Revised PKR to TKR A little nervous

[Shazama]

10 weeks out of TKR left knee revision surgery. November 8th 2022, was the date. Had to stop PT as a New Year and new insurance won’t pay. It’s expensive. Having been down this road twice before with two partials, R knee was unicompartmental inside portion June of 2015, the 6 months later and a few ski runs Feb. 2016 had then left one done with same inside partial, but that one always gave me issues. In the end the left partial became loose and painful and had to be replaced with the full TKR using the Vely’s robotic system my surgeon thankful was very good with. Now hope I can figure this out on my own. But holy cow, seems so much harder than a partial even though the surgeon cut the same scar and tissues. I’m at 127 degree bend, but worried about step ups. I seem very unstable when going down a slope and sometimes the knee will buckle. I assume it’s because of not enough thigh muscle strength. How can I rehab that best? Still have plenty of swelling and tightness around my knee too.
Any answers will help thank you

 

[benne68]

Welcome to BoneSmart, @Shazama! I'm so glad you found us!

’m at 127 degree bend, but worried about step ups. I seem very unstable when going down a slope and sometimes the knee will buckle.

With a 127-degree bend at 10 weeks, you are doing extremely well. This is truly a year-long recovery and you really can't rush it. PT and aggressive exercise is NOT necessary for a successful recovery.

That instability you are feeling going down hills is normal at this early stage. It will get better as your knee continues to heal. And, if you are struggling with step-ups, it probably means your knee isn't ready for them yet. Give it a little more time.


Even though you are 10 weeks post-op, I will leave you our Recovery Guidelines. Each article is short but very informative. Following these guidelines will help you have a less painful recovery.

Just keep in mind we are all different, as are the approaches to this recovery and rehab. The key is, “Find what works for you.“ Your doctors, PTs and BoneSmart are available to help, but you are the final judge as to the recovery approach you choose.

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.

 

[Layla]

Hello and Welcome to BoneSmart. Thanks for joining us!
Icing and elevation should help ease the tightness which is due to swelling. Please reference articles on each under the Recovery Guidelines benne68 left you above.

Also, please share the dates of your two prior surgeries, the type of partials you had and for which knee. We will add the info to your signature.

Lots of comfort and best wishes to you as you continue healing!
@Shazama

 

[Shazama]

Good morning, 10 weeks PO TKR revision, what have some of you done for pain relief? My Dr. Won’t give anything else, he just say Tylenol, it doesn’t work for me, Advil doesn’t either. At the end of the day, and after doing my exercises, I’m all swelled up and in pain again. So sleeping has be difficult. Let me know what works please. Thank you.

 

[Jockette]

The most effective way to take Tylenol is 2 x 500 mg tablets every 6 hours, to a total of 4,000 mg (4 doses) in 24 hours. You need to take it regularly, to keep up the levels in your bloodstream. If you just take the odd dose now and then, it's far less effective.

Check all other medications you're taking, to make sure there is no Tylenol/Acetaminophen/Paracetamol in them. If there is, scale back one or two of your regular Tylenol doses, so you stay within that safe 24 hour limit of 4,000 mg.

I also alternated with ibuprofen. I took it every 6 hours, and Tylenol every 6 hours, but staggered, so that I took one or the other every 3 hours. It’s always a good idea to have something to eat each time you take these.

Another way to keep your pain level down is to not do an activity that causes pain, specifically, a list of exercises. Too often we are giving exercises that our knee is not yet healed enough to do, which keeps our pain level high.

You will be fine at this point without formal PT. By now you should know which exercises you can do easily, so just do them. Or don’t do any formal exercises at this point, and just let your daily activities rehab your knee naturally. Walking, though not to excess, is also very good for recovery. Just take it slow and easy. You are healing from major surgery, not training for an athletic event.

I‘ve moved your post above out of the Monthly team thread as we reserve that thread for surgery date information, and so members can see who else has surgery the same month. We prefer all other comments and discussion to take place in a pre op or recovery thread, such as this one. Enjoy interacting with others who are on the same journey, here in this thread.

 

[beachy]

@Shazama
At my pre-op appointment with my PA I asked her if she would refill pain meds if surgeon stopped them too soon. She said yes. Now, I'm good friends with her and she knows my history so she knows I wouldn't abuse meds.
Last tkr I did need an occasional dose here and there even 3-4 months post op
Ask your general practioner if they can write a script for you.

 

[WFD]

I also alternated with ibuprofen. I took it every 6 hours, and Tylenol every 6 hours, but staggered, so that I took one or the other every 3 hours.

I do this too and it works great.

 

[Flashlight]

I found that the tylenol wasn't working for me and my PCP said I wasn't taking the ibuprofen at the right dose. Some of my discomfort came from nerve pain. At 10 weeks I had knee stiffness from standing or sitting too long. I was still using my ice packs. Fast forward to 5-months and I don't have as much stiffness, swelling, or pain. I am doing better on the stairs but not perfectly. I haven't tried to go down my 100 ft. driveway yet! I was able to use a step stool to put some dishes back. Something I couldn't do last month. I'm using my stationary bike to try and strengthen my legs. You will get there but it takes time. If you have more swelling and stiffness after doing your exercises you should cut back. Your ROM is great!

 

[shr]

I assume it’s because of not enough thigh muscle strength. How can I rehab that best?

Something that I've found helpful is backward walking someplace where there no tripping hazards. Working up to 10 minutes a day will strengthen the vastus medialis (front thigh immediately above the knee) which is important for knee stability.

 

[JusticeRider]

@shr I’m going to try this! My poor thigh is still pretty skinny.

 

[Flashlight]

Will try also! Thank You!

 

[Shazama]

Hello fellow November Nibbles,Well now at 12 weeks Post Op and I’m starting to worry about how my knee is not able to bend. It’s so hard to put on pants or shorts or my socks still. Is this normal? I am active walking on the treadmill and I even have a bike but I have seemed to have stalled here. Not sure how to get more ROM. Still tight and swollen maybe that is why, but shouldn’t that be gone by now? Any help or ideas would be appreciated.

 

[Jockette]

@Shazama Everything you describe is perfectly normal at 12 weeks. This is a very slow recovery, an average of a full year or more for complete healing.

Still tight and swollen maybe that is why,

And, yes, this is the reason. It can takes months for the surgical swelling to go down. Too much activity can also maintain swelling.

Spend more time taking breaks to ice and elevate. Try to relax. It will all settle down in time.

Regaining our ROM does not require forceful bending or painful exercises.
Regaining our ROM is more about Time than repetitions of a list of exercises.

Time to recover.
Time for pain and swelling to settle.
Time to heal.

Our range of motion is right there all along just waiting for that to happen so it can show itself.

In the general run of things, it doesn't need to be fought for, worked hard for or worried about. It will happen. Normal activity is the key to success.



By the way, I merged your newest thread with your original recovery thread, as we prefer that members in recovery have only one thread.

This benefits you because all your information is in one place, easy to find, and maintains a nice journal for you.

This also benefits our staff, as your information is all in one place, and we often go back through your thread for previous details, so we know what you‘ve been through which helps us advise you better.

So, please keep all your posts in this thread. If you’d like a new title, let us know what you want, and we’ll change it for you.

Many members bookmark their thread in their computer browser, so they can find it when they log on.
How can I find my threads and posts?

Best wishes on your continuing recovery!

 

[EalingGran]

Had to stop PT as a New Year and new insurance won’t pay. It’s expensive.

My pilates teacher ( who is amazing) has loads of free sessions on YouTube. Her glute strengthening routine is only 20 minutes side lying and I do it most days.
Just search Katja pilates on YouTube
She also has some recovery sessions and gentle classes online.

 

[Layla]

Still tight and swollen maybe that is why, but shouldn’t that be gone by now? Any help or ideas would be appreciated.

This is normal. While your range of motion is currently limited, it will naturally increase as the swelling subsides and the pain eases.
It can take up to a full year to recover and as I was reminded by my OS, swelling can remain up until that point also, gradually easing along the way. Simply engaging in the activities of daily living will help. Give it time.

Happy Three Month Anniversary! I hope you have a great day and weekend!

 

[Shazama]

Thank you! Hard to believe it’s been 3 months now at 15 weeks this Tuesday. My greatest concern still is my knee giving out unexpectedly a lot, and control of walking. It seems like my knee does one thing while I want it to do another. When I step off a curb I get a surprise buckle or I’m not able to control my thigh muscle well. while it doesn’t hurt it’s scares me and takes my breath away for the moment even though I’m totally aware. Does this mean I need more intense thigh exercise? I walk a great deal, although stairs are still a big challenge I suspect I may need to do them a lot more.
Thank you for any answers to help with this.

 

[Jockette]

My greatest concern still is my knee giving out unexpectedly a lot,

Does this mean I need more intense thigh exercise?

I would not try more intense exercise, of any kind, with such an unstable knee.

What does your surgeon say about this instability?

Also, at “only” 3 months post op, you are 25% healed, so you still have a long way to go, in this year long recovery. Slow down your activities and rest more, and continue to at least elevate your leg when you’re sitting or sleeping. You might just be doing way more than your knee is healed enough to do.

 

[Shazama]

Thank you, and maybe.. I have not talked to my surgeon since my 6wk follow up and then not for a year. I return to my seasonal job soon which involves lots of lifting and pulling, just need to make sure my stamina and strength are up for it. I need the income.

 

[Jockette]

I think you should tell your surgeon about this instability.

 

[Layla]

Happy Four Month Anniversary!
Wondering if your stamina is increasing and whether your knee is feeling any more stable than it was last time you posted? If not please consider communicating with your surgeon or his care team for advice so you're able to perform at work confidently without fear of falling, Wishing you all the best, please stay in touch.
@Shazama