TKR Mika’s Journey - 14 days in^

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Mika13

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Howdy y’all!

I’ve followed the forum for about a year or two as I prepared for my own TKR. It’s been extremely helpful to me, and I thank all of those who have shared their stories!

I had my right TKR done three weeks ago today, on 5/6/19. I’m still in my forties, but a lifetime of soccer, skating, and hiking shredded my knees at an unusually young age. I’ve had bilateral knee pain since I was 30 years old. My left knee will follow as soon as I am ready.

Surgery went well, no complications except for an allergic reaction to the latex bandage, and I was home 24 hours later. I had one week of home therapy, and began outpatient PT last week. My ROM has been good from the beginning; 96 flexion and just under 5 on extension. I’ve been using a Breg Polar Care unit for about 18-20 hours a day. My wound is healing quite nicely. I’ve discontinued my walker and have been using a cane or even just hobbling without. I stopped using Oxy about eight days ago except for for three single tabs taken on different days for breakthrough pain; I’m using Tramadol and Tylenol only. I really felt I was ahead of the game!

My luck has changed though this past week though, coincidentally as soon as I began outpatient PT. I had two sessions this week, both pretty gentle, but now the past three days I’ve had terrible swelling, that band-like tightness, pain in my lower quad, and an overall “malaise”, just having difficulty maintaining my temperature and overall feeling exhausted and a little dizzy. My ROM has decreased in both measures. Lots of difficulty sleeping and still totally unable to sleep on my side. I’m not sure if this latest bout of discomfort is from PT, or if I’m just experiencing the three-week “downer” that I’ve read about.

Any advice or words of wisdom from fellow forum folk will be greatly appreciated!

Cheers,

Mika
 
Hi and Welcome!

I read a lot on Bonesmart, too, before I finally joined.

What did you do at PT and did they bend your knee for you? Since your set back happened about the same time as going to PT, it’s worth evaluating their approach to rehab. We are all different and thankfully there are different approaches to rehab, so you decide which one is right for you.

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.

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
5. At week 4 and after you should follow this
6. Access to these pages on the website

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.
 
Thank you for your reply!

In part due to what I’ve read here, I let my PT know right away that I wanted a gentle approach, which she agreed with. My two sessions thus far have been real simple stretches, using both an exercise peanut and a leg grabber, simple squats on the total gym board, leg lifts, etc. Really basic movements.

Most of the discomfort I feel right now is specifically in the medial area. Is this common for most folks?
 
simple squats on the total gym board, leg lifts, etc.
These could be the culprit. They are more for strengthening than for mobility, and it’s way too early to do strengthening things.

I’m going to ask @Josephine to advise you.

Right now you still need Time:

Time to recover.
Time for pain and swelling to settle.
Time to heal.
 
@Mika13
I am just over 12 weeks post op and only began strengthening exercises with my PT last week.
As Jockette has already said it seems a bit early to be doing these but then I am no expert. It will be interesting to see what Josephine has to say.
 
Thank you both for your replies. I’m really blessed to have found this great community.

It’s possible that I’ve been overdoing it myself with walking, just around the house, but perhaps just too much each day. It’s also possible that I’ve simply entered into a new phase of healing. I’m noticing more distinct bone pain over this past week. And wow - that’s the worst in my opinion. Ice does not help my bone pain - it actually makes it ache more.

I’m probably doing about as well as can be expected at this point, and perhaps I just need more rest and less PT at this point.

Again I appreciate y’all allowing me to think out loud. :)
 
I’m probably doing about as well as can be expected at this point, and perhaps I just need more rest and less PT at this point.
More rest and less PT is a good place to start.
 
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?
 
Sure Josephine, absolutely. :)
 
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?
ai63.tinypic.com_eta39s.jpg


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.
 
1. Today has been a solid 5, the highest it’s been in 10 days.

2. 50 mg Tramadol & 650 mg Tylenol every 6 hours, 81 mg aspirin 2x daily, 200 mg Celecoxib 1x daily, and 5 mg Oxycodone PRN.

3. Swelling is moderate.

4. ROM: 96 flexion and 2 extension are best numbers so far, in PT last Fri they were 85 and 8.

5. Using a Breg Polar Ice machine approx 18 hours a day.

6. Leg is up on a pillow on the sofa or bed, or way up in my Milliard leg elevator for about 20-22 hours a day.

7. My activity level has been very very low since surgery. I’ve been mostly laying or sitting on the sofa. I walk around the house and out to back porch to let dog out. I’ve left house for 3 dr appts and one dinner at a family member’s house only. Only chores I’ve done is folding laundry.

8. exercise has consisted of ankle pumps ( 3-4 sessions of 10 each per day) leg lifts (sporadic, about 20 per day) leg stretches using leg grabber (1 set of 10/day) . I’ve had two PT sessions, which consisted of 10 ankle pumps, 10 leg stretches with elastic band and 10 with a big exercise peanut, 10 gentle lifts on the total exercise board, and wall stretches (for 1-2 min).

I hope that is detailed enough. I sure appreciate your assistance!
 
8. exercise has consisted of ankle pumps ( 3-4 sessions of 10 each per day) leg lifts (sporadic, about 20 per day) leg stretches using leg grabber (1 set of 10/day) . I’ve had two PT sessions, which consisted of 10 ankle pumps, 10 leg stretches with elastic band and 10 with a big exercise peanut, 10 gentle lifts on the total exercise board, and wall stretches (for 1-2 min).
Thank you. But I guess you missed that I asked for these to be in a list and not an essay!
Can you change it for me please?

way up in my Milliard leg elevator
Is this what you mean?

milliard leg elevator.JPG


That's a very bad position to have your knee in. Look in here and see what's good and what's not!
Elevation: the do's and dont's
 
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I think you will continue to have aches and pains in different places for several months as you add different activities to the mix. While the first two weeks are the worst in terms of pain, energy, beginning to walk, etc. this recovery really is a slog. While my second knee had a pretty uneventful recovery, I still get swelling and achiness in my shin area if I overdo it and an occasional pain here and there (just over 6 months from surgery). For me, the difficulty sleeping lasted about 2 months. Hang in there. It sounds as though you are doing well for where you are in recovery.
 
Hi there,
In an earlier post, you stated that most of your pain was in the medial area. So is mine. Almost ALL OF IT. Terrible, sharp pain. I don't know if this is "normal" either, but just wanted you to know, I am experiencing the same thing. I think we are approx 1 week apart from our TKRs
 
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