TKR 16 Weeks +, not sure what to think?

[VancouverUSAgal]

We certainly don't want OS to scare people away from having knee replacements but I do think maybe they should go over the possible problems that can be encountered in recovery which it seems some of them don't do very well. I had been on this site 6 mos. prior to my surgery and was very careful not to overdo the PT but still developed this ongoing pain, so don't blame yourself for not being prepared. There is only so much we can do and then a lot is up to our bodies and how they react. Now we just have to go forward and do the best we can and try to stay positive. I'm hoping we will all be better soon!

 

[oneilllm]

TY @kneeper and @VancouverUSAgal. I am so grateful for the encouragement and everything I am learning!


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[oneilllm]

TY @kneeper. Spent the weekend RICE-️ing, and trying one Celebrex a day. Felt better than I ended the week before. Still tight feeling most of the time, particularly in the back behind the knee, and still overall, with a few areas of tenderness if pressed. Keeping up the rest and icing....


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[Josephine]

@oneillm so sorry I've left you all this time. Been on a short vacation!

1. what are your pain levels right now? At rest right now, and straight - 1 sl sore/throbbing, bent 2 sore. On standing after rest, 3; walking 3, after several minutes 5.
I failed to mention occ pain in the pes anserine area, several times a day burning to sharp at 4, and the sense when walking if the giant band around my knee, 1-2 , unless more swollen, then 3-4. Tightness, stiffness, etc, I notice a few areas of tenderness to the touch, about a 3/10 that seem more joint than muscular..

hmmm ... okay - more on that later ...

I have not taken pain meds since 3 wks after surgery, and even then 1 took them only at night. I have Norco 10's which dropped my BP, so I took 5's occasionally @ night. I do have Tramadol but have never taken one. I took Celebrex 200 mg 2x/day for about 2 months but it inflamghed my GERD/heartburn so I stopped.

Why did you never take Tramadol? It's a great pain med, specially when taken with Tylenol. Fact is you need pain management after a TKR. It simply cannot be dome without. Pain breeds pain as well you know. Though at 20 weeks post-op, it's probably a bit of a moot point by now. However, did you read the article on pain management?

icing your knee and for how long? 1x per day, 20-30 min

That's nowhere near enough. You should ice at least an hour 4-6 times a day. It keeps the tissues cool as hot tissues are painful and tissues in pain become hot. Another nice little vicious circle!

I elevate when I ice. At work, when sitting, I place it on a stool on a blanket so it is about 90°. I do this every 2 hrs-ish.

That's not elevating. Read this Pain and swelling control: elevation is the key to see how to elevate properly. And elevate and ice - so an hour or more at a time 4-6 times a day.

flexion is 130°, extension to 3-4°

Well that's not bad.

I am moderately active. While I am not working a clinical nursing position, I am working 8hr days, and our hospital campus is spread our so I walk 10-15 minutes every couple of hours. I cook a meal every other day or so, and grocery shop once a week or so. I have travelled for business once already for 3½ days which involved luggage transfers and lots of walking. I also have added walking when at home.

Well you know what? That's more than enough activity all on it's own!

I have just in the last several weeks reduced PT to 1x per week, until I reached 12wks it was 3x per week. Recumbent bike and tried to do 15-20 min every other day.
I tried to walk a mile or so every other day, but lately have let my work walking substitute.
Chair squats x10 reps, 2-3 sets/day, but have put those on hold as well.
I have stairs in my home and do stairs up and down at least 4-5 times/day.
I do hamstring and calf stretches at least 5x per day.
I have bands of every strength to do knee bending and straightening with the band looped around my knee and a table, but have put these on hold these last 2-3 weeks.

I'm very pleased to hear it. Those exercises are mostly unnecessary and doing 30 resp 3 times a day is insane! Do you realise that this means you were doing something in the order of 800 exercises every day? Little wonder you have IT band and other issues - I'm only surprised that's all you have! That plus no pain meds, practically no icing or elevating. That and work of course!

I also clickety-clack when I walk - like a train.

Mine does too on occasion. In fact I can make it clack on demand when I'm trying to kick the duvet back into place over my legs!

And I'm wondering, when CAN I begin strength training?

Well not until all these issues clear up. Other than that it's a little difficult to say.

 

[oneilllm]

Hi @Josephine, I hope you had a great get-away. I appreciate your taking the time to help me!

I understand now thru the information you all have shared and they my reading here that I overused, underRICEed and under medicated. It's so interesting to me since as a nurse, we are often told what terrible patients we make and I was so determined NOT to be THAT nurse - that I was going to follow directions to. A "T". I conferred with PT, did a prehabilitation workout and ordered the ice packs they recommended. While still in the hospital, both the MD and PT actually de-emphasized icing, saying too much caused stiffness. All my friends and colleagues, previous TKRs said just the opposite, so I did more. I got a huge wedge pillow for good elevating. I left the hospital in poor pain control because he offered one regimen and it made me ill. So right away, the confusion and contradictions began. I did everything PT told me to do, even tho the muscular issues set in from the outset.

Supporting my leg at the ankle and letting the knee "hang" was THE most painful thing for me as I began, before surgery, with a certain measure of contracture due to years of dysfunction in this leg. I was so concerned about not being "straight" I stretched it relentlessly, even trying to elevate the ankle as I slept (you can guess what happened there). I have no doubt all this pulling caused a fair amount of my current issues.

Unfortunately I had not yet found this site, though it seemed like I was steadily improving until, at 12 weeks, I returned to work. I left my floor nursing job at that point, rearranging my life completely, because I knew I was not ready to handle 12+ hrs on my feet, here again thinking I was choosing conservatively. Wow.

So here I am, at a desk job, keeping my leg up to the extent I can for the 8 hrs at wrk. I realize it's not truly elevating as you point out, but am
unsure how to accomplish that at work (and delayed my return to work WAY longer than most it seemed).

My MD after the aspirations and cortisone injection said to return to the activities of day living, including walking, so he is unlikely to support more time off and I need my job.

So I'm trying to ice more at work - I wrap an ice pack around my leg and secure it with an ice wrap while at my desk. Now, as soon as I get home, I ice and properly elevate nearly continuously, and go to bed with a pack. When I wake, I get a fresh pack and ice before starting my day.

I'm trying a Celebrex a day hoping my stomachs can tolerate. I'm taking natural antinflammatories like turmeric 3x a day.

Pain-wise it's tolerable unless I walk a lot - then the stiffness and tightness, especially behind the knee above the crease really becomes intolerable. But, thankfully, I am not in pain at rest for the most part, BTW, I never took the Tramadol because by the time he gave it to me, as you pointed out, I didn't really need it - it was way down the line.

The joint does seem good: last extension was 2-4°, flexion 135°+. That seemed like the "holy grail" when I started this journey. Now I am hoping and praying this pain and stiffness abates and I can enjoy walking and all the other activities I've missed out on all these years - to be better than I was before the surgery!

TY for your all your help. So grateful I found you all here and for all your time!


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[Josephine]

I was going to follow directions to. A "T". I conferred with PT

All good though it depends upon the PT! We came upon an online protocol published by a US hospital about rehab in the first week. It said things like "all patients will have a mobile recliner so can be moved into the community room for PT every day", "there will be NO exceptions except for extreme pain or nausea/vomiting". The regimen being suggested was one I could only describe as a boot camp! I wouldn't not ever submit to or comply with such a regimen!

both the MD and PT actually de-emphasized icing, saying too much caused stiffness. All my friends and colleagues, previous TKRs said just the opposite

Ah the triumph of theory over experience!

So here I am, at a desk job, keeping my leg up to the extent I can for the 8 hrs at wrk. I realize it's not truly elevating as you point out, but am unsure how to accomplish that at work

You can't. The mantra is a trio - ice, elevate and REST. That means whole body rest. If you are sitting at your desk working, your body cannot rest. But we all have to face up to the fact that sometimes these things, while laudable, just aren't doable in real life.

I'm trying a Celebrex a day hoping my stomach can tolerate

So what's wrong with Tylenol? It's my belief this is the most under-rated analgesic going these days. Everybody seems to buy into the seriously misleading adverts put out by the makers of ibuprofen and dicofenac. I'm seriously considering complaining to the Trading Standards (UK) about this outrageous advert.

 

[kneeper]

Hi @oneilllm I know it's hard to elevate at work. Put your leg up as much as you can. I am lucky that I have some office time where I could ice, but elevating was hard. I sometimes could put my leg up on my desk and work on papers that way for a little while. I figured though it wasn't true elevating it at least minimized the effects of gravity a bit.

 

[oneilllm]

@Josephine, yes - the wisdom that comes with experience... I am glad I had some post-TKRs nagging me about icing early on. And I can't practically stay hm at this point, but trying to ice and elevate some at work. I have three days in a row off weekends and rest with nearly constant icing then. @kneeper, at work I wrap an ice pack around my leg with an Ace wrap then put up on my desk... Not perfect, but it gets it cold!

I have nothing against Tylenol at all, taking both Celebrex & Tylenol only because I thought the anti-inflamm effect of the former would benefit?

I haven't felt much different as yet, still very, very tight especially in the back from the bend up and wobbly. Will keep on keeping on - Thanks!




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[Josephine]

Well, the truth of this is that, all advertising hype to the contrary, NSAIDs are actually a very mild pain killer. Gram for gram, about 40% the pain relieving effect of Tylenol. And the anti-inflammatory effect is all right IF your principle problem is just inflammation. But it would appear your principle problem is pain, therefore you need a pain killer more than you need an anti-inflammatory.

 

[oneilllm]

TY @ Josephine. Though the joint is still swollen and warm at times (more often than not, which is why I'm working hard on the icing). Would that signify inflammation? When MD did the aspirations, now about 4 and 5 wks ago, the fluid was slightly bloody. Absent infection, he mentioned inflammation. Easy to get confused! I'm following your guidelines here and doing the Tylenol.


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[Josephine]

Though the joint is still swollen and warm at times (more often than not, which is why I'm working hard on the icing). Would that signify inflammation?

Of course!

When MD did the aspirations, now about 4 and 5 wks ago, the fluid was slightly bloody.

Yes, that's quite usual when things are inflamed.

 

[gr82cu2]

@oneilllm I'm no expert of course but I say if you can tolerate the Celebrex keep taking it. You can take it along with Tylenol with no problems anyway. I was Rx'd Celebrex following my TKR and unfortunately turned allergic to it 5 1/2 weeks later. At that point all progress came to a complete halt. I had been making progress with less swelling and greater flexion but not once I couldn't take Celebrex. I was stuck for around another month and then started to move forwards again, very slowly. NSAID's are not good pain relievers except for the fact that they relieve inflammation which in turn relieves pain. Having arthritis my body just loves to produce inflammatory fluids so I've had quite a lot of experience with them over the years. I'm having my 2nd knee done tomorrow and I'm very nervous about it because unlike last time I can't have Celebrex and won't be able to start back on Aleve until I'm off blood thinners. Tomorrow my 1st knee will be 14 weeks old and like you I'm still experiencing loads of tightness and tenderness but it is very much relieved by icing and elevating. Ice is definitely my best friend. Keep working on icing, elevating and resting as much as possible. I hope it gets better for you soon. I know how frustrating it is. Take care!

 

[oneilllm]

@gr82cu2, thank you and I will be praying for you as you start your second knee journey! When I mentioned that I didn't really know if the Celebrex was helping, folks would say, "just wait til your're not taking it". I certainly realized it once I stopped! And oh yes, is ice my friend!

I am so grateful for the guidance and encouragement here!

Go get 'em @gr82cu2!


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[oneilllm]

Hi all - well, resting more, elevating, icing. Slow gains, still creaky with some pain and swelling. Saw the MD who suggested more cortisone?!? You'll be pleased to know - I said no! Thanks for the continued support!


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[Josephine]

Good for you! I can never understand why doctors want to reach for the syringe instead of advising a reduction in activity.

 

[oneilllm]

Hi all, just checking in, a bit discouraged.... I first wrote you a little over a month ago, and since that have reduced my activity to only the walking I do at work, resting as I can there, icing and elevating consistently at home. I did feel the pain improved some. Last weekend, I had to travel out of town, and spent the day walking quite a bit for the first time In a month. Over the course of the day my knee became quite painful and stiff and since then, has remained that way, in spite of icing. It seems as tho if I overdue at all, I am back at square one, with pain, swelling, and sleepless nights, even now past the six month mark. Will I ever get over this hump?!?


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[Paradise06]

@oneilllm This is my first posting to you, having just read through the entire thread. Others will chime in also, echoing the same words "YES, emphatically you will continue to make progress"! I can empathize with you, having felt the same way many months post-op, and thinking what's wrong with me? I overdid many things in the first few months and like you, learned a lot from this site. In fact, I was 7 months post-op, when I got wiser and focused on the ongoing swelling and heat at the knee, then progressed in gentle exercises. Conclusion: knee improved immensely! Bottom line: listen to your knee, do the right things, and don't get discouraged. It will get better!!

 

[kneeper]

It sounds like the combination of the trip (car? plane?) and the walking aggravated the knee. I think Paradise 06 has some good points. Remember that it can be up to a year to be fully recovered. My knee still gets a bit stiff when I'm on my feet a lot but the "recovery" time is getting faster. You'll probably start finding that too.

 

[oneilllm]

@Paradise06 & @kneeper - thank you for the encouragement. I don't know where I would be without all you "bone smarties"! This entire process has been a huge learning curve. Even tho I am a nurse, I resisted going out and reading anything other than standard recovery material so I didn't feed my imagination with every bad thing that could happen. I have learned so much here, most especially that there is no such thing as an "average" recovery.

I expected stiffness & a rather lengthy process to rebuild strength and tone. What has surprised me is the ongoing pain and discomfort, the stalls and setbacks. For example, one of my PT "projects" in the first few months was working on stairs - not pushing off with my left, but bearing the wt on my new rt knee as I have stairs in my house. I STILL have pain on climbing that causes me to take stairs one at a time to avoid stepping up with my rt. Even the pain that develops after walking more the avg and the discomfort at night.... I expected "stiffness", yes. And after now reading about poorly healing, "loose" joints and metal allergies, I have worried maybe I am one of THEM and if I will ever get my mobility back!

Thank you for hanging in there with me, and for the continued reassurance. I appreciate it more than you know!


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[oneilllm]

Hi Bonesmart friends. It is now 2015, and in a few days, I will reach the 7 month mark since my right TKA. I do want to start this year off strong and positive, but after these many weeks of minimal activity (gentle stretching) and icing and elevating at rest, I can't rely say I improving. I have great flexion - well over 135°, extension to1-2°, less warmth, and less swelling (tho it still is visibly swollen, with fluid in the skin area at times). But, while I have some days better than others (usually after exertion which would be maybe more walking than "usual"), I still have pain, particularly behind the knee, inner left side, and generalized discomfort that can extend above and below the joint, even into the R. Hip even at times at rest, but not always. Going up stairs is still PAINFUL. The surgeon has suggested testing for a metal allergy, tho I have had no allergies of any kind or any reactions to metal in the past, CRP and cell counts are normal. He detects no looseness in the joint. I had cartilage removed in the 70s and started this process with a severe valgus deformity and contractured. I am currently on no meds.

MD is thinking (hoping?) "tightness", likes to wait a year for things to "settle" having ruled out infection. Thoughts? Encouragement? Second opinion time? Any help appreciated!!

Suggestions?


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