TKR firm pockets of swelling

[sazzie]

Hello,
I am a 59 year old female of good general health, 7.5 weeks post op after my only ever surgery right, TKR .
I had no complications during surgery or early recovery.
My scar healed well.
My ROM now is around 125/5, the flexion is nearly my personal pre op natural.
From day 1 to now I stayed on top of my PT exercises , never quite got there with the full extension though but I'm still trying. PT says it will probably improve a little when the swelling reduces in time.
I still take pain killers mainly paracetemol and ibuprofen, co codamol when pain is very bad.
I ice and elevate often,
My concern is my very painful swelling and stiffness just above and to the outside of the knee .
Is the outside the last place to heal?
It makes me wince with pain on walking . It feels like the scar on the knee is attached to the underlying tissue.
Could this just be the swelling though. Whatever it is, it presses so much on my kneecap when I walk on the bend of my uplift that I have developed a limp resulting in constant and bad hip pain.
I don't think I need a MUA because my ROM seems fine but I would like to correct this constant line of pressure when walking before I see the OS in 1.5 weeks.
I've tried self massage of various techniques. I've tried short, sharp bends after straightening (both with and without pre-icing) to try and break it free it if its scar tissue.
Sometimes when I have lowered myself into a deep bend it feels like its peeling free and I literally think "great, that's it" but it sticks again after a few seconds.
I see PT in 2 days but I don't know how they can advise anything I haven't already tried. Maybe it isn't scar tissue, just swelling which will right itself in time but in the meantime I am limiting my walking as I feel like my limping is making me vault my hip up on the uplift and becoming misaligned.
Hope your recoveries are doing well.
Any info or advice is greatly appreciated, sorry for the long post.

 

[Jockette]

What you’re describing is very common during the healing process.

I've tried short, sharp bends after straightening (both with and without pre-icing) to try and break it free it if its scar tissue.

Try to be patient while you are still in this early part of a recovery that takes an average of a year to complete. Don’t force your knee to do anything.

Swelling can last for many months, which is normal for this recovery.

I will leave you our Recovery Guidelines. Each article is short but very informative. Following these guidelines will help you have a less painful recovery.

Just keep in mind all people are different, as are the approaches to this recovery and rehab. The key is, “Find what works for you.“ Your doctors, PTs and BoneSmart are available to help, but you are the final judge as to the recovery approach you choose.

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​

elevate​

ice​

take your pain meds by prescription schedule (not when pain starts!)​

don't overwork.​

​

If you want to use something to help heal the incision, ​

BoneSmart recommends hypochlorous solution. Members in the US can purchase ACTIVE Antimicrobial Hydrogel through BoneSmart at a discount. Similar products should be available in the UK and other countries.​

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

​

the BoneSmart view on exercise​

BoneSmart philosophy for sensible post op therapy​

5. At week 4 and after you should follow this

Activity Progression for TKRs​

6. Access to these pages on the website

​

Oral And Intravenous Pain Medications​

Wound Closure​

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 the 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 the member’s history before providing advice, so please post any updates or questions you have right here in this thread.

 

[Jockette]

Yes, you do have a certain amount of scar tissue, which is necessary, in order for your surgical wounds to heal. This normal scar tissue does not need to be broken free. It will settle down and go away as you heal.

 

[sistersinhim]

More than likely what you are experiencing is caused by swelling, both inside and outside. The inside knee capsule has very little room inside it and just a small amount of fluid will restrict your knee's movements. You can concentrate on getting that swelling down and your tightness should improve.

 

[sazzie]

Thank you everyone,
So it could be swelling or scar tissue. Or a bit of both.
I will take your advice and be more patient. I continue to ice and elevate.
However...
I am really concerned about my limp and excessive hip pain so am trying to limit my walking.
Pain killers are not muting the hip pain.
I still do the easier PT exercises so I don't lose my ROM.
But I will lay off the sharper bending .
Thank you, I hope I improve at some point in time.

 

[sistersinhim]

So it could be swelling or scar tissue. Or a bit of both.

With 125 degree bend, you do not have adhesions, what you are referring to as scar tissue.

The scar tissue (which is more correctly called adhesions) is very rare, and one of the easiest ways to develop it is to work your knee too hard. Over-worked knees get inflamed and hot, and hot tissues become drier than normal and more likely to stick together and form adhesions.

This article explains the difference between scar tissue and adhesions:
MUA (Manipulation under Anaesthetic) and Adhesions

You need normal scar tissue. That's what holds your incision together, and it's part of the normal healing process. Without it, you'd always have an open wound.

 

[benne68]

I am really concerned about my limp

Many of us find ourselves limping in the early weeks post surgery. One of the best ways to overcome a limp is focus on heel-toe walking. This involves striking the ground with your heel first, then rolling through your heel to your toe, and pushing out of the step with your toe.

It's important to slow your pace and concentrate through the entire step. It takes practice, but you'll notice a difference after doing it for a few weeks. Why not give it a try?

Here is a visual

 

[sistersinhim]

My doctor told me in my early days to use a walking assistance device until my limp went away. This would help me to develop a good gait. You might try that, too.

 

[sazzie]

With 125 degree bend, you do not have adhesions, what you are referring to as scar tissue.

So, to recap the pressure restricting my bend during walking is swelling of some kind and the best option is to wait it out continuing to ice and elevate?

 

[Jockette]

Yes, and gentle movements for mobility.

 

[sazzie]

Cheers,

 

[Layla]

Hello and Welcome to BoneSmart!
Generally speaking you're doing well for less than two months post op. Lots of time left to enjoy progress in a recovery that can last a full year for some and even longer for others. I look forward to following your healing journey. Best Wishes and thanks for joining us, sazzie!
@sazzie

 

[sazzie]

Thanks

 

[Layla]

Happy Two Month Anniversary!, sazzie
I hope you're doing well and having a good week.
Stay in touch!
@sazzie

 

[sazzie]

Hello,
My recovery is improving slowly.
I made an unscheduled appointment with my OS as my pain was making me think I had tracking issues.
He did an Xray then and there.
The tracking looked fine.
He said the restrictive pain was in the location of the inner cut line and that it was inner adhesions that would break free in time.
Lo and behold, on the way home and during the same evening I felt a pricking/fizzing sensation in that area every so often.
The said line of pain/pressure was gone the morning after.
I do still have swelling, inflammation and a "bruised kneecap" feeling .
He said to be patient with these residual pains and continue physio unless painful and they will get gradually less and less.
I feel like I am getting back to normality and want to go to hairdressers and get back to work............................in that order lol.
Thank you for your support,
I'm not perfect but I can see a bright future,
All the best to you all,
Sazzie

 

[Layla]

Hi Sazzie,
Happy Tuesday to you!
I am glad you made an appointment because there is nothing like peace of mind. It is reassuring to hear that all looks as it should.

It's not too late to ice and elevate when you have time to help with the swelling. It's wonderful that you are holding a brighter future as your focus...thank you for updating and best wishes!
@sazzie

 

[mendogal]

I have experienced that feeling of pulling with my first knee and suspected it might have been early adhesions... my OS also reassured me that time would resolve this as long as I remained normally active, and he was right!

 

[CatieViv]

I'm so glad I read this thread as that's exactly what is happening with my knee right now. I figured that pulling was normal as is everything I have experienced so far but it's good to know for sure! I don't remember if I had this last time around with Miss Knee.

 

[benne68]

@sazzie This is a long, slow recovery and that can be frustrating, but it sounds like you are doing just fine for less than 3 months post-op. Baby the knee just a little longer.

Sending hugs.

 

[Fluttershy]

I'm so glad I read this thread as that's exactly what is happening with my knee right now. I figured that pulling was normal as is everything I have experienced so far but it's good to know for sure! I don't remember if I had this last time around with Miss Knee.

Me three! Feels like I have a cable running downwards tugging on my kneecap (outside side of leg) with every step! When I stretch it I feel this crackly sensation and I wish it would just pop and let go!