TKR One Year Out

[marmarmish]

The pain on my lateral knee is still with me, tho a wee bit better. The fact that it's now lasting days, says I just cannot aggravate it and must give it time to heal. Unfortunately, that means any kind of movement to encourage flexion has got to be put on hold. This worries me. In all the advice I read, even if you are not doing PT, it is recommended that you do gentle movements several times a day such as heel slides. I definitely cannot do those! They really hurt! I am walking 4x/day, averaging 4-5,000 steps. Just worried I'm not doing the knee bending exercises.

For those having troubles getting to sleep, I've come up with a little routine that has really helped me, and wanted to share...
While a hot bath may seem obvious to most, it was a revelation to me! I have always showered, can't think of the last time I actually sat in a bathtub. But one night I was chilled, achy and antsy with restless legs - a bath seemed like the way to go. Well OMG! it was just what I needed! Who knew a bath could be so wonderful! Now it has evolved into such a wonderfully soothing routine - perfect to get you ready for bed. I use Dr. Teal's Lavender Foaming Bath and soak for 15-20 min. (J ust before getting out, this is a good time to do a few exercises while you are all loosened up; pressing the back of your knee down, and heel slides.) Once out, I may take a melatonin and/or magnesium. If you are still hurting, some Tylenol PMs definitely help. And while you are still loose, this is a good time for a massage. I have one of those roller thingys with the 3 spiky balls, and then follow that with some shea butter and a hand rub. If you can get your significant other to do this once you in bed - heaven. All that's left is to be tucked in, and lights off.

I understand not everyone can get into a bath right now, but something to keep in mind for down the line???

 

[benne68]

I am walking 4x/day, averaging 4-5,000 steps. Just worried I'm not doing the knee bending exercises.

Please don't stress about this! We have loads of members who never did PT exercises; instead, they recovered with ADLs (Activities of Daily Living) and still achieved good ROM.

Here's what another member, JusticeRider, posted this about 6 months into her journey:
"I just want to add, for all those coming along, a note on ROM.....Mine has been extremely slow coming. First I had to wait out the swelling, which in my case took more than 5 months. Yes, months. At that point I began to see real progress.
"I have had to be willing to let my flexion improve at a glacial pace....Instead of forcing it, I have relied on weekly massage and using my stationary bike. I have not measured my flexion, because honestly I feel almost a PTSD type of reaction around it. All I care about is function and what I can do. My knee is very functional now, and still improving.

And at one year, here's what she wrote:
"For my one year celebration, we went for an amazing 5 mile hike up by beautiful Mount Rainier. The views were absolutely incredible! It was for sure the most challenging hiking I have done since my injury in 2020 and the following three surgeries.... I made it up to the top, and most importantly, back down again! And later…no swelling or pain!! It was the perfect way to mark my one year.


You are still early days in this year-long recovery. Please let your knee recover in its own time. You can help it with rest, icing and elevation to calm down the inflammation and allow your knee to heal. Your ROM is in there -- it just needs time to reveal itself.

 

[Jamie]

It is true that you need to do gentle bends and stretches for 5 minutes or so every couple of hours with a healing knee. This doesn't mean you need to do heel slides. You can sit in a chair and move your leg to bend and stretch it. Or you can rock on an exercise bike. Or you can place a skateboard under your foot to roll as you bend your knee while seated. There are lots of ways to bend and stretch your knee to challenge it a little without great pain.

4,000-5,000 steps is likely too much for you if your knee is in pain and swollen. I suggest you cut that in half for a while and see if that helps. Do it for a week and see how your knee reacts. As long as you're doing those bends and stretches, you'll be fine.

 

[sistersinhim]

I am walking 4x/day, averaging 4-5,000 steps

This is more than enough PT that your swollen, painful knee needs. What it needs is lots of TLC and fewer steps. No wonder your knee is swollen. Try backing off to about half of these. I bet your swelling will go down after a few days or a week.

 

[marmarmish]

Thank you for your replies - always very much appreciated! I'm sure I have some swelling, but it seems pretty minimal. This issue is specific to the lateral area where I have developed tendonitis. I've read this could be caused by the tendons being pulled tight over the bone and rubbing, as everything inside is readjusting since the surgery.

Not aggravating it is crucial for it to heal. So @Jamie, some of the exercises you suggest have also caused that rubbing motion. The last flexion exercise I did was sooooo gentle; I layed on my back and stuck my leg straight up in the air, then very gently let gravity bend my knee, and let it hang there with no pushing from me, for a few moments. I did this a few times, followed by a firm massage - and OMG! Couldn't move my leg for while, serious burning pain! It seems that ANYTHING that requires me to bend my knee results in this irritation. At first it was just mild, and would stop when I stopped. Then it would last a little longer and be a bit more sore, as I continued to do the flexion exercises. Then I guess I took it one step too far and bam, has been hurting for 3 days now. So, I am stopping all flexion exercises for a while. Tho I continue my walks - that is causing me no excess pain or swelling.

Anyway, it is the total lack of bending beyond 60 degrees, that I am worried about. How long can I purposely keep my knee from bending so it can heal, without having detrimental effects?

As always, so grateful for this website and the folks who offer us support and encouragement.

 

[Jamie]

Based on what you’re saying, I agree that you need to just maintain the walking since it doesn’t cause you pain. If you can take an anti-inflammation medication like Aleve, you might try that. Another option might be Celebrex, as it’s easier on stomachs. Check with your GP to be sure this is okay for you. It would probably be good to scale back your walking as well to something around 2,000-3,000 steps. You are right to try as much as possible to let this settle.

 

[CatieViv]

I find the only bending exercises I can do that don't cause pain are the gravity stretches. I let my leg dangle over the side of the bed and get a quad stretch that way. Lunges on the steps like my physiotherapist said to do cause lateral pain. And pain in the other leg.

I'm sorry you are going through tendonitis. I hope a few days rest will help it heal.

Sure wish I could get in the tub. My other knee won't let me kneel on it. And Miss Knee is so temperamental I don't dare

 

[mendogal]

@marmarmish - a caution from a formerly very active martial artist: if it is tendinitis (which we can't diagnose) don't expect it to resolve in days; in my personal experience plus dealing with dojo mates it typically takes weeks.
Agree with the advice to walk, but less, and ask about Celebrex.
You might want to check in with your ortho team, or primary care if they have a good grasp of soft tissue issues, on Monday for their thoughts.

 

[dotski]

She ordered x-rays, but I don't know what they will show as it is my understanding they don't show soft tissue???

X-rays would show bone in the region of the area of pain, eg if there perhaps a bone spur, etc. In my X-ray films my IT band was surprisingly easily identifiable.

I did this a few times, followed by a firm massage - and OMG! Couldn't move my leg for while, serious burning pain! It seems that ANYTHING that requires me to bend my knee results in this irritation

I’m sorry you are going through this. I hope you can still do those hot baths. That and taking it really easy will hopefully relax the muscles without having to do firm massage.

I see your Dr already prescribed an anti inflammatory (meloxicam). normally it’s a no-no to mix NSAIDs, (eg Celebrex, Aleve, etc). If it were me I might want to ask if it is safe to adjust the dose.

 

[Jamie]

@marmarmish …. Forgive me and my mention of taking an anti-inflammation medication such as Aleve or Celebrex. I missed your post that indicated you had already been prescribed Meloxicam. It is not advisable to take more than one NSAID at a time. It is correct that if the Meloxicam not working, you should talk with your doctor about adjusting the dose or maybe trying a different NSAID. They all work differently for different people and one may work better for you. Personally, I’ve found Celebrex or Aleve to be the best for me.

 

[marmarmish]

Thank you ladies for your suggestions.
@mendogal It my understanding that healing from tendonitis could take anywhere from 2-8 weeks. But it's imperative to not continue irritating that area. Not doing any flexion work for so long is what has me so concerned!
Oh well, no options really, so I'll keep my fingers crossed that this gets resolved in good time with no consequences.

I saw my GP only 4 days ago, so I'll give the current anti-inflammatory a bit of time to do it's magic. And I'm icing.
I will take everyone's advice and cut down on the walking. But my puppy isn't going to like it!
This is my boy - Eddie.

 

[mendogal]

Awwww Eddie!!!! Love that side eye!

 

[marmarmish]

Interesting article:

BoneSmart philosophy for sensible post op therapy

You will have noticed there is a significant opinion here about the potential hazards of PT. You may feel that your therapists are experts and know what you should be doing. However, over the last several years I've been here, I have observed that the more intensive the regimen of exercising...

bonesmart.org

And I've been doing a lot of these...

 

[sistersinhim]

Not doing any flexion work for so long is what has me so concerned!

I was in an immobilizer for each of my knees for 6-8 weeks after two of my surgeries. I was worried, too, about my bend not coming in, but I worried needlessly. When my immobilizers were removed, my knees were stiff and difficult to bend at first. But, as I used my knees doing my daily activities, they started to bend easily all on their own. Of course, it wasn't overnight, but after a few weeks, I was walking just fine.

Once you are allowed to bend your knee again, it will be fine. As a matter of fact, I bet it will bend even better than before your restriction after a few weeks. Just don't force it or you can slow it down.

 

[Jockette]

My PT had me do a lot of those exercises in that article and I had a very difficult, painful recovery. I now believe that ”less is more” and if I ever have another replacement I will do my own rehab at home.

 

[JusticeRider]

@marmarmish , I wonder if just sitting on a table, etc and letting your legs hang to passively let the knee bend might be something that doesn’t irritate the tendinitis?

 

[JusticeRider]

I find the only bending exercises I can do that don't cause pain are the gravity stretches. I let my leg dangle over the side of the bed and get a quad stretch that way.

CatieViv, I just saw that you recommended the same thing! Great minds think alike

 

[Layla]

Hopefully the recommendations above bring you some relief.
Love the photo of Eddie. He is such a cutie!
I hope you feel better soon.
@marmarmish

 

[dotski]

But it's imperative to not continue irritating that area. Not doing any flexion work for so long is what has me so concerned!
Oh well, no options really,

This is where I would consult my PT. Hands on assessment and experimentation under PT guidance, with gentle techniques is the best way to know if there is indeed a gentle way to gently bend the knee keeping all of the muscles that pull on IT band relaxed. This warrants a set of good assessment eyes and hands.

 

[sistersinhim]

Let your knee be your guide. If it hurts, then don't do it. When that pain is almost gone, then you can gently try your exercises.