TKR Is this normal?

[Alifpb]

Hi...had a TKR 24th Sept 2022.
After a rough couple years, needed this done now to move on in life.
With no real support, I'm sat here now dreading the night.ive had a little read on here and noticed some say about getting the blues.. maybe that's me today.
I had no idea sleep would be worse than before....which was bad.
I'm walking as much as pos, but stiffness kills.
Meds aren't really working well, not much does anyway.
Am I just being inpatient and having a bad day. X

 

[Jockette]

Hi and Welcome!

Yes, you are being impatient, which isn’t your fault, most of us were unprepared for this recovery! The early weeks are rough. Try to relax and accept it all as normal, and most of all, temporary.

Meds aren't really working well, not much does anyway.

At this stage most medications won’t take away all the pain but hopefully they should lessen it. What are you taking?

Another way to not increase pain is to keep your activity to a minimum, including any list of exercises you were given. Don’t do any that cause you pain. All your knee needs are gentle bends and short walks, for mobility.

Regaining our ROM does not require forceful bending or painful exercises.
Regaining our ROM is more about Time than repetitions of a list of exercises.

Time to recover.
Time for pain and swelling to settle.
Time to heal.

Our range of motion is right there all along just waiting for that to happen so it can show itself.

In the general run of things, it doesn't need to be fought for, worked hard for or worried about. It will happen. Normal activity is the key to success.
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

If you want to use something to assist with healing and scar management, 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.

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. 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.

 

[thneed]

I am on my second surgery (I got it done 3 days before yours), and I can attest that it can be depressing and lonely in the beginning. I had the same issue with the first knee recovery as well. It can get frustrating because we can't just get up from the chair and go do something simple, it's all such a big production. And I don't know about you, but I get tired pretty easily, and have very little stamina; just a 10 minute walk in the house wears me out. Plus, every day is so boring and one day looks much like the other. And yes, sleep is BAD for the first little bit.

But I can tell you, having experienced this with the first knee almost 4 months ago, it gets better. It might not seem it right now, but it will get better. Your knee will slowly feel better, you will be able to do more things, you will be able to sleep a bit longer. Hang in there, make sure to ice, elevate, walk, rest, and do your stretches/exercises. Before you know it, this part of your recovery will be a distant memory.

 

[Jaycey]

@Alifpb Welcome to BoneSmart and the other side of surgery. Are you icing and elevating that op leg? Ice for 45-60 minutes per session, several times per day. Getting the swelling under control will decrease your discomfort and let you increase your mobility.

Hang in there - better days ahead!

 

[lovetocookandsew]

Recovery from a knee replacement takes, on average, a full year, and sometimes longer. You're 10 days in, so it's very early days. This recovery is no picnic, and even the toughest of us get thrown by how tough it is. But what you're experiencing is on the normal spectrum, so to speak. Are you taking your pain meds on a regular schedule, so as to stay on top of the pain? If you only take a pill when your pain gets too high, you'll always be chasing the pain instead of keeping it under control. You'll likely feel some minor pain and discomfort if you take your meds on the schedule your doctor prescribed, but the bulk of the pain should be kept controlled. Over time, the pain from the surgery will fade and you'll need less and less pain meds, until you notice you no longer need them at all.

Lack of sleep is another side-affect of this surgery-taking daytime naps as needed helps with that, until you begin to once again sleep all night.

For the stiffness, which is pain, I suggest spending more time icing and elevating; ice really helps with the pain and swelling, while elevating helps in getting the swelling to go down. As long as you keep a cloth between the ice and your skin, you can ice for long periods of time. I iced pretty much around the clock in the early days, with regular breaks for walking around and doing light stretching. Over time, I naturally iced less and walked more, until I no longer iced at all.

Post-op blues are a real thing, and no fun, but many of us experience them. The good news is they do pass, and the sunshine returns!

https://bonesmart.org/forum/threads/post-op-blues-is-a-reality-be-prepared-for-it.7591/

 

[kiwicurls]

@Alifpb , the surgery is so worth having! Mine was done in April and I am very glad I had it. My knee is fantastic now! Hang in there!

 

[Roy Gardiner]

I'm walking as much as pos, but stiffness kills

Your knee is in charge. If walking makes you stiff, walk less. If you get swelling or pain after any activity, do it less. You don't have to work through pain or anything like that, just relax and the knee will heal all by itself.

 

[Zanza]

@Alifpb You are totally being too impatient! I felt the exact same way. I've had major spinal surgery, and multiple fractures from a motorcycle crash, and both those things put together were not as painful and disabling as my total knee replacement. I was completely unprepared for how lonely and upsetting it would be. Thank goodness for this forum, nobody knows what it's like unless they've been there. I'm 13 weeks out and I've only just started sleeping normally again. I see you've already got lots of good advice on this thread and if you rest and ice and elevate, you'll feel a bit better. Don't push your knee. Your knee is very unhappy now and it wants to heal, not exercise. Getting up and going to the bathroom or out to the kitchen for something to eat is plenty of exercise at this stage. And for goodness sake, when you see the physical therapist for the first time, tell them this.

• I expect discomfort. I DO NOT expect actual significant pain.
• The definition of what is painful is owned by me, not you.
• When I say stop, we're crossing the line into pain. I expect you to immediately stop.
• Trying to force me past the pain point or not listening to me will completely break my trust in you.
• I want us to be partners in this. I'm willing to try almost anything, as long as I can continue to trust you.
• If I trust you, I will go right up to the line between discomfort and pain. If I do not trust you, I will likely start tensing up as soon as any discomfort starts. At that point I may as well get a new therapist.

 

[sistersinhim]

@Alifpb, Zanza has some very good suggestions. The key to this recovery is to keep it as pain-free as you can and still see improvements. You won't see day-to-day improvements but week-to-week. You will have up and down days, just like a yoyo. If you overdo it, you will have more pain and swelling and will require a day or two of rest. We all go through this. If you listen to your knee and understand what bothers it and what doesn't, you'll have a much less painful recovery. Exercises and PT aren't what aids in it, it's gentle movements, but most of all time. You can not speed up your recovery but you can slow it down by doing movements your knee isn't ready to do. Always watch your knee's reactions to what you are doing. It's a learned thing!

 

[kiwicurls]

@Alifpb, I do understand the frustration and low feelings. I had major foot surgery ten days ago and am not allowed on my feet except to heel walk to bathroom. Personally, I am gaving a rougher recovery from this than I did my tkr but I do understand.
My thread is on other joints, bunions and more.

 

[hikertina]

Thank you so much for all the great advice as well as the support and acknowledgment of this difficult journey.

I am 2 weeks out partial knee today. I could never have been prepared for doing this alone. Yes each day seems like a repeat loop.
My psyche has definitely been wounded.

What has helped
Getting outside in the sunshine at least once a day, Having faith that this will get better. Trying to relax into recovery and self care

Recent lesson learned, I was feeling too good and overdid it. My wonderful PT told me to back off and rest. So now I will pace myself better. Still get out but keep time running errands, etc to short time. Then I go home and ice and elevate

 

[Alifpb]

hi im nearly 8 weeks post TKR.... consultant is happy with everything and doesn't need to see me again.

admittedly i was naive before op, consultant explained it was a big op and it would take time.....but the past 2 weeks at night with pain has been horrendous. i have insomnia anyway, but im barely having 2 hours sleep.
its really effecting my anxiety and depression.....im taking co codomol, maybe too many as i just get so down and not think what im doing. other meds like oral morph dont work.

my gp is a bit of a waste of time, so given up talking to him.

im planning on going back to work next week, maybe a little normality will help.

any advice re night pain.

 

[CricketHip]

Are you icing frequently? Ice is a natural pain reliever and anti inflammatory -- I would go to bed nightly with big ice packs for my THR's and they offered good comfort.
Then I found that putting a heating pad on my shoulders or back helped me feel so cozy and helped me to doze off. There's something to having ice packs in one area and heat elsewhere that really helped me.

Are you doing PT? If yes, I hope it's good facility that doesn't force your knee and cause more pain?

Wishing for you some comfort soon!

 

[panammaniac]

Hang in there. This is not an easy recovery for anybody. As others have said, ice constantly if you need to. If you don’t have an ice machine, get one. They help tremendously. Some people even sleep with them. Not being able to sleep is normal for this surgery. For me, Tylenol PM was the trick. I took that every night for about 2 weeks and I was sleeping like a log. Some people use Benadryl of NyQuil. I don’t want to give too much medication advice because I’m not a doctor, but most of us resorted to using some kind of “help” for sleeping.

Good luck with your recovery. Things will get better before you know it. You get a lot of help and support here.

 

[Layla]

Hello, I am sorry you're dealing with pain. In addition to the advice you received above, you do need to continue to work with a GP regarding the pain you're dealing with at night If you don't care for your primary doctor and you're suffering with insomnia, anxiety and depression, which you mentioned has worsened, consider finding another primary care physician you can work with rather than take the chance of self medicating, or over medicating. Please take those steps...your mental health is well worth it.
Wishing you peace of mind and comfort.

Please notice that we have merged your newest thread with your original recovery thread. Having your recovery information contained in one place will make it easier for you to reflect back on. It is also helpful for those stopping by to be able to review your history before advising or commenting.
Please post any updates, questions or concerns about your recovery here.
@Alifpb

 

[JusticeRider]

Alifpb, I agree with all the advice posted above. Tylenol pm and ice and heat (ice on your knee, heat elsewhere) at night. Try putting your nighttime dose of medication in a little dish on your nightstand so you don’t have to think about bottles and dosages when you are groggy and exhausted in the middle of the night. But most of all, as Layla said, please find a new gp and get in as soon as you can. You are in pain, anxious and depressed and aren’t sleeping. You need someone who will listen to you and help you feel better. Surgeons aren’t always great at that, but it is a gp’s job! You don’t have to suffer in isolation. Wishing you healing and comfort.

 

[Jamie]

im taking co codomol, maybe too many as i just get so down and not think what im doing. other meds like oral morph dont work.

my gp is a bit of a waste of time, so given up talking to him.

@panammaniac These comments are VERY concerning. The medication you are taking is a combination of codeine and paracetamol. Both these medications can have major physical effects if not used properly. You should NOT be taking more than 8 tablets in any 24 hour period and the doses need to be spaced at least 4 hours apart.

Comodol comes in 8mg, 15mg and 30mg strengths. Are you purchasing the 8mg pills at a pharmacy? Or are you using one of the stronger doses that is obtained with a prescription? Either way, you need to not be taking them for longer than 3 days without the guidance and approval of your GP. It will be helpful if you write down a schedule of times to take the medications through the day and night and log in when you take them. If you have a smart phone, there are many apps out there to help with this.

If you are not happy with your GP, you can elect to use someone else. Please do that, as you will need the support of your doctor as you continue your recovery.

Use of this medication can also cause rather serious constipation. Is that a problem for you?

 

[WFD]

@Alifpb , perhaps consider getting a referral to a pain management specialist (they might have a different name in the UK). I have heard good things about the results people have gotten from them.

 

[Alifpb]

thank you everyone for the messages.

i must admit ive not really been using ice or heat much but will get back to doing again more.

as for the medication.......over the years ive known ive taken too much than i should....just didnt care as was struggling. so think any meds...even the strongest dont seem to touch me....even the nurses were suprised while in hospital. i am only taking either cocodamol or paracetamol from over the counter.

i will today....after reading your comments speak with my gp....i do have insomnia....have for years, but last week i must have had 6 hours on off sleep in a week.....just dont get tired.....im taking 50mg amytriptiline... but again doesnt touch.

ive a lot going on....leaving one job going into another....depression and anxiety is kicking in more.

so again thank you again for replying.....i will try and be 'brave' lol and open up to my gp. x

 

[sistersinhim]

I have suffered from bad sleep all my life and it was awful after my tkr. I suggest you take a lot of naps. Sleep whenever and wherever you can. Getting sleep is what counts, not when or where.