TKR Acute pain in kneecap<

[sistersinhim]

This definitely a rollercoaster ride. I think the biggest problem is when we're feeling better, we overdo, then the next day or two are bad. I found that was my reaction.

 

[tonyw]

Been a while since I've posted and now 3½ months post op but still experiencing swelling and pain. Whenever I try to step up exercise I really pay for it and end up limping again until it settles down. Is it just me or is it 'normal' to still feel this after this time? I'm starting to wonder whether there's a problem as I have a lot of clunking particularly first thing in the morning - although there's no pain associated with that. I'm still on Naproxen daily to tackle the swelling.


Sent from my iPhone using BoneSmart Forum

 

[Celle]

It does take a full year for complete recovery and it may be that your knee is just a bit more sensitive to extra exercise at this point.
Try increasing your activity very slowly and see if that helps.

Let's ask @Josephine for her advice.

 

[Roy Gardiner]

Whenever I try to step up exercise I really pay for it and end up limping again until it settles down

It is your body telling you to slow down. Keep on doing less until your knee does not react, then increase gently. 10% maximum.

 

[tonyw]

Many thanks. I guess the fact that it does settle down suggests there's nothing untoward as 'damage' doesn't come and go? Personally I don't think I'm overdoing it although I'm naturally impatient so I'm going to have to be more disciplined and slow right down. My GP said I shouldn't be getting pain or swelling at this stage but said the Consultant wouldn't even consider reexamining for another two or three months as it takes time to properly 'settle down'. It's driving me bonkers and just want to get some normality back....


Sent from my iPhone using BoneSmart Forum

 

[KarriB]

Some people are prone to swelling more than others. I've seen quite a few here on BS with swelling well into months 3-4, especially when trying to add more activity. When I went back to work at 3 months my knee would swell and I'd spend my afternoons/evenings elevating and icing.

 

[Josephine]

Whenever I try to step up exercise I really pay for it

This is a BIG red flag to me. So I'd like to ask you some 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. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?

3. how swollen is your leg compared to these?

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

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

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

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

8. are you doing any exercises at home? If so what 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
- how many sessions you do each day
- enter exercise by name then number of repetitions of each
etc., etc.

Anything done at PT
- how many times a week
- enter exercise by name then number of repetitions of each
etc., etc.

 

[tonyw]

Thanks Josephine

1. 3

2. 500 mg x 2 daily of Naproxen

3. Slight to moderate

4. 120 ROM and full extension

5. No icing for a while

6. Not elevating

7. Fully active and back at work - Office

8. Going to gym x 3 a week - bicycle for 15 mins with resistance of 6/7 (quite low) Walking machine 15 mins speed at 4km an hour
Stepper for 10 mins low resistance
Also walking around 8000 steps a day 4 mile but this is sum total of everything - e.g. Walking about the house and short walk

Ive experienced swelling after last gym session and so haven't been for last week

Many thanks

Tony



Sent from my iPhone using BoneSmart Forum

 

[Josephine]

1. pain score 3

Okay

2. 500 mg x 2 daily of Naproxen

Nothing else?

3. Slight to moderate

Okay

4. 120 ROM and full extension

7. Fully active and back at work - Office

Okay

Going to gym x 3 a week -
bicycle for 15 mins with resistance of 6/7 (quite low)
Walking machine 15 mins speed at 4km an hour
Stepper for 10 mins low resistance
Also walking around 8000 steps a day 4 mile but this is sum total of everything - e.g.
Walking about the house and short walk
I've experienced swelling after last gym session and so haven't been for last week

I'm curious to know why you are still doing all these exercises 16 weeks after the surgery? Were you told to keep doing them?

Personally I don't think I'm overdoing it although I'm naturally impatient

This is your problem. You are under the mistaken belief that if you work hard you're going to get a good outcome but that's not true.

You see, it's not the exercising that gets you your ROM, it's time. Time to recover, time for swelling and pain to settle and time to heal. One thing that seems to be missing from all the PT's protocols is that all your ROM is there right from the start, just waiting for all 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. Exercise as in strength training is counter-productive and in the early weeks does more harm than good. Normal activity is the key to success.

I suggest you stop it all and just make do with your general everyday activities. You will benefit in the longrun.

 

[little red canoe]

For some the above is normal activity.. the question therefore is when can normal activity resume?

I do all the above for cardio health and to hopefully lose weight.

 

[Celle]

For some the above is normal activity.. the question therefore is when can normal activity resume?
I do all the above for cardio health and to hopefully lose weight.

No. Normal activity is the activities of daily living + work. Anything done at the gym is additional. It may well be in someone's lifestyle to work out at the gym, but that is not normal activity for a healing knee.

There is no set time, but after about 6 months, the gym activity is probably OK, but only if it doesn't upset the knee. At less than 4 months post-op, it's probably too much.
You could do upper-body workouts, though.

Remember that complete recovery from a TKR takes a full year, so 4 months is only a third of the way there.

 

[Jamie]

When using words such as "normal activity," it's critical that we're all on the same page. I think both Celle and little red canoe are correct. Some people view gym workouts as "normal activity" for them. Others might think walking 5 miles a day through the countryside is "normal activity." For a physical laborer, "normal activity" might be crawling up and down ladders and lifting heavy construction materials during 12-hour days.

The bottom line with recovery, though, is what can be tolerated by your knee at what stage in recovery. And, Tony, it's obvious that your knee is not ready for that level of a gym workout at this early stage. You are actually early, you know.... your surgery was December 1st and you are not 4 months out yet. For most people, it's not feasible to begin any type of strength training (that's what your gym workout is) until at least 6 months out. As your knee is showing you, it's just too soon. Right now your work and other daily activities are enough to keep you moving forward in recovery, so just go with that and let the strength training wait a bit. I know, that's not what you WANT to do. But all this is just temporary and you'll be able to do this gym workout and more later in your recovery. Remember.....it takes a full year to recover and sometimes even more! You have the rest of your life to enjoy this great new knee. Don't try to hurry it up. Take things slowly....increase what you do now and then....and if you have no pain or swelling afterwards then you know it's okay to move a step forward. But when you get the pain and swelling you describe, you must slow things down for a while. Patience!!! It's the hardest part of the whole process!

 

[tonyw]

Many thanks for the responses. I'm determined to do the bare minimum to see where this takes me and build up (hopefully) from there. I'm still quite sore at the moment but hope it settles down again over the next few days. Thank goodness for this site at least to maintain some hope and sanity! Very grateful [emoji106]


Sent from my iPhone using BoneSmart Forum

 

[kneeper]

With my 2nd knee at your stage I did about 20 minutes, 2 days a week. Exercise bike and a little walking on the treadmill. I stopped as soon as the knee "spoke" to me. And I did some light stretches each morning. Then I gradually built up.
With the first knee I let them push me into strengthening exercises too soon and was bothered with tendonitis.

 

[tonyw]

Just over a week since last post and very happy to report that knee is settled down - pretty much pain free. On the move walking again but nothing too strenuous and feeling much more positive as I thought I'd done some serious damage. Many thanks for helpful messages of encouragement and advice [emoji106]


Sent from my iPhone using BoneSmart Forum

 

[sistersinhim]

There's that rollercoaster ride again! But, before long those dips won't be as low or as long as they are now. Smoother days are ahead!

 

[tonyw]

Well I took a trip down memory lane given it’s just over 3 years since my TKR and logged into my account again. Looking back it took around 8 months until I reported that I was relatively pain free and well on the road to recovery. I’d endured a number I’d post op issues - one of which was intensive surface burning. With the help of meds (pregabalin) this eventually settled down. I also suffered acute patella pain and generalised post op discomfort, stiffness and swelling.
Everyones experience is unique I know and also everyones path to recovery is specific to them but I personally found cycling to be a huge benefit. I started on a static bike quite early on in my recovery but once my quads had developed a bit I started doing low impact bike rides and built up. I joined a spinning class and have been attending 3 or 4 times a week. Just over 2 years post op I cycled the coast to coast over 2 days. I’m a stone lighter than I was pre op and I’m definitely healthier than I was in terms of my heart etc. The knee is never going to be as good as it was but I’m relatively pain free. If I overdo things it swells a bit but soon settled down.
I can honestly say that Bonesmart was a God send in those dark days at the post op stage. Getting advice from the moderators and support from fellow post ops genuinely helped me get through. Again I know some people struggle and for various reasons don’t achieve a good outcome due to complications that I didn’t have. That said I would say to those struggling with pain is:

Listen to your knee. If it’s hurting don’t push yourself or do anything which is hurting. No pain no gain doesn’t work and set me back as I was trying to rush things
Try low impact exercises - try a static or ordinary bike. No inordinate weight on knees and keeps you exercising in straight lines.
Above all be patient. A TKR is a major op and time really is the essence. Try and stay positive - take good advice from people on here. Do your physio but don’t overdo things. You will get there and I can honestly say it’s the best thing I’ve done. Best wishes to all going through recovery and again thanks Bonesmart!

 

[Helizabug]

Thanks for your Post! I’m just a week and a day out. Lots to experience on this adventure, but your long term perspective is a treat. Thanks.