TKR Pain and stiffness - when does it ease up?<

[GrammyC]

Sure, I don't mind answering the questions.
1. Pain level right now is 3-4, stiffness mostly, tightness and some aching behind the knee.

2. The only thing I'm taking for pain now is one oxycodone at bedtime with one 3 mg melatonin so I can sleep. I'm not sleeping well, not because of the pain so much, but because it's hard to be comfortable. And after about an hour and a half or so I wake up to change position and then I have to get up and pee. So my sleep is interrupted a lot all night long. I can't take ibuprofen because I'm on Feldene for fibromyalgia pain and it's in the same family of drugs. Tylenol doesn't really help much if I need a little something else during the day. But if I'm really uncomfortable or having pain I can take another oxy or a 1/2 of one.

3. I'm icing and elevating off and on during the day, probably about 3 times a day. I actually just ordered a leg elevator from Footsmart because I saw one like it on this forum. I'm sure it will be easier to elevate my leg on that than on the pile of pillows I've been using.

4. I elevate more than I ice so maybe 5 to 6 times a day, pretty much when I'm sitting I elevate it.

5. Yesterday my PTA got me to 113 flexion and 4 extension. I can get myself to that general range (I don't have a
way to measure it on my own but I'm guessing) or near that when I do my stretches. But it hurts a lot to to get to that point.

6. I think I'm doing pretty well with the swelling, maybe between slight to moderate, closer to moderate I think. I'll try to post the picture I took yesterday.
The full image is really huge so I put this thumbnail here.
7. I'm up walking in the house and doing very light housework, dishes, wiping counters in the bathroom and kitchen, taking trash out, feeding my dogs and taking them outside to the dog run. I haven't been given the OK to drive yet so I haven't gone shopping or running errands (hopefully soon). I've had friends pick me up and take me to lunch, and we did go visit my daughter and grandkids over last weekend.

8. Still getting in home PT.
I'm doing stretches 3 times a day, straightening with pushing down on my knee and holding for 30 to 40 seconds 3 times each session.
Flexion stretching also 3 times a day, stepping up onto a small stool and bending as far as is comfortable, holding for 30 to 40 seconds, 3 times each session as instructed by my PT.
Up and down on my toes 20 times 3 times a day.
Marching in place 20 times 3 times a day.
Kicking my foot back towards my bum 20 times 3 times a day.
Leg extensions from knee down about 15 times, 3 times a day.
Straight leg raises 10 to 15 times about twice a day. (Quad sets)
Heel slides when I'm sitting at random times when I think to do them.
Yesterday we added going up and down 3 steps twice a day. I do go down two steps to take the dogs out to the run when I take them out. They're in a fenced area, no leashes to get tangled up in.

 

[Josephine]

1. Pain level right now is 3-4, stiffness mostly, tightness and some aching behind the knee.

That's about right for 8 weeks out.

2. The only thing I'm taking for pain now is one oxycodone at bedtime with one 3 mg melatonin so I can sleep. I'm not sleeping well, not because of the pain so much, but because it's hard to be comfortable. Tylenol doesn't really help much if I need a little something else during the day.

Honey, you're uncomfortable because you have pain though maybe low grade. And a pain score of 3-4 still needs to be medicated. I don't believe that one oxycodone per day is adequate. You also say that Tylenol doesn't really help much but I'd be interested to know how much you'd taken. MY experience with you US ladies is that you tend to only take one regular T so little wonder it doesn't work! The proper dose is 1,000mg every 6hrs which is 3-4 times a day. If I'm right, then do try them as I've suggested and then tell me they still don't work! But even so, I still think you need a dose of oxycodone in the morning as well as at night.

3. I'm icing and elevating off and on during the day, probably about 3 times a day.
4. I elevate more than I ice so maybe 5 to 6 times a day, pretty much when I'm sitting I elevate it. I actually just ordered a leg elevator. I'm sure it will be easier to elevate my leg on that than on the pile of pillows I've been using.

That's not enough but you never answered the question fully as I also asked "for how long". Assuming you're only doing something like 20-30 minutes, I'd advise that you accomplish little or nothing in 20 minutes. Ice and elevate more, for at least 40-60mins and more than 4 times a day.

6. I think I'm doing pretty well with the swelling, maybe between slight to moderate, closer to moderate I think

From your photo, your swelling is huge! This needs more intensive icing and elevating.

5. Yesterday my PTA got me to 113 flexion and 4 extension. But it hurts a lot to to get to that point.

Under no circumstances let the PT push your leg. It's counterproductive in the extreme. It causes more swelling and thus blocks the ROM. Nothing you do in activity or PT should cause pain - ever.

7. I'm up walking in the house and doing very light housework, dishes, wiping counters in the bathroom and kitchen, taking trash out, feeding my dogs and taking them outside to the dog run.

Okay, a little too much and I'll warrant you've been doing all this for a few weeks, yes?

I do go down two steps to take the dogs out to the run when I take them out.

That's okay.

My comments in bold
in home PT
exercises 3 times a day - make it once a day at most and none at all at the weekend
straight leg raises 10-15 times - a little tip, once you can do SLRs, you don't need to do them any more!
up and down on my toes x20 - that's a very punishing exercise and I don't recommend it so you should leave them out
marching in place x20 - also a very punishing exercise and I don't recommend it so you should leave it out
kicking my foot back x20 times - I've never really figured out the point in this. Activities of daily living accomplish this very well

straightening with pushing down on my knee, holding for 30-40 seconds
leg extensions from knee down x15 times
- these are both extension exercises and you don't need to do more than one! In fact, I'd go so far as to say you don't need to do them at all as activities of daily living accomplish this very well

stepping up onto a small stool and bending as far as is comfortable, holding for 30-40 seconds, x3
heel slides at times when I think to do them
- these are both flexion exercises so you really only need to do one of them. Plus doing 3 intense sessions a day (or even one) is less effective than doing them a few at a time frequently during the day. Read this Heel slides and how to do them.

yesterday added going up and down 3 steps - okay but do them once a day and not at all at the week end.

So my summary is that you need to cut back on your exercises, increase the icing and elevation and your medication. I would emphasise that your sleeping issues are due to low grade pain which is a common phenomenon and is very often interpreted as an inability to get and stay comfortable. Reducing your exercises will also help with that.

Hope this all helps.

 

[GrammyC]

Thank you for your advice and input. My PTA said today that she will be here on Monday and the PT will be here Tuesday and most likely d/c me for outpatient PT so the routines will change. I'm going to try to drive this weekend, only a short trip or two up and down our street to the parking lot at the end of the road and drive around that a bit. My PTA said it should be fine and I should have the strength to do that. Next week on Thursday I see my surgeon and then on Friday I see the surgeon who did my basal joint thumb surgery last May. So it will be a busy week. This weekend I'll ice and elevate more than I've been in preparation for next week. One big issue I'm dealing with is that all the sitting has caused bursitis in my hip in the surgical leg. It's very painful and makes it harder to do the stretches and exercises. But I will definitely take into consideration the points you made and increase my times of icing and elevating.

 

[Timetolive]

My OS told me to go to a deserted parking lot and practice slamming on the brake since that is hard with a RTKR.

 

[jarabas]

Hi GrammyC,

Have you tried icing your hip and spending more time lying down rather than sitting?
This helps with my achy hip. I hope your plan to rest and elevate and ice this weekend brings you relief (I think it will!)
Jan

 

[KarriB]

Or try changing where you're sitting. At one point I had to leave the chair that was my nesting place and move to the sofa or bed because I would get sore.

 

[shrdlu]

I thought I was elevating with my 1st knee-- but my leg wasn't elevated enough. I was only using 2 couch pillows to prop up my foot when sitting in the recliner-- my leg was actually about level at that point versus elevated. Remember "toes above nose." That means if you are sitting in a recliner and look at your feet, your feet should be obviously higher than your eyes. It is easier to elevate in bed, as a few pillows gets the foot/leg high enough-- as long as you don't also pile pillows under your upper body. Elevate as much as possible. When your leg is swollen (it looks larger than your other leg), try elevating all the time versus on a schedule. I kept my swelling down by elevating any time I was sitting or laying down. If I had doctors appointments or had to be on my feet, then I found it took about 2 days of elevation to undo the swelling during those first few weeks. When you are out and about, sit with your leg propped on the couch, chair, bench, or ottoman. I would plan where to sit at fast food places based on the bench's location, so that I could keep the leg comfortably straight. It wasn't elevation, but it kept the leg from swelling more (because I wasn't sitting with the leg bent and hanging down) for those 30 minutes or so. Then once you are home, I would suggest to go lay down and elevate for a bit before you do anything else. I am at 8 weeks post op now, and I still do those things, as it still helps.

When the recliner got uncomfortable, I would move to the bed and elevate. When laying on my back in bed got uncomfortable, I would lay on my side (either one) with my leg on a pillow pile or on my foam wedge. When sitting, I also added a soft cushion in the seat and soft pillows stuffed around my hips, which helped me from getting uncomfortable as quickly. With the 1st knee, I got tired of the recliner (my body ached and rebelled) in about 2 weeks. With my 2nd knee, by adding all the cushions and pillows, I lasted 6 weeks before my body rebelled at the recliner. One of my PTs suggested that using something to support your lumbar (the lower back) also helps with back pain from sitting too much. She suggested that if you don't have a lumbar support, try a paper towel roll or a small rolled up towel. Sometimes pain radiates, so it doesn't come from where you think it does-- so keeping your back happy might also help with your hip.

Good luck with your recovery. Remember-- control the swelling, and your leg heals faster and you help control the pain. Elevate, elevate, elevate.

 

[Josephine]

One big issue I'm dealing with is that all the sitting has caused bursitis in my hip in the surgical leg. It's very painful and makes it harder to do the stretches and exercises.

It's not sitting that causes bursitis, it's bad exercising. Look again at my post - I forgot to emphasise unwarranted exercises by crossing them out. I've rectified that so please check again and cut back on the amount you are exercising at home. You should never ever do exercises that cause you pain.

 

[GrammyC]

Thanks again everyone for your input. I'm spending much more time this weekend with ice and elevating. I haven't done any exercises today. Taking the day off. I did drive for the first time today. I admit it was a little scary at first but I did fine. We were only out long enough to get some prescriptions filled then I iced and elevated when we got home. I've been watching movies all day and just taking it easy. Hoping on Monday when my PTA comes it will make a difference.

 

[Lily0987]

Hello everyone, like Grammy C I am new to this forum. I have spent some time reading many of the threads and articles on this wonderful site. It is the first time I have come across the most sensible advice regarding post operative care for any knee surgery. I read the Bone smart mantra on one of Jamie's posts and I honestly felt like crying with relief.

 

[Lily0987]

Sorry I should say "some physiotherapists" because I should add over the years I have been going to a fantastic girl who is gentle and does incredible deep tissue massage to keep my muscles working. Sadly she doesn't do home visits but I will go back to her when I am ready. I know there are so many good physiotherapists out there so I am not criticising the profession as a whole.

 

[Josephine]

Taking the day off. Hoping on Monday when my PTA comes it will make a difference.

In order to notice any appreciable difference you will need to take off more than one day. One month would be more to the point!