TKR Ugh! Another long night ahead

coolbeadgirl

new member
Joined
Nov 30, 2022
Messages
2
Age
67
Country
United States United States
Gender
Female
Good Evening!
I am in week 7 of my LTKR date of surgery was October 6th 2022, and I had my RTKR on April 6th 2022.
I have been reading quite a few threads in this forum, and it’s reassuring that the things I am experiencing many others are as well.
I found it interesting that many people had overnight stays after the procedure, not me, it was bing bang boom out the door in 6 hours! I walked to the bathroom with a walker soon after I came out of anesthesia.
I was doing pretty good, seemingly a little ahead of the game as far as ROM was concerned, I was already riding the bike at 3 weeks, so I was pleased. Then…I was downstairs and had to use the bathroom, which doesn’t have the high seat (my lifesaver honestly), so when I got up, I twerked my knee to high heaven. The same afternoon I had PT, and even though I told him I really hurt my knee, I got a workout, to the point of tears.:sad:
Now 3 weeks later with a good break for Thanksgiving, I’m still feeling tightness and my knee is very stiff. I’m only taking Tylenol the maximum dose, as my Dr. stopped the pain meds at 6 weeks. Nights are horrible, the constant ache/throbbing can become unbearable.
I know with time it will be better, I’ll continue to ice elevate and rest, but it it is frustrating and exhausting.
Thanks for reading this long vent!
 
Hi and Welcome!

I‘m sorry you hurt yourself after doing fairly well for the first weeks. This is not unusual. This recovery takes an average of a full year, so it’s really easy to have a setback, any time actually, in that first year. I had quite a set back, at 4 months, due to a low toilet seat.

Then, to add insult to injury, your PT did more than your healing knee was ready for. This is something you really have to watch. PTs are not created equally, and many believe in a ”no pain, no gain” rehab approach.

Instead, Bonesmart believes “no pain equals more gain!

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

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.
 
Nights are horrible, the constant ache/throbbing can become unbearable.
Part of this much pain at night is an indication of inappropriate pain control, and, doing too much during the day. It seems we get through the day ok, (maybe) but the pain of overdoing during the day catches up with us at night.

Ice is also a natural pain reliever, so try using ice, or a similar cold source, and at the same time elevating your legs overnight, and see if that helps. There are helpful articles about these two recommendations in the Recovery Guidelines.

What activities are you doing, and what exercises are you doing? You might consider cutting back on these things. Your knee has been surgically wounded and really only needs gentle treatment, and time to heal.

Regaining our ROM does not require forceful bending or painful exercises.
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.
 
Similar to you, I had a really easy initial recovery on my 2nd knee replacement ( although I did have a 2 night stay - compulsory in Portugal) however in the 4th week, I must have done an incorrect movement at home, then followed by a brutal PT session, this all set my recovery back the full 4 weeks, my right knee then took a long time to recover.
Look after your knee, give it plenty of rest, make ice :ice: your new best friend, I'm now 1 year post surgery and if I've had a busy day I will still ice it. Don't let PT fool you, the tissues/muscles & nerves surrounding your knee need time to heal - Time & Patience is the essence with the knee replacements recoveries.
 
Part of this much pain at night is an indication of inappropriate pain control,
Since I’ve been cutoff prescribed pain medication two weeks ago, I’m on a regular schedule of tylenol, maximum strength, max dose, lots of ice always and leg is elevated especially at night. So what would be appropriate pain management at this point?

activity during the day is really minimal, doing some cooking/baking but with many breaks. I go downstairs no more than twice a day, sometimes not at all. Otherwise I spend my days playing my baritone ukulele, knee elevated, with ice pack. (Anxiously waiting to get back to the studio, I go downstairs and wistfully look at my unfinished projects waiting for me)

from my perspective as far as the PT pushing for that ROM, that seems to driven by what the Dr. expects it to be in his “defined” time frame goal.
I know it will get better, it’s just so very frustrating!
 
Hello @coolbeadgirl
Welcome to BoneSmart. Thanks for joining us!
I am sorry yore still struggling with pain. Even though no two recoveries are alike, even with the same person, I am wondering if this recovery is resembling your first as far as pain goes? When you think about it, your body has been through it's share of controlled trauma over the past six months through these two major surgeries. One recovery has led into the next. I am sorry you were cut off meds. You mentioned you are on a regular schedule of Tylenol, max strength, max dose. If you don't mind me asking, are you taking the Extra Strength Tylenol 1,000 mg 4 times a day at 6 hour intervals? Just checking because most meds only remain fully effective in the system for 4-5 hours, no matter what the dose. So IF you are currently taking it every 8 hours, you go at least 4 hours with no medication in your system at all. That gives the pain time to build up so the next dose takes longer to get effective. Also, it's advised to stay within the safe range of no more than 4000 mg in any 24 hr period. You must also calculate anything else containing Acetominiphin into the 4000 mg so you're not exceeding that amount.

Icing - ice
Icing for up to twenty minutes only (while elevateing) is what most of us have heard or been advised to do following an injury. Following joint replacement, ice is a critical part of pain management and should be used not only on the joint, but any surrounding areas of discomfort for as often and as long as you're comfortable doing so, always placing fabric between your skin and the ice source. Icing helps bring relief from the soft tissue trauma and internal swelling. Icing is a great natural pain reliever and best of all, it's free. While some care providers do put a maximum time on icing, others suggest you ice as often as you see fit. Icing after therapy, exercises, or prolonged activity that challenge ROM and endurance should help ease any discomfort, or preventively keep pain at bay. You may find relief through icing for weeks to months post op.


from my perspective as far as the PT pushing for that ROM, that seems to driven by what the Dr. expects it to be in his “defined” time frame goal.
The fact that you told the PT about the pain you were dealing with and he persisted to the point of tears is disturbing. I would be firm about refusing to engage in movement that causes discomfort or pain, not allowing anyone to forcefully manipulate your leg. While your range of motion is currently limited, it will naturally increase as the swelling subsides and the pain eases, just give it time.

I hope your pain begins to ease so you're able to comfortably enjoy the holidays and get the restorative rest your body needs as you recover from your surgeries. Wishing you all the best!
 
from my perspective as far as the PT pushing for that ROM, that seems to driven by what the Dr. expects it to be in his “defined” time frame goal.
This perspective is a “one size fits all” rehab protocol which doesn’t work, because we are individuals, we are not one size. It is also very old school. Pushing you to the point of tears increases the inflammation, pain and swelling, which slows your healing. I literally learned this the hard way, too.

It‘s your knee, not theirs, and you can choose how you rehab. You don't have to allow them to push you to pain.
Saying no to therapy - am I allowed to?

 
Hi coolbeadgirl, I’m sorry you’re in pain. It sounds like your knee is pretty upset and I know that is discouraging. With the amount of pain you’re in, I think it’s worth getting in touch with your surgeon’s office and requesting more pain medication. Don’t be afraid to be a little assertive and advocate for yourself. You are not a drug abuser, you are a surgical patient who is dealing with elevated pain and it is reasonable at this point in your recovery to get medication that will help control that so you can rest and heal.

I also wholeheartedly agree with the advice everyone has given above. Go ahead and ice for 45 minutes, an hour, even longer if it feels good. You are not going to harm anything as long as you have a layer to protect your skin. And maybe take a little time off from pt until things settle down a bit. I’m actually a fan of GOOD pt (not the kind that hurts). But my knee is sensitive and has benefited from some breaks from pt. Yours might as well. Best of luck to you…you can do this!
 
:hi: @coolbeadgirl
Stopping by to wish you a Happy Two Month Anniversary with hopes you're having a good day so far and the pain you mentioned a few days ago is easing.
Best Wishes for a good week!
 
I find it annoying that the amount of pain meds prescribe is at such a minimum. I too encountered this with my meds (Hydrocodone) every 8 hours which is absolutely ridiculous. I understand the worry of addiction but after a major procedure as a TKR to restrict pain control on a patient that has never had a drug issue is cruel in my book. Every case is different but I had to call and plead for more meds. Tramadol was the next meds given to me but in a very small amount to take 1 at night for an aid in sleeping. At 70 years old I find it rather far fetched I would become a druggie.
 

BoneSmart #1 Best Blog

Staff online

  • EalingGran
    Staff member since January 23, 2024
  • Jaycey
    ADMINISTRATOR Staff member since February 2011

Members online

Forum statistics

Threads
65,181
Messages
1,597,066
BoneSmarties
39,365
Latest member
Dave4562
Recent bookmarks
0

Latest posts

Back
Top Bottom