TKR Coming up on 5 months post TKR ~ still with pain when WB

[Jockette]

My PT never used a balance board. But their main focus was always ROM.

 

[fenway09]

Yes, I would be happy to answer some questions @Josephine

 

[Josephine]

Jolly good! 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.

 

[fenway09]

@Josephine

1. When I am not moving or weight bearing, I have almost no pain other than a little tender feeling along the joint line. Weight bearing it shoots to 7 or 8.

2. Dilaudid 2 mg every four hours per original script. I am currently taking only 3 2 mg per day plus one if it's a very bad day pain-wise.
1000mg extra strength Tylenol every eight hours.
Gabapentin was titrated and stopped a week ago. (max dose was 900 mg per day, for several weeks)

3. slightly swollen (if at all) but warm most of the day

4. flexion 125 to 130 plus 3 for straightening

5. Icing almost 16 hours in a 24 hour period with ice cuff machine.

6. Generally elevating while icing except when sleeping.

7. Use walker over to do the laundry. Light cleaning of kitchen. Some meal prep from wheel chair or walker. Driving myself to outside PT as of a week ago. No grocery shopping.

8. At home exercises:
recumbent bike, today 30 mins, started at 2 weeks at five minutes
Pushing quads into bed hold 3 secs 10 reps 2x daily
Heel slides 10 reps 2 or 3 x daily
Ball squeeze between thighs 10 reps daily

PT outside exercises (varies)
Starts on recumbent bike 8 minutes level 2
Calf board stretch 30 second holds 4x
Laying down on table with exercise ball at ankles and rolling it forward for hold 10 reps 2 x
Bridge with ankles on ball to hold 3 secs 15 reps
Balance board rocking back and forth 10 times 2 sets
Balance board side to side rocking 10 times 2 sets

Last week: Balance board to hold balance one minute front to back
Balance Board to hold balance one minute side to side, just using finger tips to balance
Leg raise from sitting to a point, then use other leg to help raise further 10 reps 2 sets
Then she massages my knee and around only TPF scar
When available, I ask for the Game Ready ice cuff before I leave

PS: No trouble sleeping on side with pillow between my legs

Hope those make sense Josephine ~ thanks for your help

 

[Josephine]

1. When I am not moving or weight bearing, I have almost no pain other than a little tender feeling along the joint line. Weight bearing it shoots to 7 or 8.

At 7 weeks - about par for the course

2. Dilaudid 2 mg every four hours per original script. I am currently taking only 3x 2 mg per day plus one if it's a very bad day pain-wise.
1000mg extra strength Tylenol every eight hours.
Gabapentin was titrated and stopped a week ago max dose was 900 mg per day, for several weeks

Dilaudid: that's a bit mingy! Are you not allowed to take any more than that?
Tylenol: assuming there is no acetaminophen in the Dilaudid, I would suggest you take this dose every 6 hours.
Gabapentin: 'several weeks'? I took it for about 3 months and then titrated off it. Did it work for you?

3. slightly swollen

That's not bad

4. flexion 125 to 130 plus 3 for straightening

Most excellent!

5. Icing almost 16 hours in a 24 hour period with ice cuff machine.

Okay

6. Generally elevating while icing except when sleeping.

Good

7. Use walker over to do the laundry. Light cleaning of kitchen. Some meal prep from wheel chair or walker. Driving myself to outside PT as of a week ago. No grocery shopping.

About right.


At home exercises:
recumbent bike, today 30 mins, started at 2 weeks at five minutes - good
Pushing quads into bed hold 3 secs 10 reps 2x daily - this is an extension manoeuvre so I don't recommend it. You extension is already pretty good
Heel slides 10 reps 2 or 3 x daily - same here, your flexion is already excellent to need for these
Ball squeeze between thighs 10 reps daily - or these

PT outside exercises (varies)
Starts on recumbent bike 8 minutes level 2 - okay as long as it's 0 resistance
Calf board stretch 30 second holds 4x - okay
Laying down on table with exercise ball at ankles and rolling it forward for hold 10 reps 2 x - not familiar with this
Bridge with ankles on ball to hold 3 secs 15 reps - what a ghastly notion! Absolutely not!
Balance board rocking back and forth 10 times 2 sets, Balance board side to side rocking 10 times 2 sets - I think these two are what gives you pain when weight bearing. So stop them

Last week:
Balance board to hold balance one minute front to back, Balance Board to hold balance one minute side to side, just using finger tips to balance - quite. Very likely to cause the weight bearing pain
Leg raise from sitting to a point, then use other leg to help raise further 10 reps 2 sets - I think this is best done as part of your normal ADLs and not as an exercise.

So generally you're doing pretty well except the few exercises that appear - in my opinion - to be giving you extra pain. Those I have crossed out.

 

[lopat]

@fenway09 I just read your responses to Josephine. I know you’re in pain but you are so far along! Your ROM is great! And ½ hour on a recumbent? Darn, I just managed to get it around last week. Don’t be down on yourself. You should take it easy a few days and let things settle and then start back easier.

 

[Rather]

My PT only wanted to focus on ROM. Meanwhile, my IT band and hamstrings were hurting me so much I could hardly walk. PT said they would get better when my ROM improved. I found another therapist - an occupational therapist. The first thing she did was watch me walking and realized that what I was doing was not helping my knee bend and was causing the other problems. She focused on that as well as using kinesiology tape to help with the edema and to provide support. My ROM improved. My pain lessened. And I really appreciate someone who is looking at me and my knee - not just my knee. I suggest you stop PT or find a different therapist.

 

[fenway09]

@lopat thanks nancy.....yeah and yesterday at PT she measured me again and I was at 128 and one degree shy of zero on extension but OH the pain when walking.....still using walker. Josephine was very helpful. I felt less badly about taking the dilaudid as she didn't seem phased at all and used the word mingy......which I liked. HAHA I am skipping PT the rest of the week and really trying to slow it down and just do bike only. Did 30 mins again today nice and easy, while I watched a netflix series. I think I am having a little PTSD from the pain and thinking how similar it is to the pain I had after the TPF and then my mind takes me to a bad neighborhood. This too, shall pass. Thanks for checking in. Hope you are doing well and have a wonderful holiday weekend.

 

[RAD]

‘Hi @fenway09, your flex is amazing, I’m only at 105. My extension was at 0 almost right away but bending has been much more challenging for me. Hope you have a relaxing holiday weekend and be good to yourself!

 

[fenway09]

Hi fellow Knee warriors..........how is everyone doing? So, Wed was the 8 week anniversary. My ROM and straightening are ok but still have pain when I weight bear, though definitely an improvement since a week ago. I traded in my old walker in for one with a seat and 4 wheels. When I took it into PT last week, she wanted to know if I got an extra wide one? I just said I needed one with a seat and she asked why? And I said, so I could go to TJ MAXX......she laughed out loud. I will admit it, I feel very safe using it and much more able to improve my gait and solid heel toe practice. Got cleared for pool so will start strengthening there next week. Quads are still pretty weak on the surgical leg. Today as I write this, my knee is warm and slightly swollen and I am off to PT in a half an hour and then lunch with a college friend. That will be enough for today. I still am finding my stamina is low and not consistent. Overall, I guess all is well. I am down to 2 pain pills a day, so trying not to beat myself up over that. Happy recovery to all.

 

[RAD]

@fenway09, have a good PT session and enjoy your time with your friend. PT for me after work today, then walking and resting this weekend, YAY!

 

[Jockette]

You are coming along fine.

Did you get your 4 wheeled, with seat walker in a store or online?

 

[fenway09]

@Jockette we have a lions club rotary here nearby and they loan out used ( like new) medical equipment.....walkers, wheelchairs, canes, shower chairs and more......it's such a great idea. I am grateful though I did purchase a shower chair that straddles the tub for when I had the TPF last May.

 

[fenway09]

So here we are closing in at 10 plus weeks. I am still having a fair amount of pain. Here is the description: like my knee has been clubbed and is bruised with a tight clamp around the knee and numbness down lateral side. It feels like I am misaligned, something I have felt since my original injury TPF on 5/26/18.

My ROM is great at 130 and after I have warmed up in PT I can easily get to zero. However, because I have been walking with a flexed knee for so long it still wants to flex and is putting undue stress on quad and hamstrings, at least that is what my PT thinks is wrong. Weak quads. It seems as if the minute I swing my leg over the side of the bed in the am, it starts to get warm (not terribly visibly swollen on the outside but definite difference to my other knee).

I have no pain when nonweight bearing as it as always been and no trouble sleeping. My GP is still not convinced that the pain is caused by the RSD from my original injury though I really do not think so. It is not burning or electric type pain that is reminiscent of RSD and the RSD originally diagnosed was in the foot, not the knee.

So those are my woes. Ugh.

I begin to wonder if there will ever come a day when I will not be thinking about my knee with every step. My OS is still treating me like my TKR is really a revision because of the prior trauma. I just don't know anymore. I am still taking a minimal amount of pain med so I can manage my day, along with OTC Tylenol. I hope everyone else if faring well.

 

[lopat]

@fenway09 I'm so sorry to hear you’re still in pain. I was afraid that was the case when you hadn’t posted in awhile.

Do you think it might be time to get a second opinion? I don’t know you’re whole history but it just seems like there's A problem that hasn’t been addressed.

 

[RAD]

Hi @fenway09 and @lopat! Fenway, so sorry to hear you still have so much pain! Your ROM is awesome, I’m around 115-‘120, which I’m pretty happy about at this point. I’m still taking Tylenol too, but I skip it sometimes. I still have some swelling too, but not too bad. Not much pain though. Hope you feel better soon!

 

[fenway09]

Thank you @lopat and @RAD Glad you are both doing well......I am praying for patience. I have to remember that my poor knee has had a heck of a year with the TKR being the third surgery, so its bound to be a longer recovery for me. Still doing PT and tomorrow I am aiming to get back to pool walking. This too, shall pass.

 

[RAD]

@fenway09, I’m still doing PT too! It’s hard to be patient, I know, but what else can you do? Enjoy everything you can do, and I’m sure things will improve soon.

 

[fenway09]

Hi fellow knee warriors.......I have not posted in awhile and am hoping to get some feedback from others regarding recovery process. I am still in PT and have excellent ROM ( 125-130) and I am at zero extension. However, I still have some pain when weight bearing and a very tight and numbing band feeling just below the knee. I have been focusing on quad strengthening and IT band exercises. Also, the knee itself is still very sensitive and tender ( kind of like someone clubbed it with a bat) Ugh. How is everyone else doing and have you experienced the viselike clamp and numbness down the lateral side. I also had a tibial plateau fracture in May 0f 2018, so my OS says my knee is really considered a revision and will take at least a year to feel normal or a new normal. I still ice almost daily. I have no pain when at rest or sleeping until morning and then it is very stiff.

 

[kneeper]

Feeling a bit stiff, especially after being on your feet for a length of time is pretty common even months later. Why are you still in PT?