TKR Coming along<<

[Josephine]

@Josephine
I am having tight pain alongside and under my right TKR knee which I thought was IT band pain, that could have been pulling at my kneecap as well. I know there is a patella tendon under knee also. Would you please help me determine where the pain is coming from so I could address it properly?

Perhaps you could show me where this pain is using this chart?

 

[Elad1002]

@Josephine
Thank you. C RF1
C RF 2
D RB 1
And directly under knee cap, center

Also have some pain in D RF2, though feels different, not tight or pulling, might not be related to above pain.

 

[Josephine]

So like this, you think?

I think it likely the

red is quads pain from doing too much exercising
green and the blue are both Pes Anserine and MPFL pain

​

 

[Elad1002]

@Josephine
Actually
CRF1
DRF1 alongside my knee
have been bothering me, feel very tight. What I'm gathering from the info on this site is that all of this pain is due to inflammation. I am massaging, icing, and elevating. I have been walking more without pain. plan to go back to work in 1 month, so will elevate and ice away this month. Thank you.

 

[Josephine]

all of this pain is due to inflammation

That's correct. People often fail to realise that this surgery has much more impact on the soft tissues than the bone, in terms of pain and inflammatory responses, that is. So invariably they will assume there is something 'wrong' with the new knee when they get pain.

Another point is that there are many ways that pain manifests itself which will include soreness, burning, stabbing, throbbing, aching, swelling, tightness and stiffness. So any of these will probably be best treated with some otc pain meds like Tylenol. But if you're going to do that, please make sure you take a proper working dose which will be 1,000mg - NOT the standard 325mg regular T that's most frequently sold!

 

[Elad1002]

@Josephine
Thank you! I am taking 1,000mg of Tylenol 3x day. The new guidelines in the US are 3 000mg max daily, so I take it during the waking hours every 7 hours.
I have one more question. I have had 3 courses of antibiotics since my surgery 9.5 weeks ago. I am having bowel problems as a result, do you reccomend taking probiotics. My doctor recommended taking them, but there are soooo many out there and she couldn't reccomend one over another. Just asking incase you had any knowledge in this area. Thanks.
Dale

 

[Josephine]

The new guidelines in the US are 3 000mg max daily

Just because I live in the UK doesn't mean I am unaware of rules in the US!
The truth behind this ruling is that the FDA declared they lowered this total to protect people in case they unwittingly took cold remedies or other pain meds that also contained Tylenol (acetaminophen) which could result in them taking an overdose. So as long as you are fully aware of any other medications you are taking that might contain it and take due care to add up all the acetaminophen you take in whatever medication, you can still use the 24hr maximum of 4,000mgs.

I would also confirm that to use Tylenol as am adequate pain medications after a TKR, you do need to take the 4,000mg provided you're not taking acetaminophen in anything else.

I have one more question. I have had 3 courses of antibiotics since my surgery 9.5 weeks ago. I am having bowel problems as a result, do you reccomend taking probiotics.

Absolutely! It doesn't have to be anything fancy. There are small yoghurt drinks in the dairy cabinet in supermarkets. Here are some examples (UK left, US right)

Just asking in case you had any knowledge in this area

I have knowledge about almost everything, my dear! Ask anything you want!

 

[Elad1002]

@Josephine
Thank you. Well since you've offered I do have another question. Every few days when I am walking, my knee buckles but much less than 7 weeks ago when it was buckling more frequently. At that time my OS said I have to get the quads firing again. I am presently 9½ weeks po. Is there something I can do to strengthen (if that's the problem) without adding damaging exercise? I can be certain that if I called my OS or PT, they'd have me exercising again.
Thanks

 

[Jockette]

Some things just take Time to heal and they sort themselves out. Patience is the biggest thing we have to exercise in this recovery! Hang in there.

 

[NavyGunns]

@Elad1002, one “exercise” you can do to help get the quads to work better are simple isometric type exercise. While sitting or lying with your leg outstretched, focus on tightening your quad muscles and hold for 15-30 secs. Relax and repeat multiple times. Doing these as well as the leg raises I mentioned previously should put minimal (if any) stress on your knee but will help work the quad muscles.

 

[Elad1002]

@NavyGunns
Thanks,
I'm doing these right now!!

 

[Josephine]

Navygunns is right but walking would also be a good way too.

 

[Elad1002]

@Josephine
Thanks. I have increased my walking, though difficult with broken foot.
@NavyGunns
Quad squeezes are a great idea, will continue. Thanks.

 

[Jockette]

Walking is good, but not to excess. You are still early in recovery and you have a broken foot that is healing. There is no rush.

 

[Elad1002]

@Jockette
I have been able to be up on my feet walking, standing for 45-1hr before having to elevate and ice.
Of course this is only done a max of twice a day. I'm going back to work in 3 weeks, I will be 13 weeks out. I might take advantage of being able to scoot about in a wheelchair if I must be on my feet for an extended period of time. (I work as Dir of Therapeutic Recreation in Healthcare) and I could even have my foot up! I will play it by ear because I'm not obligated to go back for 16 weeks. Thank you!

 

[Elad1002]

So finally going to get some better therapy. Found a practice who functions under a certain OS ( not mine) guidelines. It is actually a surgeon who was my second choice.
He is all about gentle flexion and functional rehab rather than numbers. He has a protocol for 4-12 weeks po doing heel slides, and flexion, extension, stair safe walking- exactly as described here on this site. He prescribes tens, deep massage as needed. It is patient focused and driven. At 3 mos he graduates people to bike at 0 resistance, gait and balance work. His name is Dr. Terry Reardon from Middletown Connecticut. Hes also a very popular surgeon with long waiting lists. I'm 10 weeks po and have made some strides since leaving PT (thanks @Josephine) but made an appointment with this new group primarily for the massage, the tens balance and gait training, (since my fall.) I'm happy to have found them.

 

[Celle]

The new PT group sounds ideal.

 

[Elad1002]

@Celle
Yes, I find this group to be unique. The doctor set the protocol and all the PTs even say, this is Dr Reardon's patient, and they all know the regimen. I explained to them what I was looking for and first thing they said was, Oh yes we have a gentle program...so whether or not I have Dr Reardon as my OS, they will follow his protocol. They dont sit you on a bike until you are at least 12 weeks po. Finally!

 

[Jockette]

I was put on a bike 3.5 weeks post op! I could barely sit up on it. It was awful. It was before I found Bonesmart, and I was as still in the “I have to work really hard in rehab” mode, so even though they told me to just rock the petals, and only try a rotation if I thought I could, I forced the rotation, trying to be a good patient. I tried even harder 2 days later and that effort took all weekend to recover from.

 

[Elad1002]

@Jockette
Yeh, (knock on wood) the last few days have really been the best in terms of pain. I have not gone to PT in 2 weeks. My gait is not that great due to broken foot, and I am.limping a bit. Maybe they can help with that, maybe not...I will see.