TKR Hi all! I have a question...<'

elzie

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First off, hello!

I had a TKR done about four months ago. My problem, and subsequent question, is that my recovery went great. I am highly motivated to heal up and be back to normal, due to ~ 12 surgeries for my intestines and a spinal fusion. My recovery has gone so well that I was cutting the grass every week starting at week 4. I went back to work, in a factory, at week 9 and have just the usual issues of standing in one spot for more than 30 minutes or so.

The problem is this: starting last Friday afternoon my knee has become very painful to walk on. I have always had lots of clunking in my knee, behind the knee cap as well as inside the knee joint. Every time I would move my knee, whether standing, sitting or laying down there would be at least one clunk, normally up to three. Now the clunking has increased and the pain is so bad that I have a difficult time walking and can't straighten out my leg anymore.

I have gone from fantastic ROM for months, being able to kneel down without issue, cut a large lawn (on a hill) and work 10 to 12 hours a day with minimal pain to not being able to walk after getting out of a chair or bed. Any thoughts?

Note - I am waiting for the Doctor to call me back today. Every time I mentioned the clunking, from the first walk I took after surgery to my visit last week, the response is always, "that's normal". Not to second guess the Doctor, but I have been a mechanic all my life and I can't help but think something isn't right.
 
@elzie Welcome to BoneSmart! Four months out from TKR isn't all that long. And with all that activity I think that new knee is trying to tell you something.

If you ice, elevate and rest does this pain ease? Are you taking anything for the pain?
 
Elzie. Way too much activity for your new baby knee. Kneeling down, walking hills, working 10 to 12 hours a day. Your knee is telling you it needed more healing time and when you didn't listen, it stopped you and forced you to stop overworking it.

This recovery is a marathon and not a sprint. TKR is major surgery, please respect that process.

Sent from my SM-J700T using Tapatalk
 
You're wise to check in with the surgeon, just in case. The surgeon is the mechanic here. But if everything is fine mechanically, then the problem could well be you've overdone it. It does sound like you've had an amazing recovery. That's good! But it can also lull you into thinking your knee is fully healed when in fact it is not. And it might have reached its limit and is reacting strongly to the overuse. See what the doctor says, but consider you might have to slow it down just a bit.
 
To me it sounds as if you've over done things with a new TKR and it's letting you know. We've had a few members with similar issues. Take a look at what a typical recovery looks like, especially in regards to activity.

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
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.
 
elzie,
Welcome to BoneSmart, glad you joined us!
Clunking is normal, increasing clunking, increasing pain, and decreasing ROM is not.
Glad you have a call to the OS, they should get you in ASAP to take a look.

At 4 months you are still very early in this year long or more recovery. Sounds like you have been very fortunate with your recovery up until now.
As others have suggested your knee is protesting all the work and activity, follow the guidelines KarriB left you, and let your knee settle down.

Please post your surgery date, a moderator will add it to your signature, having the date will help us advise you. Thanks!

Keep us posted on what your OS says,
 
Thank you for all the replies!

I do ice it, but the relief is minimal.

I am not taking pain killers.I try Tylenol once in a while, but it doesn't help.

I did have a great recovery. I was actually on vacation and just hanging around the house watching saved programs on the DVR when this happened. I could understand if I was doing something I shouldn't, or if I had been doing something recently. What bothers me is that the knee was good (the usual pain expected) until one afternoon, then not good and getting a bit worse every day.

The other thing is that I understand clunking is normal, but to what extent? When I say it clunks, I mean it clunks inside and at the kneecap every time I move it, regardless of position. Is this considered normal?

I'm sorry for all the questions, and I understand the need to take it easy (I actually am compared to my normal life). My two-level spinal fusion was a much easier recovery! LOL.
 
Id be concerned about a sudden increase in pain, limited rom and clunking. Def get it checked out.
 
Thanks, Jenn!

I realize that I may have come off as a bit ungrateful in my response. That is not my intention so please accept my apologies if anyone took my post that way :)
 
You can't compare normal activity to recovery activity. My OS wanted me to do nothing but ADLs the first month with a little PT thrown in. I refused to do any PT that hurt though. The activity progression chart outlines how to go about introducing activity slowly. Of everyone I know who's had a TKR, my dad had the easiest recover at age 69 and again at 82.

Let us know what your OS says, I'm glad you contacted him.
 
Elzie. The way my doc explained the clunking is that: the bones and cartilage from our God given knees moved smoothly against each other. Those bones and cartilage have no been replaced with metal and plastic and are now held in place with cement. They now make noise, moving against each other. Clunking is normal.

If your new pain is not being addressed by Tylenol, maybe you try a pain killer at night. Find a way to keep that ice on it for as long as you can. Take care of yourself.

Sent from my SM-J700T using Tapatalk
 
the response is always, "that's normal"
Wel a minor amount it normal but beyond that, the comment is code for "I don't know what it is"!
I try Tylenol once in a while, but it doesn't help.
Well, I bet you were taking one regular Tylenol every other day! That's not enough to be effective. You need to take 1,000mg 3-4 times a day, otherwise it's no good.

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?
 
Sure thing, Josephine! Ask away!

As for the Tylenol, I would take two gelcaps at a time, but to be honest, no more than that. My Doctor's keep me away from Ibuprofen due to past history.
 
You are wise to get it checked. I don't disagree with what everyone has already said about overactivity, but it does seem as if you've been listening to your knee all along and doing activity as it permitted, and now you're listening to it tell you something has changed.

My left knee clunks more than my right, but I have noticed when my gait is off for any reason, it clunks more. This morning, I noticed it clunking on my walk, but my lower back has been bothering me this week, so I suspect my "form" is off.

Back in January, I was standing next to my truck on the curb. I leaned forward to deposit my laptop bag on the floor of my truck. I heard a loud crack and felt discomfort. I was able to move and walk reasonably normally except on stairs. Something didn't feel right. I got an appointment to see my OS a week later. He took x-rays and confirmed I had cracked my patella. It was a freak thing.

Your situation sounds nothing like mine, except for the fact you were doing something innocuous, and now something feels wrong to you. I hope your OS can see you soon and thoroughly investigates your concern. I believe you are wise to be concerned.
 
I just heard from the PA at my Doctor's office. I have an x-ray scheduled at 7 AM Thursday and see the Doctor at 8. I'm glad they can squeeze me in quickly.

You are correct, PolarBear. While I may have been very active, I did listen to my body. I have been through enough to know that my body will tell me when it's time to take a break. The irony is that I had a very quiet and uneventful vacation at home and that's when this happened. Especially the day after I had a visit with the Doctor and we agreed everything was going well.
 
I'm glad they could get you in quickly. While I don't hope there's anything wrong, I do hope you find a satisfactory answer to the problem and are speedily back on your recovery path.
 
PolarBear, you touched on one of my concerns: while I hope the Doctor doesn't find anything, I also hope that there is something to point to that can be fixed - even though I don't want any more surgery.

Complicating matters is the fact that I have been interviewing for a new job. I currently work for a world leader in manufacturing and science based in St. Paul and while this company is great to work for, my manager and the plant manager tried to force me back to work at six weeks post-op. My company even sent a sternly worded letter to my doctor demanding I return to work immediately!

The pain also gets worse with each passing day. The knee is painful to the touch and I can't keep it comfortable at all. It's to the point where I'm starting to think it didn't hurt this much before, or after, surgery. I can't sleep much as it hurts enough to keep me awake. I went back to the pain killers last night for the first time in over three months. I can walk from the bedroom to the bathroom and back with some discomfort, but when I go down the stairs to start my day, it's all over. Ugh, I feel like all I'm doing is complaining......
 
Wishing you good luck today. That level of pain is good reason to complain. I'm with you in hoping the doctor finds something that can be fixed. Finding nothing pretty much leaves you where you started. It would be great to have your problem identified and, better yet, resolved, for your job search.
 
My company even sent a sternly worded letter to my doctor demanding I return to work immediately!
And he got his medical training when/where? Gee whiz what a plonker!

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?
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.
 
1. pain levels:Sitting, my pain level is about a three. When I get up to walk it's about a five. If I've been sitting for a while, and also in the morning, I would give it a six when I get up to walk and it stays that way until I can get off my feet for a while.

2. pain medications: I took Dilaudid shortly after surgery, and again yesterday. I will take Tramadol tonight. I am sensitive to pain killers so Tramadol is what I get prescribed. Also, I'm allergic to Percocet and Vicodin.

3. swelling:I would say it's currently between the huge and moderate, closer to the moderate.

4. The flexion is still good, past 90. The extension is no longer 180, maybe 170.

5. I do ice it often. I have an ice pack at work that I put on every hour. At home it's about the same and I'll put it on when I go to bed, too.

6. elevating: I only have this luxury at home and can only elevate it for about 10 - 20 minutes at a time.

7. what is your activity level?

8. exercises at
Currently I have stopped the exercises due to the pain.
Before the pain I would ride the exercise bike at a low to moderate pace.
I would also stretch
I also did the lateral walk across the room with the rubber band around my feetAnything done at PT
I did PT for two months after surgery, three weeks at home and five weeks at ProEx.
I did very well at PT. I did the exercises mentioned above, as well as squats, leg extensions and curls with weight. I also used the Total Gym and steps (up and down.
 

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