TKR Pain meds not working

[Jockette]

being 42 and a life long athlete and current cyclist, I am in good shape and had no issues with rom before surgery.

Then you honestly have no worries. Your ROM will return as your swelling goes down and as you heal.

Pt has me doing as many leg beds as possible

This is your problem with “low ROM.” Doing this is encouraging more swelling and inflammation which prevents ROM from improving. I don’t understand why some PTs don’t know this.

They also talked about using a dynasplint in the meantime as well?

Most of our members who have tried this found it painful and unhelpful. You can use the search feature to find others who had it.

 

[Jockette]

Here’s what another member just posted:

7 and a half month update
Just been reading some posts about MUA’s being threatened and ROM not coming along as people ( doctors) expect.
This makes me mad as I was threatened with a MUA if I didn’t improve and told I wouldn’t get the movement back if I didn’t.
Well 7 months in I’m still gaining ROM and I reckon I’m at 135 now.

 

[1ethal]

This is insane. How’s this possible??? How can there be such a discrepancy? This should be grounds for medical malpractice the way they are going at this???

 

[Jockette]

That is the $60 million dollar question!

People are all different, as are the approaches to this recovery and rehab. The key is, “Find what works for you.“ Your doctors, PTs and BoneSmart are available to help, but you are the final judge as to the recovery approach you choose.

I think all medical personnel involved in joint replacement should have to learn the Bonesmart Guidelines. There would be better outcomes with less pain in recovery.

 

[mendogal]

The "window of opportunity" is a myth. Here's why.

Some of our members have shared charts of their progress regaining flexion. As you can see, for each, it returned slowly but surely.

Campervan’s ROM history
92 - 8 weeks post op
105 - 10 weeks
107 - 5 months
110 - 6 months
112 - 7 months
116 - 9 months
119 - 11 months
118 - 1 yr
120 - 1yr 2 months

Bertschb’s ROM history
2 months - 80 degrees
3 months - 85 degrees
4 months - 90 degrees
5 months - 90 degrees
6 months - 110 degrees
7 months - 120 degrees
8 months - 125 degrees
9 months - 130 degrees
10 months - 135 degrees
11 months - 140 degrees
12 months - 140 degrees

 

[1ethal]

Thank you for the info. It’s really hard to know what to do. I want to listen to my body but I’m not sure what it’s telling me? I think I’m going to take an easy day and do lots of icing and elevating and see if that helps. This Tuesday is first outpatient pt. We’ll see what kind of torture they do.

 

[Layla]

We’ll see what kind of torture they do

I know you're kidding, please go slow and easy and don't let them push or hurt you.
Remember you're the boss, they're working for you.

As a lifelong athlete and cyclist you're obviously disciplined. PT's should understand that you've spent years as an athlete and likely recovered from some physical challenges during that time so you know how your body responds to effort. It something doesn't feel right, adjust accordingly. Let them know that while you trust them, you're not willing to force your knee into positions that feel beyond your pain threshold, leading to swelling and stiffness and stalling your recovery. See if you can agree on attainable goals within realistic timelines and you will do well. Cheering you on from the sidelines! Have a great week!

 

[EalingGran]

Pt has me doing as many leg beds as possible with a strap around my foot to pull it when I’m stuck. They do t want me pulling too hard, but enough to try and pull it

That just seems hard to me on a recovering knee. I know it seems counterintuitive to let it rest- but I wonder if swelling is making things worse?
Being such a super fit young person- you may be pushing too hard and your knee is rebelling. I never once forced my knee and I only used weights and straps from about 5-6 months. I now have 150 degree flexion which is only a few degrees off my good side.

They also talked about using a dynasplint in the meantime as well? I think it’s a brace you out on that puts continuous force to bend you leg while you’re sleeping?

I don't have any knowledge or experience of this- but I do know sleep is very precious and important for recovery. Would you be able to sleep like that?

 

[1ethal]

First in office pt session. Tomorrow will be 4 weeks out. Haven’t had pain pills in 2 weeks since my surgeon said he wouldn’t prescribe them anymore. Physical therapist thought that was absurd. Measured 65 degrees rom. He said that was not good and most patients are at 90 by now. He said ask surgeon for pain pills because they will not be able to push me in therapy without there being pain. He said if surgeon won’t prescribe, then find a new dr.

I called around and haven’t found a doctor that would take me on and work on a patient who they didn’t operate on. Asked for a referral to pain management. With the holidays nothing seems to be able to get accomplished quickly. Could be weeks before I see anyone. I’ll keep working pt in the meantime.

 

[benne68]

He said ask surgeon for pain pills because they will not be able to push me in therapy without there being pain.

Please ignore this bad advice. Your PT should NOT be pushing you into pain -- especially at this very early stage of recovery. Pushing into pain = more inflammation = less bend.

Please read the articles we've shared with you about
Myth busting: no pain, no gain
Myth busting: the "window of opportunity" in TKR

He said if surgeon won’t prescribe, then find a new dr.

I think you need to find a new physical therapist (not a new doctor) because this one clearly does not understand this recovery.
_ _ _

Also, please notice that I've merged your latest post into your original recovery thread. It's important to keep all your updates in one place. That serves as a diary of your recovery and enables our staff and other members to advise you better. So, please post any updates, questions or concerns here. If you’d like a new title, let us know what you want, and we’ll change it for you. You may want to bookmark your thread to make it easier to find.

For more on how to navigate the forum, you can read through this article:
How can I find my threads and posts?

 

[mendogal]

You 100% need a different PT.
Overworking and forcing our knees delays healing, increases inflammation, and risks harming tendons and muscles.
@1ethal

 

[sistersinhim]

Pain is very manageable aside from right after PT. Then it sucks.

Exercises during and/or afterward is a sign that your knee isn't healed enough to be doing what you have been doing. This causes extra inflammation, which causes more pain and swelling. This reduces your bend, not improve it!

3 week post op appointment wasn’t good. Only 70 degrees of flexion and he wants more than 90 degrees. It If I can’t get there in a week or two he’s going to recommend manipulation - I really want to avoid this.

It's your knee and your right to say NO to the MUA. You are very early in your yearlong recovery. Your knee doesn't need any forcing and it will only cause setbacks.

. I’m stuck at 70 degrees rom and he said possibly perform manipulation if that doesn’t improve over the next couple weeks. Really don’t want to do that.

If you don't want to do this, then don't. All your knee needs is time to heal and no aggressive PT or exercises, they are counterproductive.

 

[Layla]

Happy One Month Anniversary, 1ethal. I wish you were feeling better.
I hope you have a nice weekend and a Merry Christmas also.
Take good care and stay in touch.
@1ethal

 

[1ethal]

Thank you! Things have gotten a little better. Pain is doing ok. Physical therapy still makes it pretty sore but it’s good soreness. Not overdoing it, just working it. Rom is only 72 degrees but I’m going to keep working this process and no mua for now. I’m going to wait and see what time and pt can do for me. Only using a cane to walk so that’s helpful as well.

Still slower than I’d like in terms of recovery but I know I’m impatient. I’m hopeful the worst is behind me as I continue this rehab. Thank you all again for the help through this process.

 

[mendogal]

You're doing ok for a month out!!! You're truly NOT lagging behind.

 

[benne68]

Just keep in mind that those "measurements" are not very accurate. Because of the tool itself, there is a lot of room for human error, which is why it's better to focus on function.

Your flexion may actually be better than the 72 degrees you've been told. You might find the following information helpful:

These degrees of flexion are required for the following activities:
- 65° to walk,
- 70° to lift an object from the floor,
- 85° for stair climbing,
- 95° for comfortable sitting and standing
- 105° for tying shoelaces

 

[Layla]

Still slower than I’d like in terms of recovery but I know I’m impatient.

Probably thought and expressed by each of us at some point early on.
You're doing well, trust the process, you'll get there!

 

[AfterCare]

Thank you! Things have gotten a little better. Pain is doing ok. Physical therapy still makes it pretty sore but it’s good soreness. Not overdoing it, just working it. Rom is only 72 degrees but I’m going to keep working this process and no mua for now. I’m going to wait and see what time and pt can do for me. Only using a cane to walk so that’s helpful as well.

Still slower than I’d like in terms of recovery but I know I’m impatient. I’m hopeful the worst is behind me as I continue this rehab. Thank you all again for the help through this process.

1 month out is really only a very short amount of time.

Regarding your pain issues - I feel you, I've been there. Pain control after the first knee replacement was lousy and after the 2nd it was so bad in my case, I thought I'd rather die. Was taken a LOT of opioids as well, which did not seem to help and in fact really didn't. My PT then also tried to push me and it turned out that during my first month of "recovery" I really did not heal at all and ended up in 2 different ERs by the end of that month.

Btw., I can emphasize with the post bariatric status, though my own surgeon did permit Celebrex pre-surgeries (and post). How this tidbid is being handled seems to vary quite a bit, as I was injected Toradol (NSAID) just a week ago while I was in the hospital and then sent home with more of the same in tablet form.

I also got some genetic testing done following the knee surgeries and found that I carried some mutation which makes opioids to be less effective on me. It probably won't help with your current recovery, but might be good information to have for the future, if this is the case for you too.

Regarding PT, when I just could not deal with the exercises, I finally got permission for pool exercises. That did the trick for me. The difference in gravity provided just enough help, so I could practice my flexion and extension as I needed. Why not ask your surgeon if this is an option for you as well?

 

[EalingGran]

Regarding PT, when I just could not deal with the exercises, I finally got permission for pool exercises. That did the trick for me. The difference in gravity provided just enough help, so I could practice my flexion and extension as I needed

Just be careful in the pool. Whilst it is great for gentle movement it is incredibly easy to overdo things as well.
The couple of times I have tried pool exercises I have been very sore afterwards. I find walking easier to judge my limits.

 

[1ethal]

Hey everyone. Checking back in. I’m 6 weeks post op now and pain is very manageable now. I’ve been doing pt 3 times a week and exercises at home. Walking quite a bit as well with no assistance. Range of motion is stuck at 75 degrees and I’ve been there for 3 weeks now. Dr is pushing for manipulation and so is physical therapist. What are everyone’s thoughts on this?