TKR Crying & bending knee question

[saleenluver]

Hi! My TKR was 2 weeks ago - 6/14/22. I found this forum as I was searching Google for why I can't stop crying. I know see that this is not abnormal, which makes me feel better.
Today has been a very bad day for the pain and I have PT in just a bit. I am taking my pain meds regularly, although try to wait if possible. Yesterday I was able to go 10 hours without taking the prescription, just Tylenol. Not today, though....I am having to take it the every 6 hours.
How quickly were you all able to bend your knee? My physical therapist tells me I should be hitting 90 in my bends, but I'm only in the mid 60s. I try, I really do, but the pain level gets so high, plus I still have a good bit of swelling in the back of my knee and my calf, which hinders how much I can bend it. I keep being told if I don't get the bend now, I may never get it. I'm really stressed over this because I feel like I'm trying my best, but it's not working. Any suggestions? Thanks!

 

[sistersinhim]

Which knee did you have replaced?

I keep being told if I don't get the bend now, I may never get it. I'm really stressed over this because I feel like I'm trying my best, but it's not working. Any suggestions? Thanks!

Your PT is incorrect. You can achieve a better bend at any time, even years down the road. It's swelling that is keeping you from being able to improve your ROM. You can not improve that by exercising but you can sure slow it down by exercising too much. Over-exercising causes swelling which lessens your bend.

Each person is different as is their recovery. Most find that the Bonesmart approach works best for them, but others find that a more aggressive therapy helps them more. It's your recovery and your choice on how you recover. As you read more on other members' recovery threads, you’ll get a better perspective of what to expect. The following are our basic guidelines and should help get you started.

Knee Recovery: The Guidelines

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

rest​

elevate​

ice​

take your pain meds by prescription schedule (not when the 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 to hurt you.
b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again for a few weeks.
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. Here is a week-by-week guide for 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.

Try out our great new opportunity to improve your gait. It's OneStep. It's free and you will find it to be a huge help to you. Click here: OneStep

 

[saleenluver]

Which knee did you have replaced?

My right knee.

 

[Jockette]

Hi and Welcome!

Here is why you are crying a lot, in case you missed it in the Recovery Guidelines, I cried a lot also! This recovery is just so much to deal with!

Post op blues is a reality - be prepared for it

Post op blues is feeling depressed, weepy, nervy, shaky, fearful of the future, anxious, overwhelmed by what is happening to you, convinced it's never going to get any better and finally, uttering that most intense of all cries "I wish I never had this done!" It arises out of a variety of...

bonesmart.org

 

[Jockette]

My physical therapist tells me I should be hitting 90 in my bends,

We are each individuals and recover on our own body’s timeframe. There is no “should” for a ROM number. Your PT has a one size fits all plan, and we are not all one size. Your ROM number will improve as your swelling goes down and as you continue to heal.

I keep being told if I don't get the bend now, I may never get it. I'm really stressed over this

I agree with @sistersinhim, this is not true. My ROM continued to improve well into my second year. Please don’t listen to the people who tell you that you may never get it, no matter who they are.

 

[Cjackso21]

I found myself emotional when I was not taking my pain meds at regular intervals. I think it is because it is difficult to stop Tramadol. Then when I could finally stop taking pain meds, I had to slowly decrease the amount but stayed on the same time frame. But everyone is different and for sure the swelling and pain from trying to push too hard can also make you emotional as it can be so frustrating.... Good luck!

 

[InkedMarie]

I’m sorry you’re having a rough time. Hugs to you!

Marie

 

[Roy Gardiner]

I try, I really do, but the pain level gets so high

To reemphasise what's been said, the BoneSmart view is that you should not exercise through pain; your knee is damaged needing healing, not unfit needing training.

I keep being told if I don't get the bend now, I may never get it

We think that's nonsense. If you get 'adhesions' (bits of soft tissue sticking together) then yes, ROM may be limited. But they are rare.

Gentle stretches, without pain, are all you need.

 

[Samsrf]

@saleenluver go easy on yourself! If ever a time there was- this is it. Around 10 days post op I was 53 - 14 days roughly 57 (this is when PT started in on the MUA ****) at 3 weeks appointment I was still shy of 70 (67 maybe) at 6 week appt I was 90 degrees. At 12 week appointment ((I stopped PT and measuring about 7.5 weeks which I was measure at 105) my doctor doesn’t measure he looks at what you can do (he has had a TKR!) if I lay down in table top position trying to flex I was about 105 but when I stood up and just pulled my knee up while standing I was 115-120 he said- biggest thing was always gradual improvement. I am 13 weeks out now and I can do ADL for 6-8 hours without ice if needed. I do a lot of driving (kids) and it is right TKR so I sometimes strap ice pack on to drive or make time to ice and elevate before I know I will be out for hours. You will learn what YOUR specific limitations are and how to adapt and then be stoked for the little wind. 13 weeks out the knee is still improving (only 25% of the way there I keep reminding myself). Give yourself grace and time to heal. If the PT/docs aren’t on your team find new ones. But IMHO don’t listen to them. Are you improving? Is your pain less? Can you stand a little longer, walk a little further, bend/straitened a little more? Those are all wins. At two weeks I think I cried a lot and barely made it to the kitchen. You are doing great and you got this. Listen to all the bonesmart admins- they are right. Best of luck! (P.s. it DOES get easier- but it takes awhile try to enjoy the enjoy the new pace.)

 

[saleenluver]

Thank you all! Reading through the info provided here, as well as your responses, has me feeling much better about where I'm at and how I need to advocate for myself and my recovery. I do start outpatient PT next week, so will be a different therapist. Hopefully this one will have a different thought on things.

 

[saleenluver]

@Samsrf Thank you for that! Just seeing where you were and how far you've come gradually makes me feel sooo much better!
BTW, what is ADL?

 

[Jockette]

Hopefully this one will have a different thought on things.

You control how things go. Tell them no touching/pushing on your knee. If they do it anyway, walk out and find another.

ADL is Activities of Daily Living.

 

[saleenluver]

@Jockette Luckily, my doc actually has no pushing on the knee in his orders, so they should not try.

 

[Jockette]

I wish I’d had your doctor! Not only did my PT push, but so did my surgeon at almost every check up until I finally refused to let him at the 7 month check.

 

[kneeper]

@Jockette Luckily, my doc actually has no pushing on the knee in his orders, so they should not try.

That's good news. At two weeks it's not surprising you're not at 90 yet. Swelling impedes bending so you will gain bend as the swelling comes down. Keep on with ice (don't forget the back of your knee), elevation, rest and moving the knee somewhat gently. Try to bend to your limits but realize that a swollen knee is only going to bend so much.
Each week you may find that you can bend a bit more.

 

[saleenluver]

Hi again! Everyone was so helpful on my first question, providing tips and letting me know I was not going through anything completely unusual. Thank you so much for that. It really helped me feel better about this journey I'm on.
I seem to have hit a set back at this point. I am now 4 weeks out today. After my first post, I seemed to be making decent progress - swelling was down and ROM was improving each day. I had hit 80 bending (started at 32 after surgery) and 0 on straightening. I was feeling pretty confident on how things were going. However, for about the last 5 days or so, my knee has been swelling again with an increase in pain and stiffness. ROM has went backwards for bending. It really hurts trying to bend, so I'm only doing that once a day. I do make sure I'm at least walking and try to focus on not walking stiff legged. I am also icing and elevating more again.
Has anyone else experienced a set back like this? Is this normal or something I should be concerned about? Should I be pushing myself more as far as exercising?
As a side, I have had to put off going to PT after my first appointment on 6/28 for personal reasons. We have my next appointment set up for the 18th, so right now I'm trying to keep myself going at home.
Thank you for any insights on this set back.

 

[Vinpetrol]

Hi Saleen
I’m 6 weeks after total right knee replacement tomorrow.
I too had a set back between 3-4 weeks . I had swelling in back of knee and pains down my lower leg . I lost some Rom and couldn’t straighten my leg as good as I had previously. I was concerned about this and went to my pt to discuss . She said that the recovery road can go up and down . Minor set backs are normal as part of the recovery process . That did reassure me and sure enough 2 weeks later I am going in the right direction again . My only issue is I can’t straighten as well as I did but I’m sure it will come at it.
Hopefully this is the same for you and you will move forward with your recovery again soon .

Vin

 

[Jockette]

Yes, swelling will vary which will affect your ROM. That’s normal and nothing to worry about. You are very early in this year long recovery.

It really hurts trying to bend, so I'm only doing that once a day. I do make sure I'm at least walking and try to focus on not walking stiff legged. I am also icing and elevating more again.

Keep doing what you’re doing. This is a long and slow recovery.

 

[saleenluver]

@Vinpetrol thank you for sharing! That gives me hope that this will pass and I will continue healing.

 

[saleenluver]

@Jockette thank you for that! It is so good to hear that these issues are normal and will eventually work themselves out.