TKR More front tightness after 18 months

[Veganism]

keith55: I can't speak from TKR. My experience with THR was that my sleep patterns were weird for a few weeks. I didn't expect to get a full nights rest because I slept on and off during the day. I'm not a fan of taking too many meds, but that's just me. I would not want to take the sleeping pill in addition to the pain meds as I'd be a zombie from it. Just my two cents.

 

[keith55]

Hi Veganism,
I think I might agree with you as I've been drowsy all day so far. (3pm local). Knee has become very achy today but I managed a very short walk outside just now with two sticks.

 

[landoz]

Congratulations being on the other side you sound like you are doing well Keith this forum tells you so much more than the Drs ever do!

 

[Veganism]

keith55: were you able to read any of the articles that were posted for you? If you haven't yet (I couldn't concentrate on much when on meds), take a look. There was one about aching/swelling and another about progression in recovery. Hoping you ditch the sleeping meds.

 

[keith55]

Hi Veganism,
Yes I've read a few of them so I know about the cause of swelling - the bodies repairing fluids with little room. I agree that the sleeping pill may not have been a good idea as I'm still drowsy (6pm). Also Tramadol has given me some limb jerks (other than leg) and possibly constipation so I'll keep that in reserve if the pain becomes too much. Idstr anything about aching becoming the dominant pain.

 

[Roy Gardiner]

Knee feels a bit unstable when walking - wants to bow backwards sometimes as in opposite of kneeling

Ha!! That's NORMALITY returning. Bone spurs which have been restricting your movement have been removed, allowing your knee back to a proper range of motion, which you have forgotten. Bizarre feeling isn't it? When you have it on both knees as I did, it's scary-weird. But you get used to it, it's correct where pre-op movement was restricted.

Ache is the new knee pain today. Any ideas?

Any number. Odd aches and pains will come and go all the time -- don't worry about them.

Just a thought about ROM. Ok so you force your ROM from c70 to c80 as I did. Achievement but your knee naturally stays at c70 i.e. to get to 80 the next day you have to force it again. So what's the point of the bare ROM figure? What we all want is a knee that freely rotates to a good ROM.

You are stretching the tissue, ligaments and tendons, around the knee. They have been unable to make proper movement for months (years, maybe) and have shortened. Repeat the stretches a lot, but not painfully, and movement will come.

 

[Josephine]

Tip re articles: read all of them! We put a lot of hard work into putting together a collection of information that is not only useful but essential!

4. In recovery I tried lifting the operated leg and succeeded! but can't do that now - effect of scarring?

Not in the least. It's the effect of MAJOR surgery which has injured your quads. It will all come right eventually but don't try to rush it.

to achieve a 100 bend but I wonder if this was an error 100 + 80 being the angle of a straight line. Do we have a diagram that shows this. To my mind if your thigh is level then 90 deg means your leg is straight down and foot is flat.

That's correct but if you lift your foot, that takes it to zero (the holy grail in extension!) and if you take your foot towards your bum, that makes it a 100 and upwards. Capice?

For instance, NHS physio says "you're knee not hip so you don't need a raised toilet seat". Well as a humble recovering patient who knows nothing I beg to differ!!!!!!!!!!!! I bought one thanks to advice from this excellent forum beforehand.

Well a lot of surgeons don't like seat risers for knees as they believe the exercise is good for the knee! I never had one and never had a problem either.

He also prescribed Zinovane sleeping pill - that may be causing the drowsiness.

It's also the Tramadol! How much are you taking at a time and how often? And are you taking two paracetamol with each dose?

you have to force it again

Never ever force the knee. Only ever to the point of discomfort. Read the articles ....

In hospital a nurse said I should sit normally with feet on the floor

They know nowt!

But do please read ALL the articles. (sorry - have I said that before? )

 

[Elliemae]

Hello keith55 I also had RTKR on May 20th, so as of today we are 9 days post op, give or take a few time zone changes.

My OS does not believe in the CPM, which I was a little disappointed about but am getting home PT 3 days a week and I have been reminded ( I am super competitive) that it was the tortious that wins the race. Take it slow, ice, elevate and rest...

Please keep your updates coming and maybe we can have a little friendly competition, using the BoneSmart mantra...

 

[keith55]

Hi Josephine,
Tks for responding - I always value your input.
I've read all of them now but that doesn't mean I can remember it all.

So here's the thing. The NHS leaflet I was given recommends 10 repetitions 3X/day of
1. Heel Slides
2. Stand on step with operated leg and lean forward and back keeping body upright
3. Quad tightening by pushing knee down into bed etc
4. PC Plod style knee bends
5 Stand up/sit down from chair exercise with arms folded
Plus practicing balancing on affected leg (holding on to something) but with no indication as to how long into recovery these should be started/finished.

P/Ters did not do 5 with me but did do "marching" on the spot. This is far more than Bonesmart recommends.
Yesterday I did 2-4 fully but only a few of 1 but last night: I thought that was too much late on. So maybe the best solution is to do what you suggest and gradually build up?
Surgeon in 6 weeks "You're not walking too well - have you been doing the exercises" Me: "No I've been following the Bonesmart forum advice". So I have to find the right way to be walking better when I see the surgeon.

Also, living on my own, I can' restrict myself to just 3-4 walks to bathroom, kitchen etc - more like 10 per day. I do live in a convenient 2 bedroom flat though. Someone recommended a pusher trolley with upper and lower trays and this one thing has enabled me to look after myself. Otherwise it would have been very difficult. I am using a nursing agency for the bigger jobs such as hoovering and changing the bed and of the assessors said "you'll find that invaluable" Correct!

I found the NHS hospital prescription only allowed for daytime use and I was losing the pain battle at night since not sleeping well. So I thought I would use Tramadol at night to get me through the night - so 1 to 2 50 mg pills. Since I don't like codeine (immediate constipation) my GP said Tramadol was the only real alternative apart from morphine.

I have lifted my leg once or twice now but it is very painful in the knee so I'm still using the good leg hook method generally. Still feeling drowsy from the sleeping pill so I'm giving up on them, and I have a social visitor today pm.

Hi Elliemae,
Tks for your comment: friendly cooperation as well of course. Each knee is different so yours could be like a classic winner and mine a selling plater using a horse racing analogy.

 

[Josephine]

So maybe the best solution is to do what you suggest and gradually build up?

Exactly! You have to remember that the staff that wrote those leaflets have never had a knee replacement so they only have theory to go on. Whereas we here on BoneSmart have all had TKRs and we know what's good and what's not! Stick with us, we work on common-sense, not theory.

So I have to find the right way to be walking better

He shouldn't be criticising you at this stage. You still have a long ol' way to go. In my experience it's highly unlikely a surgeon will make such a comment anyway. You're only 10 days out and won't see him for another 4 weeks yet - you'll be surprised at the difference between then and now, so don't sweat it! You might like to read the potted version of my recovery to see how little exercising I did! Knee recovery - UK style

Someone recommended a pusher trolley with upper and lower trays and this one thing has enabled me to look after myself.

Brrrrilliant idea!

I found the NHS hospital prescription only allowed for daytime use

I don't understand this - you mean you were only allowed to have pain meds in daylight hours?

So I thought I would use Tramadol at night to get me through the night - so 1 to 2 50 mg pills. Since I don't like codeine (immediate constipation) my GP said Tramadol was the only real alternative apart from morphine.

Codeine is rubbish for knees anyway while Tramadol is excellent, specially when taken in conjunction with paracetamol. You need to adopt a routine like I had which was 5-100mg Tramadol + 2 paracetamol 4-6hrly. Take the 100 just before bedtime and set the alarm to make sure you get the night time dose.

Still feeling drowsy from the sleeping pill so I'm giving up on them,

Quite right too - if you are taking your pain meds properly, you should have no need for sleeping pills.

 

[keith55]

He shouldn't be criticising you at this stage.

No he never has criticised me but he has said he will nag me if necessary and I got the impression he would like to see 90 degrees by July 11 which is the follow up appointment. One thing I learnt to my surprise my surgeon's deputy said that the physios were independent of the surgeons e.g. in deciding when a patient can go home. This may come across as prejudiced but the physios were all young people in their 20s whereas my surgeon is in his 50s and you can't beat experience. I would expect more working together between physios and surgeons than was in evidence. Also, I received no Occupational Therapy even though I had told them I was living on my own though I had filled in a long form giving chair and bed heights etc. Without this forum and its helpful suggestions about at home after care I'd be in a mess right now.

I found the NHS hospital prescription only allowed for daytime use I don't understand this - you mean you were only allowed to have pain meds in daylight hours?

What I mean here is that I used to take 1g paracetamol at roughly 8am, noon, 5pm, 9pm before the op. They added 3 X 400 mg Ibuprofen to be taken at meal times i.e. breakfast, lunch, dinner (I used to take Ibuprofen for flare ups). So what do I take at night? However, they didn't specify the times for paracetamol - I did what I was used to. My GP prescribed Tramadol at 1-2 50mg 4X per day as required. I am wary about Tramadol as I previously had a bad experience when taking it with amitriptyline: nasty visions on falling asleep, hearing voices and uncontrolled limb movements. I am getting the uncontrolled limb movements again now.
Well tonight I've got a paracetamol dose to come so I'll pack the Tramadol as well but a good night's sleep is what I really want: no sleep at all last night. Last night it wasn't pain that kept me awake so much as being too tired mentally as well as physically.

 

[kneeper]

Hope the tramadol at night helps with your night pain so you can sleep. But it is pretty normal for your sleep patterns to be off so don't worry if you wake up in the middle of the night & can't get right back to sleep.

The exercises you have sound like all the ones i had--but not all at once!

 

[keith55]

Having a quiet day but did venture out after lunch for a very brief and short walk <5 mins. 2 hrs later a short walk around the flat resulted in pain like direct contact between prosthetic in shin and my thigh bone. Horrid and turned hot of course.

 

[keith55]

I think the Tramadol is helping. Walking on two sticks just now to do a very brief physio session I bent my operated knee and it seemed to go into an unstable wobble: weak muscles? It was pretty distressing.

 

[fiberlady]

You are just a few days ahead of me. 23 May. I am using the walker, trying to keep the leg elevated and iced. I experience the leg jerks, now and when I had THR. It stopped on it's own after awhile, so I am hoping it will do the same again. It is a very strange sensation to say the least. I have a CPM machine that the dr ordered, it does help to loosen things up.

 

[keith55]

Hi all,

Staples came out yesterday. As has been said on this forum nothing to worry about it though with 24 I was glad when they were done. The nurse put a steri strip on a gap and a dry bandage to cover the incision. She said the bandage should last 5 days but leave about a week before you can get the incision wet e.g. in the shower. How will I know when it's safe to shower with the incision site uncovered?

I still have this feeling of instability on bending the operated knee as if it would bend more than I want suddenly without any control from me. Any ideas?

 

[keith55]

A question about cooling the knee once the incision/scar is exposed ie the bandage removed.
I only have a small freezer so I've been using dura soft sleeve with gel packs that go in the freezer:

https://www.healthandcare.co.uk/cold-therapy/dura-soft-knee-sleeve-knee-ice-pack-wrap.html

Now will I be able to use this once the knee is exposed or will I find the contact between the sleeve and the skin too uncomfortable. I'm also finding that the gel packs don't stay cold for so long in this warm weather so when they have lost some of their cold I lay them straight on the knee bandage - but they come out of the freezer feeling damp - danger of infection once the bandage is removed?

 

[keith55]

I've been getting stabbing deep pains in the kneecap, not unlike the patello-femoral arthritis pains I had. OS said he would use a button behind my kneecap. Any ideas?

 

[keith55]

Recalling "count your blessings", I ought to start with the positives

1. My standing tolerance has been good almost since leaving hospital (and before). So I can stand to wash and shave and do the washing up but not to chat!
2. The swelling has definitely gone down but knee is still swollen or you could say misshapen and the swelling feels rock hard! Will that really go away with icing and elevating?

So a question: I was expecting the knee to look like my other knee in time except with the addition of a scar and so with the kneecap pointing forwards rather than sideways as it did before because of the cartilage loss. Is that a reasonable expectation?

3. I've started to "single stick" indoors now. In fact I had to a few days ago after dropping one of my sticks coming back in from a walk outside. I was able to retrieve it with a picker upper but had to get back to the flat to get it. But in fact most of the time in the flat I use the trolley since I'm usually carrying stuff including gel packs to/from the freezer. Is that a bad thing?

4. I can see progress in bend in exercises, but the knees natural angle is still roughly 70 deg and not budging. By natural angle I mean the angle of bend before which I don't have to push to get more bend. I feel like Sisyphus pushing the boulder up to the top of the hill only to see it roll down again ad infinitum.

5. I'm less active than before op and walking very slowly so I've just realised I need to do some extra strenghthening exercises for both legs to avoid muscle atrophy. I managed my first unassisted straight leg raise yesterday in the operated leg . Before I was lifting it up with other foot then holding it - only 5 seconds though and painful in the knee.

 

[kneeper]

Yay on the straight leg raise! Isn't that a great milestone!
The swelling will go down with ice, elevation and TIME.