TKR Painful knee

[Loulou67]

Hi @Nay Nay …. I’ve just been reading through your thread. I’m at 13 weeks post op tomorrow. My extension was 105 when I was discharged from physio, so you’re miles ahead of me!!
I’m a side sleeper and definitely find it easier to sleep with a pillow between my knees. I’m not taking any medication now or using any walking aids.
I still have a tight band feeling round my knee and hate the numbness on the outside of my knee.
I’m currently in the middle of a weeks holiday in a quiet village in Ireland and I’ve walked every day…. I even managed 8500 steps yesterday!!
This week is probably the first week that I haven’t thought about how I’m walking and I’ve walked normally all week, no more limps or kicking my operated leg out.
I’ve also slept the best I have in weeks…. probably due to all the cold fresh air I’m getting!!
Anyhoo…… it sounds like you’re doing great….. well done and Happy Healing to you

 

[Nay Nay]

11 weeks post op - Update on my hip pain:
I went to PT today and told him I still have a lot of tightness (that darn IT band) and some hip pain. He had me lay flat on the table and said my bad leg (tkr) is a little longer than my good leg. He thought it was because my pelvis is actually out of alignment and leaning forward giving the allusion that my bad leg is longer than my good leg. He said my tendons & muscles are tight which is causing this. He feels that this is affecting my extension, which is still not at zero. Has anyone else experience this?

We did a lot of stretching for the front and side of my hip. When he rechecked my legs they were nearly the same. My extension after all of the stretching we did was just about zero. My therapist thinks that the stretching exercising will alleviate my hip and IT band pain and improve my extension.

I see my surgeon in 2 weeks. Should I ask for an x-ray of my hip to see what is going on or wait to see if the exercises will fix this problem? I can’t wait for this to be over…..

 

[trinket]

Hello @Nay Nay, we are at about the same place with our tkr's. I've found that a combination of both Tylenol and Advil work better than one or the other alone. My dr told me I can take them together, but I usually alternate them.

I still have tightness in both of my knees, including the one the was done 13 months ago. I also had IT band issues with the 13 month knee, which I tried to solve with PT. Unfortunately, the agressive PT for my IT band problem caused me to get Trochanteric Bursitis in my hip. A cortisone injection solved the bursitis, and I decided to forget the IT band problem. It took a while, but it's finally improving. My newest knee which is about 10 weeks is also quite tight, but I've never had an IT band problem with that knee. My two knee recoveries were completely different.

The grinding bone on bone pain is gone from both knees, I can do whatever I want at the gym, and go up and down stairs with ease. Yesterday I got down on the floor using both knees. I underestimated the difficulty of this surgery, but hang in there. It will get better and someday you will love your new knee.

 

[MSuki]

Interesting timing for this comment, my PT just told me at my last session that I am having trochanteric pain, her solution is to stretch the IT band more. I also have very tight hamstrings, and having to learn again to use my hamstrings and glutes for things instead of just quads.

@Nay Nay you have 2 weeks, unless you are seeing a lot of improvement you probably should at least mention it to your surgeon when you go in.

 

[Layla]

He had me lay flat on the table and said my bad leg (tkr) is a little longer than my good leg. He thought it was because my pelvis is actually out of alignment and leaning forward giving the allusion that my bad leg is longer than my good leg.

An article that may be of interest tp you - Leg length differential - LLD.
As far as Leg Length Differential goes... many feel this sensation post op. In most cases it eases with time. We advise giving it 3-4 months as it can take that amount of time for things to balance. If at that point, you are still concerned we suggest you visit a reputable podiatrist or PT for a measurement.

As for your meeting with the surgeon, I'd let the surgeon make the call on whether you need to dig deeper at this early date.
Best wishes for a great day and weekend!

 

[Nay Nay]

Hi @trinket. Thank you for the advice. When you said that your doctor told you to take Tylenol and Advil together, do you mean take 1 pill of Tylenol and 1 pill of Advil? How exactly do you alternate them?

Unfortunately, the agressive PT for my IT band problem caused me to get Trochanteric Bursitis in my hip

How did you discover you had Trochanteric Bursitis in your hip? I can go up and down the stairs, also, but found going down is not with ease. When I am super tight - especially after waking in the morning, I have to hold on to the railing and kind of skip the step. After stretching I can climb up and down the stairs much better.

The timing is very interesting @MSuki . We’re you given exercises to do at home for IT band, and your hamstrings and glutes? I am hoping that these stretching exercises I have to do at home and with my therapist during my visits with help tremendously. My therapist is pretty positive that it will help a lot. He is very positive every time I see him. It really helps my mental state because I seem to be so down about my recovery.

Thank you for the article on LLD @Layla , that really did help. My therapist feels that my pelvis will correct with exercise. After stretching at the end of my session, he had me lay back down on the table and the legs were closer to the same length. So, perhaps, this is going in the right direction.

Thank you all for responding to me. I feel more positive now.

 

[MSuki]

I am supposed to be doing bridges for hamstrings and glutes, and I have stretches for hamstrings and IT band. Also clamshell. I have to be careful on the IT band stretches because sometimes I don’t position it right and then it pulls on my knee. I actually get a better stretch sitting on the bench at the end of my bed and sort of leaning over my leg forward and to the side (at the same time). I probably should do that with a timer every morning.

My hamstrings and glutes are still pretty weak. I think that’s why I am still having trouble going up steps. But, I’ll try again.

 

[EalingGran]

Have a look at my pilates teacher's free YouTube videos .Google Katja pilates.
She has loads of videos but there is 20 minutes glutes one which is knee friendly for recovery- with no squats or kneeling.
It was my go-to exercise in my recovery and my leg muscles are really good now.

 

[mendogal]

Hi!
To take Advil and acetaminophen together you still need to get a therapeutic dose of each.

For acetaminophen that's generally two 500 mg three times daily, which is 3,000 mg daily.

If the ibuprofen (Advil) is prescribed by a health care provider, follow their dosing schedule. If you're using it over the counter, follow the label instructions.

Because the two meds are totally different, it doesn't matter if you take them at the same time (an easier schedule) or stagger them a few hours apart - the key is keeping the blood levels of both in a safe therapeutic range until you're ready to start reducing them.

 

[Jockette]

I took both Tylenol and ibuprofen, but individually. I took them every 6 hours each, but staggered them so I had one or the other, every 3 hours. Example, Tylenol at 6am, ibuprofen at 9, Tylenol at noon, ibuprofen at 3, etc.

 

[mendogal]

Re tightness of muscles, ITB, etc....
Our arthritic knee(s) over years can easily create imbalances in gait, weight bearing, and structure, affecting feet, hips, and pelvis.

Our TKA changes every bit of that. So muscles and tendons that got constricted and short need to learn to relax and stretch. Their opposing muscles and tendons need to activate and contract effectively.

Gentle stretching has been very beneficial to me. Strength will come, don't push it.

 

[jakemedic]

Excellent thread! Lots of good information and support here. Thank you for sharing!

 

[CricketHip]

@Nay Nay You mentioned earlier in your thread that your husband massages your knee every day for you.
Maybe have him massage the thigh muscles, too? Front, back and sides..
In fact, would you consider going to a licensed massage therapist (LMT).
So many muscles cross and insert in and around the knee, I think some massage with moderate or less pressure could ease some of your issues. The painful hip, too.
Sometimes and I've found for myself, that most times it takes a village to recover.
You will do just fine, you've learned to now back off a bit plus you have a supportive PT.

 

[MSuki]

@EalingGran I will check out the videos. I need some variety in my exercises at this point!

@Nay Nay please send your husband over to my house, my shoulders are sore!

 

[sistersinhim]

Please start very slowly when trying any new exercises. They might feel ok at the time, but later on cause a lot of discomfort.

 

[Nay Nay]

Hi everyone. Just thought I would give an update on my journey.

This weeks marks 12 weeks of my tkr journey. I am doing okay, making some small gains. Yesterday at PT, I managed to squeak to a flex of 130 and an extension of 1 or 2, after stretching. Adding in a bunch of stretching exercises for my hip, thigh, and hamstring has really helped. But, I still have tightness and pain around my knee. Some days are worse than others, but it is at least a 2. I just ordered on Amazon the TENS unit. I read a post mentioned on this forum that TENS seemed to help. My therapist believes TENS helps early on in recovery when quads aren’t really working. My quads are working, but no where near where they use to be. My therapist thought it wouldn’t hurt to use the unit. The unit I bought was only 17.99, but the reviews were really good. I am hoping that it will help with the tightness and pain. My question is, has anyone used TENS at home? If so, do you think it helped?

If this tightness goes away, along with the toothache pain, I would be happy that I had this surgery done. Not there yet…. I see my surgeon on Monday.

I am so glad I have this forum to make me feel better. Thank you all.

 

[trinket]

Hi @trinket. Thank you for the advice. When you said that your doctor told you to take Tylenol and Advil together, do you mean take 1 pill of Tylenol and 1 pill of Advil? How exactly do you alternate them?

How did you discover you had Trochanteric Bursitis in your hip? I can go up and down the stairs, also, but found going down is not with ease. When I am super tight - especially after waking in the morning, I have to hold on to the railing and kind of skip the step. After stretching I can climb up and down the stairs much better.

Hello, apologies for the late response. I didn't get a notification on this and just now saw it:

I alternate by taking two Extra Strength Tylenol and two Advil at the same time. Then I take Advil every three hours. The Extra Strength Tylenol can only be taken every eight hours so I fill in with the Advil every three hours. Does that make sense? Since my post, my pain has improved greatly and I'm only taking Advil every now and then.

I had aggressive PT to work on my IT band. The morning after my first session I woke up with severe pain in my hip. I went into the surgeons office and saw the PA. He poked around my hip and found the spot with the most pain and diagnosed Tronchanteric Bursitis. He gave me an injection, cortisone I imagine, the pain went away immediately and hasn't returned. My knee is still quite tight, but I'm leaving it alone. The tightness is improved if I massage soft tissue around the knee, but tightness returns almost immediately. I don't know if the tightness will ever go away.

 

[mendogal]

Re your quads.... They are probably activating ok by now but will be weak for quite some time, so you and your PT are both "right." There's no way to hasten rebuilding quads strength because your knee hasn't healed enough for that kind of challenge - it will react with pain and swelling if you overdo it.

Inexpensive TENS units can't be programmed as well as professional ones, but they CAN often provide symptomatic relief the way menthol or capsicum topicals do, by stimulating the heck out of little sensory nerves and basically overriding the pain signals.

 

[mendogal]

Oh... Tightness....
Tight band feeling after knee replacement is one of the most common complaints I read from members, and it sure bothered me.

Josephine, our Nurse Director Emeritus, explained it quite nicely:

That tight band is caused by scar tissue but not the adhesions type of scar tissue. When the surgeon opens up the knee, he has to undercut the skin and superficial structures from that centre line to each side of the knee in order to get good access all round the bones. Part of the healing process is when those flaps reattach themselves to the main body of the leg. This healing creates a thin layer of scar tissue across the front and sides of the knee. But scar tissue isn't anywhere near as flexible as normal tissue so it feels like a tether or a clamp across the knee if there is any swelling and during later normal activity.

It will gradually reduce in size and thickness over the following months until it reaches a point where it's not substantial enough to cause this sensation, same way as does the incisional scar in the skin. But be warned that this can take several months to dissipate completely and sometimes or every time, lots of walking or standing can make it worse. It differs greatly for every individual.

This should be regarded as pain and treated as such. In the early days, take your prescription meds. In later days, take some otc meds like paracetamol (Tylenol).

 

[Nay Nay]

@mendogal , Thank you for the information on the tightness. That really helped me understand what is going on with my knee.

Yesterday, while going up the stairs, I tripped. I was rushing and was kinda running up the stairs and didn't lift my bad leg enough. I know, dumb! I jammed my knee into the step. Ouch. That hurt. It didn't seem like I hurt my implant, only the soft tissue. I was able to go about my business, but by the end of the day, my knee really hurt.
So, I just started using the TENS until last night (along with icing & elevation) and I am currently using now around my knee. It seems to be helping? My knee does not hurt as much. I guess it could just be time and rest. I am planning on trying it on my quad while I do my quad exercises. I am still learning how to use this unit, but I am hopeful this will help.