Crystal

 

[Josephine]

Think you took the words out of my mouth, Crystal!

 

[JudyS]

I am thinking if your physio people were not aggressive enough, maybe your OS should reconmmend another group? Does he communicate with them on a regular basis. When ever I question what is being done or my pt has a question he calls the doc.
Judy

 

[Jamie]

Vern, the "not aggessive enough PT" story doesn't make sense to me either. The surgeon prescribes the PT. In my case, there was constant reporting back to the doctor on progress and goals. Seems funny to me the doctor would blame the therapists. Maybe you might want to get a second opinion on where you are at this point from a surgeon in a different practice. I also agree with the idea of different (stronger) pain meds. Even low grade pain can make a huge (negative) difference in your ability to recover successfully. Good luck and keep us posted, okay! We care about you!!!

 

[Linda2]

I think I might consult another surgeon for a second opinion.

 

[Simon]

Vern

At about 9 weeks after my BTKR my OS was not totally happy with the 102/105 ROM I had but was worried about the MUA do to some other problems. He said to tell the PT to get a little more aggressive. Now the PT is very good and pain was not really a problem and he did alot of manual therapy, exercise etc. The PT was not sure if it they would bend more given the preop state but he was willing to keep trying. Very very slow we gained ROM it took 8 months to get to 120. The PT was happy that it worked.

It is interesting that the first 5 weeks there was no hands on as the manual therapy I found helpful.

Like everyone has said make sure you have enough pain killers before pt. I also found that doing some lunges (I put my leg up on the fireplace hearth and lean forward) every hour or so helped. You can also do this on a step or sitting in a chair. In a chair sit back and then keep moving your bottom forward. Another is to sit in a rocking chair and push up and down. Also you can sit on a chair or sofa and use one leg to push the other one back and hold it as long as possible.

Good luck

Simon

 

[Jamie]

Excellent advice, Simon, from someone who has "been there."

 

[Judles]

Gosh!!! As an added note, Please make sure someone is driving YOU to your PT sessions if you are taking something stronger than Ibeprophen before your sessions! There are enough crazies out on the roads! Good Luck!!

 

[backbay38]

I am only 10 days out from TKR but the last thing my surgeon said before I left the hospital was to take 2 Percocet before PT. He said my knee would blow up like a bowling ball and never mind. As it happens I haven't needed Percocet but I make sure to take 3 extra strength Tylenol an hour before. PT hurts!! It has to. Also my PT gave me the stair lunges too. He said just do some when you're as wandering around the house now and then.

 

[NLVCa]

Thanks to all of you for your suggestions and good wishes. I intend to prove the surgeon wrong and get more than 5 degrees more movement.

To add to the therapy issue, our health system in Canada and in my province of Ontario in particular is really strange when it comes to therapy. There are a small number of physio clinics that are funded by the Ontario Health Insurance Plan (called OHIP), the provincial health program. Most physio clinics are not funded. Younger people and seniors are eligible for up to 100 visits per year at a funded clinic. But OHIP doesn't pay these clinics very much for each visit, so to stay in business each practitioner has to handle numerous patients at the same time and keep them coming back as long as possible. Therefore little hands-on for each patient. The 2nd clinic I went to I paid for each visit.

Again thank you all for your suggestions and support.

Vern

 

[Linda2]

I'm also a firm believer in the frequent lunges. As you get better, put your leg up on higher surfaces and go for it. I started out on our slightly raised hearth because I could hang on! Now I use the seat of a chair. A few lunges really work out stiffness when you've been sitting a bit too long.

 

[maggy]

I'm 24 days post surgery and have been doing physio since day 7. I am now at 130/138 after much hard work. One exercise that really helps with the ROM is this one, you may already be doing it. I put a long black strap around my ankle (I bought one to use at home as well) as I sit on the end of the table, then it goes under and up through the middle of the table and back over my shoulder and I then hold it. My therapist pulls my ankle down hard to give more room in the knee joint as I pull the strap forward over my shoulder to bend my leg back under the table.

We all are encouraged to have a "coach" with us at physio to learn how to do this (and other "coach assisted" exercises) at home. My husband helps me while I sit on the dining room table for this exercise. The stationary bike is also a good one if you keep the seat low enough to stretch that knee a little more. I take two percocets before my physio twice a week and one every six hours at home.

I'm also from Ontario and agree that the physio coverage is very poor. The OHIP covered ones vary in quality but I think I hit a good one and it's at the hospital where my surgery was done. My physio sessions are 2 hrs twice a week. There are 2 PT's for about ten people and it's a "knee class". On the positive side, you do become responsible for your own exercises and therefore are more able to do them on your own at home. I'm not sure what you mean by manipulation but the therapists give lots of individual help at the beginning and whenever you need it as you progress. There's also a very encouraging group atmosphere and lots of info sharing and comparing, not to mention laughing and crying.

The thing is to keep working at it and not give up and it sounds like you've got that going for you.

Mag

 

[1jt@atime]

It's too bad he doesn't believe in MUA at this point. I had one at 8 months with success and I can think of at least one other on the fourm that had one later then I did. My MUA was more for extension but I did get about 5-10 degrees of flexion out of it. Every surgeon has his preferences.

Everyone has given you great advice. Hang in there and keep pushing....and don't forget the drugs! Karen

 

[1jt@atime]

Maggy, A manipulation is when the surgeon puts you under and manually forces your leg to flex and/or extend. Some knees won't cooperate no matter how hard you push and it's definiitely not a reflexion on the patient as to whether or not they get a decent
range of motion on their own.

You are doing great so I sure don't see one of these in your future! Karen

 

[aussie]

Hi Maggy,

I actually made myself an elastic gadget like you explained and I attach it to my ankle, feed it through and up the back of chairs and pull it over my shoulder stretching my leg backwards. I even do it while sitting at the computer. It was good to read you do the same thing.

Chris

 

[maggy]

Karen, I actually meant to ask what "manual therapy" by the PT involved, as some replies here were referring to not enough manual therapy. Instead I wrote "manipulation" which I do understand is necessary from the reading on Bonesmart that I've been doing. I certainly don't envy anyone who has to undergo that, although I hear that it's very successful. I assume that manual therapy is when the PT is bending you knee in different ways or is there more involved?

Chris, glad to hear you're using a similar exercise to my stap one. I think it really helps maintain the gains you make in PT.

Mag

 

[Josephine]

'manual' is the other option to using a machine!

 

[NLVCa]

The day after my LTKR my surgeon visited me and gave me the attached photos taken of me on the operating table. He said "This is what your new knee can do."

He has reminded me of the photos each time I have visited him with problems of flexion.

Vern

 

[backbay38]

I haven't yet gone to out-paitient PT as my PT is still coming to my house. But today he used a rubber band (the blue strength), tied it on my foot and with me on my stomach had me use the end of the rubber bank to pull my foot back toward my butt. I had been using my other foot on the instep to force the bend but this is better. Then you use the tension on the rubber band to push your leg from a 90% angle back down to the floor or bed. (I do my leg lifts and such on the floor now that I have figured out how to get down and up without kneeling on the new knee).
I don't Know what I will get oncet he staples are out and I go to out patient but I imagine it will be what most of your are describing plus balance exercises.