TKR My new left knee

[Cinders2023]

I had my ltkr on January 3, 2023. I found this forum a couple weeks prior and have been reading, but not posting until today. I thought I had done enough research to have the knowledge to get through my recovery with little to no problem. Boy, was I fooling myself. at 4 weeks, 2 days I still find that spending even small amounts of time on my feet cause my knee to swell up. I am spending most of my days icing and elevating still. My surgeon is a 2-3 hr car ride away and my 2 week follow up was a miserable affair that took 3-4 days to recover from. I have my next appointment in 2 weeks and was wondering if anyone had advice for minimizing the agony of the car ride? I rode in the back seat last time with ice pack and leg elevated best I could. I was so stiff and sore I could barely move at my dr visit. Hoping maybe just being further along will be helpful. Any other super-swellers out there? How many more weeks of constant battle over swelling can I expect? BTW I am still using a walker, trying to switch to a cane the last couple of days, but don’t trust that new knee to hold me up yet.

 

[LemonCheesecake]

Cinder, I used my walker for six weeks post op. Sorry to hear of your long car ride to your doctor. It is good to be cautious regarding falling. At nine weeks post op, I'm happy the swelling has gone down quite a bit. I wear compression knee highs because I don't want the little uphill capillaries to overwork. Things will gradually improve.

 

[WillB]

Cinders, my LTKR was on the 12th and the first week or two was horrible. Pain, swelling, sleep deprevation, you name it. I put controlling my swelling at the too of the list so I was very cautious not to overdue any physical therapy! Now at 22 days I’m finally beginning to feel better and hopeful. Hang in there and take ownership of your recovery. Don’t be afraid to advocate for YOU. This to will pass

 

[Layla]

Hello and Welcome! Thanks for joining us.
I am sorry you're struggling with the swelling. It certainly isn't uncommon to experience swelling at this point, it can go on for months, but will normally gradually ease. Aggressive PT can cause an increase as can too much, or too little activity. It is all about finding what works best for you.

Continue icing and elevating as often as you're able. Aside from sitting in the back seat, icing and elevating as best you can on your next trip to the OS, I'd advise you plan extra time for the trip so you're able to stop every hour to get out of the car and stretch and walk around a bit.

I will leave the Recovery Guidelines with best wishes for your comfort as you continue healing. Please stay in touch and let us know how you are doing.

KNEE RECOVERY GUIDELINES

As you begin healing, please keep in mind that each recovery is unique. While the BoneSmart philosophy successfully works for many, there will be exceptions. Between the recommendations found here, your surgeon's recovery protocol and any physical therapy you may engage in, the key is to find what works best for you.

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​

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 a 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 history before providing advice.

 

[JusticeRider]

Any other super-swellers out there? How many more weeks of constant battle over swelling can I expect?

Hi @Cinders2023 ! Fellow super-sweller here! My pt said sometime around week 6 “your knee just really likes to swell!” and that definitely has been its tendency. It made for a very rough first few months.

You’re still really early on, so you may just be having a very normal amount of swelling. And with any luck, yours will not be as persistent as mine has been. But for me, it wasn’t until almost 4 months out that I finally felt like the swelling was really under control. It still pops up every once in a while, but nothing like it was.

I really sympathize with your misery riding in the car too. That has been one of my knee’s least favorite activities. Sitting in back, icing, and elevating are all good, but like Layla said, stopping to get out and stretch and walk along the way will really help too.

Also, as @WillB said, try to avoid any painful pt, or any exercise or activity that causes your knee to swell. At least for a while, the knee is boss.

 

[Cinders2023]

Thank you for the reply’s. @JusticeRider, I have been following your journey with interest too!
At my first post surgery follow up with the PA for my OS I was discussing my distress with pain management (they let me run out of oxy 1 week post op before granting a refill) and my swelling was so bad, my in home PT had advised me to stop doing exercises and just walk. The PA put me on my back, put his thumb in the back of my knee and bent it as far as he could until I was in tears, asking him to please NOT do that again. I vowed nobody would be touching my knee without my consent again. That car ride home was miserable and took about 5 days to get back to where I was before the visit pain wise.

 

[benne68]

Happy one-month knee-versary!

The PA put me on my back, put his thumb in the back of my knee and bent it as far as he could until I was in tears, asking him to please NOT do that again. I vowed nobody would be touching my knee without my consent again.

I am so sorry this happened to you! I can't imagine why he would do that, but your reaction is appropriate. YOU are in control and you have the right to say "NO" to anything that causes pain.

It sounds like you found a good PT if he told you to stop the exercises and just walk. Many of our members skipped PT entirely and relied on walking and ADLs (activities of daily living) for their recoveries.

 

[beachy]

Your PA, physicians assistant, did that????
I'm so sorry that happened to you. Do you know why he did that?
My tkr was a week after yours. I definitely have swelling when I'm up for too long. I believe ice and elevation will be our way of life for awhile. Can you use nsaids (advil, motrin) with your pain meds? They help with inflammation, but not everyone can tolerate them.

 

[JusticeRider]

Cinders, that’s awful! I’m so sorry that happened to you. That PA never should have done that to you! I had a similar experience before my last hip surgery, when both my knee and hip were in a lot of pain. A resident checked my ROM and pushed my leg up until I screamed in pain. It took weeks to recover from that, I was so angry. It’s so hard to be in pain and vulnerable, we really have to look out for ourselves. If your knee is anything like mine, anything that upsets it makes it swell, and anytime it swells it delays healing. Ugh. I think your home pt has the right idea with backing off and just walking. Just listen to that knee and trust your own instincts. Nobody knows your body like you do!

 

[Cinders2023]

Happy one-month knee-versary!

Thanks, one down!

Your PA, physicians assistant, did that????

Yep. I could hardly believe it.

Today I made two 7-8 minute walks out in our long driveway using a cane and holding my husband’s hand. I’m still mostly using the walker in the house, but I want to transition to the cane and am trying to work up to it a little each day. I will have my first outside PT session on Monday. I let them know I wasn’t having any man-handling of my knee. My plan is for some gentle guidance on building my strength back to walk better. I have limped most of the last 35 years thanks to a bad car accident and the subsequent arthritis in my knee. I need to learn to walk normal all over again. Every day is an adventure!

 

[Jockette]

The PA put me on my back, put his thumb in the back of my knee and bent it as far as he could until I was in tears, asking him to please NOT do that again. I vowed nobody would be touching my knee without my consent again.

I hope you will tell your surgeon about this. It was uncalled for!

I got tired of my surgeon hurting me in my checkups. He didn’t do any sudden pushes like your PA did, but he would keep moving my leg into a painful bend to get the best ROM number he could. I finally stopped getting up on the table and giving him easy access to my leg. Next time you go in, consider doing the same.

My plan is for some gentle guidance on building my strength back to walk better. I have limped most of the last 35 years thanks to a bad car accident and the subsequent arthritis in my knee. I need to learn to walk normal all over again.

Since you have limped for a long time, keep the emphasis on “gentle.“ Some PTs was us to recover right now, regardless of our history. It will take time and patience and gentle rehab, but you’ll get there.

 

[Layla]

I am really sorry to read of the pain you endured during your PT session and how it set you back.

Great news on the two 7-8 minute walks on your driveway today. I’m sorry to read of the car accident and subsequent arthritis and limp. Thankfully you recognize that losing the limp and walking unassisted may take a bit longer due to your pre-op condition, but you seem to have the patience and willingness to take the slow and steady approach. You’re doing great and you will get there!
Happy One Month Anniversary, Cinders!
@Cinders2023

 

[Cinders2023]

Happy One Month Anniversary, Cinders!

Thanks! I can’t wait to see where I am in another month.

 

[EalingGran]

Can you use nsaids (advil, motrin) with your pain meds? They help with inflammation, but not everyone can tolerate them

I agree with @beachy NSAIDS do work if you can tolerate them. You can take stomach pills as well like omeprazole
I take omeprazole as soon as I wake and then naproxen with food an hour later.
The other thing with NSAIDS they are more anti inflammatory than directly painkiller. It often takes a week or two for them to work and I think a lot of people give up too soon on them.

 

[Cinders2023]

I agree with @beachy NSAIDS do work if you can tolerate them. You can take stomach pills as well like omeprazole

I was taking meloxicam before surgery and prescribed it after. I decided to try naproxen sodium instead just to see if it worked any better. I had discontinued my omeprazole when I stopped the aspirin, but think I’m going to add that back until I can cut out the nsaids. Today will be day 2 of the naproxen and my first outside PT. Pain has been manageable without oxy, just fighting swelling after activity, and stiffness after resting.

 

[beachy]

Ice,ice and ice some more after activity, while resting. Its a pain to always have the ice packs or ice machine, but it works. And as cold as its been I really force myself to ice my knee. And elevate while icing.
Hope your PT goes well!

 

[Cinders2023]

I had my first outside PT yesterday afternoon. Only at 10 minute drive so I sat in the front seat. I’ve been using my cane for outside walking, but took the walker as a backup. By the time I filled out the paperwork and waited 20 minutes sitting in a chair my knee was not too happy. They had to bring me a walker to get from lobby to therapy area.
We talked about what I had been doing over the last 5 weeks and I let him know about my past experience with the PA that I would not be repeating. He told me he had been doing this for 20 years and I was going to have to trust him. I said “well, it’s my first TKR and it might just take me a little time!” We did some measurements, tested my leg strength, and then some exercises. He did gently push my leg, but stopped when I moved from discomfort to pain. My only uneasy feeling is that he insisted that there was only so much time to get my ROM back and that I need to push through the swelling or loose it forever. I countered that I felt pushing to bend while swollen didn’t seen very productive if it only made the swelling worse. He did say that my knee was pretty warm and to ask the dr about it next week. He said if I wait for the swelling to go down, it may take months and then it would be too late. I think he thought I have been sitting with my leg up 24-7 and waiting to feel better.
I have 6 sessions approved by insurance and we moved my appointments to mid morning when I am feeling my best. I don’t feel bad this morning so I’m keeping an open mind.
Any member further along than me have heat and swelling in the knee beyond the first month? I thought I had read it could still be present a few months after surgery. I googled signs of joint infection and all that did was make me anxious.

 

[sistersinhim]

Any member further along than me have heat and swelling in the knee beyond the first month? I thought I had read it could still be present a few months after surgery.

Heat and swelling can go on for many, many months. Healing promotes heat and is a sign that we are healing. As long as your knee is hot and red, it's usually just fine. My knee was warmer than my old knee for at least 9 months. The more I did, the more it would swell and be warm.

He said if I wait for the swelling to go down, it may take months and then it would be too late. I think he thought I have been sitting with my leg up 24-7 and waiting to feel better.

It is never too late. Why do these people want to preach this false information? All it does is stress patients and cause them to overwork their knees, which causes more swelling. Take a look at these previous members:

One of our members, Bertschb, kept a record of his ROM process. He agreed for us to post it for those of you that are afraid you're stuck. The key is to have patience! Bertschb says:

I'm 12 months out from my surgery and have some advice based on my experience:
Don't worry about your ROM Be patient - VERY patient!!!

Here is my ROM history (more or less):
1 month - 60 degrees
2 months - 80 degrees
3 months - 85 degrees
4 months - 90 degrees
5 months - 90 degrees
6 months - 110 degrees
7 months - 120 degrees
8 months - 125 degrees
9 months - 130 degrees
10 months - 135 degrees
11 months - 140 degrees
12 months - 140 degrees

I spent waaaaay too much time worrying about ROM. I thought I'd be riding my bike a couple months after surgery but it took SIX months! Looking back on my surgery, if I knew then what I know now, I wouldn't have worried about ROM.

This is what another one of our members wrote about the slow development of her ROM. (Thank you, @Campervan) As you can see, her flexion continued to improve for a long time.

"I had a slow recovery. Here's my flex measurements at various points:

92 - 8 weeks post op
105 - 10 weeks
107 - 5 months
110 - 6 months
112 - 7 months
116 - 9 months
119 - 11 months
118 - 1 yr
120 - 1yr 2 months
125 - 1 yr 8 months
128 – 6 years "

 

[EalingGran]

Any member further along than me have heat and swelling in the knee beyond the first month?

At 14 weeks my knee is still slightly warmer and more swollen by nighttime than the other side. If I walk a lot ( over 10000 steps or do a lot if stairs) then it can be more definitely warm and a bit sore by bed time

 

[trinket]

Any member further along than me have heat and swelling in the knee beyond the first month? I thought I had read it could still be present a few months after surgery. I googled signs of joint infection and all that did was make me anxious.

At eight weeks I am still swollen and my knee area is very warm. My OS assures me this is perfectly normal, and I may have swelling for up to a year. Hopefully, it will improve before a year because my knee still feels tight. I feel like the knee joint is moving just fine and I have very good ROM, but the surrounding tissue is tight. I feel as though my ADL's are as they were before surgery, but with less intensity. I'm still thinking about my knee with every move I make.