TKR Pain relief requirements at 4 months

[Andor]

Hello again,

I have a lot of tension in my calf muscles which is restricting my ankle flexion and making it difficult to cycle. Is it ok to use a massage gun on leg muscles after a TKR? I’m worried about the effect of vibrations on the implant, though I am now 6months out so it should be firmly in there.
Any thoughts? I have a Hypervolt massage gun which I used to great effect before the operation.
Many thanks

 

[sistersinhim]

I'm sorry to read about your tension in your calf. Is this tension described as stiffness or tightness? Others have described this, but I don't remember it being at the 6-month out like yours is. I think you should be fine using the massage gun as long as you don't do it near your knee. Do be on the safe side, why not ask your OS?

 

[Rockgirl4]

I just wanted to add that it's been 5+ years since my first TKR, and I STILL feel the weather changes in my right knee sometimes. It's not 100% of the time or even 50% of the time, but I do occasionally still notice when a cold front is coming through. I live in St. Louis, and we get some massive changes in weather during the summer/fall when the cold fronts come through. We can experience a 35 degree temperature drop from morning to evening in Nov/Dec sometimes too. My TKR knee definitely notices it. I have arthrofibrosis in that knee though after 8 surgeries, and I often wonder if it's the scar tissue complaining. I'm one of those that developed the real thing (adhesions) in 2016 after an experimental procedure, trying to avoid a knee replacement. I had an undiagnosed autoimmune disease that was untreated, leading to massive swelling and inflammation though. It will be interesting to see if I experience any of that mess it in my left knee after I have that knee replaced next week.

 

[Andor]

I'm sorry to read about your tension in your calf. Is this tension described as stiffness or tightness? Others have described this, but I don't remember it being at the 6-month out like yours is. I think you should be fine using the massage gun as long as you don't do it near your knee. Do be on the safe side, why not ask your OS?

Hi
I didn’t properly reply to your message- sorry.
It’s tightness on the lateral part of my calf, peroneus longus and brevis I think and around the fibular head. When it gets bad it can cause discomfort in the lateral part of my foot where the tendons insert. I think it’s related to a tight ITB. Heat from a wheat bag can help as can suction cup massage therapy. My physio also does manual therapy which helps a lot but I only see her every couple of weeks.
I did ask my OS about using the massage gun and his answer was “it’s probably ok on the lowest setting” so I’ve decided against doing that lol! I guess there’s not enough data for a definitive answer as no he has no idea what the settings of my massage gun are!

At nearly 8months my function is definitely improving (apart from being unable to ride my bike), albeit at a slower rate but pain and discomfort is not. still a little swollen, still a little warm at times and horribly affected by bad weather.
Today is a particularly bad day as we flew back overnight from sunny MA (where both my knees were a lot happier) last night to grey, damp and rainy UK and my operated knee is really complaining . I live here so i guess I’ll just have to get used to it…
Trying not up take co-codamol but paracetamol isn’t really cutting it on these grey days.

Still only 2/3 of the way through a year long recovery, I know, but can’t really see this improving. Has anyone else felt like this at 8 months? Maybe my expectations for this procedure were unrealistic but pretty disappointed at the moment, though increasingly aware of the things that could have gone wrong that haven’t as yet so I’m grateful for that.
And this time I didn’t need to find a wheelchair at Heathrow Airport to get from the gate so I’ll take that as a win!
Onwards…

 

[Jockette]

Still only 2/3 of the way through a year long recovery, I know, but can’t really see this improving. Has anyone else felt like this at 8 months? Maybe my expectations for this procedure were unrealistic but pretty disappointed at the moment

I felt just like you, at 8 months. I had a partial and I was led to believe in a much quicker recovery than the one I had. However, after a very tough first year, I had a lot of improvement all through my second year, so don’t give up hope yet.

 

[mendogal]

@Andor
You're on the right track for this soft tissue problem using the cupping and heat plus PT as available.

Moist heat is best; assuming the wheat bag is dry so it doesn't sprout or rot, you might also warm a very damp towel around the heated wheat bag or place it under the heated wheat bag.

Other things that could be added would be above and below the identified problem. What comes to mind includes gently foam rolling the ITB; gently massaging the underside of the foot by putting a rubber ball like a pink handball (USA brands are Spalding and Pensy Pinky) on the floor and rolling the foot over it to help mobilize foot and ankle.

 

[Benay]

I'm pretty sure the restless thing is a withdrawal symptom

That's exactly what I figured too.

 

[EalingGran]

And this time I didn’t need to find a wheelchair at Heathrow Airport to get from the gate so I’ll take that as a win!

I think doing long distance travelling is quite tough for recovering knees. I am only back to properly travelling after my PKR two years ago. I can walk 6-7 miles/ day no problem and look after a three year old- but my operated knee still felt slightly uncomfortable after a four and a half hour flight to Cyprus recently. I think the air pressure changes/ immobility/ dehydration- can all unsettle a knee implant.
It is good to get back to normal activity but it does come with a slight price.

 

[Rockgirl4]

Your lower leg pain sounds exactly like what I have experienced twice since my right TKR in 2019. It was exactly like yours right after the surgery, but that was because of the surgery and the soft tissue needing a long time to recover, plus I know I have loads of scar tissue wrapped around the fibula head (my TKR surgeon saw it during surgery----it's from 7 prior surgeries). Time helped that one considerably, plus massage.

It happened again last year, and I went to PT for 7 weeks to just focus on that problem. I needed a lot of ankle and shin strengthening, plus a lot of manual therapy to ease the tightness in those areas. My calves were also VERY tight, which was pulling on all sorts of things too much--especially in my foot. This second round was caused by too much sitting, letting my IT band get tight, and just loosing strength in certain parts of my legs overall. We had had a very rough 2-3 years and I sat a lot of it unfortunately. It caused tendonitis on the outside of my foot and a flare of plantar fasciitis, as all of that soft tissue is connected. If you are tight/weak in one area, the others have to compensate and get very angry, very quickly. And after a TKR, everything is tight and angry anyway, and your lower body is compensating in all sorts of ways for the knee.

 

[EalingGran]

after a TKR, everything is tight and angry anyway, and your lower body is compensating in all sorts of ways for the knee

Agree with @Rockgirl4
My back flared up for a while after my PKR- although overall it benefited from straightening my leg. I also noticed some pain in my opposite hip ( which on Xray is actually my better one) due to putting more weight on my other leg. All sorts of weird pains can occur after this surgery. It can flare up old issues in other areas- due to extra strain.

 

[Andor]

And this time I didn’t need to find a wheelchair at Heathrow Airport to get from the gate so I’ll take that as a win!

I think doing long distance travelling is quite tough for recovering knees. I am only back to properly travelling after my PKR two years ago. I can walk 6-7 miles/ day no problem and look after a three year old- but my operated knee still felt slightly uncomfortable after a four and a half hour flight to Cyprus recently. I think the air pressure changes/ immobility/ dehydration- can all unsettle a knee implant.
It is good to get back to normal activity but it does come with a slight price.

Thanks @EalingGran. I think you’re absolutely right about this adding to my misery yesterday. I was fine after the flight out there but on day flights I get up and move about more. The overnight flight is 6hrs sitting with my legs bent plus the pressure changes, then the long trek through the airport so I shouldn’t really be surprised i was getting complaints from my tkr! it feels much better today.
And today I’m thinking it was worth it just to have been under a blue sky for a couple of weeks!

 

[Andor]

@Andor
You're on the right track for this soft tissue problem using the cupping and heat plus PT as available.

Moist heat is best; assuming the wheat bag is dry so it doesn't sprout or rot, you might also warm a very damp towel around the heated wheat bag or place it under the heated wheat bag.

Other things that could be added would be above and below the identified problem. What comes to mind includes gently foam rolling the ITB; gently massaging the underside of the foot by putting a rubber ball like a pink handball (USA brands are Spalding and Pensy Pinky) on the floor and rolling the foot over it to help mobilize foot and ankle.

Thank you @mendogal. I will try some gentle foam rolling too

 

[Andor]

Your lower leg pain sounds exactly like what I have experienced twice since my right TKR in 2019. It was exactly like yours right after the surgery, but that was because of the surgery and the soft tissue needing a long time to recover, plus I know I have loads of scar tissue wrapped around the fibula head (my TKR surgeon saw it during surgery----it's from 7 prior surgeries). Time helped that one considerably, plus massage.

It happened again last year, and I went to PT for 7 weeks to just focus on that problem. I needed a lot of ankle and shin strengthening, plus a lot of manual therapy to ease the tightness in those areas. My calves were also VERY tight, which was pulling on all sorts of things too much--especially in my foot. This second round was caused by too much sitting, letting my IT band get tight, and just loosing strength in certain parts of my legs overall. We had had a very rough 2-3 years and I sat a lot of it unfortunately. It caused tendonitis on the outside of my foot and a flare of plantar fasciitis, as all of that soft tissue is connected. If you are tight/weak in one area, the others have to compensate and get very angry, very quickly. And after a TKR, everything is tight and angry anyway, and your lower body is compensating in all sorts of ways for the knee.

Thanks for sharing your experience @Rockgirl4 It does sound very similar and like you I definitely had problems with calf tightness before the surgery. My TKR L knee was always my “good” knee that did all the work protecting my right knee which had a cruciate ligament repair 30yrs ago. It deteriorated very quickly over about 4 months but the first signs were very tight ITB and lateral calf muscles. The medial side of my left calf was quite wasted and still is but I think it’s starting to fill out a bit. It sounds like the remedy is time and patience with massage and some gentle encouragement of new patterns of movement, I guess there’s no such thing as a quick fix in this recovery!

 

[Andor]

Still only 2/3 of the way through a year long recovery, I know, but can’t really see this improving. Has anyone else felt like this at 8 months? Maybe my expectations for this procedure were unrealistic but pretty disappointed at the moment

I felt just like you, at 8 months. I had a partial and I was led to believe in a much quicker recovery than the one I had. However, after a very tough first year, I had a lot of improvement all through my second year, so don’t give up hope yet.

Thank you for your encouraging words @Jockette! I’m in a lot less pain this morning so everything seems a lot brighter. And a physio appointment this afternoon which always improves things (no exercises from her, just a lot of manual therapy that really helps!).

 

[Layla]

Today is a particularly bad day as we flew back overnight from sunny MA (where both my knees were a lot happier) last night to grey, damp and rainy UK and my operated knee is really complaining . I live here so i guess I’ll just have to get used to it…

Hey, there's hope...
Many do feel weather changes. It's especially true for patients with arthritic joints who have not had a joint replacement, but also the case even after you have a new prosthetic in place.

Weather changes are predicted by changes in barometric pressure, which is the weight of the air pressing against the earth's surface. These changes can trigger pain and stiffness in the area of the prosthesis. The activity of bone adapting and growing around the metal leads to the sensitivity felt during weather and pressure changes. These sensations normally disappear within one to two years following surgery.

Keep this little scribble in mind as you're healing from the significant trauma that IS joint replacement.

Best Wishes for your Physio today. Hope its a good session!

 

[Andor]

Thank you @Layla. I had hoped the line might be straightening out by now but i guess that’s not how it works!
A good physio session but she suggested I made an appointment to see my OS when I pointed out the warmth over my patella. she actually hasn’t noticed until i showed her. I’ve not been too worried about it as it’s not new or painful or red, just a bit warmer than my other knee in the same place. And some other bits of my other knee are just as warm So I’ve made an appointment for next week but i don’t think he’ll be impressed! But probably a good idea to go..

 

[Layla]

Hi again, Andor. Glad you had a good session today!
The increased blood flow to the area results in the warmth. Swelling and redness are often experienced also. As the healing process progresses, the warmth, swelling and redness dissipate.
The warmth can take 6 months or longer to resolve.

With that said, it will likely give you peace of mind to touch base with your surgeon. I agree with you that he probably won't be impressed.

Hope you have a nice rest of the week.
@Andor

 

[sistersinhim]

And this time I didn’t need to find a wheelchair at Heathrow Airport to get from the gate so I’ll take that as a win!

Now, that is a sure sign of your healing and is a reason to celebrate! After all, it's the little things that can add up to a big thing.

Warmth is also a sign that your knee is still healing and probably nothing to be concerned about. Having your surgeon check it out should bring you some peace of mind.

 

[EalingGran]

when I pointed out the warmth over my patella. she actually hasn’t noticed until i showed her. I’ve not been too worried about it as it’s not new or painful or red, just a bit warmer than my other knee in the same place. And some other bits of my other knee are just as warm

My operated knee was definitely warmer than the other one for about a year.
It used to worry me a lot and my thread includes lots of discussion on this topic.
There were some people here who used a skin thermometer and tracked the temperature changes. I also read a paper that said on thermo- imaging scans that knee replacements stay hotter for up to 2 years

 

[Andor]

when I pointed out the warmth over my patella. she actually hasn’t noticed until i showed her. I’ve not been too worried about it as it’s not new or painful or red, just a bit warmer than my other knee in the same place. And some other bits of my other knee are just as warm

My operated knee was definitely warmer than the other one for about a year.
It used to worry me a lot and my thread includes lots of discussion on this topic.
There were some people here who used a skin thermometer and tracked the temperature changes. I also read a paper that said on thermo- imaging scans that knee replacements stay hotter for up to 2 years

Thanks for this @EalingGran - very reassuring!