TKR Pain increasing at 5 months


new member
Jan 19, 2019
United States United States
I am a 75 year old woman and two and a half weeks out from my TKR and am doing remarkably well except for being unable to sleep for the past week. My home PT is concluding today and I my ROM is already 115-105. I had a doctor's appointment this week and half of my staples were removed--the rest to be removed in another 5 days. My problem is a painful burning sensation and tightness in the skin around my incision that doesn't respond to either the over the counter or prescription pain relievers at night. It doesn't seem to be a problem during the day and most days I take no pain relievers at all. Once I get up and moving, the pain and stiffness go away but nighttime is another story. I use an ice machine that sometimes helps but I can't get into a comfortable sleeping position to allow me to fall asleep.. I was able to sleep the first week and a half after surgery but not now. I try to nap but again, I can't seem to fall asleep. I am so tired. Also, my doctor thinks that because I am doing so well that I do not need outpatient physical therapy. My home PT thinks I should go for at least a few weeks as I am still not walking correctly without my cane and need to get on a treadmill, walk backwards and use an exercise bicycle.
:welome: to BoneSmart

Maybe it will improve when the 2nd set of staples is removed. Or, sadly, it may be just a question of time.

In the meantime:

Knee Recovery: The Guidelines

We are all different, as are the approaches to recovery. The key is, “Find what works for YOU.“ Your doctor(s), physiotherapist(s) and BoneSmart will offer advice and are there to help. The advice may vary, but YOU are the final judge as to the recovery approach you choose.

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:
take your pain meds by prescription schedule (not when pain starts!)​

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

5. At week 4 and after you should follow this

6. Access these pages on the website

The Recovery articles:

There are also some cautionary articles here

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.
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At only 2.5 weeks out your PT is just not on! There is no way you should be on a treadmill, walking backwards or using an exercise bike this early. Please stop all this and let that poor knee heal.

Focus on ice, elevation and rest. You are not in training - you are healing. Your gait will improve once that knee calms down.
Hi and Welcome!

Please tell us your surgery date and we’ll make a signature for you. :flwrysmile:

Here is another reason you can’t sleep:
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Thanks everyone. My surgery date was 11/29/21. I don't think the PT was thinking of aerobic exercise on the treadmill at this point but just a safe place to practice walking since it is winter. I wish I could nap but that seems to be elusive, too. I had a hip replaced three years ago and I couldn't sleep for a month but it had nothing to do with pain. I had read where that sometimes that is a side effect of general anesthesia which I had. The time I had a spinal block --haven't read anywhere where that might be a side effect. I know I will get through this and looking forward to having the remaining staples removed.
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@kspach Hello. I had a spinal for my TKR and sleeplessness is still an issue, it seems to be a side effect of the surgery no matter which anaesthesia was used. Nap when you can if you can , I am not good at taking naps myself. The burning sensation and tightness might be down to your incision healing, it might improve once the rest of the staples are removed. I found it difficult to sleep under the covers at night, they were too hot and heavy on my leg, the compression stockings were very warm. I ended up sleeping on top of the covers with a fleece blanket covering me , leaving my legs exposed- it also made it easier to elevate my legs at night. The sleeplessness does improve gradually, at over 10 weeks after surgery I am able to get about 5 hours in one go which compared to days of no sleep at all is an improvement.
Happy Healing.
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@kspach - I had/have the burning sensation and sensitivty to anything touching my surgical knee. I remembered this herbal pain lotion a chiro recommended to me once, Arnican, and that has worked wonders for me; I only use it on the side of my knee that I feel the most burning on, you CANNNOT use it on the wound, but it works for me. I use it at bedtime to help with sleep; I also could not sleep and was getting pretty ornery from it so I adjusted my meds. Once I was off the 12 hour release morphine I went home with, I used the dilaudid to sleep - I took one before bedtime and together with the Arnican I was able to sleep again and it's a game changer of course if you can get restorative sleep while recovering from all this. At 5+ weeks I am using only Xstrength Tylenol, still icing and elevating, doing PT and exercise bike (floor) as it's too cold outside for me! I hope you find a way that works for you to get some sleep it is so important!!
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I am 75 and five months out from a TKR. Surgery and PT went well. Now that it is spring I am hiking, including going up and down hills several times a week, and increasing the pace when I walk the dog to what Fitbit calls cardio burn (30 min.). I noticed that I have a little more pain and stiffness walking down stairs, getting up from sitting, and my hamstring, back of knee and calf are more sore than a month ago. My non-operated leg feels fine. Is this probably a result of increase exercise?
Yes, it is most likely that you have increased the hiking a bit faster than your knee is ready for. This recovery does take an average of a year, so you are still not quite halfway healed.
By the way, I merged your newest thread with your original recovery thread, as we prefer that members in recovery have only one thread.

This benefits you because all your information is in one place, easy to find, and maintains a nice journal for you.

This also benefits our staff, as your information is all in one place, and we often go back through your thread for previous details, so we know what you‘ve been through which helps us advise you better.

So, please keep all your posts in this thread. If you’d like a new title, let us know what you want, and we’ll change it for you.

Many members bookmark their thread in their computer browser, so they can find it when they log on.
How can I find my threads and posts?

Best wishes on your continuing recovery! :flwrysmile:
I was going to write this up earlier but got busy preparing for my upcoming shoulder replacement. My TKR (Nov. 30, 2021) healing was progressing well for the first 41/2 months and then this spring I started going backward in my recovery. I never did get to the point where going up and down stairs was comfortable and I always had to make a conscious effort to not go one step at a time. Some days because of the pain, particularly going down, I had to just do one step at a time.

I noticed the swelling around my knee seemed to be getting worse so I went back to my surgeon. He withdrew a lot of bloody fluid off my knee, did x-rays, and ordered blood tests to see if I had an infection. Everything came back fine and he figured I had just injured myself.

Several times over the next two months there were days when I had to use a cane and three times I needed a walker. I always walk my dog for about 2 miles every morning, always felt good starting out but I could tell if I was going to have a bad day during the last part of the walk as the back of my knee would start to stiffen up. Within an hour I was either using a cane or on really bad days the walker to safely get around. Steps were painful on those days.

Fast forward to mid-July, my sisters and I always have an annual get-together where on the 2nd day we have some sort of outing. I was in having a bad day on day 1 and having to use a walker to get around, although I assured everyone I would probably be fine after a good night’s sleep which was always the case. Sure enough, the next day I was good to go. We decided to go to a ledges area in Cuyahoga Valley National Park where we used to go as children for picnics and hike along the ledges. None of us remember how difficult the trail was—after all, we were children and it was easy. Our ages now range from 74-86 and we almost turned around getting down to the trail as it was filled with tree roots and very uneven, but we continued thinking it would get better. It did not and we hiked for almost 2 miles over tree roots, rocks and through big boulders in the path. Several times we had to wait for younger hikers who came along to help us navigate the terrain. I had brought a hiking pole and we often passed it back and forth trying to get through difficult areas. I kept saying that if my surgeon knew what I was doing he would probably drop me as his patient! We made it with no injuries, luckily. Anyway—ever since that day, I have had no more pain doing stairs, which I now do without thinking the normal way, and no stiffness behind my knee ever—I feel like I have a normal knee. I have no idea what happened or why it happened basically overnight. I was thinking I may have to postpone my TSR if I still at times needed a walker to get around. But all is good.
Wow, that is an amazing, sudden recovery! You mention Cuyahoga, is that in Ohio? I used to live in Cuyahoga County in Ohio and I‘ve been to the ledges there, and I can totally picture the trail you described.
I have no idea why that strenuous trail caused your knee to 'snap back' to normal. Whatever caused it, it was certainly a blessing!
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Jockette--yes, in Ohio. I grew up in Kent, Ohio and my parents then moved to Hudson, Ohio when I was in college.
We went to Whipps Ledges. This was several years before my PKR and the trail was rougher than I expected, but the views were fantastic! We took some photos and we look like miniature people next to the huge rocks.
Anyway—ever since that day, I have had no more pain doing stairs, which I now do without thinking the normal way, and no stiffness behind my knee ever—I feel like I have a normal knee. I have no idea what happened or why it happened basically overnight.
The body is a complex adaptive system and maybe the chaotic nature of the trail was just the stimulus yours needed to get past a stalled spot in the healing process.

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