TKR Just need advice after RTKR on 12/22/15<

[Cwhite]

So glad to have found this site. I am 4 weeks post op today. Been going to PT 3 times a week since hospital release. I have a ROM of 98 and it improves each day. Can use stationary bike, walk without assistance, but I still have unbelievable pain at night. My knee feels tight all the time and I am wondering if this is normal. Called the doctor's office today about the pain and tightness and they will call me back tomorrow. P Therapist says I improve each time and should not work about scar tissue etc. Everyone has a different healing timeline. I am up to 120 in CPM as well.
Any advice?

 

[hopefulrevision]

I am at week three since having a complicated revision with long stem rods component. I am at 96 bending and 100 straightening. I am worried I will not be able to ever bend much. It is so so painful to bend. My knee is so painful, it is difficult to stand or walk, and like you the pain at end of day is really bad. Even elevating is painful for some reason even though the PT say's I have my pillows perfect. I am still taking pain medication, but I reduced it on my own, but PT say's I am reducing too quickly based on my complicated surgery. I prefer natural remedies, but just stopped Lovenox shots for preventing DVT so have not been able to try natural yet.
It sounds like you are doing very well. Is your's a revision? My surgeon and PTs all say that revisions are much more painful than TKR, so pain is normal, yet it is so draining for me. I am not walking well yet at all.. :(

 

[Cwhite]

No, it is not a revision. Swelling is down, incision is great, just always feels tight and a lot of intense pain at night.

 

[smarttoys]

I'm glad you found this forum. It sounds like you may be overdoing it at PT and at home. A large increase in pain at night is one sign of that. One of the experts will be along shortly to advise you and give you the mandatory list of articles to read regarding your recovery.

 

[sbg224]

I also had right tkr 12/22. I am still taking norco, 3 times a day on average. I saw doc yesterday, first post op, and he feels I am on track and will do very well. He says pain can last 3 months. I thought for sure 2 weeks tops and I would be off the narcotics, cannot believe how painful this surgery is. The therapist also said this is normal. I had home PT, but this week will transition to outpatient. My knee is also tight, and in the AM around 6-7am the pain is at its worse. After 2 doses of norco starting at 6-7 am and then again around 12 noon, I can usually go until 6-7pm before I take last dose for the night. Well good luck to both of us, hope you feel better soon.

 

[Pumpkin]

Cwhite,
Welcome to Bonesmart, glad you found us.
You are almost a month out from your surgery, what you are experiencing is normal. Here is an article about the
"Tight band" feeling across the front of my knee .
Your ROM is great! Ask your OS if you still need the CPM, studies show CPM makes no difference in recovery.
It also sounds like you can cut back PT to 2x a week.

Here is the post op reading, the articles are short and will not take long to read.

First are the BoneSmart mantras ....
- rest, elevate, ice and take your pain meds by the clock as prescribed
- if it hurts, don't do it and don't allow anyone - especially a physiotherapist - to do it to you
- if your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again
- if you won't die if it's not done, don't do it
- never stand when you can sit, never sit when you can lie down, never stay awake when you can go to sleep!
- be active as much as you need to be but not more than is necessary, meaning so much that you end up being in pain, exhausted or desperate to sit down or lay down!

Next is a FAQ (Frequently Asked Questions) thread.

And here are some very crucial articles
The importance of managing pain after a TKR and the pain chart
Myth busting: no pain, no gain
Swollen and stiff knee: what causes it?
Activity progression for TKRs

Healing: how long does it take?
Chart representation of TKR recovery
Energy drain for TKRs
Elevation is the key
Ice to control pain and swelling

Home physio (PT) and activity progress: suggestions
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds
Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

And then some wise words from members who have shared their experiences ...
Where are you in recovery?? (TKR)
Five “P’s” of knee recovery
TKR: work “smarter” and not “harder”
Recovering a knee - from one who knows!
It's never too late to get more ROM!
It's worth the wait for ROM

 

[karol723]

I had a RTKR on Dec. 7th. Still need to take Tramadol 3 - 4 x a day. Tried cutting down, knee is not ready yet. This is a long process & its difficult to be patient. Try to accept the fact that it will take time to recover. Pain at night always seems to feel so much worse, doesn't it ??

 

[Celle]

Hi @Cwhite


Even though you say that your swelling is down, there will still be swelling inside your knee. It's a very small space in there and just a little bit of extra fluid is going to make your knee feel stiff. It's normal for this stage of your recovery.

I think that much of your problem is that you are doing too much and your knee is responding by giving you pain at night. Cut back at least 50% of your activity and spend lots more time resting, icing and elevating your knee. Take particular notice in the reading list that Pumpkln gave you of the article about Activity Progression for TKRs.

PT 3 times a week is too much. Twice a week is more than enough, because you only need to do a minimal amount of gentle exercise.

Recovery from a knee replacement is not a quick process. Although you will be feeling much better and able to do most things by about 3 months, it does take a full year before all internal healing is complete. If you think of it as a race, it's more like a marathon than a sprint.

Please will you create a signature, in which you put your knee surgery and its date? That makes it much easier for people to advise you appropriately. Just hover over your username (top right of the page) and select Signature. Then create the signature.
Thank you.

 

[referee54]

Been going to PT 3 times a week

I think that 3X a week is a bit much, and you are overdoing it with the new knee. PT 2X a week is enough---and, in the UK, they do not have PT at all. I had it twice a week, and it was enough---you have to give that new knee a chance to calm down and to rest. You cannot speed up the recovery from a TKR by working hard---but you can certainly slow it down, make it more painful and frustrating by over working the knee. It is not about working harder---it is all about working smarter, and understanding that in a TKR recovery, "less is more."

I am 4 weeks post op today.

While four weeks seems like a long enough time, in reality, you are just leaving the "Dark Days of Recovery"---the first four weeks. As others have said, a TKR recovery can take a long time---longer than we are prepared for and longer than we would like it to be.

Everyone has a different healing timeline. I am up to 120 in CPM as well.
Any advice?

You are doing fine, but you have to be patient. A full recovery from a TKR can take upwards to a year---my own recovery from a BTKR took me about eight months.

I would suggest icing and elevating for at least 40 minutes 5X-6X a day---you can do this by putting a cloth or a towel between the ice and the skin. I would ice and elevate for at least an hour at a time, 6X a day or more.

 

[Josephine]

Hi and welcome to BoneSmart!

I still have unbelievable pain at night. My knee feels tight all the time

Weeks 4-6 are very often referred to as the 'angry tissue' days when pain is at its worst and persistent.

In order to help you further, I'd like to ask you some questions if you don't mind, and 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 compare this with the bone-on-bone pain you had before surgery! ) Also don't forget to include 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 often are you icing your knee and for how long?

4. are you elevating your leg, how often and for how long?

5. What is your ROM - that's flexion (bend) and extension (straightness)

6. how swollen is your leg?


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

8. what kind of PT exercises and exercises at home are you doing? How much and how often?
This is the most crucial question so please help me by using the format I have left as an example

Exercises done at home: 3 sessions a day
Heel slides x10 (reps)
Straight leg raises x10
Steps x10

At PT
Squats x5 (reps) x2 (sets)
Wall slides x5 x2
Clamshells X5 x2

 

[Cwhite]

Here are my answers:

1. 6
2. Oxycodone 325 mg. 1-2 tablets every 4-6 hours
3. Ice 3 X times a day for 30 min.
4. Have not been elevating consistently
5. 98 and 100
6. Moderate
7. PT 3 times a week, home exercises 2x a day 20-30 min. Some cooking, laundry, not out and about yet.
8. Home Exercises include
Ankle pumps 10 reps X 2 sets
Gluteal Sets 10 reps X 2 sets
Passive knee Extension 10 reps X 2 sets
Supine Hip Abduction 10 reps X 2 sets
Heal slide 10 reps X 2 sets
Sitting knee extension 10 reps X 2 sets
Straight leg Raise 10 Reps X 2 sets

PT
Stationary Bike 10 min
Knee extension 20 reps
Leg Weight machine 15 reps
Leg lift machine 20 reps
Leg pulls 20 reps on a stool 20 reps
Leg roll on a ball 15 reps

Thanks!

 

[newlybionic]

From my experience I iced and elevated my knee almost constantly for at least a month and then whenever I was sitting down and for at least an hour at a time. At night I packed my knee with ice and elevated my leg to go to sleep. I did no exercises with weights for at 2 months. I tried to work very hard to rehab my knee and just caused my self more pain and it actually slowed my recovery.

 

[jarabas]

Hi CWhite,
Welcome aboard. I had my rtkr one day before you had yours. The first two weeks were hell--pain that had me crying, moaning, and writhing. Couldn't sleep. Here's what helped me.
Take the BoneSmart Mantras seriously. I started spending 50 minutes out of every hour on my back elevating my knee with ice piled on top and underneath. (I was trying to do the dishes, take a load of laundry downstairs, etc.)
I started taking my maximum dose of pain meds (2 oxycodone 5 mg every 3 hours) instead of the minimum (1 every 6) and taking it by the clock even at night. I also take 1000 mg of tylenol every six hours. I set an alarm to wake me up for my night time doses. I also spoke with my physician's assistant and described how bad my pain was --in detail. She put me on tramadol 50 mg 2 every 6 hours in addition to the oxycodone and tylenol. This made a huge difference at night especially.
I also cut way back on my pt. I essentially only did the exercises when the physical therapist came to the house. The rest of the time I did gentle stretches that felt good--some foot slides, some butt crunches. I start outpatient pt this Friday and we have agreed that we will focus on message and some hydrotherapy.
My ROM is 135 and -2, after 4 weeks with minimal exercise. I have no pain now, just some IT Band issues on the lateral side of my knee. icing takes care of this.
I guess I want to encourage you to really take the advice here to heart. It made such a difference for me.
Good luck and let us know how you are doing!

 

[Majic]

Don't expect to cut down or stop pain medication too early, it will be counterproductive in the long run. I stayed on codeine for 2 1/2 months, and only cut it out when I didn't need it. I have now cut out naproxen and am about to cut down my paracetamol. Because of this and the fact that I iced top and bottom before I went to sleep, I have had virtually no pain at night. There is no point being a martyr to pain when you have the remedy to hand.

 

[Josephine]

1. 6

That's quite high.

2. Oxycodone 325 mg. 1-2 tablets every 4-6 hours

And how many ARE you taking? 4hrly or 6 hrly? I think you need to take it 4hrly and chuck in Tylenol 1,000mg 4 times a day as well (assuming the oxycodone doesn't have any included in it)

3. Ice 3 X times a day for 30 min.

You accomplish little or nothing in 30 minutes only 3 times a day. Ice for at least 40-60mins and more than 4 times a day. Ice is nature's natural pain killer.

4. Have not been elevating consistently

Then you should. Elevate when you ice and any time you are sitting down.

7.20-30 min. Some cooking, laundry, not out and about yet.

Good. Have you read the articles left for you in post #6? There is one about activity progression which you should read carefully and digest.

My comments in bold
PT 3 times a week
Home exercises 2x a day - do them once a day at the most and none at all at the weekends

Home Exercises include
Ankle pumps 10 reps X 2 sets - these are only anti-clot exercises and you don't need to do them after 3 weeks
Gluteal Sets 10 reps X 2 sets - well okay but just do 5
Passive knee Extension 10 reps X 2 sets - I wonder how you accomplish passive knee extensions? Do you press down on your knee? You told me your flexion is 100 or so but you never said what your extension is.
Sitting knee extension 10 reps X 2 sets- you already do on extension exercise. You don't need two!
Supine Hip Abduction 10 reps X 2 sets - hip abductions are for hips not knees!
Heel slide 10 reps X 2 sets - it's a mistake everybody falls into - doing 2-3 intense spates of heel slides are not the most effective way to do them and may even cause pain. Read this Heel slides and how to do them.
Straight leg Raise 10 Reps X 2 sets - a tip about SLRs, one you can do them, you don't need to do them anymore. There is nothing to be gained.

PT
Stationary Bike 10 min - okay
Knee extension 20 reps - Do you have a problem with your extension? You haven't said so ....
Leg Weight machine 15 reps - never ever use weights or a leg press. Very harmful and will create tendinitis
Leg lift machine 20 reps - same here. You're only 8 weeks and your knee is still healing. No machines!
Leg pulls 20 reps on a stool 20 reps - is this for flexion? It's bad. Don't do them
Leg roll on a ball 15 reps - okay but do it gently!

In summary I think you're overdoing the exercises and need to cut back hugely. The thing is, contrary to what you will have been told, it's not the exercising that gets you your ROM, it's time. Time to heal, time for swelling and pain to settle and again, time to heal. One thing that seems to be missing from all the PT's protocols is that all your ROM is there right from the start, just waiting for all 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. Exercise as in strength training is counter-productive and does more harm than good. Normal mobility and stretches are the key to success. This approach will also lessen the amount of pain/stiffness/swelling you experience (which are all forms of post-op pain anyway). If you follow these suggestions I have given you, you will find your medications perfectly adequate and things will improve a lot more quickly than they would have.

If you want some confirmation that this approach works, do read my recovery threads to see how little exercising I did!
First knee. Knee recovery - UK style
Second knee. Josephine's 2nd knee story - short version where I did even less!

 

[Cwhite]

Thank you! I will follow your advice!

 

[referee54]

I know it seems like a long enough time, but the TKR surgery causes tremendous surgical trauma to the knee joint---sawing, filing, pounding, gluing---manhandling---and then you are finally closed up.

It requires a type of patience that we do not know that we have---and icing, elevating, and resting for long periods of time are tremendously beneficial.

I would also cut down on the PT to 2X a week---and even then, take a break from it---let that surgical knee lose its anger. By cutting back on the PT and your activity around the home, you will be amazed at how much better your knee---and you ---will feel.

 

[Cwhite]

Much better day today than yesterday, but I have pain in my calf. DO I need to worry?

 

[newlybionic]

The pains seem to move day to day up,and down my leg during recovery. Your therapist can help you with stretches that might relax your calf muscle. I found that to be the cause of my pain.

 

[Cwhite]

How long and when should you wear the compression stocking?