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[BILATERAL TKRs] Tight "Bands" around knees

Discussion in 'Knee Replacement Recovery Area' started by rockgoc, May 19, 2012.

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  1. rockgoc

    rockgoc New Member

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    Hi all. I am fairly new to this forum, no posts yet, so here goes! I had BTKR on February 10th with initial great recovery. Spent 3 weeks in rehab afterwards doing intensive physio, with great results. I was 110 on each knee ROM when I left hospital. Two weeks later when I got home, (we live in a remote mining camp) I was very tight in the knees and sore, but still on my pain meds, so can't really blame that. I bought myself a stationary exercise bike and a massage table so I could continue to give myself physio as best as I could. The bike seemed to help initially, but lately I seem to be as tight in the knees as I was before even 15 minutes of gentle pedalling. The muscles around the bottom of my kneecap and down the sides of my knees are so tight they feel like they could cut off the circulation, and make walking a very tentative affair. I have to make myself use my quads muscles to walk properly and not revert to walking like I did per surgery (not using those muscles at all!) I have stopped taking any pain meds now as they were not seeming to do anything, and I was experiencing sweating and chills all the time, and suspected that I may be getting a slight addiction.
    What I would like to ask is, whether you think I am just worrying for nothing? I even went back to the OS to ask him if I was healing normally and he told me to be patient and to stop worrying. I have also developed bursitis in both shoulders, probably from hauling myself around in the hospital bed via the overhead bar with my arms when I couldn't move any other way. This makes sleep nearly impossible, and no doctor I have seen about this seems to be able to help me other than suggesting that "It will go away eventually on it's own". I feel very discouraged and unhappy with how things have turned out, after being hailed as "amazing" for the first few weeks post surgery...now I just feel depressed! You comments would be welcomed.
    Jan O BTKR 10/2/12
     
  2. Campervan

    Campervan Sr Bonesmartie

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    Hi, To me you sound very normal for 3 months post op. I had the tight band feeling from the first walk I took up the hospital corridor. It was still there at 3 months and now at 5 months tends to come and go. Somebody will be along very soon I'm sure and will point you in the direction of a bunch of reading in the library and I'm sure will tell you that 3 months is still early in the recovery, lack of sleep and feeling very down are all a part of recovery from this major surgery.
     
  3. Skeeta

    Skeeta New Member

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    Hi rockgoc,
    Sorry to hear you are struggling now back home, I had my RTKR on April 2nd so I'm only about seven weeks post op. I still have the really tight band feeling around my knee and also still have a lot of swelling which is why I'm only getting 90 ROM despite going to physio and gym twice a week. From the reading I have been doing on here I understand that recovery from this surgery is going to take time and patience and I am trying to rest as much as possible during the day with just short bursts of cooking and cleaning etc. The one thing that I have found to be really helpful and try to do twice a week is hydrotherapy, I understand that you live in a remote mining camp so you most likely don't have access to a pool, but if you possibly have one nearby it would definitely be worth a try.
    It sounds as though you still need some pain medication, if the meds you were taking were not helping then maybe you can get your OS to give you something different to try, I had to get some stronger meds just for night time so I could get some sleep and it has made such a big difference. My understanding is that if you have pain then you can't get addicted to pain medication so you should be having something to help you through your day.
    I'm sure you will get lots of good advice from this forum as there are so many here that have great knowledge of recovering from this surgery and will be only too happy to help you with the problems you are having.
    Hope things pick up for you soon.
     
  4. Josephine

    Josephine NURSE DIRECTOR, BONESMART Administrator

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    Hi rock, and welcome to BoneSmart! I'll answer your post in bits - here goes!
    I think the 'intensive' bit is the key. I preach endlessly on here about the negative impact of doing too much exercise and it looks like you have just proved that in spades!
    Which kind of proves my theory. Had you cut back significantly at this point, you would most likely be past all this by now. This article might be helpful in explaining what is causing this sensation Why Do I Have That "Tight Band" Feeling Across The Front Of My Knee?
    Well, it rather depends upon
    1. what pain meds were you taking?
    2. how much and
    3. how often!
    4. what, if anything, are you taking now?
    Well, he was right but could have been a little more helpful than that. Did he ask you how much you were doing? I bet not!

    To me, this is the essence of your problem. You are doing far too much and have been all along. I know you were probably encouraged by PTs to do this and maybe even told "No pain, no gain" which is rubbish! Read that article and find out why. The 'intensive' idea has also been proven by members here to be a grave mistake and much better to go the softly softly route. You need to bear in mind the significant difference that your knee is not weak or out of condition, it's been injured and requires time to heal and recover. Once that is accomplished, then you can start on the strength training. As it is, you have, as they say, put the cart before the horse and what you have done is cause the soft tissues to become badly inflamed and angry.

    You are still only 14 weeks out which is actually still early days. I strongly suggest you cut back on all your activity and consider the following routine
    1. restrict exercise to 10 mins a day on the bike at lowest resistance and only moderate speed
    2. walk about ½ a mile a day
    3. do heel slides and/or swats but gently and not more than about 10 twice a day
    4. take at least one day off every week when you do no exercise at all except the walks
    5. the rest of the time spend resting with your leg elevated "toes above nose", icing and take pain meds (read articles below)

    And here are the articles we normally give people when they have just had surgery. Do read them all
    The importance of managing pain after a TKR and the pain chart
    How Long Does Healing Take ......
    Chart representation of TKR recovery
    Energy drain for TKRs
    Elevating your leg to control swelling and pain
    Using ice
    Swollen and stiff knee: what causes it?
    Progression of activity for TKRs

    Knee Replacement - Where Am I in Recovery?
    So What Is It Going to Take? The Five “P’s” of Knee Recovery
    Work “Smarter” and not “Harder”
    About recovering a knee - from one who knows!
    Some suggestions for home physio (PT) and activity progress




    Er, no it won't! I suffer from this myself and know what it's like. What kind of doctors have you seen? Have you seen an orthopod who specialises in upper limb conditions? Anyone else wouldn't understand the condition and would therefore have no idea how to treat it.

    You need to be checked out for rotator cuff impingement which is quite common, much more common in the shoulder than bursitis.

    This is an xray of one of my shoulders, you can see where I have marked it that the end of the collar bone has a woolly appearance which are osteophytes or bony overgrowths. These will scrape at the shoulder ligaments and cause a lot of pain, specially when you are trying to lift you arm up - about half way is when it bites the most for me.

    [​IMG]

    If you get to the right kind of surgeon there are a couple of treatments that might be offered, the first would be for RC impingement and bursitis.
    1. injection of depomedrone cortisone
    2. a small arthroscopic operation to smooth the underside of the rough bone (which surgery I am about to undergo myself)

    When you've answered my questions, I'll post more ......
     
  5. Ditzzeechick

    Ditzzeechick Senior

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    Jan-

    I had both of my knees replaced 7 days apart, Right Feb 20, 2012, Left Feb 27, 2012. My extension/ROM 1/105. I think we all suffer from that tight band feeling for quite sometime. I still have swelling and find it intensifies after PT. I have also found that Josephine is correct in reference to the amount you do in any given day. I've learned for each day of activity I need a day of rest. I have recently decreased my PT from 3 times wkly to twice wkly. My insurance for PT runs out after 10 more visits. On the advice of my therapist I'm joining my old gym where they have a pool so I can use the pool to continue to exercise and hopefully gain more range of motion. I sleep fairly well but still need pillows between my legs most nights to get comfortable. Some days I move better than others but I still cannot make a revolution on the bike! It makes me nuts but instead of worrying about it, I use a recumbent ellipitical machine which I love. I'm noticing more and more strength in my thighs and know that in time my bend will improve as the swelling decreases. From what I have read there is very little room in the area of the knee so it only takes minor fluid to restrict movement. My thigh tightness comes from exercise. I don't have any pain in my knees, just the tightness depending on the workout. Hang in there!
     
  6. kneeper

    kneeper Forum Advisor

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    I think Josephine has given you a very good plan. (hail Josephine! :) )
    You need to keep the knee moving, but you also have to let it heal. It will resist when you make it angry.:wink1:
     
  7. Josephine

    Josephine NURSE DIRECTOR, BONESMART Administrator

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  8. Jamie

    Jamie Administrator

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    Hi, rockgoc....welcome to the forum. Boy, I can't add anything to Jo's informative post, so I'll just encourage you to follow her advice and to let us know how you're doing.
     
  9. rockgoc

    rockgoc New Member

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    Josephine, and all the others who replied to my post....WOW! Thanks for all your support, it has REALLY made me feel a whole lot better about my recovery.

    To answer your questions Josephine, I was taking Oxycontin for a while but weaned myself off them about a fortnight after I came home. I then took a "floater" of Panadol Osteo 2 caps x every 6 hours, Tramadol SR 150 mg 1x morning and night, plus Tramadol 50mg x 2 caps every 4 hours when needed.

    The ferocious hot flushes followed by the chilled to the bone feeling carried on all day and night and I was not sleeping at all! Maybe a half hour at a time. My partner is suffering from this too, as we are in a caravan and he cannot get away to sleep in a quiet place, so it makes his life a misery too!

    So, when I stopped taking the Tramadol and just took some Nurophen Plus, my knees started to lock up and my ROM rapidly decreased, to the point where I thought I needed to get some pain meds going again, and I have started back on the Tramadol SR 150mg x 1 morning and 1x nightly, and 2x Tramadol 50 mg morning and afternoon and maybe at night too if I think I need them. Am I doing the right thing by going back onto the Tramadol like this? I must say I feel a whole lot better, and can bend my knees again, and my mood has improved significantly, to the point where I feel almost happy! Ha! At least I can now get up and walk around again without feeling hopeless and wanting to burst into tears every 5 minutes.

    My surgeon didn't ask me how much physio I was doing...you are certainly right there. He is a man of few words, and my physio told me not to expect much in the way of conversation from any surgeon as they are used to working on a silent body, not an awake and chatty human! I had to laugh here because she was so right!

    The surgeon just told me that he thought I was "One of these people who heals really fast in the early stages and then has to be patient with the long haul stuff later." The rehab physio constantly told me that I was the best patient she had ever had because I pushed myself so hard and got such great results. All that was in response to others who had the same surgery and advised me to go hard and listen to my physio, which I did. Like I said, in rehab, I did extremely well as I am a competitive sort of person, and making myself the best I could be was a sort of goal. Seems stupid now that I look at it through fresh eyes and hear your comments Josephine!

    I have not been doing much exercise at all due to the pain, but will start back on the bike now I have taken my meds again. I was only doing about 15 minutes a day maybe twice daily sometimes at the lowest resistance and very moderately, but it only seemed to make the knees more swollen and stiff which is why I was questioning what I was doing. There is no possibility of hydrotherapy here. A pity as I really enjoyed it in rehab.

    Also, we are 2 weeks away from moving to the other side of Australia by road. I was going to be taking about 2 weeks to do the drive, so am I being a bit ambitious? I really cannot delay this move again (the collapse of my knees and the subsequent operation happened right when I was supposed to be driving over to my new place of living). Once I am established in my new town, I will be looking to see a doctor regarding my bursitis, which was diagnosed via x-rays and ultrasounds. Your advice on this subject was very welcome Josephine, and I thank you, especially as this forum is all about the other end!

    So, hopefully I have provided some more fodder for you Josephine, and I wait for your further advice with great anticipation!
    Cheers and thanks to all who replied, once again, from Jan O

    @Josephine:
     
  10. referee54

    referee54 Moderator

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    Welcome to the forum family! you have arrived at a great site and have found some folks who are very, very knowledgeable about replacement surgeries and recoveries. I would have to say that you have been given some very, very sound advice---please also read those articles, as they also have a tremendous amount of excellent information about what you are going through during recovery and rehab/PT.

    Your surgeon gave you sage words of wisdom---recovery from these can take quite some time and requires a great deal of patience---we have, the most part, all found that out. It will challenge your level of patience and it can be frustrating, but we will be here to help you through it!

    I had a BTKR over four years ago, and it was quite challenging and very frustrating for quite some time. My recovery lasted over five months---at the fifth month, I lost the pesky little limp that I had and was at about 80%-85%; it was not until the 8th month that I felt like I was 90%-95% and getting really close to normal.

    While I didn't have bursitis, I can sympathize with you as my shoulders---AKA rotator cuffs, especially my right one---was letting me know that it was upset at what was going on with me hoisting myself around.
     
  11. rockgoc

    rockgoc New Member

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    Am I being Stupid?

    After 14 weeks I was thinking that maybe I should be trying to decrease my pain meds back to the over the counter type. Took two days to realise that maybe this was a dumb idea as my knees promptly seized up and I could barely get any flex in them at all. Most alarming! So, now I am taking 2x150mg Tramadol SR in the morning, and then another 2x150mg Tramadol SR before bed, plus 2x 50mg Tramadol "instant result" if I still have the very tight bands around the knees. I posted a while ago regarding the horrible feeling of these bands of muscle all but cutting off the circulation around each knee. It hasn't got any better with time, in fact, by nightfall, I can hardly walk at all it is so tight, and this is why I have started taking the pain meds the way I have. I get good relief on the first couple of days, but then everything seems to just stop working quite as well as it did initially. I no longer do any stationary bike riding past about 15minutes every 2nd day or so as this only seems to make the knees tighter than ever! Do you think I have developed a tolerance for the Tramadol already? What should I be doing? Help!!!
    Jan O
    BTKR 10/2/12
     
  12. Campervan

    Campervan Sr Bonesmartie

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    Re: Am I being Stupid?

    Hi, have you tried an NSAID antiflammatory such as Ibruprofen or diclofenac (Voltaren). I was taking Voltaren prior to surgery and then it was prescribed after as well. I had the tight rubber bands and if I stopped taking the Voltaren, then the bands got worse so I'd take them again for another few weeks and try to stop again. It wasn't until almost 5 months that I'm totally off them. Not sure if it was just elapse of time or the Voltaren that stopped the tight bands. BUT they do still come back, not as fierce nor for any length of time, maybe a few hours.
     
  13. bottomshollow

    bottomshollow Moderator

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    Re: Am I being Stupid?

    Rockgoc, those "very tight bands around the knees" are actually pain caused by swelling. And they are not going away until the swelling goes away.

    Are you elevating (toes above nose) and icing? If not, you should be---and several times a day. How much are you doing? You may be doing more than your knees can tolerate even at 14 weeks. I'm going to give you a couple of links to articles in the Library that address this:

    Elevating your leg to control swelling and pain
    Why Do I Have That "Tight Band" Feeling Across The Front Of My Knee?

    Hope these are helpful. Take care and keep us posted. We care.
     
  14. Josephine

    Josephine NURSE DIRECTOR, BONESMART Administrator

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    Your medication regime is somewhat over the top, my friend! I would have suggested 50-100mg Tramadol with 1,000mg paracetamol 4 times a day. It should give you a much better coverage than this big bold night and morning. Then you can drop a dose or increase it as the day develops.

    As a matter of fact, I took that routine for three full months after my op and needed every dose! When it came time to stop, I found I had already started dropping doses quite naturally during the fourth month until I had just tapered off without even thinking about it.
     
  15. rockgoc

    rockgoc New Member

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    OK I will try the method that you suggest Josephine. I have been on Diclofenac for years for a hip problem, and take three times a day.
    Will let you all know how this turns out. Cheers and thanks for the help.
    Regards, Jan O
     
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