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[TKR] 2 weeks post op pain and stiffness^

pepsicola

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Hi there!

I’m a 44 year old female who is 2 weeks post op TKR with an LCS complete prosthesis.

My ROM is good achieving 95 degree bend however I am experiencing some shooting pains and stiffness especially at night.

I know everyone recovers differently but would be great to hear if this is normal and what others have experienced 2 weeks post op. My knee often feels hot and warm especially at night.

Thanks guys
 

maryo52

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Welcome! You've found a great resource and there are many people like you who check in every day, and volunteer staff to support you by answering questions and offering suggestions.

Yes, the warmth is normal, and will continue for months. That reflects the increased blood flow to the knee, which is part of the body's healing mechanism. The stiffness is due to the swelling and that persists for weeks or months. Your ROM is good and will improve naturally.

Shooting pains at night can be a sign that you pushed your knee too much, and/or didn't ice and elevate enough, and/or need more pain medication.

Normal recovery involves various strange experiences and sensations, so don’t worry! Those symptoms are almost certainly temporary. It is important to let your body heal at its own pace. There is nothing you can do to speed up recovery, not even PT!

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
elevate
ice
take your pain meds by prescription schedule (not when pain starts!)
don't overwork.
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 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.
 
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pepsicola

pepsicola

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Ah thanks for such a speedy response.

Reading your reply I haven’t iced today and have been on my feet and quite active. My physio is very happy with range of movement etc and I cycled on a stationary bike on Friday however I do feel some of the exercises exacerbate my pain.
 

maryo52

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Well you get straight A's on resuming normal function. So why not ease up and support your knee in its healing? At two weeks I was icing 2 hours at a time, three times a day, and had my leg up almost all day. You'll achieve your activity goals quicker if you do less now. Personally, I have enjoyed having little or no pain, sleeping well, and using this recovery time to read, watch TV, write letters. That way every day is a good day.
 
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pepsicola

pepsicola

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Thanks for your reply. Yes I guess your right, I’ve never been good at doing nothing and struggle a little with the rest. I think your advice is good advice tho and will def resume icing again tomorrow and elevation.

Can I ask how long you take pain meds for?


Thanks again
 

sistersinhim

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@pepsicola, welcome to Bonesmart. Please tell us your exact surgery date and tell us which knee it was. Knowing this will help us be able to advise you better.

Many of us never took formal PT or did exercises. I am one of them. I had 11 knee surgeries, 2 of them kneecap removals and 1 tkr. Even after those I never took PT. But, I didn't just sit around and do nothing. I took care of myself, my house and yard as my knee allowed me to do. As I healed, I did more. But, my knee was always in control :ok:. This was enough therapy for me and would be for any tkr patient. All the awful pain of PT is so unnecessary.

All you have to do is use it in your daily living. Your knee knows how to rehab itself and doesn't need anyone telling it how. Just use it and it will come back like new:). You have to be patient, though, it doesn't happen quickly. ADL,(activities of daily living), going to the bathroom, brushing your teeth and bathing, fixing a light meal, getting something to drink and or a snack, those kinds of things will be all the exercise your knee needs. If you just use it daily in your living, you can have a less painful recovery. We know what works, we've been there:yes:.
 
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pepsicola

pepsicola

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My exact surgery date was 21.02.19 and was a TKR on my right knee. Thanks
 

Roy Gardiner

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I cycled on a stationary bike on Friday however I do feel some of the exercises exacerbate my pain.
Yes it does. You are healing, not training. All you need is to help retain mobility (not fitness or strength) until healing is complete. This is done with gentle stretching exercises, without pain.

Using a bike to gain ROM is pretty simple:
  • Set the bike to zero resistance
  • Set the saddle low enough so that a single rotation is a challenge; difficult but not painful. When a rotation becomes easy right from the start, lower the saddle a max of 1cm.
  • Gently turn the pedals, through discomfort but without pain.
  • Continue until the knee is 'warmed up' and the rotation is now easy, or for 2 minutes, whichever is the shorter time.
  • Repeat several/many times a day, but don't go mad. Diminishing returns will apply; my guess is that half a dozen reps would be enough
  • Do not pedal fast or for more than 2 minutes, this is a stretching exercise, not training.
  • And if you get any pain or swelling in the 24 hours after doing this, cut it down until you don't
Here is a bit more chat and some pix and how 'healing' and 'training' are different
 
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pepsicola

pepsicola

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Thanks Roy, I was asked to go on the stationery bike by my physio and did so for 3 minutes. I wouldn’t have gone off and done this myself without his suggestion and supervision.

As the swelling in my knee has reduced considerably I didn’t ice yesterday and dropped down on the medication. Maybe this is also a contributing factor for my pain. Thanks for your comments and info, much appreciated.
 

Roy Gardiner

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I suggest you take your medication according to your prescription, rather than cutting down yourself. Other than that, looks like you're doing pretty well!
 

maryo52

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OK, about medication. I don't know what you're taking but will assume it's a narcotic. We should be taking a dose to match our pain. Pills have a slot in the middle, and that's for dividing pills. So you can either reduce your dose, when appropriate, by taking less, or by taking your doses further apart. The point is to wean, not drop. Take whatever you need to cover your pain. Ignore everything you hear about addiction. That's not you.

I have known so many people who one day decided to stop their meds, because they were tired of feeling dopey or whatever. The problem is they were not taught how to adjust their dose. Using me as an example, I took narcotics for 6 months with my original TKR. At the end it was a half pill twice a day. This surgery, I've never taken more than a 1/2 pill and have taken probably a total of 10 pills in two months (I'm still amazed). So every surgery is different, every person is different.

If you ice and elevate, rest properly, and avoid painful movements, you will naturally need less. Also, if you're taking a pill that doesn't have tylenol in it, you can take 1,000 mg of tylenol 3-4 times a day for pain and use the narcotic for pain not controlled by tylenol.

Some of the articles I posted earlier offer great info on pain management, so take a look at those.
 

Spex10

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I refused all narcotics. Paracetamol saw me through. I concentrated on healing and just mobilising in normal daily activities and made a rapid and good recovery from my second TKR.
 

Jockette

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If you ice and elevate, rest properly, and avoid painful movements, you will naturally need less
This is very true! Over zealous PTs and even surgeon’s forget about how much trauma this surgery has caused in our body. Give it time to heal properly and you’ll eventually be back to things you want to do.
 

Denny39

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Hi @pepsicola
I just read through your thread this morning. It looks like you are making great progress in your recovery. You found Bonesmart about the same time I did, 2 weeks post-op. Your initial questions and concerns are very typical of many of us (I think probably close to 90%) who went into our first major joint replacement having no clear idea of how long the recovery would take or what it would really be like. Pre-op, I felt very confident that I would be pretty much up and running again 6 - 8 weeks out. Nope!

I see most of your questions have been well addressed, but I would like to add one thought to the occasional shooting pains down the side of your leg. I experienced those pretty regularly up to 6 weeks or so before they began to diminish. They always originated on the outside of the knee, just below the Patella. That is where the implant is pressed (actually hammered) into and secured by screws to the Tibia. I asked my surgeon if my knee was cemented or uncemented. He said, “Uncemented, it’s a press fit”. I worked in the manufacturing industry, and I know what “press fit” means. It means it don‘t wanna go! It makes sense that could cause some pain. If that is what is is, it will last awhile, but it’s normal and will go away. I haven’t felt it for 3 or 4 weeks now (13 weeks post-op). Sounds like you’re doing great. Keep up the good work.
 
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pepsicola

pepsicola

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Thanks so much for taking the time to reply, by all the responses I seem to be on track and doing well. I do agree that perhaps we don’t give our bodies credit for the major surgery it has undertaken and simply needs time to heal.

My Physio took me off crutches this week and onto walking sticks which I must admit am finding much harder than crutches.
 

maryo52

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I don't think I'd do well with the sticks. I remember watching "old people" (which is me now!) use those when I was a kid, thinking that it looked difficult. It sounds as if your expectations have aligned with reality, so that's good. Yes, our bodies are way more amazing then we think sometimes. PT doesn't heal the knee, our body does.
 

Jockette

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If you prefer the crutches, use them. Personally I preferred my cane rather than a walking stick.

PTs can advise but we choose what’s right for us.
 

Spex10

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Walking stick / cane? What's the difference? My sticks were provided by the hospital and are sturdy aluminium ones with good positive handles. I was down to only using one after about 10 days. Never had crutches and walker was removed from my room on day 2 post op.
 

Jockette

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Walking stick / cane? What's the difference?
To me, a cane is wrist height with a handle that you hold with your hand in a downward position.

My walking stick, also referred to as a pole, is much taller, so my hand was in an upright position when I held it. I didn’t feel it offered me any security at all, and the cane did.

I don’t have any photos of the differences, and I know the terms are used interchangeably, which doesn’t help either.

@Celle I’ve seen you post photos of these, will you post them again please?
 

Denny39

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Apparently, in the UK, they tend to use 2 “sticks” as opposed to here in the US, we lean more to 1 cane.
 

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