TKR Searing pain when trying to straighten - 8 weeks post op

[Mhroamers]

Would really appreciate some feedback.

Am 8 weeks and 1 day post op RTKR. My recovery hasn’t been an easy one and I’m still mostly on 1 or 2 crutches. The wound finally stopped bleeding after 7.5 weeks (Physio was difficult due to this) and my LTKR was meant to be 2 weeks ago but was cancelled.

I waited 6 years to do this and basically my muscles have wasted away during this long time. On Tuesday I was finally brave enough to do mini squats holding on to the kitchen bench. The night that followed the squats something went ting and I’ve been in excruciating pain ever since. Finding it difficult to put weight on the right knee now but the worst part is the pain when I try to straighten that leg making sleep even more impossible now. Something is catching and I can not describe the pain other than a knife going in. I think I can take a lot of pain but this makes me scream out. It’s been about 30 hours now and we are 3.5 hours away from the doctor. Do I wait and be patient?

 

[sistersinhim]

Welcome to Bonesmart. I'm so sorry to hear you are having such a rough time of it. Please tell us the date of your surgery so we can add it to your signature. It sounds like you may be doing too much. I will leave you our recovery articles to help you through this.

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.​

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. Here is a week-by-week guide for Activity progression for TKRs


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.

 

[Jamie]

Please do read all these articles that are posted above. Given your history and loss of muscle strength, you are trying to do too much too soon. Please stop doing ANY squats for now. They can be really rough on your soft tissues. In fact, it's way too soon for you to be attempting any strength training on that knee as it is still healing. Your best course of action is to take 2-3 weeks off from any therapy and do your own gentle bends and stretches throughout the day at home. Also, be sure to get up and do about 5 minutes of walking about every hour or two. A majority of your time needs to be spent with your leg elevated (toes above your nose) and ice on your knee. Don't be in a hurry to stop using whatever walking aids you need to enable you to walk without a limp. As an example, I used my walker around the house for a good 3 months (and I had strong legs going into surgery). It gave me the extra support to allow me to walk around with an increasingly longer stride as the months went on. It's better to keep that support and be able to walk normally than to try and push and end up limping or taking short steps.

Be sure you are taking something on a regular schedule for any pain you are having. It doesn't have to be prescription pain meds (although it could be, especially at night if you're having trouble sleeping). Tylenol is fine too. Just be sure if you take Tylenol that you're taking 1000mg every 4-6 hours throughout the day and night. And, if you take other medications that have acetaminophen in them, you must count that in your daily total to ensure that you're not taking more than 4000mg in any 24 hour period. Acetaminophen is in a lot of over the counter meds (especially sinus and cold medications) and prescription pain meds, so check carefully.

 

[MSgirl]

@Mhroamers, I am so sorry you are going through this difficult time. Maybe this doesn't pertain to your issues but I'll throw it out there. I had a great recovery from my first TKR and this one is going well also. The #1 thing my OS told me was to NOT DO SQUATS. I demonstrated what the therapy aid wanted me to do at the first (and horrible) facility I went to before I found a good one. It was just a slight, standing bend or squat and he said no, that's a squat. He supports regular PT and my walking for exercise but told me that squats put too much pressure on the new joints and would cause me a lot of pain. I still don't do them but have really good ROM without them. Just a thought.

 

[kneeper]

How are you doing? Did you end up calling your OS?

 

[Celle]

@Mhroamers
I'm sorry you're still having problems with your knee.
Please will you tell us the date of your knee replacement, so we can make a signature for you? Thank you.

 

[Josephine]

On Tuesday I was finally brave enough to do mini squats holding on to the kitchen bench. The night that followed the squats something went ting and I’ve been in excruciating pain ever since.

That's why I always advise against doing squats. It's so very easy to prang a muscle or ligament and they take ages to resolve.

 

[Beckadeez]

What was the reason given for continued bleeding? I’m sorry you’re having problems.

 

[Mhroamers]

Hello everyone. I’m sorry for not replying. I have been busy in my own misery and wasn’t notified of any replies.
Thank you everyone for your input.

Have been seeing a new physiotherapist and he was against squats but encouraged me to do weight transfers, similar to catching a ball with slightly bent knees and to pretend to sit down on bed but only slightly bend, hold, and get up again.

The medial pain is still there but not as acute.

I finally got the go ahead to go into the pool last Thursday (am now 9.5 weeks post op) and I love spending time there, in fact I’m there every single day. The pain is so minimal whilst there and I feel almost normal walking up and down the lanes and doing knee pushes with my swim noodle (although that is painful medially and I will leave that alone for now as per your advice).

Walking for 5 mins every couple of hours is a great suggestion but even 5 mins is too much for me because of the constant giving away of the operated knee as well as the left unoperated knee being so incredibly painful but I will do my best.

Your suggestion of Tylenol and Acetaminophen are a little foreign to me but I assume it’s a paracetamol and an anti inflammatory you are talking about?

** My surgery was on Tuesday 16th Jan 2018. **

Today I am seeing a new GP at the urging of my Physio, to get another opinion on various issues to do with my knee(s) and general health that are slowing my recovery down. After 6 years of this I’m not expecting much but you never know.

 

[Mhroamers]

What was the reason given for continued bleeding? I’m sorry you’re having problems.

I had a lot of oozing from the start and the scar simply wouldn’t heal around the knee cap, there was also an ongoing infection.

 

[Beckadeez]

I’m wondering, aren’t weight transfers and pretending to sit on the bed, the same thing as squats, just not a full squat? I’m sorry you’re having issues. I hope you get them resolved soon. Keep your chin up.

 

[Beckadeez]

What was the reason given for continued bleeding? I’m sorry you’re having problems.

I had a lot of oozing from the start and the scar simply wouldn’t heal around the knee cap, there was also an ongoing infection.

Oh, I guess I just didn’t read that part. I’m glad it has cleared up.

 

[Mhroamers]

I have an important question for you all. After all this time my right knee continues to wobble and give way in every direction. Some days are worse than others but basically I cannot go without crutches for fear of falling. Has anyone else experienced this? My mum also had the same surgery as me, 4 weeks after me and on the left knee however she has never experienced any letting go of the knee and is mostly walking without crutches by now (5.5 weeks post op). What is causing this? My Physio shakes his head and says it’s not normal and he doesn’t know if I will come good. I need to hear some positiveness please. Is there someone who had the same thing happening??? It also feels like the implant is moving or lose but Physio says that’s impossible.

 

[Mhroamers]

I’m wondering, aren’t weight transfers and pretending to sit on the bed, the same thing as squats, just not a full squat? I’m sorry you’re having issues. I hope you get them resolved soon. Keep your chin up.

I’m sorry, I have no idea how to respond so I’m just pushing buttons hahaha.
I guess they are little squats but more directed at achieving knee stability and to strengthen my hamstrings.

 

[Beckadeez]

You responded just fine. Maybe you could get a second opinion?

 

[Jockette]

It’s amazing how different exercises are from different PTs. I was never told to do a squat, of any variety.

 

[Babushelen]

Hi @Mhroamers I also had my RTKR on the same day as you. My OS recommended I keep using my cane if I felt like the knee was buckling. I haven’t had that feeling but apparently by his comment I assume it is a normal occurrence. My quad muscles are also weak from the arthritis and lack of exercise leading up to the TKR. Also, your PT is not the expert’s opinion of whether your implant is or is not loose; your OS is the only one who can determine that. Has your OS taken an x-ray? Mine did at the 3 week check up. Maybe you should talk to your OS and he can make the proper assessment to put your mind at ease.

You should definitely keep using your crutches until your knee stabilizes.

 

[SusieShoes]

Squats of all kinds, even the mini ones, put a lot of stress on the new knee. Of course deep squats do more, and should never be done with new knees, but even the mini ones should be held off until the knee has healed a bit more and the muscles supporting it have been built up a bit by gentler exercises like walking and doing stairs. So it’s an exercise you can put off for a little while, especially if your knee is giving you the kinds of problems you describe.

I would be concerned, too, if my knee wobbled. Pinning down the cause of that is important. If it’s muscle weakness, your physical therapist would have identified that, I hope. Definitely keep using your cane to help you stay on your feet and active. Doing so is the best exercise for your knee.

You do need to establish whether the implant is in fact moving on you. While rare, implants can loosen, so I hope you can get a visit with your OS to get a prosthesis check.

 

[kneeper]

Is the "wobble" an occasional, random "giving out" sensation? Many of us get that for a few weeks early in our recovery, but you're a ways out now. I agree that you should have the OS check it out.

 

[sistersinhim]

It also feels like the implant is moving or lose but Physio says that’s impossible.

Your Physio is wrong. As Susie said, implants can be loose. He had no right telling you that it was impossible. I find it impossible how these physios can have all these destructive exercises on a brand new knee. Your knee isn't out of shape, it is healing. It needs to heal before anything like squats are done. That can take a year or more. For me, it has been more.

If it hurts, don't do it. I used a cane for about 6 months when ever I was out of the house. Inside my house I always had something I could grab on to. You need that cane to help you learn to walk correctly. Even now, if I'm in a very crowded place, my cane comes with me!

Please reread the articles that I left for you. You will fine a vast amount of help in them.