TKR 4 Weeks, Min exercise = severe pain

[Flashlight]

I read all your posts and couldn't understand why your PT said not to try to walk until 6-weeks. I had to walk every hour on the hour up and down the hall until I was discharged and then was encouraged to continue to walk inside my home throughout the day. I did use a walker which helped keep the weight off my knee and helped with balance. This actually helped with my pain. I did online PT and each month my walking time increased. Are you resting in bed or a recliner? Are you elevating higher than your heart? At 10 months my knee swelled and was stiff more times than not. Do you live alone? It sounds like you could benefit from a nonaggressive form of PT to get you back on tract. Don't give up.

 

[TKA2023Feb8]

Daily activities are just 5-6 walks around the house on crutches, 50% weight bearing. I am more aggressive sleeping and rolling around, but it is a problem as things don't hurt when I do them, so it's hard to assess.

I find icing and anti inflams do nothing, although I continue to ice 6 times/d because I have nothing better to do. But even 24 times zero is still zero.

 

[TKA2023Feb8]

@Flashlight - Some can walk around the block at 5 days, but my PT "suggested" to avoid for 6 weeks. This was absolutely great advise with my first knee, as I independently verified that walking killed me before 6-7 weeks. I eased into it and could finally walk a km w/o pain or a limp after 3 months.

My strategy for both knees has been that if I am going to swell and be in pain, it can only be because of ROM activities.
I always ice with my knee above my heart, and try and rest the same way as much as possible. I am blessed to have a primo caregiver.

I guess I have just figured out that I also can't be on my feet, or sitting in a chair with my knee not elevated for a mere hour.

 

[JusticeRider]

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.

Check out my recovery thread if you are interested. I didn’t have your extension issues, but did have limited flexion and extreme swelling. I had a very reactive knee and it made my early recovery slow and honestly pretty miserable. I can relate to much of what you’re saying. I’m at 8 months now and the last few months have been SO much better. Take heart that it may just take a while to manage your swelling. It sounds like you’re doing all the right things with icing, elevating, etc. Don’t give up on the walking though. Even if you need a walking aid and it feels awkward, you can still get out there and walk. Just take it slow but steady. And keep asking your surgeon questions…If you have any concerns, he/she should know about it.

 

[beachy]

I was 3 months post op on April 11. Today is the first day that I've been very active all day with no swelling. I don't know why, but we just hit the point where the swelling subsides.
I could only walk about 10 min at the 6-7 week point. It gradually got better and now, at 3 months, it's 100x better than 6-7 weeks.
I can do almost anything.

 

[TKA2023Feb8]

depressing 10.5 week update

I am still swollen almost all the time after doing min exercises, as well as by spending more than 30 minutes on my feet, all still on crutches. My bend is 85 degrees, and a lousy 15 degree extension.

I saw my OS last week, who had no answers but did refer me to a fantastic PT, a former CDN Olympic team PT, who mainly does research now. I suggested blood work from my OS to test for infection (C-Reactive Protein or CRP), which came back normal.

Because I can't do anything, my quads have atrophied. My PT says to concentrate on extension and my vastus medialis quad, and don't worry about flexion. I did just google this morning and found that this inner quad is largely responsible for the last 15 degrees of extension (eureka).

But it's still a mystery why I'm so slow, in the bottom 1%?

I think some valuable info from my PT:
- 91% satisfaction rate for THA, but only 80% for TKA :( You do 2 knees and you have only a 60% chance of both being ok, if my math is correct; not very encouraging.
- 15 years ago for my (still invisible) THA, he introduced me to 10% diclofenac topical cream, by prescription only. From his research, he said 1.5% (Voltaren) is no better than Vaseline.

 

[Jockette]

But it's still a mystery why I'm so slow,

We all recover differently, and this recovery takes an average of one year, which is 52 weeks. At 10.5 weeks you are still very early in recovery. There is no Window of Opportunity. I know it’s hard, but try to relax. Josephine, our wonderful, retired nurse director with 60 years of joint replacement experience used to say, “give your knee the privilege of sorting itself out. It will, if you let it.“

Hang in there, where you are now is not where you will end up.

 

[TKA2023Feb8]

I still can't do much, but something I wish I had done earlier was to get a muscle stimulator to get my (inner) vastus medialis quad firing; minimum effort required.

My PT says it is about $200 retail, but sold it to me at his $60 cost.
Roscoemedical.com model=EMS7500

 

[Layla]

Happy Three Month Anniversary!
How are you doing? I hope the past couple weeks have been good and you're enjoying some progress.
Please consider an update when you have time. Hope to hear from you soon!
@TKA2023Feb8

 

[TKA2023Feb8]

3 Month Update
Almost 14 weeks now, and I'm sadly still in rough shape; not a whole lot better than my original 4.5 week post. I am slightly stronger with daily activities like getting out of bed etc, but extremely limited.

I am seeing the best PT I could find, the former head PT for the (Canadian Football League) Calgary Stampeders for 26 years. But he is no shaman, and you can't get blood from a stone. He has no answers.

My swelling refuses to come down. I still can only walk with crutches, maybe 50% weight bearing. I recently made a mistake by going 500 yards like that, and was in percocet pain for 2 days. Even standing or sitting for a couple hours kills me. To make matters worse, I still get headaches with any painkiller, even simple tylenol.

My swelling is always so bad, my ROM is about 15 degrees to 95. Any effort to improve that causes even more swelling.

As mentioned, I did test negative for CRP (C reactive protein), and although everyone says it is then unlikely to be infected, I demanded that I get an aspiration to test further. I will then ask for a white blood cell count.

I think I am just setting new records for slow. I am however, extremely concerned what will happen a knee bent at 15 degrees for 3 months. My swelling is so bad, I can't imagine it would appreciate an MUA.

My summer looks ruined, and if that's all it is, that might be a best case scenario.

So I hope that provides some hope for people struggling, to show them how bad it could be.

 

[sistersinhim]

I am seeing the best PT I could find, the former head PT for the (Canadian Football League) Calgary Stampeders for 26 years

This might be your problem. Rehab from a joint replacement should be completely different than it is from a sports injury. It is possible that you are working your knee way too hard and are keeping it inflamed. Your swelling is showing you that. Your bend is bad because of the swelling. I suggest you stop PT and all exercises for a month. Increase your icing and elevating and rest much more than you are doing. I bet you'll see a lot of improvement. What you are doing now isn't working. Why not try the Bonesmart way?

 

[TKA2023Feb8]

Just for the record, that excessive walking was by misjudging how far it was for an acupuncture appointment. I think that's the only evidence that would suggest that I'm overdoing it.

I don't do exercises, as I have been listening to Bonesmart. I lie 22 hrs/d and ice/elevate 6x/d. It's just so easy to make little mistakes; like sitting outside for 2 hrs...

When my OS has a problem patient, he refers them to this PT, and they work closely together; invaluable. My PT has seen dozens of problem TKA's and has just suggested the muscle stimulator, called my OS to get him to authorize the aspiration next week. I have clued him in that I can't do much, so he is not the problem; only a great direct link to my OS.

 

[sistersinhim]

That's good that your PT knows the correct recovery and your doctor is pleased with him. I pray you can find a solution to your prolong pain and swelling.

 

[wander03]

I had my right knee replaced on July 19, 2021. As I posted in my knee recovery thread, the physical therapy I experienced from that time until mid-September 2021 was overly aggressive and created a difficult situation with my knee. I have been in therapy for my knee with two different physical therapy programs since then, even during the physical therapy for both of my THRs. I do not have pain in my knee, but it is extremely tight, as if it is in a vise is the only way I know to describe it. I can walk without a cane with a slight limp if I really concentrate, but not for an extended length of time. Even then my lower back hurts after a bit. My PT has recently concentrated on increasing the strength of certain muscles around my knee.I get frustrated because my legs are strong, but the tightness in my knee persists. My ROM is about 120 and my extension is 0, so both are quite good.

I had swelling for the first few weeks after the surgery, but it did not persist as long as yours. I used a walker for quite a while, longer than most people seem to use one. But I walked better with it, and I relied on the assurance that every recovery is different. The fact that both of my hips needing to be replaced when I had my TKR may have contributed to what I consider to be a slower-than-usual recovery from my TKR. However, I did not know that my left hip was end-stage DJD and my right hip was AVN collapse until x-rays and an MRI were performed after I fell in October 2021. I still have hope that I will regain the ability to walk without a cane. I am starting water therapy this week and hope it is the therapy that will enable my full recovery.

I guess the reason I am telling you this is to share that all recoveries are not optimum. I am sometimes frustrated that a year and ten months after my TKR, I still walk with a cane. But I am not giving up hope. Please know that the staff members and members who have had TKRs are giving you advice that comes from experience. It does not make sense to me that you have not consistently walked with a walker for support during these months. I do not understand how one could expect ROM to be 120 and extension to be 0 without walking, but I'm not a doctor or a physical therapist. I encourage you to continue to follow BoneSmart because the people involved will do everything they can to try to help you. I don't know of anyone else who have had joint replacements and care so much for others during their recovery journey. I know it is probably normal to become discouraged; I've been there. But please know that this too shall pass. "Hope springs eternal in the heart of man."

Onward and Upward. Keep on keeping on to the best of your ability.

 

[Layla]

Hello @TKA2023Feb8
I am really sorry to read about what a struggle you're having. Please know that we're here if you're in need of support. I wish you comfort and better days. Stay in touch.

 

[EalingGran]

Sorry to hear you still are in so much pain if you walk 500 yards and swell so much.
Your first knee is the same age as my PKR. How is that knee doing now? Do you have any pain or swelling with it?
Just wondered as I think I would have found it hard to use my operated leg as my "good" leg after 3-4 months

 

[TKA2023Feb8]

Thanks everyone.

I wouldn't have done my 2nd knee after 3 months if my first knee wasn't in ok shape, which it was. For my extremely limited capability, my first knee feels almost perfect. It is however, a real disservice to that first knee, to not be able to fully rehab it, but hey, you're only as good as your weakest link.

 

[TKA2023Feb8]

I had researched the issue a bit and found no evidence, along with my OS's opinion, but I have to question doing 2 knees in succession 3 months apart, let alone doing 2 at once. At least my OS advised not to do that.

I think your immune system is potentially being overstretched. Maybe I would have had some issues, but maybe the issues could have been minimized. All easy in hindsight.

 

[TKA2023Feb8]

16 Week Update
I saw my OS 4 days ago May 29. As expected, he was baffled, and could but refer me to another OS for a 2nd opinion; not good I thought. He said my aspiration was negative, but I asked and he agreed to continue with infection diagnosis with a white blood cell scan.

However, he did give me a prescription for Pregabalin (or Lyrica I understand), which somehow "blocks the pain from damaged nerves".

I took one that night and woke up with less pain. After 4 days, I really feel better and can do things I couldn't do last week. I can be on my feet for hours, I feel closer to walking and can do some exercises, and min pain. I keep doing a bit more every day, and am quite optimistic now. I have a long road back, as my knee wouldn't let me touch it, and I am at least 15 degrees extension; less worried about my mere 90 or 95 bend.

It seems so obvious to me now as a layperson - that nerve damage could have been done in such a brutal surgery. I wish I could have started this magic med at 6 weeks or at least when I saw my OS at 10 weeks, but better late than never.

Thanks everyone for the help and support

 

[benne68]

Glad to read that the Lyrica is helping, @TKA2023Feb8, and that you're feeling up to doing more. Just remember to take it slow!

Wishing you all the best.