TKR Worried I should go to ER

[Sleepy]

Hi everyone!

I'm new here. I'm 8 weeks out. I can't sleep at all--like 3 hours a night tops. I returned to work Wednesday, and totally set myself back and went down a pain/swelling spiral. I've been on ice since, and I even had to return to the Oxy. I can't even do my stationary bike or walk to the corner now. The PT said this would pass in a few days. In the meantime, I'm putting on weight and feeling crappy. When will I be able to go for real walks and swim laps? Will I ever sleep again? I know everybody is different, but I'd love some insight.

 

[Jockette]

@Sleepy Hi and Welcome!

I will leave you our Recovery Guidelines. Each article is short but very informative. Following these guidelines will help you have a less painful recovery.

Just keep in mind all people are different, as are the approaches to this recovery and rehab. The key is, “Find what works for you.“ Your doctors, PTs and BoneSmart are available to help, but you are the final judge as to the recovery approach you choose.

Knee Recovery: The Guidelines

1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now, they are almost certainly temporary

2. Control discomfort:

rest​

elevate​

ice​

take your pain meds by prescription schedule (not when pain starts!)​

don't overwork.​

​

If you want to use something to help heal the incision, ​

BoneSmart recommends hypochlorous solution. Members in the US can purchase ACTIVE Antimicrobial Hydrogel through BoneSmart at a discount. Similar products should be available in the UK and other countries.​

3. Do what you want to do BUT

​

a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you​

b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.​

​

​

4. PT or exercise can be useful BUT take note of these

​

the BoneSmart view on exercise​

BoneSmart philosophy for sensible post op therapy​

5. At week 4 and after you should follow this

Activity Progression for TKRs​

6. Access to these pages on the website

​

Oral And Intravenous Pain Medications​

Wound Closure​

The Recovery articles:
The importance of managing pain after a TKR and the pain chart
Swollen and stiff knee: what causes it?
Energy drain for TKRs
Elevation is the key
Ice to control pain and swelling
Heel slides and how to do them properly
Chart representation of TKR recovery
Healing: how long does it take?

Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

There are also some cautionary articles here
Myth busting: no pain, no gain
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds

We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery.

While members may create as many threads as they like in the majority of BoneSmart’s forums, we ask that each member have only One Recovery Thread. This policy makes it easier to go back and review the member’s history before providing advice, so please post any updates or questions you have right here in this thread.

 

[Jockette]

I can't sleep at all--like 3 hours a night tops.

Here’s an article from Bonesmart’s Recovery Guidelines:

Sleep deprivation is pretty much inevitable - but what causes it?

Time and again members complain about not being able to sleep and after a while, that it gets to making them feel frustrated, despairing, depressed and even ill. I thought perhaps a short treatise on the reasons for disturbance of sleep patterns was long overdue. It won't help you to sleep but...

bonesmart.org

I returned to work Wednesday, and totally set myself back and went down a pain/swelling spiral.

This is very common. It’s so easy to have setbacks in the early weeks. And yes, 8 weeks is early in this recovery, which takes an average of 52 weeks (one year)

The PT said this would pass in a few days.

Depending on just how much you overdid, and continue to push through going to work, don’t be surprised if it takes longer.

When will I be able to go for real walks and swim laps? Will I ever sleep again? I know everybody is different, but I'd love some insight.

All in good time. You will get your energy back, and do the things you love, and sleep, but it will take a while. That timeframe varies for each of us.

 

[Layla]

Hello and Welcome to BoneSmart and recovery!
I am sorry you're having a rough time. Returning to work at eight weeks post op may be a bit ambitious as we normally recommend a Phased Return To Work, but understand that is not an option for everyone.
Phased return to work.
Getting ready for work, getting yourself there and doing whatever you do while there may be enough this early on without the further aggravation of PT, walking as exercise or using your stationary bike. Possibly step away from all of that until you're able to adjust to your return to work.

As far as sleep -
Pillows certainly help me get comfortable in bed, making it easier to drift off.
I suggest making up the bed with your most comfortable bedding / blankets along with a few extra bed pillows of different degrees of firmness. Try to block out the light if it's daytime. Minimize noise unless you feel listening to calming relaxation music, a fan, or white noise may help lull you to sleep. Make sure the room temperature is not too hot or too cold. Try to disconnect from the devices at least an hour before the targeted nap or bed time, so it's easier to wind down. Limit caffeine throughout the day and consider natural sleep aids such as Valerian, Chamomile or, Magnesium, my personal favorite, which can assist in muscle relaxation and nerves and promote healthy sleep (falling asleep and staying asleep)

An article on Magnesium from our Library -
https://bonesmart.org/forum/threads/magnesium-is-a-star.20301/

Most large grocers carry a variety of teas such as Celestial Seasonings - Sleepytime Herb Tea,
Yogi Teas, Bedtime, Bigelow Cozy Chamomile, all of which may help you relax...at least worth a try.

Wishing you comfort and the restorative rest you need as you move forward. Thanks for joining us!

 

[Layla]

Please let us know the exact date of your surgery and identify which knee was replaced so we're able to create a signature for you. Thanks in advance!

 

[Sleepy]

Thank you so much! My return to work is phased, and I'm a teacher so soon school will be out. My surgery was March 7, and it was my left knee.

I didn't really understand that recovery was 52 weeks. I thought it was 12. I think I willfully misunderstood.

Is 12 weeks anything?

Yes! Pillows!

 

[Layla]

Many are led to believe in unrealistic timelines in regard to full recovery, so you're not alone.
Complete recovery takes most a full year with many still noticing improvement into their second and third years post op, so lots of good to look forward to. Here is an article that may be of interest -

TKR recovery: how long does it really take?

 

[Layla]

Here is another -
Healing: how long does it take?

 

[EalingGran]

My return to work is phased, and I'm a teacher so soon school will be out. My surgery was March 7

I expect you are on your feet a lot teaching and standing is harder than walking for recovering knees. So I am not surprised you are finding it tough at eight weeks. I wouldn't do much else apart from work, some gentle movements of the knee and rest/ice/ elevation when not working.

 

[Sleepy]

You were right that it would take more than 48 hours after overdid it at work. At what point do I worry about the swelling? It's sis swollen and painful that even home exercises hurt. I'm starting to worry that I did something that requires medical attention...

 

[Layla]

I am sorry you're feeling anxious and in pain, Sleepy. Swelling can go on for months. It can increase after over-activity and even from too little activity (sitting around too much) Stop the exercises and any PT, rest, ICE, ELEVATE and use OTC meds for the pain, if you're feeling the need. Only you know if you need medical attention, but if you're able to trace this to overactivity or aggressive PT, I believe rest, icing and elevation will help reduce the swelling and pain. Ice as often as you're comfortable, for as long as you care to, always placing fabric between bare skin and the ice source.

Best wishes...stay in touch and let us know how you're doing.

Please notice that we have merged your newest thread with your original recovery thread. Having your recovery information contained in one place will make it easier for you to reflect back on. It is also helpful for those stopping by to be able to review your history before advising or commenting. Please post any updates, questions or concerns about your recovery here.
@Sleepy

 

[Layla]

Ice to control pain and swelling
Elevation is the key

 

[Jockette]

You were right that it would take more than 48 hours after overdid it at work. At what point do I worry about the swelling? It's sis swollen and painful that even home exercises hurt. I'm starting to worry that I did something that requires medical attention...

When I was 4 months post op I went away for the weekend with friends. I struggled to keep up with them, and totally overdid evertything. Lots of stairs were also involved, among other things. I was only away 48 hours. By the time I got home I could hardly bend my knee, from the swelling. It took a full month for me to start to improve. I would have thought at 4 months post op I was beyond such a setback.

Then, at 5 months post op, just when I was beginning to improve from that previous setback, my son got married and it was basically a 3 day, out of town, weekend event for me and the same setback happened to me again. It took another month to improve. My body must be more sensitive than others, because this time I improved more slowly and the rest of my first year was very hard.

 

[Sleepy]

When I was 4 months post op I went away for the weekend with friends. I struggled to keep up with them, and totally overdid evertything. Lots of stairs were also involved, among other things. I was only away 48 hours. By the time I got home I could hardly bend my knee, from the swelling. It took a full month for me to start to improve. I would have thought at 4 months post op I was beyond such a setback.

Then, at 5 months post op, just when I was beginning to improve from that previous setback, my son got married and it was basically a 3 day, out of town, weekend event for me and the same setback happened to me again. It took another month to improve. My body must be more sensitive than others, because this time I improved more slowly and the rest of my first year was very hard.

thats terrible!!

 

[Layla]

Happy Two Month Anniversary, Sleepy!
How are you doing? I hope better than the last time you posted.
Please let us know, we do care.
@Sleepy

 

[Sleepy]

Hi! I'm having a hard time. I got a stress fracture on my good foot. Also, I was shamed at PT for crying on Monday. This is so hard! Thank you for asking.

But, I love my lounge doctor!!!!

 

[EalingGran]

got a stress fracture on my good foot. Also, I was shamed at PT for crying on Monday. This is so hard

That is really tough to have a stress fracture. It suggests to me that you are overdoing things.It is definitely not right or professional for a PT to shame you for being upset. I would complain and a avoid that person in future. This recovery is hard but you need to look after yourself and not be pushed into exercises that cause pain or damage.

 

[Jockette]

I was shamed at PT for crying on Monday.

This is so inappropriate for them to treat you like this.

I’m so sorry about the stress fracture. If it was me I would take time off from formal PT and do things on my own at home. Your knee will be fine without formal PT. You can do some gentle bending movements to give the knee mobility, and your foot needs some extra TLC and time to heal.

Regaining our ROM does not require forceful bending or painful exercises. That is counterproductive.

Regaining our ROM is more about Time than repetitions of a list of exercises.

Time to recover.
Time for pain and swelling to settle.
Time to heal.

Our range of motion is right there all along just waiting for that to happen so it can show itself.

In the general run of things, it doesn't need to be fought for, worked hard for or worried about. It will happen. Normal activity is the key to success.

 

[InkedMarie]

Shamed at PT? Report them and find a new one. I’m so sorry.

Marie