TKR April 2022 TKR right knee

[JojoFitness]

I'm getting concerned and a bit sad. I'm four weeks out from RTKR. Doing well at PT and at home. I typically walk between 4-5,000 steps a day, both inside and out. I am still icing my knee. Swelling has gone way down and my leg and foot are almost back to normal. The stere-strips were removed by my therapist on Monday as they were all still in place. That freaked me out a bit, as well as needing to massage the incision area going forward. Good to know! But...
I am still on Oxycodone/Acetaminophen! I'm taking fewer per day but I can't seem to go any lower - the pain is too great, and I'm unable to do PT or ADL.

I can't take much Advil as I was substituting Advil for some of my Oxy doses - but it raised my B/P a lot. My PCP said it's because I normally haven't taken much advil at all, and then suddenly was taking 6-10 pills a day. But it's an anti-inflammatory and helped so much. Anyway, now it's just Oxy & Tylenol. I read so many people's posts about stopping narcotics much earlier and that makes me sad and feeling like a failure. I'm not worried about becoming addicted, I'm more worried about it never getting enough better that I don't need them. I'm cutting the Oxy's in half, and taking just a half pill every six hours, plus Tylenol in between, and then once a day I will take a full Oxy pill which I've found necessary. My surgeon just keeps refilling the Oxy at my request. But I feel like I've had no one to talk to about pain management and I think I'm taking it longer than anyone else. Any advice? Please talk me off the ledge . Thanks for reading! I appreciate every post I've read and am so thankful for this site.

 

[Layla]

Please notice that we have merged your newest thread with your original recovery thread. Having your recovery information contained in one place will make it easier for you to reflect back on. It is also helpful for those stopping by to be able to review your history before advising or commenting. Please post any updates, questions or concerns about your recovery here.

Please don’t be sad as you’re very early into a recovery that can last a full year, even longer for some. I’m wondering if your PT, even though you seem to like it, may be the reason you’re experiencing the discomfort that’s keeping you on the meds? Something to consider. Since you’re unable to engage in PT, hopefully the break along with rest and icing will help. Wondering when you last attended a PT session and if you‘d like to share exactly what you were directed to do there? Having this info may help us advise in regard to the pain you describe. Wishing you comfort and speedy relief.
@JojoFitness

 

[WFD]

5,000 steps a day is a lot for only being four weeks out. Maybe back off to 3,000 if you can and see if that helps?

 

[JojoFitness]

Wondering when you last attended a PT session and if you‘d like to share exactly what you were directed to do there? Having this info may help us advise in regard to the pain you describe. Wishing you comfort and speedy relief.
@JojoFitness

Thank you, Layla. Maybe I AM doing too much too quickly. At PT, I start off on the bike and was able to do full rotations, both backwards and forward, as of last week. I then go to the "stairs" and stretch knee in both directions. And using a band, do leg side raises. Then I'm usually put on the knee press machine (I don't know what it's called) I'm lying down on the machine, knees bent, and both feet flat on the press. After a number of slow presses, she lowers the strength and I do single-leg presses with my surgical leg. That usually exhausts my leg. ugh. THEN, a machine that strengths quads and hamstrings - two different exercises on the same machine. That's tough but feels good too. I end each session requesting an ice pack on my knee for about 10 minutes. My last PT session was two days ago, and my next one is tomorrow, May 5th.
I will finally see my surgeon on May 16th. But have a feeling he's only interested in the incision, my progress, not whether or not I'm on pain meds still. Layla, your question made me feel you also think I may be staying on these meds a long time. Right now I'm ready to do my home PT because I took a FULL pill (5 mg.) at 7:30. But my workouts are much tamer ;))

 

[Jockette]

I agree with Layla, I think the PT you are doing, this early in recovery, is reason you still need this prescription medication.

Layla, your question made me feel you also think I may be staying on these meds a long time.

The issue is not that you are still on prescription pain meds, the issue is why you need these stronger meds. You are doing strengthening exercises on a knee that is not healed enough for them yet, and that is keeping your pain level high.

Here‘s an article from our Recovery Guidelines:

BoneSmart philosophy for sensible post op therapy

You will have noticed there is a significant opinion here about the potential hazards of PT. You may feel that your therapists are experts and know what you should be doing. However, over the last several years I've been here, I have observed that the more intensive the regimen of exercising...

bonesmart.org

There’s nothing wrong with taking pain meds, I took Tylenol and ibuprofen alternately for months after my surgery. But I was careful with my activity so as not to have more pain than I needed to.

Unfortunately, not all PTs know the best way to rehab a joint replacement. You need to heal more, before you can handle the things you are currently doing.

 

[JojoFitness]

Thank you, Jockette - I've read the attachments as well as your words, and appreciate all. Perhaps I am doing too much. I will try to manage my PT at the center tomorrow. I've never been in pain doing the therapy, and a lot of it feels good - but maybe it's still too much too soon. I will stay in touch

 

[kiwicurls]

No way could I do all that physio! No wonder you’re in severe pain. I do the bare minimum, have excellent flexion and extension and take panadol 3 times a day. Had to stop the anti inflammatory drugs as they were upsetting my stomach.
I walk for 15 minutes, plus incidental walking to prepare meals, etc and Twice a day I do some gentle exercises recommended by the physio. These take all of 5 minutes.
Please ease off.
Best wishes!

 

[JojoFitness]

Thank you, Kiwicurls. So the only pain reliever you're now taking is Panadol (acetaminophen)? If so, that's impressive. I was wondering about which exercises ARE good for me at 4 weeks out, and I think what Bonesmart is saying is that it's mostly ADL. And what I'm doing is strength training. I can accept that and agree to a certain point. But working gently on knee flexion ROM seems crucial. I'm still a bit confused but will absolutely cut back on some of what my therapist is having me do. And will see how I progress. Best of luck to you too!

 

[glidefloss]

At PT, I start off on the bike and was able to do full rotations, both backwards and forward, as of last week. I then go to the "stairs" and stretch knee in both directions. And using a band, do leg side raises. Then I'm usually put on the knee press machine (I don't know what it's called) I'm lying down on the machine, knees bent, and both feet flat on the press. After a number of slow presses, she lowers the strength and I do single-leg presses with my surgical leg. That usually exhausts my leg. ugh. THEN, a machine that strengths quads and hamstrings - two different exercises on the same machine. That's tough but feels good too. I end each session requesting an ice pack on my knee for about 10 minutes.

Hi @JojoFitness , I started up a similar routine a little more than a week ago and have started ramping things up, including strength training. One of the things I've found helpful has been "assisted squats" where I'd plop myself onto a kitchen chair and push myself back up with my arms and after a couple of days of doing a few sets of 10 (spread out over the day), I can now sit myself down under legs control and stand myself up without arms assist. A side benefit of this has been fewer "buckling" events and going up stairs reciprocally has become much more natural. At the gym I use the leg press, extension, hamstring curl, and abductor/adductor machines after warming up on the stationary bike (dropping seat height every few minutes). I ice for 30 minutes after gym and elevate a couple of hours after - massaging the leg, initially focusing on the lower leg and thigh but have shifted focus to massaging the knee area as that is the only part that remains swollen. The only ROM related exercises I do are seated heel slides (as I sit at the kitchen table) and the stationary bike. I will start doing "gravity bends" - raising leg perpendicular to my body and letting my lower leg ease into a bend.

Night times are the worst hours for my legs. A couple to three hours of what I think is good sleep is followed by hours of achy knee, lower back and ankle, making sleep a choppy inefficient affair. Once the day rolls along and I'm up and about things improve and while at gym all the aches and pains seem to go away. Icing and massaging after workouts help keep the aches and pains at bay ... until night time rolls around.

As bonesmarties are quick to point out - we're all different, what works for someone could be disastrous for another ... we all need to find what works for us.

All the best!

 

[Layla]

And using a band, do leg side raises

We do advise against using bands. You probably noticed that in the article on BoneSmart Philosophy For Sensible Post Op Therapy.

After a number of slow presses, she lowers the strength and I do single-leg presses with my surgical leg. That usually exhausts my leg. ugh.

“Exhausts my leg“ = too much.

Please understand, I’m not saying I think you’re on meds for too long. However, I can’t help but wonder if you weren’t pushing yourself as it sounds like you may be, if you’d still feel the need for your current dosage schedule. It’s certainly something you could experiment with for a couple weeks. Skip the PT and see how you feel, physically, that is. It’s up to you.
I do wish you only the best as you continue on your healing journey!

 

[sistersinhim]

Then I'm usually put on the knee press machine (I don't know what it's called) I'm lying down on the machine, knees bent, and both feet flat on the press. After a number of slow presses, she lowers the strength and I do single-leg presses with my surgical leg. That usually exhausts my leg. ugh. THEN, a machine that strengths quads and hamstrings - two different exercises on the same machine.

Oh my goodness, this is really bad for a baby knee. You are not in training, you are healing from a major, traumatic surgery. Doing strength exercises inflames your knee because obviously, it's not ready for that yet. We recommend strength training not until 3-4 months out, not 4 weeks.

Right now I'm ready to do my home PT because I took a FULL pill (5 mg.) at 7:30. But my workouts are much tamer ;))

You should not take pain meds before PT. You need to feel the pain. That's your knee's way of telling you that it's not ready for what you are doing to it at this stage. Wait a few weeks and try the exercise and if you have no pain or swelling during or afterward, then your knee is healed enough to do it.

And what I'm doing is strength training.

You are still having to take pain meds because of doing strength training this early in your recovery. That's the key, it's recovery, not training. Training comes after the pain and swelling go away.

 

[JojoFitness]

3 and a half weeks is still early days in this recovery that takes an average of 52 weeks.

While pain is still going to be there for a while, there are things we can do to decrease and/or increase it. What do you do at PT? While we like to think the PT knows best, unfortunately some don’t really understand this recovery and they give us inappropriate things to do, for our stage of healing.

Ask your doctor if you can take Tylenol. The most effective way to take Tylenol is 2 x 500 mg tablets every 6 hours, to a total of 4,000 mg (4 doses) in 24 hours. You need to take it regularly, to keep up the levels in your bloodstream. If you just take the odd dose now and then, it's far less effective.

Check all other medications you're taking, to make sure there is no Tylenol/Acetaminophen/Paracetamol in them. If there is, scale back one or two of your regular Tylenol doses, so you stay within that safe 24 hour limit of 4,000 mg.

I took Tylenol for months after my replacement.

Hi - okay, I have a new plan - both to do better in recovery, and to finally get off all Oxycodone. I talked to my therapist yesterday, told her I want to get off narcotics! I've been down to taking only five 1/2 pills a day for ten days, plus an occasional Tylenol and Advil (I can't take much Advil because of B/P but I can take some). But I'm still taking those 1/2 pills.

She suggested I wean off Oxy by going eight hours in-between my 1/2 pill doses, instead of every six hours. And supplementing with Tylenol or Advil. Sounds like good Bonesmart advice too. Yesterday was my one-month post-TKR anniversary and it's time I get off them! I'm going to focus this entire weekend on bearing through the discomfort & stiffness (it's really more that than pain), lots of rest, easy walking (I easily walked a total of 6,000 steps yesterday) and not worrying about exercises, just easy stretches. AND, because of good Bonesmart advice, I'm going to focus on doing activities of daily living (I did a couple loads of laundry yesterday and but my husband folded and put away everything ) as my main source of exercise.

I'm going on and on - so sorry. Please know how much I appreciate you, Jockette, Layla, and all of the contributors to TKR recovery!

 

[Jockette]

Sounds like a good plan. Just take things slow.

 

[Layla]

A belated Happy One Month Anniversary!
I hope your plan works well with minimal discomfort only, if any.
We’re rooting for you! Wishing you a peaceful weekend.
@JojoFitness

 

[JojoFitness]

A belated Happy One Month Anniversary!
I hope your plan works well with minimal discomfort only, if any.
We’re rooting for you! Wishing you a peaceful weekend.
@JojoFitness

Thank you so much!

 

[glidefloss]

Yesterday was my one-month post-TKR anniversary and it's time I get off them! I'm going to focus this entire weekend on bearing through the discomfort & stiffness (it's really more that than pain), lots of rest, easy walking (I easily walked a total of 6,000 steps yesterday) and not worrying about exercises, just easy stretches.

Best of luck @JojoFitness ! Pretend the discomfort and stiffness are a byproduct of having run a rugged ultra-marathon or completed an Ironman triathlon or some other multi-hour/day event! The pain/aches/discomfort from my TKRs would bring back memories of some of my more grueling ultra events from years ago ... and how the aches would gradually fade away as the days rolled by.

Best of luck!

 

[JojoFitness]

Yesterday was my one-month post-TKR anniversary and it's time I get off them! I'm going to focus this entire weekend on bearing through the discomfort & stiffness (it's really more that than pain), lots of rest, easy walking (I easily walked a total of 6,000 steps yesterday) and not worrying about exercises, just easy stretches.

Best of luck @JojoFitness ! Pretend the discomfort and stiffness are a byproduct of having run a rugged ultra-marathon or completed an Ironman triathlon or some other multi-hour/day event! The pain/aches/discomfort from my TKRs would bring back memories of some of my more grueling ultra events from years ago ... and how the aches would gradually fade away as the days rolled by.

Best of luck!

Glidefloss: thank you so much! I like that imagery ...

 

[kiwicurls]

Hi @JojoFitness How are you doing now?

 

[JojoFitness]

Hi @JojoFitness How are you doing now?

Thanks for asking, @kiwicurls - I'm doing well, but feel I've plateaued. I still have nausea off and on all day, but can control it with saltines. I do have more pain and discomfort than I thought I'd have at 5+ weeks. I'm only taking Tylenol and just a few Advils because they raise my BP. Tylenol just doesn't help! I'll see my surgeon on Monday, May 16 and can't wait to see what he says and how the X-rays look. My flexion ROM is 116 with great effort, and my therapist wants it to get to 120 by the time I see the surgeon. I'll try, but not going to worry about getting there! How are you??

 

[Jockette]

It is not unusual to still have a fair amount of pain and discomfort at 5 weeks post op.

Don‘t try too hard to increase your ROM, that can often be counterproductive. I fail to understand why PTs don’t get that. Some of us take months and months to get to 120 and still end up with an excellent outcome.