TKR Worried About ROM

[leejaa]

Wow, that is a lot of activity and walking and in and out of car for 3 wks. post op. You might want to spread out the activity a bit at this time in the healing process. I hope the ice and elevation take care of your discomfort. Make sure you are listening to the knee.

 

[westsea]

leejaa . I know I need to listen to the knee more than all the other things calling to me right now. Starting today. It feels swollen this morning but not as achey as last night. So knee and I will direct from the recliner throne as the family gets ready for a visit from son and wife this evening. House is a MESS. Hamburgers for dinner. Today should be much calmer than yesterday. I mean Saturday the 14th right - not that I'm superstitious.

 

[westsea]

I think my knee wanted to go to Starbucks today, so my husband drove me over there and it did hit the spot. Riding around in the car is such a good antidote to sitting in the house all day. We walked slowly and gently around Michael's and Joann's looking for a foam rubber wedge pillow (no luck) and we did glean info at Joann's about using a serrated bread knife to cut foam rubber. I now have a good start on a pillow that will hopefully allow me to sleep in my bed! This pillow was fashioned from the one that they gave me to put between my legs after I had my THR, to prevent leg crossing.

I have a conflict I want to ask bottomshollow and leejaa to comment about. The walking caused my knee to swell more than it was but I can't say the walking hurt. The swelling felt pretty tight and added a few twinges to my knee area on the ride home sitting with my legs up on the back seat. That's the most that happened. When I got home I iced and elevated. It felt good. I think my knee likes the exercise of walking as long as its gentle. Fluid packs in there but does not seem to cause any lasting harm. Does it? The exercise of walking is good for the muscles and other tissues and probably helps the by products of healing to move along in a healthier way than sitting in a chair all day does. The increased fluid while walking causes a feeling of pressure and probably decreased ROM in a temporary way but does not hurt. When I iced and elevated the increased pressure feeling dissipated fairly quickly.

Thanks!
Linnae

 

[leejaa]

Walking is good, it does not hurt the knee. The thing is to avoid over doing and letting the swelling get too bad because it is harder than for it to go down. Sounds like you monitored yourself and reading your note your leg was even elevated on the back seat going home. Just keep listening to the knee when you walk and do what it is telling you so that you do not over do and you should be fine.

 

[bottomshollow]

Swelling is pretty much standard for a recently replaced knee. And certainly you will get some swelling with a lot of walking around even if it is not painful to do so. I don't think you have any real problem here. I could walk a lot without pain early on which resulted in some swelling---so I'd hit the recliner and elevate and ice and take it easy for the rest of the day or evening and was fine.

Take care and keep us posted, We care/

 

[westsea]

Hi Jamie ! Could I change the name of my thread from the cat is cute blah blah to "Worried about ROM"? Because that is where I seem to be heading. I'm starting to think something is wrong. Or my knee is telling me it wants to bend more but there is something in the way. My knee says it doesn't seem like just swelling. It seems more like big prosthesis and some swelling. My surgeon wrote in his op report that this part fit perfect and that part fit perfect. And it did bend a lot at the end of surgery (like 160?). But I have not been able to sit in a normal chair without putting my leg up or extending it way out since I woke up after postop in the hospital. Tomorrow is 3 weeks. I'm starting to think that I will not have much more ROM until the swelling has completely gone away. I need to talk to my OS, not the PA who I saw at the post op appointment last week, who threatened me with more surgery if my ROM didn't improve to 90 by 6 more weeks. She was not even in on the surgery. I have an appointment with the OS in 8 weeks. Hopefully this will all be a non-issue by then. The best xray the tech got in 4 tries at my postop appointment showed a not fully extended leg with a big white mass in the center of my knee area, the prosthesis. Couldn't tell much from that. Maybe if I keep dangling my leg over the side of my bed it will eventually bend to 90 degrees and not be painful while its at it. Now it is 60-70 degrees. I'll dangle a little longer, couple of weeks, but I won't wait 8 weeks. And I won't let PTs or PAs force it until I see my OS.

Thanks for the rant space.

 

[Jamie]

Please, please don't stress out over your ROM at this early stage. Swelling is what is holding it back right now. Don't push yourself....even dangling too much can irritate sensitive tissues and cause more swelling.

What you should be doing is staying off your feet, elevating your leg with toes above your knees, icing like crazy and taking something for any pain you have. Don't do any exercise more than gentle stretches and bends and no activity around the house other than short trips to the kitchen or bathroom. Put those comments from the PA out of your mind. It's way too soon to be talking about any type of additional surgery or an MUA. Geeze! These people!!!!!

 

[westsea]

Jamie, Thank you so much for your direct response! It made my fears shrink to a fraction of what they were yesterday. I will stretch gently. It seems more swollen today but I was letting gravity take it more than I should have yesterday. Today was my last blood thinner, so tomorrow I will add back in the ibuprofen that I gave up 5 days before surgery. It definitely helped my presurgical swelling.

 

[maryo52]

You cannot force your knee to bend. No PT, no exercise, not even a magic wand will make it bend.

What you CAN do is not do anything to limit the bend. The only thing limiting your bend now is swelling and tissue trauma. So if you have committed yourself 100% to the Bonesmart mantra, your ROM will increase as your swelling goes down and your tissues heal. PT does zero for healing, by the way. Zero. Rest = healing. Time = healing.

I found NSAIDs did reduce the swelling. And let me tell you something else. A post TKR knee feels really really weird. It hurts, it's big, it's clumsy, etc., etc., etc. You can not draw any conclusions from those weird feelings. Everything you're experiencing now is temporary, and you have to keep telling yourself that. It can be quite trying for some people. I know it was for me.

Watch out for this scenario: your knee is slow to bend, your ortho and/or PT pressure you to bend and even say you'll get a MUA if it doesn't bend __ degrees by [date], and then you in turn push your knee. This will, I guarantee you, backfire.

I too had a sense of panic over my bend early on. And guess what? My panic was actually justified. But it didn't do any good.

I'm glad you changed the name of your thread.

 

[westsea]

Thank you maryo52. I hope your knee has been good since 2011? I was low yesterday that's for sure. Much better today because of your encouraging words. And Jamie's. And I'm done with blood thinners.

 

[Jamie]

Each week will bring some progress. This is a long recovery and you need to think of it in terms of weeks and months, not days. Some people even keep a log of their progress - no matter how small - just to see how far they have progressed after a few weeks or months. A good way to do that is to post your successes in your recovery thread, then go back and re-read it now and then. You'll be amazed.

 

[Whimsy3]

Westsea are you using a walker or cane? Goodness I used a walker for about 3 weeks and a cane forever it seemed. I found using a walker helped my gait and helped retrain my brain how to walk correctly. Just my own opinion but I think you need to take it easy more than you are. This is coming from a very active gal too!!

 

[westsea]

Whimsy3 , I have been using the cane since the hospital. Our walker is a little too short and I got really used to the cane with my hip and before my TKR. I can walk without it but it does add stability.

Today I had PT with a different person. He gave me a lovely knee massage! I would have loved a half hour of that, but then we went on to the exercises and stretches. I came home with a device to improve extension labeled "IdealStretch.com". If you look at the website its all with people using it on their backs waving their leg in the air. My PT had me use it with my leg flat on the bed. I pull back only as much as I want on the top loop and the bed blocks over extending.

Jamie , I really love having a place like this forum to keep a sorta log of how recovery is going. And its great to get comments and encouragement too. The PT guy today was encouraging me to push myself but not physically pushing me. As long as I am in control I can keep it gentle. I'm optimistic the ibuprofen will help with the additional swelling and tightness. I'm already icing 10 times more than I did with the hip.

 

[maryo52]

Yeah, the hip recovery, I guess, is a different animal. Anyhow, I looked at that website. Interesting. . . I'd be curious to try it. But do watch out. Again, no tool or technique will get your knee bending better or faster. Think "turtle wins the race."

 

[westsea]

My knee felt more stiff again when I got up this morning. It didn't help that I tripped last night and nearly fell. I felt like Pinocchio getting my left leg when it needed to be so I wouldn't fall. I caught my balance with the arm grabbing the sliding glass doorway. I iced, but the gyrations probably added a little swelling this morning along with left overs from PT yesterday. I added back in all my usual vitamins as well as 6 200mg tabs of ibuprofen a day since yesterday morning. Pain relief is a 10/325 Norco about once every 5 hours.

Today I did my home PT with about 10 pathetic half revs on the exerbike to warm up, then the extension stretcher mentioned in previous post holding a gentle stretch 10 sec times ten reps. This one makes the knee system feel looser and more flexible. So then I did the leg dangle off the bed for 3 reps 30 secs each. That made the knee system feel tighter again. So I did 10 more reps with the extension device and it was looser again. Ah ha! I like ending with looser. Then I iced about 30 min. I will try doing these gentle stretches 3x per day and see if it helps.

 

[Lmarshall]

The ideal stretch is for hamstring stretches. Im not sure why they would give this to at this point. You are less than a month post op. What is your extension? (sorry if you already posted it). I was fare from doing anything like this at 1 month post op. I think I just started lying on my stomach and letting gravity work for a minute at a time before taking a break. I only did 3 repititions of this to start. If you want your swelling to decrease you need to ice and elevate most of the time. This will bring down the swelling adn then, and only then, will ROM increase. I am at 3 1/2 months post op and still have some extension limitations, but it is improving slowly. I guess my main comment is this: REST, ELEVATE AND ICE ICE ICE!! This should be your home therapy focus right now.

 

[maryo52]

You have the perfect opportunity to modify your routine for what works. I'm excited this tool works so well. Loose = good! Well done.

 

[westsea]

maryo52 and Lmarshall ,
I got the device at PT. Its just like the picture on the website, except I use it sitting with my leg straight out on my bed. This gives a gentle leverage on my shin which I control to push my knee down toward zero extension. It might have been meant for hamstrings, but PT lends them out to use for extension stretches. Not sure what my extension is, but its not flat on the bed unless I push on it. It seems to work for now. My flexion seems to be improving but is still not 90. Turtle, aye!

 

[referee54]

I see by your signature that yo have had less than a month of recovery from your TKR. You are still very early in the recovery stage, and your surgical knee is still very much trying simply to heal. ROM can take upwards to a year to regain and to reclaim---you have lots of time left.

Each week will bring some progress. This is a long recovery and you need to think of it in terms of weeks and months, not days.

This is right on the mark; it takes a long, long time to recapture the ROM---and remember, ROM is just aq number, anyways. In the end, as long as you can do what yo want and be pain-free about it, the actual number does not matter.

ROM progress is measure in the smaller increments---very little in the way of big gains. Swelling and over work in the early stages actualy slow down healing---just be patient and realize that this journey toward recovery is, in reality, just beginning.

 

[westsea]

I went to another PT appointment this morning. Lots of alternating extension stretches and flexion stretches. The PT said maybe I should try to push through and I said it might break my kneecap. So once again we settled on pushing to discomfort but not to PAIN. I told him I'm a turtle. I called the OS when I got home to ask what he thinks would be best. I will perhaps hear back today - they are very busy over there. I think a massage aimed at loosening the tight spots would be great along with what PT has been doing. I think pushing through is a bad idea. I

Between the PT and frequent stretches at home I am seeing a slow improvement. I'm keeping track on the recliner footrest and my heel is getting closer to my butt. referee54, I don't know what my ROM is but I know it is not yet a right angle, but its more than 45 deg. I'm interested in function, not numbers. Walking better than before surgery, alternating stairs, sitting in the front seat of the car, driving!, riding my bike!

I wish I knew how to give myself a useful knee massage. Any diagrams on bonesmart for that? Its easily accessable! I'll tinker with it. The post staple steri strips are just starting to fall off. "Hmmm, peel-ow!, wait a bit..."

Lastly, I'm trying to taper off the narcotic pain reliever so I can quit. There's still ibuprofen and acetamnophin tylenol. Beer. Oh yeah. I walked 1/4 mile-ish yesterday. I think I will slowly build on that.