TKR One month, the good and the bad<

[PolarBear60]

Hi, sharalder. What you've described sounds very familiar to me. I plan to discuss it in my weekly update tomorrow, but I'll give you a preview. I still hesitate before getting out of a chair without arms or a lower toilet seat. The excruciating pain I had doing that a few weeks ago is gone, but it's still not comfortable to do. Someday, I hope to be able to rise from those two seats without thinking about it, but not yet.

The knee is tight in the morning. A touch of the right band and stiffness. Before getting out of bed, I stretch the entire leg as straight as I can from hip to ankle, pulling my toes up toward my knees. Then I bend the knee was much as I can. I do this a couple of times until the knee loosens up. I've had to do this for a couple of years now, and I also do it for my non-TKR knee to get it warmed up for the day. And, yes, the first few steps in the morning are a little tentative while everything sorts out strength and balance-wise.

I have some tightness at the calves where the muscles connect to the back of the knees these days -- both legs. Not sure what's up with that, but I stretch those as needed, too.

I do spend a lot of time sitting at a computer many days. It doesn't bother me to do this, but I do have to "shift gears" when I stand up sometimes.

My problems with stairs and walking longer distances are more related to my right, non-TKR knee getting worse, so I'm really looking forward to getting that done in April and really getting through the recovery process.

Based upon my experience, you seem to be in a pretty normal place in recovery. The problems you're experiencing with extension and flexion may be related to returning to work and having to conform to someone else's schedule and will eventually fade.


Jean

LTKR (Stryker Triathlon): 21 April 2015
Right Knee Arthroscopy: 25 July 2006
Left Knee Arthroscopy: 10 February 2005

 

[Kansas Teacher]

Hi @sharalder . I am at a similar point in recovery as both you and Polar Bear and have a lot of the same things -- varying by the day of course. I still have some swelling and stiffness although don't really have problems getting up. I see my OS in early Oct. and will ask him about it too. I still have a painful area just below the inner side of my knee and am starting to suspect that it's bursitis but we'll see what he says. I also have some IT band issues although they're ever so slowly improving. When my IT band gets tight, I don't walk right and then my ankle hurts too! Bend and extension are great and so are stairs. Like Polar Bear, stretching warms things up and helps a lot. Like both of you, I thought all of this would be behind me now. It sure is a long long road, friends, but I do believe we'll all get there!

Roxie

 

[skigirl]

I am sorry that you are feeling frustrated, but you have gotten some good advice in the posts before mine. It does take some time before the knee is completely healed and feels like a part of your body. I found that one day I got up, went to work and thought---oh wait, I have not thought of my knee for almost five hours!!!!

I will say one thing, however, I personally would be reluctant to have a cortisone shot in a new tkr. The risk of infection is huge and something that I would not risk. I know that most docs do take sterile precautions before they do the shots into the joint---but, it would make me nervous.

If you are really worried, you could always make an appointment for a second opinion---with someone who does revisions---they are the detectives of the tkr world and they often see the problems that your own OS does not see.

Patience is probably your best answer for now. I did find that support hose helped with the swelling when I returned to work.

 

[Poppet]

@PolarBear60,
Hi Jean, its been awhile since I have posted anything. I know you had your surgery close to mine and I'm wondering how you have been doing. It has been 5 months and I was hoping at 3 I would feel close to back to normal, but it is not the case. My tight band stiffness is about gone, but now I have other issues. About a month ago the OS gave me cortizone in both knees. It helped for about 2 weeks, but now when I stand after sitting myhknee does not want to move. It is really bad at night and in the morning, I feel like I have to hobble for at least 8 to 10 steps before I can walk normally. The OS thinks it from inflammation, but I don't know what to do about it.
The herbal remadies that @Poppet recommends hurt my stomach. I take naproxin morning and night with Tylenal in between. I've gone back to work but it is very hard to sit or stand for any lenth of time.
I could use some help from anyone that is this far along.

Hi, just to clarify the terminology in this statement.. I do not make herbal recommendations as this would contravene my professional status, please refer to the qualifier in my signature block. Many thanks

 

[sharalder]

@PolarBear60 Thank you for the response. I have to keep reminding myself that our journey is slow:whistle:
I have a new issue this week. You said your calf muscles were sore, mine too. But suddenly my calf now is so sore that I am hobbling around on it. I also had my feet swell up this week. I went to my GP and they gave me some water pills and once again I am icing and evevating. Its just feels like its never ending. One of these days....
I am sorry @Poppet, I read that ginger helped with inflammation and it was my OS that recommened that I try the herbal remedies. I hope you are feeling better these days!

 

[PolarBear60]

It's funny. This week, the calf tightness isn't bothering me. The aches and pains shift from week to week.


Jean

LTKR (Stryker Triathlon): 21 April 2015
Right Knee Arthroscopy: 25 July 2006
Left Knee Arthroscopy: 10 February 2005

 

[sharalder]

Well, its been a while since I have posted anything so I thought is was time to write a 10 month update.

Right now I am so disappointed in what is going on. I am still having pain and when I complain to my OS he keeps writing in my chart and says "I See". Then he says how good my extension and flexion are. I think that is all he cares about, that his surgery was successful and the knee bends and straightens.

I can walk for about a block or 2 and then the knee is too sore to continue. I can't stand for more than about 10 minutes in the kitchen without the aching. I have learned to cook in fast shifts. Shopping is also not easy. The grocery store is okay, but bigger stores like Target are NOT fun. Going up 1 flight of stairs is okay, but coming down is not. I do about 15 to 20 minutes of stretching before I get out of bed in the morning. I am okay for a while until I get to work.

About a month ago I found that if I sat at my desk for more than 10 minutes at a time I can't put any weight on my new knee, it wants to buckle so I have to stand around my cubicle and stretch and limp around until I can walk, sometimes it is very embarrassing when I have someone knocking on our door and I can't get to the door to answer it.

I complained to my GP and I got a referral to a Pain Management doctor. I have an appointment in a couple weeks. I also have one with the OS next week, and I will be more demanding for answers this time. He has given me cortisone about 3 months ago, it helped for about a month, but that was the point of the surgery, to relieve the pain :(
I am hoping @Josephine or another advisor can help me.

I have been trying all kinds of anti-inflammatory herbal remedies, but so far I have not found anything that really helps. The soreness is about an inch above the kneecap to about 2 inches below it across the top. Also the the inside of the knee.

I am just not a happy camper right now!

 

[Josephine]

Well, I'd like to ask you some questions if you don't mind, and it would be very helpful if you would answer each one individually - numbered as I have done - in as much detail as you can but just to make it complicated for you (!) I'd like you to answer them twice
1. for your first six weeks post-op (near as you can remember) and
2. for now.
But please answer the whole set of questions twice, don't give me two answers at a time, okay?
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 compare this with the bone-on-bone pain you had before surgery! ) Also don't forget to include 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 often are you icing your knee and for how long?

4. are you elevating your leg, how often and for how long?

5. What is your ROM - that's flexion (bend) and extension (straightness)

6. how swollen is your leg?

7. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and

8. what kind of PT exercises and exercises at home are you doing? How much and how often?
This is the most crucial question so please help me by using the format I have left as an example

Exercises done at home: 3 sessions a day
Heel slides x10 (reps)
Straight leg raises x10
Steps x10

At PT
Squats x5 (reps) x2 (sets)
Wall slides x5 x2
Clamshells X5 x2

 

[skigirl]

I am glad that Jo is helping you---it sounds like something is not quite right with the knee. I think that I would begin the process of looking for someone in your area who specializes in revisions. They are the ones who see the problem knees and so they have a better grasp of the problems which occur. You can call the local clinics and ask who handles the revisions in their clinic or look up at our clinic locator. If you click on the individual doctors in each clinic near to you, you will see what each one has as a specialty.

I am sorry this has happened to you---it is a bummer, but the sooner you take the control into your hands, the sooner you will know what the problem with your knee is.

 

[sharalder]

@Josephine, Thank you for getting back to me so quickly.
Here are my answers to your questions.
6 weeks:

1) At six weeks my pain was tolerable, I think a 5 or 6. Knee was very stiff first thing in the morning, and after sitting occasional sharp pains

2) Tramadol 1 or 2 per day and 500 mg Tylanol in between

3) Iced at least 4 or 5 times a day 20 to 30 min

4) Elevated with ice, 4 or 5 times

5) 90 degrees, & 3

6) Moderate to almost huge

7) Walked around the house, light housework, a few dishes, quick meals. Drove when necessary.
back to work at 3 months.

8)Home 2 to 3 times a day
Heel slides x10
Straight leg raises x10
Slides to the side x5
Standing x10 side leg lifts and x10 back lifts
Slight knee bends x5

PT 2x a week
Side leg lifts x10 2x
Side steps x10 3x
Step ups x5
Wall slides x5
Total Gym x5 2x
Bike 5 min

Now
1) Pain when standing for more than 5 to 10 min 3 to 4. Pain and soreness when walking for more then 1 block 5 to 6.
Extreme stiffness, and knee wants to buckle after sitting for more then 10 min. in the AM, not as bad after the day goes on.

2) Tylanol 500mg 2 or 3 times a day or Motrin 300 to 400mg. I don't like strong pain meds, makes me feel strange and does not seem to help.

3) Ice just a few times a week or heat before I go to sleep at night

4) Elevate in evenings after work, 1 to 2 hours.

5) 125 & 0 last time w/OS

6) Moderate by night

7) Work 8hr, walk warehouse up stairs(ok) down(slow), sit for more then half the day. Most housework & cooking, short shopping trips, short walks, no mall, no hiking,

8) Home 2X a day
AM Heel slides x10 3x
Leg lifts x10 2x
Bridge x5 2x
Sit ups 10x 3x
Side leg lifts 10x 2x
Peddler 20 min 3x a week
No PT since mid Oct.

I asked OS in Oct. if I was doing too much or too little excersize, he said it was up to me by trial.
Leg/knee feels the same if I do all my exersizes or if I don't do any.
I recently had a pressure test for my legs to be sure the veins/arterys? were working properly and the test came back normal. Thank you for any insight you can give me.
Sharon

 

[Josephine]

6 weeks:
1) At six weeks my pain was tolerable, I think a 5 or 6. Knee was very stiff first thing in the morning, and after sitting occasional sharp pains
2) Tramadol 1 or 2 per day and 500 mg Tylenol in between
3) Iced at least 4 or 5 times a day 20 to 30 min
4) Elevated with ice, 4 or 5 times
5) 90 degrees, & 3
6) Moderate to almost huge
7) Walked around the house, light housework, a few dishes, quick meals. Drove when necessary.
back to work at 3 months.
8)Home 2 to 3 times a day
Heel slides x10
Straight leg raises x10
Slides to the side x5
Standing x10 side leg lifts and x10 back lifts
Slight knee bends x5

PT 2x a week
Side leg lifts x10 2x
Side steps x10 3x
Step ups x5
Wall slides x5
Total Gym x5 2x
Bike 5 min

For this section, I can readily see that your pain levels were quite high, you were under-medicated, icing and elevating too little. As for your exercises! While not as crazy as some routines I have seen, were nevertheless, quite punishing.

1) Pain when standing for more than 5 to 10 min 3 to 4. Pain and soreness when walking for more than 1 block 5 to 6.
Extreme stiffness, and knee wants to buckle after sitting for more then 10 min. in the AM, not as bad after the day goes on.

That is a very high pain score for 10 months out. Most likely a hangover from the sissues I mentioned above. Trouble with this kind of thing is that it gets entrenched or chronic. and therefore very difficult to manage later on.

2) Tylenol 500mg 2 or 3 times a day or Motrin 300 to 400mg. I don't like strong pain meds, makes me feel strange and does not seem to help.

Here you are again, under medicated considering your pain levels. But 500mg Tylenol is not a working dose. You should try taking 1,000mg 4 times a day, every 6hrs and the ibuprofen (motrin) 800mgs 3 times a day. These are the maximum for both drugs. You should also read this Medications: acetaminophen (Tylenol, paracetamol) and NSAIDs, differences and dangers and if you ever get any stomach issues, speak with your doctor immediately and get prescribed a PPI for protection. But I think you will find that taking an adequate dose of these will help with your pain enormously.

3) Ice just a few times a week or heat before I go to sleep at night
4) Elevate in evenings after work, 1 to 2 hours.

Well, first, never use heat on an angry knee! You draw blood to the knee thereby increasing the swelling and therefore the pain. Also ice more often and for about 40-60mins and more than 4 times a day. Your elevating is good but do you have your leg just laying on the settee flat or on cushions?

5) 125 & 0 last time w/OS

That's not bad but could be better! (this sounds a bit like a school report, doesn't it?)

6) Moderate by night

Yes, I would expect it is.

7) Work 8hr, walk warehouse up stairs(ok) down(slow), sit for more then half the day. Most housework & cooking, short shopping trips, short walks, no mall, no hiking,

Okay

8) Home 2X a day, AM Heel slides x10 3x, Leg lifts x10 2x
Bridge x5 2x, Sit ups 10x 3x, Side leg lifts 10x 2x, Peddler 20 min 3x a week, No PT since mid Oct.

I'm glad to hear you are not doing any PT now. With your work and other activities, you don't need anything extra at all !!

I asked OS in Oct. if I was doing too much or too little exercise, he said it was up to me by trial. Leg/knee feels the same if I do all my exercises or if I don't do any.

Then don't do any!

My summary is that you've been doing far too much ever since your op, that you've grossly unde-rmedicated yourself since then and as a result, now have a mild form of chronic pain - which you are still under-medicating. So try my suggestions for the otc meds and ice more. Try to minimize your activities including NO exercising, so you can rest more. See how that pans out over the next 6 weeks and I'll bet you see some difference.

 

[sharalder]

@Josephine Thank you so much for your insight!! I am starting right this minute with the OTC meds and elevate and ice and I didn't do any excercising this AM. I will keep it up for a the next month at least and see if I feel better. It was such a relief that you didn't mention the word "revision" I was almost in tears. I knew the knee joint was working well as far as the bending, it was just the pain surrounding the joint.
When I do elevate my knee I have a recliner that I use with pillows under my foot or on the couch with the leg propped up on the back cushions. I just have not figured a way to elevate at work. I have a stool under my desk and a ball to roll to bend the knee and a chair next to my desk chair to prop when I can.

Maybe you have some other ideas. Again, thank you Josephine and BoneSmart for all the info and stories, good and not so good that I have read in this past almost 1 YEAR. At this time I will try my best to follow the instructions and BoneSmart mantra about ice and elevate! (Like I should have been doing all along)

Sharon

 

[Josephine]

I'm very pleased to hear it.

When I do elevate my knee I have a recliner that I use with pillows under my foot or on the couch with the leg propped up on the back cushions.

I can't quite picture this - does it mean you have your knee out straight? Because if you do, it will cause a lot of pain. Look again at this article and what is good and bad elevating. Pain and swelling control: elevation is the key

I just have not figured a way to elevate at work.

Best is to get one or two boxes of photocopy paper. That should be about the right height.

I have a ball to roll to bend the knee.

I suggest you don't do this. Your activities at work are quite enough without it.

 

[sharalder]

Good morning everyone,
@Josephine just a quick update. Went to th OS on Wed. He felt my knee and said the pain is from bursitis and to continue with ice & elevate.also gave me cortisone.
Just wanted your thoughts....

 

[kneeper]

Ice and rest it for the next day or two. HOpe it helps.

 

[sharalder]

Good Morning,
Im not sure if I need a new thread. My left TKR was on Jan 7th. The right was 5 years ago. I’m moving fairly well, I can walk around the house fine and did a little cooking yesterday. I had a Theripist come to the house on Monday and I was feeling so well she thought she needed to show me more exercises .
I over did it and it took 4 days to recover. I will take it much slower from now on. I saw the Dr. yesterday and said I was at 90 & 0 and doing well. I feel that my knee is still stiff and swollen. Should I use the compression socks again?
Thanks for all the advise!

 

[Macknit]

I'm sure our wonderful advisors will pass on if you need to start a new forum.

I had my RTKR 5 months ago.... now my Left knee is acting up and I have my OS office visit with his PA this next week. I'm still working and hoping to get my health care coverage to take care of this L knee before I retire in early 2021...we have a good 3 month waiting period before there is an appointment with the OS. So I'm starting now.

My RTKR still has swelling at the end of each day. I used compression socks for the first 4 weeks and really enjoyed them. Then all of a sudden I couldn't stand them! Our OS office recommends the first month, so I'm glad that worked for me. Putting them on after icing and elevating was the key. My knee was back to normal. I also used the thigh high ones so the swelling/fluid could move above the knee and out to the lymph glands in the groin.

 

[Jockette]

Welcome to recovery again. Yes, you sure did over do it, if it took 4 days to recover. In this recovery, less is actually more. Try to stand your ground in the future with the PTs.

Please check your signature and let us know if those dates are correct. There is a date of January 15, 2019 for your left knee.


You can either continue with this thread, or, since this is a different knee, we can start a new thread for this one. It’s up to you

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

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 to these pages on the website

​

Oral And Intravenous Pain Medications​

Wound Closure​

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.

 

[sistersinhim]

You can stay right on this thread if you want to or we can start another one if you prefer that. It's up to you.

 

[sharalder]

Thanks for the info, I will definitely take it easy on PT from now on. My date for My left knee should be 1/7/2020. I can’t figure out how to change it.