Lounge Doctor

TKR Winner winner, chicken dinner! Bionic Liz's new RTKA

Status
Not open for further replies.

mbrown

senior
Joined
Aug 15, 2016
Messages
306
Age
50
Location
Birmingham, AL
Gender
Male
Country
United States United States
@LIT enjoyed reading your posts. Haven't had much to add so I've not commented but I'm reading along in support. Sounds to me like your pain is being pretty well managed. Just do what feels right. I'm now day 6 and the last 2 days probably taking close to what you are taking (1 every 6 hours) except once during the day I've been taking 2 just to make sure I stay ahead.
 

KarriB

omega
Joined
Apr 20, 2015
Messages
11,968
Age
64
Location
Pittsburgh, PA
Gender
Female
Country
United States United States
It was 2 months before I could sit with my leg down for any length of time, but I did have a second surgery. Even a month and a half after the 2nd surgery I had massive swelling because I went to see Wicked and dinner before, but I wasn't missing it. That night I could feel my leg swelling, by the time I got home I literally had to peel my trousers off! Then I elevated toes above nose by laying flat on the sofa with my legs up on the sofa arms with ice. But 3 weeks later I was back to teaching part time and would spend the afternoons icing/elevating. So it's different for everyone and you can turn a corner that quickly.

I definitely would've taken advantage of a recliner theater experience. Two weeks may be pushing it because you still need to get there and back.
 
OP
OP
L.I.T

L.I.T

senior
Joined
Feb 26, 2016
Messages
353
Age
45
Location
Zion National Park
Gender
Female
Country
United States United States
mbrown, thanks for the encouragement! It's good to know that others have been able to manage their pain on a similar level of meds. All my life I felt like I had a low pain tolerance b/c things like papercuts and bee stings drove me nuts! But I'd never had major surgery or broken a bone before. So when I didn't have a lot of pain after my breast reduction surgery (which everyone warned me would be miserable), I felt really lucky for the first time in my life LOL!

You are right KarriB, it's probably too early for me to make the trip to the movies. We live about 30 minutes away from the theater, and I can imagine my leg transforming to a log well before we even got there. Now if I could just bring the ice machine with me :heehee:.... OK, maybe not!

Since my hiking days have been put on hold, my hubby and I invested in a Jeep Rubicon to take on all the rock crawling trails out here. I was really bummed b/c one of the major trail events is going on mid-January, and hubby wanted me to go. Something told me I wouldn't be ready for it yet, so I declined. I'm so glad I did, as I realize that 6-8 hrs in a sitting position (not to mention the rocking and rolling) likely would have tested my limits of sanity!

In home physical therapy was this morning....and all was going well. Then PT said 'your leg isn't extending fully, do you mind if I gently help to stretch it?' He specifically said the word GENTLY. He GENTLY pressed down a bit....then leaned ALL his weight onto my leg. Sweet Mary, Mother of God! He's lucky I didn't come up swinging! I let him know in no uncertain terms that it was NOT OK to do that.

Of course, if I'm being completely honest, it actually felt good about 10 minutes afterwards, to have a little extra stretch. But I knew the swelling price to be paid would not be worth it. And now, of course, my extension is just back to what it was before.

So that leads me to my next set of questions.... How does a person tell if their lack of ROM progress is due to scar tissue forming OR due to less obvious internal swelling? I'm not necessarily asking for myself currently, but more for the future weeks ahead.

For instance, although my outward swelling has decreased tremendously in the past 4 days or so, I still feel the little tendon pops or ligament adjustments like I did when I had swelling from my knee scope. These are usually little 'tweaks' inside that either feel like a rubber band popping or like a structure under awkward pressure until it moves to a more comfortable place.

I do, however, have a 'pull' during flexion at the upper part of my kneecap (just to the inner side of midline) that only seems to give if I increase the stretch millimeter by millimeter. Even then, it is still uncomfortable (sometimes painful), and it doesn't feel like it's moving any father than my 95 degree mark, no matter what. I know I still have some swelling, but it feels differently than the other 'tweaks' and adjustments my knee is making.

Is it fairly obvious when it is an adhesion or scar tissue that is blocking progress? Also, if it is identifiable early, is there really anything one can do about it? Or is it a 'you get it (and do manipulation or surgery) or you don't' kind of thing?

Thanks for listening to me rant!

Liz
 

Celle

MODERATOR
Moderator
Joined
Nov 19, 2011
Messages
40,704
Location
New Zealand
Gender
Female
Country
New Zealand New Zealand
Hi again, Liz,
So that leads me to my next set of questions.... How does a person tell if their lack of ROM progress is due to scar tissue forming OR due to less obvious internal swelling? I'm not necessarily asking for myself currently, but more for the future weeks ahead.
I hope you're not worrying about ROM and lack of progress so early. It's only 12 days since your surgery.

In spite of what you will probably hear from you PT therapist and possibly from your surgeon, adhesions after a knee replacement are actually quite uncommon. They don't develop in the early days and they aren't just sitting, waiting to pounce if you don't do enough exercise.

The best way to avoid them is to treat your knee gently, and not to do any exercise tht hurts, and not to over-exercise. Hurting or over-exercising tends to irritate and inflame your healing soft tissues. Inflammation brings heat and heat results in tissue dryness - and dry tissues are more prone to develop adhesions. So, that's why we advise not hurting or over-working that knee.

If you have adhesions, your ROM will stop increasing, despite plenty of measures like stopping exercises, and using plenty of icing, elevation and rest for a month or so. You or your therapist may feel a "hard stop" at the point of your maximum bend.
I do, however, have a 'pull' during flexion at the upper part of my kneecap (just to the inner side of midline) that only seems to give if I increase the stretch millimeter by millimeter. Even then, it is still uncomfortable (sometimes painful), and it doesn't feel like it's moving any father than my 95 degree mark, no matter what.
You're at 95 already? That's fantastic! My surgeon doesn't expect even 90 degrees until about 6 weeks post-op, so you're well ahead of the game. You're also past the mark where a MUA would be considered, as most surgeons don't do them once your ROM has reached 90 degrees.

Your knee can still bend a little further, so there's no "hard stop" there. Don't push to get more ROM and don't hurt your knee. It will continue to bend more, slowly and in its own sweet time, as your swelling goes down. It's the swelling and the tissue damage that is preventing you from bending further right now, not adhesions.
Is it fairly obvious when it is an adhesion or scar tissue that is blocking progress? Also, if it is identifiable early, is there really anything one can do about it? Or is it a 'you get it (and do manipulation or surgery) or you don't' kind of thing?
Sometimes it's not obvious and it takes a little while to be sure of the diagnosis. Some people get rushed into a MUA unnecessarily, when a little patience, less exercise and lots of rest, ice and elevation would have improved their knee anyway.

No, adhesions aren't identifiable early, because they don't happen early.

This article may help:
MUA (Manipulation under Anaesthetic) and Adhesions

For some strange reason that I will never understand, a lot of PTs and surgeons seem to believe that you have a limited time in which to gain ROM, or all is lost and your knee will set for ever. It's a total myth. ROM can continue to improve for a year, or even longer, after a TKR. We've had a couple of people here who discovered that their ROM had spontaneously increased as long as 3 years after surgery. There really is no need to rush to get that ROM:
Myth busting: the "window of opportunity" in TKR

I hope I've managed to reassure you a bit.
 
OP
OP
L.I.T

L.I.T

senior
Joined
Feb 26, 2016
Messages
353
Age
45
Location
Zion National Park
Gender
Female
Country
United States United States
Thanks, Celle!

And in spite of my line of questioning, I actually am NOT worried about range of motion. After the PT decided to 'gently' stretch my leg this morning, I was trying to come up with some rational reason he could have had to even possibly feel the need to 'help' my extension along when I am not even 2 weeks out. (Of course, I came up with nothing)

But it just got me to thinking along the lines of 'how would a person know if their lack of progress was due to swelling or scar tissue, and would they have any recourse (outside of MUA or lysis) if they figured it out early enough.

I have a terrible habit of being curious and wanting to know' how things work'. I am absolutely certain that I was 'that' annoying child who was constantly asking questions and coming up with 'what if' scenarios. That's basically where my mind wandered after I decided my in home PT must have been a sadist to feel the need to push someone who was only 5 degrees off from straight! (no, I'm not bitter at all LOL)

No, I have completely taken what I have learned here to heart. I've also used it to help reassure my mom after her OS yelled at her for not making enough progress at week 3.

Anyhow thanks for the answer because I was just curious. You'd think there would be less of a 'rush' on ROM so that people would have to spend less $$ on ueationable procedures. Especially since adhesions can sometimes self resolve or loosen on their own within a year (a little tidbit I learned back when I got my rib cage adhesions).

Thanks for taking the time to indulge my wandering thoughts!
 

KarriB

omega
Joined
Apr 20, 2015
Messages
11,968
Age
64
Location
Pittsburgh, PA
Gender
Female
Country
United States United States
My first PT did the same thing, but to much dad and best friend after they told the PT they weren't returning. I went to the same group and watched their hands with eagle eyes, both my dad and friend had the so me how painful it was. However, my infection reared its head, I went back to the hospital and because of it ended up changing PT groups. My second group was wonderful and gentle, always asking if I was experiencing pain.
 

Celle

MODERATOR
Moderator
Joined
Nov 19, 2011
Messages
40,704
Location
New Zealand
Gender
Female
Country
New Zealand New Zealand
You're welcome, Liz! As a fellow nurse, I completely understand the urge to find out about everything. The problem can sometimes be to separate the professional curiosity from the personal recovery.

I remember that my leg swelled enormously after my revision to TKR and the top 4 inches of the skin layer of my incision split open and had to be re-sutured. My surgeon did it under sterile conditions and local anaesthesia in the treatment room. He told me not to watch, if I thought it would upset me. I watched, and told him that, "It's quite interesting, if you can stay detached from it." It didn't hurt at all.

I don't know where the idea that you only have a certain time frame in which to gain ROM originated, but I sure wish it hadn't done so. Some therapists and surgeons have their patients chasing numbers deadlines and worried that they are somehow failing. That's unnecessary and unkind.
 

newlybionic

FORUM ADVISOR
Forum Advisor
Joined
Oct 14, 2015
Messages
6,862
Age
65
Location
The Poconos, PA
Gender
Female
Country
United States United States
Hi Liz! Happy New Year! I've been reading your posts and I have a couple of things I wanted to say. You are younger than I am. I had my first TKR at age 60 (which I had been told I had to wait until then) and had a total revision on the same knee only 8 months later(long story). So if your replacement only lasts 20 years before revision (they last much longer than that now) you'd be my age. So if a revision is possible now for me by the time and if you ever need one the technology will be so much better. I only wish I had it done much earlier in my life.

As far as PT goes I learned the hard way to not do anything too taxing on my knee until it was ready for it. I followed what my current OS said "if it hurts, don't do it". And I'll add to that if you find yourself in more pain after doing something stop that activity for a couple of weeks before trying again.
 
OP
OP
L.I.T

L.I.T

senior
Joined
Feb 26, 2016
Messages
353
Age
45
Location
Zion National Park
Gender
Female
Country
United States United States
KarriB, I definitely can't wait to get to outpatient PT where I can choose my regular person - the one I have now is one of 2 that will come out to our small, tiny town in the boonies. He did come yesterday and I volunteered to 'gently' stretch my knee myself LOL... If you can't beat them, join them... (as long as I get to choose how hard I stretch)!

Celle, that is great that you could watch them stitch you up! My ex husband used to be able to do that kind of thing. I realized that I get queasy if my patient is awake and I can see their pain. I also (myself) get vaso-vagal giving blood and such... So I don't think I could do that.

But working in the operating room made me appreciate the 'separation' needed to be effective and good. There's a reason most of us OR people don't like to work on friends or relatives. And by draping a patient, it allows you to create a level of separation so that you can focus on the procedure. I understand all too well how emotions can get in the way of a surgeon trying to do a 'good job'. Had I not seen (first hand) what can happen when that separation is not there, I might never have understood!

NewlyBionic (love your name!), thank you for the reassurance. You have no idea how comforting that is to me. It's easy to hear people reassure you, but it makes a HUGE difference hearing it from someone who has been there!
 

KarriB

omega
Joined
Apr 20, 2015
Messages
11,968
Age
64
Location
Pittsburgh, PA
Gender
Female
Country
United States United States
Be sure to have a talk with your regular PT before starting, just to be sure.
 
OP
OP
L.I.T

L.I.T

senior
Joined
Feb 26, 2016
Messages
353
Age
45
Location
Zion National Park
Gender
Female
Country
United States United States
Things, for the most part, seem to be going fairly well - my swelling has gone down significantly (as long as I'm not overdoing it) and my pain is less 'painful' but more of a 'discomfort' now. With the swelling going down, my range of motion has naturally gone up. I'm still nowhere close to where I was preop (could bend all the way heel to bottom) but not sure if I'll ever get back to that level anyway. As it stands, I can sit and reach my feet enough to put on my socks, so that is exciting.

My one main issue right now is patellar tracking. After my knee scope, I had a similar issue - even with just a little swelling, my kneecap would track incorrectly and would feel like it was getting pulled off to the side. My PT used ultrasound, laser, and tens on it 2-3 times a week for a month before it was resolved.

Now I seem, after my tkr, to be having the same - or a similar - issue. The difference is that this time, I know my patella has been fiddled with, so I'm not certain if it's just swelling or something more. Most of the time, it just feels like it's pulling and 'catching' in the middle of my trying to bend my knee. But last night it was popping and jumping a little bit. Sometimes it hurts (like a stretched tendon) and sometimes it's just kind of a disgusting feeling like when bones rub up against each other constantly.

I see the PA for a follow up on Friday and will ask him... In the meantime, I am trying to ice, but for some reason, my Raynaud's is rearing it's ugly head, and every time I do, my toes get cyanotic. Grrrrrr. (insert comment about first world problems here lol) This is one of those times when I imagine everyone on the boards reminding me to be patient, that recovery is a slow process. It's also a time I need to make my gratitude list and be thankful for you all, this website, a seemingly uninfected surgery site, reduced swelling, good bend, and an amazingly small and well healing scar.

Hope everyone is having a good start to 2017!
 

KarriB

omega
Joined
Apr 20, 2015
Messages
11,968
Age
64
Location
Pittsburgh, PA
Gender
Female
Country
United States United States
You're right about everyone reminding you of patience, after all you are just 2 weeks into recovery. Being able to bend to put your socks on is great! That knee is just a baby, so give it time.
 

Celle

MODERATOR
Moderator
Joined
Nov 19, 2011
Messages
40,704
Location
New Zealand
Gender
Female
Country
New Zealand New Zealand
You're right about the patience. It's such a long recovery and everything seems to happen so slowly. It will all be worth it in the end.

One of our moderators, referee54, sometimes posts this picture. He's away at the moment, so I'll copy it from him:
patience_grasshopper.jpg
 

mbrown

senior
Joined
Aug 15, 2016
Messages
306
Age
50
Location
Birmingham, AL
Gender
Male
Country
United States United States
@L.I.T. Let me know what your PT says about the pulling, catching, popping and jumping. I'm having sensations (with the pain also) that sound identical to this. My OS told me that this is normal, due to swelling and will go away. That being said would love to hear other thoughts.
 

kneeper

FORUM ADVISOR
Forum Advisor
Joined
Dec 11, 2010
Messages
12,887
Gender
Female
Country
United States United States
I see the PA for a follow up on Friday and will ask him... In the meantime, I am trying to ice, but for some reason, my Raynaud's is rearing it's ugly head, and every time I do, my toes get cyanotic. Grrrrrr. (insert comment about first world problems here lol)
Could you put a heating pad on low or a hot water bottle at your feet while you ice?
I had my tkr in mid summer and I'd be icing away with a fleece blankie on because I'd get cold. (No Raynaud's--just got chilly). You do what you need to. :)
 

KarriB

omega
Joined
Apr 20, 2015
Messages
11,968
Age
64
Location
Pittsburgh, PA
Gender
Female
Country
United States United States
I had an electric throw that I used the entire winter I was recovering from my TKR. It was a lifesaver!
 
OP
OP
L.I.T

L.I.T

senior
Joined
Feb 26, 2016
Messages
353
Age
45
Location
Zion National Park
Gender
Female
Country
United States United States
The 'patience grasshopper' is so funny.... That's exactly where my brain goes whenever I think of patience!

Yes, I keep telling myself time will help. @mbrown I will let you know what my PA says. The other PT that I spoke to today said he's heard people complain of this, and sometimes it can be b/c of stretching of the tissue during the surgery, or a muscle imbalance from post op atrophy. Just knowing someone has heard of it before makes me feel a little better.

And I am counting my lucky stars right now that everything else seems to be quite well. I do have the stiffness in the nights/morning and the skin hypersensitivity.... And some mild swelling.... But I know all of that is par for course.

Today I iced like mad with 3 pairs of socks on, a fleece blanket around my foot, and while doing ankle pumps. I DO (as you guys suggested) see a heating pad in my future!

Tomorrow will be my first excursion out of the house since surgery. I'm a bit nervous, as it will be an hour ride in a cab, however long waiting at the doctor's office and then an hour back home.... Far longer than I have been 'vertical' at home for any one length of time. I'm seriously thinking of taking an ice pack (or 2) with me. Even though I don't need my walker, I might even bring it so I can use it for elevating my leg. I'm bringing redneck to the doctor's office :rotfl:

In the meantime, I have had far too much time on the Internet and have decided that my husband and I need one of these

Is it the drugs talking? Boredom? Cabin fever? Who knows, but it sure has been entertaining to daydream about! Lol!

Thank you guys (again) for all the encouragement!
 

Celle

MODERATOR
Moderator
Joined
Nov 19, 2011
Messages
40,704
Location
New Zealand
Gender
Female
Country
New Zealand New Zealand
Even though I don't need my walker, I might even bring it so I can use it for elevating my leg. I'm bringing redneck to the doctor's office :rotfl:
Yes, bring the walker. As well as being useful for elevating, it is a precaution against slips and falls, and it serves to make people aware that you need extra consideration and patience.

Long after I no longer needed a cane, I kept it in the car and used it when I was out in crowds, or when the ground might be slippery underfoot. As well as stopping me from slipping, it served to ward off rushing children and dogs and stop them from banging m y leg. :dogwalk: :doggie:
 

KarriB

omega
Joined
Apr 20, 2015
Messages
11,968
Age
64
Location
Pittsburgh, PA
Gender
Female
Country
United States United States
Definitely take your walker and ice. While I used a cane in the house, I used a walker anytime I left the house for the first month.
 

mbrown

senior
Joined
Aug 15, 2016
Messages
306
Age
50
Location
Birmingham, AL
Gender
Male
Country
United States United States
@L.I.T. Man that Alto is sweet!!!! Oh, and after I responded to your post on my thread I put my hand on my knee to try to detect where most of the clicking is coming from and it's definitely coming from under the kneecap.
 
Status
Not open for further replies.

New

Active Antibacterial

BoneSmart #1 Best Blog

Staff online

Forum statistics

Threads
52,512
Messages
1,398,516
BoneSmarties
32,757
Latest member
gardenguy
Recent bookmarks
0

Top Bottom