TKR Painful knee

[Nay Nay]

Hello everyone! I have never joined a forum before, but I have been reading some of the posts since my RTKR surgery on November 7th. Everything I was able to read, without joining, has been very helpful to me. This is my story….

I am a fit 63 year old woman. I had trouble with my right knee for a few years, mainly with arthritis. I had X-Rays taken in 2021 & 2022, which showed narrowing, but I was not yet bone on bone. I was NOT constantly in pain, and I was able to do pretty much everything I wanted to do. (Biking, hiking, & keeping up with my 3year old granddaughter) My orthopedist recommended stretching exercises before exercising. That all seemed to work okay until 2023. I tried a cortisone shot in July of 2023, but I was only pain-free for 6 days. My knee was getting worse! An MRI showed that I was now bone on bone. I decided to go straight to surgery because I am going on a cruise with my sister in July of 2024 and I wanted to be able to do all the excursions we planned. ( maybe I rushed this surgery?). Anyway, the orthopedist felt that this surgery was going to be “easy-least” since I am in good health, not overweight, and pretty athletic. I, unfortunately, went into this surgery with unrealistic goals! I have been diligent with my PT and do my exercises everyday! I have been pretty aggressive with my exercises because I want to get back to normal. At 9 weeks post surgery, I am at 125-127 flex, but I am having a tough time getting to zero. At PT on my own I get around 5, and with assistance I can get just about to zero, but it doesn’t stay. My orthopedist wants me to be at 135 and zero by February 5th. I am worried I won’t get there! I still have throbbing pain and I am not sleeping well at all. ( As a side note; I used OxyContin for 1 week after surgery and the doctor would not give me any more. I took Maloxicam for 30 days, along with Tylenol. So after 4 weeks i was not taking anything at all and just suffering. My PT told me last week to call my doctor and ask if I could take ibuprofen or Tylenol, which I did. I have begun taking ibuprofen or Tylenol, I switch back and forth, 3 times a day.) My PT actually had me cut back on my exercises to help my swelling. He said he isn’t concerned with my ROM, but was hoping less exercise would help the pain and lack of sleeping. So far it hasn’t helped too much. Constant toothache pain and a tight feeling around the knee. I am getting pretty depressed and actually feeling regret in having this surgery. Will it feel better when I hit the 12 week date? I need something to look forward to….
Thank you for allowing me to vent!. I feel like I complain all the time about my knee to my husband! ( by the way, he massages my knee/leg every morning and it helps temporarily)

 

[Jockette]

Hi and Welcome!

I will leave you our Recovery Guidelines. Each article is short but very informative. Following these guidelines will help you have a less painful recovery.

Just keep in mind all people are 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.

Knee Recovery: The Guidelines

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.​

​

If you want to use something to help heal the incision, ​

BoneSmart recommends hypochlorous solution. Members in the US can purchase ACTIVE Antimicrobial Hydrogel through BoneSmart at a discount. Similar products should be available in the UK and other countries.​

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 to 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 the 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 the member’s history before providing advice, so please post any updates or questions you have right here in this thread.

 

[Jockette]

I am at 125-127 flex, but I am having a tough time getting to zero. At PT on my own I get around 5, and with assistance I can get just about to zero, but it doesn’t stay.

This recovery does take an average of a year, for complete healing. These numbers are actually great, for so early in your recovery. Your straightening will improve with time as you continue to heal.

My orthopedist wants me to be at 135 and zero by February 5th.

I’m sorry your doctor has imposed a date by which he/she wants you at certain numbers. We are all different and cannot be held to a one size fits all recovery.

My PT actually had me cut back on my exercises to help my swelling. He said he isn’t concerned with my ROM, but was hoping less exercise would help the pain and lack of sleeping.

You have a wise PT, to make such an adjustment. Recovery takes time, and if indeed the PT you have been doing has been more than you were healed enough for, it will take time for things to settle down.

Try to be patient and give your knee time to sort itself out. Keep looking forward to that cruise next summer, I’m sure you’ll see quite a bit of improvement by then.

 

[Nay Nay]

Thank you so much for responding so quickly Jockette.
I will try to be more patient than I am right now. ( not my strong suit!). I do have a wise PT and I think we did more than my knee was ready for. However, I was pushing my PT to do more because I wanted to use machines in the gym besides the bike. . I, honestly, was so darn happy to be using ankle weights, leg presses and the bike. But my leg would swell and I would be in pain. I am currently doing very few exercise at home now, trying to give my knee more rest. I do ice a lot throughout the day. I am looking forward to going through the day unaware of my knee. Can’t wait for that to happen!

 

[benne68]

I have been pretty aggressive with my exercises because I want to get back to normal. At 9 weeks post surgery, I am at 125-127 flex, but I am having a tough time getting to zero.

No wonder you are in pain! You are working that poor knee much too hard for so early in this recovery. You need to back off all the exercise and let your knee heal.

I agree with Jockette that your flexion is EXCELLENT for 9 weeks out -- most surgeons are thrilled to have their patients at 120 at this point. And it is completely normal for extension to come more slowly.

I'd encourage you to cut back more on exercise -- except for activities of daily living -- for a week. Focus on icing, elevating and taking your pain meds on a regular schedule. I'll bet you'll see a huge difference in your pain levels -- as well as your sleep.

By the way, I took a cruise 8 months after my first TKR. My ROM was 2-120 at that point. But I was completely pain free and was able to walk comfortably along cobblestone streets, climb up hilly paths and do multiple flights of stairs throughout the Baltic.

There is no need to push. Your knee will be fine by July!

 

[mendogal]

I have been a martial artist, with minor and major injuries, and enjoy weight training.

Knee surgery is not at all like an athletic injury. It's more like a kinda bad auto accident.

And, in addition to injured bone, tendons, muscles, your healing body is contending with a brand new allover structure in weight bearing and gait - our bodies had responded to the increasing arthritis by developing adaptations and work arounds we can be barely aware of. Now our feet, hips, pelvis, and backs are in a long slow readjustment period.

At 6-8 weeks one *hopefully* arrives at a point where incredibly light strength training is possible. How light? No weights. No machines. Slow movements with slight increases over time WHEN the body doesn't respond with swelling and pain.

There's a difference between aching muscles from a workout and painful swelling. The latter is our knees only way to.holler "back off!"

 

[Missie281]

I know where you are. I went to a surgeon after a somewhat painful hiking and camping trip. I had surgery in a month. I worked so hard and I was in constant pain for four months. Until I found this forum. I stopped my exercise for a week. Suddenly I was sleeping at night without much if any pain medicine.
The link to the article “don’t overwork” in
2. Control Discomfort really helped. I still hope to hike this summer and I’m slowly building up exercise again, and also then backing off if my knee gets angry.
Patient I am not. This has been so hard. I have questioned my decision to have surgery, but those around me remind me that it was only going to get worse. I’m not nearly to where I want to be, but slowing down and being nicer to my knee has helped with my sleep and therefore my patience.

 

[rlwintin]

Oh, I hope you’re soaking up all the support for slowing down and being kind to yourself. It will come. One day you will notice that you haven’t thought about your knee all day. You can look forward to that. Just requires a little “tincture of time”.

 

[Nay Nay]

Thank you all for responding to me. It is all so encouraging, especially Bennie68. Going on a cruise 8 months out with no pain is exactly what I am hoping for! I think I am just like Missie281! I am not patient!! I am taking all the advice of easing off of exercises and giving my knee more rest, ice, and elevation! After this past weekend, I did sleep a bit better last night. I feel like my gait is better this morning too. (which is all so encouraging!) I will continue to take Tylenol to help with the pain. Today, the pain is not bad! Whoo Hoo!! I would say a 3-4. There is still tightness, but I can deal with that. I am watching my 4 year old granddaughter tonight, so she will be my exercise today!
Thank you all for your support. This really helps my state of mind.

 

[Layla]

Welcome to the healing side and congrats on the new knee! Glad to read you're backing off the exercising and you slept better last night.
Enjoy the grand baby tonight...so fun, I'll bet you're excited.
Stay in touch and a great week to you, Nay Nay
@Nay Nay

 

[benne68]

I am not patient!!

I'm not know for my patience either. However, my surgeon told me this after my first TKR: "The most important muscle to exercise in this recovery is your Patience Muscle."

Glad to read that you are backing off the aggressive exercise. I think you will be surprised by how much that helps with pain -- and you won't lose your range of motion in the process. (In fact, if you have any swelling inside your knee, you'll find that resting, icing and elevating will bring it down and your ROM will continue to improve.)

Keep us posted.

 

[Nay Nay]

Good morning.

Well, my better night sleep on Sunday night was very short lived! Since then I have slept horribly. (I take Tylenol, melatonin, and magnesium before bed every night.) I am back to getting out of bed and going downstairs to ice my leg in the recliner. My hip has really been hurting me these past few nights trying to sleep in bed. Has anyone else have had this problem? I have been taking Tylenol 3x’s a day, but I honestly don’t know if it is helping me. It has been 8 days since cutting back on my exercises and I am trying to rest my leg more. (I finished reading Barbra Streisand’s book of nearly 1,000 pages while resting!). This morning I just started to cry because the constant aching and lack of sleep is making me so depressed.

I have PT today ( it has been a week since I have seen him due to the holiday). I think my ROM is pretty much the same as last week…I think I didn’t lose any. (about 3-127). However, my knee hurts on the right, outer side today. I am going to ask him if this is normal. I don’t know what else to do to keep my sanity. I know I am early in my recovery at 10 weeks post op, but my gosh! I have read that 12 weeks seems to be a milestone for improvement in pain and sleep, so I am hanging on to that. But is that true?

This forum has been a lifesaver for me. Thank you all…
I am trying so hard to stay positive….

 

[raylo]

Your progress is a bit like mine, objectively doing well, but the knee still is pretty bothersome. I am at 15 weeks and my sleep is better, but still not perfect. The issue with the knee for me is that I am mostly a side sleeper and needing to roll over without tweaking the knee is hard in the first place and then finding a comfortable position for the knee is tough. It is getting better for this, but slowly. Then the hip... of course over the years with a bad knee you may have overused the opposite hip like I have. Then you add the issue of it doing double duty while your knee heals and so it hurts now walking and sleeping. Mine may need surgery at some point not too far into the future but maybe yours will feel better as the new knee improves and starts doing more of the work. In any case, it sounds like you are doing pretty well in the areas that really matter. Good luck and keep us posted.

 

[mendogal]

Lack of sleep really messes with our awareness of pain and our mood! Yes, sleep deprivation was a major issue for me!

I found melatonin alone not helpful, but when I took it immediately after finishing a mug of an herbal "sleep" blend that contained valerian, and then relaxed with only dim indirect lighting I'd be incredibly happily sleepy in an hour and could sleep through 5+ hours.

Here's an article about the post op blues....

 

[Layla]

I have read that 12 weeks seems to be a milestone for improvement in pain and sleep, so I am hanging on to that. But is that true?

Please keep in mind that each recovery is unique. While the BoneSmart philosophy successfully works for many, there will be exceptions. Between the recommendations found here, your surgeon's recovery protocol and any physical therapy you may engage in, the key is to find what works best for you.

At only twelve weeks post op, you will continue to make progress with more time. Patience can be hard to come by, especially as the weeks click on by, but brighter days are on the way. Believe that!

I hope you're feeling okay after your PT session today and get a night of restorative rest.

 

[Nay Nay]

Thanks for the quick responses everyone.

Raylo, I saw my PT this afternoon and he assured my that my knee was fine. I was so concerned I twisted it or did some damage to it tossing and turning during the night. He felt my hip pain was due to it being very tight. He explained how the ligament? ( tendon? I can’t remember exactly) that it runs down from the hip to the side of the knee cap where it ends. That exact spot was where my knee was killing me. He said this could have been tight even before the surgery. I was walking with a limp before surgery, so that’s possible. He incorporated a few stretching hip exercises and recommended that I try to sleep on my back until it gets stretched out. But if I had to sleep on my side to use a thicker pillow between my legs to keep my knee more even with my hip. He also taped my knee to keep my kneecap more stable. I see him again tomorrow, so I can tell him how my night went. I am hoping for a better nights sleep. BTW, I take melatonin and magnesium every night, along with Tylenol. So far I don’t think these pills have been helping, but keeping my fingers crossed they will tonight!
I will keep everyone update.

 

[mendogal]

That would be the iliotibial band, or ITB, a thick fibrous connective tissue that helps keep us stable.
Many people with knee or hip problems, including being post op, have ITB tightness.

 

[MSuki]

I have hip pain too, mostly in the mornings. I don’t think you are likely to hurt anything but soft tissue in bed. While it’s good to be careful and not twist it, it’s really pretty strong. Assuming you had the kind that is cemented during surgery, my doctor told me that the only way you’d damage it is if you had a fall hard enough to break a bone.

ps I wrote you an essay over on my thread, I get carried away sometimes…

 

[sistersinhim]

Here's a little IT Band Info information for you. Many of us have and do suffer from this.

 

[Nay Nay]

Thank you so much for the IT band info sistersinhim. The information was very helpful and explained it all so well.

I woke up this morning with NO hip pain! Yay! I used a thicker pillow between my knees when sleeping on my side last night. I stil tossed and turned, but I slept a bit better. I did my stretching exercises today and I see my PT this afternoon. Thank you so much for responding to my post!