Thirteen Weeks! (Knee Arthroplasty)

It seems like months ago, yet really it is no time at all! Thirteen weeks have flown by.

I kept up the rehab exercises every single day for twelve weeks. With the approval of my surgeon, I have now dropped to every second day but I have increased my walking. I was aiming for my first four kilometre walk today, but missed it by 120 metres – slight miscalculation on my part! It is important to keep up mobility work on your knee, so I do.

With the encouragement of my trusty physiotherapist, I’ve even managed to do single leg glute bridges. I was doing 30 glute bridges a day, now I’m doing 30 every second day. Unless I get super bored by Covid-19 lockdown and then I might still do sequential days.

What can I say? I. LOVE. MY. NEW. KNEE.

I think at thirteen weeks it is safe to say that! I’ve even knelt on it – not too often and not for too long as yes, kneeling on it does feel very odd. I don’t think I’d be out kneeling for long periods weeding a flower garden, for example. Plus the risk of kneeling on something sharp and not feeling it is always a possibility – to be avoided at all costs.

I can now walk down stairs normally, rather than the bringing the two feet together on one step method employed initially. My flexion was last measured (about week 10) at 145 degrees: I was very happy about that!

My right (the still natural knee) decided to be nasty almost a month ago. My physiotherapist said in her experience this is not unusual and should settle with some love and care. It seems to be settling down this week, possibly a load issue due to the operated knee not doing its fair share for a few weeks.

The only remaining issue I had at 12 weeks was a bit of pain around the kneecap getting on and off the toilet. However, even that seems to have resolved. I had adjusted one of the rehab exercises to strengthen the muscles used in that action and it seems to have worked. Plus the glute bridges, of course!

I recognise I’ve had a very successful knee operation. My surgeon is great, my physiotherapist is great and yes, I was dedicated to doing my rehab consistently and effectively. Between us we got a great result.

A word about rehab exercises. I used the word effectively in the paragraph above. From my experience, that is critical. It can be tempting to “back off” if an exercise causes a little discomfort (most don’t). Especially I found the stretches can really feel as if you are stretching! I’m not suggesting suffering pain, but at the same time don’t back off at the first twinge of discomfort either. Check with your physiotherapist if you are unsure.

One of the extra exercises my physio gave me was to lie prone (face-down) across the bed with a weight on my ankle and let my leg be stretched that way. Let me tell you, trying to take a photo of yourself lying face-down in this position is not easy, so I’ve drawn a little stick figure to give you the idea. CHECK WITH YOUR PHYSIO FIRST before trying this at home. Everyone is different!

I’m using this exercise to illustrate the discomfort factor. I started with one kilogram for 30 seconds. I can now do two kilograms for over a minute. Yes, it does hurt a bit this one. Not the actual knee, but the muscles. In my specific case we have been working on getting those muscles working properly again. I persevered. No, I didn’t let myself get into a really painful place (a martyr I am not), but I didn’t stop as soon as I felt a twinge either. The physio did warn me it would hurt a bit. The benefit is I have 145 degrees of flexion!!

We are all different, we all have different pain tolerances. Even so, we should feel as if our exercises are doing something.

The flip side of that coin, of course, is not to go to the other extreme and overdo things. When I was leaving rehab, I asked the physio how far was I allowed to walk, one kilometre, two? She looked at me and in a stern voice said, “I was thinking the end of the street”. One of her colleagues, who had worked with me on some days I was there, piped up from the other side of the rehab gym, “Just make sure she doesn’t live on Dandenong Road!” For those with no knowledge of Melbourne, Dandenong Road is very long, a major arterial road. I got the message.

I was splitting my walks, one in the morning, one in the afternoon. However with Melbourne in lockdown, where we are only allowed to leave the house once a day for exercise, I’m increasing the single walk.

I miss the gym, swimming and hydrotherapy pool. I was hoping to be back on the leg press by now! All in good time.

Oh, did I mention? I. LOVE. MY. NEW. KNEE. 

Previous:

My Total Knee Replacement
Home: Now the Willpower Kicks In

Home: Now the Willpower Kicks In (Knee Arthroplasty)

While in hospital and/or rehab, others drive the recovery process. Essentially all I had to do was follow instructions. Food was provided, bed was made for me, physiotherapists ensured I did my rehab exercises, nurses delivered ice packs and heat packs as required at the press of a button. Medications were administered on schedule. If you are catching up, the hospitalisation part of this journey is found at My Total Knee Replacement.

Once home though, I’m the one in charge. I have to do all that stuff. While I write from the perspective of living alone, I am aware that partners are not always good at enforcing encouraging patients to do what needs to be done. While partners may cook and make the bed, when it comes to the exercises, these the partner cannot do for the patient!

There isn’t anything I’ve struggled with or been unable to do since arriving home. Having said that, remember I did spend time in rehab, I did not come straight home on Day 5. The physical action of getting out of bed is easier now that it was before surgery.

Full rehabilitation takes about six months according to the experts. I’m one month down the track today. It is my bionic knee one month anniversary!

Here’s a list of my tips topics, I speak about each in more detail below. Warning, there is a scar photo at the end – avoid if squeamish!

  1. DO. THE. EXERCISES. Every day. Just DO THEM!
  2. Continue seeing a physiotherapist or outpatient rehab.
  3. Sleeping, napping, coffee.
  4. Eat nutritious meals, you’re healing.
  5. Ice!
  6. Skin care.
  7. Establish a relatively normal routine, enables better rest and movement.
  8. Protect the knee (from falls, twists, etc). Get the shoe horn!
  9. Follow your medical team’s post-op instructions to the letter!
  10. Take a walking stick on public transport.
  11. Equipment.

Exercises

Whether you went to a rehab hospital as I did after the surgical hospital stay, or go to outpatient rehab, there are a set of exercises to do to get the best out of the new knee long term. I have a list of 10 exercises and some stretches. My physio keeps adding new stretches. My programme takes about 30 minutes, not a big chunk of the day.

In my experience it is easier to be inspired to do the exercises in the early days: the excitement levels are still high! By week three post-surgery I did find I had to push myself some days. Boredom: “Do I HAVE to do the SAME things AGAIN?”. Yes, I do. Tiredness: sleeping can be quite disrupted for a while – at one point I was exhausted from lack of decent sleep. Still DO THOSE EXERCISES.

While the rehab physio said I could do half in the morning and half in the afternoon if I wanted to, I have found doing them in the morning as part of a regular daily routine easier. I can’t guarantee I won’t feel tired later in the day, so best to do them when I’m fresh.

I started walking in rehab – I did laps of the ward. Small, regular walks are recommended by the experts and I’ve certainly followed that advice. I’ve increased in the same way I would for anything else, monitoring how I feel afterwards and the next day.

Here is my last week and you can see I dropped steps on June 16 – that was also the day I went to the physiotherapist, so a reasonable amount of activity already. I’m not pushing myself to get the 3,000 steps a day target I had set myself for this week, as I was warned (very strongly) not to overdo it!

The biggest issue I have found with the rehab exercises is not the actual joint itself, but the skin! The skin initially feels SO tight I was actually scared I might pop the wound open with one of the exercises (one where I lift my heel towards my bottom). When you are home alone and not allowed to drive, this is actually quite a scary feeling. Even now, one month post-surgery, the skin is still tight, but improving daily. Plus I’ve got used to the feeling.

Do any of the exercises cause pain? Everyone is different so there is no easy answer. In my case, one of the exercises causes muscular discomfort if I hold the position too long. This is an exercise to improve the straightening of my knee. I couldn’t straighten my knee properly before surgery, so I am undoing old issues, that’s why the discomfort. The only exercise that sometimes causes any pain is standing up from a dining chair. Some days I can do it without using my hands at all, other days I still need a little support from my hands. Essentially, the exercises are painless to do. Initially, of course, pain medications helped! I’ve not been on pain medications since June 9 and the only discomfort I have is as described above.

Continuing Physio

While I felt I was fine with the actual knee exercises on my own by the time I came home, those darn glutes were still giving me grief periodically. Six days after I came home I was off to see my physio for some glute help. In my case I was super lucky, as my physio also happens to do shifts at the rehab hospital I had been in, so she was already conversant with my case! I am seeing her weekly, although after this coming week we hope to reduce the frequency. This has been invaluable for me. Extra stretches to get the hamstrings and calf muscles (both very tight) back into good condition as well. Essentially these sessions are about working on the muscles involved with the knee to get them back into the condition they were before my knee troubles began.

As an added bonus she measures my flexion and extension so I can see I am progressing. I like to have those progress measurements as motivation to keep improving my flexibility.

Sleeping, Napping, Coffee

Sleep can be disrupted. According to the information provided pre-surgery, the length of time and the severity can vary considerably from person to person. I’ve had trouble getting a decent night’s sleep and I’m not even sure why. In the early days the knee did tend to ache at night – this wasn’t pain as such, just an annoying ache. If we sleep too much during the day, then it can be even harder to sleep properly at night. While a short nap maybe helpful, don’t sleep the day away!

For me, this is easy as I’ve never been able to sleep during the day at the best of times (unless I’ve got the ‘flu or similar).

If you do have a partner, my suggestion would be to plan a separate sleeping location for your partner before you leave to have the operation. I would not have wanted any poor person to try to get a decent night’s sleep with me of late!

I’ve made sure I don’t drink coffee after 3 pm. Like the napping, coffee can affect one’s sleep and that’s the last thing I need.

Nutrition

Have a good supply of eggs! If all else fails they are quick and easy to cook.

Easy Meal!

Have a supply of healthy frozen meals in the freezer. I also had long-life milk in the cupboard and preserved fruit, just in case.

There are times when cooking just doesn’t seem like something to be bothered about, but marmalade on toast is not really a nutritious meal, especially when the body is healing. Having a healthy frozen meal is a good option.

Hydration is very important. No-one wants a dehydration headache on top of a healing surgical site.

Ice

Continuing the hospital/rehab practice, I still ice daily at some point when I feel it necessary. After my exercises perhaps, or after walking. The knee swelling and heat hangs around for quite a while, so ice is my friend!

I ice the top of the knee first, then I later ice the underneath part of the knee.

This is my preferred ice-pack, but there are many on the market.

Skin Care

As mentioned above, the skin feels so tight and this is an area you bend! Bend constantly! Nothing much can be done re moisturising or Vitamin E oil/cream until the wound is healed and permission is granted, but once moisturising can happen – oh, the relief!

Quite a large area on the outer (lateral) side of the knee is numb. This is usual, but a bit disconcerting at first. The area reduces in size over time, I’m told – I am yet to experience that myself, but it will come!

Routine

Establish a routine. Get up at the normal time, eat at normal mealtimes, go to bed at a normal time. I hear stories of patients spending way too much time in bed. Not good. It was recommended to me to lie down for up to an hour, twice a day, to let the muscles stretch out. This I do.

A routine makes it easier to meet exercise needs, take any medications at the right times, eat appropriately and fit in rest breaks.

Healing is actually tiring. Add to that disturbed sleep. On June 12, which was Day 23 post-surgery, friends kindly took me to lunch. I was really quite tired after my outing and visitors. On top of the aforementioned lying flat on the bed, rests in an armchair/recliner after rehab exercises and walks are sensible. Each person recovers differently: listen to your body, don’t push it. If the vacuuming doesn’t get done today, it really doesn’t matter.

My routine is (flexible) as follows:

  • 6:30 – 7 am get up
  • Prepare/eat breakfast
  • Morning ablutions
  • 9 am “flat” rest
  • 10 am (thereabouts) rehab exercises (and COFFEE!)
  • 11 am walk
  • Noon – lunch
  • 2 pm walk
  • 3:30 pm second “flat” rest
  • 5:30 pm dinner
  • 10:30 pm SLEEP

In between I have little rests, ice the knee, do some laundry, the typical other living type stuff we have to do!

Walking to a local coffee shop and rewarding oneself with a coffee and a treat is highly recommended once that distance is achievable, plus that provides a little mid-walk rest!

A treat is allowed every now and then.

Protect the Knee

That may sound like an odd tip but I’ve learnt the (almost) hard way. The pavements in my area could do with some tender loving care in a few places and twice in my early first walks I almost tripped – that would not have been good. I keep my eye on the terrain now.

It is important not to twist the knee, yet it is surprising how much we twist the knee in normal day-to-day activity. Once my knee started to feel pretty normal, I found myself almost (caught myself in time) twisting the knee just doing simple things like getting stuff out of the fridge or a cupboard.

Don’t cross the legs. O. M. G. That is SO HARD for a veteran leg-crosser. I’m better now, but two weeks ago I’d have to uncross my legs every time I sat down.

Stairs. I live in a downstairs apartment (selected very deliberately because of Lennie, the bung old knee). I would not have liked to try to tackle stairs if I had come home on Day 5 after surgery. Stairs and crutches or walking stick are certainly workable, rehab teach patients the correct approach. I was already proficient from my time on mobility aids with Lennie. I would have been happier about the prospect of stairs, I think, if I did not live alone. The thought of possibly falling with crutches on Day 6 post surgery, alone, is not an appealing thought. I’m sure I’d have managed if I had needed to deal with stairs.

Now, one month after surgery I can climb stairs normally holding onto the handrail, but descending is still an “operated (left) leg down one step, right leg to same step” affair.

Follow the Medical Team’s Instructions

Do I really need to say that? I don’t, do I?

I haven’t detailed too many specifics because each surgeon and rehab team, although all quite similar, will have slight variations on the theme. Different surgeons use different components – there are lots of variations. Also again, each patient is different. The rehab physio crossed out one exercise on the sheet for me, saying, “Not yet, for you”.

They’ve done this hundreds of times, they are constantly updating themselves with research in the field. Follow the instructions for the best result. Even when that means not driving for six weeks.

If you are told to wear TED stockings, wear them! Yes, they are ugly, uncomfortable and annoying. Wear them.

Take a Walking Stick on Public Transport

I’m still taking a walking stick with me when I go on public transport. For two reasons.

First, many of our trams are not that easy to get on and off. Deep steps for one thing. The little extra support getting off and on the tram/train/bus is comforting.

Secondly, the walking stick is a badge. Without it, I look perfectly normal, yet I still need extra time and space to get on and off transport. I also don’t want to get pushed or knocked over. The walking stick encourages people to give me that bit of extra space, even on the pavement.

Equipment

The exercises prescribed for rehab do not require equipment, however it can be helpful to have some. I have foam rollers and they are easier than using two rolled up towels. I also have ankle weights which have proven very handy for one of the extra stretches I’ve been given. I rather wish I had a half foam roller.

Get the long handled shoe horn. I cannot stress this enough. Most important piece of equipment ever! Absolutely fantastic! I still cannot get my runner on the foot of the operated leg without the shoe horn.

I haven’t needed rails in the shower, but the raised toilet seat is definitely needed (and can be used as a seat in the shower if needed). I was VERY careful getting in and out of the shower the first time! I did get a non-slip mat for the shower, then realised it already has non-slip tiles.

Status

This was my knee a week ago. As you can see, the left leg is still swollen at this stage, but I’m walking around normally, just not as far as usual – yet!

You can see the shin bone on the right leg, not yet on the left. The knee is still larger. But it is much less swollen that the pre-surgery knee shown in the previous article!

The scar looks to be healing really well. I’m happy. Let’s see how I am feeling when the six months is up!

June 13

The worst part about being home is the boredom! Honestly, for me, that’s the hardest part. Not allowed to drive yet, so can’t go to the gym (for upper body), don’t have clearance to swim yet either. I hope the surgeon isn’t so strict the next time around!

One unexpected added bonus is my posture seems to have improved. I’m naturally standing straighter than before. I’ll see if that continues to be the case, but a positive plus.