TKR Antpitta's 1st TKR recovery

[Antpitta's]

Hi. 18 days since my left TKR and I guess like many others a bit of a mixed bag. First up I'm in the UK so reckon some of the methods/approaches to recovery may differ a little from the majority of you who I see are in North America.

Surgery went super smoothly and (my decision) I spent two nights in hospital before discharge with excellent pain control and three sessions of physio to ensure we'd been through the basic exercises and that I was comfortable using crutches and in particular confident going up/down stairs which would make home life easy. Both physios were excellent, supportive and of the "discomfort OK/pain bad" school .... yipeee!!

The 2 hour drive home was pretty uncomfortable but happy to back and spent the first couple of days mainly resting. I'd bought a Cryo-Cuff ahead of time and have been using it regularly each day (how do people cope without an ice machine?!). I was supplied with a months worth of painkillers (Paracetamol, Meptazinol & Nefopam) plus a bottle of liquid Morphine "for breakthrough pain" though I've never felt close to opening it. Overall post-surgery pain has not been a problem and I doubt ever above 3 or 4 on the regular 1-10 scale so certainly better than I expected.

It was 10 days post-surgery when I got to visit with the local physio: boy what a disappointment. A 30 minute session which comprised of him mainly taking notes/form filling followed by an experiment to see how far he could push both extension and flexion. He was OK with my extension but clearly unimpressed with my efforts at flexion: it was visibly obvious that I had a lot of post-surgery swelling and I explained that I could go to probably 70 degrees seated but he just said "that doesn't count" and you need to show me what you can do on your back and to be honest I doubt that was more than 45 degrees even when he "helped me try harder". I was kind of shocked at that approach but having read others tales not entirely surprised. The rest of the session was just him telling me to up all the exercise reps from 10 to 30, book the next appointment for SIX weeks time and expects 140 degrees (or 120 degrees minimum) ROM. So for now I'm not sure what I'll be doing PT wise but if I do decide I want/need more I'll probably need to book/pay my own physio rather than use the local health service facility.

Anyway, apart from that I've been working through the supplied exercises adding those that I couldn't originally do until function or muscle control returned (like straight leg lifts) and gradually increasing the reps in line with the suggestions of the original hospital physio's. I was up/out walking with crutches for the first week or so but do without around the house now and just carry a hiking pole "just in case" when out in the garden (we have an extensive rural garden). And to be honest out walking my new knee feels stronger than my unoperated knee although my gait is a bit odd down to the pain there (I am/was bone-on-bone in both knees and know the right leg will need to be done in due course).

So things were going pretty well even if improving my ROM was a slow job but Sunday I woke up to find much more swelling around the knee. In retrospect I probably overdid things on Friday and Saturday and this is a reaction to it. I'm sure based on what I've read here I've backed right off the last two days (swelling a little better on Monday) with mostly rest/ice/elevation ... and patience!

There is so much good info on this forum - and amongst the stories of pain and set backs plenty of encouragement, support and ideas (for example, I've been trying out suggested alternatives to traditional heel slides to encourage improvements in flexion that I'd never have thought of). And I will try not to go to sleep at night worrying about how many degrees ROM I've managed today.

I know it is a long process, recovery is not a straight line and we're all different but I will get there!

 

[mendogal]

Wow you've done your "homework" and are off to a great start!

 

[mendogal]

It sounds like your outpatient physio was trained here in the USA, land of aggressive, hands-on "make the numbers good!" PT

It's good you already know better. I'm going to post some of our Recovery articles. Apparently you've read and absorbed some of them. Meanwhile we are here to share all your exciting milestones, answer your concerns, and if you just need to vent at 3 AM there's likely some of us in other time zones awake and on line!

Welcome to BoneSmart! You are in the very early stages of an average of a yearlong recovery. I will leave you our Recovery Articles that have helped tens of thousands of other knee replacements. We are here to help you through this journey the best we can. The very best thing for your knee right now is to rest, ice, and elevate. Exercises can come later. There is no rush to achieve ROM because it will come naturally as your swelling decreases. Your OS was able to bend your knee while checking for movements during your surgery, so it will be fine. It just takes time.

Each person is different as is their recovery. Most find that the Bonesmart approach works best for them, but others find that a more aggressive therapy helps them more. It's your recovery and your choice on how you recover. As you read more on other members' recovery threads, you’ll get a better perspective of what to expect. The following are our basic guidelines and should help get you started.

KNEE RECOVERY GUIDELINES

1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now, they are almost certainly temporary.

If you want to use something to assist with healing and scar management, BoneSmart recommends hypochlorous solution. Members in the US can purchase ACTIVE Antimicrobial Hydrogel through BoneSmart at a discount. Similar products should be available in the UK and other countries.

2. Control discomfort:

rest​

elevate​

ice​

take your pain meds by prescription schedule (not when pain starts!)​

don't overwork.​

3. Do what you want to do BUT

a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you​

b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.​

4. PT or exercise can be useful BUT take note of these

the BoneSmart view on exercise​

BoneSmart philosophy for sensible post op therapy​

5. At week 4 and after you should follow this

Activity progression for TKRs​

The Recovery articles:
The importance of managing pain after a TKR and the pain chart
Swollen and stiff knee: what causes it?
Energy drain for TKRs
Elevation is the key
Ice to control pain and swelling
Heel slides and how to do them properly
Chart representation of TKR recovery
Healing: how long does it take?

Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

There are also some cautionary articles here
Myth busting: no pain, no gain
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds

We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery. While members may create as many threads as they like in a majority of BoneSmart's forums, we ask that each member have only one recovery thread. This policy makes it easier to go back and review history before providing advice.

 

[mendogal]

Oh... BTW... My American surgeon and his assistants never measured my bend. The were happy to see me swing my leg sitting up on the table, straighten it casually on the table, and tell them what I was doing!

 

[sistersinhim]

My OS did the same as mendogal's. I was never measured, he just looked at the function of my knee. BTW, I never took formal PT and still had a great outcome! All you need to do is to use your knee naturally for it to rehab itself.

 

[Antpitta's]

Thanks for all your positive comments and pointers to the helpful articles out there on the forum.

I'm definitely not going to obsess about degrees of ROM! This last week has all been about trying to balance activity and exercise with management of swelling as I do find by the end of the day I'm noticing swelling has increased even if I'm not getting any significant pain.

Biggest eye-opener of the week has been the positive benefits of better elevation (sound purchase in decent leg support - not Lounge Doctor - but well recommended UK alternative with similar profile) and finding just a couple of hours use combined with icing takes the edge off the swelling pretty well.

At 3 weeks (today) I'm really happy with progress and starting to reduce my regular pain meds with - so far - no negative effects! Sure there will be some hiccups along the way but staying positive.

 

[benne68]

This last week has all been about trying to balance activity and exercise with management of swelling

Yes. It is so hard to find that balance! As we start to feel better, we have a tendency to overdo it and the knee lets us know.

Glad you were able to find a good wedge that gives you better elevation. Don't forget to ice when you elevate for the best result.

 

[Antpitta's]

A quick update as I hit 4 weeks from surgery today. For the most part I'm still pretty happy. Post-surgery pain has never really been an issue and I've cut back meds to just Co-codamol (2 x 8mg/500mg) twice a day. Sleep is pretty good although I'd love to be able to get back to sleeping on my side (but glad I spent the 2 months pre-surgery "learning" to sleep on my back!). So, 6-8 hours sound sleep most nights with maybe waking a couple of times if I move the wrong way.

Reading many of the recovery threads on here helps to stop me fretting too much about some elements of my progress as it is clearly better than some folks' and less than others. I've been doing those exercises (from the hospital PT supplied booklet) that I can physically perform given my current ROM - which is still only around 80 degrees but SLOWLY improving, plus plenty of stretching. Some of the prescribed exercises are physically impossible without being able to get past 90 degrees so they will have to wait.

I've found spending a few minutes several times a day rocking back-and-forth on my static recumbent bike good for loosening up as well as seeing changes in ROM. It is obvious how best flexion is early in the day - when the degree of swelling around my operated knee is at its best. I reckon I'll need at least 110 degrees to be able to cycle "properly" so still a little way off.

Walking is pretty good and un-aided for the last couple of weeks and the new knee itself feels stronger and more stable than my (as yet) unoperated right knee and the pain from that knee reminds me why I had the LTKR in the first place - so no regrets at all!

For my 4th week anniversary I tried to see how close to driving I was: mmmm - not that close! Again I reckon I need around 110 degrees to safely use the clutch (yep - still most UK vehicles are manual/stick shift) and TBH I still need to be careful swinging my operated leg into/out of the car as catching the sill or door at the wrong angle can be very painful. But with my wife we did do the big weekly grocery shop together for the first time (every aisle in a big store) which on top of my regular shorter walks earlier in the day meant I was super swollen this evening as well as finding my quads very tight. I wouldn't be surprised if things aren't great in the morning.

In fact it is just the persistent swelling despite ice & elevation (which help) that is so frustrating as it seems there is no short cut to getting past that phase. I'm open to any miracle suggestions to improve things! And I must have my wife read some more of the articles on this forum as (despite all her fabulous practical support) it's pretty clear she's heard too many "no pain, no gain" stories to think there is another way!

 

[Axx72]

No miracle short cuts to speed things along when your knee is in charge. That increased swelling is telling you that your leg needs more down time to get ready to take that next step towards increasing activity. It will come. Your journey is amazing so far and I am so envious of the amount of nightly sleep you are able to manage at this stage.

 

[mendogal]

On a cellular level there truly is no way to speed healing. Providing rest and decent nutrition and fluids is how healing happens.

 

[Antpitta's]

Thanks so much for the reminders - and info about various tissue recovery times.

As expected Friday was a bit tougher after the previous days (relative) exertions and although I didn't wake up thinking I had any more discomfort or stiffness than usual it was clear from my morning stretches/exercises that I had paid a bit of a price and even my usual regular daily walks have felt harder. Live and learn. And pre-surgery I would never have guessed how tired you could end up after just doing some extra walking!

Anyway, at least around the house things are getting more normal and I'm pretty much back to "head chef" (even if strictly amateur!) and as we have visitors for the weekend I expect to spend a lot of time on my feet hovering over the stove.

A quick question: I was thinking of getting a massage gun (surprisingly cheap on Amazon and I've read several folks positive comments on them following surgery) to see if that might help with my quads as they often feel very tight. Also there are some YouTube videos out there suggesting how they can help. Any thoughts very welcome!

 

[mendogal]

I would strongly counsel against the use of a massage gun as early in the post op healing as you are - even just on the meaty portion of the thigh.
By its very nature it's a staccato percussion and vibration that affects not just muscle but subcutaneous tissue, blood vessels, and nerves. Three months seems prudent.
The tightness you feel isn't tense muscles like after a workout. It's a combination of inflammation, the afteraffects of the tourniquet, and reactive nerves. All this needs to calm down.
GENTLE manual massage, or having a massage therapist do releases, will be more appropriate for now.

 

[Jockette]

The tightness you feel isn't tense muscles like after a workout. It's a combination of inflammation, the afteraffects of the tourniquet, and reactive nerves. All this needs to calm down.

I agree! One of our former staff members also described it as:

Stiffness/Tightness is a normal occurrence after this kind of major surgery. Your surgeon did major carpentry work and disturbed every millimeter of soft tissue in this area. You aren't tight because your muscle is underused and needs to be stretched and rehabbed. You're tight because your tissue has been disturbed and is healing...and full healing takes a full year or more.

 

[Antpitta's]

Thanks to you both for your advice and explanations (which I'm very happy to follow). Maybe more patience and less "Googling" on my part!

I have a visit to a different PT in early May. Hopefully not the aggressive approach of the previous one and see if they advise/demonstrate some GENTLE massage.

 

[Layla]

Happy One Month Anniversary!
Wishing you the stamina and comfort needed to enjoy the time with your visitors this weekend.
Have fun!
@Antpitta's

 

[sistersinhim]

Maybe more patience and less "Googling" on my part!

Many of us have learned that the 'patience muscle' is the one that needs that most work in this recovery! Dr. Google can really lead us in the wrong direction. I've learned that I should just leave that along or it'll have me 'half-dead' on some of my complaints!