TKR Webbie's saga

[Celle]

I had gotten a very painful 80 but that was with the help of a PT person holding my knee in place as he measured. OS said I needed to work the knee and push harder. It was all up to me! He said I would be left with a very stiff knee for the rest of my life if I did not accomplish a 90 degree bend.

@webbie73 , Kathy,
I'm sorry you're feeling so down.

Quite honestly, I don't think that being where you are is doing you any good at all and you would be better off at home. I don't think you have to stay there, do you? What would happen if you just said "I'm going home"?

It's only a little over two weeks since you had your surgery and expecting your knee to bend to 90 degrees is just expecting too much, too soon. My surgeon doesn't expect 90 degrees until about a month after surgery.

Your PT therapist should never hold your knee like that, or push on it. Causing pain is doing more harm to your knee. Don't allow it. Remember this, from the mantras:
- if it hurts, don't do it and don't allow anyone - especially a physiotherapist (PT) - 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

It's mostly swelling that is stopping your knee from bending. Causing you pain will inflame your knee and cause more swelling, so that becomes a vicious circle. More swelling equals less bend.

Your surgeon has told you what he believes, but I'm sorry to say he's wrong. Working your knee and pushing harder is not the way to get more bend. Instead, much more rest, elevate, ice is the way to get that swelling down. Deal with the swelling and you'll find that the bend appears.

As for being left with a stiff knee for the rest of your life if you don't achieve 90 degrees - that, I'm afraid, is an old myth that should have died long ago. There is no "window of opportunity" and no need to rush to get ROM. ROM can continue to improve for a year or longer after this surgery.
Myth busting: the "window of opportunity" in TKR

Remember these articles:
It's never too late to get more ROM!
It's worth the wait for ROM

My surgeon doesn't allow any PT for the first month after surgery, apart from simply walking around the house. His patients all do well and he almost never has to go back and help a knee to bend. I did no PT at all for my latest recovery and my knee is fine, with a bend of somewhere between 125 and 130 degrees.

See if you can get yourself home - it's a kinder and gentler place - concentrate on lots of rest, with ice and elevation and minimal exercise. I think you'll then find that your knee recovers well.

 

[Dancing Fool]

I do hope you're still on track for discharge today. I know you'll do much better in your own home, with no one harassing you about bending your knee. I'm thinking about you, and hoping you get out of there!

 

[Clipless]

I know it's difficult, but *try* not to stress over PTs and your OS' expectations and dire predictions for your knee. I dislike that approach, which is why I decided to skip home PT for my second TKR. And I'm doing just fine, thank you.

 

[Josephine]

OS said I needed to work the knee and push harder. It was all up to me! He said I would be left with a very stiff knee for the rest of my life if I did not accomplish a 90 degree bend.

Bless your heart, I know the last thing you need right now is to have two bullies caring for you!

I agree with Celle as my surgeon has the same mindset as hers. And newlybionic has it right too - the ROM will come but in it's own good time. In fact, it's there now in your knee, just waiting for the opportunity to show itself but it can't while your leg is so swollen. So get yourself home, quit the PT and just concentrate on the mantra for 2-3 weeks at least. If your ROM doesn't start showing towards the end, I'll eat my frilly nurse's hat!

 

[kneeper]

I was one of those who was not 90 in a few weeks. But once the swelling came down I started gaining. I hope you will be going home where you can give yourself some tlc. Frankly, this rehab place is for the birds.

 

[webbie73]

Thank you all for the encouragement. I talked with PT and gave him some background on my right Leg.... all the muscles shorten prior to my hip replacement and never got it back to 100% i did not have 0 extension and about 100 degree of bend. I had IT band problems along with quads always going into spasm. that has gone on for 6 years the only relief I have gotten is from therapeutic massage. Add in a leg length discrepancy that was fixed when I had the left hip replaced. As you can see I have not been "normal" in a long time.

I am heading home to sleep! LOLOLOL

 

[Pumpkin]

Glad to hear you are heading home, Rest, Ice, Elevate, and Medicate on schedule as prescribed.

 

[Thesoutherncook]

Good for you! Rest, ice, elevate and medicate! You'll feel better each day. Slow and steady wins the race! Just remember this recovery is a long term commitment! Hang in there and know you have lots of us cheering you on!

 

[Celle]

Well done, Kathy, for speaking up and explaining about your leg.
I'm so glad you're going home, where you will be able to spoil yourself and do things at your own pace.

 

[webbie73]

I am home now and my spirits are better just being here!! All I now have to concentrate on is getting the knee to bend.

Home healthcare will be evaluating me on Monday or Tuesday to see what my needs are. I think just PT even though they will do an OT evaluation. This is my 3rd joint so I think I know the drill. In fact I can dress without any aids at all. It has been a long time since that has happened.

Tomorrow morning I will take a shower in my own bathroom! That will be a treat.

When can I expect to sleep in another position? I am getting tired of my back, plus it is not good for my sleep apnea.

 

[Celle]

All I now have to concentrate on is getting the knee to bend.

Remember not to work hard at it. Use lots of rest, ice and elevation, to combat the swelling. Walk around the house a little, and do a few Heel slides and how to do them . That's all you need to do.

When can I expect to sleep in another position? I am getting tired of my back, plus it is not good for my sleep apnea.

You can try sleeping on your non-surgery side now. You may need some help to do it, especially with arranging pillows. Make sure you have a pillow between your knees, for your TKR knee to rest on. A pillow behind your back is nice, too.

They turned me on to my side while I was still in hospital, about day 3 , I think.

 

[webbie73]

I realized this thread is pretty negative ! LOL

Here are my positives:
I have walked with a cane and could do that around the house. Not ready for outside. In the kitchen I can touch counter to island so I don't need the walker to make something simple to eat.
I can dress entirely on my own, even reach me feet! I have not done that in years.
I can get in and out of bed without any assistance. Just roll onto my side, swing my legs over and sit up.
I can stand from a sitting position but not with equal weight just yet. Still have trouble sitting down because of the bend factor.
Stairs are not a problem. Up with the good down with the bad.
I can do straight leg lifts.

So there are a few positive accomplishments.

 

[Clipless]

You should be ready to side sleep now! One day after surgery I was already jamming pillows behind my back to get sort of onto my side. Try one pillow behind your back/hip, then another soft one between your knees. You might find it more comfortable if your knees aren't exactly together.

 

[Slainte]

Yep, loads of pillows will help you side sleep. My knee still likes to change position quite a bit at night, but it lets me sleep on my side longer and longer. And finally I can go right back to sleep after I roll over. Life is getting better.

 

[KarriB]

Experiment with side sleeping if it will help you to sleep, I know that's what helped me to sleep. I was able to place my left leg over my RTKR. I did wake up and have to move after a few hours, but that was better than laying on my back.

 

[Clipless]

.. I was able to place my left leg over my RTKR...

That's exactly what I do! Try it, @webbie73 !

 

[Timetolive]

I am so glad you got home. I love to read the good and the bad, although the good is better. I wish you a peaceful night of sleep with no or minimal pain.

 

[newlybionic]

I'm happy your progressing so well and are home. Remember that you are in charge of your therapy not the therapists. I hope you have a great night of sleeping. And those showers... GREAT!!!

 

[Dancing Fool]

Considering what a rough start you had, you've made a lot of positive progress! My OS recommends sleeping on the back for the first month; apparently he feels it helps with getting full extension. What is uncomfortable about back sleeping for you? I've had problems with me heels getting sore - at first I slept at the end of the bed with my heels hanging off so all the pressure wasn't on them, now I've got my ankles up on a little pillow which also takes the pressure off my heels. I did try turning on my side last night just for a bit, but found that to hurt my knee. For some reason, back sleeping doesn't - it's just not what I'm used to.

And if you have sleep apnea, I assume you're on a CPAP machine? I am, too. When I moved from the recliner to the bed on my back, my AHI went from its normal 1-2 to 35-65! Ack! I usually use a nasal pillow mask, but I tried changing from that to a regular nasal mask and my AHI dropped down to 3-6. That I can live with! So anyway, if you have a different style mask, you might want to try switching and see if it helps. I have no idea why there was such a big difference.

 

[webbie73]

On my back my leak rate with my nasal pillows goes up but my AHI has remainded very good..yay.

My discomfort comes from the numbness and nerve pain in my lower leg. It hurts with any pressure touching my leg. The actual knee does not hurt that much.

I did sleep a little while on my side this morning. Not quite ready for that yet though.

I too use a pillow so my heels hang without getting sore.