TKR Dearjr's new knee

[analysta]

Hello @Dearjr! About swelling - since you're a medical guy, maybe you like data (like I do, ahem, I'm "analysta" after all). An ergonomist friend of mine lent (lended?) me a biggish old caliper and I've been measuring swelling and keeping track. (I used a sharpie to put marks on the places where the caliper feelers have to go so it's as consistent as possible from one measurement to the next). It has been soooo interesting and has given me a sense of control over the swelling because I now can see cause and effect and maybe even progress. I can see how much elevating the legs brings down swelling, and how long it takes for swelling to go down (for me, it takes almost a half hour to see a change). I have measurements of the morning swelling and am getting a handle on what happens when I sit too long at work. I'm also starting to see how long to walk without causing much swelling (just a quarter mile, boo). And so on.

Most importantly I'm actually seeing progress in just the couple weeks I've been doing it, in terms of first-thing-in-the-morning measurements. Very slow, but definitely there. There are ups and downs and tons of what we call "interacting variables" for example whether I had PT the previous day or how well I slept. I think that, with a few gazillion more measurements, I might be able to do a regression analysis, heeeheee.

I bring this up on your thread because you think a lot about swelling. In fact, it was your posts that caused the conversation with the friend that led to all this mad-scientist stuff I'm doing. Well, it was also spurred by all the conflicting ideas of what works and what doesn't ... lots of individual experiences but not necessarily lots of data, and most importantly no data about *me*.

 

[metalheart]

Re: Analysta's post: I did the same thing for my first TKR, i.e. I measured swelling three times a day -- I just used a broken link removed: https://www.starrett.com/metrology/product-detail/1-Precision-Measuring-Tools/11-Precision-Hand-Tools/1102-Slide-Calipers/110202-Dial-Calipers/3202-12 -- for a couple of weeks because I was bugged that swelling was ongoing. I observed that my swelling was related to some very specific activities and it was affected by specific responses, especially elevating my knee and mobilizing it when stiff. The swelling did not seem to hamper my recovery but it did bug the hell out of me. It sometimes affected my range of motion, but in the long-term it was a passing inconvenience.

I am just past week 5 of my second TKR and I have ongoing swelling. Yesterday I had a followup with my surgeon and I commented to him and to his in-house PT about the swelling. Both essentially said that it is part of the process, it happens when you are more active and it should not impede recovery unless there is excessive inflammation. The advice was to not over-do any particular activity but to keep up activity and PT that aids muscle balance and overall range of motion. Those activities/exercises are very straightforward and not in anyway taxing, but they do help to keep all the parts working together. For my recovery, that balanced approach and listening to those who know my situation best is what works. Maybe they have not had a TKR, but most of us here only have a sample of two as a basis for an opinion and our surgeons have seen a wider range of outcomes.

Yep, I have some ongoing swelling from my what I am doing for a functional recovery. Sometimes it impedes range of motion, but the overall picture for me is that doing the prescribed activities within reason and addressing the swelling when it occurs did not impede my first recovery nor has it adversely affected my ongoing recovery. That is my experience.

 

[Dearjr]

@jbrooklyn. I might try acupuncture and see if it works. Are you afraid of a skin infection??
How much pt do you do?
I am learning now to be patient and accept what the course is
@Thesoutherncook its nice to hear I'm not the only ine who

 

[Dearjr]

@metalheart thanks for the info about your tkr. My os told me exactly what you said. The swelling is an extreme annoyance and will subside slowly....I think mine has gone down some ...unless it's just wishful thinking!
Your right our surgeons have done and seen this thousands of times. And being a doctor too I do the same with my patients. And you are right the swelling really is annoying me. But so is the hypersensitivity of my pants rubbing on knee
My os told me to ice when not wirking sit when working and flex when possible to keep up the rom. A lot here focus on numbers but you only need 110 to walk steps and 105 to ride a bike



@analysta funny you should measure it. My pt measured it when I came off bike and then after ice. And with no surprise it went down. That's qhy ice and elevation are important @Thesoutherncook i was saying it's nice to know there is someone else who did this not only because of pain. My reason was no Flexion to climb stairs and ride bike. Hope you have a good time at graduation

 

[Pescara]

@Dearjr I am at 16 weeks out and sometimes I swell and get stiff depending on what I am doing and how I sit. Ice is now my best friend! It's hard for me to sit still but I am learning about patience. I have also learned the dust will be there tomorrow. Check at Walgreens. They have all kinds of ice packs and some you can use for a long time. Maybe it will help at work. Sorry I couldn't help more

 

[Dearjr]

@Pescara just answering is helpful

Ice is my best friend. But can't do it enough
Just preparing for the Jewish holidays is a lot of work
But I'll be doing a lot of sitting down and icing thru it
Back to work wednesday

 

[Thesoutherncook]

This is the "ice pack" that I think is THE best! It stays cold for a long time. Perhaps it would be good for you to have to use at work?

https://www.amazon.com/Chattanooga-...thane-Over-Size/dp/B000QFZRNE?tag=ate362da-20

 

[Wanttobebiking]

JR since you are a doctor, perhaps you can explain to me the difference between effusion and swelling. Neither my PT nor my OS are concerned about what I see as minor swelling at the outside upper corners of my knee. When I showed my OS he said, "There is no effusion and therefore nothing to be concerned about." I, however, think of it as minor swelling. So I am not sure what everyone here means when they talk about swelling.

 

[jbrooklyn]

@Dearjr, very low risk of infection with acupuncture bc they use disposable needles. I have to say, I am surprised by what a large effect I experienced from one session. My tendonitis is way less swollen and painful. Tomorrow is round 2 of 3. Happy new year.

 

[SarahJane]

Have a happy and sweet new year.

 

[bdink21]

JR since you are a doctor, perhaps you can explain to me the difference between effusion and swelling. Neither my PT nor my OS are concerned about what I see as minor swelling at the outside upper corners of my knee. When I showed my OS he said, "There is no effusion and therefore nothing to be concerned about." I, however, think of it as minor swelling. So I am not sure what everyone here means when they talk about swelling.

@Wanttobebiking Joint effusion is swelling within the joint so in the joint capsule. Swelling or edema is outside of the joint so in the soft tissues which is most likely why your OS is not concerned. Hope that helps.

 

[Celle]

Effusion is a collection of fluid within a body cavity, such as the knee. I think of it as being a bit like a puddle. Theoretically, you could stick a needle in and aspirate it - although that's not always advisable with the knee.
Swelling is more diffuse, within the soft tissues. Because it's not all collected in one place, you couldn't aspirate it.

 

[Dearjr]

@Wanttobebiking celle and bd link are right
Swelling can be anywhere and sometimes used in different ways

Just finished the holiday. Used compression sleeve from 830 till 2. Kept down swelling and felt good with it. Just annoying to get used to it
After took a 15 minute walk. Later in day the knee became swollen again. But seems to be less
Last night woke up with knee feeling uncomfortable. First time that happened. Usually just wake up every 2-3 hours for no real reason. Perhaps it's the half of the knee that has feeling??

Anyone know how long you could wear the compression sleeve?

 

[Dearjr]

Just a little info for you following this

I was using the generic term swelling. I have it over the knee cap. It is putting at times. But I also have fluid under the knee cap and in the lateral side

Any comments about this?

 

[Dearjr]

Had a restful holiday
For a compression sleeve for the knee and wore it for the day. It pushes the fluid to other places. However it returns soon after but slightly less
The sensations on the knee cap are annoying. Somewhat sensitive at times. Along with the scar being sensitive
Does this mean some feeling is coming back in the numb 1/2?

Cut down on pt but not seeing major result
Knee still swells under and side of knee cap after walking on it about 5-10 mins

 

[SarahJane]

Thanks for the update. Just curious -- are you still icing? Is the swelling affecting your ROM?

 

[Dearjr]

I am still icing almost 3 times a day or more. As far as the pt measuring it it hasn't affected my rom. I'm still at 115 myself. Can't say if I could do more without it though. How are you doing?

 

[Gojennygo]

Hi Joe,
Happy New Year! I am glad to read that you made it through the holiday weekend alright. As I read your thread and the thoughtful, detailed responses from others, I am reminded repeatedly about the importance of patience! It must be human nature to look forward, to look for change and improvement.
How about looking at our new knees like babies? We celebrate and enjoy each new phase of development as they mature, and we would never rush them along or be impatient with them!
Just think back to a few weeks ago, look how far you and I and everyone on here has come.

 

[jmdearras]

The sensations on the knee cap are annoying. Somewhat sensitive at times. Along with the scar being sensitive

I have the same issue. Wearing gym shorts for now.

 

[susie09]

@Dearjr - L'Shana Tova. I've had both of my knees done - the left about a year and a half ago and the right seven months ago. I think my mother did me a great service many years ago when she told me that it takes a year to recover from surgery. You know, those were the days when pretty much every surgery was done with a general and you could probably expect to be in the hospital for at least a week. She understood that there was more to it than just waiting for an incision to heal. There was the actual healing process, the effects of anesthesia, the overall trauma of surgery, etc. I might be back to normal activities within a few months but when I'd have a day where I was unusually tired or had no energy or just didn't feel like myself, she'd remind me that I'd had surgery and I was still recovering.
I do have to admit that I believe in a more "active" PT program than most people here. Not "aggressive", but "active". I'm an athlete and I know what works for me. I don't suggest that others do what I have just because it works for me and I completely respect those who have had success doing less. I will also put my recovery right up there with those who got good results doing less because as a good friend frequently says, "There is more than one path to the top of the mountain." The extension on both knees is "0". The last measured flexion on my left knee was 140 (7 months ago) and I suspect I've added a few degrees since starting Barre classes. My right knee was at 125 when I was released from PT - it's probably around 130 now and I have no doubt that it will end up pretty close to my left knee in time.