TKR Long painful recovery?<

[kmak81230]

I went through a period over a couple of weeks - around the 2 month period - where I had a sharp pain behind my knee. It was like a pulled muscle and my PT thought it was the popliteal muscle. I iced and elevated and took shorter strides when walking and it got better. I also experienced what I called "the wobble" - felt like knee was giving way, not painful but I was glad to have my cane when it happened. I only experience it now if my leg is really tired.

 

[Polkadot]

I also have had pain behind the knee, and like @kmak81230, my PT identified the popliteus muscle as the probable culprit. (I also have tight hamstrings, which contribute). The popliteus evidently is a short muscle deep in the tissues that helps stabilize the knee. Kmak said she shortened her stride, and @KitKat said walking more slowly was key in dealing with this.

Their ideas match what my PT told me: Pain in this muscle usually occurs when the biomechanics of movement are "off," particularly if hip, foot or knee is experiencing more stress than usual, or one or more of these is "overcompensating" for another's job. So it makes sense to me that slowing down the walking and shortening the stride would help, because it would encourage better biomechanics when walking. Paying attention to how you walk is evidently as important as how far you walk!

My PT massaged that area quite a bit, which seemed to help with the pain over time. She also recommended putting a golf ball under the knee and gently rolling it around the area. I'm not too good at getting down on the floor yet, so have only tried it a few times and can't attest as to its utility. (NOTE: she did NOT suggest that I try this until about week 12).

KitKat also suggested using a cane for longer walks. That would make sense, too, because the longer the walk, the sloppier the form (for me, anyway).

 

[Polkadot]

Re pain meds: I don't think anyone has mentioned how Tylenol choices may affect pain control, but I found the following valuable:

I was using Tylenol Extended Release, which is two 625 mg tablets every 8 hours. I thought it a good choice because of the "extended-release" feature; logically at night the release that happened partway through the drug's cycle would keep me medicated, right? However, it wasn't doing a very good job for me.

I saw a discussion where people swore by taking Extra Strength Tylenol--two 500 mg tablets every 4-6 hours instead. This necessitated getting up in the middle of the night to take another dose in order to maintain the strength of the drug in my system. To my surprise, this worked much better! Some nights I didn't wake up and take the next dose, but most nights I did, with much greater comfort.

If you think about it, the second scenario keeps a higher dose of pain med in one's system more consistently. Initial higher dose, plus better coverage = better pain management! Just be sure not to go over the daily limit of 4000 mg of Tylenol (acetominophen), including all meds that have it in them.

 

[Jarginko]

Thanks for the always helpful and supportive comments. When I said my knee collapsed, it just buckled briefly. Since then I also find I have to walk slower. Walking down a hill or even slight slope causes similar pain behind my knee. I'm watching it, it does seem to get better, and I will take advice about seeing OS if it recurs or continues.

 

[Jarginko]

Now I’m back because of bad nights and different pains.

I’ve tried different drugs —. Tylenol, which doesn’t seem to do much for me, Tylenol PM which helps sleep for 4 - 6 hours. It seemed to help less as I took it regularly . Melatonin, 10 mg, helps a little for first couple of hours.

I know time is necessary for recovery but I’m getting discouraged with this. Added to my bad nights, I’m having all different pains during the day. Sometimes sharp pains, sometimes burning, sometimes a very sharp pain/cramps combination when I try to bend my knee back.

I go upstairs a full step each leg, with pain in new knee, down stairs I still do using baby steps-put operated leg on lower step, follow with good leg, repeat.

I’m ventilating now, just hoping some responses will help to encourage me again, knowing others have similar problems this far out (10 weeks). I find reading this site helpful anyway.

 

[Josephine]

I know time is necessary for recovery but I’m getting discouraged with this.

Discouraged at only 10 weeks? "Time" in this case is around 3-4 months and probably a lot longer.

I still do using baby steps-put operated leg on lower step

I remember with my first knee, it was 5 full months before I was going downstairs 'normally'!

I'd really like to offer you some structured advice but in order to do that, I also need to ask you some questions. Are you willing for me to do that?

 

[Pheebs52]

@Jarginko, this is a very tough and lengthy recovery process that no one who hasn't been here can possibly understand. I am at 5 months post-op and still can't always manage the stairs as I'd like. Most of the time, but definitely not always. That said, I found a great deal of improvement occurred between 10-14 weeks and hope you find the same. When I look ahead, I see nothing but improvement in store, because the worst is behind me and it is for you as well. It doesn't happen as quickly or dramatically as any of us would like, but it does happen, inch by petty inch. Hang in there, it gets better, s-l-o-w-l-y!

 

[berman2921]

The only medication that was helping me to sleep was 2 mgs of Lunesta. I was pretty desperate from insomnia and it seemed I would never regain normal sleep. Moreover I had to go back to work 5.5 weeks after the surgery. And then all of a sudden I started sleeping. It was like a miracle.

I'm thinking about having RTKR now and spending some time on the forum brought back not very pleasant recent memories about LTKR recovery

 

[kmak81230]

As the others have said, this recovery is really long - much longer than many of us anticipated. I agree with the others that there seems to be good improvement in sleeping, stairs, etc somewhere around the 3-4 month period. 10 weeks is still quite early in recovery - I was still not sleeping perfectly, still having pain on and off and not proficient on stairs (particularly going downstairs). You will get there -- it just takes time, gentle care, and lots and lots of patience. Hang in there!

 

[Jarginko]

yes, Josephine, i am glad to answer any questions

 

[Josephine]

Here y'go then!

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 forget to factor in 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 swollen is your leg compared to these?

4. what is your ROM - that's flexion (bend) and extension (straightness)

5. are you icing your knee at all? If so, how often and for how long?

6. are you elevating your leg. If so how often and for how long?

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

8. are you doing any exercises at home? If so what and how often?
This is the most crucial question so please help me by using the format I have left as an example
(which means please make a list and not an essay!)

Exercises done at home
- how many sessions you do each day
- enter exercise by name then number of repetitions of each
etc., etc.

Anything done at PT
- how many times a week
- enter exercise by name then number of repetitions of each
etc., etc.

 

[Jarginko]

1. 1 - 4
2. 5 mg oxycodone, bedtime & 4 hours later, 1 Tylenol pm bedtime. Nothing during the day, only for sleep
3. Slight
4. Flexion 125, extension, 0
5. Yes, upon waking, before bed, and after activity or exercise. 18 minutes each
6. Yes, when icing, and when sitting
7. I walk well, around house easy except stairs, painful. Walk outside for shopping, to car, public transportation, etc. Lengthy sitting I do not do, I get up frequently or slide leg back and forth.
8. Exercise 2x per week at physical therapy
stationary bike 10 minutes
hamstrings stretch 3x30 seconds
flexion 10 10 seconds each
calf stretches, 3 x30 seconds each
leg machines for quads
hamstrings
leg presses 3 sets 10 each
quad set on half roll
10 reps for 10 seconds each
straight leg raise 20 reps
short arc quad 20 reps
followed by massage and 10 minutes ice.

 

[Jarginko]

Since I started the Tylenol PM with oxycodone at bedtime, I am blissfully getting a good night’s sleep - five in a row now! This makes me feel sooo much better. No meds at all during the day. Still have pain on stairs and a troublesome sharp pain just outside my knee going down side of calf. Always when I bend leg getting in and out of car, flexing, and sometimes just because it wants to. Not sure about this one.

 

[bottomshollow]

@Jarginko, that so few of us have in abundance. You are really doing very well just a little over 3 months post op. The stairs will continue to be something of a problem for several months, but will eventually be pretty easy to manage. Those crazy "zingers", as I call the sudden sharp pains, will also take a bit longer to just disappear. So given enough TIME and PATIENCE, you will return to "normal".

Hang in there and keep us posted. We care!

 

[SusieShoes]

You really are doing well! That pain upon bending your knee getting into and out of cars sounds familiar. I had something similar in my left knee. My right knee stopped hurting three months before my left knee did! That nagging pain just hung on and on, gradually getting better, but never going away... until one day it did go away. It has made about two appearance since, when I slept funny in bed. Go figure. But having a lingering painful spot, or some zingers, is all normal.

I still find going up the stairs a bit of a labor. Easy enough, but not yet to the point where I'm not consciously doing them. The more stair climbing I do, though, the stronger the legs.

 

[Josephine]

11 weeks

1. 1 - 4

okay - a bit high for 11 weeks out.

2. 5 mg oxycodone, bedtime & 4 hours later, 1 Tylenol pm bedtime. Nothing during the day, only for sleep

You need to be taking something during the day so the pain doesn't build up. I suggest Tylenol 1,000mg 3-4 times a day. You could probably do without the oxycodone. See if that's the case and if not, add in 1 oxy at bed time.

3. Slight swelling

okay

4. Flexion 125, extension, 0

VERY good!

5. Yes, ice upon waking, before bed, and after activity or exercise. 18 minutes each

You accomplish little or nothing in 18 minutes. Ice for at least 40-60mins and more than 4 times a day.

6. Yes, when icing, and when sitting

okay

7. I walk well, around house easy except stairs, painful. Walk outside for shopping, to car, public transportation, etc. Lengthy sitting I do not do, I get up frequently or slide leg back and forth.

You mean stairs are painful going downstairs, yes?

my first observation here is that your ROM is pretty hear perfect so you have no good reason to be doing all these exercises but I'll comment on them all the same
Exercise 2x per week at physical therapy - I'd cancel that, if I were you
stationary bike 10 minutes - this is about the only exercise I would approve

flexion 10 10 seconds each - you've not actually said how you do this one but since you flexion is already 125, there is no need for it
leg machines for quads, leg presses 3 sets 10 each - do not ever use gym machines, they can be injurious to knee replacements
short arc quad and quad set on half roll - these are unnecessary for you now
straight leg raise 20 reps - same as this - let me tell you something: once you can do an SLR, there is no need to do them any more!

hamstrings stretch 3x30 seconds - do you have tight hamstrings - which is a tight pain in the back of the knee and above it. If not, stop doing these
calf stretches, 3 x30 seconds each - same with these

So you can see my summary is that you no longer need any exercising at all! Your ROM is perfect and it's my observation that the pains you are experiencing - Like these ...

Now I’m back because of bad nights and different pains. I’m having all different pains during the day. Sometimes sharp pains, sometimes burning, sometimes a very sharp pain/cramps combination when I try to bend my knee back.

.. are all exercise induced! All of them. Stop the exercises, forever, not just for a few days, and the pain will abate over time.

 

[Jarginko]

Thank you all for your encouraging words - very helpful. Also, Josepahine thanks for the advice. I shall follow along as best I can. This forum is very helpful overall....

 

[Jarginko]

I am now a little over three months since surgery. All of the above comments have been very helpful and encouraging. A problem I’m having now is inability to lay on one side or the other. When I do, whether with a pillow between my legs or not, I fall asleep a bit but wake up with pain which peaks as I turn to lay on my back. My best sleep comes the first half of the night when I lay on my back, legs straight out. Problem is, my back starts aching so I try fetal position on my side and the result is as described. This even if I try keeping one leg a little straight while on my side. I can’t sleep on my stomach, so the last four hours or so of bedtime are a lot of up and down, walking around, etc. Has anyone experienced anything similar? Does it go away over time? Any suggestions? As always, while I do not appear on here frequently due to outside demands, I very much appreciate this site and everyone on it.

 

[Jockette]

I have always been a side sleeper but since surgery I have found that I am very comfortable sleeping on my back with my operated leg elevated on my foam wedge. I also have low back issues.

At 8 months post op my operated leg is still very uncomfortable if I lay on my side, even for a few seconds!

 

[SusieShoes]

For a long time, I also had trouble sleeping on my side. My best sleeping position was on my back with legs propped up on my foam wedge. I kept trying to sleep on my side and it was as you describe... I’d sleep for a while and then have pain, so I’d switch to on my back with the wedge. That’s how I got through the night.

Eventually, though, I found it possible to stay sleeping on my side. The pillow between the knees helped. There would still be the occasional night with pain (back to the wedge). But little by little it became normal. I no longer need the pillow between my knees and sleep normally.

Patience is the name of this game!