TKR Worried About ROM

[referee54]

we settled on pushing to discomfort but not to PAIN.

There you go! Great!! Remember---the PT works for you...not vice versa.

I told him I'm a turtle

WE are all turtles---there is no hurry; the faster you try to get there---or the faster that you PT tries to get you there, the slower and more frustrating progress will be.

Between the PT and frequent stretches at home I am seeing a slow improvement.

Slow improvement is what you will see---and it is improvement! This is a journey, and marathon, it is not a sprint. Do not be afraid to give your knee breaks in the routing; listen to your knee; it is in charge.

Oh yeah. I walked 1/4 mile-ish yesterday. I think I will slowly build on that.

I would not do that quite yet; you are less than a month out of surgery---the first four weeks are the "Dark days" of recovery, and your knee is still healing. There will be plenty of time to walk long/longer distance, but right now, just settle on little victoires that will end up winning the war---recovery.

 

[Lmarshall]

I think its terrific you have so much energy and enthusiasm at less than a month post op! Just a word of caution, stretching is important, but be extra careful. At 7 weeks post op I was really pushing my stretching to the point of uncomforatble and, I thought, within the safe zone. Last few sessions we concentrated on stretching with me lying on my stomach, bringing my leg back, bending at the knee, trying to increase flexion. I suffered a quadricep tear, that I feel, was in part to too aggressive stretching. At n o point was I in pain...I was just uncomfortable. Once I recovered from the quad tear (took me 10 full days to fully weight bear again), I had to restart all my ROM. I learned a very hard lesson...not to rush the strecthing. I now focus on aquatherapy and doing gentle walking and exercising in the water. ROM will come! Now, I am not saying we are all the same, Im just telling you to be careful how hard you push.

 

[kneeper]

Sounds like your latest PT is on the right track. Sounds like you are making steady progress--as others have said you're early in the game.​

I'd say it's fine to take the knee on short outings if you feel up to it, like your trip for coffee but be sure to ice and elevate afterward.​

 

[westsea]

Thank you @Lrandall and kneeper ! I am beginning to see the long haul aspect of the knee recovery in a real way. I was basing my expectations on my right THR I had in early April. First, I think my THR was easy for a THR, like on a scale of 1 being hard to 10 being very easy it was about an 8 or a 9. I still can't reach my right foot very well but that hip has got me through the left knee getting worse and now the knee recovery so far and I sometimes forget I got it replaced until I go to put on my right sock. Stretches will take care of that soon.

Sooo...My OS said knees are more work than hips to get back to normal and I think "okay", and the energy drain chart shows maybe a week or 2 longer energy drain for a knee than a hip and I think "I can deal with that". It was my concious forebrain that said it understands. I think now my whole body understands that the knee will require a lot more patience than my hip did.

Also this time with the knee I have less help from the family running the house. My husband was getting over his own surgery and my very helpful son got a full time job (thank you!!). My daughter at home is hard to get to help. So we have limped along (nagging the daughter which has its own energy drain). Husband is all better now but that's just in the last week. Company coming tonight and we have our work cut out for us with this mess and food prep. I need to do a small trip to one store for some birthday presents, and pick up a little of the mess, and make some appetizer type stuff.

I am wanting to cut down my narcotic drug intake so I can quit soon. I was getting that kind of jittery feeling before my next clock dose (from withdrawal not pain). And anyway, the pain is getting more into the category that can be handled with tylenol and ibuprofen. Ibuprofen is helping with some of the knee swelling so far. So last night before bed (9PM ish) I took 5mg Norco which has a little tylenol, 50mg hydroxizine, and 600 mg ibuprofen. I repeated that when I woke up around 3AM (except no ibuprofen) and then slept til 730am. I swapped back and forth from bed to recliner less than usual and I think I got enough sleep for a change. It was way better than the 5mg Norco every 3 hours by the clock. This reminds me of trying to get the baby to sleep all night. Right now my knee is the baby. Patience was important then as well.

Hope you all have a nice weekend!

 

[Josephine]

the energy drain chart shows maybe a week or 2 longer energy drain for a knee than a hip

At first I thought you must have misread the articles and then checked - now I think I need to redo them!

Company coming tonight and we have our work cut out for us with this mess and food prep. I need to do a small trip to one store for some birthday presents, and pick up a little of the mess, and make some appetizer type stuff.

At 4 weeks? No way you should be doing all this at 4 weeks! Take a look at this Activity progression for TKRs which says

Weeks 4 and 5
Increase walks around, out in the garden or street, to 20mins, longer if you feel up to it.
PT can now get serious but never ever overdo it. Exercise bike 10 minutes and try for full rotations if you can

Additionally activity:
Gather a little bit of laundry, or put it in the machine, or take it out but not all of it
Now you can do a little dusting and tidying; do a little meal prep (for yourself not the family!)

I am wanting to cut down my narcotic drug intake so I can quit soon.

I wouldn't recommend this. Time to start letting go of them is when you start forgetting doses.

So last night before bed (9PM ish) I took 5mg Norco which has a little tylenol, 50mg hydroxizine, and 600 mg ibuprofen.

I'm sure you are aware that hydroxizine is simply an anti-anxiety med and not a pain killer. So that means you had just 5mg Norco and 600mg ibuprofen. And the 'little' Tylenol it had in it was, as far as I am aware, just 325mg, yes? To be honest, you'd have been better taking another 2 regular Tylenol with that Norco and forgetting the NSAIDs.

Ibuprofen is an extremely mild pain killer and the 600mg you took was probably equivelant to less than one regular Tylenol (325mg). Plus which it is fraught with issues - see here NSAIDs, acetaminophen (Tylenol, paracetamol) differences and dangers.

 

[kneeper]

If you're having guests at 4 weeks *they* should have to bring the food and it should be on paper plates to minimize the cleanup. Also, you should take yourself off for a nap if needed & tough on the guests.

 

[westsea]

My son and his wife brought some chicken ranch cheese dip and chips. Mmmm. My other son brought his sparkling personality .

 

[maryo52]

I also have a couple of sons, and their visits were breat boosts to my morale. There is family that uplifts and helps, and then there is family that depletes. Sounds as if yours is the former.

 

[kneeper]

sounds good.

 

[westsea]

4 weeks post op yesterday. I was bummed early about a seeming decrease of my meager rom. So I decided at 4 weeks it is okay to push a little harder on my home PT. I could do some of the stretches better than a week or two ago like push back with my good right leg while sitting on my bed. I still can't get my exerbike to a full rotation but seemed slightly closer. Then I iced. I walked down the block and back and then walked upstairs every other leg! Its borderline still but it worked. Then I iced. I always save time to ice after I push it.

And being as I had been off narcotics more than 24 hours, I drove my car to Fred Mayers and bought a couple of things and drove home. True I had to put the seat back all the way back so I could scoot back and get my left leg past the car door but then it all fit. It would be hard to do a longer trip than just around our town due to leg complaining about being stuck in a certain bend for too long.

I still can't seem to get comfortable enough to sleep in my bed but I keep trying different positions in there to check. Sleeping on my back on the recliner is a marginal replacement to stretching out on the bed.

As my body adjusts to no narcotics, I have goosebumps sweeping across the entire thing and intermittent sinus stuffiness and nausea. Icing makes the goosebumps worse, but that should all be gone by the weekend. If I can get rid of the last 3 steristrips and the tiny scabs where the staples were I can soak in a hot tub. Of course it is now fall and our weather has returned to a more normal chillyness. But it was a beautiful summer here in the Seattle area, almost always warm, lots of dry, and more thunderstorms than I have seen here in my other 4 summers put together. I'm glad I didn't have to work (meteorologist).

Linnae

 

[Lmarshall]

Sounds like you are doing great and making steady progress!

 

[westsea]

I went to PT yesterday morning and it was illuminating. She measured my ROM at 80 flex and 7 ext which was much better than when I started. I found out that when we are stretching for flexion and extension we should do it in small amounts several times a day because the tissues are elastic and return to their tighter condition when you stop stretching. So you have to keep stretching then to remind them of how they need to change. That is in contrast to working out which you do every other day with rest between to heal the tiny tears in the muscles and gain strength. So since yesterday morning I have been doing a few flexes and a period of extension every hour or two during the day. I don't know if its working but at least its not swelling much. Sloooooww progress so far if any. I'm optimistic!

Also today I put my recumbant exerbike at max length and got the pedals all the way around forward and backward! My knee loosened up a bit as I continued. I'll make it longer at PT next Tuesday and get the pedals all the way around there too. I'm tall so No I was not lying down!

 

[TxT365]

Linnae, when you say you're having trouble sleeping, have you tried a couple of pillows offset so that your knee is still elevated? I do that at times. At other times, I just try to find the best position and end up tossing and turning. When you throw in a bi-pap machine, it gets frustrating sometimes.

I talked to my PT today about taking a bath, swimming and using a hot tub. She said not yet. All of the staple holes must be completely healed, with no scabs anywhere on the incision area. The reason she gave is because the incision went all the way down, not just a surface scratch. So you want to make sure everything is 100% healed so that absolutely no bacteria has any chance of getting in. However, in 1 month, I should be good to go swimming for my son's 2nd birthday!! Yes! So just be careful.

I found that I was only taking 2-3 pills a day for the pain so I've asked the doc to change my pain meds and she did. I have one refill on it, and after that, I'm hoping to be on straight over the counter pain management. I understand your desire to get off the narcotics.

 

[westsea]

TxT365 , Hi Trish. I like to mostly sleep on my sides. I can sleep on my back for awhile and I do elevate the leg then, but my back starts to ache and its time to switch positions. Also my mouth falls open and dries out inside and I bet I snore pretty bad. I can find a sweet spot on my good side with the op leg up on the pillow kinda bent but the op leg starts aching within a half hour. Things will get better, but it's so slow!

I asked the nurse today about the bath and lotion and she said as long as the incision was completely healed, no scabs. She didn't mind the staple scabs.

Aren't 2 year olds cute?...oh wait, terrible twos. But cute! My baby is going on 21. I kinda miss having little kids at times but not right now. I don't even have enough energy for me.

I had my last Norco last Sunday morning and I am feeling better but still kinda yucky at times. When I got my hip done it was a week before I felt normal after I quit the narcs. I think part of my problem is not sleeping well. And last night I got up to get some ice because my knee ached. I think I over did the exerbike yesterday when I found out I could get the pedals all the way around. Slooowww dooowwwnnn.

 

[westsea]

Its 6 weeks post op today. The ROM is slowly improving and I do believe its 90 to 100 now - pushing, just eyeballing it. This morning the knee was a little more swollen either because I was pulling weeds (beautiful fall weather) or because of the stretch I did yesterday. I finally got my heel past the recliner footrest, so I just sat there awhile with it that way. It was fairly comfortable til I flexed my foot to add a little bend. Naw, I think it was the gardening. I scootched down the front steps on my butt weeding but had to get up three times, then did a little bend over weeding. To get up off the step I have flip over to get onto my hands like a pushup and then get up. I don't know... Turtle still. Walking around stores is best with a cart to push. I'm not taking regular walks yet but I'm using the cane less. The knee is still a little swollen all the time so I'm taking it easy. I can sleep in my bed all night now. I have a pillow leaned on another pillow for the leg. Mostly I'm still stuck on my back but I can angle a little to each side comfortably. Thank goodness for small favors...

 

[maryo52]

Hey, Turtle is faster than Snail!! Eyballing ROM is the best way to measure. I refused measurements! Felt too much like grades.

 

[westsea]

We went to my son's wedding 550 miles south to Eureka CA on Wednesday and got back home last Monday. It was hard to stretch out my leg in the car and that would cause aching at times. I finally found an unexpected place to extend my leg while driving the Subaru though so that worked well. I drove all the way down. My husband was grinding his teeth at times...but I had fun. Love cruise control! I wasn't able to stretch out and elevate as much as at home, but the motel ice machine and 2 ziplock bags worked out nicely. The motel bed was firmer than mine and I finally found a comfortable way to sleep on my side! Whew! Its now adapted to my memory foam topped home mattress. Sleep is good...

10 weeks post op tomorrow. Still slow improvement. Last week at PT, she measured my flexion at 90 deg with me just using my leg muscles and at 97 deg with her gently pushing til I said stop. I could have let her push longer but... Extension was 5 deg with a weight pulling my ankle down while I was face down on the edge of the table. I can pedal the recumbent exerbike all the way around with the seat at almost max distance out from the pedals. It seems like such slow improvement. I did walk downstairs alternating legs at PT but its harder at home. I think my stairs are slightly higher rise or smaller run. The physical therapist said I can probably end with my appointment this next week which is Thursday. Thats fine with me. I think most of the improvement I got was from home practice anyway. At PT they were nice and encouraging though. I see my OS on Tuesday, first time since surgery. I think he'll be encouraging too and say as long I have even slow improvement I will get where I want to be.

Question: Is it normal to feel an uncomfortable rubbing in my knee when walking up the stairs, which I have been able to do for awhile? What would be a good exercise to strengthen the muscles so this gets better? Its not as bad as that sharp pain when I had weak knee muscles for ages off and on before I had the tkr.

So meh...

 

[westsea]

To whom it may concern: My left knee is almost 6 months old and my right hip is going on 11 months. The hip recovered quickly compared to the knee. But the knee is finally getting to a point where I think it will be back to normal eventually (knock on wood...). I'm not "worried about ROM" anymore. I can bend my knee probably to 120 deg and more if I push. How does one measure one's own ROM? It was a long process with times of despair through 3 months, but very slow progress continued as I looked at it week to week. At 4 months post op I raised my bike seat and managed to pedal with some discomfort, but now I can ride my bike with the seat at a normal level with little discomfort. I still ice after a bike ride.

Fitness went down hill over the last year and a half, so I joined a gym and have been working on strength on the upper body and core, and carefully on the lower half.

I can get useful work done in my neglected garden again. Die Himalayan blackberries!

Hang in there you all and listen to your bodies.

 

[NuNe4Me]

Forget about ROM - focus on how you feel.

 

[westsea]

I feel less worried about how my knee will end up now that I can bend it noticeably past 90 deg. It feels good to bend it now. I only said the "worried about ROM" thing because I named my thread that when I couldn't bend my knee past 70 deg 2 weeks postop and the PA said things about my lacking ROM. That made me worried for awhile, but things are looking really good at almost 6 months postop. You will get to ride your bike again too!