TKR Which exercises to continue pre MUA?

[Focuspositively]

Friday, Dec 20 (4 weeks post op) update: I had a busy week: I had 2 medical appointments on Monday (eye and allergy), one on Tuesday (message) and then physio on Wednesday. It was too much and set me back. At physio, I did about 2 min on bike (just stretching) and then she measured me and sent me home. My knees were too stiff to do anything. I rested all day Thursday. Physiotherapist had said not to do anything. My pain levels are higher since stopping the hydromorphone this past Tuesday. Monday, I started taking Celebrex 200 mg twice a day but cut it back to once a day so I’d have enough supply to take it for a month instead of the 2 weeks prescribed. I also started taking 1 capsule of magnesium Glycinate at bedtime. So, overall I feel like I’ve hit a setback. More pain and stiffness and can’t do what I was doing (no daily stretches, no 7.5 min walks). Some progress: I have been using my cane now instead of the walker. I slept 6 hours without waking up to take a pain med last night. I’ve been able to shift to sleeping on my side in the wee hours of the morning for 30 min - 2 hours.

 

[sistersinhim]

Some progress: I have been using my cane now instead of the walker. I slept 6 hours without waking up to take a pain med last night. I’ve been able to shift to sleeping on my side in the wee hours of the morning for 30 min - 2 hours.

I'd say these are some wonderful improvements! Even I can't sleep 6 hours without waking up, of course, that's menopause! Sleeping on your side is always helpful in getting a good night's sleep, and you're doing it!

 

[mendogal]

It sounds like a temporary stay in the OverDid It Club (ODIC) - we have all visited there, some of us multiple times!!!
Your PT is right - rest, ice, elevate and slowly resume walking and daily activity.

Are you able to use OTC acetaminophen? We recommend two 500 mg "extra strength" every 6 - 8 hours, to stay within the safe 4,000 mg/24 hour limit. It's perfectly fine to use it alongside Celebrex - totally different classes of medications.

 

[Focuspositively]

Resting today in addition to yesterday was the right call. I had less pain and stiffness. My next physio is on Monday (in 3 days). Reading the material on this site has been reassuring. I’m learning to listen to my body. Still discouraging though. I felt like I was starting over yesterday; however, stopping the hydromorphone last Tuesday probably influenced my pain levels. In addition to the daily 200 mg Celebrex, I’m taking 1 - 650 mg of Tylenol Arthritis Pain Acetaminophen Extended Release tablets every four (4) hours. In your opinion, is that as good as the two (2) 500 mg acetaminophen tablets?

I’ve come to the conclusion that I’m reacting as if I have some level of PTSD from my experience at the physio clinic where I went for PT after my first knee (Aug 27, 2024). They pushed me too hard through pain, stiffness and swelling. I’m grateful for your support. I’m also very emotional since these surgeries. I’m also in menopause (I’m 63) but felt stable emotionally before these surgeries. Also, I’m having night sweats again. I think it’s probably a reaction to all the anesthetic type of meds I’ve been on. @sistersinhim @mendogal

 

[mendogal]

If you're taking 650 mg you can take up to 6 of them over a 24 hour period.

Oh my hot flashes and sweats got way worse for quite a while postop!

 

[Layla]

Hi there Focuspositively!
A challenging or difficult PT session, while distressing, typically doesn't involve the same type of threat to life or safety that leads to PTSD...thankfully for you. Your discomfort or pain while certainly valid is different from the kind of trauma known as PTSD which is a mental health condition that can develop after experiencing or witnessing life threatening or intensely traumatic events such as combat, a serious accident a natural disaster, or violence. I hope understanding this offers you some comfort and relief. The way you're currently feeling is normal and it will pass.

Surgery is a major stressor. It's a BIG event. The stress and discomfort leading up to the procedure, anesthesia, the pain of early recovery...all contribute to our emotional state. You are not alone. Most of us experience the post op blues to some degree, even if only fleeting. I remember feeling as though my emotions were all over the place. We lose our independence, often feel isolated being stuck at home, worry about our outcome or how long it will take to feel normal again. Be patient, give yourself time to recover both emotionally and physically. You're doing well and it will get even better. I hope you have a peaceful weekend.
@Focuspositively

 

[Layla]

Here is an article from the Recovery Guidelines you may not have read. See if you feel it applies -
POST OP BLUES

 

[Focuspositively]

The magnesium glycinate works amazingly. I’m having success with only taking 1 - 165 mg tablet at night!

 

[Focuspositively]

Thx for clarifying the difference between PTSD and Post op blues. You’re right I don’t have PTSD and it IS reassuring to know that. I feel very nervous going to PT and worried that I’ll experience pain, swelling and setbacks from overdoing it because of my experience with overdoing PT with my first knee. It’s also the combination of overcoming the trauma from the surgery, the residual effects from the opioid and anesthetic type meds and the tiring pain which also affects my stress like you say. @Layla

 

[Layla]

You're welcome and I'm happy you're feeling reassured.
You'll be okay! I truly believe that!
It should become easier with the passage of time. Remember that you are in control when you go to PT. Do what you're comfortable doing. Be honest about your pain in PT so the therapist is able to adjust exercises accordingly. Let them know when you need a short rest or if you want them to modify and exercise for you. You can do this while still letting them know you appreciate their guidance and hopefully they'll be more understanding.
Explain that you want to improve and challenge yourself, but only within the boundaries of what you're able to tolerate. They should understand.
This will be you soon ->
@Focuspositively

 

[Focuspositively]

Here’s my experience with an MUA this year:

My RTKR ROM Progress: (when you see two numbers the first number is active - or by me without PT pushing leg and the second number is with PT pushing leg)
Sept 10 - 75 (2 weeks postop)
Sept 11 - 90
Sept 23 - 85 then 92 (4 weeks)
Oct 4 - 90 then 97 (5.5 weeks)
Oct 7 - 90 then 96 (6 weeks)
Oct 9 - 94 then 96
Oct 15 - 84 then 99 (7 weeks)
Oct 18 - 86 then 99
Oct 21 - 95 (8 weeks)
Oct 23 - 82 then 100
Oct 28 - 82 then 98
Oct 30 - 90 then 99
Nov 4 - 89 then 89 (10 weeks)
Nov 6 - 89 with PT pushing then 92 on my own doing wall slides
Nov 8 - with PT 70 then 88 on my own
Not 15 - 65 then 85

MUA was done Nov 21 (12 week post op) on my RTKR while he did a LTKR. During the surgery the Surgeon measured the right knee which had the MUA at 123 but ONLY 3 hours later it was not even 90 due to swelling.
Dec 4 by Surgeon (eyeballed) 98 left 95 right
Dec 5 by physio (14 days post-op) 69 left (active no pushing) 78 right
Dec 11 (20 days post-op) 80 left and 88 right (after the recumbent bike and an exercise using bands connecting the feet together and sitting on a high seat. The patient controls the stretch by pulling one foot which bends the other knee. )
Dec 18 64 left 75 right
Dec 23 (4.5 weeks) 78 left 80 right

You can see that my RTKR ROM hit a plateau then decreased. It was because I was pushing it too hard and the knee reacted by tightening up and swelling. After the MUA, the Surgeon said there was very little scar tissue so that tells me that it was the swelling that prevented the ROM. When the hospital PT asked him why did my ROM dropped to not even 90 three hours after the MUA when he had measured it at 123, the Surgeon said that happens sometimes and I’ll just have to work it. So, I’m starting all over again.

I’m now 5 weeks post op from my LTKR and MUA on my RTKR. I’m not pushing myself like last time and not worrying about getting my ROM quickly. I’m in less pain that way, and feel like I’m making progress. My Surgeon said that swelling can last a year. So, why aggravate it?

 

[sistersinhim]

I am so sorry to read that you are disappointed with the MUA's outcome. Adhesions, not scar tissue, are actually really rare. Normally, it's the swelling and inflammation that result from this very traumatizing surgery. It takes a long time for this inflammation to go down. It is the inflammation that causes swelling, stiffness, and pain. The very best way to lower the inflammation is treating the knee very gently with no pushing or aggressive exercises. Increasing the icing, elevating, and resting is the best thing to help your knee to heal. Keeping your swelling down will cause a better ROM, both bend and extension.

My Surgeon said that swelling can last a year. So, why aggravate it?

Exactly! Very well said!

 

[Layla]

I’m now 5 weeks post op from my LTKR and MUA on my RTKR. I’m not pushing myself like last time and not worrying about getting my ROM quickly. I’m in less pain that way, and feel like I’m making progress. My Surgeon said that swelling can last a year. So, why aggravate it?

Atta girl, FP!
Considering you're only a tad over one month post MUA, give yourself the grace and time you deserve.
Don't you wish you could just settle in for a long Winter's nap then awake and all was perfect?
If only we didn't have to be patient.
You'll get there! I hope you have a pleasant weekend.

 

[Lupyhippie]

I am reading this in anticipation of TKR scheduled for 3/3 but probably I’m going to delay it again 1. Bc I’m scared. And 2. I’ve got a lot on my plate right now.

But looking at your rehab ROM numbers (I’m a numbers person) it does jump out to me that there was a pattern in physio pushing you then having several days to get back to the higher value. Then down again. Thanks for posting these as it reinforces w ne that I need to go very slow with the ROM and not push it. I think that a smaller ROM w maybe a gain every week or so is a better plan (and suggested on this site ). So again thanks. Hope your healing is progressing.

 

[Focuspositively]

@Lupyhippie
Thx for noticing the correlation between my ROM #’s going down after PT sessions on my first RTKR done August 27, 2024. It’s because of the swelling it caused from pushing through pain. I’m babying my knees this time after my LTKR and MUA on my right on Nov 21, 2024. Fortunately, I have a supportive PT in a new clinic that listens to me. She only measured me at my last week’s session and listened and chatted with me about other progress I was making. We didn’t do any exercises. She hasn’t given me any new exercises and has even only scheduled me now for every two weeks. Each session is only 20 minutes long. Such a contrast from the PT clinic I went to for my first knee! She said whatever I’m doing at home is working. She’s pleased with my results even though the ROM numbers aren’t as good right now compared to others at this stage. She remarked that my right leg (1st replacement) is MORE swollen than my left leg. It’s also not as straight as my left leg but it had been in worse shape before the surgery. Bone on bone on right and half bone on bone on left knee.

My next hurdle was worrying about what the Surgeon would say at my 8 week postop appointment today. I thought he wouldn’t be happy with my ROM and was going to advise another MUA on left knee. I didn’t sleep well last night worrying about it. Turned out, all he said was that I needed to continue to exercise my left knee and didn’t say anything about my right knee. He cleared me to go swimming in a public pool and for driving. He wants to see me in 5 months. That was all he said. So, I’m so happy with the way this recovery is going now that I’m only doing a few stretches, and short walks daily. Mostly just icing, elevating and resting. This, resulting in less pain, much less tightness, less swelling. At my last measurement I was:

ROM on Jan 8 (7 weeks minus 1 day):
left 63 active 67 passive
right 80 active 90 passive

Slow and steady wins the race in my case. I even forgot to take my scheduled Tylonol twice today, because I didn’t feel any pain because I was so happy. I also didn’t use my cane today walking around the hospital for my X-rays and meeting with my surgeon. I hope I sleep better tonight.

 

[Jockette]

That’s a fabulous update!!

 

[mendogal]

@Focuspositively oh what a great update!!!!

 

[Layla]

Fortunately, I have a supportive PT in a new clinic that listens to me. She only measured me at my last week’s session and listened and chatted with me about other progress I was making. We didn’t do any exercises. She hasn’t given me any new exercises and has even only scheduled me now for every two weeks. Each session is only 20 minutes long.

Sounds very promising!

Slow and steady wins the race in my case. I even forgot to take my scheduled Tylonol twice today, because I didn’t feel any pain because I was so happy. I also didn’t use my cane today walking around the hospital for my X-rays and meeting with my surgeon. I hope I sleep better tonight

I hope you slept well again last evening. I'm guessing receiving a nod from your surgeon put a little pep in your step afterward. You're doing well as you focus positively. Thanks for sharing your journey with us and supporting others along the way!

 

[Focuspositively]

@Layla Yes, I slept well last night probably because my visit with my Surgeon went well. Today I started a weekly very light Aqua aerobic class. I cut back on some of the exercises to avoid overdoing it but it was 45 minutes long which is a lot compared to the gentle stretching and walking I’m doing at home. I hope I’ll sleep well tonight and not have increased swelling in my knees tomorrow.

A lifeguard on duty chatted with me about my recovery and encouraged me to only ice for 20 minutes at a time so that it didn’t prevent the blood from flowing to the incision to repair the cut. I tried explaining how knee surgery was different than other injuries and can tolerate up to 45 minutes. He wasn’t having any of it. People try to be helpful by sharing what they know even if they haven’t gone through it.

is there a timeline when people can sit for longer periods of times without straining their legs and knees or is it dependent on the patient?

 

[Layla]

People try to be helpful by sharing what they know even if they haven’t gone through it.

Yes, I agree and he had good intentions. This is what we believe to be true -

Icing for up to twenty minutes only is what most of us have heard or been advised to do following an injury. Following joint replacement, ice is a critical part of pain management and should be used not only on the joint, but any surrounding areas of discomfort for as often and as long as you're comfortable doing so, always placing fabric between your skin and the ice source. Icing helps bring relief from the soft tissue trauma and internal swelling. Icing is a great natural pain reliever and best of all, it's free. While some care providers do put a maximum time on icing, others suggest you ice as often as you see fit.

Icing after therapy, exercises, or prolonged activity that challenge ROM and endurance should help ease any discomfort, or preventively keep pain at bay. You may find relief through icing for weeks to months post op.

With that said, we've had at least one member who's OS did not advise icing and her recovery went well also.
Her thread if interested -> https://bonesmart.org/forum/threads/second-knee-replacement-done.74524/

I do think the timeline for sitting comfortably is dependent upon the individual and their extent of healing, their muscle strength and overall flexibility. Start slow 15-30 minutes and see how you do. It may or may not be comfortable due to any swelling or stiffness you're dealing with which will likely cause discomfort. Gradually build as your comfort level allows. Unfortunately everything seems to take patience and time, but you'll get there!
Sweet Dreams!