TKR Kygirl's Second TKR Recovery

[kygirl13]

The TKR was completed today. Doctor said it went well with no serious issues. No issues with anesthesia this time. I'm very achy right now and working on the pain killer schedule. I set up alarms for when I take my pain killers and I know that it can take a little to build up levels. I'm already moving more but only when my body says "Hey, we need to move a bit." Today was mostly sleeping, re-hydrating and elevate/ice. It sure does help knowing what to expect.

 

[benne68]

Welcome to the healing side, @kygirl13!

Even though you've been through this before, 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 we are all 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 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
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

Good nutrition is very important during recovery:
Dietary Tips for Recovery
Nutrition Basics


Also please notice I've moved your surgery post out of the pre-op forum and into the recovery forum. Please post your updates here.

 

[Jockette]

Welcome to recovery again!

It sure does help knowing what to expect.

This is so true!

 

[Layla]

Welcome to the healing side and congratulations on your new knee! May your recovery be smooth and easy.
Lots of comfort to you as you begin the journey!
@kygirl13

 

[Rockgirl4]

I'm happy to hear things are going well so far, and I agree. It's so nice to know what to expect the 2nd time around!!

 

[kygirl13]

One week post op and I had forgotten about the spasms. Other than meds and icing/elevation, any other suggestions about spasms? This go around, the spasms seem to be throughout the entire leg including the bottom of my foot. This TKR, the surgeon used a specific nerve block to stop pain in the back of the knee. Frankly, all it seemed to do was numb my calf and the back of my knee was ridiculously painful along with the injection site. I don't think it was useful at all. Other than the swelling being constricting and wild spasms, the knee seems to be calming down a bit.

 

[mendogal]

Hi - what a bummer!!!!

May I ask you to help me understand if by spasms you mean spasmatic muscle contractions, like charlehorses or cramps, or if you mean the electrical "zingers" from nerves.

I've seen members sometimes use the word to describe either, and our advice will be different between the two!

 

[kygirl13]

Some are muscle spasms, some are zingers, some are a sudden tightening in areas and some I can see twitching. It is very active for sure.

Had first PT session and this guy isn't focused on numbers and he was very clear not to do anything which causes pain. I think I only did 5 exercises but all natural motion without all of the pulling and pushing. It is a relief not to have the therapist from last time. Let's put it this way...I left there feeling better and more relaxed instead of limping out in more pain like I did last TKR.

 

[Layla]

Some are muscle spasms, some are zingers, some are a sudden tightening in areas and some I can see twitching. It is very active for sure.

Sounds normal, kygirl. Small sensory nerve fibers are cut with the incision.
While healing you may experience sensations of tingling, pins and needles, itching, burning and even the feeling of a minor electrical shock. These are usually good signs that the nerves are spontaneously firing through the regeneration process.

Good news that you work well with your PT. It's not always easy to find a therapist that is on the same page as you as far as expectations go. Long may that relationship be a good one!

 

[mendogal]

I agree that, however annoying it is, it's normal healing.

For muscle spasms, some of us find an oral magnesium supplement is useful - try in the early evening if the spasms are worse overnight.
I also keep a topical magnesium spray by my bedside for immediate use with light massage on carpopedal or calf cramps.

Away from the surgical area, a daily regimen of moist heat followed by gentle stretching might also help.

 

[sistersinhim]

I left there feeling better and more relaxed instead of limping out in more pain like I did last TKR.

I'm so glad you have an up-to-date PT this time. Having the correct therapist is very important in recovering from a joint replacement.

 

[kygirl13]

Went to my second therapy session today. Not once did I hear about where I "should" be. I heard that I should only bend or stretch until I feel the stretch but no pain. There was another patient there and we were comparing notes. He mentioned that for his first TKR recovery, he was placed on his stomach with his knees hanging over the edge of the table and then they hung weights from his ankles. He said he was crying. He said the therapist isn't doing that this time. We are both hearing "no pain"...just gentle stretch. I'd say that what this forum preaches is now what this therapy group is doing....finally. I very much look forward to my sessions this time as I can see improvement and I don't feel like I'm going be set back.

 

[mendogal]

PT the way it's supposed to be!!!

 

[Rockgirl4]

That's fantastic!!!

 

[kygirl13]

Currently, 4 weeks post op, and things are moving along nicely. I am dealing with low backache just above the hip joint which sometimes radiates down the leg. I know that with the readjustment of learning to walk with a new straight leg, there might be some issues with muscles and such. Is that possible? Otherwise, I'm off the heavy painkillers, exercising well and experiencing greatly reduced tightness in the knee.

 

[Layla]

Hello and Happy Thursday!
Post surgery you're likely unconsciously adjusting how you walk and stand as you favor your healing knee.
This altered gait can strain your back muscles leading to the discomfort you mentioned. Also, the muscles around your knee may be weak which affects your overall alignment. In addition, we spend more time sitting in early recovery and that can also lead to poor posture and back pain. Be careful that you don't overdo it in PT, if you're engaging in regular sessions because that may also contribute to back pain. I believe it will ease with time, especially since you're only four weeks post op. Maybe try heat, or icing on your back and see if helps.
Wishing you comfort and speedy relief.
HAPPY ONE MONTH ANNIVERSARY!
@kygirl13

 

[benne68]

I am dealing with low backache just above the hip joint which sometimes radiates down the leg. I know that with the readjustment of learning to walk with a new straight leg, there might be some issues with muscles and such.

I had a problem with low back pain after my second TKR last year. It seems to be fairly common when we have knee or hip replacements. As Layla noted, when our gait is changed, we often feel it in our backs.

Heat on my low back was helpful during the early weeks. Plus, as soon as the surgeon said it was okay (as my 6 week checkup), I saw a massage therapist. After a few sessions, all lot of the tension in those muscles was released and I was able to switch to stretching to keep the problem at bay.

 

[kygirl13]

Thanks everyone! PT is now mostly done at home as I have most of the equipment. I agree that my gait has changed as well as my gait speed. I'm enjoying the decreased limping even if the other muscles complain. My other problem is that I find myself forgetting that I had surgery and I just go...perhaps a bit before schedule. Or, I find I am expecting pain when I try some movement so when I do the movement,I suddenly realize that there is no more pain. (I call that flinching, in my words.) Lots of mental recovery involved which I have forgotten about. Anyway, overall, this go round has been much better overall. The PT did some massage on my knee and it was just heaven...pure heaven.

 

[mendogal]

It sounds like you're experiencing typical adjustment, both structural and mental!

This is another recommendation for a good massage session.

Before I could comfortably lie on my tummy or op side, my massage therapist had me sidelying on the non op side. She has a big wedge she uses with her pregnant clients. My entire new knee side was fully supported, elevated in a neutral position at hip level, parallel to the table, with as much or little knee flexion as I liked.

She was able to do lumbar, sacral, and hip releases that were indescribably wonderful!!!!

 

[kygirl13]

2 month progress??? I think I'm at 9 weeks currently. This recovery has exceeded my expectations, to be honest. My husband and I have discussed this off and on since the surgery. It could be more positive attitude, a different approach or more pre-op conditioning. We think it might be that I didn't wait as long for the surgery. On my right knee, I put it off for 12 years and there was a LOT of damage to the femur. I could barely bend it before the operation. The doctor said he was very surprised I could bend the right knee at all. It did get most of its bend back but a longer and more painful recovery. For the left knee, I had it operated on 18 months after we decided to do the surgery. No physical damage to the bones. I had 125 degree ROM before surgery. It will return to that or close. Interesting thing I have noticed with the left knee, the more I bend it and straighten it, the better it feels. When the right knee was recovering, the more I bent it, the worse it felt. It is the tale of two knee recoveries. I'm getting ready to head back to work next week with no restrictions other than icing as needed.

I do massage my knee and it really helps so much. I'll see at my 3 month appointment about going to a massage therapist.

Any suggestions about "waking" up the nerves? I rub (lightly) the numb areas and use different textures to stimulate the nerves. Thanks for any advice!