TKR Hello 4 weeks post op<

[AussieDi]

Hi all i had my right knee replacement operation just over 4 weeks ago on March 23rd. Pain and swelling/bruising all seem to be calming down. The last two days i have noticed the operated knee feels a lot stiffer. Is this just part of the healing? Although i have just joined i have been following the advice offered here on Bonesmart. I am walking around the house on one crutch and do the exercises for ROM and extension about 3 times during the day using ice and taking pain meds regularly. Any thoughts thanks............

 

[KarriB]

Welcome to BoneSmart and we're glad you've been able to use the information here. Swelling at 4 weeks is typical. This recovery is a rollercoaster ride with lots of ups and downs. It may take a few months before you experience less swelling and stiffness. Here is your own copy of the recovery guidelines to come back to anytime.

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.​

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. Here is a week-by-week guide for Activity progression for TKRs


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.

 

[sandi4213]

Welcome to BoneSmart AussieDi. I am just 3 days ahead of you, my LTKR was 3/20. I think the stiffness on and off is normal. I will have a great day or two where my knee feels like it is stretching well and then a day or two when it is very stiff. This is probably due to activity levels. On the stiff days, I figure my knee is trying to tell me there is swelling and it is time for an elevation and icing day. This usually takes care of it and I am moving better the next day. Good luck with your continued recovery and be sure to let us know how you are doing. Hearing everyone's experiences helps us all.

 

[AussieDi]

Hi Sandi, thanks so much for your reply. Yes it is very up and down isn't it? I have found so much useful information on this forum and i have changed my exercise regime from 3 lots during the day to more often every 2 hours or so but less of each exercise, so i will see how that goes. Think little and often is better but if the stiffness continues i will take your advice and have a rest day. Are you using crutches and do you walk around a lot? I have started walking around the house and up and down the stairs with one crutch and ventured outside on the pavement for a short walk. Good luck with you recovery, hope it all goes well.

 

[eliza61nyc]

I've posted this before, it's a chart my P/t gave me. sums up recovery nicely. take it easy, listen to your body. read, then reread Bone smart mantra

 

[Josephine]

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?

 

[AussieDi]

Yes Thank you, that would be great.

 

[Josephine]

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)

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?

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.

 

[AussieDi]

1. Pain level this morning at 3
2. Pain medication taking ibuprofen 2x200mg every 4 hours and if i get more sore during the day will take Paramol 2 tablets every 6 hours (each tablet contains dihydrocodeine Tartrate 7.46 mg and Paracetamol 500mg).
3. Swollen is at slight
4. My ROM bend is at 95 degrees and extension is at 0.
5 I am icing my knee for 20 minutes at a time and eight times a day.
6 Yes i am elevating my leg when i sit downstairs on a lounge chair which is about 3 hours total during the day but my knee aches more when i sit in the chair so alternate with coming upstairs on the bed. I lie on my bed for about 3 hours during the day but leg is not elevated.
7. Activity level has become more active in the last week. I am walking up and down the stairs with one crutch 4-5 times per day and walking into the kitchen to make myself a drink, get dressed, washed etc. My husband has been at home for the last 4 weeks but is going back to work this week as i am now strong enough to do things on my own. I have been outside the house walking up and down the pavement twice for a few minutes using one crutch.
8. Yes i am doing exercises each day. 4 sessions each day each session consists of:
Lying down with leg straight pushing knee into bed x 5
Heal leads x 5
With straight leg lifting leg off the bed for 5 secs x 5
Sitting on edge of bed and using plastic bag sliding leg back and bending as far as is comfortable with some degree of discomfort but not painful x 5
Please note up until a few days ago i was doing x 10 each session and only 3 times a day but decided less each session but more often might be better?
PT: I have had a local NHS physio come to the house but she just uses the Goinometer and checks my ROM and i only saw her at 3 weeks and she said i was doing well. She is coming again this week to check my progress.

Just to let you know my background i have arthritis in both my knees but the right knee became much worse in the last 18 months and I couldn't straighten it so i was walking with the leg bent at 18 degrees. The surgeon said there was a lot of bone growth behind the knee which he said was pretty grotty. I was only in hospital 2 nights as i was determined to get up and use the crutches so i could get out of there. I was very weak for the first two weeks and was on the slow release morphine at night, but after the two weeks i gradually gained more energy and strength and my main problem is now getting to sleep as i can't get comfortable on my side so struggle sleeping on my back. Managing a few hours sleep each night. The last few days the knee feels tighter and the ROM has only just improved from 90 to 95.

 

[Maryanne]

Hi AussieDj,
I had LTKR on 24th March, so one day after you. I was completely unprepared for the pain and lack of mobility post op. I had read about it but I think I just didn't take it in.

Having found this site I felt much better that my symptoms seemed to be very average.I am very pleased with my progress in the last week or so,I didn't do much exercise to begin with except general moving about the house,bathroom etc.

I took a lot of regular pain relief with top up oral morphine when needed, usually at night.

I am now really quite mobile, walking about half a mile each day, just slowly using two crutches,otherwise only using one crutch or sometimes no crutches if I have things to hold on to like in the kitchen.

I have only had two physiotherapist sessions but they were pleased that I was doing well, so have been discharged unless I want to go back.
I am very well aware that I have good days and bad and if I do a bit more my knee will be stiffer and more swollen.

I have been fortunate, sleeping quite well considering that I hadn't slept properly for months prior to my operation.
What I am fed up with is wearing these stockings,which I have been told I need to wear for the first six weeks. It will be bliss to expose my legs again.

I am at 0 degrees straightness and 105 ROM.

 

[AussieDi]

Hi Maryanne,
thanks for your post. It sounds like you are doing really well.

I think i am now ready to do more walking and you have inspired me to try!
I think i have been a bit over cautious, so I will go out tomorrow and use both crutches and walk a bit more and see how I go.

Yes it is very up and down thats for sure. I am probably more worried about getting the knee to bend more but I am hoping the more mobile I become it will improve gradually.

The stiffness in the knee worried me but I guess it is something that will hopefully improve with more movement too.
The one thing I wasn't prepared for was the way the general aneasthetic knocked me around and the lack of energy the first two weeks were the worst for pain and weakness, so I am happy to be through that stage!!!

I have to go back to my job in early June, full time Research technician, but I can go back in a graduated way, starting with fewer hours, but I do feel like I need to make improvements each day now!

I only had to wear my stockings for 4 weeks and yes was glad to get them off!!! Good luck and hope all continues to go well for you! Aussie Di

 

[KarriB]

If you are going to walk a bit more remember you need to plan for a return. I cut the time in half and set my phone timer for that time so when it goes off I run around and walk home. But please take a look at the activity progression chart because too much activity will put you in the ODIC as well as in pain.

Activity progression for TKRs

 

[sandi4213]

Hi. Sorry I didn't get back sooner, but I was out most of yesterday and when I got home, was too tired to get on the computer. I started with a walker and used that about 2 weeks then used my cane all the time for a week or week and a half. Now I walk around the house unaided and most out of house walking, too. I never had crutches. Yesterday I used my cane because we were out most of the day in another town. I sure appreciated it by the end of the day.

It sounds like you are listening to the great people on here. Take good care of that new knee and it will do a good job for you

 

[Jennszoo]

I hate crutches. I'm so glad to be using a walker, I find it 100% less bothersome than crutches. My underarms are thanking me. Lol.

 

[Celle]

@Maryanne and @AussieDi

You will notice that I have edited your posts, above, to put the large block of text you posted into paragraphs.

It is very hard to read a big block of text, and many people stop reading after the first couple of sentences. So, to make your posts more readable, please separate what you write into paragraphs.
Thank you.

 

[Josephine]

1. Pain level this morning at 3

Really? Did you also take into account other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness? If you do, what's your pain score then?

2. Pain medication taking ibuprofen 2x200mg every 4 hours and if i get more sore during the day will take Paramol 2 tablets every 6 hours (each tablet contains dihydrocodeine 7.46 mg and Paracetamol 500mg).

Well dihydrocodeine is not a very good pain killer for TKR and 15mg of it is very mild. Also ibuporfen is worse than useless.

3. Swelling is slight

If your knee is stiff then there must be more swelling, most likely internal swelling.

4. My ROM bend is at 95 degrees and extension is at 0.

That's not bad under the circumstances.

5 I am icing my knee for 20 minutes at a time and eight times a day.

You accomplish little or nothing in 20 minutes. Ice for at least 40-60mins and more than 4 times a day.

6 I am elevating my leg when I sit downstairs on a lounge chair which is about 3 hours total during the day but my knee aches more when I sit in the chair so alternate with coming upstairs on the bed. I lie on my bed for about 3 hours during the day but leg is not elevated.

One thing you need to do is not let your leg be totally immobile for 3 hours! Just bend it up and wiggle it around every so often! It will help a lot.

7. Activity level has become more in the last week. I am walking up and down the stairs with one crutch 4-5 times per day and walking into the kitchen to make myself a drink, get dressed, washed etc. My husband has been at home for the last 4 weeks but is going back to work this week as I am now strong enough to do things on my own. I have been outside the house walking up and down the pavement twice for a few minutes using one crutch.

Are you going upstairs because you need to or just for the exercise? If the latter, then stop it!

I have a physio come to the house but she just uses the goniometer and checks my ROM and I only saw her at 3 weeks and she said i was doing well. She is coming again this week to check my progress.

My comments in bold
doing exercises 4 sessions each day - do them once a day and none at all at the weekends
pushing knee into bed x 5 - this is an extension exercise and since your extension is 0, there is no need for you to do these
straight leg lifts for 5 secs x 5 - a tip about SLRs - once you can do them you don't need to do them any more!

until a few days ago I was doing x 10 each session and only 3 times a day but decided less each session but more often might be better? no it's not! Once a day is plenty but none at all at the wekeends!

Heel leads x 5 - I assume by this you mean heel slides? (predictive testing I presume!) These are very easy to do badly and this is bad! Read this Heel slides and how to do them properly.
Sitting on edge of bed and using plastic bag sliding leg back and bending as far as is comfortable with some degree of discomfort but not painful x 5 (heel slides) - same as above.

In short, you've been doing far too much exercising. I would urge you to read these articles
BoneSmart philosophy for sensible post op therapy
Myth busting: no pain, no gain
Saying no to therapy - am I allowed to?

 

[AussieDi]

Hi Josephine, thanks for taking the time to reply.

Yes I know it may seem hard to believe but pain level is only 3. It has reduced a lot in the past week and I am not waking up needing pain relief in the night now. The first 2-3 weeks I was on the morphine long acting overnight and had the short acting one when I needed it but I find the ibuprofen works for me and is good for inflammation.

After suffering with a bent arthritic knee and working full time for the past few years my pain with the new knee is still less painful than before. As for the ice I was always led to believe that 20mins is the maximum as leaving it on too long isn't good and could cause possible nerve damage? Perhaps I am misled about this?

Sorry I meant I spend a total of 3 hours upstairs during the day but not in one go. I get up every hour or so and move about.

Yes I did actually mean heel slides (oops not leads!!) and I looked up how to do them properly on this site which was very useful for me.

I have taken on board your advice and will ease up on the exercises but now my energy levels are much better I am going to try very small walks outside on my crutches and see how that goes.

Thanks again best wishes to you.

 

[AussieDi]

I hate crutches. I'm so glad to be using a walker, I find it 100% less bothersome than crutches. My underarms are thanking me. Lol.

Hi yes I had used those underarm crutches many years ago when I broke my leg but fortunately here in the UK they tend to use elbow crutches which are fantastic and I feel very safe and they are so easy to use.

 

[Celle]

As for the ice i was always led to believe that 20 mins is the maximum as leaving it on too long isn't good and could cause possible nerve damage? Perhaps i am misled about this?

We hear this a lot and icing for just 20 minutes may be appropriate after injuries, but icing for longer seems to work better after a TKR. As long as you have something like a tea towel between your skin and the icing product (to prevent frost bite) , you can ice almost indefinitely. Hundreds of people here on BoneSmart have iced as we recommend and not one has reported any nerve damage. I used to ice my knee all night and found it effective and helpful.

 

[KarriB]

I used my ice machine for an hour every time I put it on. It was too much work for just 20 min. My PT would leave ice packs on indefinitely after therapy.