TKR My Knee Odyssey<

[SusieShoes]

How long would you all (all forum users who read this) consider the "early weeks of recovery" to be?

Well, seeing as you asked... I would call the first 12 weeks "early recovery." The first six weeks are prioritized to your body, because your body takes about that long (more or less, bodies being different from person to person) to complete the first stages of physical recovery: replace lost blood, get a good start on knitting damaged tissue together, make new bone, seal the skin, and do all that it needs to do inside the knee capsule --which was really traumatized. Six weeks is where lots of people start to feel better, but...

They're not there yet. They're still healing. Yes, the major work is in place, but just like with building a skyscraper, just because you can see there's a building taking shape, that doesn't mean it's ready for habitation. Lots of stuff isn't in working order yet. Same with the body. It's still building, repairing, and pulling back some of the scaffolding it put up to do the initial part of the job: swelling, for instance. Getting rid of swelling is what allows the new stuff and old stuff (the things not damaged by the surgery) to start working together as a team. And that part takes about... six more weeks.

So most people (but not all people) by 12 weeks are doing pretty well. They have lots less swelling, so lots less pain. They are doing more, and feeling better. But they're not recovered yet. They're entering a transitional phase of recovery. For my own recovery, I called it consolidation, but I don't think there's an "official" term for it. It's the phase where I noticed I was consolidating my gains: my energy was returning (if I didn't do too much); my brain fog was clearing; I could sit for longer periods (but not for too long); I could stand for a half-hour (yay!); I could walk for a longer periods without suffering consequences (but I still had to listen to my knee to make sure it wasn't for too long); I could sleep more normally (thank the Lord!); and I needed much less pain control. In fact, at the end of this period, I needed no pain control.

That period lasted another three months. At six months, then, is where yes, a person has left behind the "early days." They've entered late recovery, but I'd say even late recovery has two phases, because I notice a big difference between six months and ten months! I haven't made it to my full year yet, so I'll hold off any pronouncements about at what point I felt fully recovered. I will say I felt quite recovered after the six month period, and more and more as time went on.

Patience is difficult. I have to admit looking back is WAY easier than being in the middle of it.

 

[ebungalow]

This was a SUPER helpful breakdown of a possible recovery timeline! Thanks SusieShoes.

 

[Jockette]

That’s right, you have completed 11 of 52 weeks. (give or take)

Most of us were not prepared for how long this recovery takes. Some take longer and some less, but it’s still a long time. We all want it to hurry up.

 

[Steve4kids]

I get all messed up with threads posts and dates reply to posts that are years old. I guess I need to figure it out.

I read your journey, I think maybe it was years ago, but maybe not. I felt compelled to send this to you.

I’ve been chopped up so much I honestly don’t know how many times. Gosh you're a trooper. You are trying to do everything right. People don’t fit into schedules and time tables. We heal and feel pain differently for many reasons. It’s been a very short time since you traumatic knee surgery. They hacked it with power tools screws and hammers. Your healing and it will take some time , YOUR TIME NOW. I bet your Dr and therapist have not had a TKR. Time to break away now.

DONT LOOK FOR THEM TO CARE THAT MUCH ABOUT YOUR PAIN. THEY DON'T.

They see patients all day long. You are not special. If it hurts just tell him you need more, demand it , it is Patient Rights. You're right that with all the opioid stuff they won’t risk a letter from the DEA. Ask for a referral to a Pain Management if you have PPO find one yourself. But be careful and use them wisely

You are doing therapy all this time, for months, like they wanted you to. Stop. They cut your pain medicine when you are hurting. So listen to your body. Do this bone Mantra thing, ice, elevate and da da da. All that therapy keeps it inflamed and hurting. Sounds like you have done enough to stimulate those muscles. Now let that swelling and healing start. They are not telling you this because they don’t know, crazy right. You'd think they would.

These Bonesmart folks will just keep telling you this until you are sick of it. They are right.
Gosh, such a short time really. Look at these other people on this site. You hear anyone saying 3 months I’m walking great and now I’m skiing after 9? They are few and far between or just plane none. You've got to ice and rest now. It takes time, ice for a year. Don’t make that knee angry

You are hyper aware of your knee. You can’t break it, it’s stronger than your bone. Do normal things: step on it, walk. Start going up a stair or step and lead with it. It’s not going to buckle or break. It’s successful for you. It’s hard at first. You can’t injure it
You will learn to trust it, stay cozy.

Flow, don't stress this will pass. Don’t obsessively think about it or think it’s bad , don’t fall too much into looking for answers here anymore. You've got your answers, you're doing great, fear not.

Get better and encourage others on this site. That’s what it’s for even if you have to slide out of bed or crawl, do it. I Broke my ankle soon after my TKR. I was in bed for a year or more. I squirmed on the floor like a worm to go to the bathroom so much pain. My ankle and knee at the same time. My ankle hurt so bad I forgot about my knee and it got better, it doesn’t hurt and it feels greaaat. My ankle really hurts though.

You've got a comfortable place, you're lucky, enjoy it, you will heal.

On pain, yeah sometimes it hurts, use those pain pills wisely. Try Googling ibuprofen and Tylenol. They just did a study that 500 Ibuprofen with 250 Tylenol has more pain relief then hydrocodone or oxycodone. Wow, wish I had seen that sooner. Look it up.
(Oops sorry Josephine starting to ramble.)
I have to slow down because I get so worked up they will edit this.

Just hang in there Dear One. Let not your heart be troubled, this too shall pass.
I will check in maybe in a few days. You're doing great.

 

[Murry]

Thanks for the encouragement, Steve4Kids! Yeah, I know my impatience is nearly as big of a problem as my knee pain . Been called out here several times already for it, and each is well-deserved, but I’ve gotta say that this is my 12th orthopedic surgery (5 other knee surgeries, 3 hip, 3 shoulder), all due, docs say, to my many years of playing and teaching hardcourt tennis - and this knee replacement has definitely has been the most painful and difficult to rehab.

As a former athlete, my brain was wired to follow this mantra: If you want to improve, you work harder. I did that through decades of sports competition, until my poor old body said, “Enough!” Even through my parade of surgeries, I pretty much recovered, after a short period of inactivity, through hard work.

So, that’s why this is a huge mental, as well as physical, struggle. It goes against my very nature. My physical therapist friend was over at our house last evening for a social visit and even she, trained to push post-op patients, told me in no uncertain terms that I had to change my approach and thinking and try resting it. In my mind I WAS resting it, as 20 minutes at a turtle’s pace on a treadmill and 15 minutes with no resistance on an exercise bike feels more like rest than exercise to my brain. But I am determined to try to “do better” now, which ironically means to “do less,” so the message has been heard and received.

Just FYI: I can’t take anti-inflammatory meds like ibuprofen or Aleve because they quickly destroy the lining of my stomach, so my pain control options are limited. Otherwise, I would definitely be trying to take ibuprofen and acetaminophen. But thanks for the suggestion and for taking time to encourage me.

I look forward to the day when all my posts on here will just be encouragements from the “other side” of this journey to those who are where I currently am.

Question for all you Bonesmart folks: I keep reading about how while icing is great for inflammation, if you do it for longer than 20-30 minutes at a time, it actually does more harm than good because it reduces blood flow, and hence hinders the healing process.

So they sent me home from the hospital (11weeks ago) with one of those great continuous flow ice/cryotherapy machines ... which do pretty much the opposite of 20-minute, on-again, off-again icing.

I’ve used these machines following other surgeries, too, and they’ve been very helpful. I put mine away after about 4 weeks post-op and have just been using ice packs a few times a day since, but I'm thinking about getting it out again, since inflammation and pain continue for me. But I’m unsure because of the conflicting info about using ice/cold therapy. Any words of wisdom out there?

 

[Celle]

As a former athlete, my brain was wired to follow this mantra: If you want to improve, you work harder. I did that through decades of sports competition, until my poor old body said, “Enough!” Even through my parade of surgeries, I pretty much recovered, after a short period of inactivity, through hard work.

Recovering from a planned knee replacement is a whole new ball game. Work hard to recover may work after athletic injuries, but it is completely the wrong approach for recovery from a TKR.
Your knee needs to rest, so it can heal.

My surgeon doesn't allow any PT at all for the first month after a knee replacement. He says your knee needs that time, to start on its journey of healing. For that month, we rest, ice and elevate our leg, and walk around the house.
After that month, we just go to PT once every 2 weeks, where we are shown a few new exercises to do at home.
His patients all do well and achieve good ROM, as I did, and he hasn't had to do a manipulation to help with ROM for the past 4 years, because nobody developed adhesions. I think that speaks for itself.

I can’t take anti-inflammatory meds like ibuprofen or Aleve because they quickly destroy the lining of my stomach, so my pain control options are limited. Otherwise, I would definitely be trying to take ibuprofen and acetaminophen.

Be glad you can't take NSAIDs. They're far more dangerous than the manufacturers would have us believe.
They're also not very good pain killers.

Acetaminophen (Tylenol/Paracetamol) is not an NSAID. It is a good painkiller, if taken in the correct, therapeutic dose, which is 1,000 mg 4-6 hourly, to a total of no more than 4,000 mg in 24 hours.

I keep reading about how while icing is great for inflammation, if you do it for longer than 20-30 minutes at a time, it actually does more harm than good because it reduces blood flow, and hence hinders the healing process. So they sent me home from the hospital (11weeks ago) with one of those great continuous flow ice/cryotherapy machines ... which do pretty much the opposite of 20-minute, on-again, off-again icing. I’ve used these machines following other surgeries, too, and they’ve been very helpful. I put mine away after about 4 weeks post-op and have just been using ice packs a few times a day since, but I'm thinking about getting it out again, since inflammation and pain continue for me. But I’m unsure because of the conflicting info about using ice/cold therapy. Any words of wisdom out there?

Once again, it's a different story after a knee replacement. You can ice continuously and do no harm, as long as you have some material between your skin and the icing medium, to prevent frost bite.
To get any appreciable benefit, you need to ice for at least 45 minutes.

I used frozen gel packs, one at the front and one at the back of my knee. I would go to sleep with them on and replace them with fresh ones when I woke during the night.

 

[Jockette]

I have a friend who will be having both knees replaced in the hopefully near future. She has had many knee surgeries and told me she’s never gone to PT. ( @sistersinhim , I thought you’d like that! ).

Anyway, she’s not at all worried about the replacements because she’s had so many previous surgeries. I’m afraid she might find the same you did in that this one is very different.

 

[Josephine]

I can’t take anti-inflammatory meds like ibuprofen or Aleve because they quickly destroy the lining of my stomach

Pleased to hear it! You might like to read this to enforce your reasons Medications: acetaminophen (Tylenol, paracetamol) and NSAIDs, differences and dangers

As a former athlete, my brain was wired to follow this mantra: If you want to improve, you work harder.

And that would be entirely correct but you're not dealing with athletics now - you're dealing with surgical recovery which is, as Celle said, a whole other ball game! NO comparison whatsoever.

I keep reading about how while icing is great for inflammation, if you do it for longer than 20-30 minutes at a time, it actually does more harm than good because it reduces blood flow, and hence hinders the healing process.

Again, this is a different kettle of fish than the usual situations were you ice, like twisted ankles or such. This is a MAJOR surgical assault which has impacted upon your knee and your leg about 12" above and another 12" below. Quite different.

Earlier in this thread, I asked a question but you never responded to it. So here it is again!
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?

 

[kneeper]

One of the toughest lessons of TKR recovery is that you aren't in charge of it. So much of it is just letting the body heal itself.
It wouldn't be a bad idea to try the ice machine again if you like it.

 

[Murry]

Hi @Josephine -- Thanks for your response from a few weeks ago. I'm sorry it's taken me so long to get back to you. When I first joined this forum, I actually did wholeheartedly agree to allow you to ask me any questions you might want to ask, but I never did get those questions from you. It's okay and I don't mean to sound defensive -- I know you are helping many, many people through this forum and it's completely understandable that that particular post from me escaped your notice. Regardless, I'm definitely giving you permission again, so fire away.

Just a quick update on my knee situation, in case that helps you frame the questions you'd like to ask me ...
I'm 15½ weeks post-op and continuing to have a good bit of pain and "hotness" in my knee. My OS did xrays at my last visit, which was just a week ago, and he said those looked fine.

I've been mostly behaving myself -- spending a lot of time with my knee elevated and with my "ice machine" on it. I'm using the exercise bike for about 10 minutes most days, just to keep my knee loosened up.

My OS is concerned that my ROM isn't as good as he'd like (it was 108 degrees at my last visit) -- he wants it to be at 120 when he sees me again in about 3 months.

I still cannot walk normally or for very long, and standing still is also pretty uncomfortable after a few minutes. I find that I begin to change my gait after my knee gets irritated, which then causes pain in my hip and lower back.

I'm currently taking Tramadol (50 mg) -- sometimes 1 pill every six hours, sometimes 2 if I know I'm going to be out and about. (My prescription is for 2 pills every six hours, so I'm staying within those parameters.)

I know I'm not supposed to compare myself to others, but I keep running into folks who had TKR about the same time I did and who are playing golf, exercising and not taking any pain meds at all. And I know this recovery is a marathon and not a sprint, but it's discouraging to still have so much pain and not be able to walk more than 1/4 of a mile or have to use so many "pain points" to cook a meal.

And I'm concerned about the heat I continuously feel coming from my knee (even though my doctor doesn't seem concerned).

Thanks for letting me bend your ear. If you have questions for me I haven't addressed here, please just ask.

 

[kneeper]

Those golfers are the exception. Even when I was off the prescription pain meds I took Tylenol. The knee can stay warm for months.

 

[Josephine]

@Murray 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.

 

[Murry]

Here are my replies to your questions:

1) pain: from 2 when sitting with ice on it and taking Tramadol to 7-8 when meds wear off and after a busy day when I’m on my feet a lot

2) medication: Tramadol 50 mg - 2 every 6 hours; I can get by on one pill at night ot when I’m not active

3) swelling: moderate

4) ROM: last checked a month ago and it was 108 degrees- feel like it’s improved slightly since then (maybe 115 degrees?)

5) Icing? Yes - use ice machine most days, 3-6 hours

6) Elevating? Yes, 3-6 hours per day; also, my legs are elevated all night because we have an adjustable bed

7) Activity level: cooking, doing occasional grocery shopping and errands, driving, church and social activities

8) Exercise (all at home - no formal PT now):
recumbent exercise bike: 15 minutes, 5-6 days per week
quad sets: 20 reps, 3-4 days per week
short walks: maybe 1/4 mile, 4-5 days per week

 

[Josephine]

all at home - no formal PT now

Before I get to your responses, can you please detail what you were doing the first 6 weeks after surgery?

 

[Murry]

I was going to PT 3 times per week, where I would do heel slides (the PT would gently “assist” here to increase ROM) is , quad sets with the e-stem to aid contraction, and some manual therapy to work out muscle knots on my quadriceps and hamstrings. I also had an CPM machine I would use for approximately 4 hours per day at home. I kept ice on my knee most of time I was at home, even throughout the night.

 

[Josephine]

1) pain: from 2 when sitting with ice on it and taking Tramadol to 7-8 when meds wear off and after a busy day when I’m on my feet a lot

Ouch!

2) medication: Tramadol 50 mg - 2 every 6 hours; I can get by on one pill at night when I’m not active

I suggest you also take Tylenol 1,000mg with each dose as the two enhance each other very nicely.

3) swelling: moderate

And did you factor this in to your pain score? It's worth at least another 3 points.

4) ROM: last checked a month ago and it was 108 degrees- feel like it’s improved slightly since then (maybe 115 degrees?)

Okay

5) Icing? Yes - use ice machine most days, 3-6 hours. I kept ice on my knee most of time I was at home, even throughout the night.

Good - very good.

6) Elevating? Yes, 3-6 hours per day; also, my legs are elevated all night because we have an adjustable bed

okay

7) Activity level: cooking, doing occasional grocery shopping and errands, driving, church and social activities

okay

but why are you still doing these? You're 18 weeks out, for pity's sake! It's time you stopped it all
recumbent exercise bike: 15 minutes, 5-6 days per week - okay
quad sets: 20 reps, 3-4 days per week - stop these now
short walks: maybe 1/4 mile, 4-5 days per week - good but do make sure your whole walk is ¼ mile, not there ¼ and ¼ back!

PT 3 times per week - I suggest you stop these altogether
heel slides (the PT would gently “assist” here to increase ROM) - 'assisting' is not permitted. The only number that counts is that which you can achieve on your own
quad sets with the e-stem to aid contraction
manual therapy to work out muscle knots on my quadriceps and hamstrings.
CPM machine I would use for approximately 4 hours per day at home

At 18 weeks you shouldn't need to be doing exercises of any kind. You never told me what your extension is but your flexion is fine though your moderate swelling could indicate a problem as indicated by your ROM (that's flexion AND extension, bwt). In order to improve your ROM, you need to stop the exercises where I have indicated and rest and elevate a lot more.

 

[Murry]

Thanks so much, Josephine. I appreciate the help you’re giving me and so many others through this site.

 

[Murry]

Any opinions out there about whether walking on a treadmill is ok? I'm about 18 weeks out but am still having a hard time walking "normally." I also continue to have enough pain to require me to take Tramadol (50 mg) every 6-8 hours and I don't want to make that worse, but all this inactivity is driving me bonkers. We live in the country where all the convenient outside walking surfaces are pretty uneven (trails in the woods) or unstable (gravel) so it seems like the treadmill would be a good option for working on re-establishing a more normal gait and improving my muscle tone. (My quadriceps muscle was pretty atrophied prior to my TKR due to years of hip surgeries and compensating.) Thoughts?

 

[SusieShoes]

A treadmill is better than the kind of outside walking you describe. A little bit of uneven walking is one thing, even good for rehabbing a new knee, but trails in the woods and unstable pavements are a bit much early on and asking for mishaps. So treadmill it is!

Walking is such an excellent exercise for a new knee. It's what knees are designed to do. Start out with short distances/times/speeds and work up gradually to what your knee tells you is all right. If your knee swells and is painful, that's when you cut back for a bit before increasing distance again.

I rehabbed my knee using walking, mostly, and it was a gradual process as my legs grew stronger and I regained stamina. Another good exercise for a new knee is a stationary bike.

 

[Mutti3]

I used a treadmill , but didn’t like the unnatural ambulation. I felt I was pulled if walked to fast, and dragged if I walked too slow. Out door walking there is control with your pace,and a more natural gait. Walking on uneven surfaces help strengthen the knee( slight side to Side motion). Try treadmill it might be a natural fit for you.