TKR Progress of a November Nimble

Space Knee

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Hi all,

I found this forum after my surgery, which was on Nov. 6, 2017. I had a TKA, makoplasty on my left leg. At four weeks, I'm able to bend my knee to 102 degrees, and straighten it to 0 degrees. That has been with the help of an amazing team of in-home physical therapy folks. I start general rehab in a week (early December), now that most of the swelling is down. I can walk with a cane, but use the walker late at night.

The biggest things I still struggle with are tightness in the knee area, which is lessening slowly over time, and a sciatic nerve that just wants to be jangling more than it should. Also, fatigue. My sleep is not back to normal yet (walking up twice a night for painkillers) and loo visits. Currently I am using Tramadol mostly at night, and extra strength Tylenol during the day. Between the two I can keep the ache down to a dull roar. Most times the pain is around a 1 or 2, sometimes up to 3. Bruising is fading, and I am still wearing compression socks during the day.

Still also struggling with emotional response to the whole situation. I thought I was well prepared, but every once in a while, it's just too much and the tears flow. Is this normal?

I have been reading people's stories and am heartened that I'm not the only one facing these issues. Glad to have found this space!

Space Knee
 
Space Knee,
Welcome to the otherside!
Your ROM is fantastic for a couple of weeks out of surgery.
I still struggle with are tightness in the knee area
It is normal and will subside with time and healing.
"Tight band" feeling across the front of my knee

Here is your copy of the recovery guidelines, the articles are short and will not take long to read.

Knee Recovery: The 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
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
5. At week 4 and after you should follow this

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.

Keep us posted on how you are doing.

 
The biggest things I still struggle with are tightness in the knee area
This is pain and should be medicated "Tight band" feeling across the front of my knee
Also, fatigue
Read the articles Pumpkln left you - there's one on the energy drain.
My sleep is not back to normal yet
Also one on sleep deprivation!!

I'd really like to offer you some structured advice but in order to do that, I also need to ask you some questions. Are you willing for me to do that?
 
Thank you both for the kind responses. I did indeed read most of those articles, and read others today. I am happy to answer questions. The tightness across the knee is slowly relaxing.
 
I am almost 9 months post op and my knee is still tight, but better than it was early on. Be prepared that it might take a long while to go away.

I was very emotional in the first months after surgery.

This recovery knocks the socks off us!!!

Best wishes to you as you recover!
 
Thank you. I am prepared for the long run. I think what is surprising is the intensity of fatigue, for example. I had one other major surgery some years back and the fatigue with that was not quite as much. Of course, I was younger then.

My team prepared me pretty well but did caution me that reality is always more intense.

I found the initial PT to be quite gentle so far — there’s not a hard push to get to 90 degrees, and I have been able to pursue the knee flexibility in my own time. It wasn’t too hard to get to 90 after the first swelling had subsided. I credit that to an aggressive ice/elevation/ gentle stretching regimen.

I still have a small area of swelling in the knee, and continue with the icing a few times a day as needed. The walker is still my friend at night (trips to the loo). I have a cane, and that has been useful on my trips to the doc for post-op visits, etc. I CAN walk slowly without aid, and I know that I need some gait correction on down the line.

The sciatic nerve is jangly and a thorough discussion with a doc yesterday about the corrected alignment in my leg helped me understand why it’s being noisy. They have me on a baby dose of gabapentin, which quiets it down quite a bit. Some gentle PT stretching is also helping that. Eventually it should settle down as I heal.

One thing that I found quite fun was to put on some Celtic music and do my toe and leg stretches to the rhythms. This is mostly while seated. It actually lifted my spirits, too. It felt good to “dance” again.
 
Welcome! I am 10 days behind you and am glad to hear you are doing well. My home pt told me I was about ready for a cane. I imagine it makes life much easier! Keep us posted.


Sent from my iPhone using Tapatalk
 
Beginning week 5:

Still dealing with the stiffness in the knee but it is slowly dissipating. My last in-home PT is tomorrow and that has been very helpful. I start outpatient rehab on the 12th. I will make it clear that I will not tolerate the "no pain no gain" attitude.

The meds are still my friends, especially at night. We added in gapapentin to cAlm down the sciatic nerve. That has been an issue off and on for a few years, and the med does help. So now it's tylenol and tramadol, plus the gaba.

Others have mentioned the appetite loss -- I am still dealing with that a bit, although it's coming back slowly. But, i really am not eating a ton of food and have lost some weight. That's ok--i need to lose some. But, i am not dieting. Just eating smaller portions as i can handle them. I seem to get full pretty fast.

Emotionally I am doing better. Oh sure, i still get discouraged, but that almost always happens as I get too tired.
So, i just have gotten better at recognizing the warning signs.

The fatigue is still kicking my rear. I am napping at will and the moment I start to feel the least bit tired, I stop what I am going and head to rest. Still wake up a few times a night for meds--my iPhone has a full schedule of med timings programmed in.

As for exercise, i enjoy a few minutes walking every hour or two. I do stretches and a few other moves a few times per day as I am able, and then ice afterwards. I can walk without the cane for a short ways, and use the walker for night-time trips to the loo.

One question: how long do they recommend we wear these pressure socks? I wear knee highs through the day and take them off for bed.

Thanks to all for the advice and encouragement. They mean a lot and have helped me adjust my activity to get a better recovery.

Above all, I have to thank my spouse, who has been a real champ throughout all of this. Not sure what I'd do without him.

Cheers!
 
Spouses should get special awards of some kind. They really do have to come through in a big way.

I only wore compression stockings in rehab for a week. I didn't have them for at home and have not once used them. Surgeons are all different about using them, though. Why not call your OS and find out if you still need to wear them. It could be you don't. :) Unless you really like them, in which case it might be up to you.

Your fatigue should gradually become less at this point, but it can still come at you out of nowhere. One day might feel like you've kicked that energy drain to the curb... and then the next day you need to take three naps. Eventually it goes away entirely, but give yourself a couple of months. You're smart to have picked up on your warning signs! :ok:
 
SusieShoes,

I will give them a call in the morning. After I saw your response, I went back over my notes from both PCP and surgeon, to see what they said. Due to concerns about clotting, I am on 325 mg of aspirin through this next week. (I have a blood disorder so that's why they are extending the use of aspirin longer than usual). Once that's over, I can bump the aspirin down to my usual 81 mg. The stockings were part of the deal for the clotting -- I have two different sets of instructions: the commentary from the checkout nurse said "wear them for at least two weeks during the day, take off at night". The commentary from the hematologist/pcp, etc. said to wear them daily, take off at night, and then don't need to wear them once I start rehab (which is next week).

I actually don't mind wearing them -- they have also reduced the swelling in my ankles, which is a good thing. They also seem to help with my walking.

Currently, I'm walking for about 5 minutes every two hours or so, doing some gentle stretches and the usual isometrics for about 20 minutes and then icing. The doc most recently told me to ice at least 30 minutes but not longer than an hour. So, I put the cuff on, get a book, and read. The biggest issue I have with the ice cuff is that it makes my toes cold, even with socks on. So, there I am, wrapped up in a down comforter with my leg propped up and icing. ;)

We have a treadmill and with my PT's guidance I got on it for the first time for about four minutes the other day at the slowest speed (0.5 mi). No pain, just a nice feeling of walking. We are using it to help correct my tendency to swing my leg out to the left in a curve as I walk. This was a problem before surgery and I think it developed as a result of the pain in my knee as I walked "bone on bone". Walking "heel, toe, heel, toe" slowly has been quite nice and the results are starting to show.

Now, I am still napping a couple of times a day, and still waking up three times a night for pain meds. But, the pain is subsiding and under the doc's orders, I'm slowly ramping down the amount of Tramadol I'm taking (in conjunction with Tylenol 325 mg tablets). There's still some pain, and I do have a med schedule. And, in another part of this thread I mentioned the gabapentin for the sciatic nerve -- and that baby dose is helping a lot.

This week has included a LOT of resting, icing, slow movements, and just generally pampering myself. I hope it all pays off soon!
 
The biggest issue I have with the ice cuff is that it makes my toes cold, even with socks on. So, there I am, wrapped up in a down comforter with my leg propped up and icing. ;)
I had my surgery in June and it was hot, but I was still cold while icing! KarriB used an electric throw to help keep her warm. And I iced the whole time I was sitting or laying down, even all night long.

It sounds like you have this under control and are doing things right! Icing longer won't hurt you and is a great pain killer!
 
I have done some icing at night, but only in the first couple of weeks. Now, I do it during the day when I need to lay down and rest, I slap that cuff on and let it go, usually around 45 minutes to an hour. Got lots of reading to catch up on, so it works out.

It's funny how the cold is felt in my toes and feet even though I'm icing my knee and upper shin. I figure the bone or the nerves are acting like a pathway to conduct the cold. Since it's winter here, I'm not wild about cold feet though. So, today I kept my sheepskin slippers on all day and that seemed to help a lot, too!
 
Update: i had my first full night's sleep in six weeks last night!

I will take what I can get!! :loveshwr:
 
Hooray for a full night’s sleep! Some people wait longer than you for that to happen. I’m crossing my fingers:fingersx: your good sleep continues.

I too have cold feet (literally) and wear warm socks to bed or while lounging. There’s a company in New Zealand that makes thick, cushy bed socks. I buy them from Sock Dreams. I also wear soft warm alpaca socks with my sheepskin slippers. Anything to keep the feet nice and toasty. :) :-) (:
 
I have some kind of cuddly socks I wear, just need to remember to put them on when I ice. ;)

Had my first rehab visit today (this after the initial in-home PT visits). It went well -- without straining I can go from 0 to 105 degrees in ROM, and my leg strength is very good. The knee strength is still weak, as to be expected. So, we will continue doing very gentle quad strengthen moves, no more than 10 or so at a time, and we will also work on gait correction. In a couple of weeks, they MAY let me do a little stationary bike, but only if they think it's do-able. I was quite impressed with their approach -- they are definitely NOT into the 'no pain no gain' philosophy -- and they knew about this forum.

I'm walking with a cane that has four prongs on the bottom, and with that I can walk almost normally, if a bit slowly. Went to the grocery store today and was able to pick up a few things with the hubby without having to sit down.

As for the full night sleep -- the past two nights have been interrupted by loo visits once each, but otherwise, deep sleep. So, that's good.

So, six weeks out and I can see a light at the end of a very long tunnel. ;)
 
You are blessed to have such a good PT! I wish they all would be like yours'. So many of them have never heard of Bonesmart, much less agree with our way.

Sleeping well already is wonderful and unusual! Potty visits, unfortunately, are a must for many of us! Going back to sleep afterwards is a good thing!!
 
What an excellent report! The interrupted sleep for bathroom visits is par for the course; keeping well-hydrated is important to recovery, but means more trips to the toilet. It’s annoying, but if you’re getting enough sleep you’re ahead of most!

Your therapist sounds like a keeper! :yes!:
 
Well, it's seven weeks ago today, Sergeant Pepper taught the knee to play... or something like that. I'm walking around the house a bit more steadily, although still favor my left knee a bit. The stiffness around the knee is still there, still feels a bit like a rubber band around it. But, I am able to get through all the exercises and rehab without too much trouble. I did overdo it a bit one day last week and yes, the knee does let you know when you have! Thankfully, I have my ice cuff and it is a dear friend! :)

Going out in public, I still use the cane, just because I never know when I'm going to get tired while walking through a store or waiting for the rehab to start.

All in all, it's going well, if slowly.
 
Oh, and I am grateful daily for the icing cuff. It is such a great thing to have. Since the stiffness is slowly abating, any time I do some exercise, I spend some time with the cuff afterwards with some elevation and relax time.

Still waiting for the last of the scabs to leave and then I can start water exercise at the local rec center. Does anyone else do water exercises?
 

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