TKR Pain Behind the Knee

[pjkopks]

(I actually first posted this under my pre-op question thread. I'm still learning the ropes on here, so if posting this in the way I have now is not the way things are done, please kindly and gently instruct me. I'm just looking for the reinforcement and encouragement this group seems to be good at giving.)

My surgery was last Monday, the 11th. All went well, and I came home on schedule. One of my pre-op worries I obsessed abut was getting up the steps at my house. This group assured me I would be well prepared, and you were totally correct. Despite having one previous ortho surgery, I feel I was incredibly naive about the pain level of this procedure. I do not tolerate the pain meds all that well. They make me nauseous, so I have Zofran, but then that adds to the sleepiness. You all know the cycle.

I think I vastly overdid it today for five days out. Because I feel miserable from the side effects, I opted to try to manage on Tylenol only during the day. By about 4, I took a pain pill, so I "let the pain get ahead of me" as the common saying goes. I also pushed myself too hard with the PT I was taught at the hospital. What is wrong with me? I have a brain. So tomorrow, my plan is to take the commonly given advice---take my pain meds on time and not push myself.

I am keeping ice on my knee most of the time. Until today, I had very little swelling, but today my ankle and knee are clearly swollen. I'm just kiind of doing my own therapy with this entry: use my brain, do what the common directives say to do, backing off pushing myself, and giving myself healing time. I've cried a lot today off and on, feeling like I am missing spring, missing grands, missing being with family for Easter, missing life. Thanks for letting me vent.

 

[NightQuilter]

@pjkopks welcome to the other side! It does take a bit of time to both get into the sync of pain management and trying not to be a superhero. Recovery is no race - every person and every joint recovers differently and at its own pace. You know the BoneSmart pain drill - Rest, Ice, Elevate, & stay ahead of the meds. With respect to PT, there are MANY who say "forget about it!" Why, because our DAL (daily activities of life) are plenty of activity for a brand new knee - getting in and out of bed, to and from the toilet & shower, and preparing meals. While it may seem like you are missing out of some the the usual joys, remember that once you allow your knee to heal properly, you will be able to enjoy all those activities and grands so much vigorously for a much longer time!

 

[glidefloss]

Hi @pjkopks , it's towards the end of my 2nd post-op day and things really started looking up for me this noon. Prior to that I was behind the pain curve and last night I took 1 50mg Tramadol tablet which, along with Tylenol/Advil (1 tablet each) every three hours, I was able to get ahead of the curve. From level 8 to level 2-3 now. That said, through morning today, my left leg was so unstable that going downstairs ... and then upstairs ... wasn't the most fun thing. I then spent most of the afternoon icing (2 1-hour sessions) and elevating and massaging my leg downwards to flush out the excess fluids (they make their way to lymphatic system and on to the bladder.) I used a yoga strap to pull my leg up, held on to the straps with one hand and used the other hand to massage the leg. I must have spent a cumulative time of an hour doing that. By dinner time, my leg felt stable and going down and back up the stairs was no longer an issue.

From my own experience --- please remember that we are all different and our bodies can respond very differently to different things --- icing is of little use for me, especially in re swelling reduction ... but I'll continue to do it just because; elevating is very helpful, the higher the elevation the better; massaging while elevating was "gold" for me.

I've not really done any of the exercises the hospital PT gave me ... yet ... my plan is to aggressively address swelling and either tomorrow (day 3) or day after, leg willing, I'll start doing them ... with not very swollen legs (I hope).

Finding something that works for you is a blessing. When I had my RTKR 4 months ago, I fumbled around a lot trying to find something that did the job for me. I'm applying many of the lessons learned from the first knee.

I hope you get ahead and stay ahead of your pain curve and find a good way to handle swelling, etc.

All the best on your recovery!!

 

[Jaycey]

@pjkopks Welcome to the other side! It is sometimes hard to find your own routine in the early days of recovery. Keep trying - you will soon find what works for you.

Staying ahead of the pain will let you increase your mobility. Ice and elevate to decrease the swelling that is causing pain and limited mobility.

Here are your recovery guidelines:
Knee Recovery: The Guidelines
We are all different, as are the approaches to this recovery and rehab. The key is, “Find what works for YOU.“ Your doctor(s), physiotherapist(s) and BoneSmart are here to help. But you have the final decision as to what approach you use.

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 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 a 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 history before providing advice.

 

[MonarchMom]

Just some ideas, but can you get outside for some fresh air? Even if just to sit and enjoy spring for a few minutes. Or by an open window if you can’t? Listen to the birds and sounds of people and nature. Maybe schedule a future visit with grandkids or phone them when you’re feeling more rested. We have the same surgery date! I’ve started backing off the heavy-duty pain meds so am checking here often for help, advice, and encouragement. I have to wear stockings so not looking forward to changing them tomorrow! But icing is definitely worth it!! And taking rest days!!

 

[InkedMarie]

Good morning! It sounds like you know what to do now. Why are you missing family today, Easter? *If* you’re up to it, show up in time for dinner, stay as long as you can and go home. My surgeon told me to be as social as my body tells me to be. Three days post op, I needed friends & a bonfire so we brought my ice machine, extension cord and Lounge Doctor wedge to elevate and I spent little over an hour and it did me a world of good.

Marie

 

[Jockette]

I've cried a lot today off and on, feeling like I am missing spring, missing grands, missing being with family for Easter, missing life.

Post op blues is a reality - be prepared for it

Post op blues is feeling depressed, weepy, nervy, shaky, fearful of the future, anxious, overwhelmed by what is happening to you, convinced it's never going to get any better and finally, uttering that most intense of all cries "I wish I never had this done!" It arises out of a variety of...

bonesmart.org

 

[MarkTKR]

Hello my friend!

This process is about learning. If we all knew exactly how our bodies would respond to everything we would know the exact meds needed and exactly how much PT to do and all that. But we don't. You have to learn.

The admins here are great and they have a wonderful list of good solid advice articles. But like you are learning, nothing will be exactly right for you. You need to learn what you need and can tolerate.

When you overdo, you learn a new data point. Next time you will not overdo hopefully, or not as much at least.

I also believe there is "under doing". In this recovery process we want to get back to some sense of normality. This means we have to do "something" to get us there. Doing nothing will not. But doing too much can and will actually slow you down more.

So keep a journal. Write down what works and what doesn't review it. Learn and you will take much better care of yourself.

Best of luck!

 

[Jockette]

(I actually first posted this under my pre-op question thread. I'm still learning the ropes on here, so if posting this in the way I have now is not the way things are done, please kindly and gently instruct me.

You are posting fine! I did move a couple of the replies you got (to your post in your pre op thread) to this thread, and since you basically copied that post to this one, I deleted that post in your pre op thread. So, all is well!

Best wishes for a great recovery!

 

[pjkopks]

My thanks to those of you who took the time to respond. Today looks a little brighter (although it is really, really cold and dreary here). I have a wonderful husband who is being a rock star with his help and tolerance!

 

[MonarchMom]

My husband held the puke pail last week! He was a trooper to do that without complaining. My daughter is home in between exams and she washed my hair today over the laundry tub. I feel human again!!

 

[FourCats]

@pjkopks stop beating yourself up! You did what all of us have done at some point. Take it easy for a few days, continuing to ice frequently. Every day will bring some Learning, not always positive but we learn from the negatives, too.

Keep visiting the forum, posting questions, successes, not so good choices, and vent all you need to. We get it!

 

[NightQuilter]

I see others have commented on the swelling and massage to process fluids out. Huge fan of that! The swelling adds significantly to the pain and stiffness. I had a friend with her own massage table who specialized in lymphatic and shiatsu massage. Although I only wanted her to come over so I could get on her table and stretch (since the floor was so far away), what we learned was her massaging got all that fluid worked gently through the knee compression and by my week 3 follow up with the OS, he was shocked I had minimal swelling. She just worked very carefully around the knee so as not to move the stitches at all. I also am an advocate of letting gravity help - I used to lay on the couch with both legs up against the wall and read for hours to help drain the lymphatic fluid through the tight knee joints.

 

[pjkopks]

I am a week out, and my PT told me yesterday he thinks I am doing well. His comments were reassuring. I still feel like I am in so much pain. Maybe I have tried to back off some of the pain meds too soon. The narcotics make me feel a little nauseated and very fuzzy, so I have tried doing without them during the day except just before PT. Too soon? I am about to decide the side effects may be worth it afterall. Every muscle in my leg hurts. My knee was very constricted prior to surgery which may account for why the muscles hurt so much now. I am pretty much at 0. Something had to have been stretched mightily for that to happen!! On the other hand, I am dubious that I am even at 85-90 at this point. They said I was at the hospital, and the PT guy gave me credit for 86, but I feel like I have regressed since that (only a day ago). Every stinking part of my leg hurts to touch. It aches. Is this normal? Should I go back to taking the pain meds every 4 hours?

 

[Jockette]

the PT guy gave me credit for 86, but I feel like I have regressed since that (only a day ago).

Your bend will vary depending on swelling, and this is very early days, so dont worry about it.

Every stinking part of my leg hurts to touch. It aches. Is this normal?

Yes!

If you are in pain, and have a medication that helps you, then I would take it. Sometimes we do have to put up with some side effects (depending on what they are) to get the pain relief we need.

Another way of controlling the pain is to not do things that increase it. Be careful with your activity this early.

Taking a pain medication before PT could mask the fact that you might be doing more than your one week old knee is ready for, and then later on that increased pain hits you. By not taking that medication right before PT, you’ll be more aware of a discomfort before it becomes a full blown pain.

 

[glidefloss]

Hi @pjkopks , what you're going through with all the muscle aches and pains are pretty much what I'm going through as well - and I'd worked really hard in the weeks leading up to my LTKR to strengthen my legs as well as stretch them as "lengthly" and deeply as possible -- and yet the muscles are super tight and sore even as I've done Zero exercises so far (I'm day 5 post-op).

With my RTKR, I jumped into rehabbing from day two and experienced basically the same aches and pains ... leading me to now conclude that the soreness and pain are mainly due to the trauma caused by the surgery.

All the best on your journey!

 

[Jockette]

leading me to now conclude that the soreness and pain are mainly due to the trauma caused by the surgery.

Pain/Stiffness/Tightness is a normal occurrence after this kind of major surgery. Your surgeon did major carpentry work and disturbed every millimeter of soft tissue in this area. You aren't tight because your muscle is underused and needs to be stretched and rehabbed. You're tight because your tissue is healing...and full healing takes a full year or more.

 

[pjkopks]

Thank you, friends, for your responses. I am feeling really naive. I thought I was prepared, but this has been so much tougher than I thought it was going to be. I've had a foot surgery before, and it was no picnic, but I really think this first week after tkr has been worse.

 

[sistersinhim]

We ladies have often said that this recovery is worse than having a baby. The pain for both is awful, but a knee replacement's awful pain lasts for weeks or even months. The best thing for your recovery is to keep the swelling and pain down. This allows for the healing to begin easier. Your first month, at the least, should be spent concentrating on icing and elevating, not a lot of exercises. Your ADL, (activities of daily living), is all you need in a brand new baby knee. That is the only way I healed after 12 knee surgeries.

 

[glidefloss]

We ladies have often said that this recovery is worse than having a baby.

I've heard a number of TKR'd women say that, so I guess there's something to it! Then again, as one of 8 in my immediate family, and as one of ~70 first cousins on my Mom's side, I grew up thinking that having a baby was no big deal ... else why would my Mom and Aunts have so many! That all changed when I was present with the delivery of my first kid ...