TKR 5 weeks out from right TKR

[Donkfish]

Hi all. New to the forum and just wanted to share my experience. 62 year old guy here, I had right TKR on March 15. So far, my recovery has been really smooth. There's a lot written here about pain management, so I guess I've been extremely lucky. I've had virtually no pain the entire time home. I took 1 tramadol the first day home from the hospital, and 1 oxy that night to make sure I slept, and that's been it. I came home with the On-Q nerve blocker, and that lasted about 4 days. I was worried when it ran out that it was going to start hurting, but it never happened. Mostly I've had stiffness and discomfort, and I found that icing worked really well. I probably iced 3 or 4 hours a day, and it really helped. I had one bad day when I thought about taking a pill, and that was after I overdid it in PT at the 3 week mark. I definitely agree with the Bonesmart approach. Pushing won't help, it only hurts. It's not rehab, it's healing, and your body knows how to do that.

The knee was swollen, but not terribly so. I got to 90 degrees on day 3, and 115 after a week. The therapist said this was pretty quick. I got off the walker after about a week, and stuck with the cane until the end of week 3. I'm still stiff and still limp, but every day is getting better. I have to go down stairs one step at a time, but I can go up normally. I'm a golfer, and have been chipping and putting for about a week. I'm hoping I can play a round in a few weeks, but it just depends on if things continue to progress well. Today I did a 15 minute peloton low impact ride, and in a couple of days I'm going to try 30. I might regret it, but I'm gonna give it a shot.

One thing I found interesting was my 1 month follow up with the surgeon. He took a look at the x-rays, scar, swelling, and range of motion and told me I was "done". He said I hit every milestone I needed to hit, that I could stop PT and just get on with my life. I still have some healing to do, but my body will do that on its own. He said I won't hurt the knee no matter what I do, and I can and should do whatever I can tolerate. Was pretty surprised to hear that, but it sounds like it's aligned with the Bonesmart approach. I told him about the lack of pain and he said it was unusual but did happen. He asked me to share my recovery thoughts on his website, because he finds a lot of people are very afraid of the recovery and put the operation off too long, and that maybe if they see that it's not always terrible they'd find it encouraging.

Anyway, sorry for the rambling, interested to hear any thoughts you might have.

 

[Layla]

Hello and Welcome to BoneSmart and recovery. Thanks for joining us!
It sounds like you‘re experiencing a great recovery so far. I will mention that we do suggest you use an assistive device until you’re no longer limping. Here’s a tip -
Try heel-toe walking when you're limping.
This involves striking the ground with your heel first, then rolling through your heel to your toe, and pushing out of the step with your toe.
It takes a concentrated effort, but I believe you'll notice a difference. Give it a try.
Here is a visual on heel-toe walking -

I still have some healing to do, but my body will do that on its own.

It can take a full year for complete healing, for some even longer, so its refreshing that you realize that. As far as the Peloton, rather than ramp it up to 30 mins after doing fifteen, are you able to increase it gradually instead, so you don’t overdo it and stall your recovery? Just something to consider.

I’ll leave our Recovery Guidelines with best wishes and hope you’ll continue to share your healing journey with us! Stop back often, we’ll be here.

Knee Recovery: The 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
6. Access these pages on the website
Oral And Intravenous Pain Medications
Wound Care In Hospital


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.

 

[Jockette]

He said I won't hurt the knee no matter what I do,

Hi and Welcome!

You won’t hurt the new joint, but you can still upset the soft tissue that can take an average of a full year to heal.

You are very blessed with the recovery you are having. Just be careful, setbacks can happen when we feel great and then we do more than the healing knee likes.

Thanks for posting such an encouraging experience!

 

[glidefloss]

Wow, @Donkfish !! Excellent results! Though it's be wishful thinking to have my own recovery be as smooth, it's great to see that it's actually possible.

All the best on a continued smooth road forward!!

 

[InkedMarie]

It sounds like you’re doing great! Please keep us updated

Marie

 

[Donkfish]

Now a couple of weeks later, so 2 days short of 7 weeks since my surgery. Everything feels pretty good, my major issue is just what I'd describe as tightness. I have good range of motion, but it's not loose and natural yet, kind of like a hinge that needs oiling. Strength is coming back. I can go up stairs normally now, but I still have to single step it down. It's a lot harder to gradually lower myself on the bad leg. Lots of noise and clunkiness also, but I guess that'll probably pass. I can sit in any position for as long as I need to, it's just that when I get up it can be pretty stiff until I walk it off. Walking itself is no issue. I walked over a mile a week and a half ago with no problem at all, and am now starting to walk the dog. I was a little concerned because he's big and strong and pulls on the leash a lot, but even when he pulled I was able to pull back with no problem. Relied more on my good leg, but the bad leg was still pretty strong.

I'm excited because I'm going out golfing today! Riding in a cart, of course, and I'm only going to hit short shots, 100 yards or less, and swing easy. If it acts up I'll switch to just chipping and putting, but I'm hoping it holds up.

Thanks for all the advice and good wishes. Great site, really helpful.

 

[FourCats]

It sounds like you’re on target in this lengthy recovery.

 

[sistersinhim]

It's not rehab, it's healing, and your body knows how to do that.

What an accurate statement.

I could stop PT and just get on with my life. I still have some healing to do, but my body will do that on its own.

Yep, another sensible attitude.

it's just that when I get up it can be pretty stiff until I walk it off.

That stiffness is normally the last thing to go. Swelling causes a stiff feeling. Even if you can't see outside swelling there's probably still inside swelling. There's not that much room inside that knee capsule, so the fluid makes movements harder. Ice and elevate to get the swelling down and it should help.

 

[Jockette]

In addition to swelling causing stiffness, stiffness is also a normal occurrence after this kind of major surgery. Your surgeon did major carpentry work and disturbed every millimeter of soft tissue in this area. You aren't tight because your muscle is underused and needs to be stretched and rehabbed. You're tight because your tissue is healing...and full healing takes a full year or more.

 

[Donkfish]

Had a pretty big setback today (Friday). I've been going to PT still, focusing on quad strength. I feel like it might be helping, and haven't had any pain. Wednesday we did a lot, but when I left it felt good. Yesterday I walked 3 miles total in 3 separate walks, and also stood on my feet for about an hour and a half. The walking wasn't in an effort to work it, I just had places to go and thought I could handle it. I felt ok until today. Today I feel like I'm back at week 2. Lots and lots of pain when I bend it, I can't go up stairs normally anymore, getting in and out of the car is agonizing, etc. If I twist it at all I get sharp, shooting pain. Funny thing is I don't have any extra swelling, and in fact its a little less swollen than Wednesday. I went to PT today but didn't do anything, just had a massage around the area. The therapist said she thinks it's all about the quad, that it's overworked, tired, and super tight, causing it to pull on the attachment point. She thinks the pain will go away when the muscle rests and recovers. I don't know if this is right but it makes sense to me, I probably just overdid it. My quad definitely feels fatigued. I'm not doing anything for the next couple of days and hope that takes care of it. She recommended rolling and stretching the quad, and I might do that. Pretty frustrating, but hopefully temporary. The other time something like this happened was week 3, and it recovered after a few days of rest.

I know it has to heal on its own, but I do feel that if it doesn't hurt, working it should be helpful, or at least can't hurt. I guess the issue is that you sometime get a delayed reaction. We'll see what happens, hopefully tomorrow is a better day.

 

[FourCats]

It sounds like you’ve joined the ODIC (over did it club) which I’m a frequent visitor. Your knee is probably swollen so you might try elevating and icing.

 

[Donkfish]

Yeah, I think so. Hopefully a couple of days of rest get me back on track. Funny this is, it's not any more swollen than usual. But I have fired up the ice machine again. That really helps me with the pain.

You're about a month ahead of me. How's your recovery going?

 

[FourCats]

@Donkfish I’ve been having some pain in both knees (first one a year old) which I attribute to yard work … visiting the ODIC too often! Last fall I was not able to tend to the leaves and garden clean up so I’m trying to catch up while doing spring tasks. OS put me on meloxicam last week to see if that helps at all.

 

[kneeper]

As you've learned it is so easy to overdo when you're making progress overall. So often you feel pretty good at the time and pay for it later in the day.
Generally a day in the ODIC just leads to a day or two of TLC and then you're back on track, having learned to go a bit easier the next time. It really is trial and error.

 

[Donkfish]

Yesterday was my 10 week mark. I've completely recovered from my stint in the ODIC, and I've been golfing. 2 weekends ago I did 9 holes, and was pretty sore and tired by the end. Biggest issue was my quad - it was really tired. I couldn't have gone more than 9 holes if I wanted. This past weekend I tried 18 on Saturday, and it went fine. So I tried 18 on Sunday, and it went fine. So I tried 18 on Monday, and it went fine!. Still some quad fatigue, and I can't rotate back on my leg as much as I'd like, so it's affecting my swing a little. But I'm able to play, and each following day my knee and leg felt a little stronger than the day before, so I think it's helping the recovery. I think that's pretty good for 10 weeks out. It's good to come here and read through this thread, because it makes me realize how much progress I've made in the last 3 weeks. Just going day to day I tend to focus on what I can't do, but looking back I'm so much further ahead than the last time I posted. So still a ways to go, but I'll get there.