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TKR One Week Post Op/Pre Existing Lymphedema

TeriseD

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Jan 19, 2025
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Hello All,

Had left TKR Jan 13, discharged Jan 14. I'm a 64yo female, with previous TKR on right side 8 years ago. Although this time has been an overall easier experience so far, mostly due to a healthier lifestyle over the past 2 years, including losing over 100lbs and being physically active, I'm in ALOT of pain, partially from my pre existing lymphedema, which was not a factor with my previous TKR. My left leg is literally three times the size of my right, all the way from my toes to my upper thigh. I realize part of this swelling is unavoidable and naturally occurs after this type of surgery, but since not being able to wear my thigh high compression stockings, I've gained 20lbs of fluid on my 135lb frame, causing extreme pressure, burning and pain. My CLT did wrap my leg with compression bandages but I was only able to tolerate those about 6 hours due to severe knee pain and pressure. I'm at my wits end trying to figure out how to deal with this, especially since my surgeon refuses to increase my Percocet from 5 to 10mg. I'm also taking additional acetaminophen plus Celebrex, using Polar Active Ice machine 12-16 hours a day, including overnight, doing my home exercises 3 times a day, attending outpatient PT twice a week, and walking short distances around my apartment complex hallways. I noticed the "coming soon" Lymphedema section here, and hoping there may be others who've experienced similar issues who can give me some tips. Any input is welcome!
 
Welcome to BoneSmart, @TeriseD !

Yes, post-op swelling added to existing lymphedema is bound to complicate things for you. I'm glad you already have a professional on board monitoring and working with you on the lymphedema in terms of drainage and compression.

Many of us didn't have formal PT the first couple of weeks postop, in accordance with our surgeon's advice that in the initial weeks Less Is Better.

Personally the only exercises I did for a few weeks were the recommended hourly (during waking hours) short walk, plus ankle movements and quad sets done while icing and elevating.

If PT is doing anything with you sitting on a chair or standing at this early stage of your recovery, it's likely counter productive for you.

My only question is, has you primary care or lymphedema specialist ever had you on short term low dose diuretics? I know long term use isn't generally a part of treatment, but they might deem short term use appropriate in this post op phase.

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.
 
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Hello and Welcome to BoneSmart!
Congrats on the substantial weight loss. That's fantastic.

I didn't notice that you mentioned elevation at all. Article here -> ELEVATION
Please excuse me if you already understand the following -
Since it's our lymph system that rids the body of fluid, you want to get the fluid to the lymph nodes in your torso area so your body can more quickly process it. The lymph system works rather slowly on its own and much more efficiently with the assistance of gravity. The fluid isn’t draining into the hips, but contained with the lymph system and moving to the torso and lymph nodes located there.

Thanks for joining us, Terise! I hope you have a good week. :)
@TeriseD
 
Thank you both! @mendogal I sent a request to my primary doctor today for the diuretic I used to take. That was a wonderful suggestion. @Layla I do struggle with elevation, especially "toes above the nose", as my furniture and bed aren't conducive to doing so. I do keep my feet up as often as I'm able. News flash, my surgeon just granted my request to increase Percocet, and hopefully I'll finally get a bit of relief and a few hours of sleep tonight.
 
I do struggle with elevation, especially "toes above the nose", as my furniture and bed aren't conducive to doing so.
If you are interested in elevating, you can try one of the suggestions in the ELEVATE article or look into the Lounge Doctor which many have and love, I being one. There is a link and photo at the top of the page if you care to check it out.
A great rest of the week to you!
 
Unfortunately I'm not able to afford the Lounge Doctor or similar wedge pillow. I did read the Elevation post but the photos (jpg's) aren't visible, and I'm not able to see the do's and don'ts. My recliner definitely doesn't lift my legs up high enough, and I'm unable to raise the bottom of my bed. Pillows and towels don't work at all.
 
@TeriseD
First off well done in reducing by 100 lbs. That takes real strength of mind. I am totally new to all of this 12 days in and therefore don’t have the experience/knowledge that Layla and mendogal have but I’ve had to adapt things and I thought something might help you. I also wanted to say that you’re doing more already than I am and I’m a few days ahead of you from a RTKR.

I have other issues that have made my journey so far more complicated. So I won’t do any out of house PT until the end of Jan( UK Physio) my other conditions mean that quite apart from the surgery I tire extremely easily and pain is a daily problem pre surgery anyway, so since Monday I’ve adopted an approach to exercise which will allow me to encourage my brain-muscle connection to develop, without tiring myself out and possibly increasing pain to the point of it being difficult to keep on top of, which is what was happening and had then meant I found it hard to do anything else that day, which is obviously counterproductive. You’re carrying all that extra fluid around so at a minimum you’re likely going to tire much more easily too.

I don’t know if it will help you, but what I’m doing is, instead of setting specific regular times to do a block of exercises, I’m simply keeping my leg “alive” throughout the day by rotating my foot, tightening my quads and doing knee presses, whenever I think of it which means a regular low impact stimulation of the muscles. Along with that I go up and downstairs 5/6 times a day and do about 4x 5 minutes walks. I’ve found that has meant I’m doing enough walking and gentle regular and consistent exercises, which is becoming more manageable for me. I’m not getting over tired(well no more than anyone post surgery) and my pain has been more manageable. So it’s a regular low impact consistent exercise plan through the day, rather than less frequent high impact exercise plan at set times in the day.

I had to stop icing and like you find it difficult elevating as in I find it uncomfortable. I use different combinations of pillows until I find something that’s somewhat comfortable and again just do that as often as I can. Only time will tell if it works of course, but it’s working at present.

Anyway we’re all different so this may not help but I hope you find a way that suits and helps you soon.
 
Oh and have you tried looking at the “Elevation” section another device to see the images? That worked for me.
 
Oh and have you tried looking at the “Elevation” section another device to see the images? That worked for me.
I thought maybe it was a browser compatibility issue. I tried all 3 of my devices, phone, tablet and laptop, with both Chrome and Samsung browsers, but none are showing the images. The only one I'm able to see are the Lounge Doctor links. The rest appear to be broken images.
 
I'm sorry you aren't seeing the images in the article, @TeriseD. Not sure why that's happening.

Since you aren't able to get a Lounge Doctor, here is that best alternative.
Using a pillow stack.

pillow stack.jpg



A pillow stack can often fall apart, so one of our BoneSmarties suggested using three inexpensive pillows and giant safety pins (available on Amazon) to create a pillow wedge. This can be a good alternative if you choose not to purchase a foam wedge.


And here are the major do's and don'ts:

When you are relaxing and elevating your legs, it's not enough to just put your foot on a foot stool like these:


foot stool 2.jpg



and the leg flap on some recliners only comes up to about 30 or 40 degrees before the back rest starts to go down. Many recliners also keep the feet below seat level even with the chair reclined. You're not getting proper elevation in any of these situations.

foot stool recliner.jpg



For a KNEE REPLACEMENT, it's also not a good idea to try and elevate with your leg totally straight like this as it stresses the muscles at the back of your knee tremendously, which can cause pain instead of helping it.


elevating angles.jpg



You may hear that you should try to keep your legs straight when elevating in order to help with your leg extension. But when you have a swollen, painful leg already, this is not helpful and can be quite uncomfortable, if not torture! A slight bend at your knee is much better for both you and your new knee.

Don't EVER use a wedge that keeps your knee bent, either - like this. It really is a
nonofinger.gif

as it puts pressure on the wrong places in your leg.


elevate 4.jpg


At a minimum, your foot should be above the hip and the higher the better in order to get good drainage for the lymph and tissue fluid that is the primary cause of swelling. This also helps with the pain levels.

We often quote, "toes above nose" which gets the point across very well, although this is more appropriate in cases of extreme swelling.

- If you are a knee patient, never have a bundle of pillows or a cushion firmly behind the knee or belly of the calf as shown in these six photos below. All these positions cause compression in the knee and calf which may result in a blood clot, especially in the early days post-op.

bad elevate 1-horz-vert.jpg



Hope you are able to see the images here.
 
Cleared Cache?
Good suggestion but unfortunately that didn't resolve the issue. I'll keep working on it, possibly a browser or security setting.

So do you have lymphedema? Your tips were very helpful and I appreciate you taking the time to share them with me. I'm icing my knee right now while doing ankle pumps and quad sets. Started taking chlorthalidone (diuretic) yesterday and this morning, I somehow (miraculously) squeezed into my oldest, most stretched out thigh high compression stockings. Took about 20 minutes but my legs are already feeling better.
 
@TeriseD Are you still not able to see the images in my post above (#11)?
 
@TeriseD Are you still not able to see the images in my post above (#11)?
No. All I see are descriptions such as foot stool.jpg and pillow stack.jpg. When I try to "view image" I get a page stating the following,

"Oops! We ran into some problems.​

You do not have permission to view this page or perform this action."
 
Cleared Cache?
Good suggestion but unfortunately that didn't resolve the issue. I'll keep working on it, possibly a browser or security setting.

So do you have lymphedema? Your tips were very helpful and I appreciate you taking the time to share them with me. I'm icing my knee right now while doing ankle pumps and quad sets. Started taking chlorthalidone (diuretic) yesterday and this morning, I somehow (miraculously) squeezed into my oldest, most stretched out thigh high compression stockings. Took about 20 minutes but my legs are already feeling better.
No i have Fibromyalgia RA and Raynauds and the surgery just made them all go into overdrive. Add to that applying ice was so intensely painful. Why I didn’t think about the Raynauds. I guess I was so focused on getting swelling down I completely forgot about it’s affect on pre existing conditions. 20lbs of lymphodema is a huge amount to be carrying in addition to the TKR. Let’s hope the compression helps you move forward x
 
Ok I downloaded it to my Kindle then uploaded it so you can see an appropriate 3 pillow stack, with good angles for hip and knee elevation and nothing pressing against the back of the knee.
[Bonesmart.org] One Week Post Op/Pre Existing Lymphedema
 
@beralc Oh my, that's a lot to deal with. I can see why icing would be so painful. Do you have both RA and OA? How does your Fibro affect your TKR recovery? Do you live alone? About 5 years ago I discovered I was ANA positive, had extensive lab work, including autoimmune panels, but nothing conclusive. Had a few symptoms of RA, Lupus, and Chronic Fatigue Syndrome, but not enough for official diagnosis, so my rheumatologist said it was 'Undifferentiated Connective Tissue Disease" or UCTD.
 
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