TKR Painful knee

[mendogal]

To address your key question about extension.... MANY of us take time getting to 0 degrees! At less than four months out it's not unusual.

In my opinion, letting PT passively stretch you to zero only means that 1) you already have the innate ability and 2) if you stop letting him stretch you, you'll have less swelling and will be more likely to achieve it and 3) in my direct experience, it was relaxing my leg, not stretching it, that eventually let it go.

 

[EalingGran]

Lying on my tummy on the bed and letting my lower leg overhang the bed edge, was the best way to encourage extension for me. I know some people don't like that experience but it suited me.

 

[Nay Nay]

Wow, very interesting. According to my surgeon the PCL is not usually saved. I guess mine was in decent shape.

I have tightness behind my knee, and of course the front of my knee, that seems to caused by my ligaments being tight. Stretching is suppose to help. I guess time will tell!

 

[MSuki]

I would have loved to comment but I didn’t know what a PCL was!

 

[EalingGran]

Posterior Cruciate Ligament (PCL)
Anterior Cruciate Ligament ( ACL)
Medial Collateral ligament (MCL)
Lateral Collateral ligament (LCL)
These are the four ligaments around the knee. Cruciate ones are cross shaped- hence the word Cruciate.
Just done a bit of reading and seems to be very variable which are retained. Seems to be no clear difference in outcomes though- whether or not PCL retained.

 

[mendogal]

@Nay Nay ... A few reassuring words about That 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).

 

[MSuki]

Interesting, I always assumed the tightness was internal swelling. It makes more sense with the scar tissue why riding my bike every morning loosens me up.

 

[Nay Nay]

Thanks so much for the information @mendogal . Like @MSuki , I thought it was due to swelling or my quads and ligaments that are not strong enough yet. You are right though....if I do a lot, it gets even tighter!! This morning it was tight, but then after I cleaned the house, I could not believe how much tighter it got!

 

[mendogal]

Interesting, I always assumed the tightness was internal swelling. It makes more sense with the scar tissue why riding my bike every morning loosens me up.

Replying to both of you. Definitely both contribute. The swelling, even minimal, makes it worse because there's nowhere for it to go!

 

[Nay Nay]

Today is my 14th week of recovery. My knee is slowly getting better, so that is good. I still am not sleeping great, but I can deal with that. (I wasn't a great sleeper before surgery) I have a tendency to join the ODIC pretty often. On Saturday, I cleaned the house from top to bottom, which hasn't really be done great since my surgery. Then we had company. So by Saturday night my knee was screaming! Yesterday, I only did a few stretching exercises, and rested. I took Tylenol, but I don't think it gave me much relief. Today, my knee feels tight, but not as sore.
We had a snow storm, here in NY. So, I cancelled my PT, but my last PT sessions is on Thursday. Here is my question to everyone: Besides doing daily living activities, do I need to do all the exercises the PT and surgeon gave me everyday? Right now I do all of them except the ankle weights when I am sore. My ROM is pretty good, although I am not at zero yet. (my flex varied from 120 - 128 last week) Should I extend my PT for another few weeks? I do plan on going to the gym 3 days a week to do the bike and some machines. (also to do my upper body) Is that enough exercises for my knee. I am hoping as the weather gets better here in NY, I will be able to hike or walk on the days I do not go to the gym.

On my good days, my knee feels pretty good and I am walking better then before the surgery. On my bad days, my knee feels worse then before surgery. I am hoping for more good days then bad days....I know it will get better. Thank you all for listening to me.

 

[mendogal]

Great update!
Everyone is different with handling exercise. Many people only ever did their ADLs plus walking. Some of us have been accustomed to exercising regularly, be it a workout or a sport, and prefer to slightly challenge our new knees without repeatedly joining the ODIC.
Going to the gym 2-3 x week (varying what exercises you do in order to not overwork any muscle-tendon group!) and walking is plenty of exercise. There is no reason for daily exercises in addition; on non-gym days you might do some light stretching and ROM.

 

[WFD]

I would suggest asking your PT if you have any specific muscle weaknesses or imbalances that you should work on, so you don’t let a problem area persist, especially if it is gait related.

If they are just recommending general strengthening exercises then like @mendogal says, you can take care of that yourself in your own way.

 

[SheilaE]

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….

Hiya,
had my LTRK dec 1. My days are mostly pain free...I am up to a mile every day. I do random exercises all day...just 1 when I feel it, then another later...anyway..My nights are not as good. I know that the healing process causes much of the firing in the knee and leg. My ache is right behind my knee, a knot I can feel, Before bed I put heat then the massager. Helps for a few hours, then the body takes over and scrunches up my knee in sleep --I can't move it for a minute and it is shooting aches...take my other foot--straighten the leg, and it feels better. I get up and walk around the house for 10 min. and then come back and wrap and ice pack and fall back to sleep. The ice helps so much to go back to sleep. Of course it's only a few hours, then up again....I
'm sure it willet better...but dang...I just push the ice pack to the floor when I wake up and find it warm...lol...helps a lot tho. (ps....doesn't help the tightness tho)

 

[benne68]

On my good days, my knee feels pretty good and I am walking better then before the surgery. On my bad days, my knee feels worse then before surgery. I am hoping for more good days then bad days....I know it will get better.

Yes, @Nay Nay, the good days will continue to increase in number, and the bad days will slowly disappear. We like to say this is a roller coaster recovery and looks a bit like this:

Just remember, at 3 months post-op, you are still only one-quarter of the way through this year-long recovery. It does get better, it just takes time.

We are here for support whenever it's needed.

 

[Nay Nay]

Thank you everyone for the advice!
Today is my last PT ( ) and I hope all goes well.

Last night, I thInk, I tweaked my knee, tossing and turning in bed. My knee cap actually hurt. I was a bit concerned, so I went downstairs at 2 am, got my ice pack, and elevated in the recliner. I stayed there until about 4am. This morning it feels very tight, but my knee cap doesn’t hurt like it did last night.

I am going to the gym tomorrow. The gym I belong to just put in a pool, sauna, & whirlpool and now it is open for use. I am so excited to get in the water and do some water therapy for my knee. So many good ppl on this forum have said it was very beneficial. I plan to ask my PT for some exercises to do in the water, along with walking around the perimeter. Any advice on the best things to do in the pool? I am not a swimmer, but I am hoping they have something like a boogie board to hold onto to kick my legs. ( Is that a good idea to do since I am 14 weeks into recovery?)

Thank you all for your words of wisdom, and constant reassurance! I so appreciate all of it!

 

[benne68]

Any advice on the best things to do in the pool?

My main advice is that it is very easy to overdo things. In the pool, with the bouyancy of the water, we often don't realize how much "work" we are actually doing.

Go slowly your first time and do less than you think you can handle. Then, see how you feel the next day, and use that to judge whether your knee is ready for more, or if you need to do a bit less.

Enjoy!

 

[EalingGran]

Definitely agree with @benne68 about going easy in water.
I did a spa day with my daughter when I was about 4-5 months. I just did a few very gentle exercises whilst my daughter did lengths but I felt it much more after than an apparently much more vigorous pilates session a few days before.
Water is really deceptive.

 

[Nay Nay]

Thank you for the great advice.
I did take it easy in the pool. I did not do too much at all, side, front & back kicks, along with walking 1/2 the length of the pool and back. I also tried the hot tub and sauna, but again, not for long. I am home now icing my knee. It feels a bit sore, but not too bad. I just have to figure out a schedule of when to do water therapy, stretching, machines, and the bike. I am not doing anything this weekend, except for stretching. I am still not at zero, but extremely close, according to my PT ( a1-2). A cold measure yesterday at PT of my flex was 120 without really trying for a better flex. I think after stretching I could be around 125. I know it will get better…but I am just trying to be happy with my new knee….still not loving it.

 

[Layla]

I am just trying to be happy with my new knee….still not loving it.

Give it time.
At only a little over three months post op there is still plenty of time to make progress...and you will.
A great weekend to you!

 

[mendogal]

The first time you take a nice walk on a sunny day and realize it didn't hurt will be a milestone to remember, and you WILL get there!!!!