TKR 6-7 month appointment coming up

Smilechild

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Hi all. I had my TKR on Jan 3, 2022. I had ACL reconstruction about 25 years ago and a meniscus clean-out 3 years ago. The main reason I scheduled my replacement this year is to be able to focus on celebrating my daughter at her wedding in November - not my knee pain. I had expectations of a quick recovery as I'm not overweight, rode my bike almost every day, and did other quad strengthening exercises pre-surgery. I have a cementless knee which was not discussed pre-surgery.

The surgery went fine. Swelling went down pretty quickly. (At least I gathered that from early appointments.) I have full range of motion and actually achieved flexion pretty quickly compared to many and maybe by 3 months I had my extension in a good place. I have been doing aquatic PT for a couple of months now following traditional pt prior to that. I still have swelling in the bursas - most predominant is pain and tenderness in the "Goose Foot" (Pes Anserine), but also behind the knee and lately pain below the knee cap. I was given a cortisone shot in that bursa at maybe 3 or 4 months which really gave me little to no relief that I recall. I hear loud and clear on this forum that icing, elevation and rest are the big three to recovery, and I agree. I'm just not consistent with it unless I find a good book to read. I'm a bit ADHD, so I am not one to stay in one place that long.

Stairs in particular are still definitely pain producing and difficult due to stiffness. After the failed relief from the cortisone shot is when I began working exclusively with the current PT who identified the main source of pain, began taping the area and got me in the pool. The tape is on the bursa in a starburst pattern. When it was first done, I got amazing relief. My knee even cooled off (it's still usually fairly warm to the touch- but that's been improving over the past week) which thrilled me. Progress! But you can't stay taped up as it will weaken the skin, and it of course didn't actually give me a pain-free knee. But it did enable me to be more mobile. My daily home exercise is hamstring stretching, quad sets, and raised leg, all with a flexed foot. And I've been going to PT 3x a week since the beginning. I also ride a 3-speed cruiser bike for 30-50 minutes - to get my heart pumping! Walking for exercise is more painful, so even taking the short steps and rolling the foot that are recommended.

So my question to this forum is what questions might I need to ask the surgeon or his PA when I see him in a couple of days? I don't think cortisone shots have ever been that effective for me, but have a suspicion he'll suggest that again. Oh, I don't take pain relievers much at all as they ramp up my already loud tinnitus. I've used CBD cream which gives some very temporary relief. Alright. That's about it. I'm going to ice and elevate now.
 

sistersinhim

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I think it's too soon to be expected to be pain free. This surgery takes an average of a year+ for complete healing. You are just a little past the halfway point. We recommend you cut back on all those activities. They are keeping your knee inflamed. Even though your surgery was in January, I'll still leave you your very own recovery articles. These will give you an idea of what is normal and what isn't.

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: The Guidelines

1. Don’t worry: Your body will heal all by itself. Relax and let it. Don't try and hurry it, don’t worry about any symptoms now; they are almost certainly only temporary.
2. Control discomfort:
rest
ice
take your pain meds by prescription schedule (not when the pain starts!)​
3. Do what you want to do BUT...
a. If it hurts, don't do it, and don't allow anyone to hurt you.
b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again for a few weeks.
4. PT or exercise can be useful BUT take note of these
5. Here is a week-by-week guide for 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.

Try out our great new opportunity to improve your gait. It's OneStep. It's free and you will find it to be a huge help to you. Click here: OneStep
 
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Smilechild

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I had my appt this morning w dr and he didn’t seem too worried about where I am, so I’m going to try to let my worries go. He encouraged me to take Aleve regularly. Interestingly, he said it’s best to stay upright for 30 minutes after taking it to reduce possibility of stomach ulcer. Never heard that. He recommended staying active but not to overdo it.

So I’ve taken it sort of easy today until I did my bike ride. I didn’t realize just how much it actually hurts after awhile so I’m going to back off on my time with that. It hurts mostly as I come over the crest on the stroke and the skin feels so tight at that point! It actually feels that way daily at full flex. Does that ease up?
 

2chains

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@Smilechild You are a few weeks ahead of me in your journey! I also was very active prior to surgery and very "surprised" at the speed of recovery. In my rehab I continue to do more cycling as the walking is still painful even for a short period of time.
Sorry to hear cycling is bringing on pain for you. A 3 speed cruiser sounds fun I hope you can adjust your time and still continue to enjoy it!

I have skin tightness in the knee when cycling but not full on pain.
My doctor mentioned staying hydrated but also to use a dry skin lotion. Have you tried applying lotion to the knee? I have been applying lotion once a day but also massaging the skin. I definitely notice when I miss a day or so as I am in a very dry climate...Alberta, Canada.

A heat pad with moisture feature is also something I use 30 mins before cycling to loosen things up. It is similar to what PT applies at the onset of my visits and found it works for me!
 

sistersinhim

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It hurts mostly as I come over the crest on the stroke and the skin feels so tight at that point! It actually feels that way daily at full flex. Does that ease up?

That pain and tightness will go away as you continue to heal more. I, too, enjoy bike riding and couldn't wait to get back to it. I started back very slowly eventually working up my times as my knee allowed.
 
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Smilechild

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@2chains Thanks for those suggestions. Particularly the moist heat prior to cycling. And extra moisture. I’ve been trying to be more diligent w hydration. Early on in recovery I was steady drinking water, but as I’ve gotten busy with life I’ve slacked off a bit. I stayed off the bike yesterday. If it’s not too cranky later today I’ll do a much shorter ride
 

MaryCat

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@Smilechild we had our TKRs about the same time. I’m a little frustrated too that healing is taking longer. On my feet all day, lots of steps, and a few hours in start to lose my ROM and knee stiffens. Also a bit warm to touch.

In the meantime just trying to do what works for the knee and gets me closer. Without aggravating it too much- working 3 days a week instead of 5, losing almost all of the weight I put on after surgery. Aqua therapy 3x a week in our pool. And icing/elevating daily.

Also trying an anti-inflam haven’t used before- meloxicam. Celebrex wasn’t helping.

I’ll try the moist heat and lotion for sure. I have one of those cheapie Theragun type devices and use it with lotion on the soft tissue to help break up a bit of soreness.
 
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Smilechild

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@MaryCat Thanks for your comments! I have eased off the bike a little bit and and for the past couple of days have been doing more specific self-massage on the tender areas to try to loosen up scar tissue a bit. I think it’s helping, although it’s early in the day so I might think differently in a few hours. I’ve moved one of my exercises to the deep end of the pool - so that feels like progress. I’ve also been experiencing more pain on step ups in the pool, so am just slowing that down a bit. Trying to give more time to ice & elevate. My knee is actually almost cool to the tough this morning! That’s progress!!
 

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