TKR 4 Weeks, Min exercise = severe pain

[TKA2023Feb8]

Right knee replaced Oct.18, 2022. I swelled easily; most strengthening exercises killed me, so I concentrated on ROM and did what I could. I was about 87 degrees at week 2, 105 at week 6, and 125 at week 10. I did use a band to gently, manually bend my knee. It hurt, swelled a lot, but I successfully ignored much of what PT had to say. PT did say to avoid much walking before 6 weeks. Walking did kill me, so I took their great advice and it all worked out fine; quite happy with 128 degrees and able to walk a km. pain free at week 12.

Left knee surgery Feb.8, 2023. I have this recent first knee experience, which is why I am perplexed.
I am 4 weeks out, and really can't even do 5-10 simple, unassisted, non-painful bend exercises, without having to endure a 36 hour painful Oxycodone recovery.

I'm not so worried that I am only 70 degrees at 3 weeks, but it just seems like my knee is saying "don't touch me". For the record, I ice and elevate all the time, but it doesn't seem excessively swollen; just painful.

I know they say to stop if something hurts for 2 days, but is it within the realm of possibilities that I just need to do nothing for up to 6 weeks while I heal?

 

[Layla]

Hello and Welcome to BoneSmart and recovery! Listen to your knee, it knows what's best.
Please refrain from engaging in movement that causes discomfort or pain. While your range of motion is currently limited, it will naturally increase as the swelling subsides and the pain eases. Give it time.

No two recoveries are alike, even with the same person, so this isn't surprising, but none the less painful or disappointing for you. I am sorry for that.

Is it within the realm of possibilities that I just need to do nothing for up to 6 weeks while I heal?

Yes, aside from the activities of daily living and some walking it is wise to let your knee heal from the controlled trauma of TKR.

I will leave the BoneSmart Recovery Guidelines with best wishes for comfort and lots of patience as you begin your healing journey again. Stay in touch, we'd love to follow your progress.

KNEE RECOVERY GUIDELINES

As you begin healing, please keep in mind that each recovery is unique. While the BoneSmart philosophy successfully works for many, there will be exceptions. Between the recommendations found here, your surgeon's recovery protocol and any physical therapy you may engage in, the key is to find what works best for you.

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

the BoneSmart view on exercise​

BoneSmart philosophy for sensible post op therapy​

5. At week 4 and after you should follow this

Activity progression for TKRs​

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.

 

[benne68]

it just seems like my knee is saying "don't touch me".

Yes, that's exactly what it's saying! That poor knee has been through lots of trauma from all the carpentry work your surgeon did.

It sounds like you were very fortunate with your first surgery and recovery. But, as Layla said, no two knees are alike -- even in the same person. We have quite a few members who have had TKRs on both knees at different times who will attest to that. I'm sure some of them will stop by to share their stories.

Hang in there!

 

[beachy]

I'm 7, almost 8 weeks, post op. 3, 4, 5 were some of the most painful weeks for me. Its my second tkr, too. This one is different. Not worse, just different.
Let your new knee rest awhile longer. ADLs, short walks around the house, heel pumps are all you need.

 

[FourCats]

Welcome! My two knees were very different during the recovery period. One thing I reminded myself of constantly was that me left knee (which was needing replacement) was bearing a lot of weight and responsibility during the right knee’s recovery. I believe that may have contributed to the seemingly longer and more difficult recovery time.

 

[Layla]

Happy One Month Anniversary!
I hope you've had a good week so far and the rest of it is even better.
Take good care.
@TKA2023Feb8

 

[TKA2023Feb8]

Thanks for everyone's help.

I'm 5 weeks now. I'm still pretty pathetic, struggle with any tiny ROM exercise, but have learned a lot here about not pushing it too much.

I don't see my OS for 2 weeks, but clearly look on track to go in there at 75 or 80 degrees, where he might recommend MUA.

I know I'll still be swollen and healing, so I would never agree to the MUA at 7 weeks.

However, it seems that many here might say that I will recover ROM over time, and no one ever needs MUA.

Tough question, but when is MUA appropriate?

 

[benne68]

when is MUA appropriate?

An MUA will only “speed up your ROM” if you have a true adhesion, which is different from scar tissue.
This article explains the difference between scar tissue and adhesions:
MUA (Manipulation under Anaesthetic) and Adhesions

If there is no adhesion, it won’t make much difference, and you will find yourself back at day one of your recovery. Some doctors are too quick to recommend this procedure, when patience and being careful with your activities early in recovery, and time to heal, are all that is needed. As a reminder, here's the article we shared earlier about Myth busting: the "window of opportunity" in TKR

 

[TKA2023Feb8]

thanks Benne68.

5 1/2 weeks now, I just thought I would document my troubles.

I have about 80 degrees bend. I am currently doing zero exercises for the last 2 days, because the simplest of things still kills me. All I do is walk around the house a few times a day with 50%(?) weight on crutches. I spend 23.5 hrs/d in bed elevating, icing 6-10 times a day, on diclofenac anti inflams. I think the anti inflam is a bandage on a bullet wound. Not sure the icing even helps, but it's easy.

For the record, with my first successful knee, I was correctly advised by my PT to not walk much for 6 weeks. It did kill me to walk 100 meters even at 6 weeks, so I am not fazed by my inability to walk much on this 2nd problem knee.

The Problem:
Last Thurs Mar.17, I did 10 simple knee bends, sliding my foot on my hardwood floor, from maybe 20 degrees to 70. The last one I maybe held at 80 degrees for 10 seconds; to resistance but no further. There was zero pain. Shockingly, (yet again) I was in tremendous Oxy pain and swelling Thurs nite and all day Friday.

I think even bending my knee to max to measure will hurt me. I think I may go into cocoon mode until I see OS in one week.

Only the great support and info on this website allows me to be (somewhat) comfortable with this strategy, so thanks to all.

 

[beachy]

For me, weeks 4-7 were some of the toughest. Mentally and physically. And, like you, this is my second tkr. This knee was in very bad condition and a lot more work was done during surgery.
The swelling for those above mentioned weeks really tested me and I stopped the little PT I was doing. It took weeks of icing, elevating, resting. Week 7 I started wrapping in an ace bandage.
By week 8 I had much improved. I still have some swelling with activity, but nothing like those weeks 4-7!

While no 2 tkr recoveries are alike I encourage you to keep up with icing and elevating. Your ADLs and a little walking will help as far as PT for now.

 

[TKA2023Feb8]

Thanks beachy, invaluable info.

 

[Jockette]

I think even bending my knee to max to measure will hurt me.

Don’t let your OS bend your knee, or do it yourself, to the max. You are early in this year long recovery and you just need time.

My OS hurt me every time, making my knee bend as much as he could, to get the best number. I finally had enough and stopped letting him do that. It’s just a number.

You had a successful TKR last fall and there’s no reason this one won’t also be successful, in your body’s own healing timeframe.

People are all different, as are the approaches to this recovery and rehab. The key is, “Find what works for you.“ Your doctors, PTs and BoneSmart are available to help, but you are the final judge as to the recovery approach you choose.

This is what one of our members, TortiTabby, experienced:

(Just so you know, ADL means Activities of Daily Living.)

“At my six week appointment this is what my OS wrote in my visit summary: "She reads an online website called Bone Smart which states to not push through pain following knee replacement. If she were to follow this direction, she will have to learn to live with a knee that only reaches to 85 degrees of flexion. I believe this website is very misleading."

It has now been 20 weeks and all I do is ADL and this is what my ROM has done:
3.5 wks: 75
6 wks: 85
7 wks: 90
10.5 wks: 95
14 wks: 100
17 wks: 105
20 weeks (where I am today): 110
I am so thrilled it keeps improving and improving and I know now that I will get to my goal of 120 (or even better, dare I say!)
So, if a OS or PT bullies you into thinking your ROM will not improve over time they are wrong. By the way, I haven't been back to see the OS since that horrible appointment at 6 weeks, but I sure am going back when I reach 120 just to say, "Ha! You were wrong, BoneSmart was right!" “

And,

“Just an update for those who are apprehensive about gaining ROM:
It has now been 26 weeks and all I do is ADL and this is what my ROM has done:
3.5 wks: 75
6 wks: 85
7 wks: 90
10.5 wks: 95
14 wks: 100
17 wks: 105
20 weeks: 110
26 weeks (where I am today): 120!!!
I did it! My goal of 120! No "pushing through pain", no PT after the first 3 visits, and most importantly to me: No MUA! My surgeon who said I would never get beyond 85 ROM without pushing through pain was wrong, wrong, wrong. I'm excited to see if it gets even better. “

 

[TKA2023Feb8]

Mar.30 @7 week update:
I just saw my OS for a checkup. He said my knee looked good, and to "suck it up and move it, because you have to break up the scar tissue", a pretty generic response that I was somewhat expecting.

If I believed everything I've heard, it sounds like everyone's knee becomes a scar tissue factory. Not sure if that's a myth and all that prevalent...

It is still so sore and still unavailable to do almost anything. I did however measure a shockingly decent 86 degrees, although only -19 extension. I know it's still swollen so I haven't yet worried much about ROM. I'll just be happy when I can actually do some exercises. Thanks again to those who have taught me patience.

I have developed what I've read is (MOH) medication overuse headache. I take percocets or tylenol 3 or tramadol and then I have to take a regular tylenol to offset the headache. It is a catch 22. However, I had the same experience with my first knee on tramadol, and I just dealt with it. It certainly makes you want to minimize the painkillers you take. I am aware of the risk of breaching the 4000 mg/d of acetaminophen.

 

[benne68]

Sorry you are struggling, @TKA2023Feb8. Are you still icing and elevating? Ice is a natural pain killer that can really help. I stopped a bit too soon when I was recovering, but once the pain and swelling spiked, I went back to it and it made a huge difference.

 

[TKA2023Feb8]

Thanks, but I ice 6 times/day, take anti inflams 2/d, use anti inflam diclofenac cream, elevate, rest 23 hr/d.

Yesterday I felt ok and tried to straighten my knee just a tiny little bit, and I am too sore today; another failed attempt.

I am but an experiment to see what happens when you do nothing for 10 weeks, and see what kind of ROM you can get ever back.

 

[Rain Dancer]

My experience shows that, unless there are adhesions, range of motion can improve far into your recovery. My flexion was locked at about 93 degrees for 20 months. I found out that the flexion was stuck because the implant was impinging the popliteus tendon every time I flexed the knee and resulted in constant pain, swelling, and stiffness.

After releasing the popliteus tendon last month, my flexion is now at 103 degrees, and this week I was able to peddle backwards on the recumbent bike for the first time since my TKR. I am so glad that I refused to have an MUA at 12 weeks. Other people have had ROM improve in the 2nd and 3rd year without an MUA or additional surgery.

All knees are different, and it sounds as if your knee is on its own special, painful journey. My knee is still a prima donna and does NOT like to be stressed by exercise. But, I can do more and more without it overreacting, and I can see a future in which my knee will be normal. I hope that your knee calms down soon and that you have a complete recovery.

 

[sistersinhim]

I am but an experiment to see what happens when you do nothing for 10 weeks, and see what kind of ROM you can get ever back.

Doing nothing is just as bad as doing too much. You should be doing your normal daily activities with gentle movements including bends and stretches. You can also ice for hours at a time as long as you have protection on your knee from the ice pack. I iced and elevated the whole time I was sitting or laying down for at least 2-3 months.

 

[Layla]

A belated Happy Two Month Anniversary!
How are you doing since you last posted? Hopefully enjoying some progress with the activities of daily living along with some gentle stretches and daily walks, but not to excess. Please let us know, we'd love to hear from you. Have a great week!
@TKA2023Feb8

 

[TKA2023Feb8]

9 Week Update

Thanks Layla.
I guess I've been waiting for a breakthrough that hasn't come. I am barely any better than my original 4 week post.

My knee is still a swelling machine, and what's unique is the minimum effort it takes to irritate it. As I am slightly more aggressive with daily activities, it is swollen all the time. I was unable to find any poster who had my issues. I was finding it a bit depressing hearing people say they only have 90 degrees bend after 3 months and it bothered them on their 2 hour hike

I can only walk with crutches 50% weight bearing, and not very far. In the last week I have found that I can't even spend an hour on my feet, or else be in quite serious pain for a couple days.

Minor bending and extension exercises continued to be a problem, so I was just letting myself heel. My bend at my 7 week check was 86, but I prepared and did nothing for 2 days before that meeting, so it's kinda artificial. Since then, I've never been more than 80, swollen all the time.

But just in the last week, I am worried how bad my extension is; maybe -20 degrees. My understanding is that bending is nice, but extension is more crucial, and I am not looking good. It is worse than a pic I took at 2 weeks.

I still ice 6 times/d, elevate, anti inflams. The key is behavior modification to not swell so badly in the first place, and avoid a 48 hour recovery, but I still can't figure out the balance.

 

[sistersinhim]

What does your doctor say? What are your daily activities like? Something has definitely angered your knee and you might be able to link it to that something. You can ice and elevate all day and all night long as long as you have a cloth between your knee and the ice pack. I did this and it helped to keep that swelling down.