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TKR Acute pain in kneecap<

tonyw

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Hi All
I'm just post op 2 weeks. Making reasonably good progress but I'm experiencing significant burning pain at night time. I was initially prescribed pregabilin in hospital but GP stopped these upon return home. Otherwise on Naproxin, Paracetemol and Tramadol. Using lots of ice throughout the day but each night I feel as though the knee has been scalded which is excruciating
Anyone else experienced these symptoms and / or found a solution? Thanks Tony


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mwetzel394

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I wake up at around 2am, with the same pain, on days where i work the leg harder, ie. PT days, get ice on there will help and oxcontone if you can get it from your doctor, were vert similar. I i had my surgery Nov 28, good luck


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Roy Gardiner

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Time, I'm afraid, is what it takes. Don't forget to take your pain medication on schedule, not just when you are in pain.
 

KarriB

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Welcome to BoneSmart! Sometimes extreme night time pain can mean you're putting too much stress on the knee. Take a look at these articles and determine if you're possibly doing too much.

First are the BoneSmart mantras ....
- rest, elevate, ice and take your pain meds by the clock
- if it hurts, don't do it and don't allow anyone - especially a physiotherapist - to do it to you
- if your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again
- if you won't die if it's not done, don't do it
- never stand when you can sit, never sit when you can lie down, never stay awake when you can go to sleep!
- be active as much as you need to be but not more than is necessary, meaning so much that you end up being in pain, exhausted or desperate to sit down or lay down!

Next is a FAQ (Frequently Asked Questions) thread.

And here are some very crucial articles
The importance of managing pain after a TKR and the pain chart
Swollen and stiff knee: what causes it?
Energy drain for TKRs

Myth busting: no pain, no gain
Activity progression for TKRs
Heel slides and how to do them

Extension: how to estimate it and ways to improve it

Elevation is the key
Ice to control pain and swelling

Healing: how long does it take?
Chart representation of TKR recovery
Myth busting: the "window of opportunity" in TKR

Myth busting: on getting addicted to pain meds

Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?
 

Josephine

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Hi Tony and welcome to BoneSmart!
Otherwise on Naproxin, Paracetemol and Tramadol.
You may be undermedicating. Can you tell me what times you take these and how many tablets at a time?
Using lots of ice throughout the day but each night I feel as though the knee has been scalded which is excruciating
That sounds suspiciously like ice burn. What are using for ice? Ice packs? Frozen peas? A machine of some kind? Also, are you putting a tea towel or similar between the ice pack and your skin?

Read the articles Karri left you - there's lots of essential information in them.
 
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tonyw

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Hi Josephine
Thanks for responding
I'm taking medication x 4 per day 8.00 - 12.00 - 17.00. & 22.00
2 x 50mg Tramadol x 4 times per day
2 x 500mg Paracetemol x 4 times per day
2 x 250mg Naproxen x 2 times per day

I was on Pregabillin x 2 per day but GP said this was no use?

I'm using a Velcro knee sleeve with ice which was issued by the hospital. Typically I'm doing 20 mins around 6 times a day. I experienced burning from outset in hospital but informed 'it's normal' for TKR. Getting no or little sleep is the worst bit of this!
Thanks for any advise ce


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Josephine

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8.00 - 12.00 - 17.00. & 22.00
Those times are too irregular
0800-1200 is 4 hrs
1200-1700 is 5 hrs
1700-2200 is 5 hrs
2200-0800 is 10hrs​

A 10 hour gap is going to allow your pain to skyrocket and you'll then be playing catch-up which is a very poor place to be in. For full effectiveness you must take them 6hrly, so 0800, 1400, 2000 and 0200. Set an alarm for the 0200am dose so you don't miss it.

Pregablin won't be of use if you don't have the particular kind of pain called neuropathy which is when the nerves are irritated and over working. The electrical signals that go up to your brain are all haphazard and causing irregular feedback that we perceive as pain. Pregablin blocks this activity and thereby stops this feedback. It therefore doesn't work on the normal kind of post-op pain.

I'd also like to ask you some other questions if you don't mind, and it would be very helpful if you would answer each one individually - numbered as I have done - in as much detail as you can then I'll come back as see where you are ....

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

2. how swollen is your leg compared to these?
ai63.tinypic.com_eta39s.jpg


3. what is your ROM - that's flexion (bend) and extension (straightness)

4. are you icing your knee at all? If so, how often and for how long?

5. are you elevating your leg. If so how often and for how long?

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

7. what kind of exercises are you doing? How much and how often?
This is the most crucial question so please help me by using the format I have left as an example
(which means please make a list and not an essay!)

Exercises done at home and how many sessions you do each day
enter exercise by name then number of repetitions of each
etc., etc.

At physio (how many times a week do you go there)
enter exercise by name then number of repetitions of each
etc., etc.
 
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tonyw

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Many thanks for your interest and support!

1. Scale of 5 day but Nightime Scale of 9

2. Moderate

3. 95 - fairly straight i.e. Back of knee hits surface

4. Ice x 6 times per day for 20 mins

5. Elevation 4 / 5 times for 15 minutes

6. Can undress / dress, shower, but if household, washing machine, basic cooking, make a coffee. Using cane in house, crutches outside

7. 3 x 30 slips am / lunch / evening

3 x 10 straight leg lifts (quads) an / lunch / evening

Walking on crutches about 0.5km

I've developed a problem today which suggests I might have infection. Wound is weeping (slight) pus and about 2 inches of wound is reddened on cut. Seeing ward staff tomorrow re infection when I attend 1st Physio

Kind Regards and thanks Tony

Start Physio tomorrow


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newlybionic

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I would suggest having an around the clock schedule for your medications. As Josephine has pointed out you have a 10 hour gap at night which is when most people feel pain more often after a day of activity. You also need to elevate an ice for much longer than 20 minutes at a time. Try doing that for 45 to sixty MI uses 4 or more times a day. It also seems like you are doing a lot just 2 weeks after surgery. please check out the following activity progression.
http://bonesmart.org/forum/threads/activity-progression-for-tkrs.14334/

One last thing is to make sure you are elevating correctly so that you get that swelling down.
 

ACDCJen

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Hi @tonyw

Welcome to recovery!!! Sorry to hear about your pain and ice situation. Just wanted to add that I bought an ice machine and I wear it all night. It has straps to hold it on, and I've never personally woken up with ice burn. Maybe this would also work for you? I have the polar cube and it's been awesome for both of my TKRs. I ice all day long, and usually for hours at a time. When my knee feels hot, I just slap a regular ice pack on it and it helps coils it down. I also elevate whenever I am not walking or standing, so 95% of the time. It does help!

Hopefully there will be other feedback that can help you.

Jen
 
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tonyw

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Hi Jen!
Thanks for the post. What model of ice machine is this as it sounds very interesting?
Tony


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tonyw

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Thanks Jen! Had good news earlier - wound isn't infected and 1st PT session went well and ROM up to 105 which was positive. Very tempted to get a machine though to assist process and burning sensation
Appreciate your help
Tony


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tonyw

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Thanks everyone for constructive comments. I'm new to BoneSmart and now really appreciate the value of peer and expert support. [emoji106]
Tony


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newlybionic

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Your ROM is excellent! I'm glad to hear that the info on this forum is of value to you.
 

Josephine

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1. Scale of 5 day but nightime scale of 9
9 is very high. But then, you're only 2½ weeks out and given the long gap between doses, it's hardly surprising.
2. Moderate swelling
Another sign of out of control pain.
3. 95 - fairly straight i.e. Back of knee hits surface
That's pretty good for 2½ weeks!
4. Ice x 6 times per day for 20 mins
5. Elevation 4 / 5 times for 15 minutes
You accomplish little or nothing in 15 or 20 minutes. Ice and elevate for at least 40-60mins and more than 4 times a day.
6. Can undress / dress, shower, but if household, washing machine, basic cooking, make a coffee. Using cane in house, crutches outside
I think you never finished your sentence here "but if household, washing machine, basic cooking, make a coffee" ... what?
7. 3 x 30 slips am / lunch / evening
What do you mean by 'slips'? What ever they are you shouldn't be doing 90 reps three times a day of anything! No wonder you are in pain!
3 x 10 straight leg lifts (quads) am / lunch / evening
Let me give you a tip: once you can do leg lifts (straight leg raises) you don't need to do them any more. You certainly shouldn't be doing 30 three times a day! 5 first thing in the morning is plenty.

I suggest you don't do any exercises but that doesn't mean do nothing. Walks to the bathroom and the kitchen on as 'as needed' basis are quite sufficient. Read this BoneSmart philosophy for sensible post op therapy
 
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tonyw

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Just got a Crycool Cuff Cooler to assist with cooling the burning pain I've experienced. 1st impression is excellent and looking forward to a nights sleep at last!


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sistersinhim

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You are very new in your recovery and your knee is a newborn. Be very careful with PT and don't do anything that hurts. If you do, you are hindering your recovery. All your knee needs right now is healing. You are active enough that you don't even need PT, especially with that ROM. Don't let PT push you or even touch you. Please read the articles that were left for you and follow the Bonesmart way and your recovery will be so much better. The majority of us on here followed the suggestions on here and are doing great!
 

Josephine

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Jolly good, @tonyw but can you answer the questions I left - they are in bold
 

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