Revision TKR Against the wind

[skippyhak]

Day 54. Over did it this week. My target was 3000 steps per day and I've averaged 3900 per day. Plus my rehab has been twice a week; so that gives me at least 2 days off or more. This week my rehab was Wed and today. One day off. So I was sore before I went today and then added more activity and exercises on top of the soreness. I learned to back off when soreness is elevated but I did not want to cancel last minute. So....I'll pay with pain for the next few days. Bonesmart.org has taught me so much plus 3 rounds of replacements; it starts to make sense. When I look back on my 1st replacement I was constantly overdoing it, creating a bunch of soreness and swelling and then wondering if my surgery was a bust. Now I know that nothing is wrong with my replacement just that I DID TOO MUCH. "Easy does it." Everyone have a good weekend and rehab smart!

 

[skippyhak]

Almost a week later and knee still has increased soreness. I thought I was managing the activity well but my knee is now telling me different. After a week of "cutting back" and having no improvement as far as the pain goes. The pain is on the inside of the knee from the middle down to the lower part below the kneecap. If I move certain ways it kinda grabs momentarily and the pain spikes up to a 6 or 7 on the pain scale. If I rub around on the knee I don't find sore spots near the surface. The pain spikes occur when I move after sitting for a period, if I try and extend or stretch my leg out as far as possible while laying down it will grab and hit the same sore spot and spike up 6 or 7. This is all new over the last 7 days. Anyway...thinking I was cutting back was really not "cutting back" at all. It was just not increasing beyond what I'd been doing.
So here's my analysis..... increased my activity, wasn't elevating as much, reduced how much I was icing. Result was and is "increased soreness".
So I'm canceling rehab for tomorrow and probably for next Tuesday as well. I'm staying off my feet as much as possible for the next 4 or 5 days and see if any improvement. If no improvement I'll give it another 4 or 5 days. If still no improvement then I'll start to worry!
Suggestions or ideas are welcome!!

 

[Celle]

Sometimes, when you've been overdoing it with exercise, it takes quite a long time before your knee settles down again. Sometimes as long as 3-4 weeks!

It's only 2 months since you had the revision. I think you're probably trying to push for too much, too soon.
Remember that complete recovery takes as long as a full year, so your new knee is still only a baby.
It's wounded, not lazy, so treat it gently and don't try to rush its recovery.

 

[skippyhak]

Thanks Celle! Hopefully it will settle down sooner than a month or 2; but I'll just try and be patient and see how it recovers and progresses.

 

[sistersinhim]

Patience will pay off. Slow and easy = a much quicker and less painful recovery.

 

[skippyhak]

I’m discouraged and worried about the state of my recovery from my surgery of August 14. Feel like a crippled old man (71) and my dreams of walking briskly, golfing, hiking seem far off. I’m depressed. My hope is patience and just trying to take it one day at a time.
I had come to believe that a “revision” is a longer tougher recovery than the original TKR? but my surgeon said “actually easier and faster than regular TKR”. That is not true in my situation so far, but I did buy into that right after my surgery since I had lower pain levels and it just felt better. But at about 4 or 5 weeks out my progress seemed to stall or maybe moving at a snails pace is more accurate. I kept a journal over the previous 2 replacements and I was doing quite a bit more as far as activity at the same time periods prior. I'm a year or 2 older and maybe 5 surgeries in 28 months has taken a lot of my strength away? 2 years ago I was way more active on a daily basis. The surgeries and recoveries have led to a much more sedentary existence. I want to be active again but pain pushes me many times to want to get off my feet. Chronic pain is a big worry. Some of the worst pain spells over the last 2 years are very worrisome. Anyway....bad stretch presently. Back to rehab today.
Trying to reposition myself to a longer recovery.

 

[Jordon6]

@skippyhak I truly sympathize with you! I totally agree with what you've felt since your revision. My revision was June 13-4 weeks before yours and I am still not where I thought I would be!

Just know- you're not alone in what you're feeling. We've just got to keep telling ourselves that our knees are babies in this! And 3/4 months just may not be enough time.

It's hard listening to others that are doing so much better, though!

Give it more time! All of the surgeries have been tough on your poor knees. They NEED more time to heal! Forward is forward!

Best wishes!

 

[skippyhak]

Thanks @Jordan6 .... looks like yours has been a long hard journey. Thanks for the kind words and support. I'm heading out the door to rehab but I plan, when I return, to go and read your story and journey.
Thanks again!!

 

[Jockette]

I understand how you feel, I am 7 months out and I think I’m way behind some others who’ve had surgery after me.

I had a check up today with my surgeon and he was ok with where I am in recovery ( I was so worried he wouldn’t be. He tells me to do things that Bonesmart says not to and I was afraid I would have to defend my going with the Bonesmart approach, but that didn’t come up)

This is my first replacement and I had a partial. My recovery is not going the way the partial promoters said it would.

Anyway, my rom was measured today for the first time ever without being pushed. Comfortably it was 114, by leaning in a bit I got a 120. My surgeon never touched me today. (He usually pushes me to a painful place to get the higher measurement. I did not allow that today )

Kind of low numbers, in my opinion, for 7 months, because it hurts if I push anymore, but it is what it is. That’s why I think I’m slower than others. I have confidence it will get better, though.

I’m sure that 5 surgeries in 28 months has taken a huge toll. Try to cut yourself some slack. I’m sure it’s hard but your body needs time to recover. You will get stronger in time.

 

[Jockette]

@Jordon6 I do agree it’s sometimes hard to listen to those who are doing so much better than us.

 

[Celle]

I’m discouraged and worried about the state of my recovery from my surgery of August 14. Feel like a crippled old man (71) and my dreams of walking briskly, golfing, hiking seem far off. I’m depressed. My hope is patience and just trying to take it one day at a time.

@skippyhak - I understand how you feel, but please give yourself and your knee more time. It's only just over 2 months since you had your revision and complete recovery does take a full year - no matter what you were told before. It's a marathon, not a sprint.

Don't think that where your knee is now is where it's going to end up. It's still a work in progress. Give it time!

After the first few weeks, recovery does seem to slow down, but as long as you are making progress, however slow it seems to you, your knee is going to be OK.

From my own experience, the recovery time after my revision was about the same length as the recovery time after my primary knee replacements.

 

[skippyhak]

My rehab session was not very encouraging as far as my progress today. Operative word was ”plateaued”. Its more the way she said it and the look on her face that really bothered me. They seemed as concerned as I am.
The advice was "be patient and try pushing yourself harder."
Thanks to Celle, Jockette and Jordan6 for all your kind words and encouragement!!
I'm going to just move forward and see if there is something different I need to do? But until tomorrow I'm going to try and put it all aside and start with a fresh attitude in the morning. My mantra today is courtesy of Scarlette O'Hara: "After all, tomorrow is another day!"

 

[Jockette]

“Be patient and push yourself harder” don’t seem to go together. They are opposites.

And the tones and facial expressions and info that goes against Bonesmart’s approach are exactly why if I ever have to have another replacement I will not go to PT. Their expectations are too stressful. Recovery is difficult enough without all that.

Recovery would go so much better if everyone told us “of course your rom will return, it just takes time to heal”. And it will return.

Please don’t stress about it. I have been stressed throughout my whole recovery and overthought just about every minute because I didn’t think I measured up to other’s expectations.

And today I had a really good check up even though my rom is lower than what my dr would like. Thankfully he was very nice to me and accepted my recovery for what it is. I feel like a heavy weight has been lifted off my shoulders.

 

[sistersinhim]

I was so worried he .wouldn’t be. He tells me to do things that Bonesmart says not to and I was afraid I would have to defend my going with the Bonesmart approach, but that didn’t come up)

There's no reason to tell your OS what you are or are not doing. It's your knee. Your OS has done his job, and now it's yours to heal it the best way. Only you know your knee's reactions to what you do, so you are the responsible one.

I never told any of my surgeons through the years that I wasn't doing PT. I just said that I was working on it, which was true...by doing my ADL!

 

[skippyhak]

New day! Bad night. I've been sleeping on my back with both legs elevated since my surgery. I have no pain while sleeping in this position and when I get up and start moving it's not a bad transition to get up and start moving and walking. Last night I tried sleeping on my side with pillow between my legs. Fell asleep and woke an hour later and when I tried to move my leg/knee spasmed and locked up. Pain shot up high; maybe 7 or so on pain scale. It took 5 minutes for it to subside. Brutal. That episode will keep me away from that sleeping position for now. Knee and leg quite sore today.
I have an appt with my surgeon in 3 weeks. I'm just going to continue to try and exercise my knee and move forward. I'll see if my recovery starts improving. My progress is very slow at present so maybe it will improve.
I've also set an appt with a pain mgmt. Dr. a week after I see my surgeon. I'm doubtful that I'm going to get a clean recovery on this knee. This knee is so bent and deformed that I cannot imagine that it will straighten and improve significantly. Even though I'm only 2 months since the surgery I'm early on.....but I think pain mgmt might be my only long term solution to hopefully retain a certain amount of activity.
PS: I'm thinking of getting an evaluation from another PT that was recommended to me. I really like my present PT but I'm beginning to think they fault me for my present bad "numbers". Maybe time for a change of scenery.

 

[SusieShoes]

Side-sleeping can be so elusive! I'm a side-sleeper, too, and had exactly what you describe! Every time I'd try to side-sleep, I'd wake up with my left knee in pain. Sometimes even my "good" right knee would be sore. So I'd stop doing it for a week or so, and then I would attempt it again. Wake up with knee in pain. The pain would subside quickly -- quite unlike over-exercise pain -- but it was not conducive to good sleep.

Only after four months was I able to sleep all night on my side and wake up with pain-free knees.

Which is to say keep trying, but give yourself and your knee some slack. What you're experiencing is completely normal. It will resolve as your healing progresses into better territory. This might take a few months. If you can be patient, and trust your body to be ready on its own terms, it might be less worrisome.

Another PT might be a good idea. So might no PT at all. If your PT thinks you've plateaued, does that mean PT wants you to exercise more? Aggressive exercises can lead to the painful knee you are experiencing.

 

[jaschembra]

Going back to one of your posts from last week - I overdid it one time and it set me back at least 2 weeks - at least that's how I felt. Maybe even 3 weeks. So, really listen and pay attention to what your knee likes or doesn't like. Good luck on this slow journey we are on! I don't like dealing with what I've termed chronic pain lately either.

 

[skippyhak]

Thanks SusiesShoes and Jaschembra for the kind words and sharing your experience.
Side sleeping is NG for now. It's just so familiar and my long term sleeping posture. Tried it 3 or 4 times over the last week or 2 and the results have been spasm/cramp..all have been very painful but last night was high on the pain scale. Like getting a tooth drilled with no novocaine!
I thought long and hard before this revision but the hope of getting a solid result was worth the chance based on the info I had. The pain and agony of this procedure and the long recovery is a test. I had emergency surgery 2 years ago for a small bowel obstruction and the surgeon was telling me that its a painful procedure. That was nothing compared to TKR's.
Anyway...I'll continue to plod along and follow my nose.
PS: While I was lying awake last night I was thinking about how I handle the pain. After the 1st month most of the pain is based on movement. If I'm sitting with my legs elevated my pain for the most part is negligible. But after 9 weeks a simple thing like going up the stairs and planting my foot and driving off of it to the next step, simple enough, but today that pain hits 4 or 5on pain scale. So a simple task is now a painful exercise and I get to the top of the stairs and I can feel the extra energy required to do a simple task because of the pain. So the pain is there to remind you that you cannot yet return to a normal life. I've still got a lot of soreness, tenderness inside and below the kneecap.
Just kind of rambling here....

 

[Celle]

My rehab session was not very encouraging as far as my progress today. Operative word was ”plateaued”. Its more the way she said it and the look on her face that really bothered me. They seemed as concerned as I am.
The advice was "be patient and try pushing yourself harder."

Well for one thing, a plateau is not a dead halt. It's a time when your knee is consolidating its progress before it moves ahead again.

And "be patient and try pushing yourself harder" is not only a contradiction - it's also total baloney.
Pushing harder won't work. It will just irritate your knee, making it more upset and swollen.
TKR: work “smarter” and not “harder”
Knee recovery - Lose the Work Ethic!!

It's not exercising that gets you your ROM - it's time. Time to recover, time for swelling and pain to settle, and time to heal. Your ROM is there right from the start, just waiting for all that to happen, so it can show itself.

Be patient - yes. What's the rush? Complete recovery takes as long as a full year, whether it's from the initial replacement or a revision.. It's a marathon, not a sprint, and you can't speed it up, no matter how much you want to. Your knee will recover on its own schedule, not anyone else's - not yours and not your therapist's.
Where are you in recovery?? (TKR)

In any case, there's no need to rush to get ROM (Range of Motion) because it can continue to improve for a year, or even much longer, after a knee replacement. There isn't any deadline you have to meet:
Myth busting: the "window of opportunity" in TKR

But after 9 weeks a simple thing like going up the stairs and planting my foot and driving off of it to the next step, simple enough, but today that pain hits 4 or 5on pain scale. So a simple task is now a painful exercise and I get to the top of the stairs and I can feel the extra energy required to do a simple task because of the pain.

It takes some people as long as 4 months or so before they can do stairs comfortably. Once again, you're expecting your knee to do too much, too soon.
Patience, Grasshopper!

 

[skippyhak]

Thanks you Celle!! These PT's sure make it difficult when they start with the guilt trips.
I've kept a journal for my previous knee surgeries so I looked back this morning to see what I wrote on day 66 last year and the year before. It reads almost the same as if I'd written it today. So I guess the area of 2 months is struggle time for me. 3 for 3. So....I'm not going to over react to my misery. I'm just going to keep my nose to the grindstone and move forward each day.