TKR Knee discomfort

[wilbo58]

Hi everyone, so glad l’ve found this website as l have so many questions l will be asking to people who have and are going through TKR.
The main questions at the moment are that l’m 6 weeks after the operation and l just cannot sleep as l have an aching pain around the knee , thigh and it’s when l go to bed .
I wake up now at the same time every night after 2 hours sleep , eventually go back to sleep for 1 hour then wide awake from 4.30 as l just cannot get back to sleep aching or without which is not often.
I take meds before going to bed and elevate my leg so what else could l try .
I never use to have a problem sleeping through the night before my operation..

 

[EalingGran]

I used to rest my leg on the ice cold jacket of my Aircast Cryocuff and then change the icy water when I woke up.
Unfortunately sleep problems are incredibly common. Even small amounts of pain keep us awake at night.
Once I was off opiate painkillers I got some zopiclone from my GP. And alternated it with diphenhydramine ( an OTC sedative antihistamine). Getting a decent amount of sleep is really helpful for recovery.

 

[Jockette]

Hi and Welcome!

As @EalingGran mentioned, sleep problems after this surgery are very common. Here’s an article from the our Recovery Guidelines about why:

Sleep deprivation is pretty much inevitable - but what causes it?

Time and again members complain about not being able to sleep and after a while, that it gets to making them feel frustrated, despairing, depressed and even ill. I thought perhaps a short treatise on the reasons for disturbance of sleep patterns was long overdue. It won't help you to sleep but...

bonesmart.org

I will leave you the rest of 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

2. Control discomfort:

rest​

elevate​

ice​

take your pain meds by prescription schedule (not when pain starts!)​

don't overwork.​

​

If you want to use something to help heal the incision, ​

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.​

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.

 

[Layla]

Hello and Welcome to BoneSmart! Thank you for joining us.

so what else could l try .

This is a problem for many, so you're not alone...cold comfort, I realize. I am sorry you're struggling to get the restorative rest you deserve after this major surgery.

Try lots of pillows, It is something that helped me get comfortable in bed, making it easier to fall asleep. You can experiment with different arrangements to find what works for you. I surrounded myself with them so I could rest a leg, or arm easily enough, whatever felt comfortable. It can evoke the sensation of feeling swaddled and anything that feels soothing may certainly help you drift off.

Do all you're able to basically "set the scene" for sleep. Make up the bed with your most comfortable bedding and blankets along with extra bed pillows of different degrees of firmness. Try to block out the light if it's daytime. Minimize noise unless you feel listening to calming relaxation music, a fan, or white noise may help lull you to sleep. Make sure the room temperature is not too hot or too cold. Try to disconnect from the devices at least an hour before the targeted nap or bed time, so it's easier to wind down. Limit caffeine throughout the day and consider natural sleep aids such as Valerian, Chamomile or, Magnesium, my personal favorite, which can assist in muscle relaxation and nerves and promote healthy sleep (falling asleep and staying asleep)

Apply ice for a time before bed to reduce swelling and numb the discomfort. Try some relaxation techniques if you feel they may work for you such as deep breathing, prayer or meditation or even some gentle stretching may help relax your body and mind.

An article on Magnesium from our Library -
https://bonesmart.org/forum/threads/magnesium-is-a-star.20301/

Most large grocers carry a variety of teas such as Celestial Seasonings - Sleepytime Herb Tea,
Yogi Teas, Bedtime, Bigelow Cozy Chamomile, all of which may help you relax...at least worth a try.

Time will also help, but that takes patience, especially when you're restless and tossing and turning all night.
Wishing you many nights of peaceful sleep soon!

 

[benne68]

Hi @wilbo58 As Layla says, most of us have difficulty with sleep during the early months of recovery. Her suggestions about the pillows, icing and magnesium were all very helpful for me.

wake up now at the same time every night after 2 hours sleep , eventually go back to sleep for 1 hour then wide awake from 4.30 as l just cannot get back to sleep aching

I dealt with a similar problem during my last TKR recovery. When I awakened during the night from pain, I would make myself get up and walk around -- just back and forth up and down the bedroom hallway -- for 5 minutes. Somehow that helped things "reset" and I was able to fall asleep when I went back to bed.

I know it doesn't feel like it right now, but it will get better with time.

Sending hugs

 

[wilbo58]

Hi everyone,
I’m just over 6 weeks out off having a TKR. I have already posted my first newbie message and mentioned l would be asking for help and advice on other issues if possible.
So here goes … now like l’ve already said 6 weeks after the TKR and l’m doing the exercises and going for 30 minutes walks daily.. but my knee on the outer side feels like it’s popping and when l sit and move my leg forward and backwards while holding my hand on the certain area l can feel it ..
It is hard to describe but it feels like it’s popping out and in but it’s not affecting my walking or exercising .. any idea what could cause this or anyone had this happen to them ..

 

[mendogal]

If there's no pain associated with it and if everything feels really stable when you're walking, it's likely ok. I certainly had odd experiences like that and other members have as well.

(It would be helpful if you further qualify exactly where "my knee on the outer side" is. Do you mean the outer part of the kneecap, or a small area directly adjacent to the kneecap, or the entire structure of the joint, or the tendon/muscle just above a slightly lateral to the kneecap?)

It's not unusual for our tendons and the IT band to act strangely during recovery from a TKR. Sometimes it's that they were disrupted during surgery. Sometimes the trauma and swelling leads to a rubbing or friction. Sometimes that's compounded by the fact that as our arthritis worsened our soft tissue structure - muscles, tendons, ligaments - did their best to compensate, so some of them got tight and contracted for support while their counterparts became stretched and lax. Surgery reset things so there's a period during which things need to resettle.

If there's pain, instability, or it's making you nervous, best to check in with your ortho.

 

[wilbo58]

Thank you for replying.
When l said side of the leg , yes l mean the outer side of the leg .
I think and l’m sure but is this where you mentioned the IT band runs.
Does it hurt , it can be uncomfortable if l’m getting out of bed and moving my leg sideways to get out and then straighten it.
Walking it doesn’t cause pain but feel discomfort .
I’m hoping it is related to swelling and will settle down eventually…

 

[Jockette]

@wilbo58 I merged your newest thread with your original recovery thread, as we prefer that members in recovery have only one thread.

This benefits you because all your information is in one place, easy to find, and maintains a nice journal for you.

This also benefits our staff, as your information is all in one place, and we often go back through your thread for previous details, so we know what you‘ve been through which helps us advise you better.

So, please keep all your posts in this thread. If you’d like a new title, let us know what you want, and we’ll change it for you.

Many members bookmark their thread in their computer browser, so they can find it when they log on.
How can I find my threads and posts?

How can I find my threads and posts?

There are a couple of ways you can find categories of threads on the forum. You are able to use links in the main forum toolbars at the top of the screen to quickly access certain types of threads: your own threads, threads with your posts in them, and watched threads. You can also use links...

bonesmart.org

Best wishes on your continuing recovery!

 

[mendogal]

Thank you for replying.
When l said side of the leg , yes l mean the outer side of the leg .
I think and l’m sure but is this where you mentioned the IT band runs.
Does it hurt , it can be uncomfortable if l’m getting out of bed and moving my leg sideways to get out and then straighten it.
Walking it doesn’t cause pain but feel discomfort .
I’m hoping it is related to swelling and will settle down eventually…

It can be either the lateral quads or the IT band - it's often hard to distinguish, and the quads probably have more nerve endings than the very tough fibrous ITB.
It's a common place for us to experience pulling, snapping, and/or discomfort.

For most people it's temporary and slowly fades.
For a very small number, it lasts longer term and may indicate something is catching.

Gentle massage and stretching is worth a try.

 Oh! If you provide the exact date and which knee, we'll create a custom signature that lets members see at a glance where you're at on your recovery journey.

 

[wilbo58]

 Oh! If you provide the exact date and which knee, we'll create a custom signature that lets members see at a glance where you're at on your recovery journey.

I had the TKR on 30th sept 2024 on my left knee ..

 

[wilbo58]

Another night with only 3 hours sleep, l just cannot get comfortable and switch off .
No matter which way or position l’m in.
It’s not a pain like the first few weeks after the surgery it’s a aching pain and it starts high up near the hip and down the side of the leg to the knee , which makes me think this is IT band related.. how can l calm this aching pain down when l try to lay down to sleep .
I cannot take inflammation tablets as l’m on high blood pressure meds.
I’m so tired now after so long without proper sleep at night ..

 

[Dearjr]

@wilbo58 maybe try some melatonin and see if that helps

 

[Layla]

Hello wilbo,
If it is your IT band, what about looking into foam rolling before bed...if gentle massage and stretching isn't helping. Then there's ice or heat. Ice will help if there is swelling or inflammation and heat if the pain feels more like muscle tightness. Have you tried elevation while lying down? This may reduce strain on the IT band, allowing muscles to relax. Im sorry you're unable to get the restorative rest you desire and deserve. I hope this turns around for you soon.
@wilbo58

 

[Layla]

See if this article describes your pain -> IT Band Issues and Treatment

 

[wilbo58]

Just an update on how l’m getting on.
My knee still feels tight and have discomfort on the side of the knee when walking, like a popping/rubbing which doesn’t help when doing my exercises.
Seen the physio this week and they said l should concentrate on strengthening the femoris . I’m still not sleeping well at night as the aching down the IT band and above the knee keeps me awake, l have tried to elevate and use cold packs and warm hot bottles on the areas but cannot get comfortable to get back to sleep so 3 hours at most is all l get..
Can l use a deep heat cream or spray on my leg now because l might try this just before going to bed and see if this helps ..
Any help and suggestions would be greatly appreciated..

 

[Jockette]

Can l use a deep heat cream or spray on my leg now

You can try that on the side of your leg, just keep it away from your incision area. I would avoid a spray as you have less control of where it lands.

What exercises are you doing? Sometimes we overdo the exercises we are told to do, and sometimes well meaning physios give us exercises that we are yet healed to do, as not all physios really understand the healing process from a joint replacement.

 

[wilbo58]

Can l use a deep heat cream or spray on my leg now

You can try that on the side of your leg, just keep it away from your incision area. I would avoid a spray as you have less control of where it lands.

What exercises are you doing? Sometimes we overdo the exercises we are told to do, and sometimes well meaning physios give us exercises that we are yet healed to do, as not all physios really understand the healing process from a joint replacement.

Will try some deep heat cream on the IT band from hip to knee to see if that helps ..
physios gave me the stretch exercises for bending the knee from a chair , on the floor , towel under the foot on the ground to straighten the leg , lift the leg while laying on the floor, and towel under the knee while on the floor and lifting the foot while pressing down on the knee to strengthen the quads ..
Doing these 3 times a day and a 20 minute walk ..

 

[Jockette]

and towel under the knee while on the floor and lifting the foot while pressing down on the knee to strengthen the quads ..

I would pass on this one. This could be one that is causing/maintaining your pain.

Doing these 3 times a day

I suggest no more than once a day, and don’t do them all at one time. Space them out throughout the day. Your leg is not unfit, it has been surgically injured and needs to heal. Doing all these 3 times a day is not allowing for enough healing.

20 minute walk

This is good. In fact, you could just do this and skip all the others. Don’t forget, every movement you do, just going about your day, gives your knee important healing movements. It’s what I like to call “natural PT.”

 

[mendogal]

@wilbo58
For the ITB and lateral quads above the knee: I have some long term problems there on my R TKR (which despite that is fully functional, just tight and achy with prolonged flexion). I have had good luck with the roll on version of Bio Freeze Professional, available OTC online.

You might also try slow massage across the quads and ITB (not lengthwise, but across the fibers).

For exercise: I agree with @Jockette that it's counterproductive to do multiple reps/sets daily. And I say this as a person who loves strength training at the gym but who also understands the physiology of healing. I did a few reps here and there, scattered throughout the day, with icing and elevation in between.

When you say "pressing down on the knee" I would suggest merely contracting the quad, no manual pushing needed.