TKR Pain and swelling!

[MandyJed]

I am 52 years old and had TKR on 12/13/23 after dealing with early onset arthritis/bone on bone/meniscus tears for the past 2 years. I did a lot of “pre-hab” therapy for strengthening and lead a fairly active life as a full-time teacher and photographer. I am STRUGGLING with pain and stiffness 4 weeks out. PT says flexion is 105-110 but it is so painful and I can only stand it for a few seconds. I am only able to sleep for about 60 minutes at a time and then in horrible pain the rest of the night. Taking meloxicam (once a day) and Tylenol for pain but I don’t feel like they help at all. Despite my best efforts with icing/ellevation/PT my knee swells most days and is so incredibly stiff and painful. I keep worrying the surgery will not be successful or that I am doing something horribly wrong. I feel like some I’m reading about are doing so much more than I am right now. I feel so far from being able to get back to normal activities and work. Is there something else I should do??

 

[CatieViv]

Rest ice and elevate as much as possible. Take a break from physio. It's very early days yet. You may need to ask for stronger pain meds for a short while. You will get there but this is a year long journey of recovery. I understand how you feel. We are the same age. It's hard not to be able to be active. Give yourself lots of grace and work on that patience muscle! Believe me, mine has had quite the workout!

 

[sistersinhim]

Welcome to Bonesmart @MandyJed. You are in the very early stages of an average of a yearlong recovery. I will leave you our Recovery Articles that have helped tens of thousands of other knee replacements. We are here to help you through this journey the best we can. The very best thing for your knee right now is to rest, ice, and elevate. Exercises can come later. There is no rush to achieve ROM because it will come naturally as your swelling decreases. Your OS was able to bend your knee while checking for movements during your surgery, so it will be fine. It just takes time.

Each person is different as is their recovery. Most find that the Bonesmart approach works best for them, but others find that a more aggressive therapy helps them more. It's your recovery and your choice on how you recover. As you read more on other members' recovery threads, you’ll get a better perspective of what to expect. The following are our basic guidelines and should help get you started.

If you want to use something to assist with healing and scar management, 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.

KNEE RECOVERY 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.

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 these pages on the website
Oral And Intravenous Pain Medications
Wound Care In Hospital

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 a 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 history before providing advice.

 

[MSuki]

I vote with @CatieViv for asking your doctor for some better pain meds. You should not have to deal with uncontrolled pain. How often are you going to PT? Might be you are doing too much vs too little, and if they are forcibly pushing on your knee that is guaranteed to make it swell up. It can create a vicious cycle because the swelling then leads to more pain and less ability to bend.

I think I was sleeping 2-3 hours at a time until about week 7, but I’d entertain myself for an hour then go back to sleep. Sounds like your sleep is much worse but again caused by the uncontrolled pain.

I hope you can get with your surgeon or primary care and get some help with this!

 

[CatieViv]

Also on sleep, sleep when you can. If you aren't sleeping well at night, go ahead and have a nap during the day. You will eventually be able to give up the daytime nap. Magnesium might also help with sleep. I think better pain meds will improve sleep as you won't have as much pain.

 

[MandyJed]

I vote with @CatieViv for asking your doctor for some better pain meds. You should not have to deal with uncontrolled pain. How often are you going to PT? Might be you are doing too much vs too little, and if they are forcibly pushing on your knee that is guaranteed to make it swell up. It can create a vicious cycle because the swelling then leads to more pain and less ability to bend.

I think I was sleeping 2-3 hours at a time until about week 7, but I’d entertain myself for an hour then go back to sleep. Sounds like your sleep is much worse but again caused by the uncontrolled pain.

I hope you can get with your surgeon or primary care and get some help with this!

I am going to PT 3 times a week and they are most definitely forcibly bending and straightening my knee. I just found this forum today and am reading through seeing maybe that is not the best thing to be doing - at least as much as they are doing it. After reading your message and others I think I will call my surgeon’s office tomorrow to discuss more medication for at least another week or 2. The pain and lack of sleep is so bad I’m worried my body will not be able to recover well. Thank you for responding to my post.

 

[Layla]

they are most definitely forcibly bending and straightening my knee.

I am so sorry you’re hurting. Please do not allow anyone to forcefully manipulate your leg. Do refrain from engaging in movement that causes discomfort or pain. While your range of motion is currently limited, it will naturally increase as the swelling subsides and the pain eases. Give it time.

At not quite one month post op, it’s still very early days in a recovery that can last a full year for some and even longer for others. What seems like excess pain, likely due to overactivity, should ease if you dial back the PT, ice / elevate often and get lots of rest, sleeping whenever you’re able.

Your meds should be effective enough to keep you comfortably mobile and they may very well be, if you’re able to step away from the overly aggressive PT you’ve been engaging in. I do wish you comfort and hope you’re able to get the restorative rest you need so your strength and stamina increase.
Please keep us posted, MandyJed. Best Wishes!
@MandyJed

 

[Layla]

Please identify which knee was replaced and we’ll add that information to your signature.
Thanks in advance!

 

[mendogal]

I'm glad you're going to call about pain medicine!

Some folks find that once they have the pain under control they sleep better. Some of us unfortunately do continue with few hours of nighttime sleep even with good pain control.

In addition to an evening magnesium supplement, some of us have found these helpful....

OTC diphenhydramine, an antihistamine also used as a sleep aid because it makes you drowsy; it's also included in some cold, flu, etc "nighttime" combination meds.

Low dose melatonin, low dose sustained release - not for long term use but I have used for a week at a time without ill effect. It should be taken an hour to hour and a half before going to bed, and during that time stay in a dimly lit area to allow this hormone to activate.

Valerian root - an herbal remedy, it can be taken in capsule form but that dose might be high compared to my preference, herbal "sleep" blends that include a smaller dose of valerian and make me pleasantly drowsy. Plus the other tea flavorings make it nice tasting! Celestial Seasonings and Traditional Medicinals sell teabags by the box. Their sleep blends without valerian aren't effective.

 

[MandyJed]

Thank you so much for taking the time to respond and for the encouragement. I keep feeling so worried I am not doing enough or the right things.

 

[Layla]

Try to relax, it will all be okay.
Just remember, you're healing an injured leg, treat yourself with the TLC you deserve.

Something that helped me remain mobile without overdoing it was the Activity Progression.
Activity progression for TKRs

Slow and easy is the best way to go. PT can wait, especially the kind of PT you've endured.
Read lots of threads here and you will see how others recovered successfully. Don't worry, your body is healing and knows what it needs, just listen to the signals you're receiving.
A peaceful Friday and weekend to you!
@MandyJed

 

[MSuki]

Getting your pain under control and swelling down are top priority now. You can’t bend a swollen leg. Then you can work on ROM. Even then, my PT always emphasizes not going to the point of pain, especially a sharp pain. (She doesn’t have a lot of sympathy for sore muscles but if something causes pain then she immediately has me stop and changes the exercise to something else that doesn’t hurt). Hope you have a better weekend!

 

[Axx72]

Each person is different as is their recovery. Most find that the Bonesmart approach works best for them, but others find that a more aggressive therapy helps them more.

Thank you so much for taking the time to respond and for the encouragement. I keep feeling so worried I am not doing enough or the right things.

I feel like some I’m reading about are doing so much more than I am right now. I feel so far from being able to get back to normal activities and work. Is there something else I should do??

Everyone from every walk of life share their stories here. Everyone is different and have different measures of self assessed failures and successes. Everyone recovers at different rates and to different levels... so many factors involved.

Try not to base your recovery on other's achievments and enjoy your own success. When you look at where you have come from and and how far you have come, it can put your recovery into perspective. Break your recovery down into small goals. A little better than it was an hour ago or a day ago. Sooner or later you will look back and say look at far I have come!!

 

[Layla]

Hey...you hit a milestone today. One month post op, to date.
With each passing month you'll feel stronger and more steady on your feet.
Hang in there, brighter days are on the way!
Happy One Month Anniversary!
@MandyJed

 

[benne68]

I keep feeling so worried I am not doing enough or the right things.

You are doing just fine for one month post-op!

I'm two days behind you in recovery and experiencing all the same thing that you describe: I'm struggling with sleep, swelling and stiffness. My flexion is only about 100 degrees.

Since this is my second TKR, I know that what is happening right now is completely NORMAL. But I understand how scary it can be the first time around.

Keep icing and elevating, take your pain meds on a regular schedule and do not let anyone force your knee into flexion or extension! This is a long, slow recovery and trying to push through pain will only set you back. You have the right to say "no!"

Try to be patient. You and I will both get better -- it just will take time.

 

[MandyJed]

Please identify which knee was replaced and we’ll add that information to your signature.
Thanks in advance!

My right knee was replaced.

 

[Susie-Q]

Here's another chart that might help you realize just what's going on in your body after surgery. I know it helped me slow down when I realized that my bones that had been drilled into and implants inserted were going to take a full 12 weeks to heal. Pushing things prior to that will only aggravate and delay healing.

I also think PT 3 times a week is WAY too much. I would skip a week of PT completely, give yourself time to heal and rest up and then go back to 1-2 times a week MAX.

I hope you are having a relaxing day and giving yourself lots of TLC.

 

[MandyJed]

I have appreciated this site and the responses to my initial post so much. I am close to 6 weeks post-op now. I am still struggling so much with sleep. I don’t know whether I should call my doctor and ask for some sort of sleep medication or different pain medication (I am only taking meloxicam 1x a day for pain currently). I am hesitant to add more medication but I am getting desperate to sleep. I still have 5 more weeks of approved leave from teaching but I am getting worried I won’t be ready because I feel so far away from being able to walk around and teach all day. Some days ( like today) I feel as though I am moving backwards with pain/stiffness. I am praying this is normal and that something isn’t wrong. My knee feels so tight most of the time. I would appreciate any advice or assurance that these things are common.

 

[MSuki]

Have you tried benadryl? I did not sleep more than about 3 hours at a time for I think about 7 weeks, but am sleeping all night now. Or the doctor will likely be willing to give you something. I had a lot of trouble when I was taking hydrocodone because for some reason it keeps me awake instead of making me sleepy. I have an antihistamine called azelastine, it’s over the counter now but used to be a prescription I had, and it makes me sleepier than benadryl. I am more comfortable with those than the prescription sleeping pills, probably because I have allergies! I think it’s normal to have stiffness but if your pain is not well controlled I would ask the doctor.

 

[Jockette]

I am still struggling so much with sleep.

This is a very common complaint, and here‘s some reasons why:

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 am only taking meloxicam 1x a day for pain currently

It sounds like you might be under medicated, I suggest you ask your doctor about Tylenol, which can be very helpful for post op pain.