End of First Week after TKR

It's been one full week since the operation.  Today, Tuesday morning, and my mind is asking, "... why  did you do this?"  The pain is very constant and the level hasn't really dropped below a 5 on the scale of 1-10 yet, 10 being unbearable.  There have been times when it's been 9 and that is usually during or right after therapy.  But there is light at the end of this tunnel

Prior to the operation I was having pain but it was a bit different, arthritic.  Arthritic can be hard to explain if you haven't experienced it before.  It's a deep ,in the joint, nagging, and constant irritation.  Maybe a tooth ache would be a good comparison. 

Today's pain is deeper in the bone but to be expected when you understand or see the procedure.  Bone is being cut away to create smooth and level surfaces then holes are drilled for plastic attachments.  Lastly they hammering and glue parts to attach them to the bone.  Kind of like a wood working project.

Ice is one of my main weapons to fight this and I have several different ways in which I use it.  Coupling this with meds, massages and heat pads creates the right mixture of ingredients.

I invested in this last time and have kept it for all kinds of reasons.  The DonJoy Iceman machine is a wonderful tool that can be used on a lot of body parts.  It is a cooler with a small motor that forces water to flow in and out over ice via tubes.  At the end is a pad that you place on the area you want to ice down.  I've found that an ace wrap helps to hold this in place.  Ace wrap is good for hold all kinds of ice packs in place. 

The pump is quiet.  I usually get about 3 to 4 hours out of a cooler full of ice and water.  This is what I use when I'm going to be resting for long periods of time and when sleeping at night.  Other times I use ice packs (two zip lock bagies with ice and water), reusable ice blocks , and soft ice ( it doesn't freese but is cold enough to do the job)

Keeping the blood flowing in the lower legs is something the doctors want and to help with that they have me using a compression machine right from the start. Continuous Enhanced Circulation Therapy (C.E.C.T) is accomplished using a machine that presses your calf area every 15 seconds or so.  It runs on a AC and battery power.  I'll have to use this for the first 10 days after surgery.  I can take it off during showers and exercise other wise it's on almost 24 hours a day.

I've mentioned a few times doing research knowing more about the procedure, recovery and rehab.  I spoke to several people before hand which was in my opinion the best resource to start with.  Those with practical experience made the information I red about easier to understand.

A found a book, "Knee Surgery,"  written by Daniel Fulham O'Neill, MD.  It has a wealth of information about what to do prior to surgery so that you have the best possible outcome and what to do for rehab after.  I specifically use this book because it had a section on Returning to Sports and Competition (chapter 12).  He covers getting back to basketball, tennis, skiing, etc.  Many sports I thought I might have to give up all together. 

I reached out to Dr O'Neill and he provided some thoughts specific to cycling in my recovering process. 

Daily Physical Therapy is the base of recovery just like miles are the base of a successful cycling season.  The physical therapy isn't too hard and each day we add an exercise or two to the routine.  Up to this point it's been mostly isometric muscle work and some flexibility moves.  The hardest is flexibility but it's the most important.  This is basically, how far can you bend your knee back.  For standard everyday living 67 percent of knee flexibility is needed for the swing phase of the gait, 83 percent to climb stairs and 90 percent to descend.  Lastly, 93 percent to rise from a chair.  I'm shooting for way beyond these numbers.

Several methods are used to work on flexing the joint; push, pull and gravity.  Sitting in a chair I can slide my leg backwards as far as I can.  The muscle is tight but there is also swelling which makes it difficult.  I pull back to where I can hold it for 5 seconds and then release or rest.  I do it again and am able to come back a bit further.  10 reps to start.  After the last one I hold it and measure the degree with a Goniometer (kind of like a math protractor).  If you have had a good bike fit you've seen one of these before.

Another method to increase flexibility is to have someone else push your leg.  While in the hospital the physical therapist did this for me because I was still gaining the feeling back in the leg from the block.  They know what they are doing and can watch your expression for pain levels. 

Gravity. Laying on my back I lift up my leg up straight and then bend it at the knee joint slowly controlling it with my muscle.  When I get to a stopping point I very lightly release the muscle and allow gravity to pull it down with support of my hand.  It hurts, a lot.

Yesterday I had my second in home PT session.  We added in ankle raises while standing and squats using a banister for support.  My body tried to shift my weight to the good right leg.  The therapist helped straighten that out pulling my hips to the left as I performed the move.

The huge success in my mind this week are two things:  1) I put my crutches back in the garage as a sign that I won't be needing them during the rest of the this process.  2)  I'm able to climb stairs using both legs going up and down.  It's a slow process and I use the support of the walls or railings some.  The goal is to get full weight support and mental confidence.  I'm not far off from that.