43 right knee replaced 4 wks post-op w/pain

[mbw43]

I am new to this but I wanted to hear from others especially younger folks who have had knee replacement. Right knee replaced 8/6/07, due to RA. I had a rt hip replaced Nov. '04 and was scheduled for the left knee replacement 2 days ago but had an infection so it was delayed. I have only about 80 degrees ROM, which they say is due to lots of scar tissue and swelling. I'm still taking pain meds because it's painful. I have be waking up at nights in severe pain, can't find a good position to sleep in. I'm waiting to have a manual manipulation done. Bottom line I don't think my recovery is going as it should and I'm pretty depressed about this. My hip replacement recovery was much faster and easier. I am having a hard time emotionally dealing with this surgery. Help. Any advice or anyone having similar issues of depression? I'm not a depressed person by nature but for some unknown reason I'm having a really hard time with this knee surgery which makes me wonder what is going to happen when they do the 2nd knee. All comments welcomed please.

 

[Josephine]

mbw - I feel for you. But I have to tell you that having a hip done is a whole different ball game than having a knee done. The hip is a much smaller joint compared to the surrounding mass of tissue than is the knee.

And did you know that the knee is the largest joint in the body? This brings with it all sorts of other parameters and difficulties - more healing to be done, for starters. So you cannot and should not be comparing the two - not no way!

The function of the knee is different as well which is why it seems so tough to get going and keep it going so it improves. Oddly, the need for a manipulation post op is much more prevelant in rheumatoid patients than in patients with osteo-arthritis because the RA is a disease and affects the soft tissue as well as the bone. OA is a degenerative condition which mostly only affects the bone and immediate soft tissue like the cartilage and cruciates.

Therefore, I am urging you to despair not. Recovery is going to be protracted a) because it's the knee and b) because it's RA>

Were/are you on steriods? That can have a profound effect upon healing and rehabilitation as well. If you read through the threads in this section, you will find many who have trod (pardon the pun!) the same path and what they have done to ease things for themselves.

I'm sure once you've had the manipulation done, you will find it a lot easier. Till then, don't give up. Things will get better but slowly.


I advised my sister to keep a daily journal of her condition and you know what? In only three months she was looking back and realising what improvements she had made after all!

Please keep in touch and let us know how you are doing. I'm sure others will chip in here and give you the benefit of their experience.

All the best
Jo

 

[amyk]

Dear mbw43,

I just had my knees (both at once) replaced almost four weeks ago. I only have OA - I say "only" because I have read alot of stuff about RA being a harder recovery. But I am writing because I too have had issues with depression. Being an emotionally high strung person, I wasn't surprised - typical Amy, I figured. But my friend ruptured her achilles tendon right around the same time of my operation. She NEVER gets depressed. I just spoke with her yesterday and was shocked to hear her telling me how depressing the whole reality of being disabled is, and how unpleasantly surprised she is by these blues. And my other friend has had a hip replaced that healed very slowly and also experienced terrible bouts of the blues. Last week I had the weeps every morning. Yikes.
So PLEASE know you are not alone! It is very common. Also very commonly denied or disguised by patients, because often folks in rehab are already feeling growing selfconconciousness about their constant need for help help help.

You will feel better - have you tried doing a little excercise for your upper body? Sometimes getting the blood pumping helps, even if it isn't officially rehabbing your knee!

 

[mbw43]

Hi:
Thanks for the reply. I had my second knee done on 9/12 - 1 month ago and depression was a big part of my recovery. I was physically weak for the first week and I was crying almost all day. Fortunately there was a psychologist on staff at the rehab center and she was very helpful to me. Also for some unknown reason my welbutrin meds were reduced from the regular dosage. So putting it all together - the fatigue, loss of blood, pain, incorrect meds equals disaster for me. Fortunately I turned it around with the help of family, therapist and meds and recovery has been fine ever since.
Buy you're very right, no one discusses the depression that goes along with these types of surgeries.
Hope your recovery is going well.

B

 

[Josephine]

Good to hear from you, mbw43. And wonderful to know that you have come through in the end. Well done you!

 

[Dixie]

I would think that some kind of anti-depressant might be in order during your recovery period. Talk to your doctor about it....a new joint is a major and difficult life change. Depression could easily settle in amidst frustration. My doctor has told me there's no reason I should not double my Celexa (20 MG) if I become depressed during the early healing period. I know it's going to be rough but I am trying to make sure that I have everything available just in case. Good Luck!

 

[Sue]

Josephine, your suggestion to keep a daily journal is a great one. I was going to post something today about that very topic.

My best friend had two knee surgeries (TKR and a revision) before I had my surgery, so I have been relying a lot on her for advice and support. She suggested I keep a little notebook of my progress, starting at the hospital.

I am so glad I did this! I'm three weeks post surgery now, and there are up days and down days. The notebook helps to remind me on the bad days that it's not all bad.

In fact, I've begun to see a very definite pattern. Every time I get a little bit more mobility (such as moving from walker to cane, or starting to use the stairs), it's very uplifting, but then I invariably have an increase in knee swelling and pain that night and sometimes into the following day. So I can see how very easy it is to overdo things and how important it is to act with moderation.

Anyone who hasn't yet had their knee replacement or who has just had it--I'd strongly suggest you start a little journal. It definitely will help you deal with some of the emotional ups and downs.

Sue

 

[Cathie]

MBW-
When I read your post, I was amazed. I was trying to say just that in a previous post, but seemed to have missed!!! I have been very depressed myself. My right knee surgery was 10-12. While doing in-home therapy, 2 weeks into it, my PT told me to go ahead and cry and I just burst out in tears. unfortunately, it continues to this day. I feel I should be further along than I am, and expectations are too high. My PT believed that because I am a middle aged woman, who was constantly on the go in spite of knee pain before surgery, that this sudden halt in life takes a huge effect on me. My house is not as clean as I would like it and that frustrates me. My boss is awaiting my return to work, fortunatley she is patient. The doc told me 4 weeks - but that is NOT going to happen. More frustration. I am trying to keep myself busy doing little things each day and then exercizes and rest.
Sound familiar???? I think we are in similar situations, as others may be. It helps to know I am not alone in this.......thank you for your post.....it hit home with me....

 

[Sue]

Cathie and MBW,

I can totally relate to these feelings, too. My surgery was on 10-18. I kind of hit the wall emotionally a few days ago. I was just DONE with sitting around trying to keep busy when I would rather be back in the swing of life. But I can't be fully back in the swing of things yet, so I'm having to take baby steps. It is very frustrating.

I don't know if anything that I'm doing would be any help to anyone else. But I did find some help in talking to my family about my feelings. I told them that I'm bored. (I am the queen of telling my children, "Only boring people get bored," so they really teased me royally about this!) And they are stepping up and helping me with my boredom. My daughter said she would help me get back to selling on eBay and Amazon (I had to put my stores "on vacation" for surgery)...she would help with the packing and take the packages to the Post Office.

I also started making more phone calls to friends. It's been my experience that when I'm in my own head too much, it helps to find out what other people are doing.

Hope something helps!

Sue

 

[Josephine]

Post-op blues is so much more common than people give credit for. I just posted this elsewhere but think it might be useful here too.

It's very natural to get the post-op blues. Time when you feel life's a bit of an anti-climax. You spent all that time getting hyped up ready for the surgery, planning, creating expectations and day dreaming how it would be when you had had it done and could get on with your life. Yes? And now you are in that boring, depressing "holding pattern", a kind of plateau where nothing seems to be progressing.

But it is.

Deep inside your knee, the tissues are healing, getting used to the presence of this foreign body. The bone is healing. The ligaments are adjusting to the realignment of the knee structure. They need time to do all that. Just rest, do your exercises and relax. And be prepared for that day in a few months time when you get up one morning and realize that the knee op wasn't the first thing you thought of when you woke!! Then you'll know it was all worth it.

 

[lindaolson65]

Hi, MBW!

I had my TKR the same day you did (I'm 60). I've worked in orthopedics for years and had the advantage of following a lot of patients during their postop programs, plus I have many friends who've already been through this. The one ongoing theme was rehab, rehab, rehab! I work on my flexion throughout the day, as well as strength, balance, gait, etc. It takes tremendous dedication and commitment, but I do believe it's worth it. It does require working through discomfort, but it does pay off.

I'm hesitant to share this with you because it's a good news/bad news sort of thing. but I, too, struggle with night pain. I get to sleep just fine, but when my body wants to shift positions, the pain of movement wakes me up instantly. The good news is, apparently this is quite common. The bad news is, it can go on for months! But knowing that it IS normal helps me cope. Like you, I find it difficult to find a comfortable position. Sleeping on my back with my leg straight is most comfortable, but eventually I simply have to move. I also have sleep apnea, so sleeping on my back is the worst position possible, but I manage. Definitely challenging! So I still wake up 7-8 times a night due to pain.

Bottom line, I share your issues in the sleep department, but I know it will get better. One thing that has helped me (because I didn't want to stay on the Ambien and narcotics my doc prescribed to me for this long) is taking timed-release melatonin at night. I actually take it with Excedrin PM and find I sleep longer between bouts of pain. I moved a small frig into the bedroom next to my bed and keep a gel pack in the freezer section. During the night, when the pain gets bad, I grab the gel pack (mine is an Elasto-gel, which totally wraps around the knee) and ice/elevate (ABOVE YOUR HEART) right there in the bed. I also find that getting up and walking around helps a lot. It's the static position of the knee for long periods of time while asleep that seems to create the pain response.

BTW, I have found the stationary bike to be a huge help, not only in loosening up the knee and building strength, but also in improving/maintaining flexion. I find I start out rather stiff, but after 20-30 minutes on the bike, I have much better flexion.

I hope the above helps. It's a slow process, but I have noticed steady progress - probably because I've made a daily rehab program my top priority and literally spend hours a day working on it. I have no doubt it will pay off in the long run. FYI, I find there are days when I get discouraged, too, so don't get the impression I have found this easy either. In fact, I posted a question to the masses regarding medial knee pain that I've been battling.

Wishing you all the best -

Linda

 

[Josephine]

Hello, Linda! Sister ortho nurse! Great to see you

 

[Sue]

It really helped me to hear what you're doing to deal with the pain at night, Linda. I am also waking up with pain. I find that it is mostly due to stiffness from sleeping in one position. It's a less severe pain than I get when my knee really swells up from overuse. And I can usually deal with it by getting up and moving around a bit. Sometimes I use one of those one-use disposable chemical cold packs that you can get at the pharmacy. (Rather than go downstairs to get ice out of the fridge!)

I am looking forward to the day when I can just turn over and get in a more comfortable position, like I used to be able to do! But until then, I seem to have to get up to work the kinks out instead.

 

[torktoo]

WOW, this forum is exactly what I needed to read! My husband suggested I try to find a forum regarding TKR recovery and this is the best. I, too, am 43 and just had my right knee done 10-16-07. I was not prepared for how painful and seemingly slow the recovery is. Also, before this forum no one had told me anything about the night pain or the depression that has hit me so I thought I was going through something no one else had dealt with. Plus, 4 weeks seems like such a long time of recovery to everyone who hasn't had this done so I started feeling guilty that I was still needing help from people (I'm not driving yet) and that I am still in pain quite a bit of time. My therapists say I am doing very well in my recovery but I never had a time frame given to me of when to expect to feel a whole lot better. Before the surgery everyone kept saying "you're young...you'll breeze through this" so I expected to be "up and running" pretty quickly. My surgeon finally told me at my 3-week post-op visit that the recovery is actually a lot more difficult for a younger person because the bones are more dense and have more blood and that causes swelling and that there is more muscle that is cut through and has to heal. I wish I would have known that before so I could have been more mentally prepared. I appreciate reading suggestions on dealing with the night pain. I am still taking a Percocet before I go to bed (with Melatonin)and then usually waking up between 3-4 a.m. and taking another Percocet. I was concerned that I still needed pain pills at 4 weeks post-op but the physical therapist didn't seem to be concerned. My hardest time seems to be evening-night. My right foot/ankle/leg get so restless, like the nerves are just going haywire. I get stabbing-type sensations right on top of my incision. I'm wondering if anyone experiences those same feelings. Thanks for a great place to vent and learn!

 

[Josephine]

Hi, torktoo, and welcome to the forum! Always nice to know we are meeting people's needs.

And yes, all that you are describing is pretty much par for the course. Sadly some people's pain persists for a long time though that is more often the exception than the rule. What is not fully understood is that the knee is very nerve rich and therefore the aftermath is not like having an appendix removed or even a hip replaced.

Also, being the largest joint in the body, it takes a lot of adjustment for it to change from the mechanics of the natural joint to the artificial one. The stresses that are placed upon it during that rehabilitation period are what accounts for a lot of the pain and discomfort but no-one can predict how long that period will last. The answer is "keep taking the tablets" and, of course, the ice packs. It will get better eventually but in its own time.

 

[Sue]

I'm glad Torktoo brought up the topic of pain medication. It's been wearing on my mind a lot that I'm still taking Vicodin frequently, one month after my right TKR. My physical therapist wants me to take it before my PT appointments. Then after the challenging workouts, I am sometimes in a lot of pain, so I end up taking more medication later in the day.

Also, even on days that I don't have PT appointments, if I get out and do anything, I am really sore afterwards and sometimes take some pain medication.

My best friend had a knee revision two weeks before my TKR, and she only had to take pain meds for two weeks after surgery. We were discussing pain yesterday, and, to her, if it's only achiness, not sharp pain, she can tolerate it. I wish I could say the same is true for me!

I always try to alleviate the pain with ice and elevation first. And I also try to keep my mind active with something that will distract me from the pain, such as a TV show or an audiobook. But if I've done all that, and I still feel lousy, I go ahead and take some Vicodin.

My surgeon is a pleasant enough guy most of the time, but he has told me that he is in the business of surgery and not pain management. So I am sure that I have gotten my last refill of Vicodin from him.

We changed insurance recently due to my husband retiring, so I have a new primary care physician, but I don't know her very well and she doesn't seem like the sort of person who would be willing to help me with pain over the long term as I recover from this knee surgery.

So on Monday, I am going to call the Pain Clinic at the local university to see if I can have someone work with me on pain as I continue to work really hard at my physical therapy. My surgeon suggested the Pain Clinic--he was kind of looking down his nose disdainfully as he said it, and he said something about it being for people who were addicted.

I am not so worried about addiction as I am about how I am going to really work hard at recovering if the pain is stressing me out. I've had various surgeries and arthritic problems in the past, and every time I've needed to take pain medication, I've been able to stop when the pain was no longer a problem.

I also have 17 years of sobriety in Alcoholics Anonymous, so I'm really aware of the issues, signs, symptoms, etc. of addiction. I think I'm on safe ground with the way I'm currently taking the meds. I never take more the prescribed amount and I only take it when I'm really hurting and after I've tried other things first.

Anyway, I guess I just wanted to talk about this and maybe get your feedback, Josephine. My husband (remember him? Mr. Denial?) thinks I will probably be all better by the time I run out of my current prescription of pain medication. I could really identify with Torktoo's frustration...people saying that you're young so "this will be a breeze." This is definitely the hardest physical challenge I have ever faced--harder than the 3-day labor I had with my youngest child. I really want to do my best at the PT, and, with my therapist's guidance, I am also starting to work out at the gym and in the pool again this week.

 

[Josephine]

Gee, I am now going to tell you something that might upset or encourage, I don't know but I think you should hear it. My sister - the one who had her knees done 22 and 14 months ago - is still in extreme pain with both her knees. We (that is she, her surgeon, her GP and I) are all perplexed. I have worried my head around this all ways come Christmas and cannot come up with a single answer. Initially I thought it was due to the fact that she had so much deformation and shortening in her knees that the ligaments and general structure were having a tough time adjusting to the restoration of the natural length and structure. But were that so, it should be diminishing by now, I would have thought. My latest 'theory' is that she is having some kind of hypoallergenic reaction to the metal but that is so rare as to be unlikely and anyway, she's not the allergic type.

She also has an old lumbar injury (at 16 - she is now 75) for which she has taken dihydrocodeine for years as a result of which, her GP has decided that she is addicted to them! So, though she has discovered that diclofenac helps her greatly, he won't prescribe them and dihydrocodeine! Sympathetic, huh!? So I managed to wangle her some over the internet (ssshhh!!) and she now has some relief. (Doubt I will be able to do it a second time, though)

I advised her to keep a journal some months ago and to grade her pain scores 1-10 each day.She has done that and says that over a period there seems to be a marginal improvement but then it goes right back to square one again for no apparent reason. She has a dog that she walks 4-5 times a day and has never let pain stop her from doing anything. She still acts as a labourer for her son when he is working on the extension to their house!

But you are right, doctors are not at all helpful sometimes and I might suggest that, in the case of your os, it's probably because he's at a loss what to do! I do know of others who have long term pain for a whole variety of reasons known but many, many more unknown.

It's a real mystery that almost never happens in any other joint replacement.

 

[Cathie]

Last night was the first night I slept thru the night, til hubby got up and made tons of noise!!! But, I thought maybe this would help someone. I have been sleeping on a recliner for the past few nights after trying to sleep in a bed. I also took 3 tylenol before I went to bed. For some reason, not being totally flat in bed seems to help.

As for the pain meds, my doctor told me at 4 weeks that they will not refill the pain meds (I am on Norco) after 6 weeks, which is coming rather quickly. So I only take them before I go to PT. The problem I see here is that he wants me in PT for a while yet, so that may pose a problem. I wonder if these doctors know just how much pain is involved in this rehab.

 

[torktoo]

Congratulations, Cathie, on your night of sleep! Saturday I slept from 10 p.m. until 6:30 a.m. and felt like a million dollars! I did have to take a pain pill at 6:30 but then I drifted back to sleep for a little while longer. Unfortunately, I was back to being up all throughout the night last night. I think I'm going to try your suggestion of sleeping in the recliner tonight and see if that leaves me less restless. Also, I am going to try to go to bed with over-the-counter pain relievers and just keep the Percocet for PT.

 

[lindaolson65]

Hi, all! I'm the 3-month+ postop TKR with the tibial pain, and I have a theory about the night pain that may or may not make sense. Since I, too, have problems with positional pain during the night (even now), I can totally relate to your frustrations. I find as soon as I get up and walk around (which I do multiple times during the night), the pain immediately goes away, so I'm wondering if this all may be related to circulation in the limbs. Given the immobility while asleep, and the sudden pain with motion, I suspect the joint is accumulating more fluid while still, and once I get up and moving, all is well. Doesn't help with the solution, other than getting up and walking around to loosen everything up.

As for meds, last night I had to take a couple Darvocet because the pain was so severe, so I can relate to your concerns. But as a rule, I go to bed with 2 Excedrin PM and timed release melatonin, which does seem to help. I found the pain episodes were basically the same whether I took the above or the Darvocet, so why use the latter? Only in severe cases, like last night, will I resort to Darvocet.

To help with the pain, I also use pillows for support of the knee when I lie on my side, although my best position is on my back with my leg elevated on pillows. I find pillows help relieve the pressure on the joint.

I'm one of the fortunate ones with a good doc (who's very kind) and former orthopedist clients who are good resources as well. They've all agreed that the night pain can go on for months and months and eventually will resolve, and it's just a matter of patience. That's easy for THEM to say! But since it's normal, I feel a lot better than if this was an unexpected development.

Whoever told you younger patients that a TKR will be a breeze clearly hasn't had a TKR! I think it's cruel to give people false expectations before surgery. I'd much rather know what I'm in for so I can prepare mentally and physically!

If any of you are having deep pain in the tibia as I do, I have found that when it develops, I do best getting off the leg entirely and icing and elevating. This pain evolves in late afternoon and continues through the evening, but I'm finding it better if I avoid walking on hard surfaces and restricting my workouts to the stationary bike (which is far gentler on the joint), rather than using the treadmill or ellyptical machine. My doc said that the bone can take a year to adjust to the components, so, again, it seems a matter of patience and listening to your body. Don't do activities that exacerbate the symptoms. So I've cut back on my walking and focused on the bike. Perhaps that will help you, too.

Hope this helps.

Linda