TKR Knee pain after 5 months is unbearable

[referee54]

How do you deal with sleep or lack thereof? My sleep has been nonexistent and I get around three or four hours a night. I need 7-8 to function when teaching and my school frowns on naps....lol

Still not getting much sleep but I'll talk to the doctor about what I can take.

I also was having trouble with sleeping---the day I returned to the classroom I might have had two to three hours sleep the night before.

My Os had told me that he would write me a script, but I was too stubborn. I finally gave in and took Ambien for ten nights and it re-established my sleep pattern, and the rest---well, let's just say that I was well rested..'

 

[referee54]

I'm now scared about what will happen next.

Please do not be scared. If you need to slow down and be more gentle with your recovery---that may be a big help

If you do need an MUA, it is not an admission of defeat---many others have had an MUA and it has opened up a new world of ROM to them. AS Jamie posed the question, did the surgeon mention a "window" for ROM? I hope not, as he would be incorrect.

 

[Nannharwood]

Well folks, I'm here again in pain and trying to sleep but to no avail. I'm a little worried about losing some of my ROM because the nice folks came to pick up my CPM. I measured today at 107 on my left leg and 100 on my right, two weeks after my manipulation. I've made great strides in my measurements because my left leg was at 82 and my right leg was at 75 before the manipulation two weeks ago. Has anyone else experienced this dilemma ?

Also, how do you deal with pain on the job until you can get home to take your medication? My doctor told me about Tylenol but how much do I take at one time? I'm unable to take Aleve because of stomach issues. Please advise and many thanks.

 

[Celle]

The correct dose of Tylenol is 2 x 500mg tablets = 1Gram, 4 times a day (4-6 hourly). Don't take more than 4 Grams in any 24-hour period.

 

[DogLoverx3]

Don't lose hope Nannharwood. If you've looked at my thread, I had a HARD 1st 5 weeks (part of it my own fault). I've dealt with huge pain, countless crying fits and more than a few thoughts of 'what the heck have I done to myself'? I've felt that things will never get better, but ya' know what? They do. As discouraged as you may be right now, think back 2 weeks and recognize all the little advances that you've made. Sure, we'd all like our advances to be BIG ones, but for some of us, that's just not in the cards. Although we shouldn't compare our recoveries to anyone else, I do and I know that I'm behind most everyone else who had TKR the same week I did. While I may be lagging behind others, I know that I'm improving in my own way. Baby steps are certainly annoying, but I'll take what I can get. ;-) I've made some great advances with my ROM (which was 'stuck' for more than 2 weeks) and although I'm still in more pain than I'd like or 'think' I should be in, it's just how things are. We can only control what we can control, so don't be too hard on yourself. We all understand and have been there. Keep up the great work!!!

 

[Nannharwood]

I'm so tired of pain that is constant and never seems to end. My surgery was December 10, 2013. I saw my doctor today and he told that I shouldn't be using a wheelchair at all or my cane. Problems is, I can't walk very far and my room is on the opposite side of the building. Walking that far is just nearly impossible. By the end of the school day, I can hardly walk out of the building. My pain meds are the only thing that helps but I'll only have that for two more weeks and it's only twice a day. Tylenol arthritis barely helps and icing works but it's not that easy to do while teaching. I'm tired of people asking or telling me that they know so and so who had both knees done and they're doing great. Guess what? I'm not! I do exercises and my ROM is stuck at 115 and I fought like heck just for that amount over the last few months and with an MUA to boot. Please advise and let me know that I'm not alone or crazy.

 

[Campervan]

@Nannharwood
Being on your feet all day teaching at five months post op is tough and I'm sure will be impeding your recovery. If my Rom had been 115 at five months I would have been over the moon as I didn't reach it till 9 months. I had a slow recovery and certainly couldn't have stood all day at 5 months. Here's my flex measurements at various points:
92 - 8 weeks post op
105 - 10 weeks
107 - 5 months
110 - 6 months
112 - 7 months
116 - 9 months
119 - 11 months
118 - 1 yr
120 - 1yr 2 months
125 - 1 yr 8 months

When the moderators come along they are going to ask you what else you are doing in your day, such as housework, cooking, etc. So perhaps post that ready for them. And perhaps list the exercises you are doing. It could be you're overdoing it and the knee isn't getting time to calm down so staying inflamed and causing your pain.

 

[maryo52]

Well that sounds like no life at all. You're right to come on here for help. Things are not right, and it doesn't sound as if your surgeon is helping.

I'm tired of people asking or telling me that they know so and so who had both knees done and they're doing great.

Oh I know this territory all too well. It's bad enough that we feel disappointed in our lack of progress, and people's well-meaning comments just make it worse. Find a phrase that will cut them short and save yourself at least that little item of misery.

A small percentage of us have knees that don't bend well. There are three main reasons why this can happen. One is the surgeon didn't get the knee in right. Second is there are adhesions or scar tissue. Third is there's an infection or other disease process affecting the area.

Assuming the best, that you had scar tissue and thus the MUA, be assured that your ROM is fine and will get better on its own without any effort. So if you're 115 on your bend, what are you on extension? Are you able to fully straighten?

You mentioned that you worked hard for your ROM. There's a Catch 22 in this business of reluctant ROM. When PT accelerates to get the knee bending, it actually has the opposite effect. I'm guessing that early on your knee was "behind" the norm for ROM and it was then that the aggressive PT began. That level of PT does not help because it's hurting a knee already injured during surgery. Thus there is a backlash of inflammation, swelling and pain, which interferes with ROM, which the PT approaches this aggressively, and thus a vicious cycle has set in. Then they do a manipulation and continue this unhelpful approach so you can "keep" ROM gained in MUA.

I found that the efforts of pushing my knee resulted in a lot of pain. At five months I was just past 90 degrees ROM and taking 1/2 percocet every 4-6 hours. When I took a vacation from PT at six months, my pain went away. I never did formal PT again. It was not needed (except some efforts since then to get the quad firing better).

Now your case sounds a bit extreme, so before I continue to guess what's happened, please fill us in by describing your ROM at various points of your recovery, your sessions with physiotherapy (frequency, length, and what was done), PT at home, and how much/how often/what drug you're taking now. It would also be informative to know where you had your knee done/what state/hospital.

Some parting advice -- trouble with TKRs are almost always soft tissue. The bone/joint part got fixed, but they injured the soft tissues in the process. It's the soft tissues that TKR recovery is all about. So as we help you sort this out, go back to as much icing and elevation that you can do, rest, massage, margaritas, watching your favorite movies, etc. Your knee needs a knee-cation!!

And we will help you out of this awful fix. Thank goodness schools ends soon!

 

[Roy Gardiner]

By the end of the school day, I can hardly walk out of the building.

I do exercises and my ROM is stuck at 115 and I fought like heck just for that amount over the last few months and with an MUA to boot.

Would I be correct in saying that you are on your feet all day teaching?

So you travel to work, stand all day, travel home? When did you start? Were your knees recovered at the time of starting?

I am now going to guess. Your knees were not fully recovered when you returned to work. They have not improved since. If that's true, then given the amount you are doing (work and PT and fighting for ROM) I'm not surprised. Knees must be allowed to heal before they can be worked fully, if one doesn't allow for that then recovery basically can stop.

If one pulls a muscle, one cannot train. One must wait until recovery is complete -- knees, same thing.

If this rings true with you, then I suggest you must find a way of doing much, much less and allowing healing to proceed.

This, as Mary so rightly says:

...go back to as much icing and elevation that you can do, rest, massage, margaritas, watching your favorite movies, etc. Your knee needs a knee-cation!!

 

[jjillek]

Oh Nannharwood, I am so very sorry to hear of your situation and continuing pain. My RTKR was 5 1/2 months ago and I have followed BoneSmart suggestions all the way. Frankly, I am unable to imagine my recovery without frequent reference to the library and forum! Now, that said...those that have posted before me are exactly right! I am healthy, strong and fit, but would be totally unable to follow your activities without pain and swelling! I have been quiet here...but I had to respond to you ! I thought the wheelchair for the long school corridors was a great idea for your situation...it takes pressure off your knee! Yes, I understand that you. " should" not have to use it, but realistically, you do! My attitude is " do what you have to do to recover".

I have recovered at the lake. My cabin is on a hill which is on an incline from water to road, with activities on different levels. When I realized that my knee did not "like" inclines & especially inclines with gravel....I purchased a snazzy red golf cart to assist. Of course, I still daily walk from one level to another; however, the golf cart is in frequent use. I consider this on the same level as your use of the wheelchair.

I attend many athletic events at the local college and typically carry a cane. Once again, there are areas of rough terrain, holes in grassy areas, berms, long walks and crowds.....26 steps to get to a restroom! I have not "needed" a cane since the first month....but have thankfully avoided several falls by being prepared.

School will be over soon! Rest, ice and elevate! Please relax...you will continue to be in my thoughts.

 

[Josephine]

I saw my doctor today and he told that I shouldn't be using a wheelchair at all or my cane.

Well from his point of view, he's right. At 5 months you should pretty much be back to normal.

Problems is, I can't walk very far and my room is on the opposite side of the building.

On the opposite side to what?

My pain meds are the only thing that helps but I'll only have that for two more weeks and it's only twice a day. Tylenol arthritis barely helps and icing works but it's not that easy to do while teaching.

What pain meds are they? And why are you using Tylenol Arthritis? It's only 650mg per tablet. How many are you taking per day?

By the end of the school day, I can hardly walk out of the building. I do exercises and my ROM is stuck at 115 and I fought like heck just for that amount over the last few months and with an MUA to boot.

You are between the classic "rock and a hard place", my dear! Trying to do everything and gaining nothing.
1. you cannot work and do exercises
2. you should not be 'fighting like heck' in exercises. You gain nothing by that
3. all your problems are down to pain. Pain actually comes in many forms including soreness, burning, stabbing, throbbing, aching, swelling and stiffness. All of these need medicating though not always with narcotics.

You are still in relatively early stages but I must tell you about a man I met recently who had started out on much the same path as you are right now after his BTKR. In his case, he had plunged into super exercises (said he's been a fitness freak before his knees went!!). So from week one he was doing huge amounts of exercising every day and walking 1½ miles three times a day! I met him when he was 5 years out and he was STILL in severe pain, STILL had limited ROM, and STILL had hugely swollen legs. I couldn't say much but I know he's got this condition for the rest of his life now - chronic tendinitis and swelling. He'll never get any better.

I don't tell you this to scare the bejeebers out of you, just to wake you up to the fact that you have to take action now if you are to rescue your legs and get back some kind of normalcy. This means resting more, doing less exercising and taking pain meds properly.

I tell you this truthfully - now is the time. The choice is yours.

 

[kneeper]

Can you get a stool for your classroom so you can sit a bit during class on and off while you're teaching? Depending on your grade, you can do that to varying degrees.

 

[Mimi]

Nannharwood you are neither alone or crazy. I can relate to much of what you are saying. My story has an infection one week after surgery, horrible swelling, a very hot knee, quads that did not function for 3 months and having to use a walker for 3 months and a cane for 2 months. My swelling only started to go down when I stopped all PT at 5 months. It took another 7 months before my knee was a normal size. I had a great deal of pain from day one and was never given anything strong enough to help me. I understand the pain issues. As for ROM I had 95 degrees flexion and -18 degrees extension when I left the hospital. Then I got the infection and it all stopped. I worked very hard on both flexion and extension for 5 months. I got to 105 and -5 when I left PT at 5 months. At home I rode a stationary bike every day for months. My leg felt like concrete.

Last year, 2 1/2 years after surgery, I went to a new PT. I was told I had too much PT at the time of surgery. I worked very hard last year to get some better ROM . I have been at 0 for some time but the 105 was 102 last year. After 2 months pf PT I got it up to 118 and my world is so different. Steps are easier and natural, there is no pain ( there hasn't been any pain since 1 year out). And I finally lost the concrete feeling in my knee.

So my advice for a recovery that is not all roses and lollipops, stop the PT till you are pain free and your knee has no swelling. Walk and do the light stretches. Ice and elevate and take your meds. Get good rest when you can. It will improve and things will get better...it just will take longer than those who have a smooth recovery.

 

[Jozilla]

Very good post Mimi. When I went back to work at a desk job at eight weeks I stopped PT. just my daily activity which was not nearly what you are doing was enough! Take care and slow down where you can.

 

[Mimi]

Jozilla, I am 3 years post op. Maybe I wasn't clear. The take it easy part is in the post op recovery time. And for me that was a year!

I am fine now and go to PT once a year to maintain my ROM and maybe get a few degrees here and there. You can gain ROM well after surgery, I am proof of that it just takes some work.

 

[Jozilla]

I was unclear - not you! Sorry. I thought your post was very beneficial to nannharwood's post. I feel so bad that she is still suffering so much. It is interesting to hear how you are doing three years out @Mimi. I am only six months out still need my other knee done but look forward to saying I am three years out!

 

[pippi]

As always Josephine thankfully had the best way of saying things that need to be said in the way I only wish I could.

I will not try to improve or add to her post but only to assure you that you are not crazy or alone. Nothing could be further from the truth. There is always someone on Bone Smart for you (it could be a different person at a different time) that reads your post, has been in your shoes and will take the time to reach out and amazing will lift you up at the lowest points. It is rough at school but with the good information provided above you can fight this battle and eventually although it may not seem it win the war.


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