TKR Painful Recovery

[Slainte]

@CATSMUM got an IT band from Amazon that she said helped a lot with her IT problem. Just search and you will find it. Simple thing, but made a big difference for some folks. Mine was burning like mad at night. I did a few of the stretches in the library, and then had to stay off my feet for two weeks due to a blood blister under my big toe. When I got back on my feet, the IT band problem had resolved itself. I think it needed a good rest.

 

[Celle]

@Josephine
Tanya1811 has given more answers to your questions, in Post #16.

 

[Tanya0811]

Good Evening, I have a question: today is eight weeks since my surgery. Aside from everything else my new knee is 4 cm larger than my non-operated one. Is it considered a significant swelling or not? Visually it does not look like huge compare to the other one, but 4 cm?
Switched from oxycodone to TRAMADOL, like it much better, at least do not feel weird.

 

[Tanya0811]

[QUOTE="Slainte, Thank you very much, will find it.

 

[Celle]

It is normal to still have some swelling at 8 weeks. As long as you're making steady progress and still doing lots of
rest, elevate, and ice , I wouldn't worry about it. You'll notice that you still get some swelling, especially after extra activity, for several months yet.

If measuring your knee causes you to worry about it, I wouldn't bother measuring.

 

[kneeper]

To barge in here @Tanya0811 I can tell you I sure wasn't doing 16 steps 3x a day at your point in recovery. Maybe once a day.

 

[Tanya0811]

Thank you all for your replies. I am not measuring the swelling any more, just icing it. Came from PT today, absolutely exhausted. It includes half hour of massage and exercises, the half hour of pretty vigorous pool exercises. After that I feel like I ran a marathon. Tomorrow going to work. The agreement is that twice a week I come to the office, and the rest work from home. Driving is 35 minutes, the hassle is that I have to carry my laptop back and forth. But it's good that only two days a week I must be in the office. Taking my ice packs with me. Taking TRAMADOL now instead of oxycodone. TRAMADOL is easier on my body and stomach.
In terms of pain, it is more now like surgical pain all over the knee rather than the pain concentrated in one spot like before. The scar is also pretty bumpy and tight, and PT advised to get a CICA CARE scar patch. I have ordered it on Amazon, will try. I also massage the scar with vitamin E oil, but it us still pretty tight.
And the last thing. My flexion today was 97. Not great, but better than 95. Will try to bend it more tomorrow.
Good night to all of you.

 

[Celle]

I really think you're doing too much PT, Tanya. PT should not exhaust you. You really don't need to do lots of vigorous exercise in order to rehab your knee. It's probably contributing to your pain, too.
TKR: work “smarter” and not “harder”

You don't really need to massage your scar, either. Mother Nature is pretty good at healing you, without intervention. All it takes is time, and all the lumps and bumps will flatten out.
Of course, if massaging (gently) feels good, then do it by all means, but there's no need to buy fancy oils. Baby oil is as good as anything.

 

[Tanya0811]

Celle, Thank you so much for guiding me in this situation. I have not yet figured out how to respond to someone personally, therefore writing on a thread. The reason I am doing this PT is that it includes a heated pool. The girl who does my PT is much more reasonable than the previous one that I quit. She is convinced that the IT band is a culprit, and that the massage and stretching will do the trick. My concern is that when I am trying to bend the knee more than I can it really, really hurts. But, on the other hand, by NOT bending it I will not achieve more ROM at all. So, probably need to find a borderline between workout and discomfort, not an easy thing, but with your guidance and reading other folks' posts, hope to get to some common sense. One more question, the PT girl said that in order to achieve more ROM and reduce pain I need to do knee cap mobilization, i.e. with my hands moving the patella back and forth (UP AND DOWN) and side to side. I tried, it is not painful, but a little scary, can I dislocate the knee cap by doing it? Thank you again. Stay well.

 

[Celle]

My concern is that when I am trying to bend the knee more than I can it really, really hurts. But, on the other hand, by NOT bending it I will not achieve more ROM at all. So, probably need to find a borderline between workout and discomfort, not an easy thing, but with your guidance and reading other folks' posts, hope to get to some common sense. One more question, the PT girl said that in order to achieve more ROM and reduce pain I need to do knee cap mobilization, i.e. with my hands moving the patella back and forth (UP AND DOWN) and side to side. I tried, it is not painful, but a little scary, can I dislocate the knee cap by doing it?

Don't bend your knee until it hurts. That won't improve ROM. It will slow it down. Just bend it gently. The ROM will come, all by itself, as long as you don't irritate the knee. ROM increases spontaneously as your knee heals and the swelling goes down.
I did no PT at all and no exercises for my latest TKR and my ROM is great.

Likewise, kneecap mobilization is not necessary. The kneecap will mobilise all by itself. You won't dislocate the kneecap, but doing kneecap mobilization won't do anything to help, either. Leave it alone!

Do exercise gently in the water. It's very easy to overdo it in there.

To tag someone, you just put the @ sign in front of their name, like this: @Celle . Don't leave any gaps between the @ and the name, but do make sure there is a gap after the name.

 

[Clipless]

@Tanya0811 , please listen to Celle and follow her advice!

 

[Josephine]

My concern is that when I am trying to bend the knee more than I can it really, really hurts. But, on the other hand, by NOT bending it I will not achieve more ROM at all.

There's a joke that goes
Patient: "Doctor, my arm hurts when I do this" (twists are behind his head)
Doctor: "then don't do it"!
Nuff said?

I do recommend you read my recovery threads to see how little exercising I did!
First knee. Knee recovery - UK style
Second knee. Josephine's 2nd knee story - short version where I did even less!
The moral being that one does NOT have to 'work hard' for ROM. It's there all the time, just waiting for you to allow the swelling and pain to subside so it can show itself. Working hard for ROM is a total myth.

One more question, the PT girl said that in order to achieve more ROM and reduce pain I need to do knee cap mobilization

Another myth! I never touch either of my patellae and they're just fine, thank you. I really have no idea where these girls get the weird and totally unsubstantiated ideas from. No-one does this in the UK.

 

[kneeper]

Yeah, my instructions included kneecap mobilization. It does feel weird, but not painful. I did it a bit--my PT showed me, and it was on my instruction sheet from the OS. I'd go ahead and do it if it's on your instruction list--but it's nothing vigorous. Just kind of gently moving the kneecap around. I don't think it can hurt to do it. But like Celle says, not every OS or PT has people do it.

My OS said no "lotions or potions" as Josephine says particularly help the scar. It may seem like it's really stiff or hard but it does settle after time. I liked to rub some cocoa butter with vitamin E on my scar. I think keeping it moisturized (and protected from the sun) is the main thing once the incision is closed. I know with my first knee it seemed like it took forever to lay flat and fade but it did.

On the bending--listen to the knee and through trial and error you will find the balance between keeping the knee moving and giving it needed rest, ice and elevation.

 

[nomoreski]

Have awful pain on the lateral side of the knee where IT band attaches and where fibula attaches to the tibia.

Hi. I also am having IT band issues post op...had it pre op too. I had been using a tennis ball for self massage, but my hands have been so stiff since surgery, i am having trouble with the ball. I tried my rolling pin...but it is waaay to big so went on a search and came across a printer's brayer. It is also helping massage some of the knots out of my quads too. Keep posting your progress and what is helping.

(https://www.amazon.com/Speedball-Deluxe-2-Inch-Rubber-Brayer/dp/B001KWGU92/?tag=ate362da-20)

 

[Josephine]

Or try this Acupressure massage

 

[Tanya0811]

Hello Everyone,
I have not communicated for a while, but still hanging in there. It is almost three months after the surgery, but the pain is still strong and persistent. My OS said he did not know where the pain is from, made several hypothesis, either an IT band, or hamstring, or popliteal space or else. To make along story short I had an MRI done and went to NY to the hospital for special surgery (HSS) for the second opinion. The MRI among other things said " deficiency of LCL and MCL, however absent of clinical relevancy, has little significance" ?
The doctor in HSS was very cautious in his statements, but said that he would have made my LCL and MCL much tighter than it is now made. He suggested that we wait some more time, say three more months to see how it goes, and then decide what to do. When I asked if something can be done with the LCL arthroscopically, he replied that the only way to fix it would be a revision surgery.
So, I left his office not very much encouraged. Walked a lot today in hope to may be strengthen this ligament? Will probably go for the " third opinion" if it does not get better.

Hope you all are doing OK here. Best wishes to everyone.

 

[Josephine]

Walked a lot today in hope to may be strengthen this ligament?

It never ceases to amaze and frustrate me how many times people will think the 'obvious' way to sort out a painful ligament is to indulge in excessive exercise.

You're only 13 weeks out - quite early really and pain is still your leg's way of saying

So if you have problems with the collateral ligaments, they need to be rested and not exercised. You can also try some topical NSAIDs like Ibuleve or Neurofen gels and Acupressure massage. Otherwise, see if a chiropractor can help you.

 

[Tanya0811]

@Josephine,
Thank you, I have just applied VOLTAREN gel. I have a question though. Why it hurts more at night, I.e. At rest that when I walk? And another one, in your opinion, if the LCL is not well balanced during the surgery, is there still any hope that it will heal by itself without a revision surgery?
Thank yo again for responding so quickly and for being so helpful.

 

[Josephine]

Why it hurts more at night

Why does it? It's a mystery that has confounded many learned minds for years! There are theories in plenty.

if the LCL is not well balanced during the surgery, is there still any hope that it will heal by itself without a revision surgery?

As I believe I said previously, it depends what's actually wrong with it. Not knowing that, I'm afraid I cannot offer an opinion. Sorry