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TKR 12 Week Update and Tight Band Problem

BillinPA

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Please add me to the October Group. My left TKR was Oct. 14. Bill.
 

Roy Gardiner

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:welome:

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!)​

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

Celle

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@BillinPA - I have added you to the October Feisties group, but please write about your own knee in this thread, which is your recovery thread. Thank you. :flwrysmile:
 
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BillinPA

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Thanks for the welcome and advice @Celle and @Roy Gardiner.

Today I celebrate 8 weeks post TKR and I thought I'd share my experience to this point. Overall I thought I would be farther along by now - walking without assistance, or significant discomfort, and at times have been very frustrated and depressed that I'm not there. But thanks to the BS guidelines and member's stories I'm gradually coming to understand that recovery will be longer than three months, and I'm adopting more realistic expectations. I've organized my experience into Good, Bad and Undecided categories.

My surgeon practices a protocol designed to get you out of the surgical center in the least amount of time, eliminate or reduce the use of opioids for pain control, and get you back to normal as quickly as possible. The goals of the protocol are for 80% to go home same day, and 18% overnight, return to work in 2-10 weeks, limit narcotics to 0-7 days, be 90% healed in 12 weeks, and full recovery in 12-24 months.

The Good

1. Got home same day and had a two day honeymoon - It started off great. I went in at 8 am and I walked into my home with a walker at 1:30 pm that afternoon. The pain management protocol called for taking 6 naproxen and 6 extra strength acetaminophen starting the day of surgery plus 5 mg oxycodone as needed for 'breakthrough' pain. Thanks to the long lasting novocaine they injected into my knee I felt absolutely no pain until 6 pm the day after surgery.

2. Minimized the use of oxycodone. The novocaine wore off at midnight on day two and I needed the oxycodone every 4 hours for 3 days. I was happy to stop the oxy after using only 18 of the 28 pills I was prescribed and before I had any adverse affects.

2. No major complications like blood clots, infections.

3. I was able to care for myself early - the day after surgery I was showering, dressing, getting up and down the stairs, toileting. I started driving in week 3.

4. I got good results from my 6 week - twice per week outpatient PT. I started outpatient PT on day 16 (week 3) post op. My ROM on day 1 of PT was 101 deg, on day 2 of PT it was 120 deg. I was walking in the house with a cane for 10-15 minutes. PT consisted of short and log arc quads, straight leg raises, standing hamstring curls, and standing hip abductions with ankle weights starting at 2.5 lbs and increasing to 5 lbs. Other exercises were step ups, terminal knee extensions and the use of the leg press. Since my ROM was good the focus was on building leg strength. I 'graduated' from my 6 week outpatient PT program with a 0 degree extension and 128 degree flexion, with 'good' strength. I'm able to climb stairs normally, leg over leg, although I'm not able to come down yet leg over leg.

The Bad

1. Sleep disruption - In eight weeks I have not slept longer than three hours as a stretch. After three hours my knee invariably cries for attention whereby I have to ice it to put it back to sleep for another three hours.

2. Knee stiffness - Starting in week two to three of my PT my knee got notable stiffer, and my walking became uncomfortable making it difficult to maintain a normal gait. My PT and surgeon rule out scar tissue of fibrosis and tell me its due to swelling which will just take time to heal. They remind me that it may take a year to fully recover. So much for the 90% in three months. After spending some time reading the BS guidelines and member's stories, I'm beginning to think my knee stiffness may, at least in part, be due to my PT program being somewhat aggressive.

3. Elevated liver enzymes - In week 6 I had my routine 6 month checkup and found that my liver enzymes were 8 time normal! My internist had me stop the 6 extra strength acetaminophen and halve the dosage of naproxen to get my enzymes down. From a pain perspective I was not quite ready giving up all of the acetaminophen, but I realize you can't live without a liver. Repeat lab work is scheduled in two weeks.

4. Longer than expected recovery time - As I mentioned earlier, at this point I had hoped I'd be farther along - walking normally without discomfort, and not needing pain medication. I also expected the progress to be steady and significant from week to week. I realize this was probably an unrealistic expectation, and I will have to be far more patient going forward to relieve my frustration.

Undecided

PT - I'm still on the fence in deciding how aggressive to be with PT on my own going forward. I admit I've been of the "No pain, no gain" school, but I'm becoming more open minded to this being a myth, and slowing down either the intensity and/or frequency of the PT exercises.

Overall Merit of TKR - I obviously must suspend judgment on this until I'm farther along. In the meantime I have to trust the many who say that by 1 year I will be happy you had the TKR.

Bill
 

Roy Gardiner

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I admit I've been of the "No pain, no gain" school, but I'm becoming more open minded to this being a myth
It is correct if you are training, but not if you are healing. Hurting damaged soft tissue makes it worse, not better. Indeed, even when training the pain you experience is muscles being damaged; it's them being rebuilt during recovery that makes you fitter. And muscles work differently from ligaments and tendons.
 
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flacie1

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@BillinPA I couldn’t agree more with your assessment of these first weeks post op. I’m almost 6 weeks post op and I too thought I’d be much further along. Just goes to show that our knees are in charge of our recovery, and they let us know when we have over done it. I’m worried that I over did it today. Went back to work today, stayed longer than I planned and I’m beat. Sending you lots of healing vibes.
 

Macknit

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I went back to work at 6 weeks part time, then started full time at 8 weeks... I had some swelling and pain but icing and elevating took care of it. I've been doing gentle PT since day 3 post op (that means lymph massage at the first visit only!)

Now I'm paying for a very busy weekend and Thursday/Friday of last week. It is easy to get a set back, no matter what the numbers are early on. I was fairly quick with ROM, but I'm finding the 3rd month, has been part of me feeling so good one day, that I over do my activities and now have to feel like I'm in week 2 again! And I don't have any opioids to help! I just take an anti-inflammatory and X-strength Tylenol.

I kept thinking oh at the 3 month point this will be so much better :nah:not so much!! When you over-do it....it can set you back... for quite some time.

I did a lot of training with the military in my younger years...so no pain, no gain was always part of my life. I keep saying this is just like life's journey many peaks and valleys! And yes..One year for the verdict!
 
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BillinPA

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@flacie1 and @Macknit Thanks for sharing and thanks for the healing vibes, I'll put them to use right away.

In retrospect I wish I had known more about the recovery process than I did, so I could have had more realistic expectations. I talked with friends who had TKR but I did not get a sense of the ordeal it can be. All of them said I would be glad I had it done and by week 12 I'd be back to normal. And two of them had bilateral TKRs the same day. I can't imagine going through that.

Well my next milestone is next week when I have my bloodwork redone. Hopefully my liver enzymes will come down and I will be able to resume at least some Tylenol to get me thru the night. Right now the two Alleve I take do not carry me thru the night. So the drill is sleep 2-3 hours, wake up and get an ice bag out of the bedside cooler, sleep another few hours and repeat.... Good thing I have an understanding and deep sleeping wife.
 

Macknit

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I had been reading BoneSmart prior to the surgery and felt as prepared as I could be, and yet...each of us experiences it so differently I don't know if we can really be prepared for how relentless it seems at times!!
I was seeing the same PT before my knee and she had warned me about the nociceptors in our bones that will be sending pain signals after surgery. The insomnia, setbacks, and severe restless leg syndrome that I developed, I somehow missed in my preparations!! :oyvey:
Hopefully, your blood work returns with a good liver enzyme report and you can return to your Tylenol! Happy Trails!
 
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BillinPA

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Moderator, please change my title to “12 Week Update and Tight Band Problem”

This week I am 12 weeks post op. In the month since I last reported there has been some progress but a continuing problem.

Sleep - I have returned to my bed for sleeping and eliminated the ice packs every couple of hours during the night. The knee still calls for attention every three hours, but a trip to the potty seems to offer enough stimulation to quiet it for another couple of hours.

Liver Enzymes - have returned to normal after discontinuing the 3000 mg/day Tylenol I had been taking. So I now have Tylenol back in my arsenal for pain management on a limited basis.

Stiffness - The big issue which has gotten worse is the feeling of a tight band across my knee which resists bending and causes discomfort to the point that it affects my gait, and my desire to walk. I have only about 20 degrees of flex before I encounter this resistance at which point I stop bending the knee and consequently don’t walk properly. If I try to push beyond this point I get a localized sharp pain in the outside of the knee. Interestingly, if I do heel-to-butt exercises the resistance and discomfort diminish with each rep until after 15 reps I can fully flex the knee to over 120 degrees with minimal discomfort. Unfortunately, within a minute after stopping the exercises, the tightness returns. After considerable research here at BS and elsewhere I’m led to believe that this is a common problem caused by swelling and/or scar tissue which should resolve with time. In the meantime here is what I’m doing on various fronts.

Pain Relief – I continue to take two Alleve a day for pain relief and the continued swelling I have in the knee. I add a Tylenol if I will be doing a lot of walking. I would like to get off all meds as soon as possible.

Ice and Elevation – I’ve increased icing and elevation to three to four times a day.

Exercise – I tried once to ‘Work Through’ the stiffness by increasing the duration on the exercise bike and doing a lot of “heel-to-toe” reps during a day. “Tight band” feeling turned into “Iron Brace” feeling that night and following day. I abandoned that approach. I’ve significantly cut back on the take home PT to about 50% in favor of more “rest, elevation and ice”. Still looking for right balance of exercise vs rest.

Attitude – I’m still working on acceptance that this could be a one year recovery.

I’d be very interested in some specific feedback on what I should or should not be doing to encourage the resolution of the “Tight Band” issue.
 

Jockette

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Attitude – I’m still working on acceptance that this could be a one year recovery.
This is a one year recovery, and even longer for some of us.

Here is an article on the tight bend feeling:


I read this that one of our other advisors wrote:

“Many members think PT is needed to alleviate tightness. Tightness is a normal occurrence after this kind of major surgery. Your surgeon did major carpentry work and disturbed every millimeter of soft tissue in this area. You aren't tight because your muscle is underused and needs to be stretched and rehabbed. You're tight because your tissue is healing...and full healing takes a full year or more.”
 
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BillinPA

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Thanks @Jockette.
A big difficulty in accepting where Im at is the advice and or experience of friends and family who have gone thru this with far less difficulty.
BTKA: "The week after discharge I went out to dinner with a cane."
"By week 8 you will be walking normal without pain"
"I was golfing in week 6"
"You gotta keep bending that knee and working thru the stiffness"

I just hope that eventually I can say that the TKA was worthwile, and I can become a voice of optimism and support to others who travel in the slow healing lane.
 

Jockette

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I know what you mean about those comments from others. Most of us get those comments. I truly think they forget the details. There just aren’t that many miraculous recoveries.

Read other threads here, from members going through recovery, and you will find that others are struggling in these early months and that you are having a normal, average recovery.

I’ll have to find a post by @Celle where she tells about her friend Will. He tells people he went back to work at 2 weeks post op. The reality of that is not what he implies.
 

Jockette

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Here it is:
My friend, Will, boasts that he went back to work 2 weeks after a TKR. He genuinely believes now that he had no problems and no complications - he isn't trying deliberately to deceive anyone.
The truth of it is this:
  • Although he did go back to work so early, he did it in a wheelchair.
  • His wife helped him get up, washed and dressed, and she drove him to and from work.
  • He stopped taking pain medications, saying they were "for Sissies".
  • Consequently, he was in pain and grumpy all day.
  • His colleagues wished he had stayed at home.
  • He rested in bed all the time, except when at work.
  • His wife waited on him, hand and foot.
  • By the time he was really recovered, his wife was a worn-out wreck.
He doesn't tell the full story, because he doesn't remember it.
He genuinely thinks he had a fast, uncomplicated recovery, and that's what he tells people.

His wife exacted her reward for looking after him so well - she got an orange sports car for her next birthday.
 
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Hah. I agree! Yes, comments are comments, and then being honest to yourself and honoring your own experience in this. And for sure memory can be selective. And people have varied support systems. I don't plan on being in the:

'...colleagues wished he had stayed at home...' Crowd.

Once you return to work IMO you need to be fairly self-sufficient or you need to stay home. It's a balance of timing for recovery vs. resuming work.

Aside from fellow TKR folk and friends/ family acquaintances and coworkers bore fast of the stories of surgery and recovery. You have to have good/ safe/ affirming places to vent and talk. And not lean on one source too heavily.
 
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Macknit

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Ha @Jockette ! What a great story...I'm sure it's 100% true and people just forget or intentionally suppress pain or suffering and lock the box they've suppressed it in!

I really believe our brain can suppress any difficulty we face...up to a point, then for some PTSD kicks in....basically the lid of the box leaks.

I know that oversimplifies the issue of how we handle the stress of this surgery, however I do believe many people have to make those comments about how easy this recovery was because they never "sorted it out"in their own heads.

@BillinPA Luckily for us, BoneSmart fills this gap and helps many of us "sort it out" in order to move forward. We can complain, whine, cry, or laugh to express our frustration and it is accepted and we are made to feel normal, which is really the only healthy way to get through this!

Thanks again Jockette for sharing that particular story and BillinPA like life's highway, whichever lane we travel in, we do eventually get there!!

Hang in there and good luck in your recovery.
 

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@BillinPA I am having similar recovery issues. If I sit too long, it worsens to the point where it becomes difficult to stand. I had decreased the number of times I elevate and ice, but I am going to have to bump up those tried and true interventions.
I also have been going to a good massage therapist, and that has really helped me.
 

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