TKR Pain 2 years after TKR

[Newboots]

What a shame you haven’t got more supportive people around.So unhelpful when they don’t know or understand what you’re going through. Tell them all to watch the knee replacement video.
I managed on my own after two weeks if it’s any consolation but it’s hard going.
And you take those pain meds for as long as you can .The sickness thing is not great either . I found that it wore off after about 2 weeks.
Will you get daughter help over Christmas? Hope you do.
I’m still doing the ‘ it will get better ‘ mantra although not in great pain I’m not progressing as well as last time.
Just keep thinking of the summer when going out for a walk will be a purely normal thing!

 

[Mom2Lucy]

Hi @Mollymax, reading about your pain level makes me wonder if you need a different med than morphine, it doesn’t seem to be working all that well for you. My first two or three weeks were misery, the first med I was sent home with didn’t help much, I was in agony. After nearly a week, the OS changed it, and the relief was readily apparent. But he didn’t want to refill it after five days! Relented and gave me another five days worth. That was it.... Canada is very hung up on the opiod crisis, and I believe it’s making pain management almost redundant. Hang in there. And I wish your husband could actually feel the pain that you’re in. That would be such an eye opener for him.

 

[SusieShoes]

I’m sorry your husband is being less than supportive. After seeing you through your last surgery, he should be more understanding. The first weeks are rough for anyone.

Stay with your pain control and keep on top of your resting, elevating, and icing schedule. These things will work to reduce your swelling and help keep the pain down. You’ve been down this road before, so you know what to look for. As for all those other people... someday they might be asking you for advice on dealing with this!

 

[schpooko]

@Mollymax So sorry you are in so much pain. To have people who have not gone down this road give advice or say man up is so insensitive. My OS said this is a hard recovery especially the first four months and my RA says total knee replacement is "a brutal surgery". Those were his words not mine. But he is truthful. It is a hard surgery and I know he has not had TKR in neither knee.

I know everyone is different but sometimes the doctor has to play around with different meds to get pain controlled. I do know tylenol works really well with pain meds. I know all about the opioid crisis everywhere and its so unfair to the people who really need the medication. I asked my OS beforehand about what his situation was with issuing paid meds before my surgery and he told me 90 days. Its a shame you get a time limit to get better!

Feel better and call OS if you need to. Merry Christmas and remember the Bonesmart forum is always here for you... Schpooko

 

[Mollymax]

It's 3.45am and no sleep tonight. The pain is pretty bad in the back of my thigh but worse in my calf. I have had all the pain relief I can take but it's not touching it. Don't know why it's not working. For me I would say pain level is an 8. I just want it to ease off.

 

[Mom2Lucy]

Have you got a cold pack of some sort you can put under the back of your leg, @Mollymax ...I often found ice too cold behind the knee, but once it wasn’t as “icy”, and just cold, it seemed to bring some relief. Just an idea to try, I sure wish that pain would ease off for you.

 

[Dkm]

Hello, I did not have great success with hydromorphone and called my OS office and they switched me to Percocet. It was immediately apparent that was a better drug for me. Really be clear with them if you are not getting the relief you need. One other insight, I also had pain in areas away from the knee, and actually got some of the best relief from a registered massage therapist. I had a lot of tightness knots and spasms going on as my leg was adjusting to the new knee. The pain meds really don't do that much for that it seems, neither does the icing as it was more about tightness than inflammation. I got a tiny bit of relief by using heat in those areas to relax them, while still using ice on my knee at the same time. This was suggested by my PT. If you can get a massage therapist you may be surprised. My next knee surgery I will actually be more proactive about using massage because it was one of the only Pleasant things I have done during recovery. It is soothing and caring and it's something that does not make things more painful and it's not difficult. Apart from finding it useful physically, it was also great mentally and emotionally.

 

[Newboots]

@Mollymax hope you finally got some sleep.Have you tried Tramadol with paracetamol as an alternative.? Josephine recommended it to me as an alternative to co codamol.Maybe Josephine will have some good ideas.

 

[Spex10]

It's time you contacted your doctor @Mollymax. You need to have some advice re pain control. It's possible you need a change of meds. Also we're approaching the weekend and public holiday closures... Phone the surgery today and ask for a telephone consultation. It couldn't hurt...

 

[Mollymax]

Thanks everyone for your concerns. I eventually got some sleep. I know the pain wasn't this bad last time. It seems to stretch my whole leg from hip and thigh right down through knee and calf. My calf is very tight and sore to touch as is my shin too. My foot is black and blue and very swollen which didn't happen last time. Even hubby is starting to get concerned seeing me in so much pain. He is used to me being a strong person. I will see how today goes and if things don't improve then I will contact the hospital ward tomorrow or my own doctor.
Part of me thinks I also have sciatica because why else would my hip be so sore. I am watching the area around the dressing to make sure it isn't becoming inflamed or anything but there is no sign of that.
The morphine is due to run out at the weekend and then I go back onto dihydrocodeine. I have an allergic reaction to tramadol so can't take that. The last one I was out doing daily short walks at this stage. I haven't even left the house yet this time.
I know I turned badly in bed last night and the knee gave a really sharp pain through it which didn't help. Its strange how this knee recovery is so much different from the last one.

 

[sistersinhim]

I bet this knee had to have a lot more work done to it than the first one. This newborn knee had to carry all your weight while the old replacement was healing. Your new knee more than likely had more damage. I do remember reading that it was holding you back from walking after your LTKR.

 

[Josephine]

Here y'go then, Mollmax!

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?

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.

 

[Mollymax]

Today so far hasn't been too bad but I have elevated and iced. Pain meds starting to wear off as I feel knee hurting so time to take more. I have been keeping a diary of the times etc of taking the meds so I don't miss any thinking I have taken them.
@sistersinhim it possibly did need more done to it as you are right I could barely do any walking due to the pain in it. Even everyday steps hurt. Surgeon didn't say, she just said it had gone well and straight forward.

 

[sistersinhim]

Many OSs are great surgeons, but people of few words. Mine was that way. All he said about the recovery was that I'd hate him for a few months! I'd already been on Bonesmart for 6 months, so I knew what to expect. That was a great preparation for a tkr!

 

[Spex10]

'Straightforward' was the word my OS used too. Maybe it's all just routine to them: some knee area tissues are just in better shape than others? Looks like yours took more manipulating about than for your last knee.

 

[Mollymax]

She did say to me that this one was going to be more painful than the first because people tended to find second one hurt more. I couldn't see why but her words have come true. Right now it's my hip that is aching the worst and the pain is going right down my leg. I don't understand why my hip should be so painful.

 

[sistersinhim]

You are walking differently now, and that affects your whole body. Your hip is probably reacting to that different walk.

 

[Mollymax]

@Josephine not sure best way to answer these so will do it as bullet points

1. Right now the pain is about a 7 with it being a 9 during the night

2. morphine sulphate capsules (zomorph) now reduced to 1 x 10mg twice a day due to finish on 24th Dec, 10mg morphine oral every 6 hours again due to finish on 24th, 500mg paracetamol 2 tablets 4 times a day.

3. swollen as photo 2

4. ROM was 80 last night. Don't know extension

5. icing 3 times a day for an hour each time

6. elevate as much as possible while sitting down with it on pillows to raise it

7. doing no housework as hubby doing it, only making myself a drink. Very little walking around the house. Hardest thing is climbing 13 stairs every time I need the toilet. (I didn't have this with other knee as stayed in my caravan then)

8.
heel slides x 8 x2 a day
thigh squeezes x 8 x3 times a day
straight leg raises x 8 x3 times a day

No PT. I don't see physio till 28th Dec.

 

[Josephine]

1. Right now the pain is about a 7 with it being a 9 during the night

At one week out, that's about right but it should be less.

2. morphine now reduced to 1 x 10mg twice a day due to finish on 24th Dec, 10mg morphine oral every 6 hours again due to finish on 24th, 500mg paracetamol 2 tablets 4 times a day.

I strongly suggest you ask your GP to prescribe you Tramadol 50-100mg 4 times a day. It's my belief that Tramadol is terrific for TKR pain management. You should also take it with 2 paracetamol with each dose. I actually created a couple of charts which you might find useful - assuming your GP is helpful!

3. swollen as photo 2

And oyu did factor the swelling in as pain? People often forget to do that.

4. ROM was 80 last night. Don't know extension

You can assess that yourself using this tool
1. put your leg on a bench, seat, bed, floor or anything similar but preferably something fairly firm.
2. with not too much pressure, press the back of your knee down - use your leg muscles, not your hand!
3. slide your hand, palm down, under the back of your knee

a) if you can get your entire hand under easily, it's probably about +10 degrees
b) if you can get just your fingers under, it's about +5
c) if you can get your fingers under but it's a push, it's +0
d) if you can't get your fingers under at all, it's -5 or more​

Here's a graphic to explain the degrees involved

5. icing 3 times a day for an hour each time

3 times a day isn't really beneficial. Ice for at least 40-60mins and more than 4 times a day.

6. elevate as much as possible while sitting down with it on pillows to raise it

same as above

7. doing no housework as hubby doing it, only making myself a drink. Very little walking around the house. Hardest thing is climbing 13 stairs every time I need the toilet.

That's good exercise!


heel slides x 8 x2 a day - people believe that this exercise will improve flexion but it won't! I suggest you don't do it
thigh squeezes x 8 x3 times a day - same with this - it's non-productive.
straight leg raises x 8 x3 times a day - here's a tip. Once you can do SLRs you don't need to do them any more!
No PT. I don't see physio till 28th December - jolly good! I strongly suggest you don't do exercises at physio. Just let them measure you and that's it.

Do note that it's not the exercising that gets you your ROM, it's time. Time to recover, time for swelling and pain to settle and time to heal. One thing that seems to be missing from all the PT's protocols is that all your ROM is there right from the start, just waiting for all that to happen so it can show itself. In the general run of things, it doesn't need to be fought for, worked hard for or worried about. It will happen. Exercise as in strength training is counter-productive and in the early weeks does more harm than good. Normal activity is the key to success.

 

[Mollymax]

Extension I would say following your guide is +5

I am allergic to Tramadol. Had a really bad reaction to it when given it for arthritis so can't take that.

I have dihydrocodeine to go back to once the morphine stops but it's slow release so only twice a day.

Yes I factored in the pain from swelling in the pain score.

That's great I can stop doing the SLR. It took 2 weeks before I could lift my leg last time. Had no problem this time. I will stop doing the other exercises then. As you say my stair climbing countless times a day is enough exercise especially when other knee is still healing too.