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TKR Nettie's knee - underestimated this surgery

nettie

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I had a TKR (Left) on August 17, 2020 and wow did I underestimate this. I thought I knew what I was getting into, but the recovery is much harder than I expected.

Things started out very rough on the day of surgery when the nerve block wore off much earlier than expected and I woke up in intense pain in the recovery room. After that, they were just chasing the pain and it took a long, long time to get it under control.

I am 4-5 weeks out from surgery and I am still taking narcotic pain medication regularly (every 6-7 hours), plus Tylenol in-between, which doesn't seem to do much. I feel anxious about still taking so much pain medication.

My doctor is expecting me to come off the pain meds and every time I try to take less, the pain and stiffness becomes unbearable.

Sleeping has been difficult but is slowly improving. Generally I cannot sleep more than 2 hours and then I wake up. Because the knee is so stiff I have to move around a bit, do some heel slides, and walk a little before going back to bed.

I am going to PT 2-3 times a week. It was painful the first couple of weeks - I cried every time I went to a PT appointment. But after reading the advice on BoneSmart, I talked to the therapist about the therapy being too intense and she was receptive to that and backed things down.

My ROM has been slowly improving. At 2 weeks I had gotten to 90 degrees, and since then have gone to a max of 103 degrees, which I think is OK for now.

I feel very fortunate that I am recovering pretty well, but the stiffness, pain, throbbing, lack of sleep, frustration, is taking a toll and I just didn't think it would be this bad. Reading the posts on this forum has been very helpful in making me feel like I am not alone, and that I will get better someday, but it will take a while. I had both hips replaced three months apart in 2013/2014 and I did get a good result from those surgeries, so I am holding out hope for the knee.

Thanks for listening and if this resonates with you, drop me a line. Sending good wishes and support to everyone recovering from surgery :)
 

Sara61

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@nettie :welome: to BoneSmart
Thank you for your surgery details a signature will be added for you.
Meanwhile I will leave you the BoneSmart guidelines xx

Knee Recovery: The Guidelines
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
6. Access these pages on the website
Oral And Intravenous Pain Medications
Wound Care In Hospital


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.
 

Sara61

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The early days are pretty tough for the most of us, as not many surgeons or doctors really tell you what to expect after, so the amount of pain, stiffness and swelling is quite alarming, and the lack of sleeping disturbing but the good news is that with time it does get better, just remember to take things easy, rest plenty, ice frequently and elevate your knee as much as you can.
At night if you have difficulty in sleeping use BoneSmart to chat/vent and laugh, there is always someone online somewhere around the world on BoneSmart ready to help you xxx
 

Zara

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I had PKR on September 17th. I had a rough couple of days after the nerve block wore off and pain meds didn't really help. I also like you could not sleep which is very frustrating. Today I actually slept and pain has declined. I tried a different combination of meds which seemed to help. Hand in there things will get better. All of the articles and advice on this forum is super helpful but I don't think anyone can truly be prepared for the recovery unless you already been through it.
 

springtigger

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I'm with you. I was doing great until about 4 weeks in. I think the PT was way too intense and now I'm in more pain, mostly cuz it's sharp, stabbing and I never know when it's coming. See my recovery post. I've been off pain pills and muscle relaxers but calling in Monday for refills. Tylenol/ibuprofen combo isn't cutting it. I, too, am gonna have PT dial it way back or stop altogether for a while. I do seem to have longer sleeps when on my side-especially when the side with all the pain is laying flat on the bed. One thing I've had to accept is this wasn't arthroscopic surgery and I'm not 20. Hang in there and good luck!
 
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nettie

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Tomorrow is 6 weeks since my TKR (left side). A week ago I was feeling hopeful because suddenly I regained strength in my leg and was able to do the leg lifts that previously were not possible.

However, the stiffness has not improved and ROM has not progressed (max so far has been 103 degrees).

I am taking hydromorphone 2x/day with Tramadol and 2 tylenol in-between and Celebrex, which barely controls the aching/pain/discomfort. My doctor wants to me to wean off the prescription meds, and I would love to be off of them as well, but when I cut back on the meds my discomfort and stiffness is almost intolerable. What other combinations of meds might help me get through this phase? Before surgery I took Diclofenac which seemed to help inflammation more than Celebrex, but I have read that Diclofenac might inhibit healing ?? I was told not to take Advil or Aleve, but I am not sure why.

I realize I need to discuss these issues with my doctor, but any advice from others who have been through the surgery and recovery is appreciated, realizing everyone is different and what works for one might not work for someone else. Nevertheless, I am still interested in what has worked for others. XO
 
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Jaycey

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@nettie 6 weeks out is still early days! Are you icing and elevating? Ice is a natural painkiller. If you ice for 45-60 minutes several times throughout the day I think you will see improvement.

Please don't worry about ROM. It will come with time and patience. This recovery can take up to a year or more.

What exercises are you doing now and how often? If you are doing any I would stop them until you get this pain under control.

Diclofenac, Advil and Aleve are all NSAIDs and not recommended for any extended period of use. Here's a link to some details on medication in our Pain Management area.
 

Celle

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I am taking hydromorphone 2x/day with Tramadol and 2 tylenol in-between and Celebrex, which barely controls the aching/pain/discomfort. My doctor wants to me to wean off the prescription meds, and I would love to be off of them as well, but when I cut back on the meds my discomfort and stiffness is almost intolerable. What other combinations of meds might help me get through this phase?
I think you might be able to help yourself in two ways.
First, cut back your activity and increase the amount of time you spend resting, icing and elevating your leg.
Second, try a different combination of Tylenol and Tramadol, to help you cut out the Hydromorphone.

First, cut back your activity a bit. A flexion of 103 is pretty good at 6 weeks post-op. It's probably no longer necessary to go to PT twice a week. Once should be enough. Also check your activity against the article on Activity progression for TKRs that is in the recovery guidelines left for you.
As well as that, make plenty of time for rest, ice and elevation.
It is normal to still feel stiffness at 6 weeks.

Second, to get off the Hydromorphine, try this combination of Tramadol and Tylenol. There are two charts, one for 4-hourly doses and one for 6-hourly doses .


You need to use Tylenol Extra Strength, with 500 mg in each tablet, not Tylenol Arthritis.

I see that you've had two hip replacements previously. Recovery from a TKR is harder than recovery from a THR, so try not to expect your recovery to be similar:
TKR or THR: which is more difficult surgery for recovery?
 
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nettie

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Thank you for helpful tips! I am elevating and icing regularly, but I will make sure to keep at it. I was hopeful there were some meds other than Tramadol and Tylenol to try, but maybe not. Will try to be patient and give my body time to heal on its own without pushing too much exercise while I have pain and swelling.
 

Starsfan22

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@nettie I had my second TKR the same week you did. I learned a few things during my first recovery.

Movement is good, too much is bad, really bad.

You will learn when exercise is too much, your knee will tell you , it will be loud and clear.

It's easy with the first knee to not know if your in pain from overdoing or it's just
healing. The moderators always advise us to back off and see if the knee responds, then slowly add exercise back in. Best advice ever.

No one prepares us for the constantcy of this recovery. It's like having a newborn, it just let's up. It does but way down the road.

We also don't learn from our mistakes easily. When your knee finally feels a little better you'll want to do too much, and you will, and yes you'll pay for it. Gotta laugh, and you'll get there too.

Hope this helps in some way.
 
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nettie

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We also don't learn from our mistakes easily. When your knee finally feels a little better you'll want to do too much, and you will, and yes you'll pay for it. Gotta laugh, and you'll get there too.
@Starsfan22 - Yes, I think this is what is happening. I start to feel a little better and then I expect I can do more, or I expect that I will continue to feel better, but Noooooo!! It doesn't work like that. Lol. Your message is very helpful, especially since you have the experience of your first TKR last year and now you are recovering from the second. I had both my hips replaced and I knew what to expect the second time around. But the TKR is entirely new to me and the slow recovery is creating a lot of anxiety. I will try to laugh more -- great advice. :)
 

WhenImOld

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Oh @nettie! I feel you. I'm now 15 weeks out from my RTKR. Those first few weeks I couldn't believe I did this to myself voluntarily. And every second was focused on my knee. Once it would feel moderately better, I simply had to get up and move, which would invariably put me right back on the couch for another round of pain, ice and self pity. At 15 weeks tho, I actually have periods where I don't think about it. The days that I over do it are fewer and further between and today I even went to the gym. It'll slowly get easier.
 
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nettie

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Those first few weeks I couldn't believe I did this to myself voluntarily.
@WhenImOld - Yup!! I definitely have felt this way. It's hard now to think back and compare the pain before the surgery to the pain I have now, which is more of a constant "ache" than a "pain." It's different, but I can't say yet that it's "better." I hear everyone saying that 6 weeks is still early in recovery, but I feel like I have been living every day in dog years, where 6 weeks feels more like 6 months. Good to hear that at 15 weeks there are times when you don't think about your knee. I think about my knee just about every minute of the day. On the positive side, I know that I am making progress. I am grateful for each day of healing. But I did underestimate this surgery. Maybe it's better I didn't quite understand in advance what I was getting into. Thank you for the validation and good luck in your continued healing :)
 

WhenImOld

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I hear everyone saying that 6 weeks is still early in recovery, but I feel like I have been living every day in dog years, where 6 weeks feels more like 6 months. Good to hear that at 15 weeks there are times when you don't think about your knee. I think about my knee just about every minute of the day. On the positive side, I know that I am making progress. I am grateful for each day of healing. But I did underestimate this surgery.
This was me for so long. I don't sit still well. :heehee: My mental progress check was always 'could I do this last week?' And then it became, 'when was the last time I thought about my knee?' We have very uneven gravel in our back yard so my daily test became watering. Each day I'd try another step or two, judging my strength and balance each time. Today I realized I'd watered the whole garden without even thinking about where to step or my balance at all. The only reason I thought about it was I need to step up from the patio into the house. But it is SO slow!:groan:
 
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nettie

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@WhenImOld - GOOD FOR YOU!! It must feel wonderful to do something like water your garden and not think about every step you are taking! Sounds like you are doing great and your patience is paying off! Keep going! I will do the same. Slow and steady wins the race.
 

babycatcher

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I had my LTKR on 12th August and resonate a lot with what you say. My ROM today was only 95 degrees but I’ve had three days now without painkillers. It sounds like you’re doing great but it’s a long slow but steady progress to a pain free mobile goal!
 

Dizzy

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We also don't learn from our mistakes easily. When your knee finally feels a little better you'll want to do too much, and you will, and yes you'll pay for it. Gotta laugh, and you'll get there too.
@Starsfan22 - Yes, I think this is what is happening. I start to feel a little better and then I expect I can do more, or I expect that I will continue to feel better, but Noooooo!! It doesn't work like that. Lol. Your message is very helpful, especially since you have the experience of your first TKR last year and now you are recovering from the second. I had both my hips replaced and I knew what to expect the second time around. But the TKR is entirely new to me and the slow recovery is creating a lot of anxiety. I will try to laugh more -- great advice. :)
This is so true! Went grocery shopping yesterday....paying for it today!!! :hairpulling:
 
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nettie

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@babycatcher - The prevailing wisdom on this forum is that your ROM will improve on its own time as your body heals, so try not to be discouraged or overly focused on a number because the healing will come and the ROM will improve along with it. But I totally understand the concern and frustration when you are in the midst of recovery. I am in the exact same boat as you, with our surgery dates only days apart. Three days without painkillers is amazing!!! Good for you! I still need to take something every 6 hours or so. I can't imagine going three days!! That's a wonderful sign that you're doing well.

I was feeling pretty good yesterday, but then I went to PT and may have overdone it there. The knee is sore and aching again. I am considering canceling my appointment scheduled for later this week, as so many on this forum have advised that PT may not be necessary and/or could set you back if the exercises are too aggressive. I am trying to listen to my body, but it sends me mixed messages about what I need to do.

Hang in there babycatcher!! I'll be thinking of you.
 

sistersinhim

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But after reading the advice on BoneSmart, I talked to the therapist about the therapy being too intense and she was receptive to that and backed things down.
Good for you and for your therapist. I believe the vast majority of PTs don't want to hurt us, at the time or afterward. Only a very few believe that pain = gain, which is definitely not true after joint replacement.
I have read that Diclofenac might inhibit healing ??
I broke my foot and ankle when my knee was less than a year out. My ankle doctor told me to come off of the diclofenac because it slows down bone healing. I picked up some bone and tissue repair from Amazon to help with my healing. Whether it did or not, who knows, but I took it anyway.
I am elevating and icing regularly, but I will make sure to keep at it.
I iced and elevated the whole time I was sitting or laying down for the first 3-4 months. This helps with the pain and swelling and lowering the need for the pain meds.
 

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