Revision TKR 16 Months Post TKR

[dotski]

So I have been reading a lot of the posts on here to maintain my sanity and hopefulness. After the Dry Needling I have made it to 103 flexion and 4 extension. I am still taking muscle relaxers which really help the quad from guarding. I have defined made some small gains. I purchased an Ortho Pedal for my bike which allows me to reduce the ROM required to pedal. With that and raising the seat I have been able to ride for about 30 min or 6 miles. When I am done with a ride my knee feels like the old days. No pain and I can walk 100% normal for about 15 minutes after. Then the quad on the inside of my knee tightens back up and the swelling returns. Dr. Said a month out of MUA isn’t unusual due to the stretching of the quad and pain of the procedure. Ice and elevate for the rest of the evening and next day. If I could just get the inner quad to stay loose I would feel so much better. Not so much pain but a constant aching. I am at week 14. Trying to remember slow is better. This forum is amazing. Just struggling today after working in the yard with a lot of walking/limping. Trying to stay down today. I am so mentally worn out from this. I know, I know patience right. Uggg

This sounds like a dramatic improvement in a short period of time! I wonder if the muscle rebound tightness is just a normal training response (delayed onset muscle soreness)? Hopefully it will eventually learn to relax. I have found muscles to have such a mind of their own, stay stubbornly tight in a viscious cycle. Pre-op, persistence always paid off. Pre-op, heat was my best friend for tissue tightness, and icing made the muscles worse. Currently I wish I could put heat on my knee to loosen it up, but know it will increase the inflammation. So my icing is always accompanied by a heating pad for the muscles.

I can’t wait to be able to have a good tub soak! Hot/cold contrast baths or showers always loosened me up pre-op (cold to encourage contraction of vessels for fluid return, reduce inflammation, then heat up loosen off the muscles again). Have you tried that or is there still too much inflammation? Everyone’s metabolism and response to heat/cold is different.

I’m also grateful to you and others for sharing their dry needling experience. I’ve had it done before and found it got muscles unstuck from the connective tissue, but gosh it hurt at the time! My PT does it so I’m looking forward to trying it soon. My OS said it was ok to try (at my 2 week checkup) as long as the needles stayed well away from the joint.

 

[benne68]

I am at week 14.

While it is 14 weeks since your TKR, keep in mind that having the MUA "resets the clock" and you should really be thinking of yourself as 4 weeks post-op!

I know it's hard to patient, but this really is a "tortoise recovery": slow and steady wins the race.

 

[Layla]

We're glad you're here! It's all going to be okay...just give it time.
@JamesW57

 

[JamesW57]

Thank you for the reminder and encouragement.

 

[Layla]

Hi James,
How are you doing one month post MUA? I hope well.
We'd love to hear from you as time allows.
Best Wishes as you continue healing.
@JamesW57

 

[JamesW57]

Hello Layla,

Sorry for the delayed response. MUA went well, they were able to break up the scar tissue which has feed up flexion a lot. At MUA I was at 80 degree flexion with the PT applying pressure. I am now almost 2 months out from MUA and as of 2 weeks ago my flexion is at 100 degrees with pressure from my other foot. I have had Dry Needling twice which has helped a lot. My issues now are a lot of swelling and my inner quad is still trying to fully engage. Still a lot of pain when standing or walking for more than 20 minutes. Mainly caused by the swelling which forces me to struggle with flexion. I am trying my best to be patient and just let it heel without overworking it. Dr says this swelling could last quite a while. Frustrating as I am very limited in what I can tolerate. Guess I will continue to stretch lightly, ice and elevate. Thanks for reaching out.

James

 

[SkiGram]

@JamesW57 Glad to read your flexion is increasing. I would keep up with dry needling, it will continue to help your ROM. I'm still working on flexion and straightening. My PT recommended to continue to ice and elevate. I do find that using a heating pad prior to my workouts helps to relax my muscles. Good luck, it's a long slow recovefry, but you got this!

 

[JamesW57]

Thanks SkiGram. I absolutely enjoy stretching in the hot tub it makes it a lot less painful. I will give the heat pad a shot before my next workout. Really glad to hear you are progressing. My PT is taking final measurements on Monday and is setting me out on my own. He did leave the door open should I need to return. Thank you for the reply and yes I tell myself every day to accept a slow recovery. Some days are better than others. Take care and stay in touch.

 

[Layla]

Thanks for your response, James. No apologies necessary.
With patience and more time, I'm sure you'll be back to all that you love.
Best Wishes for continued healing!
@JamesW57

 

[JamesW57]

Hi all,

This forum has been irreplaceable for me! Thank you so much!!

Sorry for the long message up front.

Hope this message finds everyone making some positive progress no matter how small. Without repeating my whole journey i will say the 2 months you have been through is tough. My TKR was July 18, 2023 and MUA on Sept 26, 2023. It’s now Dec 3, 2023. My last PT session was Nov 20, 2023. I was at 4 extension and with PT overpressure 105 extension. So here it in a couple of weeks I will be 5 months out but using MUA date 3 months.

My last Dr appointment was Nov 14, 2023. My knee is still warm, swollen and internally inflamed. He said, like BoneSmart, that this could last a year or more. Very discouraging!!

So finally to my statement and question.

Statement: BoneSmart, for me, is absolutely correct that I have been over doing the stretching and exercises. I hurt my low back and had no choice but to stop. After being down for a week my knee definitely feels better. First 15 minutes in the morning for me is great. Then the swelling returns with just normal around the house walking. So, I am not gaining strength which then causes problems with walking and normal daily activities.

Question: Since it doesn’t seem to matter how light of activity I do should I go ahead and peddle my indoor bike trainer for a few minutes a day? I don’t want to continue setting myself back.

Lastly emotions are all over the place as I am finally trying to stop the muscle relaxer, used to relieve quad guarding, and tramadol to make it less painful when the knee gets fired up and swollen (which is every day all day). Ultimately, this is so much more difficult than I could have imagined. Like a few of you my Dr left me with, we don’t know why this happens to some and not others but I will see you next July. PT advised keeping pushing it and eventually it will, hopefully, stop swelling soon.

Sorry for the whining but know that I appreciate any thoughts.

 

[Layla]

Hello James,
No apologies necessary as this is a journal of your recovery to reflect back upon whenever you're in the mood, or feel the need. We understand the emotional aspects of recovery, you're not alone in that. Continue to remind yourself this is only temporary and know that we're here whenever you need to vent.

As you mentioned, the MUA did set you back, so there is still time for healing to occur and to enjoy progress in other areas. Feel free to continue icing and elevating for the pain and swelling. Possibly it's not time to give up the meds yet, if you're not feeling ready. As for activity other than the Activities of Daily Living, I wouldn't push it. Let your comfort level be your guide at this point.

I hope you have a good week!
@JamesW57

 

[Layla]

Following is an article from the BoneSmart Library that you may not have read -
Post Op Blues

 

[JamesW57]

Thank you for you advice, suggestions and support. Very much appreciated. I will read the article in hopes of validation and/or advice with coping.

 

[sistersinhim]

PT advised keeping pushing it and eventually it will, hopefully, stop swelling soon.

Your poor knee hasn't had a chance to really heal yet. When you had your MUA, it set your recovery back to that date because it caused lots of inflammation in those soft tissues that were trying to heal from your TKR. That means that you count your new recovery date from September 26, 2023, not July 18, 2023. Your swelling after exercises is telling you that your knee isn't ready for what you are doing. Your PT telling you to keep pushing it will keep it swelling not reduce your swelling.

What you need to do is to back off your exercises and just do a few of them and let your daily activities be your rehab. You should see your swelling reduce and then your knee can heal.

 

[JamesW57]

Thank you for taking the time to reply with your thoughts and support. It means a lot.

 

[dotski]

Hi @JamesW57 I’m sorry you have had a difficult recovery. I have similar questions about how hard to push as it is horrible seeing muscles waste away and be in such pain.

I’ve always found that for me the best way to treat pain that comes from inflammation (swelling) is to treat the inflammation first. Which comes in many forms through what we eat, supplements that your pharnacist/Dr consider safe, anti-inflammatory medication (Celebrex has been a godsend for me), and the best natural anti-inflammatory - ice and cryotherapy. Constricting the vessels with cold can slow the influx of chemicals that inflame the knee. Some articles and research I’ve seen conclude that ice delays healing….but this is generally for isolated injuries and not the healing from surgery. For a TKR, I feel that we are continually re-injuring tissues at a micro level - not necessarily a bad thing - a good thing when done in a controlled manner with enough time for tissues to adapt and recover. Preventing an OVER-reaction of inflammation is where, IME, the ice is beneficial.

Compression knee sleeve has been a huge part of controlling my swelling also. Combined with compression sock so fluid isn’t trapped below the knee.

I’m about to try aquatic therapy - as I struggle to find strength exercises that don’t inflame my knee - hoping the water will help counteract pain and swelling but will take it easy first few times and see how body reacts.

My PT says that an increase in pain and swelling after adding load/exercise is normal …but what isn’t normal is if you don’t return to baseline (usual swelling and pain) within 24-48 hours. This makes it nearly impossible to determine cause and effect! So I’ve been waiting 24-48 hours to properly assess my body’s reaction. My OS says the same thing.

 

[JamesW57]

Thank you for the thoughts dotski. I will ask my Dr about Celebrex. It’s an anti inflammatory right? The majority of my pain I think is from the inflammation and internal swelling. I still do consistent light stretching but anything beyond that equals days of swelling and pain. I will say, time is definitely our friend. My knee very slowly feeling more normal during the few good moments. Keeping moving forward I say. Thanks again

 

[Layla]

Hello James,
As you know, what works for one, may mot work for another. It's best to consult with your OS, or a member of his care team with any questions you have in regard to OTC or prescribed meds. Please allow them be your educators. After all, your Primary Care Physician and Orthopedic Surgeon have your medical history at hand and are the experts on what may or may not benefit you.

I hope your mood is improving and things are looking up. It can be a slow process, but hold your brighter future as your focus. You will get there.
Have a nice weekend, James!
@JamesW57

 

[Jamie]

Celebrex is an NSAID, but it is a different class than other NSAIDs such as Advil, Aleve, or ibuprofen. For many people it is easier on the stomach. It must be obtained with a prescription from your doctor. Talk with your GP to see if it’s appropriate for you.

 

[Layla]

Hi James,
Wondering how you're doing these days? It's been three months today since your MUA and I hope you're feeling confident in your progress.
Best Wishes for all things good in the New Year!

@JamesW57