TKR Pain meds not working

[benne68]

While this is your decision, I can tell you that -- based on the experience of many of our members -- six weeks is very early to be saying you need an MUA.

Since you are doing PT 3 times a week, @1ethal there's a good chance that you are doing more than your baby knee is ready for. That is causing inflammation and swelling inside the knee -- and that it is why your flexion is "stuck."

If ROM is being blocked by swelling and inflammation, no amount of pushing and shoving will increase your ROM. Your knee needs rest, ice, and elevation to help get the swelling and inflammation to calm down and allow your knee to reveal the ROM that has been there all along.

Many of our members have discovered that by stopping all the PT and going back to icing and elevating, they are able to see improvement in flexion over time.

Here are progress reports by members whose ROM returned slowly but surely.

Campervan’s ROM history
92 - 8 weeks post op
107 - 5 months
110 - 6 months
112 - 7 months
116 - 9 months
119 - 11 months
118 - 1 yr
120 - 1yr 2 months
125 - 1 yr 8 months

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

TortiTabby's ROM
6 wks: 85
7 wks: 90
10.5 wks: 95
14 wks: 100
17 wks: 105
20 weeks: 110
26 weeks: 120

 

[mendogal]

@1ethal
Some of our members declined MUA, stopped PT, rested, iced and elevated 45 minutes at a time several times daily, walked as tolerated, and lightly puttered or did very gentle exercises and did ok (I recommend a few brief daily sessions of seated heel slides done very slowly with deep breathing and relaxing into the stretch to the point of discomfort, never pain).

Some of our members opted for MUA and totally regretted it.

Some of our members opted for MUA and were very pleased with the outcome.

We tend to come down on the side of slow recovery, no MUA. In truth, there's no one "correct" answer for each and every person. We will be here to support you.

 

[Layla]

Happy Two Month Anniversary!
How's it going? We haven't heard from you in a few weeks. Consider leaving us an update next time you're here.
Hope to hear from you soon!
@1ethal

 

[1ethal]

Yes I’ll be 9 weeks post op this Wednesday. Unfortunately, not a whole lot better. In PT 3 times per week. Strength is getting better, but still stuck at 75 degrees range of motion. My rom has not gotten any better since week 3. This cold weather is very rough on the joint. Still feels very weird to walk on, just not normal at all. Going on this Thursday for another follow up and to discuss mua. Dr said the more surgeries you have, the faster scar tissue builds up. This is my 5th surgery on my left knee.

 

[benne68]

This is my 5th surgery on my left knee.

Would you share the details of those other surgeries so we can add them to your signature. Having that history available can help us give you better information.

 

[1ethal]

Initial injury was dislocated knee cap, torn quadriceps acl and mcl.
Surgery 1 - stitching knee cap back to quads and acl ans mcl repair.
Surgery 2 - arthroscopy to repair torn cartilage from rehab
Surgery 3 - arthroscopy to repair torn cartilage from rehab
Surgery 4 - cartilage implants (from the side of my femur) into distal end of femur under kneecap as all the cartilage was gone. Surgeries were from 1996-2000. That lasted me until 11/20/2024 when tkr happened.

 

[1ethal]

Also wanted to ask, how long before it doesn’t hurt after physical therapy? On PT days, by the end of the day, I’m at the point I can barely walk again.

 

[mendogal]

Also wanted to ask, how long before it doesn’t hurt after physical therapy? On PT days, by the end of the day, I’m at the point I can barely walk again.

PT shouldn't hurt that much!

There's a difference between the "healthy" benign muscle ache after a good workout (as we experience regardless of surgical status) and outright knee pain with increased swelling.

The pain and swelling is our new knee's only way of telling us very clearly "back off!"

It is likely that the dose of activity crammed into a typical PT session is simply too many repetitions within a very short part of the day.

When I quit PT I selected a couple of key exercises that I felt were beneficial, and just did a few reps at a time scattered throughout the day - then the next day did zero except walking and household stuff.

So one way to approach PT is to plan to do only set of each exercise. Let them know you won't do another set, because your knee has had enough of that exercise for today.

Don't do any exercise that causes pain. Don't let them pull or push on your leg.

 

[1ethal]

The PT doesn’t hurt when I’m doing it. It actually feels really good to do the exercises. But, when I’m done my leg is spaghetti and after I ice it, it’s pretty much useless. They do push on my leg trying to achieve more range of motion. This is very painful!

 

[Jockette]

But, when I’m done my leg is spaghetti and after I ice it, it’s pretty much useless. They do push on my leg trying to achieve more range of motion. This is very painful!

The PT you are getting is inappropriate if it makes you feel like this afterwards. This could be hindering, rather than enhancing, your healing.

 

[mendogal]

Pushing on your leg will NOT increase range of motion.

Reduced swelling and relaxation - yes, relaxation, not work! - increase range of motion.

For flexion (bend) the best exercise is seated heel slides, done very slowly and with deep breathing and a focus on relaxing and allowing the quads to relax and let go. The first few can just be done within your current comfort zone, slowly going into it, holding for just a few seconds, slowly releasing. Then try just a few going a little further, into the range of mild to moderate discomfort, but not to pain.

For extension (straightening) relaxing is even more important! Pushing or using weights simply doesn't work. Many members have found it helpful to lay on their stomachs on the bed, allowing the leg to slightly hang off so gravity works a stretch. Deep slow breathing, and only holding it for a couple of minutes - and again, it should always stay only in the discomfort zone, never painful.

 

[Layla]

But, when I’m done my leg is spaghetti and after I ice it, it’s pretty much useless.

I am sorry to read this. It is sad you've been pushed to this point and I hope you'll put a stop to it. This is a clear indication you're doing too much.

Please refrain from engaging in movement that causes discomfort or pain. Do not allow anyone to forcefully manipulate your leg. While your range of motion is currently limited, it will naturally increase as the swelling subsides and the pain eases. Give it more time.

Hopefully you're comfortable challenging your PT to work with you in a way that doesn't leave you vulnerable to a fall from loss of stability / balance due to the weakness after your sessions. An accident like that will set you way back. Consider sharing any concerns you have with the PT mentioning you'd like to modify the exercises so you're not taxing your muscles in the way you have been.

All best wishes. Keep us posted.

 

[Layla]

Happy Three Month Anniversary!
How is recovery going? I hope you found a healthy balance in PT so you're progressing without enduring pain afterward. Let us know how you're doing when you have a minute.
Take care!
@1ethal

 

[1ethal]

Things are finally getting better. I did have a manipulation done on 1/29 and it has helped tremendously! My range of motion is 110 and seems to continue getting better. I did back off pt as well and it’s helped a lot. Finally, some relief.

I do still have some pains when walking. It’s not major, but it keeps me from walking totally normal. Assuming this will continue to get better with time as well?

 

[Layla]

I do still have some pains when walking. It’s not major, but it keeps me from walking totally normal. Assuming this will continue to get better with time as well?

I'm happy to read you're doing well and making decent progress post MUA and without PT.
Pain when walking is not unusual at this point and do remember that MUA can set you back some. We do suggest using an assistive device IF you're limping.

It was nice to hear from you, thanks for taking the time to update. Enjoy the weekend!