TKR Cinski’s Recovery<

[Cinski]

Hello Everyone. I had my first TKR on June 26, 2018 (I’m 11 weeks out). Second knee is scheduled for mid October.

My goals are to get back to alpine skiing and hiking/backpacking in the mountains.

Early recovery went well but I’ve been struggling recently. I’m guessing I overdid my exercises. I have a tendinitis above my patella which is incredibly painful (especially when moving my leg upward with a bent knee). I’m at about 115 degrees flexion and 1 degree extension. My knee swells and gets very stiff if I don’t keep compression on it.

I’m looking for advice and encouragement. Should I just completely rest the knee?

I was in great shape prior to surgery and it’s frustrating feeling that my legs are getting weaker. I’m also concerned about mobility when I have my second knee done in October (which I want to do because it hurts too and deductibles).

 

[Dizzy]

Cinski, it's nice that you were so active but that was BEFORE TKR.....this is a whole new ballgame!! My guess is yes, you probably have been overdoing in the exercise department. I think you probably need to slow down. As I'm sure you have read, in other posts, that recovery can take up to a year. We all hope to be the exception to that but....the knee is in charge!! Hope things get better for you.

 

[Pumpkin]

@Cinski,
You are still very early in recovery from your TKR, what you are experiencing is normal.

Should I just completely rest the knee?

It sounds like you need to give your knee a break from too much activity. Doing too much can set back your recovery, finding the balance is challenging.
Where are you in recovery?? (TKR)

Give this first TKR time to heal, you will be fine for your upcoming second TKR.

@skigirl returned to teaching skiing and skiing almost daily, she may be able to advise you on her recovery.

Here is your copy of the recovery guidelines, the articles are short and will not take long to read.
You will find relevant articles about healing, and managing your continuing discomfort.

Knee Recovery: The Guidelines
1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now, they are almost certainly temporary
2. Control discomfort:

rest
elevate
ice
take your pain meds by prescription schedule (not when pain starts!)
don't overwork.​

3. Do what you want to do BUT
a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you
b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.
4. PT or exercise can be useful BUT take note of these

the BoneSmart view on exercise
BoneSmart philosophy for sensible post op therapy​

5. At week 4 and after you should follow this

Activity progression for TKRs​

The Recovery articles:
The importance of managing pain after a TKR and the pain chart
Swollen and stiff knee: what causes it?
Energy drain for TKRs

Elevation is the key
Ice to control pain and swelling
Heel slides and how to do them properly

Chart representation of TKR recovery
Healing: how long does it take?
Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

There are also some cautionary articles here
Myth busting: no pain, no gain
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds


We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery. While members may create as many threads as they like in a majority of BoneSmart's forums, we ask that each member have only one recovery thread. This policy makes it easier to go back and review history before providing advice.

 

[Josephine]

I'd really like to offer you some structured advice but in order to do that, I also need to ask you some questions. Are you willing for me to do that?

 

[skigirl]

Jo must be laughing because you sound just like me when i joined the forum. I did not want to be down, but unfortunately, this is major surgery and you have to be down for a bit. I tended to over exercise, which really is just plain silly because you can not build muscles until your quad is fully functioning. If you knee is swollen and tight, the quad is probably not fully functioning. With my second knee I gave in and had a much easier time.

Here is what I did---for two weeks I spent most of my time in bed with knees propped up on three pillows. no exercise except quad sets and easy leg raises. I could raise my leg in the hospital. By three weeks, i began gentle PT and really did nothing strenuous until 12 weeks. By the end of the first two weeks, when i was down 80% of the time, the swelling was really down quite a lot. At four weeks my doc told me to lie down for two hours for every one hour up.

At 12 weeks, I wanted to be done, but alas, I was not!! I could ride my bike for ten miles, but I could walk 2 or 3 miles---slower than I had ever walked!! I was still resting in the mid day too.

I was lucky, I got on the bike on day three and could pedal it around, so that was a great non weight bearing exercise for me. I rode for 5 min. the first time and my pt made me stay there for a week. Then, I began to ride for 10 min. Here is the formula---ride for 8 min---swelling? if no, then increase if yes, than decrease the time for a few days. That really was how we did all exercises. My pt would only let me do a few step ups until I could do them without any swelling, for instance.

I had my knees done in April and May and skied at Christmas---I am a ski instructor. I skied about 100 days on the knees. There are so many folks with fake knees in the ski area!!! If you have swelling now, I would take a week---down more than up, feet elevated with cushions or pillows, rest, read some books or watch some videos or movies. At the end of the week---where is your leg? if it is less swollen and moves more easily, then you have your answer. If it is more swollen, call your doc for advice.

oh, and just to reassure you, I got back 100% of my knee strength by four months and skied with ease at five months. Don't fret about fitness, it will come back!!!

 

[Cinski]

Josephine...ask away, I’m open to all suggestions.

Skigirl...I’m always happy to hear from skiers. Skiing is what I do. I’ve ceased doing anything that hurts (still primarily patellar/quad tendon above the patella). Swelling in the tendon is decreasing.

We’re up in Banff Canada on a long planned vacation. I’m trying to behave . Snowing this morning. Thanks for your help.

 

[Josephine]

Here y'go then!

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. And don't forget to factor in other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness).

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.

 

[DIYSteve]

My goals are to get back to alpine skiing and hiking/backpacking in the mountains.

I share these goals, along with XC skiing, ski touring (AT), bicycling and scrambling. Based on recent progression in my recovery, I'm confident I'll be skiing this season, ski touring next spring/summer and in the mountains on foot next summer.

How is your recovery going?

 

[Cinski]

Josephine: Here are the answers to your questions.
1) Worst pain is the patella tendon (above the patella)...occasionally an 8. Short, stabbing pain. In general the knee isn’t too painful. Definitely stiff. A 3-4 on the annoyance scale.

2) Pain medications. I was originally prescribed Percocet, then a hydrocodone/Tylenol. I can’t tolerate Tramadol. Haven’t taken those since about 4 weeks post surgery. Now on Naproxen 220 mg. I take 1 or 2 every 12 hrs. Usually base the dose on anticipated activity level. I occasionally top that off with a 625 mg Tylenol sustained release, usually 2 tablets.

3) Swelling comparison. Between slight & moderate.

4) ROM. About 117 (occasionally can get to 120) and 1 degrees.

5) Icing a couple of times a day for 30 minutes or so.

6) Not real good at elevating.

7) Activity level. Doing housework, groceries, etc. Average 3000-5000 steps a day.

8) Exercises. I’ve backed down a lot since the tendon issues. Usually once a day, I do 10 reps once.
Quad sets
Heel slides
Leg raises (both adduction, abduction, laying on my back and stomach)
A glute activating leg slide laterally while on my stomach
Calf raises
No resistance exercise bike 2-3 times a day, no more than 5 minutes.

9) No exercises at PT now.

 

[Josephine]

1) Worst pain is the patella tendon, occasionally an 8. Short, stabbing pain. In general the knee isn’t too painful. Definitely stiff.

8 is pretty bad. Did this stiffness factor in your pain score?

2)
Now on Naproxen 220 mg, I take 1 or 2 every 12 hrs. Usually base the dose on anticipated activity level.
I occasionally top that off with a 625 mg Tylenol sustained release, usually 2 tablets.

Naproxen's okay but do NOT, on any account, take them to "anticipated activity level". Pain serves an important function here which is to let us know if/when we are doing too much and over-stressing the knee. Mask it at your peril!
Regular Tylenol is better than sustained release because it deprives you of extra cover.
I recommend you take 1,000mg every 6hrs. Much better!

3) Swelling comparison. Between slight & moderate.

I see - and did this factor in your pain score?

4) ROM. About 117 (occasionally can get to 120) and 1 degrees.

1 is nothing - count it as zero! So you're very good!
And when you say 'occasionally' does that infer you are getting it will 'assistance'? Because the only numbers that count at those you can achieve on your own. Assisted bends don't count.

5) Icing a couple of times a day for 30 minutes or so.

You accomplish little or nothing in 30 minutes. Ice for at least 40-60mins and more than 4 times a day.

6) Not real good at elevating.

Then you should get real good at it! Elevate when you ice!

7) Activity level. Doing housework, groceries, etc. Average 3000-5000 steps a day.

That's 2-2½ miles! I strongly suggest you put your Fitbit away for the time being!

Exercises. I’ve backed down a lot since the tendon issues. Usually once a day
Quad sets x10
Heel slides x10
Leg raises (both adduction, abduction, laying on my back and stomach) x10
A glute activating leg slide laterally while on my stomach x10
Calf raises x10
No resistance exercise bike 2-3 times a day, no more than 5 minutes

My first comment is that you are now 12 weeks out and should be stopping all these, plus your ROM is 117/0 so they are unnecessary. Any more improvement can be achieved with the usual ADLs (activities of daily living).

9) No exercises at PT now.

Good

 

[Josephine]

8) Exercises. I’ve backed down a lot since the tendon issues. Usually once a day, I do 10 reps once.
Quad sets
Heel slides
Leg raises (both adduction, abduction, laying on my back and stomach)
A glute activating leg slide laterally while on my stomach
Calf raises
No resistance exercise bike 2-3 times a day, no more than 5 minutes.

This answer is not complete .
I need - how many sessions you do each day and the number of repetitions of each

 

[Cinski]

I do the exercises once a day (except the bike, as noted above) and do 10 reps of each exercise.

 

[Josephine]

My responses are above