TKR Over exercising 21 weeks post TKR

[ChillTime]

Hi all, I had a right TKR on February 2, 2022. My early recovery was uneventful - not much swelling, scar looked good, able to move easily … BUT pain has been constant until around 18 weeks. At 18 weeks, I started experiencing more and more pain-free days and stretches of what I consider normalcy (feeling like myself). I still had some painful days, after too much activity, and I followed advice posted here to take it slow, easy, and let my knee dictate how much to do.

My PT, who knows me well, says I am a slow healer, but that all looks very normal. My doctor has basically said that healing is variable and to give myself some time. During our last conversation, he said he is not concerned. I have not been back to see him since week 11 and have tried to be patient. My constant companion is the ice machine — I have iced and elevated for at least 45 minutes several times per day. I’ve done stretching exercises when I have felt good, and biking and walking as tolerated. But, I am still not able to walk more than approximately 1 mile without experiencing pain afterwards.

My concern: at 21 weeks, are some painful days, coming after pain-free days, considered normal? I know my recovery is considered “somewhat early in the experience” at 5 months. I felt so good last week (like my old self — active and happy) that I know I overdid activities. There are certain activities, such as climbing stairs, that really irritate my new knee. Stationery biking feels pretty good, and I do that when my knee isn’t hurting. My PT says my quads, hamstrings and glutes are weak and that I need to strengthen them, and I do believe this may be the case.

I’m frustrated today and wanting to be active. Is what I’m experiencing at 21 weeks considered normal — or not typical but possible? Any insights or advice is appreciated! Thank you.

 

[Jockette]

Hi and Welcome!

Yes, all that is normal for 5 months, and even longer. You are actually doing very well. Continue to try to balance activity and resting, and things will improve.

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.

Just keep in mind all people are different, as are the approaches to this recovery and rehab. The key is, “Find what works for you.“ Your doctors, PTs and BoneSmart are available to help, but you are the final judge as to the recovery approach you choose.

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.

 

[ChillTime]

Thank you, Jockette. I have read and followed these guidelines, and they have rescued me numerous times during the past 21 weeks — Bonesmart is a great source of support! I’ll continue on — take care!

 

[kneeper]

It is a bummer when you feel good enough to be active but still have limits. The recovery process is ongoing for many months. But it sounds like you're doing well.

 

[ChillTime]

Thank you for your input kneeper. I am better each day now and thinking that when I feel really good while working out (I am excited to get to the gym), I should hold myself back a bit. It is hard to gauge what’s enough/too much at this point. This setback was a doozy, though! It’s nice to hear that I am somewhat typical — no one wants to be an outlier when healing from a TKR!

 

[MaryCat]

I thought I’d be back to full activities sooner too. My TKR was 3 weeks before yours and I still have to ice every day after work. More stiffness and loss of range for me. Still working only 3 days a week but doing low impact workouts on my off time (bike, mat, pool) and that’s helping. Also helping w the fact that I put on 15 lbs after surgery. Good luck- these setbacks definitely get annoying.

 

[ChillTime]

Yes, these setbacks ARE annoying. I figured I was almost completely healed at 21 weeks and could push myself — but NOPE, that’s not the case with my knee! I now have a love/hate relationship with my ice machine — ha! This recovery is definitely challenging my patience but it’s also made me a stronger person. Thank you for your input, and hang in there, too, Mary Cat!

 

[ChillTime]

Sigh, I am back on the couch with my ice machine after a nice, pain free day yesterday where I did a lot of walking — too much — and some major cleaning of our house. Last night, I knew I had overdone it again! I’m approaching 22 weeks completed and wonder if everyone does light exercising (biking on stationary bike, water walking) when feeling achy and overdone? Up to this point, I have not pushed exercise during a setback but wonder if it’ll help loosen up any tightness I may have?

 

[Roy Gardiner]

I have not pushed exercise during a setback but wonder if it’ll help loosen up any tightness I may have?

It is easy to overdo things. Exercise is not the cure for any symptoms brought on by exercise; just back off and do some gentle stretching

 

[Tower6brkrs]

if you have access to a shallow lap pool; even a hot tub I would recommend some aqua therapy. walking, lunges, squats, -whatever your able- to do. Water is almost no impact, great for ROM and the mental affects were really helpful for me. heat packs could help the tightness/circulation. good luck

 

[kneeper]

Well, now you know it's too early for a long walk and major cleaning on the same day. Sometimes it's us and sometimes it's friends and family who think all should be normal after 3 months and it just isn't. :(

 

[ChillTime]

Thanks, all! I am SOOOOooooooo ready to be feeling back to normal and am only halfway there. It helps to know that I'm not the only one. Take care.

 

[ChillTime]

After getting back to the gym this past week and doing very, very light weights for my quads, glutes and hamstrings, and after riding the stationery bike for under 20 minutes each day, I felt very good, though a bit sore (as I expected). I consider this the first "bona fide" exercise I have had in ages, and it felt so good to be "human" again! The lap pool was filled, and I couldn't get in yet due to filled reservations, but that will happen this coming week. It was not until today that I started feeling the familiar achiness, heat and bit of swelling in my knee as I spent time doing house work (about one hour constantly on my feet, walking back and forth). Now it's back to the ice machine and elevation.

I had a PT visit last week to work on my soft tissue. My PT looked at the paper copy of my recent x-ray and remarked that the lower piece of the implant did not look to be fully seated and that it appeared to be offset a tiny bit. He did say that it could be the angle of the x-ray, that he would have to look at the actual x-ray, and that the implant could be completely normal. It's possibly a moot point. I have filed that info in the back of my mind as food for thought down the road.

I am headed back to another ortho doctor next week. I am getting a 2nd opinion from him about the need for surgery for a torn rotator cuff -- though I know it is inevitable; there are two tears from a spur. I was given this diagnosis two weeks ago and have had to let the shock wear off before taking action. I'll need to schedule that surgery within the next 6 months, and in the meantime, will also discuss my ongoing knee issues with this doctor, who used to treat my knees but is no longer doing knee replacement surgery.

It feels good to report a TINY bit of progress with my knee (gym exercises), even though I have another surgery on the horizon!

My question today: how many people out there were having knee issues -- achiness, pain, feeling limited, etc. at 6-8 months and have progressed to become pain free and are happy with their result? It might help a lot of us to know that there's hope out there. Thanks for being there!

 

[vwolfvoa]

I’m 15 weeks out from my left TKR, and definitely feel when I overdo it…I had put the ice machine away, but it’s coming back out today! For me, it’s just about being too busy to worry or think about the knee, until the pain and stiffness demand my attention! But I am 7 years out from my right TKR, and I while haven't given it a thought in over 6 years, it was a journey! So, as most members here will assure you, there’s plenty of hope!

 

[ChillTime]

Thank you vwolfvoa!

 

[Smilechild]

Just read your thread. I’m @ 27 weeks and identify w some of your struggles. Trying to step back and give the knee some love, but I’m more than ready to be more active w less pain! I’m icing and elevating as I text. One of my goal’s is to walk ¼ mile without discomfort, fyi. I swam in the ocean last week - which was exhilarating to be able to do so. And that evening my knee was cooler to the touch and less painful than normal. That was a big win! With that under my belt, I’m going to try (w my pt’s guidance) some short distance swimming using little fins in the pool. I also attended a tai chi class this week. Very gentle but really flexed my mind, which I very much need! I’m looking forward to continuing that class.

 

[ChillTime]

I hear you, Smilechild! For the past 2 weeks I have gone to the gym every day or two to water walk, ride the stationary bike, do a few light weights, sit in the hot tub and then the sauna. It has helped mentally as well as physically. I feel almost “normal” again. I used to run lots of mileage and participate in triathlons and that’s in the past, but I do love to exercise and move. Just getting in the water (like your ocean swim — good for you!) helps immensely. Hang in there and let me know your progress. My Ortho who did not do my knee replacement (used to do them and I wish he had done mine) told me recently that it can take a year to heal. The setbacks are emotionally devastating at this point for me, but I do feel confident that we will get there eventually!

 

[Irongirl56]

Chilltime, your ortho had it right, it can and probably will take at least a year to heal and get all your strength back in that leg.

I have been “training” (triathlete) diligently since a few months post op ie swim, bike, slow run, fast walking, trail running and lots of strength training. I am a bit over a year out and feel like my leg strength is just getting back to what it was before I had all my knee problems. I was doing some road and trail races at 6 mos but slowly.
My knee doesnt bother me except for a few tendon twitches now and then but it is all the other muscles ie quad, calf, hamstring that also take a hit when you have this kind of surgery and are laid up for a bit afterwards. I am currently training for a backpack trip in Yellowstone which is really helping to gain strength back in that leg, so just know it is a slow ride but you will get there!

 

[ChillTime]

Thank you, Irongirl56 for the great vibes! I am happy for you that you're able to do what you love. This recovery is definitely a slow ride, and I will hang in there and watch things continue to improve. We are at the beach for a week each month, and I have noticed my knee is always better there - ha - but really! I think I'm more relaxed (vacation mode) and less stressed about whether I'm healing normally or not. I'm halfway through at this point, so thanks again for the good info.

 

[ChillTime]

I am very discouraged today. At 25 weeks post TKR (end of July), I visited my PT who has been massaging my knee and supportive tissues. He knows how sensitive my body is at times, and he did too much by gliding down my kneecap to loosen scar tissue and then cupping my IT band. I was in pain and lots of discomfort for a few days after (not going back again!).

Then, my husband and I went on a planned vacation for a family wedding. I was very nervous about walking while at the airport and while sightseeing, as walking over a mile at a time irritates my knee. I medicated before walking (Tylenol and 25 mg of Tramadol) and was fine. One day I walked 3 miles. I danced at the wedding and didn't think about my knee once. Yay! I thought that progress was being made and that I was moving in the pain free direction, at last!

When we returned home, I went to the gym the next day and did what I've been doing all along (a bit of water walking in the lap pool, low weights for my quads, hamstrings and glutes) and then rode the bike for 20 minutes. That was 1-1/2 weeks ago, and I am still in pain. The pain starts out as really achy, then progresses to the low-grade, achy pain after I ice and elevate. There's soreness too. I've been icing, medicating a little, and taking it very easy. I'm better now but still wondering if complete recovery will EVER happen??!

I even noticed a popping in my knee while walking this past week. I have no swelling, I am not limping, and my knee looks normal. I'm sure there's a little swelling inside the knee (it feels "congested"). There's still pain, though, and that's my issue.

I called my doctors office and made an appointment to see him in 2 weeks. At this point, when is further testing -- such as an MRI, or blood work, considered appropriate? I really, really did not want to be this person with the knee pain issue, but I am. My PT who knows me well says I am a slow healer. I had had meniscus surgery for a large tear on this knee 11 months before the TKR, and it was mostly painful after that. I wonder how much that factors in, too? Today I am at exactly 27 weeks. Any advice is much appreciated. Thanks all.