TKR 8 months post TKR and still swollen

[armywife]

Hi Josephine,
Thanks for merging - I really should do this on the computer and not on my phone!

Here are my answers.
1and 2) my pain goes from a 1 to about a 4 (mostly pressure and throbbing). I was on Celebex twice daily - which was controlling the pain. Then I got stomach problems (to include vomiting, abdominal pain, nausea, gas, diarrhea). I can't tolerate much else than Tylenol. I do take a prescription for heartburn daily and have always had GI issues)

3 and 4) I ice 4 times a day for at least 40 minutes at a time. I lay on the couch and prop my leg up (toes above nose and knee just above my heart). This helps my knee but does nothing for my heartburn.

5) I am not doing much around the house AT ALL. My Mom is doing the cooking. I have cleaning ladies come every two weeks for the majority of the cleaning). I'm still not driving and haven't been out shopping at all. We go out to dinner about once every two weeks. I feel like I'm not doing enough at times.

6) I go to PT usually 3 times a week. I do quad raises, heel lifts, heel slides, very low hamstring extensions and low weight leg press. I do the bike for 15 minutes (slowly). None of this bugs my knee it mostly exhausts my quad muscle (which was seriously lacking after my 5 previous surgeries including a total of 12 weeks completely non-weight bearing) I do wall slides to gently stretch my ROM (I can get to 90 easily but not much past). My PT stretches me - to the point of discomfort not pain. She also works on sliding the patella (which does have obvious scar tissues issues). And moving the patella hurts. While at home, I mostly do stretches sitting in the chair rockingthe ankle as well as some quad raises and an occasional short walk outside.

That's about it!
Heather


I do feel like a slacker because I'm "supposed" to do these exercises every day at home, but, honestly, I don't.

 

[Jamie]

Don't let yourself feel like a slacker. You NEED a day of rest in between those exercises. All you should be doing on your off days are gentle bends and stretches and whatever walking you do to get around the house to fix something to eat or drink or to go to the bathroom.

 

[armywife]

I sure do wish I could pedal through a revolution on the bike....at 95 degrees I cannot do it yet.

I started off WAY back on the bike and have been able to move up. I actually like doing the bike. It makes me feel productive!

And I read the Bangor Daily News headlines on my phone every day! I'm from The County. ;-)

 

[armywife]

My off days definitely consist of sitting around or laying around - which is hard to do with a 5 and 8 year old running around the house and my almost 65 year old mother doing practically everything!

I keep thinking I will wake up one day and VOILA! All will be ready to go!

 

[Josephine]

I really should do this on the computer and not on my phone!

Yes I can always tell when people are working on their phone or tablet! That darned word autofill!

I ice 4 times a day for at least 40 minutes at a time

Ice more. Any time you are resting, watching tv or reading (even if it IS the Bangor Daily News!) have ice on it.

I lay on the couch and prop my leg up (toes above nose and knee just above my heart). This helps my knee but does nothing for my heartburn

You don't need to lay flat when you elevate. I never did (I have reflux too). See here elevation is the key.

So what are you doing for your reflux? You need to be pro-active about that. Are you taking lansaprazole (omeprazole) daily, twice daily? Taking anything else as a supplement? I take lansaprazole 30mg twice a day and any time I get heartburn I take a sachet of Gaviscon Advanced. This makes a 'raft' on top of the stomach contents and prevents it from regurgitating up into the oesophagus (gullet) which is not designed to cope with such intensely acid material, hence the burn. If you have persistent heart burn you need to tell your GP about it. And never ever take NSAIDS. Read this and see why NSAIDs, acetaminophen (Tylenol, paracetamol) differences and dangers.

I can't tolerate much else than Tylenol.

What else can't you tolerate- codeine, Percocet, Vicodin?
How much Tylenol do you take at a time (in mgs)?

I do quad raises, heel lifts, heel slides, very low hamstring extensions and low weight leg press. I do wall slides to gently stretch my ROM

Usually these are done in reps and sets - so many reps make a set and so on.
So how many reps and sets are you doing and how many times a day (or per visit to PT).

None of this bugs my knee it mostly exhausts my quad muscle (which was seriously lacking after my 5 previous surgeries including a total of 12 weeks completely non-weight bearing)
And moving the patella hurts

With that history it's not surprising. You've had a rough time of it, my dear.

I do feel like a slacker because I'm "supposed" to do these exercises every day at home, but, honestly, I don't.

If it's any consolation, I never did much either but then I never had previous surgery or a toddler to look after!
But you can read my (very short) recovery story here Knee recovery - UK style.

I keep thinking I will wake up one day and VOILA! All will be ready to go!

If only it were that simple! I'd be out of a job for starters!

 

[maryo52]

If I were your mom, I would love doing what she's doing. I'm 61, your mom is 65. It's an age where we discover all the ways we're not needed anymore. It's a gift to your mom! I would love to be running after grandchildren.

 

[armywife]

I have a script for Aciphex (rabeprazole) which is the only thing that helps my heartburn (and I love Gaviscon when I need extra help)!

I am only taking a 500mg Tylenol once in the morning. I can't take much for pain - everything except dilaudid makes me vomit. I think the Celebrex was really helping the knee discomfort but, once again, meds don't like me much.

At PT - I do about 3 sets of 10 reps of each exercise (well, mostly about 2 sets to be honest). I don't do any real sets at home on non-PT days. Sshhh

I'm going to a military formal ball on Saturday - wearing a long dress and compression hose under it. Hubby bought me a "dressy" cane (black to match my dress as my cane is wooden). I even ordered ballet style slippers (and I do mean slippers as in house slippers) to wear! Not much dancing for me. Usually these functions involve lots of drinking and dancing. I'm nervous about having any alcohol. I'm already a bit tipsy when I walk! ;-)

and my Mom/Grammie is amazing. But I'm sure she's exhausted. We always joked that I was 41 but my knee was 91. I think her 65 year old knees are closer to 40!

 

[Josephine]

I am only taking a 500mg Tylenol once in the morning.

500mg of Tylenol really isn't worth the bother. Proper pain management only kicks in with 1,000mg.

I don't do any real sets at home on non-PT days. Sshhh

and no 'shhh' about it!

 

[kgang1957]

8 weeks today RTKR and just finished the best PT session I've had in weeks and it's all because I listened to everyone and read everything on this site about what is not "normal" pain, i.e. stiffness, tightness, etc. I just couldn't justify taking narcotics for this, but I did suffer from it from time to time. So today I wake up feeling tight knowing I have a PT session at 9:30am. At 8:45 I took one of my 5 mg Percocet. I started my session being able to PEDAL THE BIKE, forward and backward, which was a personal goal of mine! I was able to tolerate the tendons in the back of my knee being massaged and stretched, something I would normally need a break from before continuing.....not today! It just seemed like I was able to get through everything so much easier and I was able to bend my knee a bit further also. Needless to say I'm going to take a pain pill before every remaining PT session (3 weeks, 2x/week) and I THANK EVERYONE (especially you, Josephine) for all the great information and all I can say for anyone else new to the site, READ AND LISTEN to everyone/everything, because IT WORKS!

 

[armywife]

Quick update here - I'm close to being 3 months out from my surgery. My recovery is still very slow. I have a lot of swelling still which is affecting my progress. I wear a compression stockings every day, have done a dose of steroids and currently have a script for Toradol (sp). I ice and elevate 3 times a day (for about a full hour each time). I do PT 2 or 4 times a week. I do leg raises, recumbent bike, stretches, light weights and calf raises. Nothing wild or painful. I'm having more difficulty with muscle tighten than my knee. My PT assistant said I have the tightest hip flexor she has seen in her 30 year career). My quads feel tight and are painful. Calf is tight, too. I stretch (gently) often throughout the day.

My best range of motion is 188° - which was today (on my own).

Any suggestions besides what I'm doing? The knee is starting to feel "right" (with some rough spots here and there).

 

[Josephine]

currently have a script for Toradol

Toradol is in a group of drugs called nonsteroidal anti-inflammatory drugs (NSAIDs). It works by reducing hormones that cause inflammation and pain in the body. It is also used short-term (5 days or less) to treat moderate to severe pain, usually after surgery. So how long have you been on this? And have you read this article about NSAIDs? NSAIDs, acetaminophen (Tylenol, paracetamol) differences and dangers.

My best range of motion is 188°

Who measured that for you? It's anatomically impossible to get 188 degrees. 148 might be the best even a really skinny knee could manage.

Any suggestions besides what I'm doing?

To answer that, I need to ask you some questions:

1. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine)

2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?

3. how often are you icing your hip and for how long?

4. are you elevating your leg, how often and for how long?

5. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and

6. what kind of PT/exercises are you doing? How much and how often? (detailed details would be appreciated!)

 

[armywife]

Guess typing on my phone makes for errors! I've gotten to 118° on my own!

I am only on Toradol as needed (he gave me just enough for the 5 day dose of one every 6 hours. I only take one after PT days. I am very careful with my NSAID use
(hubby is a CRNA and very knowledgeable about meds).

My knee pain is usually just around a 1 or 2. Very minimal pain now - lots of muscle stiffness (quads and hip flexors mostly).

No pain meds - I take Celebrex on the days that I don't have a toradol. I also take a flexiril some nights for the muscle tightness and spasms.

I elevate and ice my knee at least 3 times a day for a whole hour each time. I use a heating pad on the quad and hip flexor at the same time.

I do PT 2 or 3 times a week. I do lots (3 sets of 10 of them all) of leg raises, stretching, wall slides, heel lifts

 

[armywife]

Oops -

Then I do the bike for 15 minutes and light weight hamstring curls and leg press (about 20 of each)

My activity level is still pretty low. I have cleaning ladies, so I do a bit of dinner making and light picking up (I have a 5 and an 8 year old, so things get a bit messy quick). I don't run many errands (not even one a day). If I go shop, I use the electric carts, so I don't wander around the store.

I feel like the more stretching I do - the better the whole leg feels. My knee really feels quite good.

Heather

 

[Josephine]

I've gotten to 118° on my own!

That's better! and pretty good too.

hubby is a CRNA

Oh that's good ............... what's a CRNA?

My knee pain is usually just around a 1 or 2. Very minimal pain now - lots of muscle stiffness (quads and hip flexors mostly).
No pain meds

You do realise that 'pain' also includes soreness, burning, stabbing, throbbing, aching, swelling and stiffness? So you should try some Tylenol 1,000mgs up to 4 times a day and see the difference that makes. I bet it will help tremendously!
And such pains usually arise because the muscles are being overworked. You're only 12 weeks out from major surgery and the impact of that is body-wide, not just in your knee! So take it more easy on yourself (there's a song in there somewhere! )

I do PT 2 or 3 times a week.
I do 3 sets of 10 each of
leg raises
stretching
wall slides
heel lifts

I suggest you try a week's total vacation from all exercises to start with. You really don't need them much now anyway as you are 'there' in terms of ROM and more time will get more all on its own.

Then, if you really must, start back in with a much reduced routine like this
- alternate days for first two weeks
- no exercises at all at the weekends ever again!
- leg raises 5 am and 5 pm
- stretching gently 5 three times a day
- 5 wall slides am and pm
- 5 heel lifts am and pm

Increase up from there very slowly, cutting back if the pains reoccurs.

 

[armywife]

Thank you! A CRNA is certified registered nurse anesthetist (he does everything that an anesthesiologist but is not an MD). He practices completely independently (he's in the US Army).

I have such issues with the NSAIDs and my stomach (and I'm on a prescription drug, rabeprazole/Aciphex for GERD). Even Tylenol bugs it.

Thank you. And happy new year!

 

[Josephine]

registered nurse anesthetist

Oh wow! That's what I call a job!

I'm on a prescription drug for GERD

Yes, me too! I've been on one for around 30 years and have recently had to double the dose and have occasional symptomatic doses of Gaviscon - had to have two last night! It's a bummer, isn't it? As a result I now no longer use any form of NSAID but I do find paracetamol okay.

 

[armywife]

Hi all,
I haven't posted in months and months. I had TKR at 41 (8 months ago). I was struggling for a long while with my recovery. Knee feels OK now but the whole leg is swollen and very uncomfortable. I saw my surgeon who agreed it should not be so swollen. He referred me to a vascular surgeon who did a vein study. The study showed nothing that can be surgically fixed. So why the leg pain, heaviness and swelling?! They suggested ice, elevation and compression stockings. Not particularly helpful for a busy Mom with a 6 and 8 year old. I had this surgery to get rid of the chronic pain not to trade it in for a different one.

Anyone have issues with this? What can I do?! I'm so frustrated. This surgery has not gone my way. Ugh
Heather

 

[Pumpkin]

Hi Healther, Welcome back,
Sorry to hear you are having such problems. A lymphedema specialist may be able to help you, some members have had excellent results. Find a PT, OT, or massage therapists who has advanced training in lymphedema. You should be able to find someone in your area, check the yellow pages, or with a hospital wound care department.
Also you may want to start thinking about a second opinion, fresh eyes to take a look at your leg.

 

[skigirl]

I would have some difficulty with a doc who sent me to a vascular surgeon---when we both know that something is not right with the tkr. I would look around for a revision specialist---we have a clinic locator up on the top of the page on the blue line. When you find a clinic near you, just look at the bios of the docs---there will be one who specializes in revisions--that is the one you want to give you a second opinion on that leg.

 

[coley]

You poor thing, I can honestly say I know how you feel as far as the not working out as you had hoped! I too put all of my faith into my rtkr working(third time around) although I feel it's even worse than to start with:( I now see a pain specialist and who feels it will probably be this way forever!!! I have good days and bad days and very very very bad days as I'm sure you know? I survive on pain meds, refuse to ever use the oxy range of drugs as I felt these were not good for me and were very addictive, so I stopped cold turkey! I feel so much better now, yes the pain is terrible but at least I'm in control of it! I hope everything gets better for you and they find a reason for all of your swelling. Have you tried magnets? I've just started using them, I will try anything as I'm sure you and everyone else out there in pain will too. Good luck army wife