TKR Pain and swelling!

[Layla]

I am only able to sleep for about 60 minutes at a time and then in horrible pain the rest of the night.

You definitely need to touch base with your surgeon's care team on this.
Thankfully you have five weeks for things to improve, recovery to progress, sleep to regulate. Try not to stress (easy to say) because anxiety never helps anything. A lot can change over the next five weeks, and it's not uncommon at all to have pain, stiffness and to struggle with sleep at this point. First, you need adequate pain control so you are able to remain comfortably mobile and you're relaxed enough at bedtime to fall asleep.

You mentioned taking Meloxicam 1x daily. We often recommend Extra Strength Tylenol 1,000 mg 4 times a day at 6 hour intervals because most meds only remain fully effective in the system for 4-5 hours, no matter what the dose. That gives the pain time to build so the next dose takes longer to be effective. So this may be something you can talk over your OS's care team. Also, it's advised to stay within the safe range of no more than 4000 mg in any 24 hr period. You must also calculate anything else containing Acetominiphin into the 4000 mg so you're not exceeding that amount.

If you're concerned with increasing or adding more medication, consider Magnesium which can support muscle relaxation and nerves. Also, promote healthy sleep (falling asleep and staying asleep. Others have tried Melatonin and even various herbal remedies in the form of teas which are readily availabe at most grocery stores.

I wish you luck and some well deserved restorative rest. Please stay in touch and let us know how you're doing.

 

[mendogal]

Insomnia is a real bummer for many of us in the initial weeks after knee surgery. Definitely sleep whenever (and wherever it's safe and comfy!)

Icing, elevating, napping.... All help, but for some of us it was endangering our mental health. Before it gets there consider some nonprescription remedies....

If you're lactose tolerant, a glass of warm milk! If you're not diabetic, a teeny bit of honey makes it even more comforting... plus milk is high in magnesium! Helps us relax!

If you aren't a milk drinker, or want an easier way to, an evening magnesium supplement has been very helpful for some members.

OTC diphenhydramine, an antihistamine also used as a sleep aid (Benadryl) because it makes you drowsy; it's also included in some cold, flu, etc "nighttime" combination meds.

Low dose melatonin, sustained release - not for long term use but I have used for a week at a time without ill effect. It should be taken an hour to hour and a half before going to bed, and during that time stay in a dimly lit area to allow this hormone to activate.

Valerian root - an herbal remedy, it can be taken in capsule form but that dose might be high compared to my preference, herbal "sleep" blends that include a smaller dose of valerian and make me pleasantly drowsy. Plus the other tea flavorings make it nice tasting! Celestial Seasonings and Traditional Medicinals sell teabags by the box. Their sleep blends without valerian have never ever made me sleepy.

Personally, I was in your desperate situation, and the one thing that worked for me was taking the melatonin immediately after drinking the valerian herbal blend, then relaxing in a dimly lit room. Asleep in an hour, slept five hours.

 

[Jamie]

You have received several good options to consider. Please be sure to coordinate any supplements or herbal medications you want to use with either your surgeon or your GP. There can be reactions with both prescription and over-the-counter products that need to be evaluated by a medical professional. Your pharmacist is also a good resource for these things.

 

[MandyJed]

It sounds like you might be under medicated, I suggest you ask your doctor about Tylenol, which can be very helpful for post op pain.

Thank you for your recommendation. I called my doctor yesterday and they did recommend I take Tylenol every 6 hours to help keep the pain from “building” during the day and night. Hoping this will help.

 

[MandyJed]

Again - thanks so much to everyone who replied and gave me suggestions. I appreciate each one so much.
I have one more question about using heat on my leg - not directly on my knee. I am having issues with the muscles in my thigh and calf being so tight and cramped up that I am unable to walk correctly or bend my leg. I have read different things about using heat in combination with ice on the knee. Does anyone have experience with using heat?

 

[benne68]

It's okay to use heat on your calf and thigh -- just keep it well away from your knee, @MandyJed,.


Are you attending PT? If so, suggest you discuss it with your therapist, who can help.

I'm at about the same point in recovery and also have problems with muscle tightness in my calf and thigh. I spoke with my PT about it. He did some very targeted massage and it helped a lot, so he recommended that I buy myself a small vibrarting massager to use at home. Here's a photo of the one I ordered:

I've been using it twice a day for the past 3 days and already have noticed improvement.

 

[MandyJed]

I’m a 52 year old woman and had right TKA on December 13th after several years of early onset arthritis and previous knee procedures and meniscus surgeries. I posted on here several weeks ago and the responses have been extremely helpful. I couldn’t figure out how to post onto that thread so I’m sorry if I did not do this correctly. I have been doing PT 2-3 times a week along with lots of exercises and stretching, etc at home. I’ve made progress but it seems like it is so slow. I am still struggling with some pain, extreme stiffness and terrible sleep. I am an elementary school EL teacher and required to walk 7000-9000 steps a day at work including outside duties, etc. i feel like I should be able to go back to work but I can barely walk around my house and short walks outside without swelling and pain and stiffness. Twice in the last week i have stumbled and almost fallen. My PT says she thinks it is because my quad muscle is extremely weak. I am wondering what is the average time people return to work? I meet with my surgeon again tomorrow and will discuss with her but I don’t know if my situation is normal for those returning to work or if I should wait for a few more weeks.

 

[sistersinhim]

Hello @MandyJed,
You'll notice that I have merged your two threads together as it's best if members in recovery only have one thread. We find it much easier for everyone.
This is because:

• That way, you have all your information in one place. This makes it easier for others to go back and review your history before providing advice.
• If you start new threads, you miss the posts and advice others have left for you in the old threads, and some information may be unnecessarily repeated
• Having only one thread will act as a diary of your progress that you can look back on.

Please keep all your questions and updates on this thread. We won't miss your new question as, between us, the staff read all new posts each day.
If you need an urgent response to a question, tag a member of staff.
Tagging other members and answering tags

If you prefer a different thread title, just post what you want and we'll get it changed for you.

Here are the instructions on finding your thread, How can I find my threads and posts?

A helpful hint - Many members have found it useful to bookmark their thread so they don't lose it.

 

[mendogal]

At six weeks postop you're still very early in the healing process. It IS slow and there's no way to speed it up.
It's very easy to slow it, however, by overdoing it. My concern is that in your concern about return to work you and your PT are rushing you.
Even a minor sprain or strain needs 6-8 weeks to heal, during which time overusing the area will reinjure it and create setbacks. That's why minimal exercise is best, just walking, activities of daily living, and very slow gentle stretches are best.
A knee replacement isn't a sprain or strain. Bones, muscles, tendons, and ligaments have all been traumatised. That's why our surgeons, sometimes grudgingly, admit it takes a year to really recover.
Having a my first TKA just a year ago, and my second seven months ago, I agree!

Can you do a phased return to work, starting no earlier than 12 weeks and very part time? That seems to work for some of our members, plus time and space to ice and elevate at work.

 

[mendogal]

Here's a good post about phased return to work.

Painful stiffness and poor sleep are unfortunately common for many of us at six weeks. Cutting back on activities while increasing icing and elevation are very helpful.

Insomnia is a real bummer for many of us in the initial weeks after knee surgery. Definitely sleep whenever (and wherever it's safe and comfy!)

You might consider some nonprescription remedies....

If you're lactose tolerant, a glass of warm milk! If you're not diabetic, a teeny bit of honey makes it even more comforting... plus milk is high in magnesium! Helps us relax!

If you aren't a milk drinker, or want an easier way to, an evening magnesium supplement has been very helpful for some members.

OTC diphenhydramine, an antihistamine also used as a sleep aid (Benadryl) because it makes you drowsy; it's also included in some cold, flu, etc "nighttime" combination meds.

Low dose melatonin, sustained release - not for long term use but I have used for a week at a time without ill effect. It should be taken an hour to hour and a half before going to bed, and during that time stay in a dimly lit area to allow this hormone to activate.

Valerian root - an herbal remedy, it can be taken in capsule form but that dose might be high compared to my preference, herbal "sleep" blends that include a smaller dose of valerian and make me pleasantly drowsy. Plus the other tea flavorings make it nice tasting! Celestial Seasonings and Traditional Medicinals sell teabags by the box. Their sleep blends without valerian have never ever made me sleepy.

Be aware: even benign herbals and supplements can interact with your routine or post op prescription meds, either making their effects weaker or stronger. If you're on meds you may want to check with your doctor or pharmacist, or even check online for interactions.

 

[MSuki]

I think going back to work at 6 weeks might be doable for some at a desk job, particularly if you could work from home and have easy access to ice. For a job like yours where you’re on your feet it might be more like 12 weeks. Not what you want to hear I know. Everyone is different so your mileage may vary, but from your description it is very clear that right now you need to slow down and get some rest. As @mendogal pointed out, overdoing exercise will not speed up your recovery.

The thing is, most of recovery is your body healing from the trauma of surgery. You can’t speed that up through exercise. And if you overdo, it just causes extra swelling and pain. Be gentle with yourself and see if you can work out a later return to work.

 

[lrj]

I had trouble sleeping as well. I was off the good pain meds about a week out. My problem was not related to pain. I was on Eliquis (blood thinner) for 30 days post op. Once I was done with the blood thinner, then I started sleeping better.

 

[MandyJed]

I think going back to work at 6 weeks might be doable for some at a desk job, particularly if you could work from home and have easy access to ice. For a job like yours where you’re on your feet it might be more like 12 weeks. Not what you want to hear I know. Everyone is different so your mileage may vary, but from your description it is very clear that right now you need to slow down and get some rest. As @mendogal pointed out, overdoing exercise will not speed up your recovery.

The thing is, most of recovery is your body healing from the trauma of surgery. You can’t speed that up through exercise. And if you overdo, it just causes extra swelling and pain. Be gentle with yourself and see if you can work out a later return to work.

Thank you so much for your response. I am such a type A person and teaching/education is so hard right now that I have felt so incredibly guilty for taking this time off. I think you are right - I am not going to get better if I don’t allow myself to heal.

 

[Layla]

Hello MandyJed,
I hope the pain, stiffness and sleep have all improved as you inch your way closer to returning to work.
With any luck you're able to do a phased return, but not certain if that's an option as a elementary teacher.
It is two months to date since your TKR. Happy Two Month Anniversary! I hope you have a good week.
@MandyJed

 

[Layla]

Hello MandyJed!
How are you doing at this milestone of three months post op? Please let us know as time allows.
Hopefully you're pleased with your progress and feeling stronger and steadier on your feet with each passing month. Happy Three Month Anniversary!
@MandyJed