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[BILATERAL TKR] Grinding in knee joint after 8 months<

Roper1218

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First of all, I apologize if I am reinventing the wheel by bringing these issues up. I did search on IT Band and back pain.

I am 7 weeks out of double knee replacement. Horrible first 2 weeks which I expected.

4 days after surgery my low back pain started, 10 days after surgery something popped in my right knee when I came down a few steps. Since then I have pain on the outside of my right knee when ever I lift my leg when trying to walk. No pain when siting and doing leg extensions.

I can bend both knees to 130 deg and straighten to 1-2 degrees. I have what I imagine to be the common problems after TKR (tightness...) I don't need a cane unless walking on rough ground, up steps, or very far.

I have been doing outpatient PT twice a weeks, 7 different stretching exercises 3 times a day, seeing a Chiropractor once a week for back pain, and therapeutic massage on my IB band once a week. I am also walking a 1 mile a day.

Nothing is helping the pain on the outside of my knee (or back) which can cause me to walk with somewhat of a stiff leg. I'm suspect the bed rest after surgery and change in my gait is causing my low back pain. Back hurts worse when sitting down, but also hurts when standing, or laying down. Ice does help .

I know I am still in the early stages of recovery, but am having a hard time seeing any light at the end of tunnel. Not sure how to proceed. Patience with pain is not exactly one of my virtues.

Any thoughts, ideas, or guidance would be greatly appreciated.

Thank you all.
 

Jockette

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Hi and Welcome to Bonesmart!

You have a high activity level for 7 weeks out. I would suggest you pull that back a bit and some of your pain will probably ease up, but it can take more than a few days.

I am going to tag @Josephine
our forum administrator and nurse director to address your concerns.

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.

Knee Recovery: 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.
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. Here is a week-by-week guide for

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.
 

Celle

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Here is an article about IT Band Issues:
ITB (ilio-tibial band) issues and treatments

I'm also going to ask @Josephine, our Nurse Director, to advise you.

Your ROM (Range of Motion) is very good. I think now's the time to ease back on the exercises and activities and give your legs a chance to calm down.

Please will you tell us the full date of your bilateral knee replacements, so we can make a signature for you? Thank you.:flwrysmile:
 

sistersinhim

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What was the exact date of your bilateral knee replacement? We will add it to your signature. Knowing that will help us advise you better. I think you should cut back on your activities to get your pain under control.
 

DLR

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Having had it band problems after my first three, I agree with the ease up suggestion. I would even go so far as suggesting pulling out the crutches or canes to allow the inflammation to settle down in it. Once that happens ( it can take a good 7 to 10 days of babying) massage and dry needling can help
 

Josephine

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I'd really like to offer you some structured advice but in order to do that, I also need to ask you some questions. Are you willing for me to do that?

But please know that I cannot respond to your answers until I know the actual date of your surgery.
 

tool guy

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Hi Roper,
I was also hit with serious backpain after both surgeries in the form of sciatica that moved from the right side to the left side after the left was done. Thankfully as the hobbling and limping got better so did the sciatica.
When I was able to sleep or rest on my stomach after a while and stretch those lower vertebrae back the regular back pain diminished as well.
heat and a tens machine worked well for me when the flareups were at their worst.
good luck with the recovery!
 
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Roper1218

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I appreciate all your help.
My bilateral knee surgery was Dec 5, 2018.

Please feel free to ask me any questions.

@DLR it's amazing how different your rehab is in the UK as opposed to what I went through. It was difficult to manage the pain so I spent time in a rehab facility so they could give me more pain killers. For the 1st 13 days after surgery I had PT twice a day. It was pretty terrible, but that is why my ROM is pretty good.
 

Pumpkln

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@Roper1218 ,
You'll notice I have added your surgery date to your signature, thanks for providing the exact date.
You might want to slow down and spend more time resting, icing, elevating, and medicating on schedule as prescribed, give your knee a chance to heal in this year+ recovery.
 
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Roper1218

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Thank you Pumpkln, I will try giving my knees a rest, although it kind of goes again my nature. I went into the surgery very naïve. I think that my surgeon and probably many others do a very poor job of setting the right expectations for patients. I have a friend who starting playing pickleball again after 12 weeks. (very fun game). I expected that by 12 weeks I would be good to go. After hours of reading treads on this forum I have a better understanding of what to expect, but is doesn't make it any less painful or less frustrating. I want a magic pill that make it all better (don't we all). I will keep reading and learning. Thank you
 

Josephine

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For the 1st 13 days after surgery I had PT twice a day. It was pretty terrible, but that is why my ROM is pretty good.
No, I think you were just very, very lucky!



And questions? Here y'go then!

It would be very helpful if you would answer each one individually - numbered as I have done - in as much detail as you can then I'll come back as see where you are ....

1. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine. And don't forget to factor in other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness).

2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?

3. how swollen is your leg compared to these?
ai63.tinypic.com_eta39s.jpg


4. what is your ROM - that's flexion (bend) and extension (straightness)

5. are you icing your knee at all? If so, how often and for how long?

6. are you elevating your leg. If so how often and for how long?

7. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and

8. are you doing any exercises at home? If so what and how often?
This is the most crucial question so please help me by using the format I have left as an example
(which means please make a list and not an essay!)

Exercises done at home
- how many sessions you do each day
- enter exercise by name then number of repetitions of each
etc., etc.

Anything done at PT
- how many times a week
- enter exercise by name then number of repetitions of each
etc., etc.
 

Roy Gardiner

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I can bend both knees to 130 deg and straighten to 1-2 degrees.
I am 7 weeks out of double knee replacement.
That's absolutely brilliant after such a short length of time.
I had PT twice a day. It was pretty terrible, but that is why my ROM is pretty good.
If it was painful, you got better in spite of it, not becaues of it.
I have been doing outpatient PT twice a weeks, 7 different stretching exercises 3 times a day, seeing a Chiropractor once a week for back pain, and therapeutic massage on my IB band once a week. I am also walking a 1 mile a day.
Ease up!

Your body has been cut up, sawed, hammered, and put back together all in a couple of hours. Your muscles and ligaments were pulled aside to allow this. Your poor body is now trying to recover and heal (and doing a good job of it, too, judging by your ROM). What it does NOT need is strenuous exercise. Imagine 'working hard' to recover a broken leg or a sprained muscle; you can't, and walking on a broken leg or exercising a sprained muscle are counter-productive, obviously. It's much the same with TKR, you have damage needing healing, not unfitness needing training.

All you need is to help retain mobility (not fitness or strength) until healing is complete. This is done with gentle stretching exercises, without pain.

Look at the guidelines. Don't do anything that hurts or causes swelling the next day.
I'm suspect the bed rest after surgery and change in my gait is causing my low back pain. Back hurts worse when sitting down, but also hurts when standing, or laying down. Ice does help .
Yes, you get all sorts of aches and pains, some severe. Your body is adjusting to completely new knees, and your gait will indeed be different. I don't suppose the bed rest did any harm.

This will be fixed with TIME. Please relax. Nothing wrong with chiropractors, although I don't know how they help with soft tissue (could easily be my ignorance!) and things could be displaced not by BTKR but by years of compensation for your knees before then. Nothing wrong with massage, either, I found it helpful.

You will be fine. As I said, it takes time, and quite a lot of it.
 
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Roper1218

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Hi Josephine,
Thank you for helping me navigate this nightmare and for all the help you give others.

Here are the answers to you question.
1. pain levels: I have some moderate pain 4-5 in my right lower ham string. Knee pain is probably a 3-6, low back pain is 6-7

I would be doing pretty good if it wasn't for the low back pain and IT Band pain at the knee. The knee pain is only when a accidentally twist them, going up/down stairs, getting in the car, and getting up after sitting.

2. Pain medication: I have oxycodone 5mg, take 1-2 as needed, Tramadol 50mg 1-2 as needed and Tylenol 500mg.
I also have edible marijuana that I use occasionally during the day. I understand not to mix it with opioids.
Right now I am using the pain medication on an as needed basis for my lower back. I pretty much need it to get through the day. Still a lot of squirming when I am sitting down.
I think my knees would be ok with Tylenol most of the time.

3. swelling: my left knee is slightly swollen and my right knee is moderate. This is the knee with the IT Band pain.

4. ROM: Bend 130 deg for each knee, straightness -1-2 degrees from straight.

5. Icing: I have only been icing my knee once a day for about 20 minutes. I ice my low back several times a day for 20 minutes and all night. Could sleep without the ice on my low back.

6. elevation. I'm not doing anything to elevate my knees.

7. Activity level: I'm retired and have a wonderful wife taking care of me so I don't have to cook and clean. I walk around the house, walk about 1 mile each day, go up to our upstairs bedroom a few times a day.

8. exercises: Until yesterday I was doing these exercises 3 times a day. Giving everything a rest now.
seated hamstring stretch 4 reps / hold the stretch for 30 seconds
lower trunk rotation for low back (4 times to each side - hold for 30 seconds)
knee to chest (supine). 4 times on each let, hold for 30 seconds
Piriformis stretch supine - 4 times with each leg- hold for 30 seconds
Hip abduction supine 3 sets of 10
IT Band stretch supine (put a strap on my foot and slide it over the other foot until I feel a pull in the IT Band area
Hamstring stretch supine-- put a strap on the foot and raise my leg until I feel the pull in my hamstring. The strap helps to pull my foot back.

PT twice a week and consists of the exercises above plus resting my feet on a big ball and rolling the ball to my gluts. There is also a little rolling of the IT Band with something that looks like a rolling pin.

I am convinced that my back won't get better until I get the IT band knee pain under control. I try to walk normally, but usually end up swinging my leg like it is stiff.

I'm trying the chiropractor at least once a week in hope that it will help. Apparently different areas are out of wack each time I go. I understand that HOPE isn't a sound strategy.

Therapeutic massage once a week on both legs. Band areas, not where it attaches at the knee or hip, and low back. Other than the good feeling during the massage I haven't seen any improvement.

Thanks again for your help.
 

maryo52

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It seems that your knee function is fine. I'm sure you've realized by now that there's a little over-emphasis on PT and a misconception that PT is key to fast recoveries. I have met more people than I can count who did more PT thinking they'd recover faster. However, tissue healing requires rest. Swelling in your legs is a signal to elevate and ice.

It's fairly common to have some other body part act up during joint replacement recovery. Do you have a physical therapy routine for that? Great that you're doing massage and seeing the chiropractor. Any form of support is a plus.
 
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Roper1218

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Hi Maryo52,
I'm still having trouble getting it through my mind that working PT hard isn't the key to recovery. Gutting it out has usually worked, but since I haven't made much progress in the last month I'm giving rest/heal a try. I have PT exercises that include ones for back and hamstrings, but I will wait a little while before starting them again.

I will look into dry needing my IT band after I talk to my doctor,

Thanks for your guidance.
 

maryo52

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I haven't tried dry needling. I'm intrigued. My PT rolled my IT band yesterday. That was my first awareness of IT band and it was a little sore. What a process this is, huh?
 
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Roper1218

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Lots of words come to mind when I think about the recovery from TKR, but most are NOT polite.

Can anyone recommend a good pad for elevation of both knees? I have looked on-line but most of them have as many bad reviews as good ones.
 
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Elad1002

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@maryo52
FYI, I was all set for dry needling yesterday when my PT called to tell me you have to be 12 weeks po. I'm just 9, so will have to wait.
 

sistersinhim

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