TKR 2 second knee now done. ( 3.5m apart)

Dkm

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Hello everyone. I had my TKA back on November 14th 2018. Finally found BoneSmart a few days ago, wish I had found it a lot sooner.

Thank you to all those who was posted and replied to everybody and for all the articles and information. Simply excellent and useful.

I was having all the usual struggles in the last 4 weeks. However, my progress has been great. I left the hospital within a day walking with a walker with the range of 83. Had 90 at the 2 week mark.

Had the usual ups and downs that everyone seems to describe. I now have the range of 100 unaided and 110 with help. My extension is very close to a zero. I never had a really big problem all the way along. Over the last weekend I have a concerning change. My range on a heel slide is still good. However, I have developed extreme stiffness and some pain on the outer side of my knee (feels like band up and down). It feels like an IT band issue.

I also have new tightness just below the kneecap. Just a note, the kneecap is totally my own, just cleaned up. The stiffness does not come into play on a heel slide much but is extremely limiting when I am standing and try to lift my leg behind me like you would for a quad stretch when you would grab your ankle or to lift the leg to take a regular walking step.

I am wondering if I should be calling my OS about this change. It has persisted for several days now. My PT thought maybe we over did it on Friday and we went really light on Monday and I have been very nice to my knee. I'm doing all the icing and elevating as I should. However it feels like something is really getting stuck and I am concerned. It seems to be worsening.

I also now swell more easily and improve it with more difficulty than before. Any insight would be most appreciated as I went from actually being comfortable walking to the bathroom unaided to now feeling the need for my Walker again.

I have read all of the articles that the moderators typically send out as well as many threads and replies. If this has happened because perhaps something was overdone at PT or by me at home, how long can I expect before it calms down? I feel like I am doing everything to calm it down and it seems to be worsening.

One other note, I am on Percocet mostly at night but we added Advil a week ago. I am on aspirin daily for 1 more week for clot prevention. With this change I have had to up the Percs more often. I was on hydromorph post op but it wasn't super effective for me so hence the swap to Perc.

Thanks in advance for any and all insights.
 
Hi and Welcome!

It could very well be overactivity causing this. It doesn’t take much to upset a 4 week old knee, but it can take a while to calm it down again.

I am going to tag @Josephine
our forum administrator and nurse director to address your concerns.

I know you said you’ve read the Recovery Guidelines, but everyone gets their own copy, so here you go:

Recovery Guidelines:
Each article is short but very informative. Following these guidelines will help you have a less painful recovery.

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
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
5. Here is a week-by-week guide for

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 the 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 the member’s history before providing advice, so please post any updates or questions you have right here in this thread.
 
Thanks!
I am also looking for good info on scar care. I have been massaging as per my PT instructions to loosen any adhesions. My scar actually looks excellent. I just feel like it could do with some moisturizing as it feels a little dry and tight. I keep reading that you should leave it dry and conflicting information that you should put something on it.
 
Last edited:
Hello @Dkm - and :welome:

I think it's very likely that, at 4 weeks, it is increased activity that is making your knee more stiff and swollen.
Complete recovery from a knee replacement takes a full year, so your knee is still very new. Treat it gently and don't try to rush its recovery. If you think of recovery as a race, this is a marathon, not a sprint.

Most of the exercises you've mentioned are not necessary so early in recovery, so cut them back adn spend more time resting, and icing and elevating your knee.

I am also looking for good info on scar care. I have been massaging as per my PT instructions to loosen any adhesions. Why scar actually looks excellent. I just feel like it could do with some moisturizing as it feels a little dry and tight. I keep reading that you should leave it dry and conflicting information that you should put something on it.
First, stop massaging your scar. There are no adhesions there that you need to loosen. What you have there is normal scar tissue that is part of the normal healing process - it's mending the cut made in your leg and holding the incision together. Leave it alone. Your body knows what it's doing and Nature has been healing wounds for thousands of years.

If your incision has healed completely, with no open areas or scabs, you can put any sot of moisturizer on it. If it's not completely healed, don't use anything, in case you introduce some infection.
 
how long can I expect before it calms down?
That depends upon what you've been doing to make it angry! But it would rarely be less than 4-6 weeks and probably longer.
I feel like I am doing everything to calm it down and it seems to be worsening.
You shouldn't 'do' anything!
I have been massaging as per my PT instructions to loosen any adhesions.
"loosen adhesions"? Whatever next! That's a total, 100% fallacy. For starters, if you should have adhesions (which is unlikely given your ROM) then no amount of superficial massaging would have any affect on them at all!
My scar actually looks excellent. I just feel like it could do with some moisturizing as it feels a little dry and tight.
Then put some cream on it. Whatever takes your fancy as long as it has no perfume in it. E45 or similar would be good. But just now and again. Don't make a religion out of it!


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?
 
Yes, questions are fine.

Also let me clarify the statement but I was doing everything to help it calm down. What I was doing was going heavy on the rest ice and elevation. My concern at this point is that it was much better a week or so ago and the way that it is angry seems to be very different and persistent despite doing rest, ice, and elevation.

I also have a TENS machine and have that on board as well.

Also to clarify, my scar is doing extremely well, however I was feeling it was causing some restriction and had it assessed by my PT and there are two areas that are not mobile when the rest of it is.

I tried to upload a file with a picture for everybody but it keeps giving me an error message from the site. Thanks again everybody
 
I had a good, normal recovery and, having gone through the whole thing, can testify that your knee will have ups and downs. Good days and bad days. Good weeks and bad weeks. And those can happen for no discernible reason, or for reasons you think are too minor to possibly cause any issue at all.

My left knee was a diva. Once it flared up for a week because I... slept funny. I don’t even know exactly how I slept funny, only that I slept on my side one night and my left knee disliked whatever position it was so much it flared up for a week. Pain down one side. Stiffness. Hotter. I did the usual things to settle it down: elevated, iced, and rested, though I continued my daily walks. And it settled down.

A month or so later my left (again, always the left) flared up after I... had lunch with a friend. Stiff as can be. Was it the lunch? Was it the booth? Was it sitting for two hours laughing with my friend and ignoring my knee? I’ll never know. Again, I iced and elevated and, well I rested less, but it settled down.

I’ve gone several months now without even a twinge of a flare-up, so there may be a point at which these things cease to happen. But in the early months... expect to have stiffness that gets worse, new pains that show up out of nowhere, and other mysteries.
 
PTs are big on mobilizing the patella, mine did it, too. I didn’t know it at the time, but it really isn’t necessary.

I think we do too much in this recovery when just plain old, let it heal, will do wonders.

Bonesmart is all about a gentle approach. Quite radical, in light of what most of us are told. But gentle really does yield results, with less pain that doing things can cause.
 
I also have a TENS machine
Did you apply and use it according to this article? TENS machine
I tried to upload a file with a picture for everybody but it keeps giving me an error message from the site
Then email it to me and 'll post it for you! [email protected]

Yes, questions are fine.

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?
ai63.tinypic.com_eta39s.jpg


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.
 
Hello, we are very close on our surgery dates! I about a week ago got pain under the knee cap and they think my knee cap isn’t tracking correctly. We are working on strengthening the hip and butt which will pull the knee better. All exercises are very easy and nothing my knee can’t handle.

As for the scar I put coconut oil on it and massage it, feels good and makes it not so sensitive. My left leg which is 9 weeks feels great and no scar tissue or lumps. The right does have two tight spots and I can feel scar tissue so I’m massaging that too!
 
For scar stuff - I believe in Arnica! Im taking it orally as well as lightly massaging it into my leg. I put it on my scar as it helps erase it quite well, and massage it into the sides as that feels really good. Especially my medial side! Nothing crazy just a bit of self love.
 
Sorry for the delay in reply. I really do appreciate all the insight. As it turns out it was an IT band issue, basically the same as runner's knee, however it was originating and my gluteal muscles. I had been having some aching coming on there for a while and just figured that our sofa cushions we're setting this up.

I am sharing this as what I misconstrued as general stiffness turned out to be something entirely different. The moral of the story just don't assume everything but that's weird is it typical knee issue.

My PT was able to assess this and and it was very apparent I bet my general range and movement was fine, but the IT band syndrome is the issue. We have begun to treat it along the protocols for that condition and things are calming down. Of course rest, ice and elevate are big on the list.

But the reason those alone weren't calming things down was that this issue specifically needs some stretching and massage to help resolve it. Now that we are doing IT band syndrome protocols things are going in the right direction. Of course, we also rotated pillows on a sofa to get rid of the major cause of this issue.

For my general progressions, all is going as unpredictably as everyone says. I do feel like I am moving out of the trenches and now into the long slow steady Journey that lies ahead. I had all of the usual frustration and upset at times that it felt like the in the trenches phase was going to go on for months.

This new phase of slow and steady with some better sleep an easy pain management it's now something I feel I can get my head around and be patient with. I agree with everyone that they do not really warn you appropriately about how long your life will be impacted & such a profound way.

Once again, do talk to your PT frankly about any concerns or issues or changes you experience. Mine is a good one and he sat down and listened what was going on. He didn't make any assumptions, investigated it thoroughly without bias but it was all about the TKR. He also reminded me but it is important to be aware of all other areas affected do to your body adjusting, gait changes and even the increased time spent in a resting position. Everything is connected

Thanks again everybody and I will keep posting as the journey continues.

Ps, how soon has anyone been allowed back into a public pool? My surgeon really wants me at 6 weeks to be absolutely safe about infection risk. It is hard to wait as I really relied on this before the surgery for my niece, Fitness and mental relaxation. I know it will be beneficial to the TKR knee but I am getting impatient because it was an essential part of my arthritis control and my left knee that has not been replaced yet is really starting to show the effects of my pool regimen being gone.
 
Don't risk going into a public pool until your incision has healed completely, with no open areas or scabs. Any break in the skin might provide entry for an infection.

When you do get into the pool, be very careful not to overdo the exercise. Because the water bears most of your weight, it's all too easy to get over-tired. You may not realise that while in the water, but you certainly will once you get on dry land again.
 
When you do get into the pool, be very careful not to overdo the exercise. Because the water bears most of your weight, it's all too easy to get over-tired.
My surgeon prescribed pool “therapy” at 4 weeks post op. My first (and only) session was 50 minutes of countless knee bending exercises and walking frontwards, sidewards and even backwards! :yikes: It took me 3 days to recover and I did not go back to the pool.
 
Thanks for the confirmation. My surgeon wanted 6 weeks to be safe about infection. Thanks also for the warning about overdoing it in a pool yes. I can see how that would be easy to fall into. On a positive note had one of my best days ever. PT this morning working entirely to calm things down and releasing some trigger points. Came home, pain is great today, stiffness is the best it has actually ever been at this late in the day. Was able to sit at my desk comfortably today without major swelling. Woohoo, I know things will go back and forth but got to take this day as a landmark of feeling like another new and better phase.
 
Celebrate the good days. As you heal, you'll have more and more of those!
 
@Dkm would I be correct in assuming you don't want my advice after all? I posted questions in post #9 but you seem to have ignored them
 
Hi Josephine

Sorry I did not reply to your questions earlier. With the IT band syndrome situation the answers we're literally changing pretty much daily. Once we nailed down what was going on, my concern was fully addressed by my PT, so I no longer felt I needed to take up your time to work it up in so much detail here. If I get into another situation where I need you to assess in detail, I will go back to the questions reply to them and tag you. I really do appreciate you reaching out with the questions, but just to reiterate during the last week things were literally changing daily all with really good Improvement. Thanks again
 
Hello everyone. Overall things are going very well. The IT band syndrome is really band syndrome is really calmed , massage therapy has been a great addition to recovery both physically, mentally and emotionally. My surgery was November 14th 2018, so I am 5 weeks as of today. I now walk unaided around the house without any concern. I have one new thing I was just wondering about. I have what I think is an internal Stitch sticking out from my scar. I have email pictures to my OS to find out if I need to go in sooner than my January 3rd, 2019 recheck. My question for anyone who has experienced this is what did their doctor end up doing about it? Also my major concern is I really want to get back into a public pool, my scar is healing up and closed really well, however I feel like this one stitch sticking out creates a perfect Channel for possible infection getting in. Any input on that would be greatly appreciated. Not sure if at this point I should change the title of my thread or even how to do that.
 
I feel like this one stitch sticking out creates a perfect Channel for possible infection getting in.
It would be advisable to stay away for any pool or bath until that stitch spot is completely healed. To have stitches become visible is not that unusual. You just have to be careful about them. You have done what you needed to do by sending photos to your OS.
 

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