TKR Getting stressed re Nurse visit today!!

[Sharrazan]

I had my TKR on Friday of last week. I seem to be doing well, although my knee badly swollen and sore. Pain killers ( Codeine) not doing much at all. I was discharged from the hospital yesterday, but very concerned that the Physiotherapist kept stressing I have to be aware of how important it is to achieve this 90 percent movement in my knee and to keep up the exercises. I appreciate the point here, but surely if badly swollen and more to the point painful, how can I physically achieve this so very soon after the operation? I am starting to get nauseous as I attempt this movement yet again. What is the average time to achieve this please. I am 72.

 

[Celle]

Hello @Sharrazan - and

Please will you tell us the full date of your knee replacement and which knee it is, so we can make a signature for you? Knowing the exact date will help us to advise you appropriately.
Thank you.

You are correct. While your knee is so swollen, it won't bend to 90 degrees, because swelling physically stops it from doing so.

You don't have to make yourself ill with trying to force your knee to bend. Instead, spend as much time as you can resting, while icing and elevating your leg, to try and reduce that swelling. There are articles about how to ice and elevate in teh recovery guidelines that I'll give you.

At this early stage of recovery, you do need to exercise a little, and that can be achieved by walking around your house every couple of hours. I'm not suggesting you lie like a log and do nothing whatsoever.

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 increase spontaneously, whether you do formal PT or just let your normal Activities of Daily Living (ADLs) be your exercise.

By the way, most surgeons don't expect 90 degrees until about 6 weeks post-op.

 

[Celle]

And here are the promised recovery guidelines, with lots of helpful articles:
Knee Recovery: The Guidelines

People are all different, as are the approaches to this recovery and rehab. The key is, “Find what works for YOU.“ Your doctor(s), physiotherapist(s) and BoneSmart are here to help, but YOU are the final judge as to the recovery approach you choose.

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.​

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. Try to follow this

Activity progression for TKRs​

6. Access to these pages on the website

Oral And Intravenous Pain Medications​

Wound Care In Hospital​

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.

 

[Goma]

I was on oxycoden, celebrex and panadol for two months at least after surgery for pain. After that I went to tramadol. Can you get stronger pain relief ?

 

[Tykey]

The bend almost always gets worse in the first few days, so no panic!

But it always comes back as the knee heals and the swelling goes down. Just keep up the gentle exercises as far as you are able but not to the point of pain.

After a month or less, you will pass the 90 degrees and more.

Don't keep measuring it! It will drive you up the wall to no benefit.

Just let it happen, enjoy the ride

 

[mature mama]

Elevate, ice and rest!! Your knee needs to recover.

My right knee took some time to get to 90 degrees, like maybe 3 months or so. It bends very well now 2 years later. My left knee which is 5 weeks tomorrow was at 90 degrees in a month.

Rest and recover. Read and binge tv. You will reciver at your own time.

 

[Sharrazan]

Thank you Goma! Unfortunately no strong options work for me at all!
I am resting more now and icing and waiting on nature taking its coarse!
I do worry that so much swelling still two weeks tomorrow after operation, will cause damage to knee bending, but I am learning to be patient! Thank you.

 

[Celle]

I do worry that so much swelling still two weeks tomorrow after operation, will cause damage to knee bending, but I am learning to be patient!

Once the swelling starts to go down, your knee will begin to bend more easily. The swelling is just a nuisance - it won't do any damage.

Don't let anyone tell you that you only have a set amount of time to achieve Range of Motion. That's an old myth that should have died long ago.
Your ROM can continue to improve for a year or more after surgery, so you have plenty of time.

Please tell us the full date of your knee replacement and which knee it is, so we can put it into your signature. Then we'll be able to see your surgery date at the bottom of every post you make, and we won't need to keep referring back to your first post. Thank you.

 

[Jockette]

I do worry that so much swelling still two weeks tomorrow after operation, will cause damage to knee bending

The swelling will definitely affect the bending, but won’t damage it. This surgery causes a lot of trauma to the whole leg. Your surgeon did major carpentry work and disturbed every millimeter of soft tissue in this area, thus the swelling.

There is no date by which you must have a certain degree of bend. It varies for each of us, even two different knees on the same person, whether done on the same day or not. Try not to worry about the bend. It will come. I was so stressed about my ROM my whole first year, but it continued to improve even into my third year post op, so don’t let them pressure you about it.

 

[Sharrazan]

Once the swelling starts to go down, your knee will begin to bend more easily. The swelling is just a nuisance - it won't do any damage.

Don't let anyone tell you that you only have a set amount of time to achieve Range of Motion. That's an old myth that should have died long ago.
Your ROM can continue to improve for a year or more after surgery, so you have plenty of time.

Please tell us the full date of your knee replacement and which knee it is, so we can put it into your signature. Then we'll be able to see your surgery date at the bottom of every post you make, and we won't need to keep referring back to your first post. Thank you.

Apologies, new here ! !
My operation was 12th March - right knee.
Thank you so much for your input which is so helpful at such a painful and worrying time!

 

[Sharrazan]

Further apology! Operation date 12th March 2021!

 

[Celle]

Thank you for your surgery date. I've done your signature and added your name to the March Musketeers surgery team thread.

 

[Sharrazan]

Thank you Celle! Appreciated

 

[sistersinhim]

Think of a water hose that is full of water with the nozzle closed off. Can you bend that easily? Of course not. Your knee is the same way. It can't bend well with all that fluid in it. That's why we recommend icing and elevating. That helps to get that swelling down. As that swelling goes down, your ROM will improve. Your knee bent well during surgery or your surgeon would have never closed it up, so you know it will bend better as it heals more. Many of us had ROM improvement even after a year or more.

 

[Ref1]

Good to read this. Starting week 8
PT states ROM 125-130 degrees is where I need to be but not there
Was at 110 2 weeks back with assistance
So your thread makes me feel better

 

[sistersinhim]

PT states ROM 125-130 degrees is where I need to be but not there

Not everyone's knee results are the same. This is not a cookie-cutter recovery. Your body is completely different than anyone else's. Your ROM is fantastic for 7 weeks out. Most OSs look for 90 degrees at 6 weeks and you have surpassed that in less than two weeks afterward.

PT puts way too much emphasis on ROM. Numbers aren't what counts, it's function. I'm around 125 now and I can do anything I want to do. Do I worry that I don't have more bend. No, I don't. No one should unless it is negatively affecting their life after they are completely healed, which is normally a year.

 

[Sharrazan]

Three weeks ago today I had my TKR. I have had bad swelling since day 1. Nurse due today to take out last of my staples, but she was horrified that when she visited me two days ago to start the staples removal, I could still not bend my knee! I am now obsessed with this lack of movement not helped by the fact the painkillers I have been given including Oxycoden and Tramadol just do not help me!
I am also dreading my first visit to the Surgeon next week since my operation. I was never filled with this "dread" after my THR!! I am almost 73 and this is now depressing me somewhat.

 

[Jaycey]

@Sharrazan Are you icing and elevating your op leg? I suggest you focus on icing today to get that swelling under control. Icing will also help reduce your pain levels. Ice for 45-60 minutes per session, as many times per day as you can.

You will notice that I merged your newest post with your original recovery thread. For several reasons, we prefer that you only have one recovery thread:

• That way, we have all your information in one place. This makes it easier to go back and review your history before providing advice.
• If you keep starting new threads, you miss the posts and advice others have left for you in the old threads, and some information may be unnecessarily repeated
• Having only one thread will act as a diary of your progress that you can look back on.

Please post any updates, questions or concerns about your recovery here. If you prefer a different thread title, just post what you want and we will get it changed for you.

If you need an urgent response to a question, just tag a member of staff.

Many members bookmark their thread in their computer browser, so they can find it when they log on.

 

[Sharrazan]

@Sharrazan Are you icing and elevating your op leg? I suggest you focus on icing today to get that swelling under control. Icing will also help reduce your pain levels. Ice for 45-60 minutes per session, as many times per day as you can.

You will notice that I merged your newest post with your original recovery thread. For several reasons, we prefer that you only have one recovery thread:

• That way, we have all your information in one place. This makes it easier to go back and review your history before providing advice.
• If you keep starting new threads, you miss the posts and advice others have left for you in the old threads, and some information may be unnecessarily repeated
• Having only one thread will act as a diary of your progress that you can look back on.

Please post any updates, questions or concerns about your recovery here. If you prefer a different thread title, just post what you want and we will get it changed for you.

If you need an urgent response to a question, just tag a member of staff.

Many members bookmark their thread in their computer browser, so they can find it when they log on.

@Jaycey, yes icing and elevating daily. Also had huge problems when I had THR a couple of years ago.
Thank you for your advice, duly noted.

 

[eaglemom]

Take a deep breath and now slowly exhale. You will get through this - but its all on your knee's time line. Not the surgeon's, nurse's or PT's time line - your knee's.

I've been through multiple surgeries and each one is different. What worked before don't work now, etc. One thing I will say is my last revision I've been 90% the Bonesmart way. The missing 10% was the hospital ordered home health. When she came the first time I told her I was in charge & she will never ever touch my leg. If she wouldn't agree then she needed to leave. She didn't leave but she wasn't happy. I reasoned with her that she'd being paid to do nothing - and that helped her somewhat. I literally walked around the house or outdoors with her for a few minutes then laid down and we chatted. She called it "unorthodox" but said I was one of the first patients that had ever said anything to her. We agreed to disagree about too much exercise. Your in charge here.

I also have a huge problem with swelling. There is nothing I can do but give in. I've talked with my knee to not swell but it's not listening!!! I'd make certain you ice/elevate multiple times per day, not just once.