Mako Robotic Arm TKR ONE WEEK

Posted by saeternes @saeternes, Dec 3, 2019

Therapy started this morning and I was looking forward to getting an opinion about my progress from "Alex." Since the rough 3-hour ride home from the hospital, I had doubted myself in terms of whether or not the Mako robotic arm was worth going to such lengths. But now I am happy I did it, since Alex pronounced me at the top in terms of one-week progress, with only one other person having done this. I could tell he was genuinely impressed, and he also had worked at our local large orthopedic group, so he has seen plenty of knee replacements. Like me, Alex veers away from competition and from creating too much inflammation and swelling through painful exercises, instead saying push it slowly several times during the day and make steady if not linear progress. He did not want to take off the thick bandage and pad at the knee so could not get accurate measurements, but he eyeballed it from several angles. As many of you have mentioned, he also said strength training can wait a while longer.

Next week I will be able to see the scar, how long it is, and in general how things look once the stitches are removed. Although I have nothing to compare it with, the Mako right now seems to have been a good decision. I should also mention that I don't have any real pain when pushing the ROM, so maybe that is the nerve ablation kicking in?

@saeternes I am so pleased for you, it sounds as you are making great progress and that the Mako was the right decision for you. It sounds as if Alex (is he the physical therapist?) is in agreement with my doctor in not pushing it.
Good question if the ablation is helping you with the ROM. What is it up to now? Mine actually decreased when I went from my in-home therapist to the outpatient one. He really was at a loss as to how to do “gentle” PT.
JK

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@contentandwell Alex is my PT. The bandages prevent him from getting a real measurement although he said close to 0 on extension and way beyond 90 on bend, about three weeks ahead of where he thought I would be based on his experience. There is a thick pad in the way and it prevents me from bending as far as I physically can. Next Tuesday I get the bandages off and the stitches taken out, that will be 2 weeks, so then we may have a measurement. Alex also recommended quad tensing and buttock tensing, which I will do several times a day, as well as shallow squats, which he also did not expect me to be able to do but I could. I honestly think none of this is because of my efforts, although I try several times a day. I credit the ablation and the Mako process. I will be interested in seeing the wound which should be smaller than that of the traditional TKR because it is not necessary to pull muscles and ligaments aside to see the entire bone surface, and the program guides the saw (still in the hands of the surgeon) based on the 3D scan. Alex also mentioned that he had seen weird gaits develop out of abandoning walkers, crutches, and canes too often so suggested slow-going. It looks like I have found the perfect therapist!

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@saeternes

@contentandwell Alex is my PT. The bandages prevent him from getting a real measurement although he said close to 0 on extension and way beyond 90 on bend, about three weeks ahead of where he thought I would be based on his experience. There is a thick pad in the way and it prevents me from bending as far as I physically can. Next Tuesday I get the bandages off and the stitches taken out, that will be 2 weeks, so then we may have a measurement. Alex also recommended quad tensing and buttock tensing, which I will do several times a day, as well as shallow squats, which he also did not expect me to be able to do but I could. I honestly think none of this is because of my efforts, although I try several times a day. I credit the ablation and the Mako process. I will be interested in seeing the wound which should be smaller than that of the traditional TKR because it is not necessary to pull muscles and ligaments aside to see the entire bone surface, and the program guides the saw (still in the hands of the surgeon) based on the 3D scan. Alex also mentioned that he had seen weird gaits develop out of abandoning walkers, crutches, and canes too often so suggested slow-going. It looks like I have found the perfect therapist!

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@saeternes Alex definitely sounds like a good therapist, you are lucky to have found him. My therapist has been excellent for some things, but not for my knee.
I will be looking forward to hearing what your ROM is when you are able to measure it. The woman I know in my water class who had robotic, I presume Mako, said hers was 145! I didn’t think that was even possible.
JK

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@saeternes: happy to hear about your progress so far. You and Alex seem to hit it off. He sounds a lot like my therapist – encouraging, challenging, supportive, but gentle. I’ve been competitive all my life, so of course, even though rehab is not a competition, I simply could not resist to beat the averages by a mile (of course, except – as mentioned – for whatever strange reason I could not get my knee fully extended). I believe a good therapist is also part psychologist, matching the approach to the patient. Some need more encouragement, some need hand holding, some need scolding, and some need to have limits set for them, so they don’t go overboard. I’m sure @dixiedog could chime in here.
Sorry to side-track. Curious about your official measurement numbers, and scar length. Mine is quite short, even with conventional surgery, but perhaps that is because there’s not much extra padding around the knee, so access was easy? Regardless of numbers, as long as you are feeling good and improving, that’s all that matters. I’m sure you’ll rock it!

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@saeternes: meant to include comment about walker in my earlier post. Since I had no clue about walkers, I accidentally ended up with a loaner that had 4 swiveling wheels. We had removed all area rugs from long hallway and traffic areas in the house, so other than the bedroom I was faced with hard surface floors (hardwood, tile, synthetic tile). Yikes! Instead of providing support, the swiveling motion was hard to control. I ended up expending a lot of energy just to keep from bumping the darn thing into walls. That’s one of the reasons why I found it easier to leave it be. The loaner place is only open certain hours of certain days, and by the time the next business hours came around, I had gotten used to moving around on my own, and did not go and exchange the wayward walker for a stationary or at least fixed wheel one. I’m pretty sure I would have used a walker for a longer period if it actually had been helpful, instead of stressful.

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@contentandwell I don't expect to get my new knee to 145! That's basically pushing up against your leg and buttocks completely. Alex told me the goal was 120-125 and anything extra was good but not necessary. @ellerbracke I almost made the mistake of getting the four-wheeled walker, especially when that urge was confirmed by reading on this man's very comprehensive site https://mykneereplacementrecovery.com/, which was so helpful in other ways. Fortunately I continued to look around and learned exactly why one needs the two-wheeled model, for the problem you describe. My surgeon had the correct kind of walker listed in the recovery materials he gave me, but there was no explanation as to why, so naturally I was thinking, how can I improve that? This tendency of over-thinking sometimes can come back to bite you! Watching me walk from the back with the walker, Alex corrected a slight turning in of the foot on the surgery knee, so now I am conscious of it and thinking of it as I move, walking slowly and trying to make sure my form is correct. Like you, I also am competitive, but that is offset by my strong aversion to pain and preference for gradual change (especially when pain is involved!). My experience in trying to hurry various physical processes along is that when it comes to the body, slow change is better than fast change, and sustaining proper form is always good. But next Tuesday I should have my numbers and can post them. I totally understand the urge to beat the numbers, which I have to fight against at the eye doctor's so that my prescription will be accurate. You are right that a good therapist will work with whatever personality quirks we have.

I have a very itchy rash on my upper thigh where the My-Q pain drip was inserted. It came out last Friday. I suspect the rash is from the tape that held it in place. I was surprised when I pulled it out – a long, thin, very stretchy piece of elastic with black nodes along the way. It stretched a lot when pulling and I was worried it could break and half of it stay in there, but that did not happen. Anyone else with this rash problem?

I can see some mild bruising on the back of my leg and it is still swollen. I hope that the swelling will start to go down soon. Maybe it has, I can't tell. If it does not seem to change soon I will start measuring and watch it.

For a laxative, I have switched from ducosate sodium to bisacodyl USP, and that solved the vomiting problem. I am able to have some bowel "movements" with the help of my toilet bidet seat. It is the kind with "endless water" (i.e. heats on the spot instead of having a tank) and very powerful. Outside of the knee surgery, this addition to our household has been most welcome. I tell everyone once you have one you will never want to go back. Anyone with any gastro issues should invest in one of these if at all possible.

I am posting a lot so that any future Mako patients will be able to read in detail about the process, the recovery, and so on. I was happy to have come across @debbraw and her story because it was the first detailed comparison (via experience) between traditional and Mako knee surgery that I had read. I really appreciate the feedback from all of you, it helps tremendously. Thanks for spending the time to read my posts and comment.

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@saeternes

@contentandwell I don't expect to get my new knee to 145! That's basically pushing up against your leg and buttocks completely. Alex told me the goal was 120-125 and anything extra was good but not necessary. @ellerbracke I almost made the mistake of getting the four-wheeled walker, especially when that urge was confirmed by reading on this man's very comprehensive site https://mykneereplacementrecovery.com/, which was so helpful in other ways. Fortunately I continued to look around and learned exactly why one needs the two-wheeled model, for the problem you describe. My surgeon had the correct kind of walker listed in the recovery materials he gave me, but there was no explanation as to why, so naturally I was thinking, how can I improve that? This tendency of over-thinking sometimes can come back to bite you! Watching me walk from the back with the walker, Alex corrected a slight turning in of the foot on the surgery knee, so now I am conscious of it and thinking of it as I move, walking slowly and trying to make sure my form is correct. Like you, I also am competitive, but that is offset by my strong aversion to pain and preference for gradual change (especially when pain is involved!). My experience in trying to hurry various physical processes along is that when it comes to the body, slow change is better than fast change, and sustaining proper form is always good. But next Tuesday I should have my numbers and can post them. I totally understand the urge to beat the numbers, which I have to fight against at the eye doctor's so that my prescription will be accurate. You are right that a good therapist will work with whatever personality quirks we have.

I have a very itchy rash on my upper thigh where the My-Q pain drip was inserted. It came out last Friday. I suspect the rash is from the tape that held it in place. I was surprised when I pulled it out – a long, thin, very stretchy piece of elastic with black nodes along the way. It stretched a lot when pulling and I was worried it could break and half of it stay in there, but that did not happen. Anyone else with this rash problem?

I can see some mild bruising on the back of my leg and it is still swollen. I hope that the swelling will start to go down soon. Maybe it has, I can't tell. If it does not seem to change soon I will start measuring and watch it.

For a laxative, I have switched from ducosate sodium to bisacodyl USP, and that solved the vomiting problem. I am able to have some bowel "movements" with the help of my toilet bidet seat. It is the kind with "endless water" (i.e. heats on the spot instead of having a tank) and very powerful. Outside of the knee surgery, this addition to our household has been most welcome. I tell everyone once you have one you will never want to go back. Anyone with any gastro issues should invest in one of these if at all possible.

I am posting a lot so that any future Mako patients will be able to read in detail about the process, the recovery, and so on. I was happy to have come across @debbraw and her story because it was the first detailed comparison (via experience) between traditional and Mako knee surgery that I had read. I really appreciate the feedback from all of you, it helps tremendously. Thanks for spending the time to read my posts and comment.

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Also I wanted to correct something I had said before: it IS painful to work on bending. I just completed the 10 min bend (two 5 min segments, pulling back with strap while on chair) and it hurt like heck. So the ablation is not wiping out that pain!

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@contentandwell

@saeternes Alex definitely sounds like a good therapist, you are lucky to have found him. My therapist has been excellent for some things, but not for my knee.
I will be looking forward to hearing what your ROM is when you are able to measure it. The woman I know in my water class who had robotic, I presume Mako, said hers was 145! I didn’t think that was even possible.
JK

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JK: must be something in the water??? I also have a woman who works out in my senior center pool, and after her 45 minute water exercise class she actually can pull her heel all the way to her normal size butt. Her TKR was 6 years ago, so not robotic at the time, I think. Maybe I can equal that, 5 years from now. There’s always hope.

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@ellerbracke

@saeternes: meant to include comment about walker in my earlier post. Since I had no clue about walkers, I accidentally ended up with a loaner that had 4 swiveling wheels. We had removed all area rugs from long hallway and traffic areas in the house, so other than the bedroom I was faced with hard surface floors (hardwood, tile, synthetic tile). Yikes! Instead of providing support, the swiveling motion was hard to control. I ended up expending a lot of energy just to keep from bumping the darn thing into walls. That’s one of the reasons why I found it easier to leave it be. The loaner place is only open certain hours of certain days, and by the time the next business hours came around, I had gotten used to moving around on my own, and did not go and exchange the wayward walker for a stationary or at least fixed wheel one. I’m pretty sure I would have used a walker for a longer period if it actually had been helpful, instead of stressful.

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@ellerbracke I'm surprised you were not advised on what type of walker to get, most doctors have a preferred type. I had the type with two wheels and it worked out well. My brother-in-law, after a hip replacement, was told to get the one with no wheels. At least you were finally able to navigate without a walker though. I didn't use the walker for long either but I used more recently again when I fractured my femur. That's amazing that the woman in your water class can get that much flex in the water!

@saeternes Frankly, I always wondered if the woman who said she had 145 flex may have heard the doctor or PT wrong! That does sound a bit too much from what I have heard.
JK

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@ellerbracke

@saeternes: happy to hear about your progress so far. You and Alex seem to hit it off. He sounds a lot like my therapist – encouraging, challenging, supportive, but gentle. I’ve been competitive all my life, so of course, even though rehab is not a competition, I simply could not resist to beat the averages by a mile (of course, except – as mentioned – for whatever strange reason I could not get my knee fully extended). I believe a good therapist is also part psychologist, matching the approach to the patient. Some need more encouragement, some need hand holding, some need scolding, and some need to have limits set for them, so they don’t go overboard. I’m sure @dixiedog could chime in here.
Sorry to side-track. Curious about your official measurement numbers, and scar length. Mine is quite short, even with conventional surgery, but perhaps that is because there’s not much extra padding around the knee, so access was easy? Regardless of numbers, as long as you are feeling good and improving, that’s all that matters. I’m sure you’ll rock it!

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You are very fortunate to have found a PT (or PTA?) that seems to connect well with you and is a listener. Being a PT (as mentioned), I was disappointed with my treating PT/PTA as it was an extremely busy clinic and looking back, I know that a non-PT patient would have assumed their behavior was the norm. But for me, I was thinking what the heck and I'm paying (and insurance) X dollars for this session which I could have done on my own. I regretted not going to a prior PT (that I have seen prior to surgery) and it's hard to say if my current outcome would be different had I seen him but he definitely has all the qualities one needs in PT. But just like anything: once you leave the therapy place- you have to be compliant and do what's needed without overdoing things.

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@contentandwell

@ellerbracke I'm surprised you were not advised on what type of walker to get, most doctors have a preferred type. I had the type with two wheels and it worked out well. My brother-in-law, after a hip replacement, was told to get the one with no wheels. At least you were finally able to navigate without a walker though. I didn't use the walker for long either but I used more recently again when I fractured my femur. That's amazing that the woman in your water class can get that much flex in the water!

@saeternes Frankly, I always wondered if the woman who said she had 145 flex may have heard the doctor or PT wrong! That does sound a bit too much from what I have heard.
JK

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I am not all surprised by the walker issue- most people/professional have no clue. And in the pre-joint classes, they often just way "get a walker". There are pros/cons to all styles with the swivel ones are by far the worst due to many safety and instability issues- I would never recommend one. I ended up using crutches (for stairs) and front wheeled walker at home, and eventually a straight cane.

Regarding the ROM: 145 degrees of knee flexion- that is no where near the norm; norm values for knee flexion (while on your back)- is 130-135 degrees and the numbers depends on several factors including scar tightness, quad tightness, having a larger calf (like a very muscle bound person), or a large calf, etc. When you measure knee bending (flexion) in supine, it is often less due to tightness of the quad; in sitting- this is the easier position to cheat and have a inaccurate measurement and 145 degrees is possible to measure- but it's not due to pure knee motion (usually comes from hip motion) and often sloppy technique by the therapist.

As far as how much you need? Many patients get hung up on the number- for example, a quest to get to 125 degrees for example. For functional purposes (this is for daily activities), usually a minimum of 90 degrees is needed (like to go up steps) but around 110 bend is optimal for the minimum number. With bending, If you get more great, but having more won't necessarily change your function. In comparison, if one has a lot of scar tissue and can't bend past 80 degrees (while on their back, for example), this has a much larger impact on the ability to do functional activities.

There's a need to get full extension- which is often lacking due to tightness as well. A lot of people forget the value of having near full extension (often called zero, 0 degrees) which is needed for optimal function.

If you have other therapy questions, ask away!

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@contentandwell

@saeternes Alex definitely sounds like a good therapist, you are lucky to have found him. My therapist has been excellent for some things, but not for my knee.
I will be looking forward to hearing what your ROM is when you are able to measure it. The woman I know in my water class who had robotic, I presume Mako, said hers was 145! I didn’t think that was even possible.
JK

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145 is most likely measurement error- average knee bend is around 130 to 135 degrees.

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@dixiedog : Thank you for all your remarks and information. Yes, the pre-surgery class only mentioned “a walker”, no specifics. I’m not really surprised, since in the hospital I ended up with an extra wide version – for 200 lbs + people, which was also a little hard to handle. Regarding flex: yes, 125 is probably very good, quite enough for great function. Mine officially ended at 132 at end of PT, but I can tell that it has further improved (as by how close I can get the heel to my butt while on my back). Extension seems to come easy for most people, not for me. It is at least as important as flex in order to maintain proper form when walking.
As far as PT goes, I really was lucky. I had worked with several of the therapists in that particular office before (shoulder surgeries), and they know me very well. Progress was pretty quick – mostly they showed me what exercises to do, and to do them properly, and then sent me off to work at home. Since they knew that if they said 30 repetitions, I would do all of the 30, and then report back how difficult/painful/achievable those were, and at the next visit that would be discussed and evaluated. Some exercises had to be modified because of long-standing problems with Sciatica, but we were able do work around that. One of the therapists freely admitted that they tend to give most people a fairly high # of repetitions in the assumption that they would do perhaps half of those. With me, they told me absolutely not more than what they indicated. All in all, while TKR rehab is not pleasant by any means, good support from the PT people makes a huge difference.

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@dixiedog

I am not all surprised by the walker issue- most people/professional have no clue. And in the pre-joint classes, they often just way "get a walker". There are pros/cons to all styles with the swivel ones are by far the worst due to many safety and instability issues- I would never recommend one. I ended up using crutches (for stairs) and front wheeled walker at home, and eventually a straight cane.

Regarding the ROM: 145 degrees of knee flexion- that is no where near the norm; norm values for knee flexion (while on your back)- is 130-135 degrees and the numbers depends on several factors including scar tightness, quad tightness, having a larger calf (like a very muscle bound person), or a large calf, etc. When you measure knee bending (flexion) in supine, it is often less due to tightness of the quad; in sitting- this is the easier position to cheat and have a inaccurate measurement and 145 degrees is possible to measure- but it's not due to pure knee motion (usually comes from hip motion) and often sloppy technique by the therapist.

As far as how much you need? Many patients get hung up on the number- for example, a quest to get to 125 degrees for example. For functional purposes (this is for daily activities), usually a minimum of 90 degrees is needed (like to go up steps) but around 110 bend is optimal for the minimum number. With bending, If you get more great, but having more won't necessarily change your function. In comparison, if one has a lot of scar tissue and can't bend past 80 degrees (while on their back, for example), this has a much larger impact on the ability to do functional activities.

There's a need to get full extension- which is often lacking due to tightness as well. A lot of people forget the value of having near full extension (often called zero, 0 degrees) which is needed for optimal function.

If you have other therapy questions, ask away!

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@dixiedog I was actually to my orthopedic surgeon this week. My flex is @117. I was told they can improve that if it’s a problem for me but I think it’s functional enough. The improvement would involve a minor outpatient procedure. I have always had full extension.
My problem now is severe, recurrent bursitis. That is causing a limp which is affecting both knees. It is worse this time than ever before.
JK

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@contentandwell I'm responding to the news of your bursitis! I have it below and toward the inside of my surgery knee. It's so tender, driving me crazy. Am taking anti-inflammatories and icing the area. Hope you feel better!

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