TKR Which exercises to continue pre MUA?

[Layla]

Hello again!
Today is your big day! May you have an uneventful surgery and recovery. Hope to hear how you're doing over the next several days. Lots of comfort to you as you begin your healing journey.

When you have time, please clarify that your Left TKR was completed on the 21st along with a MUA on your RIGHT knee. We will edit your signature to include the MUA. Please conform that info is correct.

Healing hugs!
@Focuspositively

 

[Focuspositively]

Hi Layla, yes, my surgery yesterday, November 21, 2024 was successful! I had a Left TKR and a MUA on my right knee. So far, this recovery has been easier. I had a nerve block in my thigh above my knee, a spinal anesthesia and the medication to relieve me of pain. My blood pressure stayed stable and I was released from the hospital the same day. After the MUA and before we left the OR, my surgeon showed me how flexible my right knee was. He wiggled it in the air and it was SO flexible. He said it measured between 120 and 125 flex ROM postop in the OR; however, 3 hours later in the Recovery Room, the physiotherapist said it didn’t even look like I achieved 90 degrees. The swelling had already started! The Surgeon told her that that happens sometimes and I’ll have to work it to get my flex. He said that he could tell that there was very little scar tissue in the knee when he performed the MUA. I have 0 degrees extension.
I managed the (about 18) stairs to the second floor at home fine. I feel stronger than after the first RTKR which I had 12 weeks ago. I slept 9 hours last night. I know because I use a sleep apnea machine and it records the time. I set timers to wake up every 4 hours to stay on schedule with my pain meds but woke up before they rang every time. I was able to get back to sleep afterwards. I’m so happy with the results so far. My first scheduled physio session will be 14 days postop. I’m doing the exercises, that were given to me by a physiotherapist at the hospital, at home until then. But starting off with less amounts and working up to the suggested number of repeats by the time I get to the appointments at the hospital physio clinic. Less because I don’t want to aggravate the swelling. @Layla

 

[mendogal]

@Focuspositively

Welcome to the double healing side!

Your post-MUA knee doesn't need PT exercises.

The fact that there was very little scar tissue, and excellent flexion right afterwards that decreased rapidly with swelling means the exact opposite:
Your knee needs to be elevated toes over nose and with ice anytime you're not up walking - just like your brand new knee!

The short hourly walk, plus ankle movements, and quad sets while elevating that we recommend after a TKA are going to let your post MUA knee recover from the new trauma.

 

[Focuspositively]

please remind me of the quad sets while elevating that you recommend @mendogal

 

[Layla]

Hello Focuspositively,
Thanks for the update and welcome to recovery! it sounds like you are off to a good start after the controlled trauma of TKR and the MUA. Hopefully you can get the swelling under control with ICE / ELEVATION and meds on schedule for pain. You're wise to go easy on any exercises, slowly building as your body comfortably allows.
Eighteen stairs up to your second floor...wow, you're a champ! I hope you have a good day!

 

[Layla]

Hi again!
Because you and I are both currently online and I see, mendogal, is temporarily away, I will answer your question on quad sets.

While lying on your back, tighten your top thigh muscles as you attempt to press your knee downward towards the surface your leg is resting on. Hold for 5 seconds. I was instructed to do ten, three times per day. Not sure if I did. I really let my comfort level dictate what I did and didn't push through pain. You can gently do the quad sets while elevating. I hope this helps.
@Focuspositively

 

[Focuspositively]

yes thanks! Another question is I’m supposed to remove my bandage over my surgical scar to let it air at 5 days post op. It’s quite bloody. If it’s still seeping I have more bandages to put back on. Should I order some of the cleansing product you recommend to put on the scar once I remove the bandage? Would doing so help remove the blood that has seeped out? @Layla

 

[Layla]

Hi again,
Are you able to consult your health care provider on Monday to re-confirm instructions for wound care if it's still seeping blood then? If there is significant bleeding from your wound the gel is not meant to stop the bleeding. It may soften dried blood allowing it to run off the immediate area.
I'm sure your surgeon's care team will approve use of the product since the Active Antimicrobial Hydrogel will aid in the healing of your wound while preventing infection.

active antimicrobial hydrogel

bonesmart.org

 

[mendogal]

Thank you @Layla re quad sets reply!
I add: they can be done anytime you're in the recliner, sitting on a couch with legs up on a pillow on the coffee table, using the Lounge Doctor, etc.
I never counted reps or did sets, just randomly did bunches of them anytime I was relaxing, icing, and elevating.

 

[Focuspositively]

Today is Day 5 post op of LTKR and of R MUA. I felt extremely well the first 3 days and not as well the last two. What happened? Does the pain meds not work as well? ie does your body get used to them?
My swelling increased in both legs so I started sleeping with my legs up on a leg support wedge at night in addition to using it during the day. I take short 5 min walks around the kitchen/dining room area 4-5 times a day. I do the quad exercises and ankle pumps and four other exercises given to me by the hospital: started 1 x a day and increased to now today will be 5 times, three sets a day (about 30 minutes after taking my 1 pill of hydromorphone and two 365 mg pills of Tylonol). I’ve been sleeping well every night until now. I’ve been waking up every 4 hours to take my pills.
They say days 3-8 are the worst for pain and swelling. Why is that? Do the meds not work as well or does the swelling increase by then and then start to drop off? I can’t wait to get to day 9.

 

[Jockette]

Today is Day 5 post op of LTKR and of R MUA

My swelling increased in both legs

and four other exercises given to me by the hospital: started 1 x a day and increased to now today will be 5 times, three sets a day

These exercises are why your pain has increased. I know the hospital told you to do these, at this frequency, but really, this is too much for 5 days post op. Right now “less is more.” You are healing from a major surgery that caused a lot of trauma to your knee and leg. You need time to heal before stressing your knee with these exercises.

I take short 5 min walks around the kitchen/dining room area 4-5 times a day. I do the quad exercises and ankle pumps

This is all you need to be doing right now. There will be plenty of time later to work on more rehab.

Elevating as much as you are is good. Icing can be very helpful for pain also. Just be sure you have a cloth between you and the cold source.

The MUA was also a traumatic experience for your first knee, which causes swelling.

Rest as much as you can, while icing and elevating. These are very early days for both knees, as the MUA does cause a setback with increased swelling.

 

[Layla]

I felt extremely well the first 3 days and not as well the last two. What happened?

Swelling from the controlled trauma of surgery and from manipulation of soft tissues has occurred. A double whammy for you. Both legs are healing. Then there's the muscle soreness from PT. I am sure it seems unimaginable to step away from the recommended protocol, but you can certainly try by experiment and my guess is with rest, ice and elevation, the pain will begin to ease.

Here is a refresher on activity progression post op for Weeks 1 & 2 just in case you haven't read through the Recovery Guidelines.


Week 1
Walks around your home - trips to the bathroom and kitchen to get a snack normally cover this.
Be up on your feet several times a day, as you need to. A 5-6 minute walk every 3-4 hours is plenty
Spend most of your time resting and elevating

Week 2
Add this to the instructions from Week 1
Start on a plan of walks around the house 3-4 times a day for about 5 minutes, but don't push through too much pain, or wear yourself out. Stop before you reach that point.

Try it...see if it helps. I'm betting it will.
Good luck and lots of comfort to you!

 

[Focuspositively]

Thanks @Jockette I was also told at the hospital to take my bloody bandage off today (day 5) and let it air but if it still seeped to put a clean bandage back on it. They gave me a couple of extra bandages. My question is: how am I supposed to air it if it’s wrapped in the Game Ready ice machine sleeve during the day? Any thoughts? I had trouble with seepage on my right knee (first surgery) up to 6.5 weeks post op.

 

[mendogal]

I'm not Jockette, but yes, you can unwrap for fifteen minutes at a time a couple of times a day while maintaining elevation.

 

[Focuspositively]

Update:I took the bandage off. I’m using a skinny towel to shield me from the ice machine’s sleeve. I never did ask whether I needed to protect my skin from the ice machine’s sleeve. No seepage so far. The wound looks good.
I’m just walking and doing the ankle pumps and quad exercises. Focusing on elevating, rest and icing.

 

[mendogal]

You're on the right track!
Yes, we normally counsel everyone to use cloth (for me it was my flannel or bamboo pj bottoms) to protect the skin.

 

[eaglemom]

Isn't the Game Ready a great ice machine? I don't think you can over ice your knee. It's very important to have something on your skin - towel, pj pants, etc - between the incision the the ice machine cuff. You do not want to have that directly on your skin.

Sounds as though your doing great. Elevating icing and resting are a perfect mantra for you at this stage of healing.

 

[Focuspositively]

Feel better this morning after cutting back on my exercising yesterday. I’ll do the same as yesterday but add 1 of each of the exercises to my LTKR (6 days post op) and 5 of each of the exercises to my RTKR (13 weeks post op).
Getting down and up off the couch has been my latest challenge. Once I’m there though it feels so good. Thx for listening and your support.

 

[Layla]

You're a champ!
It's like you have two flat tires, or two bad wheels right now.
I'm guessing each day is a mystery as you wonder which will perform better today...Lefty, or Righty?
Hang in there, brighter days are on the way!
@Focuspositively

 

[Layla]

Happy Three Month Anniversary, Righty!
I hope you sleep well tonight!
@Focuspositively