TKR New knee newbie

Aldergap

new member
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Feb 18, 2024
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Hello all, glad to find this forum and all the support and information it offers.

I’m just about 2 weeks post-op with a RTKR on 2/7. I was told at age 37 that both knees would need to be replaced, as I was bone on bone, but to wait as long as I could. Well, I waited until I was 48 for the right, and will have my left done sometime later this year.

These last 2 weeks have not been easy, and I extremely underestimated the pain that comes with this type of surgery. I have always had a pretty high pain tolerance, but I’m not 100% sure my nerve block took, as I woke up in excruciating pain. They kept me in the hospital 2 extra days to get it under control, and almost 2 weeks later, it has lessened but is still pretty intense at times.

I started outpatient PT a few days after surgery and it is going ok. I’m very clear with my therapist when something does not feel right or natural and they have respected that. I purchased a stretch strap for home use and it’s really helped me.

My right leg is now quite a bit longer than my left due to the spacing of the new joint, and it is causing a lot of sciatica pain in that leg. It’s very hard to stretch so while I’m icing my knee, I also use a heating pad on my back.

I have a pico dressing over my wound, and it is supposed to come off in the next day or so. Everyone at PT is so fascinated by it as they have never seen it before.

I have been icing and elevating my leg as much as possible, and I’m craving a good night sleep as the nighttime seems to be extra painful and so hard to find any good position, especially with the extra back pain.

I was also prescribed to use a cpm machine for 8 hours day (4x2 hour sessions), and it is not pleasant. I’ve tried to transition into doing more active stretching instead of using the machine.

I’ve had many moments where I’ve asked myself what have I done—it’s been a rough few weeks, and as someone who never stops moving and also does everything herself, it’s been so hard to slow down and ask for help.

Looking forward to learning more in this forum!
 
Welcome to BoneSmart!

At two weeks out, even without the sciatica, nighttimes are rough for folks with new knees - pain, inability to get comfortable, and insomnia are all present. It does get better over time - the line here is that the patience muscle is what needs the most exercise!

Before leaving you some links to helpful articles I want to say my whole ortho team was insistent that in the initial few post op weeks "Less is better." Rest, ice, elevate. Walk every hour. Don't do any counting of reps or sets - do some ankle movements and some quad sets throughout the day (the quad sets not for strengthening - just to help activate the quads); light heel slides only within comfort zone.

If you're over active, or if PT is over-exercising you, or pushing or stretching on a two week old knee, that will increase your pain and swelling at night.
 
Welcome to BoneSmart! You are in the very early stages of an average of a yearlong recovery. I will leave you our Recovery Articles that have helped tens of thousands of other knee replacements. We are here to help you through this journey the best we can. The very best thing for your knee right now is to rest, ice, and elevate. Exercises can come later. There is no rush to achieve ROM because it will come naturally as your swelling decreases. Your OS was able to bend your knee while checking for movements during your surgery, so it will be fine. It just takes time.

Each person is different as is their recovery. Most find that the Bonesmart approach works best for them, but others find that a more aggressive therapy helps them more. It's your recovery and your choice on how you recover. As you read more on other members' recovery threads, you’ll get a better perspective of what to expect. The following are our basic guidelines and should help get you started.

KNEE RECOVERY 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.

If you want to use something to assist with healing and scar management, BoneSmart recommends hypochlorous solution. Members in the US can purchase ACTIVE Antimicrobial Hydrogel through BoneSmart at a discount. Similar products should be available in the UK and other countries.

2. Control discomfort:
rest
ice
take your pain meds by prescription schedule (not when pain starts!)​

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

5. At week 4 and after you should follow this

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.
 
@mendogal thank you for the reply and the links! I’ve lurked for a few days and have read every article you’ve included! So much great information!
 
May I ask if you've tried sleeping in a recliner? Some of us slept fitfully in recliners when we couldn't sleep at all in bed.
At other times lying with both legs up on the three pillow stack or something like the Lounge Doctor (just make sure there's no direct pressure on the back of the knee).

If you want to consider some nonprescription remedies....

If you're lactose tolerant, a glass of warm milk! If you're not diabetic, a teeny bit of honey makes it even more comforting... plus milk is high in magnesium! Helps us relax!

If you aren't a milk drinker, or want an easier way to, an evening magnesium supplement has been very helpful for some members.

OTC diphenhydramine, an antihistamine also used as a sleep aid (Benadryl) because it makes you drowsy; it's also included in some cold, flu, etc "nighttime" combination meds.

Low dose melatonin, sustained release - not for long term use but I have used for a week at a time without ill effect. It should be taken an hour to hour and a half before going to bed, and during that time stay in a dimly lit area to allow this hormone to activate.

Valerian root - an herbal remedy, it can be taken in capsule form but that dose might be high compared to my preference, herbal "sleep" blends that include a smaller dose of valerian and make me pleasantly drowsy. Plus the other tea flavorings make it nice tasting! Celestial Seasonings and Traditional Medicinals sell teabags by the box. Their sleep blends without valerian have never ever made me sleepy.

Be aware: even benign herbals and supplements can interact with your routine or post op prescription meds, either making their effects weaker or stronger. If you're on meds you may want to check with your doctor or pharmacist, or even check online for interactions.
 
@mendogal I haven’t tried a recliner but I do have an adjustable bed and put the end way up, along with a pillow under my feet to take much of the bend out of my knee (though not locked out at all).

It’s like the nerves in my legs go crazy at night and it’s hard to settle down.
 
It’s like the nerves in my legs go crazy at night and it’s hard to settle down.
Unfortunately this is all a part of this recovery. Ice and elevate. Are you taking your pain medication around the clock as prescribed?
 
It’s like the nerves in my legs go crazy at night and it’s hard to settle down
Have you tried a Magnesium supplement? Something to consider...

Magnesium supports the following:
Bone health
Healthy blood sugar
Cardiovascular health
Muscle relaxation and nerves
Promotes healthy sleep (falling asleep and staying asleep)


An article on Magnesium -
https://bonesmart.org/forum/threads/magnesium-is-a-star.20301/

Wishing you relief and restorative rest. :)
 
I was prescribed 6 hours a day on the CPM both times but my average was probably 2 hours the first week and one after that. I realized on second knee that my leg doesn’t really fit that well on the machine - I have pretty short legs. I thought it was good early on to get the leg moving without effort but I don’t think it’s supposed to be terribly uncomfortable.
 
You're welcome! I hope that it works for you.
Like anything, it works for some, but not for all.
Have a great weekend!
@Aldergap
 
:hi: Happy One Month Anniversary, Aldergap!
How is recovery going for you these days?
Please let us know, we'd love to hear from you.
Until then...all the best!
@Aldergap
 

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