TKR Montecresto’s Recovery

[Layla]

Oh my …and I was worried we frightened you off in cautioning about aggressive PT.
I am so sorry to read about what you endured, it had to be frightening for you and equally so for your poor wife. Thankfully it’s behind you now.

I am happy you found a gentle and reassuring PT and you’re enjoying your sessions. I will still caution you that it’s not necessary to push it, or work through pain. If anything ever hurts, please stop.

I’m glad to hear your anxiety has eased, you’re getting out for some light activity and planning for a transition with the assistive devices in the days ahead. All wonderful news. Thanks for stopping by to share an update.
You’re on your way to a brighter future!
@Montecresto

 

[Montecresto]

Graduated from the walker to the cane today and I’m up to 105* on the CPM……

 

[Montecresto]

and I was worried we frightened you off in cautioning about aggressive PT.

Haha, I don’t frighten that readily…..

 

[Hey Jude]

This is interesting. The swelling I have is not just the operated knee but my whole leg. Since surgery, I have spent a lot of time lying down with my leg elevated, in between gentle exercising, and the swelling has been gradually reducing around my calf and knee. But my thigh is still very swollen and I wonder if this is because I am not supine and the lymph system is restricted. I will try the breathing and massaging to see if that works.

Also I find that as soon as I am on my feet to have a walk around the house I can feel the swelling returning down my leg and straight away my skin feels tighter and stretched rather like a balloon being filled up with water! Consequently I don’t like spending a lot of time on my feet, but I don’t want to spend all my time lying down either! I guess, like everything else, it is trying to find the right balance. But I’d be grateful for any tips.

 

[Hey Jude]

Graduated from the walker to the cane today and I’m up to 105* on the CPM……

Gosh, sounds like you’ve had an awful time since your surgery. I’m sorry you have been through so much. But really good to read that you are now making so much progress. Hope it is plain sailing from here for you

 

[Montecresto]

Graduated from the walker to the cane today and I’m up to 105* on the CPM……

Gosh, sounds like you’ve had an awful time since your surgery. I’m sorry you have been through so much. But really good to read that you are now making so much progress. Hope it is plain sailing from here for you

Well thank you for the encouragement. I certainly haven’t had any plain sailing however. I believe the CPM machine caused me a serious set back. By the time I reached 115* on it it was quite uncomfortable. I found that I was kind of pushing back at it when it approached the limit. After two days of getting up to 115* I experienced a set back. Swelling and pain overcame me and ROM was reduced. I found I couldn’t even do the little home exercises like knee slides….

My wife called the OS office and the PA said to send the CPM back, that I had over done it and to do no exercises over the weekend and to talk to my PT about it Monday. So I’m done with the CPM and it’s supposed to be picked up any time…..

PT was reduced to much milder reps and less weight on the mechanical tools….

But I have not gotten back to where I was, my ROM is less than what it was and I’m very depressed about it all. I’m definitely not progressing along the lines of the typical TKR recipient…

My daily pain is still out of control and the doctor changed me from opioid management to muscle relaxers and Tylenol ES…..with that my pain has increased. But he insisted that at one month (I'm one month out today) I should not still be on an opioid…typical usage is 2 weeks. My nurse practitioner friend agrees with the doctor on that as does the PT. As do I btw, just because im scared of them and I know they aren’t great long term….

So here I am a month out, I need to be measured at PT tomorrow but I believe I’m at best 90* flexion and -8 extension.

That, and the chronic (often acute) pain has me very depressed and just generally pessimistic about my recovery and the future of my knee…..

 

[Jockette]

and less weight on the mechanical tools….

You are still not getting appropriate PT. It is too early in recovery for any machines or weights. This is why you still have so much pain.

I’m definitely not progressing along the lines of the typical TKR recipient…

You are progressing very typically for someone who is overdoing inappropriate PT.

BoneSmart philosophy for sensible post op therapy

You will have noticed there is a significant opinion here about the potential hazards of PT. You may feel that your therapists are experts and know what you should be doing. However, over the last several years I've been here, I have observed that the more intensive the regimen of exercising...

bonesmart.org

 

[Montecresto]

I feel ok at PT, I’m listened to and adjustments are always made per my requests. My surgeon has told me discomfort in PT is acceptable while pain is not and I feel I’m doing good with that. The CPM however didn’t work for me beyond 105* for some reason and I’m glad to be off of it.

In my own home exercise I’m doing ok… but I guess I’m being impatient wanting to see progress quicker than I am.

My recumbent stationary bike arrived last week and I’ve been really liking it….

 

[Hey Jude]

Sorry to hear about the pain you have been suffering. All I can offer is my own limited experience. I suffered with terrible constant pain and lack of sleep for the first two and a half weeks after surgery. My doctor has since increased my meds, the pain is now manageable and I feel like a weight has been lifted from my shoulders.

I wouldn’t worry about not being a typical TKR recipient. I’m sure I’m not following a typical recovery pattern. In fact my surgeon even told me to expect a longer than average recovery period (though he didn’t say why!) We are individuals after all.

I was also very depressed and worried when in constant pain. Who isn’t? I very much doubt you need to take strong meds long term, but it sounds to me like you might need them at the moment.

 

[Montecresto]

Yes my surgeon did warn me after surgery that my pain and recovery would not be typical. He did however tell me why. Going in to surgery he noticed that I did not have full extension already. This was due to a laparoscopic surgery 16 months earlier that left me in worse shape….so he had to do some work in the very rear of the knee (a release) and deal with a 4” Baker’s cyst.

He also told me that I had an excessive amount of scare tissue that he had to cut and scrape out. The typical one hour fifteen minute procedure was two and a half hours.

I’m four weeks out and pain is only marginally better than it was during the first week. The surgeon told me that typically a patient will be on opioid based pain medicine for two weeks and often patients don’t even take all that. But he didn’t want me on them past a month so I’m now using a muscle relaxer….

 

[Layla]

Hi @Montecresto
I mainly hang out on the hip side, but just noticed its a special milestone for you tomorrow.
Happy One Month Anniversary! I'm sorry you're still dealing with pain and hope you'll soon be enjoying more steady progress and getting back to all you love. Best Wishes for your comfort moving forward.
I hope you have a good rest of the week.

 

[MistyBlue155]

I just need to chime in on PT. For my first TKR I did PT and my angry knee and I hated it. I went for I guess 4or5 weeks 3 times a week. It made me dizzy and sick to my stomach. I decided never again. I´m 7 weeks out with RTKR and just doing fine except for when I over did it on bike (lesson learned) . At my 6 week PO, surgeon said whatever your doing keep it up. I´m off meds, I ice 3or 4 times a day, exercise throughout day.
So I agree with Bone Smart, do what works for you.
Great recoveries to all.

 

[WFD]

I mainly hang out on the hip side

When I first glanced at this, I thought you meant the popular forum where the cool kids hang out. I wondered why you thought knees weren't cool...

 

[Montecresto]

Hi @Montecresto
I mainly hang out on the hip side, but just noticed its a special milestone for you tomorrow.
Happy One Month Anniversary! I'm sorry you're still dealing with pain and hope you'll soon be enjoying more steady progress and getting back to all you love. Best Wishes for your comfort moving forward.
I hope you have a good rest of the week.

Thank you. Saw my surgeon for the first time post op yesterday, he said looking at fresh X-rays and his thorough exam of my knee, he said it looks great, he was pleased with the way it is healing and pleased with the progress of my ROM (111*/-7*) but he said that my level of pain, while not unheard of, was atypical at 4 weeks out. Although he could not say why I’m experiencing such pain….

But in response, he up’d my pain management regimen to every 4 hours verses every 6. He prescribed me a 12 day steroid dose pack and added a nerve pain pill, Gabapentin. Can’t say that I’m happy with the level of narcotics I’ve got to take, but I also can’t stand the level of pain…..

 

[Layla]

I'm sorry! I hope this combo helps and your pain eases soon...for good!
It is encouraging that all looks good though...so that's the bright spot.
Wishing you a peaceful pain free weekend!
@Montecresto

 

[sistersinhim]

It sounds like your doctor is very reasonable and am happy he upped your pain meds. Four weeks out is hardly anything compared to a yearlong recovery for most. To help ease your pain more, ice and elevate every chance you get. You can't over ice as long as you have a cloth between your knee and the ice bag. I iced and elevated every time I sat or laid down. I even iced and elevated all night long for about 6-8 weeks. I found this really helps with pain and swelling reduction.

 

[lovetocookandsew]

With my TKR, I was in a great deal of pain for, if I'm remembering correctly, about 6 weeks. After that I still had pain but not nearly as much. It was strange, but with my revision, I had pain for only about 2 weeks, which was kept under control with an On-Q pump, then miraculously I had very little pain from then on, and the ice machine took care of that. I think more people have a lot of pain for a while than your doctor is admitting to. I know from being here that many people have enough pain for a while to need pain meds. But I'm glad he adjusted your pain meds; it's hard to function when in a lot of pain, and part of this recovery is the need to walk regularly, which won't happen if you're in too much pain to do so.

 

[Montecresto]

It sounds like your doctor is very reasonable and am happy he upped your pain meds. Four weeks out is hardly anything compared to a yearlong recovery for most. To help ease your pain more, ice and elevate every chance you get. You can't over ice as long as you have a cloth between your knee and the ice bag. I iced and elevated every time I sat or laid down. I even iced and elevated all night long for about 6-8 weeks. I found this really helps with pain and swelling reduction.

I do believe my surgeon is reasonable and appreciate his efforts to mitigate my pain. I have found that I can’t fully follow the pain medication every four hours though. I feel over medicated and don’t like the feeling at all. But, I will follow it on PT days. It is my experience that icing is the chief tool for pain relief. I have an ice machine, and am in it as often as not. No need for the cloth between because the ice machine is delivering at 34-38* water around my entire knee, well enough to shrink swelling, but not cold enough to do tissue damage. I have a temperpedic bed and sleep all night long with my leg elevated….

 

[Montecresto]

With my TKR, I was in a great deal of pain for, if I'm remembering correctly, about 6 weeks. After that I still had pain but not nearly as much. It was strange, but with my revision, I had pain for only about 2 weeks, which was kept under control with an On-Q pump, then miraculously I had very little pain from then on, and the ice machine took care of that. I think more people have a lot of pain for a while than your doctor is admitting to. I know from being here that many people have enough pain for a while to need pain meds. But I'm glad he adjusted your pain meds; it's hard to function when in a lot of pain, and part of this recovery is the need to walk regularly, which won't happen if you're in too much pain to do so.

Interestingly enough for me, if I’m in the middle of a really bad pain fit, which has me in bed just writhing, clenching my teeth, crying out, if I get up and walk, I get pain relief. But I can’t do that for too long, and some of those fits last hours……

Hopefully the new pain management regimen will keep me out of those really bad fits….

 

[kneeper]

You're doing great for 4 weeks in terms of your ROM. I hope this new medication regimen will help. Also consider how active you are. It doesn't take much at 4 weeks to make the knee angry. I like that you are using your ice machine. That should also help with pain control. Definitely ice and elevate after exercise or time on your feet getting your meals etc.