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Clunking! (UK)

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Toffee

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Hi all, just found this site and rather impressed!
My husband had a RTKR on May 30th after a motorbike accident 30 years ago left him with condylar fractures and subsequently complete loss of joint space - he's just 46!
So, 2 weeks on, the scar is healing beautifully and there is no sign of infection. However he has not yet had a full nights sleep and is still taking the same array of painkillers he was taking on discharge 13 days ago.
He is worried about the pain - it is most intense above the patella, I guess where the femoral part of the prosthesis sits - and also the feeling that the joint is now clunking as he moves it!!!
Would appreciate wise words/reassurance from anyone who has experienced similar things.
Thanks x
 
My Toffee,
Your hubby is still in the early, early stages of recovery! I am still not able to sleep through the night. I am happy if I can get 2 hrs stright. Is he elevating and icing his knee? What does PT say about his knee? He needs to keep ahead of the pain not let it get ahead of him or he will have a hard time get it back under control.
Jo or Jamie will be on soon and they can give you a lot more info then I can.
But like I said he is still in the early part of all this.
 
Welocme to BoneSmart!!! Glad you found us.

I ask PT this question on Monday...I am eight weeks out...and my knee started clunking. Three things..swelling, fluid and a weak quad muscle.

Hope this helps
 
I believe the clunking will get better when he re builds his muscles. They do go thru a bit as well......And the sleep humm well I am still hoping for that...lol. It takes time so there is nothing wrong with him..lol..Tell him whenever he feels he is tired take advantage of it and sleep its ok.....It will get better .I do get more sleep now then I did at 2 weeks. Who knows he might just do it sooner. I sure hope so...Welcome and post anytime....
 
Welcome, Toffee (love the name,,,its also the name of my poodle!!!!)...Give yourself more TIME!!!..
 
Re: TKR May 30th

Hi, Toffee, and welcome to BoneSmart. We're so glad you found us. We have many members as young as your husband with joint replacements - some even in their 20's! Don't hesitate to post any time you have a question or concern...or just to say hi and report how you both are doing! We'll be here for you.

The pain above the kneecap is very common. It is likely the quadraceps muscle which (depending on how the surgery was done) was either cut or moved aside. That muscle is key to a good recovery, so he may find it hurts some as he gets the muscle tone and strength back. The clunking is something that happens also as all the knee parts and body parts adjust to each other. In most cases it will go away as the muscles get stronger. So don't worry.

But...DO make sure he takes his pain meds on a schedule and not just when something hurts. if you wait until you feel the pain, you will be playing catch-up. It doesn't work as well and more medication is required. Much better to stay on a set schedule. Have him take stool softeners as long as he is on prescription pain meds. Constipation is NO FUN!! He should be icing the knee front and back very often during the day and elevating it above his heart to keep swelling (and pain from any swelling) down.

He is fortunate to have a good caregiver like you. Hang in there.....use the forum.....and things will get better for him!!
 
Thanks all of you - it's funny how you know the answer deep down isn't it? LOL!
He is visiting the PT three times a week and is very committed to doing the exercises in between and the PT is happy with his progress
I would just like to say a little more about the pain. What DH is describing is a regular (almost rhythmic) crescendo of pain to the point where it feels like the knee will explode. The only thing which seems to help (i.e. pre-empt or prevent this) is almost constant use of a TENS machine.
Any ideas?
Thanks again!
 
All I can say is if you look back at threads mine included. When I started out patient PT. I believe alot of us, me included said my knee feels like its going to blow up, explode. exspecially when bending....Yes the answers are deep deep inside...lol!!!!!!!!! He is still so new out of surgery a few other things might come up please post but It just sounds normal to me..Sorry I wish I had a better answer. I used to tell my kids to step back, never knew what was going to happen..lol
 
Hi there, Toffee. And welcome to BS again!

A few things have jumped out at me from your posts:

1. No mention of ice. Ice is the knee patient's friend! Ice, ice all the time. The relief is extraordinary! Get several of those blue gelpacks - you can sometimes find them in the Pound Shop. Keep them all in the freezer so he always has some ready. Wrap 2 or 3 or even 4 of them around the knee and hold in place with a hand towel, scarf or bandage. When they are fresh out of the freezer, though, have a protective liner between his skin and the gelpack else he might get a burn. A thinnish tea towel would do nicely. Then once the intense cold has gone, he can put it directly onto his knee and get the full benefit.

I was extravagant and got one of these gizmos - was the best thing I ever did and much, much better than a TENS! You can save that little life-saver till later!

[Bonesmart.org] Clunking! (UK)
broken link removed: https://www.physioroom.com/product/Aircast_Knee_Cryo_Cuff_with_Cooler/2272/35982.html


2. Pain med need to be taken proactively which is before the event not after. On the understanding that a picture is worth a thousand words, let me show you my chart ...

[Bonesmart.org] Clunking! (UK)



Pain score, if you recall is 1 is no pain at all, 10 is the worst pain you can imagine.

Finally, three weeks out and already you're both worrying about not sleeping, still taking pain killers and still having pain! Well, let me tell you this

~ he's had MAJOR surgery and the recovery is going to be MAJOR too!
~ major surgery means major healing which takes time, energy and patience
~ the knee joint is the largest and most sensitive joint in the body, very nerve rich which means that surgery on it is one of the most painful going
~ he should not thrash himself with the physio just yet. This is not a race that he has to achieve X amount of flexion or whatever in the shortest time possible. Some surgeons don't even let their patients start physio until the third week anyway. Mine didn't, I had no physio sessions, only 3 assessments and now I have 130 flexion and am perfectly fine at week 12. He'll get there and sure and steady is often a lot more productive than rushing at it frenetically.

Another chart for your delectation ....

[Bonesmart.org] Clunking! (UK)




end of lecture!
 
That throbbing pain would signal to me that he's not taking pain meds on a schedule (1-2 pills every 4 hours day AND all night long). Be sure to follow the dosage guidelines on the pill bottle to a "T."

Jo's charts show it best. Inadequate pain management is usually the problem when someone is so new in recovery.
 
Hi and welcome to the forum from a fellow Brit!

Jo and Jamie, and the others, are so right. Your hubby must keep on top of the pain with the painkillers. I hadn't come across this forum when I had my first TKR last October, and tried to give up the painkillers too soon. As a result I don't think my progress was as good as it should have been.

With my more recent TKR, now 8 weeks ago, I have been following the advice of Jo and Jamie and co. and took the painmeds for much longer. My recovery has been much easier and quicker this time. I very rarely take anything now unless I've been overdoing something or find it extra difficult to sleep (sleeping is the biggest problem), when I just take paracetamol or ibuprofen.

I notice the occasional clunking but it doesn't hurt and doesn't bother me. Any pain I now have is more of an ache and is above the patella where I assume the muscles need the most repair.

I'm sure your hubby will be absolutely delighted with his new knee in a few weeks' time, but he needs to be patient - it's a long road to full recovery!
 
Hi again!
Thanks for the lecture (!)
DH has been using ice from the word go, though since reading jo's advice I have now increased the frequency and also placing 4 packs all around the leg as suggested.
As for meds, he is taking 2 acupan or 2 tramadol every 4 hours on the nail - as I write this his pain score is 8!
PT took much more gentle approach yesterday and gave him a thorough examination - reassured us that all appears normal.
We are both shattered and anxious - hubby feels he was not fully prepared to expect this much pain - but we are very grateful for everyones advice :-)
Anything else?
 
Tof.....are you sure these pain meds are strong enough? Watching your DH in such discomfort is indeed disheartening!!
 
Toffee, it sounds like you need to give the surgeon's office a call and see what changes they can make to the pain meds. Pain levels should NOT be consistently at the 8 level....or the 5 level. Poorly managed pain like that will impact his ability to do PT properly and to heal quickly. If for some reason the surgeon will not do something different with the pain meds, don't give up!! Try your primary doctor...or a pain management specialist. Pain management is critical!!
 
Im sorry he is still in pain, but it really will get easier soon. How are you doing. I know its hard, my husband was very tired...Keep the ice, medicine etc he'll get thru it..Will keep you both in my prayers....
 
Update Re: Clunking!!!

Thanks again for everyone's advice and encouragement. It has been a tough but productive day. I took him back to the hospital and saw the surgeon and he has revised the meds - hooray! We now have morphine patches and arcoxia (similar to NSAID). Typically the surgeon was quite blasé and said it was nothing to worry about. :shk:
Time will tell....
 
I am really glad he gave him something stronger that will help alot.....Hang in there let us know how he is doing.............We are here for both of you...Its really hard work but the rewards are amazing................
 
Way to go, Toffee!!! Assertiveness pays off - ALWAYS!

Don't give up if this doesn't work. Keep trying until you find the pain meds that give him relief. Your surgeon's attitude is somewhat typical unfortunately. That's why it is sometimes better to work with your primary doctor. But the OS did was was needed and that's a good thing. I'm sure prescribing pain meds seems very dull compared to surgery....
 
Hi everyone!
I'm pleased to report that after a much more restful weekend, DH is reporting pain scores of 2-4 and his leg looks more like a leg and less like a ham!!!
Unfortunately he feels quite epoxy and nauseous, but as I pointed out it's that or the pain!
He's done really well at physio today - but not overdone it!
Here's to progress!
 
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