TKR 5 weeks out from TKR, stiff and frustrated<

[labmum]

I had a right TKR on the 12th April. I had 4 days in hospital and 2 weeks in a rehab hospital doing physio and hydro therapy daily. When I left hospital my knee was still swollen and very stiff and it’s exactly the same now 5 weeks out!!

I currently attend the hospital as an outpatient doing physio and hydro twice a week. I do exercise at home every day but I just can’t see any improvement. While I’m doing my physio and especially hydro my knee seems to loosen up and I think I see improvement. I come home elevate and ice and when I’m done my knee is back to square one.

The stiffness is horrendous at times, I can’t sit comfortably with my legs down as the pressure is too much I also get shooting pain on the inside of my knee. My skin is hypersensitive and burns especially at night. My flexion is currently at 85, but it’s an effort to push it to that.

I’d be grateful for any advice. I’m so over it!!

 

[Pumpkin]

@labmum
Welcome to BoneSmart, glad you joined us!

Sounds like you are doing too much exercise. Allowing the therapists to push and shove your ROM causes swelling and inflammation resulting in stiffness and pain.
Suggest you cut back your exercise and request a gentle PT, or cancel PT. You need to let your knee heal, then your ROM will reveal itself, as the inflammation and swelling go down.
Saying no to therapy - am I allowed to?

The walking you do around your house, and a few gentle activities in the link below are all you need right now.
Heel slides and how to do them and Extension: how to estimate it and ways to improve it .

Here is your copy of the Knee Recovery Guidelines, the articles are short and will not take long to read.

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. 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 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 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.

 

[labmum]

Thanks for your reply, I’ve really found your site helpful, it’s reassuring to read other people’s stories!

Can you tell me what ROM is average for 5 weeks post op? The therapist aren’t actually too bad, they don’t physically push , but do encourage verbally

I’m also supposed to be off pain meds by next week, but I’m a bit wary of this because of the pain I’m still experiencing. I take Palexia 100mg in the morning and 150mg at night with paracetamol in between as needed, would it be reasonable for me to stay on the meds for now?

I think I went into this surgery totally unprepared! I usually research everything but so many people said to me how great I would feel and it was the best thing they had ever done, that I just assumed it would be easy and by my 6 week check up I would be fully recovered and ready to go!! How wrong I was!! Should have done my research.

 

[Jockette]

Most of us were not prepared for this recovery! Research probably wouldn’t have helped you much, unless you found Bonesmart and read some recovery threads, as our medical teams don’t tell us enough, and a lot of what they do tell us is not the gentle approach that Bonesmart recommends.

There really isn’t an average ROM for 5 weeks as we are all different.

One way to need less pain medication is to stop doing things that cause pain, like too much exercising and trying to push your knee further than it’s ready for. I’m going to tag @Josephine, our nurse director to advise you

Also, keep in mind it’s not exercising that gets our range of motion back, it’s Time:

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. Exercise as in strength training is counter-productive and in the early weeks does more harm than good. Normal activity is the key to success.

 

[Pumpkin]

Can you tell me what ROM is average for 5 weeks post op?

Some will have less than 90 degrees, with others at 135 degrees at 5 weeks. There is no average.
Every recovery is different, some recover slower, some recover faster. Be sure not to compare yourself to any one else, the other knee on the same person can be radically different from the 1st TKR.

If they are going to cut your medications back, you will need to cut back on your exercise and striving for ROM.
Take care of your knee, Rest, Ice, Elevate, and Medicate as advised.

Josephine is away from the forum, it may be a few days before she responds to Jockette's tag.

 

[Jodingers]

Hi @labmum , I'm 8 weeks now + doing great. I'm absolutely sure I'm doing great because at 2 weeks I started to follow bonesmart advice, my knee was so swollen, stiff and painful. I was manically doing exercises in an effort to do well as quickly as possible. Completely counter productive, you can't bend a swollen knee! Please do read through the advice given, I stopped all exercises, just walked, pottered around, 5 minutes on my exercise bike from around 3 weeks, iced + elevated as much as possible. The difference was amazing and I haven't looked back.
My best advice is be patient, ice + elevate, walk a little more every few days, ice + elevate, rock to and fro on the exercise bike (it will improve gradually) ice + elevate! Try wrapping your knee in cling film (saran wrap) , it reduces the friction and burn, and pop an ice pack on top to sleep.
It does get better. Wishing you well

 

[labmum]

jodingers, thanks so much for your advice, you are right, there’s not much you can do with a swollen knee! You are certainly made to feel that the more you do the better. I will take yours and others advice to cut right back and try to get the swelling down. Good luck with the rest of your recovery

 

[Spex10]

Absolutely do that @labmum. Just forget the PT and do as @Jodingers says. It works. I know because I've done it this way on my second TKR and haven't looked back!

 

[Bionic]

@labmum
I am 11 weeks post op today. My knee is only just over 90 ROM now. My knee has felt completely stiff the whole time, as if there is a tight bandage around it. However, last weekend the stiffness from the back of the knee disappeared. It's still stiff at the front but it has given me great encouragement and made a big difference to the way I am walking.
It's a slow and winding road but I think things are now on the up so don't be discouraged if you think you are having a slow recovery. Give it time and wait for the swelling to go.

 

[labmum]

Thanks everyone for your advice, I’m now realising I’ve been expecting too much too soon! I’m definitely going to reduce my physio and be a little more gentle with my poor knee.

 

[Jodingers]

Well done, I think half the battle is getting your head around the long recovery. Realising I had to be patient was definately the hardest part for me and even now I have to remind myself. I was very active and danced competitively and professionally for many years, pushing through pain is no deterrent for me, par the norm, accepting u can't do this is so difficult. But it makes sense.
I'm glad you're dealing with your knee and hope your progress is great!

 

[Josephine]

I’m now realising I’ve been expecting too much too soon! I’m definitely going to reduce my physio and be a little more gentle with my poor knee.

@labmum I'd really like to offer you some structured advice but in order to do that, I also need to ask you some questions. Are you willing for me to do that?

 

[labmum]

Sure , ask away!

 

[DLR]

@labmum I can relate to your frustration. My surgery was Apr 9 and I have hit the blues and frustration this past week...it is normal but difficult...wishing you the best

 

[Josephine]

Here y'go then!

It would be very helpful if you would answer each one individually - numbered as I have done - in as much detail as you can then I'll come back as see where you are ....

1. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine. And don't forget to factor in other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness).

2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?

3. how swollen is your leg compared to these?

4. what is your ROM - that's flexion (bend) and extension (straightness)

5. are you icing your knee at all? If so, how often and for how long?

6. are you elevating your leg. If so how often and for how long?

7. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and

8. are you doing any exercises at home? If so what and how often?
This is the most crucial question so please help me by using the format I have left as an example
(which means please make a list and not an essay!)

Exercises done at home
- how many sessions you do each day
- enter exercise by name then number of repetitions of each
etc., etc.

Anything done at PT
- how many times a week
- enter exercise by name then number of repetitions of each
etc., etc.

 

[labmum]

DLR, thanks! It’s a longer road than I expected, my knee is still very stiff and sometimes it’s difficult to imagine things will ever change All the best to you for a speedy recovery

 

[labmum]

Josephine, hope I’ve posted this correctly, still trying to navigate the site properly!!

1. Pain level 4

2. Pelexia ( tapentadol )100mg in morning. 150mg at night, Lyrica 75mg morning and night. Panadol as needed

3 huge

4 flexion 80/90 depending on my knee on the day . Not sure of extension, I have no problem with straightening, my therapists been mainly concentrating on my bend

5 I try to ice about 4 times a day

6. I elevate when I ice for about 1 hr a time

7. I do the dishwasher, put washing in , just light housework. I also have a walk around the shops when I can get some to take me as I’m not driving yet,

8 knee extension 20 x twice a day
Sit to stand 20 x twice a day
Step ups 20 twice a day
Cycling 5 min a day
Try heal slides but find them difficult
I also go to rehab sessions twice a week for 2 hours which is a mix of physio and hydro therapy

At this stage my knee is still very stiff and I find exercises bending my knee quite difficult

 

[Josephine]

7 weeks out

1. Pain level 4

okay

3 huge

Huge swelling adds about 7-9 points on your pain score so your pain levels are actually a lot higher than 4.

2. Tapentadol 100mg in morning, 150mg at night
Lyrica 75mg morning and night.
Panadol as needed

Your medications are inadequate. You need to add in 1,000mg Panadol (paracetamol) 4 times a day at 6hrly intervals.

4 flexion 80/90 depending on my knee on the day . Not sure of extension, I have no problem with straightening, my therapists been mainly concentrating on my bend

That's probably why you have so much pain and swelling

5 I try to ice about 4 times a day.
I elevate when I ice for about 1 hr a time

Ice and elevate for at least 40-60mins and more than 4 times a day.

7. I do the dishwasher, put washing in , just light housework. I also have a walk around the shops when I can get some to take me as I’m not driving yet,

Did you read the articles left for you in the second post of this thread? Amongst them was one entitled and it contains this advice. Pay special attention to the first paragraph ...

Weeks 6 and onward - add to all the previous
Start taking car trips to the shops but keep them short and sweet at the start, no longer than 15-20 minutes
Take at least one 5 minute rest while you are out

Activity: a very little ironing, washing, meal prep but get someone else to clear up after. Wash up but someone else clears the table, brings you the dirty dishes, dries and puts them away after, NOT you!!

Cycling 5 min a day - okay but have NO resistance on the cycle
heel slides but find them difficult - I'm not surprised if you have 'huge' swelling, so stop doing them. It will only make your swelling worse
knee extension 20 x twice a day - and how do you do these? Please give me a description
sit to stand 20 x twice a day - again, these are causing your swelling and pain, stop them
step ups 20 twice a day - same here
I also go to rehab sessions twice a week for 2 hours which is a mix of physio and hydro therapy - I suggest you stop these, they are only making your knee worse

Summary:
1. change your pain medications as suggested
2. increase your icing and elevating
3. do less as recommended - item 7
4. quit all your exercise/PT sessions. If you are concerned about refusing to do therapy, you need to read this Saying no to therapy - am I allowed to?

 

[labmum]

Josephine, thank you so much for your advice, I will certainly do as you suggest. The knee extensions are sitting on a chair and lifting and straightening my leg. I see my surgeon this week so I’ll be interested to see what he has to say. I am starting to realise that recovery is a longer process than I had expected and I’m
actually coming to terms with that!!, ....finally!!

 

[Roy Gardiner]

I find exercises bending my knee quite difficult

As Josephine has said, you don't need strength building exercises yet. You have damage needing healing, not unfitness needing training.

All you need is to help retain mobility (not fitness or strength) until healing is complete. This is done with gentle stretching exercises, without pain.