PKR 18 months post op

[Hellie19]

6 weeks post hip surgery label tear and 20 weeks post patellofemoral replacement, suddenly my replacement feels sore and like its burning. Any ideas. ???

 

[Celle]

It could be that your knee has been taking an extra load while you are recovering from your hip operation.
You could try extra rest, ice and elevation for a while, to see if that helps.

 

[Hellie19]

Maybe. I'm exercising as much as I can to strengthen the quad as my leg still gives way and I want it to be as strong as possible as I am having another patellofemoral replacement on the other side in the next 6 weeks.

 

[charmed-life]

I can do my stretches and weights and stationary bike and cross trainer, but I wanna cycle outside and walk hills again and get sweaty in an exercise class. I know I shouldn't rant and things could be worse but I just want to get fit and active again. - feeling low.

If you can watch a computer screen (or get internet on your TV), try watching cycling videos while you use exercise bike - not quite like actually being outside but it helps. Some have prompts to change tension or speed too if you are able to.


Sent from my iPhone using BoneSmart Forum

 

[Hellie19]

OK so getting ready for my next patellofemoral replacement with tibial tubercle osteotomy. Think the recovery is gonna be so much harder this time. Anyone else had the tibial tubercle thingy ??

 

[Hellie19]

I had my right patellofemoral knee replacement in Dec 2015 and I've just had the left one done on 15/6/2016 and the pain, the swelling etc is so much worse.. I cant stand with my leg straight. My calf, thigh and knee are so swollen and seconds of standing on it makes it worse. The ice dims the pain but the painkillers don't touch it. I know my surgeon said no two knees are the same but its unbearable has anyone any tips working for them.

 

[LFitz]

I'm so sorry to hear that this second knee is causing you so much pain. I feel your pain, I experienced similar in my first 2 weeks. I wonder if your meds need to be adjusted if they aren't touching the pain. I see you've been a member since your first replacement and I'm sure one of the moderators will be along shortly to offer some advise. Icing and elevating at this stage is all I now but I just wanted you to know your thread is seen and I am sending prayers your way.

 

[Josephine]

the pain, the swelling etc is so much worse

Yes, you cannot compare the two surgeries.

I cant stand with my leg straight. My calf, thigh and knee are so swollen and seconds of standing on it makes it worse.

In order to give you structure advice about this, I'd like to ask you some questions if you don't mind, and 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)

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?

4. What is your ROM - that's flexion (bend) and extension (straightness)

5. are you icing your knee at all?

6. are you elevating your leg, how often and for how long?
And do you elevate your leg totally straight?

7. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and

8. what kind of PT exercises and exercises at home are you doing? How much 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: (enter number) of sessions each day
enter exercise + enter number of reps and sets
enter exercise + enter number of reps and sets
etc., etc.

At PT
enter exercise + enter number of reps and sets
enter exercise + enter number of reps and sets
etc., etc.

 

[Celle]

Hi @Hellie19

I'm sorry your knee is causing you some problems. JOsephine willprobably be able to suggest something, once you have answered her questions.

Meanwhile, here is some reading for you - the BoneSmart recovery reading list.

First are the BoneSmart mantras ....
- rest, elevate, ice and take your pain meds by the clock
- if it hurts, don't do it and don't allow anyone - especially a physiotherapist (PT) - to do it to you. exercise only gently.
- if your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again
- if you won't die if it's not done, don't do it
- never stand when you can sit, never sit when you can lie down, never stay awake when you can go to sleep!
- be active as much as you need to be but not more than is necessary, meaning so much that you end up being in pain, exhausted or desperate to sit down or lie down!

Next is a FAQ (Frequently Asked Questions) thread.

And here are some very crucial articles
The importance of managing pain after a TKR and the pain chart
Swollen and stiff knee: what causes it?
Energy drain for TKRs

Myth busting: no pain, no gain
Activity progression for TKRs
Heel slides and how to do them

Extension: how to estimate it and ways to improve it
Elevation is the key
Ice to control pain and swelling

Healing: how long does it take?
Chart representation of TKR recovery
Myth busting: the "window of opportunity" in TKR

Myth busting: on getting addicted to pain meds
Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

 

[Suz]

Hi Hellie~ Sorry you're having such a tough time. There are wonderful members here who are very knowledgable of what you're going through. As well as endless articles and postings that will help you find your way in the coming weeks & months of your recovery.

I'm hoping Josephine will see something in your current status that will help you feel much better!

 

[Celle]

Once you've answered Josephine's questions, she will be able to advise you more fully.

 

[Hellie19]

Josephine
In answer to your questions:
1) Right now I would say my pain is at No7, rarely does it go below 5.

2) The meds I was sent home from hospital with were 30mg Codeine and 500mg Paracetemol.

3) The swelling is between moderate and huge but closer to huge.

4) I do not know what my ROM is as it's not been measured.

5) I am icing my knee a minimum of 20 minutes every 2 hours, as the hospital suggested.

6) I elevate my leg for the biggest part of the day, as this is the most comfortable position. Obviously it is down for toilet visits, mealtimes at the table and the walks I do around the house, roughly once every hour for a few minutes.

7) Currently only doing very limited such as making cups of tea etc.

8) I have not started physio yet, my first appointment is monday which will be 12 days post op)

I am however doing heel slides four times a day 10 slides each time.
I am also trying straight leg raises three times a day.

Looking forward to hearing from you.

 

[Josephine]

1) Right now I would say my pain is at 7, rarely does it go below 5.

Ouch!

2) The meds I was sent home from hospital with were 30mg Codeine and 500mg Paracetamol.

Okay but how many tablets are you taking and how often?

3) The swelling is between moderate and huge but closer to huge.

I would imagine!

4) I do not know what my ROM is as it's not been measured.

Okay. Not to worry. I expect if you have that much swelling it's pretty low anyway.

5) I am icing my knee a minimum of 20 minutes every 2 hours, as the hospital suggested.

You accomplish little or nothing in 20 minutes. Ice for at least 40-60mins and more than 4 times a day.

6) I elevate my leg for the biggest part of the day

Good, but I also asked if you were keeping your leg totally straight while elevating it?

7) Currently only doing very limited such as making cups of tea etc.

Good!

8) I have not started physio yet, my first appointment is Monday which will be 12 days post op. I am however doing heel slides four times a day 10 slides each time.
I am also trying straight leg raises three times a day.

I strongly suggest you stop doing these. You're not even one week out and it's far too early to be doing anything like that. You're just making the swelling worse and bad swelling = poor ROM and pain.

I need a couple of extra answers before I can comment further
1. how many tablets are you taking and how often?
2. are you keeping your leg totally straight while elevating it?

When you give me these answers I'll come back and finish my advice.

 

[Hellie19]

Hi Josephine
I also forgot I already yake Gabapentin 300mg X 3 three times a day and 30/500mg cocodamol X 2 four times a day.

My leg is kept straight when elevated and i try to keep my heel higher but because of my Back problems and Hip Problems (for which I had surgery in March) I find this quite uncomfortable so often with the leg elevated I sort of lie on the opposite side to take the pressure off my hip and back.

Its all very uncomfortable.

Helen

 

[Josephine]

I also forgot I already take Gabapentin 300mg X 3 three times a day and 30/500mg cocodamol X 2 four times a day.

Yes, I thought so. Co-codamol isn't very good for a TKR. I suggest you contact your GP and ask if you can try something else as it doesn't seem to be doing the job very well.

If you can suggest to him/her, I'd suggest Tramadol. A much better pain killer, especially when taken in conjunction with paracetamol. This was the routine I used for my knees though for some reason the one I used first didn't work so well second time around!

My leg is kept straight when elevated and I try to keep my heel higher but because of my back problems and hip problems (for which I had surgery in March) I find this quite uncomfortable so often with the leg elevated I sort of lie on the opposite side to take the pressure off my hip and back.

That does sound uncomfortable. But I thought perhaps you were keeping your leg straight because that is a problem when you don't have perfect extension. You need to have your knee slightly bent otherwise you just cause more pain. Look at the images in here and see what's right and what's not!
Pain and swelling control: elevation is the key

 

[kneeper]

My thoughts exactly. It can be very painful to keep your leg *perfectly straight* in the first few weeks.

 

[Hellie19]

Been to see the nurse for a wound check today, she said her 80 year old mother had a TKR, but she had no pain and nor had other people she had seen and that being 47 she couldn't see why I was experiencing pain. I don't really know anyone who ha had a patellofemoral placement to compare.. m physio was imposed with how well I got over the first one and my hip surgery both within last 6 months but now I feel I must be a right wuss where the pains concerned ??

 

[kneeper]

Clearly this nurse has fallen into the comparing knees trap and the "young people heal faster" fiction. Not to mention that your knee is barely a couple of weeks old. Of course you'll have pain. Tune her out.

 

[Suz]

@Hellie19, I bet she hasn't had her either of her knees replaced! She wouldn't make such ignorant statements if she had. I suspect she was telling you 'un-truths' regarding those she say never had any pain. I don't believe that is possible coming out of this surgery. For most anyone I know who has had their knee replaced the first weeks are maddening pain.

You are certainly not a wuss!

 

[Hellie19]

Thank you, I was beginning to think maybe I shouldn't be feeling this way but then I also thought yes I am only 47 and I have had two patellofemoral knee replacement and hip surgery in the last 6 months Plus I have arthritis in my spine. I am very aware of then benefits of exercise and once again I Will aim to be back at the gym starting strengthening exercises at 8 weeks. Just right now has left me wondering. Thanks again for your comments they have helped.