Revision TKR YYZ Back To YYC!

[Jockette]

He did mention the good old 'no pain no gain' adage and I could contact their office if I have any additional issues lol.

Well, if you do the no pain no gain thing, you would probably have to call his office for more pain medication. (which many are reluctant to give, even though they push this rehab protocol)

It is a long journey but if you stick with the BoneSmart approach the journey will be less painful and you will still reach the same final destination. Ultimately you get to choose the path, the tough rocky road through painful PT, or the BoneSmart path through the meadow with the pretty wild flowers

 

[2chains]

@Jockette you are right he is very lean on pain meds and heavy on physio-he wanted me to go to pt at day four and no way that was happening! Even my GP was shocked at this recommendation! She has indicated the new up and coming surgeons are in tune with the new way of doing recovery and very supportive.

I have full intension of going through the meadow with the pretty wild flowers!

 

[2chains]

22 days post op. My GP has switched me to traditional crutches. The cane really impacted my gait in a terrible fashion and the hunching down with the walker was causing me to have medial pain in a vary localized area.
I'm focusing on walking erect with un tilted pelvis and swing through from hell/toe/flex/leg bend/reach. I have adjusted down my daily walking routine to meet the demands of the more efficient stride I now have. I estimate my distance on my home walking route is now 310m although it is on carpet, there are stops, starts and a few turnarounds it is definitely not at full speed to date. I'll soon start outside as the ice melts and start going four houses up and back which is 320m all on concrete and see how it goes.

I'm doing well with the cycling forwards and backwards 2x day 6min each time maybe need a small time increase soon? Doing my surgical stretches and PT 2x day (not 3-4 times as suggested) and also limiting it to 10 reps of each. My pain has lessened in last day of two and increased timing between meds to 5 hours.

I've added a daily chore to help out my wonderful partner, with a 3 hour sleep in, and feeding my fur friends in the am...I'm awake at 5.3am anyway! Sleep has been one of the most difficult activities to achieve to date. Three hours at first but then waking up every hour or so until 5am. Might try cbd gummy's to assist.

Still getting up every 45mins to hour in the daytime and moving around about if the pain is not too bad. Trying to focus on good posture with the new crutches. Still feel very tired after doing the one chore so no chance of overdoing it at the moment. Physio is on mondays so we'll se how that progresses.

 

[Susie-Q]

Check with your PT on when to increase time on the bike. You are still very early days and at that point I don't even think I was doing the bike yet and I only did around 5 minutes each session well into my 3rd and 4th month. You are still in the healing stage and don't want to do more than your baby knee will allow.

 

[sistersinhim]

Might try cbd gummy's to assist.

Please also with your doctor before starting any CBD product.

 

[2chains]

@Susie-Q Thanks for the reminder! I'm trying to keep myself at a steady pace and I shouldn't increase both my daily walking and cycling efforts at the same time although I do enjoy them more than the ROM exercises!

@sistersinhim I'll follow up with the Rx.

 

[2chains]

Week three brings 5 more ROM exercises from the surgeon. At this point doing these with only 3 reps with very minimal ROM as I don't want to overdo it.

My new shoulder crutches are going good and feel walking and gait is improved after the first few days with them. You really need to focus in straightening your pelvis and standing upright with your shoulders back to use effectively.
Since I started with them I do find increased tightness in the calves and will continue to hold back on my walking distance everyday this week.

I find I'm getting pain in my arch and inner lower leg and wondering if I'm going to need an orthotic to adjust my step? Is it common to need an orthotic after TKR?

 

[Jockette]

You are probably walking a little differently right now, thus the discomfort in your foot and shin. Some members found it best to buy new shoes. Wearing older shoes with the pre TKR wear pattern could be a problem. Although shopping for new shoes so soon after surgery might be a challenge.

 

[2chains]

@Jockette I never even considered needing to buy new footwear. Makes total sense after looking at the wear patterns on my current shoes. My Feet are always tough to fit so no online shopping on this one!

 

[Jockette]

Shoe shopping is quite a challenge for me, so I don’t envy you right now!

 

[2chains]

Seem to be in much more pain the last few days...not sure what I did but I think the blues have set in! Didn't do any exercises yesterday other than a bit of to and fro to the b-room.
Trying to get my extension thus trying to sit and sleep without a pillow under knee the last two days. Not sure if that is the issue.
I'm still on crutches and I'm 4 weeks today and fell bummed out about not being able to put much weight still...

 

[FourCats]

One of the things that helped me with extension is to lie on the bed with a rolled towel under my ankle and let the knee “drop”. I started with a minute before I felt the pull; gradually was able to do about three minutes.

In regards to using crutches: with my first one I was very hesitant to let go of the walker because I was afraid of falling. Finally my PT told me my fear was that the new knee wouldn’t hold my weight. She then reminded me that the new knee, being metal, was stronger than a “real” knee. Two days later I had transitioned to a cane and by the next week I was walking without any assistance.

 

[Jockette]

Extension can take a while to return, and 4 weeks is too early to worry about it. Just walking will help it. Some members take a longer stride to give the back of the leg a bit more of a stretch, but I didnt feel steady when I tried it.

There is no window of opportunity for regaining ROM (both bend and straight) so try not to worry about it. All will improve as you heal. Sometimes it’s hard enough to just get through the day, without worrying about such things.

 

[2chains]

@FourCats Thanks for the idea I'll give that a try!

@Jockette More great words of wisdom! Thank you!

 

[Susie-Q]

This chart was always a good reminder for me to realize how much things are still healing. Especially those bones, that take 3 months to fully heal! Sorry things are going slower than you like. Remember, your knee is in charge!

 

[2chains]

@Susie-Q That table really puts things into perspective! Patience is on my new years resolution list every year!

 

[2chains]

Looking back at my previous posts I wanted to follow up on a few things.

At 6 weeks:
I found that my issues with sleeping disappeared. Lots more sleep was welcome!

I was still using my peddler but the smaller circle peddling didn't have enough of a range of motion. At physio I persevered with the recumbent rocking back and forth.

My issues with blurred vision also seemed to have cleared up. One less feeling that I'm getting older!

I also felt at that point that things were starting to progress a little faster and more positive about my progress.

I also had my final 6 week OS phone consult. I mentioned to him again my continued issue with pain walking due to inflammation at the joint line. The advice was to continue walking as best I could. ..uugh

At 8 weeks:
I mastered backward full circle on the recumbent bike at PT! It took the next visit a week later to get going forward.
My GP wanted me to do more cycling with a bigger pedal circle. I began to use my upright bike at home but it is in my basement and too heavy to move. This involved going down 2 sets of stairs everyday and found this caused inflammation flare ups. I was rocking back and forth initially.
Started to take Naproxen for inflammation.

At 10 weeks:
I completed the full range of motion on my upright at home! I was pretty stoked about that as I initially felt I'd never get there! The immediate effect of this was I was able to do my stairs one two method! I continue on the bike going backward for 5mins and forward for 5mins.

The knee flex was progressing slowly and the extension even slower! Still had lots of the pressure sensation in the joint which I feel was the limiting factor. Going for 15min walks every other day.

Now at 13 weeks:
Cycling is going great although I'm not at the ball of my foot yet on the pedal. Doing 6min forward and 6min backward.
My bending is at 105 last measurement. The extension is still not there...15 I think?

Not feeling intense pain anymore at the ROM limits however I do have the pressure sensation and flare up if I push a bit past. I've worked up to 4 - 30 min leg roll under ankle stretches each day for straightening over the last 10 days. Results are coming but very slowly...

Still taking Naproxen x2 each day for inflammation as the pressure sensation continues when walking.

 

[benne68]

Hi @2chains, and thanks for sharing your update.

Gaining ROM takes time. We have members who have continued to gain ROM into their second year. Here are reports from two folks whose ROM returned slowly but surely.

Campervan’s ROM history
92 - 8 weeks post op
105 - 10 weeks
107 - 5 months
110 - 6 months
112 - 7 months
116 - 9 months
119 - 11 months
118 - 1 yr
120 - 1yr 2 months
125 - 1 yr 8 months and still this now at 1yr 10 months

Bertschb’s ROM history
1 month - 60 degrees
2 months - 80 degrees
3 months - 85 degrees
4 months - 90 degrees
5 months - 90 degrees
6 months - 110 degrees
7 months - 120 degrees
8 months - 125 degrees
9 months - 130 degrees
10 months - 135 degrees
11 months - 140 degrees
12 months - 140 degrees

Extension often takes longer than flexion, so don't be concerned if it seems slow. You are doing great: being able to spin the bike pedals and climb the stairs are big achievements! It's function that counts -- and it sounds like you are getting yours back.

 

[sistersinhim]

I've worked up to 4 - 30 min leg roll under ankle stretches each day for straightening over the last 10 days.

What helped me get my extension to come in was walking with a long stride, with heel to toe stride. These longer strides help to stretch those big tendons and muscles behind the knee. I always had something I could grab on to because an extra-long stride can throw the balance off. I either had my walker close or a chair or countertop. My extension improved doing this and without pain.

 

[2chains]

5 months update today. I'm not yet thrilled by my new knee but it is improving!
Things are progressing although the slow pace is a challenge.

Now fully straightening 0 degrees after a lot of sitting on my living room floor letting it sag! (I am very surprised and pleased I can get down/up from the floor. ) Flex is now the new challenge reverting back to 95 degrees. PT has been great but is now concerned and suggesting that I push flexion...unfortunately I am found that if I bend my knee to the point of resistance and a bit past that flare ups typically last 2 days. I am easing off of and maybe only going to push 1 of 15 reps in each exercise if at all.

I am on short term disability through work and they are emphasizing the continued PT visits although I am paying out of pocket. Going to PT every 10 days and doing daily prescribed exercises at home. Cycling along with the bending, straightening and strengthening exercises typically 2.5 hrs per day.

I find that I continue to have good sleep every night and very thankful for it! Most of my aids to daily living are doable and am working up to extended standing ie. dishes or folding laundry or vacuuming. I feel that 10 minutes is my standing limit. Walking is still a painful undertaking and very limited for me. Every few days I have been going to a local park with a beach towel and walking for 10 minutes then sitting on the grass for 5 minutes rest. Any more walking sets me back for days.

I continue to have stiffness and I purchased a heat pad with moisture feature and have found 30 mins use prior to exercise loosens the knee up nicely. Stairs are a work in progress -upstairs I'm using one two method and slow pace with handrail. Going downstairs is still one at a time. The step down exercise flares things up since day one and keep those to a minimum.

I am scheduled to return to work modified two days week @ 6 hours on monday and will follow up.