TKR L Knee TKR on October 7, 2019

[Den5]

This is my first posting on this forum. I am 4 weeks post L TKR today. First 4 days post op were easy, then I had severe pain (7-8/10), swelling and bruising from knee down to just before toes for the next 10 days. ED visit on Day 8 assured me of no blood clot. Days 15 to 28 have been moderate pain (4-5/10), and only mild swelling. PT twice a week has been VERY PAINFUL to the point of tears on 2 days. At 3 1/2 weeks, I reached 0 deg extension and 115 deg flexion. I'm walking without aids but still awkward steps. It hurts to sit in kitchen chair after 10-15 minutes. I tire easily. Sleep is weird. I stay awake about 1 to 2 hours later each night. Last night the pain increased to 7/10 at 2 am. After taking, 1/2 Percocet at 2 and another half at 2:40 am, it finally settled enough to sleep - I slept until 12:30 this afternoon! Next PT is tomorrow at 1:40 pm. For pain I'm taking Celebrex at noon and midnight, 1/2 to 1 Percocet 3 or 4 x/day, Tylenol up to 5 tablets per day, and Robaxin every 6 hrs if needed.
Because I have psoriatic arthritis I have also restarted Humira weekly. I'm wondering if my pain level is normal at this point in recovery?

 

[Jockette]

Hi and Welcome!

Those pain levels are normal for the way your PT is pushing you. This is not necessary and if you cut back that PT, your pain level will probably decrease. Are they force bending your knee? (mine did) If so, they shouldn’t. What kind of exercises are you doing?


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.

Especially read Number 4 about PT.

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.​

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.

 

[Pumpkin]

Den5,

PT twice a week has been VERY PAINFUL to the point of tears on 2 days

Very painful PT is unnecessary, and may be setting your recovery back. Suggest you ask for another PT who has gentle approach to your recovery. You may have to go to another clinic.
Give your knee a chance to heal, as your swelling goes down, your ROM will be there.

 

[LindaO]

I agree that painful PT is not necessary and likely hindering your recovery as it causes additional swelling and pain. Gentle PT keeps the joint and muscles moving without the severe pain. I hope you can convince your therapist that you won't tolerate being brought to tears.
Please keep us updated!

 

[tlfiore]

@Den5 My heart hurt for you as I read your post. I am by no means an expert, nor have I been through nearly half as much as so many others out here. Others have much more experience than I do. I would be broken for a number of reasons had I not found Bone Smart pre-operatively (just a few weeks prior). The folks on this website are knowledgeable and spot-on with their experiences and advice.

With that said, it seems obvious you are being pushed beyond your current limits, given your knee is still highly reactive and compromised. Cannot believe you are brought to tears during/after PT. Something seems wrong with the entire PT system (not just yours but the entire system in general).

Anyhow, I wish you strength and healing. Perhaps speaking up to your PT therapist and requesting a subtler program will prove beneficial.

Please hang in there.

 

[Den5]

Today I am 5 weeks post op and doing MUCH better! I did ask my PT to tone down the intensity and she did. I told her that it was causing increased pain and setbacks. I'm down to one half tablet of Percocet 1x/day along with Celebrex and Tylenol. I seem to hurt the most when sitting at a table. Are there any recommendations for mobilizing the knee scar tissue?

 

[Jockette]

There is no need to mobilize thus area, it will take care of itself. And, it’s seems it’s mostly a US thing to do.

 

[Den5]

Now at 12 weeks post RTKA. Pain is present when rising from a chair but not when walking. Also, I wake with inability to move my left leg until a do many little foot slides? Normal?

 

[Den5]

Sorry, meant LEFT TKA!