TKR An Outdoor Lover's Recovery

[Kneeophyte]

We live in the San Francisco Bay area of California & my Good Spouse & I have been lap swimmers at whatever public pool was closest to our workplaces for many years. In the current work from home situation, that's meant we've both been swimming at an outdoor pool (with many covid controls) near our home for many months. I'm at 6 weeks post-TKR & today was my first day back in the pool. Lots of oddness, needing stairs & handrails to emerge from pool, inability to do a flip turn, suddenly baggy swimsuit (c diff episode sure had an added impact there), very slow lap pace, but it was HEAVEN.

 

[Jockette]

I agree about the dental thing, and yet so many surgeons and dentists still “require” them, which is why I searched for a new dentist. The woman on the phone that I spoke with at the original dentist office actually told me they follow what the ADA says, and to look it up. I did, and the ADA no longer recommends it. I didn’t call her back to inform her.

Of course we are all different, and some people just feel better about taking the antibiotic, and that’s fine. I‘m glad I had a choice and made the decision that I am most comfortable with for me.

 

[Jockette]

I’m glad you enjoyed the pool. Just be sure to take it easy, as it’s very easy to overdo things in a pool.

My PT put me in a pool at 4 weeks post op, for almost an hour, doing countless exercises and lots of waking. She made me come up the steps to get out foot over foot, which was my first attempt. It took me 3 days to recover from this PT session. That’s when I stopped being compliant! I did not go back to the pool, but I’m not personally a fan of pools anyway. (I think I’m the only one!)

 

[Kneeophyte]

I'm now at 7 weeks post-tkr. Have been off all oral NSAIDs & other regular pain medications for some time starting before/during my un-fun bout with c diff infection (weeks 5 & 6).

Now knee & ankle of tkr leg swell (& knee gets very stiff) if I walk much. I scaled back to 5 minutes easy walking per waking hour. Also get swelling & stiffness when I've tried to resume exercises I'd been doing before coming down with c diff. I've had no outside PT, earlier I used some of exercises MyMobility app suggested. I'm still elevating & icing once or twice a day.

Sound pretty normal, considering?

The bright spot is that I've been able to swim my pre-tkr distance (1/2 mi, 0.8 km) with no problem (well very slow with feeble flutter & dolphin kick). Also without knee after effects - swam yesterday & swelling & stiffness continued to improve from earlier. So at least I can get in some exercise & enjoyable outdoor time.

 

[sistersinhim]

Great that you can swim. It was months before I was able to swim without causing pain afternoon. It sounds like your recovery is going quite well.

 

[Kneeophyte]

Anyone have comments on their experiences using a topical NSAID on knee after a TKR?

I stopped using oral NSAIDs when I came down with C diff, a very nasty gut infection related to having taken post-TKR antibiotics. (Oral NSAIDs can be hard on the gut & mine needed no further stressors.)

I've now finished the initial C diff treatment & am hoping to avoid being in the ~35% with a recurrence. After double-checking with my PCP -- who I trust to have a more thoroughgoing whole-body-health outlook than my OS -- I re-started using a topical NSAID on my knee.

Always hard to be sure, but it SEEMS like the topical NSAID is helpful in reducing knee stiffness & achiness.

 

[Kneeophyte]

OK, I know we all heal on our own schedules, but on the AVERAGE, how long after tkr do people benefit from including a session or two of icing & elevation in daily routine ... assuming they are paying attention & avoiding pushing knee too hard?

On average, is it helpful to continue daily sessions for many months?

A kind friend-of-a-friend loaned me his ice machine, realize I don't have the foggiest idea of when I might not need it....

 

[Jockette]

Icing is very individual, I did it until about 6 months, because I thought I was supposed to. I finally stopped because it was starting to hurt, and I wondered if that might have been because I didn’t have enough swelling to cushion the ice pack, if that makes sense. To be honest, I never liked icing and I didn’t really get the pain relief from it that so many mention.

Do you have a lot of pain and swelling?

 

[Goma]

I am 4 months out and don't ice anymore unless I really need to which is rarely. I found it just made me cold. Now when I rest I put my leg on my ottoman. My knee is solid now and feels good. Icing is individual depending on progress.

 

[FCBayern]

After I went back to work I still iced every evening for most of six months @Kneeophyte. I also kept a couple of jell packs and a large Ace bandage to hold them in place if my knee was getting cranky, which it did on and off for several months. If I had a really busy day I iced as a precaution for close to a year.

 

[Celle]

Anyone have comments on their experiences using a topical NSAID on knee after a TKR?

Topical NSAIDs aren't generally used after a joint replacement. I'm not sure how far they will penetrate into your knee, but some will be absorbed into your general circulation and there are some dangers to be aware of. NSAIDs do increase your tendency to bleeds and they can have other adverse affects as well.
NSAIDs Diclofenac. ibuprofen increase risk of heart problems: new study

I would be more inclined to use icing and elevation instead.

Always hard to be sure, but it SEEMS like the topical NSAID is helpful in reducing knee stiffness & achiness.

OK, I know we all heal on our own schedules, but on the AVERAGE, how long after tkr do people benefit from including a session or two of icing & elevation in daily routine ... assuming they are paying attention & avoiding pushing knee too hard?

It really is a very individual thing how long people continue to ice their knee, so I don't think we can suggest an average time.

If your knee swells, then you still need to use icing and elevation. Sometimes once a day is enough, but more frequently probably helps even more.
You are using your knee quite actively while swimming, so a session of icing when you get home seems like a good idea.

 

[Kneeophyte]

Thanks all, even with quite a range suggested in the answers, it gives me some idea of how long to continue borrowing that ice machine.

When I do return it, it doesn't mean I can't ice the knee. Probably like most on this forum, I was icing the knee at times over many years. Have accumulated a collection of flexible ice packs, wrapping gizmos, etc. Plus I'll still have my trusty 2L pop bottle with its elegant towel & rubber-band cover (for heel elevation and, early on, much more comfortable for me than the wedge pillow I tried).

 

[Jockette]

I never had an ice machine, but I do have a variety of gel packs! Yes, I kept my favorites and tossed the ones I tried and didn’t like.

 

[Bikeknit]

I used topical nsaid's on my knees for months a couple of years before my surgery and they helped. But I generally did not use them after as I had some other options. Because of stomach inflammation I'm also told not to use oral nsaid's. I've gotten different opinions from different medical providers about the potential of the topicals to enter the bloodstream - for instance my OS told me to stop them a week before my surgery but the preop people at the hospital said it was okay to use them til only a day before.

Thanks for the discussion on oral antibiotics and dental procedures. My primary doc also says, "no way" while my OS insists for life. I'll have to make my own decision there.

 

[Kneeophyte]

Thank you for the comment, Bikeknit, I guess I'm fairly comfortable with the topical NSAIDs, from what my careful PCP has said, they should present way less of an issue for my digestive tract than the oral NSAIDs did (of course maybe way less swelling/ache reduction too).

Wow, two TKRs last summer, you are very brave! One of your recent posts commented on wishing for more extension. Too bad we bonesmarties can't set up some trades -- I'd cheerfully give up a bit of extension for someone's excess flexion. But right, both are supposed to return on their own timeframes. I sure am looking forward to that because I want to be able to once again hike & cross country ski on normal trails, ones with actual elevation gains & losses.

 

[Kneeophyte]

Limping... assuming the TKR is the only reason for limping, will it just gradually improve & go away? Though my leg can bend, it doesn't seem to flex on its own when I walk, at least not yet.

I'm sure many of you have been through this & I'll be interested to hear your experiences.

 

[Jockette]

Yes, that will improve as you heal. you are still in early days. Use your cane more, that might help. I found even as I healed more, the limp would return when I was tired, until I healed even more.

 

[Kneeophyte]

Thank you Jockette, that is reassuring.

But you mention using a cane. Would using one likely help most people recovering from a TKR?

I relied on a walker for much of the first week -- it was important to ensure stability. Since then, there's seemed to be no more need, fortunately my balance has been fine. My knee has been consistently stiff & not bending much when I walk, but there's also been no problems with weight-bearing.

(No matter what, I will definitely again use my hiking poles when hiking becomes possible.)

 

[FCBayern]

When I graduated from the walker to a cane I used it until I started forgetting it @Kneeophyte. When I left it in a shopping basket in a store parking lot and had to go back for it, I knew I didn't need it anymore. Others have used trekking poles for that little bit of extra support to assist walking limp free. Find what's comfortable for you and use it until you can walk limp free without it.

 

[sistersinhim]

I think using a cane while you are out would be a good idea. Anyone can bump into you or you could misstep and down you'd go. Also, using a cane will make those around you more aware and be more careful around you. I used mine in stores for at least 6 months just to be careful. Now, I still have one in my care, just in case!