Hi. It has been three months post TKR in left knee. It is still very swollen ( although an improvement from 2 months ago). At the last PT session I achieved 85 bend. It is really getting me down. After the slightest activity it swells up and I am limping really badly. I am doing my exercises. I ice about 4-5 times a day and elevate whenever i sit down. Straightening the knee is a real challenge when standing. This has been an ongoing problem since the last arthropscopy in 2019. I was due a TKR in 2022, but unfortunately was diagnosed with breast cancer, so it was delayed whilst I underwent 6 m of chemo, mastectomy and 1.5 years of immunotherapy. My knee was terribly swollen by the time it was operated on ( I could barely bend it). I just feel like its taking forever and I just want my life back. Will I ever get more bend?! And am I doing damage to it now? What if I can’t get the swelling down? Does it ‘set’ like this? My surgeon said i had to sleep on my back but I just cant do it. Am I going wrong here? If i dont sleep, I feel really depressed, so its really important to me.
TKR 3 months in and still swollen, with disappointing bend
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Welcome to BoneSmart @bodie123 !
I'm sorry you're having a rough time and want to reassure you that you're still in the early days of a one year + recovery, with time to heal and regain function.
The major bar to both flexion and extension is swelling. Physio and exercises that try to push, pull, and actively work the new knee often are "too much, too soon" and in fact create more painful inflammation and swelling.
Several of our members have taken several months to reach 90 degrees of flexion, but continued to slowly progress over a year or more and had very functional knees.
You're on the right track with icing and elevation. Our members (including this volunteer staffer) strongly recommend icing while elevating "toes above nose" with each session at least 45 minutes to prevent rebound swelling. As long as there's fabric between cold pack and leg, it's quite safe.
I'm going to add our postop links to helpful articles.
Welcome to BoneSmart! You are in the very early stages of an average of a yearlong recovery. I will leave you our Recovery Articles that have helped tens of thousands of other knee replacements. We are here to help you through this journey the best we can. The very best thing for your knee right now is to rest, ice, and elevate. Exercises can come later. There is no rush to achieve ROM because it will come naturally as your swelling decreases. Your OS was able to bend your knee while checking for movements during your surgery, so it will be fine. It just takes time.
Each person is different as is their recovery. Most find that the Bonesmart approach works best for them, but others find that a more aggressive therapy helps them more. It's your recovery and your choice on how you recover. As you read more on other members' recovery threads, you’ll get a better perspective of what to expect. The following are our basic guidelines and should help get you started.
KNEE RECOVERY 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.
If you want to use something to assist with healing and scar management, BoneSmart recommends hypochlorous solution. Members in the US can purchase ACTIVE Antimicrobial Hydrogel through BoneSmart at a discount. Similar products should be available in the UK and other countries.
2. Control discomfort:
3. Do what you want to do BUT
4. PT or exercise can be useful BUT take note of these
5. At week 4 and after you should follow this
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.
I'm sorry you're having a rough time and want to reassure you that you're still in the early days of a one year + recovery, with time to heal and regain function.
The major bar to both flexion and extension is swelling. Physio and exercises that try to push, pull, and actively work the new knee often are "too much, too soon" and in fact create more painful inflammation and swelling.
Several of our members have taken several months to reach 90 degrees of flexion, but continued to slowly progress over a year or more and had very functional knees.
You're on the right track with icing and elevation. Our members (including this volunteer staffer) strongly recommend icing while elevating "toes above nose" with each session at least 45 minutes to prevent rebound swelling. As long as there's fabric between cold pack and leg, it's quite safe.
I'm going to add our postop links to helpful articles.
Welcome to BoneSmart! You are in the very early stages of an average of a yearlong recovery. I will leave you our Recovery Articles that have helped tens of thousands of other knee replacements. We are here to help you through this journey the best we can. The very best thing for your knee right now is to rest, ice, and elevate. Exercises can come later. There is no rush to achieve ROM because it will come naturally as your swelling decreases. Your OS was able to bend your knee while checking for movements during your surgery, so it will be fine. It just takes time.
Each person is different as is their recovery. Most find that the Bonesmart approach works best for them, but others find that a more aggressive therapy helps them more. It's your recovery and your choice on how you recover. As you read more on other members' recovery threads, you’ll get a better perspective of what to expect. The following are our basic guidelines and should help get you started.
KNEE RECOVERY 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.
If you want to use something to assist with healing and scar management, BoneSmart recommends hypochlorous solution. Members in the US can purchase ACTIVE Antimicrobial Hydrogel through BoneSmart at a discount. Similar products should be available in the UK and other countries.
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. At week 4 and after you should follow this
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.
Last edited:
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If you provide the exact date of your L TKR we will create a custom signature so members see your recovery status at a glance.
Many of us suffered with insomnia.
In the first couple of weeks I napped in bed on my back, legs on a pillow, or in the recliner. Then I added in lying on my non-surgical side, enough pillows between my legs to keep the surgical leg parallel to the bed at hip level, knee comfortably slightly bent.
Other members report using a nest of pillows including the huge body pillows.
Insomnia is a real bummer for many of us in the initial weeks after surgery. It's generally not the meds, it's... everything about the trauma, discomfort, energy drain!
You might also consider some nonprescription remedies....
If you're lactose tolerant, a glass of warm milk! If you're not diabetic, a teeny bit of honey makes it even more comforting... plus milk is high in magnesium! Helps us relax!
If you aren't a milk drinker, or want an easier way to, an evening magnesium supplement has been very helpful for some members.
OTC diphenhydramine, an antihistamine also used as a sleep aid (Benadryl) because it makes you drowsy; it's also included in some cold, flu, etc "nighttime" combination meds.
Low dose melatonin, sustained release - not for long term use but I have used for a week at a time without ill effect. It should be taken an hour to hour and a half before going to bed, and during that time stay in a dimly lit area to allow this hormone to activate.
Valerian root - an herbal remedy, it can be taken in capsule form but that dose might be high compared to my preference, herbal "sleep" blends that include a smaller dose of valerian and make me pleasantly drowsy. Plus the other tea flavorings make it nice tasting! Celestial Seasonings and Traditional Medicinals sell teabags by the box. Their sleep blends without valerian have never ever made me sleepy.
What finally worked for me: a mug of sleep tea with valerian followed by a 3 mg sustained release melatonin, immediately going into a dimly lit room and relaxing. When I got sleepy, turning off the light and lying down with my legs up on the Lounge Doctor. After a few hours I would wake, move the Lounge Doctor away, and sleep more.
Be aware: even benign herbals and supplements can interact with your routine or post op prescription meds, either making their effects weaker or stronger. If you're on meds you may want to check with your doctor or pharmacist, or even check online for interactions.
Many of us suffered with insomnia.
In the first couple of weeks I napped in bed on my back, legs on a pillow, or in the recliner. Then I added in lying on my non-surgical side, enough pillows between my legs to keep the surgical leg parallel to the bed at hip level, knee comfortably slightly bent.
Other members report using a nest of pillows including the huge body pillows.
Insomnia is a real bummer for many of us in the initial weeks after surgery. It's generally not the meds, it's... everything about the trauma, discomfort, energy drain!
You might also consider some nonprescription remedies....
If you're lactose tolerant, a glass of warm milk! If you're not diabetic, a teeny bit of honey makes it even more comforting... plus milk is high in magnesium! Helps us relax!
If you aren't a milk drinker, or want an easier way to, an evening magnesium supplement has been very helpful for some members.
OTC diphenhydramine, an antihistamine also used as a sleep aid (Benadryl) because it makes you drowsy; it's also included in some cold, flu, etc "nighttime" combination meds.
Low dose melatonin, sustained release - not for long term use but I have used for a week at a time without ill effect. It should be taken an hour to hour and a half before going to bed, and during that time stay in a dimly lit area to allow this hormone to activate.
Valerian root - an herbal remedy, it can be taken in capsule form but that dose might be high compared to my preference, herbal "sleep" blends that include a smaller dose of valerian and make me pleasantly drowsy. Plus the other tea flavorings make it nice tasting! Celestial Seasonings and Traditional Medicinals sell teabags by the box. Their sleep blends without valerian have never ever made me sleepy.
What finally worked for me: a mug of sleep tea with valerian followed by a 3 mg sustained release melatonin, immediately going into a dimly lit room and relaxing. When I got sleepy, turning off the light and lying down with my legs up on the Lounge Doctor. After a few hours I would wake, move the Lounge Doctor away, and sleep more.
Be aware: even benign herbals and supplements can interact with your routine or post op prescription meds, either making their effects weaker or stronger. If you're on meds you may want to check with your doctor or pharmacist, or even check online for interactions.
Last edited:
Jcx
member
C'mon
junior member
Don’t beat yourself up over this recovery journey bodie it’s a process for sure. I rolled onto my left side slightly around 4 or 5 days in with my right leg over the top of the left and onto a small pillow keeping my left leg as straight as I could and my right leg bent with my knee on the pillow, that was the first nights sleep since I got home. About 6 or 7 days I rolled onto my right and put my leg on a long king size pillow, I absolutely could not sleep on my back it was not happening.
I too am 3moThursday and also still swollen but continue to get better just a little bit everyday. I have some stiffness and clicking and what feels like things are coming unstuck, still some pain from my groin thru my thigh behind my knee down thru my calf and instep but I can push thru most of the day,
My bend came slow due to the severe swelling, I was 70* at 2wks and 110* at 6wks but now I seem to be only progressing very slowly but as long as you’re a little better everyday you’re progressing.
I quit PT a few weeks ago when they started being too aggressive with squats and weights and other stuff that just caused more swelling. Take it slow and easy walk as much as you could. We will get there!!!
I too am 3moThursday and also still swollen but continue to get better just a little bit everyday. I have some stiffness and clicking and what feels like things are coming unstuck, still some pain from my groin thru my thigh behind my knee down thru my calf and instep but I can push thru most of the day,
My bend came slow due to the severe swelling, I was 70* at 2wks and 110* at 6wks but now I seem to be only progressing very slowly but as long as you’re a little better everyday you’re progressing.
I quit PT a few weeks ago when they started being too aggressive with squats and weights and other stuff that just caused more swelling. Take it slow and easy walk as much as you could. We will get there!!!
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Welcome to BoneSmart! Thanks for joining us, bodie.
I am sorry for the health challenges you were forced to endure, while also dealing with knee issues.
Bless your heart!
You have received some good advice above from staff and our supportive members, Jcx and C'mon.
I will suggest you take the time to read Post Op Blues from the Recovery Guidelines and know you're not alone.
The depressed mood will pass!
bonesmart.org
In an effort to give the members visiting your thread an idea of how far along you are, we'd like to create a signature for you. Through your initial post, I estimated your TKR as sometime in September? Will you please verify an exact date and also for the arthroscopy if you'd like to provide the month and year, we'll add that too.
I wish you perfect healing and good health over the holiday season and many blessings in the New Year!
@bodie123
I am sorry for the health challenges you were forced to endure, while also dealing with knee issues.
Bless your heart!
You have received some good advice above from staff and our supportive members, Jcx and C'mon.
I will suggest you take the time to read Post Op Blues from the Recovery Guidelines and know you're not alone.
The depressed mood will pass!
Post op blues is a reality - be prepared for it
Post op blues is feeling depressed, weepy, nervy, shaky, fearful of the future, anxious, overwhelmed by what is happening to you, convinced it's never going to get any better and finally, uttering that most intense of all cries "I wish I never had this done!" It arises out of a variety of...
bonesmart.org
In an effort to give the members visiting your thread an idea of how far along you are, we'd like to create a signature for you. Through your initial post, I estimated your TKR as sometime in September? Will you please verify an exact date and also for the arthroscopy if you'd like to provide the month and year, we'll add that too.
I wish you perfect healing and good health over the holiday season and many blessings in the New Year!
@bodie123
Hi and Welcome!
Here are some reasons you can’t sleep:
bonesmart.org
The only way I am able to sleep on my back is to have my legs on an elevation foam wedge. I adjusted to that so well that I still sleep that way, 7+ years later!
Since your leg was so swollen before surgery, and a low ROM then, it will probably take you longer than average for it to all settle down. I know it’s hard, and 3 months does seem like a long time, but as was said above, this recovery takes an average of a year, so try to understand that and give yourself grace to let your body heal on its own timeframe. There is no “window of opportunity.” Don’t let your medical team pressure your body to go faster than it can.
bonesmart.org
Here are some reasons you can’t sleep:
Sleep deprivation is pretty much inevitable - but what causes it?
Time and again members complain about not being able to sleep and after a while, that it gets to making them feel frustrated, despairing, depressed and even ill. I thought perhaps a short treatise on the reasons for disturbance of sleep patterns was long overdue. It won't help you to sleep but...
bonesmart.org
The only way I am able to sleep on my back is to have my legs on an elevation foam wedge. I adjusted to that so well that I still sleep that way, 7+ years later!
Since your leg was so swollen before surgery, and a low ROM then, it will probably take you longer than average for it to all settle down. I know it’s hard, and 3 months does seem like a long time, but as was said above, this recovery takes an average of a year, so try to understand that and give yourself grace to let your body heal on its own timeframe. There is no “window of opportunity.” Don’t let your medical team pressure your body to go faster than it can.
Myth busting: "window of opportunity" in TKR
This "six week window of opportunity" surgeons often speak about is little more than a myth. It presupposes that all patients have the ability to create adhesions which is far from the truth. It also ignores the simple fact that in the first 3-4 weeks after surgery, swelling reactive to the...
bonesmart.org
bodie123
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Thank you so very much for your replies, I feel a lot better! I think my surgeon sent me into freefall as he said he was so disappointed with my progress and he was expecting much more bend when he saw me. He makes me panic as he infers that if I havent got to a certain point then I will never get there. My TKR in left knee was on 6th Sept 2024. Thanks again.
Wow, that is no way to talk to a patient. We are all different, as are our own healing timeframes.
There is no date by which you must be a certain number.
After a tough first year I had a lot of improvement in all ways, in my second year, as my whole leg continued to relax and heal.
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My surgeon said to sleep any way that was comfortable and not to worry about the implant as it would be fine.
I agree with @mendogal to prioritise sleep. I got some zopiclone from my GP which really helped and I alternated it with other remedies as suggested above.
If your knee was really swollen and stiff before surgery then it is perhaps not surprising that it will taken time to loosen up.
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Hi again bodie,
Three months post op is still early in the recovery process. You are making progress, although not as quickly as you'd like. Everyones journey is different. The consistent effort you're making is more important than rapid improvement.
I wonder if your OS would be gentler on you if you expressed that you're feeling rushed and overwhelmed?
Set small attainable goals for yourself and have confidence you'll meet them. This recovery can take a full year and even longer for many to feel normal. With patience and persistence you will get there.
You can do this!
If interested, go to the thread I'll link below and read Posts #18 and 19
You will find the Post Number in the very top right corner of each post. These posts are from members who felt pressured and had concerns about their progress also. I believe you will take comfort in their words and not feel so alone.
https://bonesmart.org/forum/threads/4-days-post-ltkr.79097/
A great rest of the week to you!
@bodie123
Three months post op is still early in the recovery process. You are making progress, although not as quickly as you'd like. Everyones journey is different. The consistent effort you're making is more important than rapid improvement.
I wonder if your OS would be gentler on you if you expressed that you're feeling rushed and overwhelmed?
Set small attainable goals for yourself and have confidence you'll meet them. This recovery can take a full year and even longer for many to feel normal. With patience and persistence you will get there.
You can do this!
If interested, go to the thread I'll link below and read Posts #18 and 19
You will find the Post Number in the very top right corner of each post. These posts are from members who felt pressured and had concerns about their progress also. I believe you will take comfort in their words and not feel so alone.
https://bonesmart.org/forum/threads/4-days-post-ltkr.79097/
A great rest of the week to you!
@bodie123
kneed to know
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You mention you are elevating while sitting. Have you considered an elevation wedge pillow for your hours in bed? There is quite a range of styles from $25-100+ on Amazon. I am a week behind you & also having challenges with the tradeoff between "PT exercises" vs swelling from weight bearing. It's helpful to have this forum to get a wider orientation to recovery. The Light will be turning around & increasing soon at Winter Solstice!
ouchie!
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Hi bodie, I had my TKR on 17th Sept so just a few days after you. I quit PT visits when it became a chaotic group class and a horrible physio woman who was very rude to me. I still do PT at home 2-3 times a day, only 4 different exercises each session. I find my knee swells quite a lot especially near the end of the day and if I overdo things a bit. I’m a carer for my husband so sometimes have to do stuff when I’d rather just rest but there you go. Icing is your friend.
Luckily my OS wasn’t obsessed with ROM so I didn’t have that pressure. I don’t go for many walks as I do so much walking around the house and up and down the stairs every day just doing household things. My physio said not to worry about sleeping positions, if it feels comfortable then that’s fine, she said. I used to use soft pillows for resting the leg on when in bed but I don’t need them anymore.
Another thing you could try is to ditch the caffeine. So drink decaf tea and coffee, honestly it tastes just the same. And ditch coke which is full of caffeine. Caffeine wakes up the brain too much! It’s really helped me sleep better.
All you’re saying is much how I feel. I would love the swelling and discomfort to go but we are so early in our recovery and I think time will be a great healer. 3 months is so much better than those first few weeks, weren't they an awful time? Do you get out at all? Going out for a coffee with friends is so good for the soul. We will get there, do not despair. You take care.
Luckily my OS wasn’t obsessed with ROM so I didn’t have that pressure. I don’t go for many walks as I do so much walking around the house and up and down the stairs every day just doing household things. My physio said not to worry about sleeping positions, if it feels comfortable then that’s fine, she said. I used to use soft pillows for resting the leg on when in bed but I don’t need them anymore.
Another thing you could try is to ditch the caffeine. So drink decaf tea and coffee, honestly it tastes just the same. And ditch coke which is full of caffeine. Caffeine wakes up the brain too much! It’s really helped me sleep better.
All you’re saying is much how I feel. I would love the swelling and discomfort to go but we are so early in our recovery and I think time will be a great healer. 3 months is so much better than those first few weeks, weren't they an awful time? Do you get out at all? Going out for a coffee with friends is so good for the soul. We will get there, do not despair. You take care.
This is what I like to call “natural PT” and really is all you need to you recover.
bodie123
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Thank you to all those that kindly gave me their advice. I did try to reply but could only replyto a few. Is there a limit I wonder?
I am now 4 months post TKR left knee. I can still only get 83 degrees bend as it seems so swollen still. After Christmas hosting and being generally more active I feel it is swelling more. Icing seems to help more than elevating. It is so hard to get the balance right.
I am now 4 months post TKR left knee. I can still only get 83 degrees bend as it seems so swollen still. After Christmas hosting and being generally more active I feel it is swelling more. Icing seems to help more than elevating. It is so hard to get the balance right.
Did you try to reply in this thread or by sending a PM? There is not any limit to posting here in your personal recovery thread.
It's not uncommon to experience additional swelling as we get more active. I had it happen to me with my first TKR. And, yes, it is hard to find that fine line between doing too much and doing just enough. Cut back on your activity for a few days and see if that helps bring the swelling down along with the icing.
I know it's difficult, but try to be patient. My surgeon likes to say that the most important muscle to exercise during recovery is the Patience Muscle."
And please keep us posted!
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