TKR Jean6183 Recovery thread<

[Spex10]

I wouldn't have expected to walk down the stairs normally at your stage.

 

[Jockette]

PT added some leg presses and low weight and some bands

This type of exercise is very bad for a 4 week old knee, it is not healed enough to handle this. I’m going to tag @Josephine to come talk with you.

Very few of us are doing stairs foot over foot at this point.

 

[Josephine]

PT added some leg presses and low weight and some bands. Still can't walk down the stairs normal but that's because I still have swelling and my bend isn't far enough yet.

Those are very much NOT advised. Read this BoneSmart philosophy for sensible post op therapy which was in your list of Guidelines left for you earlier. You have read them all, haven't you? If not, I urge you to go back (post #7) and read them now!

I was told I could drive this week and I'm only doing it sparingly because I get tired so easily. Is that normal at 4½ weeks.

Here again, you've clearly not read this article from your Guidelines Activity progression for TKRs.

You have to remember that 4½ weeks is very early in your recovery. Very early indeed. Read that article about activity progression and see that you are advised to only do this in week 4

Weeks 4 and 5 - add to all the previous (see article)
Increase walks to out in the garden or street; to 20mins or longer if you feel up to it but don't forget that means 10mins there and 10mins back!

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 entire family!)
AND THAT'S ALL!!​

I'd really like to offer you some structured advice but in order to do that, I also need to ask you some questions. Are you willing for me to do that?

 

[kneeper]

I didn't drive until 6 weeks with my right knee. Partly because of pain meds and partly because of leg strength/need for quick braking. With lefty I'd say it was 5 weeks and then I started out with only short trips.

On the leg press issue--my first PT had me try them (with very little weight), supposedly to help with the bend. I doubt they did anything I couldn't do with simple heel slides other than potentially aggravate the knee. I only agreed to the leg press once.

 

[jean6183]

Josephine Yes, you can ask me questions

I looked at your guide & they have me doing about every exercise you have as a not to
do.

 

[sistersinhim]

I looked at your guide & they have me doing about every exercise you have as a not to do

We have years and thousands of patients' experiences behind those lists. We know what inflames a tkr and what lets it heal without causing setbacks. We offer this advice for free. PT is a money making business. Keeping you inflamed, swollen and in pain is keeping you going back, hoping for relief. But, relief comes only from gentle movements!

 

[sistersinhim]

@jean6183, you don't have to quote a post to answer to it. Just go down to the bottom of the page and start typing and hit 'post reply'.
https://bonesmart.org/forum/threads/how-to-use-the-quote-feature.14729/

 

[jean6183]

Sorry about the "QUOTES". I was on my phone and having issues replying . I have no pain during therapy or after.. but will talk to them tomorrow about what i'm reading on this site. I appreciate the guidance. ** I've really had no pain, but maybe a level 1-3 the first week. but I stopped all pain pills a week after surgery **

 

[sistersinhim]

You know that PT going to want you to keep coming back. It's there 'bread and butter'! If you quit, they loose that money!

 

[Celle]

Just to add another thought about post-op PT:
My surgeon doesn't allow any PT at all for the first month after a knee replacement. He says your knee needs that time, to start on its journey of healing. For that month, we rest, ice and elevate our leg, and walk around the house.
After that month, we just go to PT once every 2 weeks, where we are shown a few new exercises to do at home.
His patients all do well and achieve good Range of Motion (ROM), as I did, and he hasn't had to do a manipulation to help with ROM for the past 4 years. I think that speaks for itself.

 

[Josephine]

Here y'go then!

It would be very helpful if you would answer each one individually - numbered as I have done - in as much detail as you can then I'll come back as see where you are ....

1. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine. And don't forget to factor in other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness).

2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?

3. how swollen is your leg compared to these?

4. what is your ROM - that's flexion (bend) and extension (straightness)

5. are you icing your knee at all? If so, how often and for how long?

6. are you elevating your leg. If so how often and for how long?

7. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and

8. are you doing any exercises at home? If so what and how often?
This is the most crucial question so please help me by using the format I have left as an example
(which means please make a list and not an essay!)

Exercises done at home
- how many sessions you do each day
- enter exercise by name then number of repetitions of each
etc., etc.

Anything done at PT
- how many times a week
- enter exercise by name then number of repetitions of each
etc., etc.

 

[Dolly Girl]

Ooooo, leg presses are not good. Listen to these people, can the PT and do gentle heel slides and walk around. Rest, ice, elevation. All this other nonsense will set you back in the long run.

 

[jean6183]

1. pain besides day two surgery 1-2.. slight stiffness when i bend it.

2. pain meds. percocet , but stopped after one week. Motrin 800 mg 3 x's day and sometimes tyelonol 2-325mg between motrins.

3. slight swelling

4. ROM 115 Extension 5

5. icing about 2-3 times a day for 30-60 minutes

6. only elevate while icing so 2-3 times a day

7. light housework, cooking, grocery shopping (not big shopping trips, just what i need)

8. PT at home 1-2 times a day heel slides 2 sets of 10, quad sets 2 sets of 10, straight leg raises 2 sets of 10, side laying hip abductions 2 sets 10, bridging 2 sets of 10.
PT outpatient 2 times a week. heel slides 20, holding for 10 seconds, quad sets 30, straight leg raises 30, laying flat on table, drop my leg off side of table for stretch 3 sets for 10 seconds, let press 2 sets 20, leg extension 3 sets 10. squats 2 sets of 10 , standing heel raises, and toe raises 2 sets of 10. I also have band around my feet and bring each foot in half circle, not sure how many i do. Then i do them side by side in slight bend in knees..

 

[Josephine]

Some detail you've missed out!

2. pain meds. percocet , but stopped after one week. Motrin 800 mg 3 x's day and sometimes tyelonol 2-325mg between motrins.

The question was: how much are you taking (in mg please) and how often?

4. ROM 115 Extension 5

You appear to be referring to ROM as just flexion - it's not. It's flexion AND extension. Plus Extension is usually given as more than straight (a minus -) or less than straight (a plus +) so which is yours?

8. PT at home 1-2 times a day heel slides 2 sets of 10, quad sets 2 sets of 10, straight leg raises 2 sets of 10, side laying hip abductions 2 sets 10, bridging 2 sets of 10.
PT outpatient 2 times a week. heel slides 20, holding for 10 seconds, quad sets 30, straight leg raises 30, laying flat on table, drop my leg off side of table for stretch 3 sets for 10 seconds, let press 2 sets 20, leg extension 3 sets 10. squats 2 sets of 10 , standing heel raises, and toe raises 2 sets of 10. I also have band around my feet and bring each foot in half circle, not sure how many i do. Then i do them side by side in slight bend in knees..

This question stated quite clearly "please make this a list and not an essay!"

 

[jean6183]

2. motrin 800 mg 3x day,
Tylenol 2 - 325 mg 2x day as needed

3. +5 on extension 115 flexion

8. At Home PT
heel Slide 2 sets 10
quad sets 2 sets 10
straight leg raises 3 sets 10
hip abduction side lying 3 sets 10
bridging 2 sets 10
squats supported 2 sets 10

outpatient PT
heel slides 3 sets 10
quad sets 3 sets 10
straight leg raises 3 sets 10
hip abduction 3 sets 10
bridging 2 sets 10
squats supported 3 sets 10
single leg stand 3 sets of 10 seconds
standing heel raises and toe raises 2sets 10
leg presses 3 sets 10
leg extensions 3 sets of of 10
stationary bike ~ 8 minutes

 

[Josephine]

1. pain besides day two surgery 1-2.. slight stiffness when I bend it.

3. slight swelling

Did you factor the swelling and stiffness into the pain score? Because if you didn't, then I would make it around 4-5.

2. Motrin 800 mg 3x day,
Tylenol 2 - 325 mg 2x day as needed

I suggest you try adjusting your pain meds a little. For instance, try Tylenol 1,000mg 3-4 times a day at 6hrly intervals.
As for the Motrin, I've never been convinced that NSAIDs are a very good for pain relief. Besides which, they have some nasty side effects Medications: acetaminophen (Tylenol, paracetamol) and NSAIDs, differences and dangers

3. +5 on extension 115 flexion

115/+5 is very good and the extension will improve in time besides which you are only 6 weeks out yet which is still very early.

5. icing about 2-3 times a day for 30-60 minutes
6. only elevate while icing so 2-3 times a day

You accomplish little or nothing in 30 minutes. Ice for at least 40-60mins and more than 4 times a day.

7. light housework, cooking, grocery shopping (not big shopping trips, just what i need)

Did you read this article from the list of Recovery Guidelines?
Activity progression for TKRs because if you had, you should know that shopping is to be limited


At home PT
heel slides 2 sets x10 - your flexion is excellent so you no longer need to do these
quad sets 2 sets x10 - same here
straight leg raises 3 sets x10 - same here, plus once you can do these, you no longer need to do them!
hip abduction side lying 3 sets x10 - these are not appropriate for the knee
bridging 2 sets x10 - nor these
squats supported 2 sets x10 - nor these

outpatient PT
heel slides 3 sets x10 - again, you don't need to do these, your flexion is excellent
quad sets 3 sets x10 - nor these
straight leg raises 3 sets x10 - nor these
hip abduction 3 sets x10 - these are not appropriate for the knee
bridging 2 sets x10 - - nor these
squats supported 3 sets x10 - nor these
single leg stand 3 sets of x10 seconds - nor these
standing heel raises and toe raises 2sets x10 - these are good for causing muscle strain
leg presses 3 sets x10 - if using the leg press machine, DON'T! It can cause implant loosening
leg extensions 3 sets of of x10 - you don't need these
stationary bike 8 minutes - this is okay

Summary:
1. Adjust your medications as suggested
2. ice and elevate more
3. quit the exercising, you don't need them
4. quit the PT, you don't need that either

If you are concerned about refusing to do therapy, you need to read this Saying no to therapy - am I allowed to?

 

[jean6183]

Thank you ..

 

[jean6183]

Josephine. My grocery shopping is limited. I'm a widow and I have to do something maybe others wouldn't have to do. I was using the motorized cart but now I don't need it. I don't use a crutch or cane either.

 

[Jolease]

@jean6183 I have read your recovery and it sounds like you are doing awesome in such a short time. I myself am close to your age and have had 2 partials within 4 months and it has been horrible. I am seeing a second opinion surgeon Friday and am praying he takes me on and does my tkr. Your posts has given me hope and I hope When I get my 3rd surgery it goes as smooth as yours has so far. Happy healing!

 

[jean6183]

@Jolease I'm doing very well. They are very happy with my results. I'm not sure if it's my age and the fact that I worked out 4-5 days a week prior to surgery (for the last 6 years) and including the day before that has helped me.. Are you getting full replacements ? I wish you the best of luck, please keep me updated...