TKR 6 month pain and blues

[Enzo]

Hi everyone, I had a total left knee replacement on October 20,2023. First month or two were hideously painful but I managed to deal with it and have made seemingly great progress. The swelling has finally subsided and my range of motion is now about 120. At about 4 1/2 mos out I finally had a week or two where I felt almost no pain, just slight discomfort at times and had a string of nights when I actually slept pain free for 6 or 7 hours. My euphoria didn't last long however. For the last few weeks I have again been experiencing quite a bit of discomfort and pain, especially at night. A dull throbbing pain in the shin area....resulting in little sleep. Also, getting the knee "going" in the a.m is seeming like more of a struggle. I know from what I have read here and elsewhere that I should count my blessings compared to much slower recovery many have but I can't help but worry that something has gone wrong. Why am I now at almost 6 mos out in more pain and getting much less sleep than I was getting a month ago? Shouldn't recovery be more or less linear? I do have an exercise routine where I use the upright bike for 30 mins or so and use gym equipment to strengthen various leg, thigh and hip muscles and I am not doing anything more than I was 5 or 6 weeks ago so I don't think "over doing it" is the problem. Just surprised (and alarmed) that there seems to have been set back instead of a linear progression. Would appreciate any wisdom/insight, especially if others experienced the same and it turned out to be relatively normal and not a sign that there is something "wrong". Thanks

 

[WFD]

Shouldn't recovery be more or less linear?

Ah, no, actually. It can be two steps forward and one step back kind of thing. Someone will pop in with a graphic that illustrates it, I don't have a copy.

I am at 8 months and I cannot do half an hour on an exercise machine without crippling myself, but I am kind of a worst case example.

It seems likely to me that you are in fact overdoing it. I suggest you back way off for one week and see what happens. If you are overdoing it you are in essence halting your recovery and maybe making it go backwards, so a break might be very illuminating.

 

[mendogal]

Welcome to BoneSmart!

Yep, in my experience you hit what I have learned from observing many members is the danger zone of 3 to 6 months post op where folks taper off of rest, ice, and elevation and continue to make demands their new knees can't keep up with.

Progress is never linear and I'll explain why:

First of all, basic healing has to happen.

Second, during the long period leading to needing surgery, our whole structure - muscles, tendons, ligaments, and even bone positions relative to each other - was slowly and often not noticed by us (mal)adapting to that knees needs. Suddenly in the OR our body structure was reset. So at the same time traumatized tissues were healing, tissues that had grown constricted and short need to learn to relax and stretch while those that had become lax need to tone up.

Third, our evolving recovery means that we don't always know day to day what our new knee's capabilities are. It's therefore normal and natural that as we gain self confidence we challenge the knee. The problems lie in not respecting pain - it's one and only mode of complaint! and in no longer providing ample rest - a day off - for it to recover from a challenge or the ice and elevation to allow it to recover and be ready for more.

There's a good reason that strength training is not done daily - muscle undergoing strength training is literally being broken down and must have that day or days to complete a cycle of break down and rebuild.

There's a good reason that increases in activity, be it based on time, distance, resistance, whatever are done in small increments with a plateau allowed between increases.

 

[mendogal]

Welcome to BoneSmart! You are in the very early stages of an average of a yearlong recovery. I will leave you our Recovery Articles that have helped tens of thousands of other knee replacements. We are here to help you through this journey the best we can. The very best thing for your knee right now is to rest, ice, and elevate. Exercises can come later. There is no rush to achieve ROM because it will come naturally as your swelling decreases. Your OS was able to bend your knee while checking for movements during your surgery, so it will be fine. It just takes time.

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 GUIDELINES

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.

If you want to use something to assist with healing and scar management, BoneSmart recommends hypochlorous solution. Members in the US can purchase ACTIVE Antimicrobial Hydrogel through BoneSmart at a discount. Similar products should be available in the UK and other countries.

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.

 

[Enzo]

Thanks both above for responding! I think I assumed that since I had not really increased the demands I was putting on my knee from month 4 until now that it must be something else... that dreaded something else we are forced to think about while we can't sleep because of the pain. So easy to start think of infections,dislocations,etc!
I am guilty of cutting out the ice and elevation once I had a week or so of real sleep though.
I am going to stop with the bike and the machines for a week or so get back to elevating and icing and see what happens.

 

[Layla]

Ah, no, actually. It can be two steps forward and one step back kind of thing. Someone will pop in with a graphic that illustrates it,

I am going to stop with the bike and the machines for a week or so get back to elevating and icing and see what happens.

Let us know. I'm betting it will help. Have a great day and weekend!

 

[Loulou67]

Hi Enzo….. we are TKR twins!!! I had my left TKR on 20th Oct too !!! I totally get where you’re at, and why you’re concerned…. If you read through my thread you’ll see my ( many) ups and downs….. only a couple of days ago I was worrying over the same thing…. Have I gone backwards, why am I now feeling pain and stiffness again??? I guess we have to keep going, go back to icing and elevating and have faith that by Oct 20th 2024 this will all be a distant memory…. Good luck and keep posting….. this site has been a tremendous help to me

 

[Enzo]

Hi Enzo….. we are TKR twins!!! I had my left TKR on 20th Oct too !!! I totally get where you’re at, and why you’re concerned…. If you read through my thread you’ll see my ( many) ups and downs….. only a couple of days ago I was worrying over the same thing…. Have I gone backwards, why am I now feeling pain and stiffness again??? I guess we have to keep going, go back to icing and elevating and have faith that by Oct 20th 2024 this will all be a distant memory…. Good luck and keep posting….. this site has been a tremendous help to me

Thanks Loulou ! It is very helpful to hear from and read of other's journeys and I am especially glad to have found a twin ! For some reason(even before the TKR) my mind seems to always slide towards the worst case scenario. I find it hard to fight that. I am not really a negative person but I have to know what's going on, research everything to death and be prepared for the worst.Drs don't seem to help much because it seems they downplay the whole process and then just say everything is normal. I wish I had found this sight earlier in the process...even before the surgery. I would have been more realistically prepared.