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TKR Donm's Recovery Thread.

Donm

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I am 3 weeks post left TKR on 2/17. Been working hard on rehab at PT facility as well as at home. I am 125 degrees range of motion and can stand alone on the surgical leg and throw the ball 30 times. All of this has been praised by therapist and surgeon. However, I can’t sleep at night more than an hour at a time then laying awake for 2-3 hours. I stopped oxymorons during the day a week ago and last night was my first night without any pain med before I went to bed. Encouraged by rehab but frustrated with night pain and insomnia. Is this normal?
 

Rubyroo

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Yep- what you are describing is normal. Not a lot of sleep happening in the first several weeks if not a couple months. Don't over do it with your activity- the over activity can cause lots of pain and swelling. Ice and elevate every chance you can. Sleep anytime you are able- even if you take naps during the day- you have to get it however you can. This is a marathon, not a sprint. Baby steps! Take care of that baby knee!
 

Jaycey

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@Donm Welcome to BoneSmart! Sounds like you are under medicated. At only 3 weeks out you still need pain control. Have you tried taking Tylenol before going to bed? In addition many of our members take an ice pack to bed and ice the knee.

Here are our recovery guidelines for your reference. Note the article on sleep deprivation.
Knee Recovery: The Guidelines
1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now, they are almost certainly temporary

2. Control discomfort:
rest
ice
take your pain meds by prescription schedule (not when pain starts!)​

3. Do what you want to do BUT
a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you​
b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.​

4. PT or exercise can be useful BUT take note of these

5. At week 4 and after you should follow this Activity progression for TKRs

6. Access these pages on the website

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.
 

Celle

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Hi @Donm - There are often two reasons for poor sleep at night: overwork and under-medication.

Jaycey has already suggested you still need to take regular medication. Since you are off the Oxycontin or Oxycodone, you could try Tylenol on a regular schedule..
The most effective way to take Tylenol is 2 x 500 mg tablets (Tylenol Extra-Strength) 6-hourly, to a total of 4,000 mg (4 doses) in 24 hours. You need to take it regularly, to keep up the levels in your bloodstream. If you just take the odd dose now and then, it's far less effective.

Check all other medications you're taking, to make sure there is no Tylenol/Acetaminophen/Paracetamol in them. If there is, scale back one or two of your regular doses, so you stay within that safe 24 hour limit of 4,000 mg.

The other thing - exercise. You've done well, but in order to achieve the goals your PT set, you've probably been working your knee hard. That really isn't a good idea this early in recovery. Your knee has been through major surgery and it needs time and gentle treatment, so it can heal.

There's no need to rush to get ROM (Range of Motion) because it can continue to improve for a year, or even much longer, after a knee replacement. There isn't any deadline you have to meet:
Myth busting: the "window of opportunity" in TKR

In any case, it's not exercising that gets you your ROM - it's time. Time to recover, time for swelling and pain to settle, and time to heal. Your knee has the potential to achieve good ROM right from the start, but it's prevented from doing so by swelling and pain. As it heals and the swelling goes down, your ROM (both flexion and extension) will naturally increase.

Do check your activity level with this article, and try to cut it back a bit if you see you're doing too much, too soon.
Activity progression for TKRs

This is a year-long recovery, no matter how young or fit you were before surgery. It's a marathon,not a sprint, so you need to pace yourself.
 

Sara61

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Insomnia in the early stages of recovery is the norm, try not to worry about it and take "cat naps" throughout the day -sleep will return normally later in your recovery, maybe read, chat on BoneSmart, watch tv. If it is the pain keeping you awake then take your Tylenol prior to going to bed and maybe try not working your knee so hard at PT during the day the bend & extension will come with time, I was lucky my DH chose to sleep in another bedroom so I was able to lie awake and read etc without bothering him xxx
 
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Donm

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I am now almost 5 weeks post TKR. Generally doing well after setback from a torn calf muscle. My biggest issue is still nighttime pain and discomfort. I sleep sporadically til about 4:00 am then can’t go back to sleep. How long does the nighttime pain last?
 

Jaycey

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How long does the nighttime pain last?
There is no time line for this. Are you taking anything for the pain. Try taking Tylenol before you go to bed. An ice pack might also help ease this.
 

Jockette

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You will most likely still have pain for a while. Doing more activity than your knee is ready for will also maintain a pain level. Try not to overdo, even with the exercises.
 

Rubyroo

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Donm, do you have one of the ice machine units? They really help deal with the pain. I wore mine all night and as much as I could when I was sitting and elevating during the day.
 

Rucked Up

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HI Don - I feel your pain.
I'm a few weeks ahead of you but I can relate!
4am wake up's, yup I do that and at 4am too.
Like others have said, this is not a race, my guess is you are doing too much too soon.

I tried something a few days ago, I did next to nothing (no p/t, no exercise, no extra anything) and I haven't woken up in pain. My unscientific self-study tells me my nighttime pain directly correlates to how much I do during the day.

It might be a bit extreme (to do nothing); the relief in pain and added sleep may be worth it. (YMMV)

LUCK!
 

sistersinhim

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I tried something a few days ago, I did next to nothing (no p/t, no exercise, no extra anything) and I haven't woken up in pain. My unscientific self-study tells me my nighttime pain directly correlates to how much I do during the day.
That is so true. You will find that your ROM will improve, too.
 

steverup

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definitely continue to ice at night.. I’m three weeks post-op (mark 4th) and if I don't ice I don’t sleep. A few night now I’ve surprised myself by actually sleeping all night! Mostly I’m still waking a few times a night.. it’s a long rehab so be a patient patient!
 

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