TKR ACIM

[Layla]

My unsolicited opinion, and we all have one...is that it is okay, IF there is no increase in pain, swelling or stiffness, afterward, or today (we often suffer the next day for the sins of the day before) I think it may help your ROM and circulation without stressing the joint. The step count is kind of high, but again if there's no pain or swelling, you're likely handling it well. The key is listening to your knee and if it protests, dial it back, rest, then proceed slowly. May your day be a good one, ACIM!
@ACIM

 

[ACIM]

❤

 

[Jamie]

The 4,000 steps is a lot at this stage. But each of us is different. If you were able to do that yesterday plus some pedaling and have no increase in pain or swelling by the end of today, then your body was ready for it. Just be very aware of your body signals. It's a good idea to do increases in activity or exercise slowly with a day of less activity in between so that you know your limits. Sometimes if you keep increasing your activity every single day, the impact on your still-healing soft tissues can build up and you will start hurting.

So, hopefully, you'll feel great today and you can do a little more tomorrow.

 

[sistersinhim]

Do you think the 4,000 steps yesterday was too much?

I think that was way too much for a knee that is just 3 weeks old. You should be concentrating more on resting, icing, and elevating. Getting up for a short walk every hour of so is fine. Taking care of your daily needs will give you all the walking you need to do for the first couple of months.

The main thing is to let your knee be your quide. When you have increased pain and/or swelling that night or the next day, then it was too much for the healing stage your knee is currently. You can gradually try increasing your walking and then cut back the next day to see how your knee reacts. If good, then go back to that increased you did the day before. Listening and reacting to your knee will normally give you a less painful recovery.

 

[ACIM]

Thankyou.

 

[ACIM]

Too funny! But I must be brutally honest and tell you that I have probably been overdoing it almost every day since surgery. Not egregiously or extremely overdoing it, just overdoing it. The last three nights in a row I have been awakened at 4:00 a.m. in the morning by a very angry, noisy knee; extreme throbbing in a very specific spot just on the inside of the knee. This seems to be the most vulnerable spot from my surgery.
So this morning I woke again at 4:00 a.m. I am excited as I have a 9:00 a.m. appointment to get my hair done and then a pedicure so I'm not even bothering to go back to sleep. I will try very hard to take it easy today but I must tell you I really miss being able to do things and even though the knee is not hurting throughout the day it is still in such discomfort in and out of the day. Best thing I ever did was take that extra week off work, thanks to you guys! Again, best thing I could have ever done. Hugs.

 

[Jockette]

Enjoy that hair and pedicure appointment, and then really take it easy the rest of the day.

Let us know how the pedicure goes. You might find that your knee might protest the leg positions needed, though. Ice and elevate when you get home.

 

[Layla]

Hello and Happy Friday!
Consider giving yourself a break and take the weekend off from overdoing it.
Just try it and see if the 4 AM pain episodes ease.

Relax and enjoy the pampering today. It is a good sign that you're healing and returning to life. You're reclaiming some normalcy, confidence and control after weeks of focusing on healing. You've earned it!
Happy Friday and hugs back at you.
@ACIM

 

[sistersinhim]

I had a lot of pain in my medial area, too. I received my surgical report and read that my doctor had done a medial release. That explained it! Maybe you should request your report from the hospital. It is very interesting reading! Below is an explanation about a lateral release, which is done the same except on the inside of the knee.
Lateral Release Explained

 

[Jockette]

Maybe you should request your report from the hospital. It is very interesting reading!

I agree, and it can be a very interesting read. Way back when (it’s been 8 years since my PKR) I took sistersinhim’s suggestion, but I didn’t ask for mine until my one year check up. I understood a lot more than I expected to, but I’d been reading Bonesmart almost the whole year, so I knew a lot more at that point. And, like her, I learned that my surgeon had also done a lateral release, when he did my PKR. He didn’t tell me that in any of the many check ups he required. So, I had more to heal from, than others who didn’t have that additional procedure.

There’s a good chance you didn’t have any additional procedures during your TKR, but it might still be a good read for you, if you’re interested.

 

[ACIM]

Excellent advice as usual. I will certainly ask for the full report when I go for my 6-week follow-up which is in about 3 weeks. Never knew what a lateral or a medial release was. You're right. Bonesmart has all the answers.

 

[ACIM]

Question: for the past five nights I have been awakened anywhere from 3:30 a.m. to 4:30 a.m. the reason I have been awakened is because of the inside of this knee starts throbbing so badly that I wake up. I'm usually up for an hour or so and we'll take some Acetaminophen p.m. to get back to sleep. But last night I woke up at 3:30, again due to constant throbbing from the inside of my knee. Now it is 6:38 a.m. EST and I am still up despite having taken up to eight acetaminophen p.m. the throbbing will not stop. I have iced in elevated. I have also stated, I believe, that I feel under medicated since after the surgery. Given that this is my fifth joint replacement surgery I certainly believe I have trauma associated with this. The pain and Rehab of each surgery has taken tremendous effort on my part. Because of the five joint surgeries I also know that I incredibly have not only a resistance to any surgery but also a very low level of pain tolerance. There has been confusion between my doctor's office and myself regarding my pain meds and I have been told that the current script I have it's the last one they will write for me. I am 3 weeks and 4 days post up. Initially, I was given oxycodone at 5 mg and to be taken once every four to six hours. Contacted my doctor and asked for hydrocodone instead, which he gave me. I have found from past experience that I do better on the hydrocodone. So he prescribed one hydrocodone for every 6 hours. But then I found out that the hydrocodone was not really helping the pain and asked to go back on to the oxycodone. I tossed the rest of the Oxycodone pills he had given me since I had the hydrocodone in pocket. But since that time I have found it necessary to go back on the oxycodone which started me back on again about 10 days ago. One 5 mg oxycodone every four to six hours. I finished the script and called in to get one half of my usual script of the 5 mg oxycodone as I felt certain this would be the end of the pain meds. As I said before, I do believe he under medicated me not understanding or knowing that I have serious trauma regarding surgeries now. I would love to go see him this week and have him check out my knee, or at least the inside of it, the part of the knee that is facing the opposite knee. For whatever reasons it just won't stop throbbing. I don't know what to do. Is any of this normal entering fourth week post op? I welcome your feedback.

 

[Layla]

Hi ACIM,
I am sorry you're dealing with ongoing early morning pain that awakens you. Consider calling the office of your OS today and speaking with whoever is on call, often a PA. They can go over meds with you and advise. You are very early into the healing process at only 3.5 weeks post op, so pain is common. I do think post operative pain can disrupt sleep this early on, and it may be an indicator that you're doing more than you should during the day. A check in with your surgeons office, and then making an appointment if they feel you need one may be beneficial.
@ACIM

 

[EalingGran]

Do you think the 4,000 steps yesterday was too much

Not necessarily. My knee loved walking. It was standing or being seated with the leg down, that it hated in the early weeks and months. Your knee will let you know what is 'too much' and it varies from person to person. The important thing is to listen to your body and to gradually improve without causing pain and further inflammation.

 

[Jamie]

There is no mystery here. You’re overdoing things.

Please reduce your exercise and activity dramatically for at least a week. All you need to do during this time are gentle stretches and bends every few hours during the day along with a 5 minute or less walk around the house every hour or two. You want to do just enough to keep your knee mobile. The rest of your time should be rest, ice and elevation. By doing more than you should at this early stage, you may have created the beginning of chronic inflammation in your knee. You don’t want this, so prompt action is important. The pain shows up at night because you are immobile for long periods and will notice it more.

As for the medication, I sincerely hope you didn’t take 8 acetaminophen PM close together! The dosage for this product is TWO caplets in a 24 hour period. Taking more acetaminophen than recommended can cause kidney problems and is potentially dangerous for you. This is not the acetaminophen product you should be taking anyway. If you’re using acetaminophen for pain use the Extra Strength version with 500mg per tablet. Take 1000mg (two tablets) every 6 hours on a set schedule throughout the day and night. This gives you the maximum of 4000mg within any 24 hour period. When taking this high level of acetaminophen, you must also count in any other products with acetaminophen in them like pain, cold, sinus, or allergy medications - either prescription or over-the-counter. If any other meds have acetaminophen, you will need to reduce the amount of Extra Strength acetaminophen you take.

I agree that you should contact your surgeon’s office today for advice. If they will not prescribe any stronger medication for pain, you can try calling your GP. Sometimes they are more understanding of this need when you are early in surgery. But, your main problem is doing too much too soon. When you get that inflammation calmed down, your nighttime pain should be much more manageable.

 

[ACIM]

A wealth of advice. Unfortunately I am out of my opioid pain medication and that is the reason for the acetaminophen overload. I recognize this is not a good thing but pain puts me in a rather desperate position. Indeed, I have developed trauma over my last five joint surgeries, trauma. Just spoke to my doctor's nurse and gave her all of the details about the excruciating pain I'm feeling on the inside of my knee and, from what I have read on the internet, some of the reasons for this pain. Bottom line is the number one explanation appear to be nerve damage. But there were other examples given that had to do with miscalculations on surgery, etc etc. The nurse is going to speak with the doctor and contact me as I did suggest that I was able to go in to see him if needed. Woke up at 7:00 a.m. this morning because of terrible inner knee pain and only now, at about 11:00 a.m. EST am I starting to feel a little better. I promise I am doing nothing today unless I am called in to see my doctor. I do believe I have overdone working the knee when it is not ready. Could not agree with you more. Blessings.

 

[Jamie]

As a backup, you might go ahead and contact your GP. Perhaps he or she would prescribe something for pain like Tramadol if they won’t do anything stronger.

 

[Jockette]

I do believe I have overdone working the knee when it is not ready. Could not agree with you more. Blessings.

The best way to control pain, and need less pain medication, is to not overwork the knee.

 

[ACIM]

But I have delayed reactions pain. I don't know if I've done too much until 3 or 4 hours later when the pain kicks in. However, am taking this very seriously now as there is nothing worse than being in pain. I was supposed to go back to work tomorrow but between BONESMART and another friend of mine I've put work off another week, thank God!
Spoke to my doctor's PA today and she said that all sounded just like nerves starting to regrow and heal and that's where the pain was coming from. Of course I told her I had no other symptoms, no swelling no redness, just pain. Went to sleep promptly after speaking with her and have been sleeping most of the day. I probably needed it. Thanks bone smart!

 

[Layla]

But I have delayed reactions pain. I don't know if I've done too much until 3 or 4 hours later when the pain kicks in.

Consider tracking your activity over the next week or so, at least for a couple of days. Keep track of symptoms also and you may either realize you're just doing too much in a day, or be able to connect the early morning pain with something you did.

Wondering if you're laying on your side when you wake with the pain in the area you described? If so, try a pillow between your knees to prevent them from touching and for better alignment also.

You can also try icing right before bed to ease any inflammation, or have an ice pack in a small cooler bedside that you can grab when that pain comes on in the early morning hours so you don't have to use the stairs.

Thank goodness you don't have to return to work yet. I hope you sleep well tonight.