Revision TKR Bruising 3 years out

[KarriB]

It's normal for your knee to be warm, especially right now so soon after surgery. My OS told me it may be warm for months. Clicking is normal also, it usually goes away with use.

 

[Pumpkin]

Glad to hear the nurse is on you side and will advocate for you. You and your nurse can also check with your primary physician if the OS office balks.

 

[Vintage51]

With both surgeries (left and right knee) the week after surgery was the worst of it. I too had painful lower leg with my first knee. I was discouraged because I didn't understand the recovery. The second week I felt better and by the 4th week, I felt human again.
Fast forward to my LTKR, (3 weeks ago) I experienced the same pain. But I knew it would end. Instead of pushing PT during the early weeks, I relaxed, made sure I medicated correctly, iced properly, and inch by inch moved forward. If it hurt, I eased up. You will have good days, followed by less good ones. Each morning is like starting over. But each day you will improve. 3 weeks off the table and I'm walking with a cane. Best to you.

 

[Josephine]

1) My pain level right now is about a 7 and I've taken my pain meds already. It's like a steady throbbing in my knee no matter how I lay

Oh my, that IS high.

2) The doctor has me on Percocet 5-325 (oxycodone and acetaminophen) 1-2 tabs every 4-6 hours. I take 2 every 4 hours because it's as long as I can go before the pain gets unbearable.

I do agree with the others that this medication is clearly not suiting you. This does happen and needs to be taken seriously.

He said to let him know tomorrow if I'm still hurting to the point where the meds aren't working and he will call the doctors office himself.

I suggest you take this nurse up on his offer as untreated pain will cause swelling which, if left untreated, can become chronic and difficult to treat. If your surgeon doesn't want to help, I suggest you try your GP. Others have done this and found their GPs to be very accommodating. personally, I prefer Tramadol (take with Tylenol) any day.

3) I ice my knee almost all day long. The only time I don't ice it is if I'm walking, going to the bathroom or bathing. I use a Breg polar care cube

Jolly good!

4) I elevate my leg whenever I'm not up walking around, which right now is most of the day. I have extreme numbness and tingling in my lower leg and foot so not elevating it gets quite unpleasant to the point where I feel like there's a million needles stabbing me all at once.

Do you elevate with a straight leg? If so, that's why you are having problems. I suppose someone in the hospital told you to never let your leg rest bent which is a nonsense! When your leg is swollen, you cannot keep it dead straight without consequences. Look at this as see how the right and wrong ways to elevate Pain and swelling control: elevation is the key.

5) My flexion is about 100° right now (I could go more but I'm afraid to tear my stitches) and my extension is about 2° (still working on the straightening right now)

No don't do that. That ROM is fantastic for one week out. Absolutely fantastic!

6) I have moderate swelling with bruises almost everywhere

I would imagine so and the bruising doesn't help as the blood coagulates and causes your tissues to become hard. But it will get resorbed in time and the leg will soften. In the meantime, do NOT attempt to force bend your knee because it won't Swollen and stiff knee: what causes it?. This article was in the collection Pumpkln left you in post #3 of this thread. You did read them I trust? You might also find this article informative as it shows how common this extensive bruising is Bruising after surgery

7) My activity level is pretty low right now because it's only been a week and I can only handle being up for about 10 minutes before the pain, numbness, burning pins and needles kicks in and I have to lay back down. I don't do any shopping right now because I cannot drive (I own a big pickup truck and cannot safely get in and out of it right now plus I get dizzy spells) I'll get up, walk around the house, walk out to the porch for some fresh air, sometimes switch the laundry maybe pick a few things up off the floor and it's time to lay back down. I use a walker to get around

All good. Keep up the good work!

My comments in bold
My exercises at home right now are minimal - good
heel bends 2 reps of 10, 3-4 times a day - heel slides are very easy to do badly and this pattern is badly! Read this Heel slides and how to do them.
quad flexes 1 2-3 tines a day - I would give these a miss for now
CPM machine about 4 hours a day - does this cause you pain? Because if it does, stop using it. Its effectiveness is very dubious anyway.

My physical therapist has me on light exercise only right now because my pain is not being controlled good enough for me to do heavier exercises, so she's giving time to see if my body naturally heals out of some of the pain since my doctor will do nothing to help manage the pain

I would tell her you want to pass on any exercising right now even when you do get your pain management sorted. I've shown that all this exercise therapy is not only unnecessary but often counter-productive as it causes more problems that it solves. I recommend you read my recovery threads to see how little exercising I did!
First knee. Knee recovery - UK style
Second knee. Josephine's 2nd knee story - short version where I did even less!

We have a number of members on here who have quit PT altogether and gone on to get a really good result, which they might have done anyway, but without all the pain and anguish! @Celle is one. The point being that your ROM is already really good. Start 'therapy' and you will see it decrease and the pain increase. Please don't let that happen.

I've noticed that since my surgery the back of my knee joint is a little warm (not hot) and my kneecap is a little wiggly if I mess with it and it makes noises. Is this normal too??

Warm joint is a sign of healing and perfectly normal. As is the wiggly kneecap! All normal!

 

[Celle]

Josephine is right - you don't need PT in order to rehab your knee. I didn't actually quit PT. I was fortunate to have two different surgeons, neither of whom believed in lots of PT.

For my partial (PKR), back in 2000, I was shown a few exercises in hospital and discharged to do them by myself at home. Sometimes I did them a few times, but I'm bad about exercising. I went to out-patient PT about four or five times over the course of a couple of months, and I was shown a few more exercises each time. That was all. My knee recovered well and the PKR lasted me for 11 years - longer than most.

I had a new surgeon for my revision to a TKR. He didn't allow any PT at all for the first month after surgery. He says that the knee needs that time, to begin its recovery from the surgery. All I did was walk around the house a bit and do a few heel slides, when/if I remembered. I rested, iced and elevated my leg.
After a month, I went to PT, where I was shown a few exercises. I only went back twice more, at two-weekly intervals.

My last TKR (the other knee) was 19 months ago. I had no PT at all. As before, I walked a bit and did a few heel slides. After a month had passed, I wasn't sent an appointment for PT. I knew what to do, so I didn't pursue it. I did tell my surgeon at my six-week appointment and he said, "Well, you're doing OK. You don't need it."

Both my knees are great. I have full extension and a good bend (125+) in both of them. They're strong and I can do anything I want to with them.

 

[Timetolive]

I am sorry you are having so much trouble with your doctor's office. Who is covering his patients while he is out? I would call and ask that question. It is a good idea to let your home health nurse call. He can probably get better results from this doctor's office. As a last resort, you can always to the ER if you feel something is really wrong.

My kneecap wiggles also and that is what it is supposed to do. It needs to be free so it can glide easily. In fact, I was given specific massage techniques to keep it lose. Have you been instructed how to do this? If not, is there a reason you are wiggling it? Does it hurt? It will make a noise - as my OS told me, the knee is mechanical and will make noises at times. These will lessen as your muscles recover and strengthen.

Good luck and I hope you get some relief. You can have 4 weeks of "Dark Days" of recovery, then things will start to get better.

 

[Xanaphia]

@Josephine I read all the articles that Pumpkin posted. Such a wonderful wealth of information! I'm truly glad I found this site because I've had do many questions answered and I've learned so much.

I don't elevate straight legged, they told me I had to but I don't because it's just too painful, I use the pillow stack method. If the CPM hurts I don't use it.

Last night everything got the best of me and I just couldn't take it any more so my husband took me to the ER and they checked me for blood clots and infection and everything came back fine. My prosthesis looks good. The doctor said that I have some fluid built up in my knee which is probably causing the really bad knee pain. He said that is normal after surgery and would go away over time. They gave me muscle relaxers to calm down the muscle spasms, and said that my doctor has an obligation to take care of my pain whether he's in the office or not so I'm going to have my nurse call his office and see if he can get somewhere with them.

Today the pain is a little less intense, which is nice. They changed my bandage for me and the 7 inch incision looks scary but is perfectly fine, no infection there. So that helped ease some of the anxiety, knowing that everything is ok. As for PT, I will not let them do anything that causes severe pain. I've read so many places that PT isn't necessary after knee replacement. Thank you for the info about the heel slides.

 

[Josephine]

I don't elevate straight legged, they told me I had to but I don't because it's just too painful, I use the pillow stack method. If the CPM hurts I don't use it.

Jolly good! That's the right way to do things.

The doctor said that I have some fluid built up in my knee which is probably causing the really bad knee pain.

Yes, it's called swelling! Remember?

said that my doctor has an obligation to take care of my pain whether he's in the office or not so I'm going to have my nurse call his office and see if he can get somewhere with them.

Brilliant - make him do his job. That's what he got paid the big bucks for.

As for PT, I will not let them do anything that causes severe pain

No, that's not the right thinking - don't let them cause ANY pain. Mild discomfort at the most, no more.

But given what you've been going through, don't do ANY PT, not a thing. Just rest. It won't affect your overall recovery so if the PT starts on about the "window of opportunity" you can tell him/her from me that is OLD thinking and is a myth!

 

[Xanaphia]

The PT came to the house today and measured my ROM my extension is at -10° so I've got a ways to go on that and my flex is 95°. There's still quite a bit of swelling that's probably inhibiting it. I wish I had something better than the Breg polar care wrap. Seems like this one doesn't get very cold and only covers the front. I've got a homemade ice pack in the freezer, waiting for it to be ready so I can use it on the bottom of my joint. We did do some exercises but she helped and it was just uncomfortable, no real pain and they were light exercises. My nurse is going to have her supervisor call my doctors office because she's dealt with them before and she says the nurses are like a hive of angry bees. She said I should have gone to Baylor and she's probably right lol

 

[newlybionic]

Your range of motion is actually very good for your stage of recovery. It's not been a week. Many surgeons are happy if their patients hit 90 by six weeks so you are way ahead. Extension for me took a while but it will come. Right now the best thing is to rest, elevate and ice your knee. BTW I put the frozen blocks you get for a picnic chest in my ice machine plus some ice. It seems to keep it much colder for a longer period of time.

 

[Josephine]

my extension is at -10°

-10 (blue flag) is good. You mean +10 (red flag) which is not. However it's not at all bad for one week out. It wouldn't be too bad for one month out!

my flex is 95°

Again, that's good for one week out. And also would be good for one month out!

There's still quite a bit of swelling that's probably inhibiting it.

No 'probably' about it! Did you not read this article in the recovery articles Swollen and stiff knee: what causes it?. It was in the collection Pumpkln left you in post #3 of this thread and I reminded you in post #24! Pardon my asking but you do know how to use links, don't you?

I wish I had something better than the Breg polar care wrap. Seems like this one doesn't get very cold and only covers the front.

Then by some gel packs! There's a whole range in this article Ice to control pain and swelling - also in the recovery articles!

We did do some exercises but she helped and it was just uncomfortable, no real pain and they were light exercises.

Did you read this in my earlier post? You do seem to be making me repeat myself over and over!

I would tell her you want to pass on any exercising right now even when you do get your pain management sorted. I've shown that all this exercise therapy is not only unnecessary but often counter-productive as it causes more problems that it solves. I recommend you read my recovery threads to see how little exercising I did!
First knee. Knee recovery - UK style
Second knee. Josephine's 2nd knee story - short version where I did even less!

 

[Xanaphia]

Lol yes I know how to use the links ;) I read them. I missed the one on swelling which I just read now (must be my fuzzy head) and that does explain alot. I did tell the PT no exercise today but she was very insistent, saying I had to or my knee would get stuck the way it is. I kinda argued with her a little bit, telling her I know that's not true. She finally relented a little but still insisted on a few minor exercises. I agreed because they were simple, like the heel slides, and none of it was painful.

 

[Jamie]

Good for you for speaking up for yourself with the therapist! Some gentle bends and stretches are fine each day. As are a few walks about the house from room to room. But that's all that's really needed at this point. I second the suggestion to get some gel packs for icing. I had 4 big ones and used two at a time (front and back on the knee) pretty much day and night. I even slept with them, changing them out when I got up in the night to use the bathroom. If you have 4 of them, you'll always have a couple ready in the freezer. Just be sure to wrap them in a kitchen towel so as not to get freezer burn on your skin. They work very well.

 

[Celle]

I just used the gel packs, too, and they worked fine. I had about six and kept them all in the freezer. I used one at the front of my knee and one at the back every time, and i knew that I always had some replacements, already frozen.

I went to sleep at night while I was icing my knee and I had a replacement pair in a chiller beside the bed, so that I could replace the thawed ones if I woke in the night. You can ice all night without doing any harm, as long as you have some material between your knee and the gel pack - so that you don't get freezer burn.

 

[Josephine]

Good for you!

 

[kneeper]

My nurse is going to have her supervisor call my doctors office because she's dealt with them before and she says the nurses are like a hive of angry bees.

I'm glad your home nurse will advocate for you.
Gel packs can work really well for icing. I had 2-3 so I could always have one in the freezer ready to go.

 

[Bsutton]

The article on this forum about "ice to control pain and swelling" the ice packs made from water and alcohol are a very good idea. But I have something that works even better. Instead of ziploc bags, if you have a vacuum food sealer, use the bags that come with it. Just freeze the water and alcohol, and it will be like a slush. Then fill them, get all the air out that you can, and seal the bag without using the vacuum feature. I made some, and have been using them practically non-stop for the last 5 months. They are still holding up, with no leaks. You can get the roll refills and make them to any length, even to wrap around your leg. They are wonderful! I have the ice machine, but hated it, because the pad was stiff, and didn't fit on my leg. It was also a pain to keep refilling.

 

[newlybionic]

Was the nurse manager able to get some help for you? I hope that they were.

 

[Xanaphia]

Nope no help. I expected as much from this doctors office. They called me today and said they will not change nor go up on my pain meds for any reason, however I can get another script for the same ones when this one runs out. Lucky for me the pain is actually seeming to be calming down. I've got my extension to 100° and my flex to +5 still a ways to go but it's better than yesterday. I keep telling myself, one day at a time, and when it really does start hurting I refuse therapy in favor of elevation and ice. My PT is a bit frusterated with me but I'm sure she wouldn't want someone forcing her to do severely painful things either

 

[newlybionic]

A range of motion of 5 to 100 is excellent so soon after surgery! It will only get better from here on out. I'm glad the meds are starting to help better and keep up the good work!