Revised PKR to TKR +PKR - Redsta Recovery

[redsta]

Hi,
I had a medial partial knee replacement on the 25th of Feb 2019. My recovery was going really well and I was walking without crutches at 4 weeks. My knee was never really swollen or bruised, I had quite a bit of pain but it was manageable. I overdid it a bit I think last week (just getting back into the swing of regular household duties - nothing extreme) now my knee has swollen. It's not painful but it feels awful. I have rested it really well for three days and hired a game ready machine to ice it. It hasn't eased the swelling at all. This almost exact thing happened at the 6 week mark after I had a scope as well. I am on 1000mg of Naproxen as an anti inflammatory per day and taking paracetamol for pain. Any ideas, suggestions or help appreciated!

 

[FCBayern]

@redsta Welcome to BoneSmart! All of us seem to over do it as we start to feel better and it can really set you back. A moderator will be along soon to offer you links to a bunch of really helpful articles. In the mean time I hope you feel better soon.

 

[Celle]

Hello @redsta - and

Please will you tell us the full dates of your arthroscopy, and which knee was replaced, so we can make a complete signature for you? Thank you.

People who have a partial knee replacement are often told they will have a faster recovery than if they had a total replacement. Usually, that turns out not to be true. Partial or total, it's major surgery and recovery takes a long time, as long as a full year for complete healing.

So, it seems as if you have probably been overdoing the activity a bit too much for your knee. Check what your activity level should be against this article:
Activity progression for TKRs

The best way to treat swelling is to reduce your activity and spend more time resting, elevating and icing that knee. It can take several weeks for the swelling to start to decrease, so be patient. There are articles about elevation and icing in the recovery guidelines, which I will give you now:

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.​

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 Care In Hospital​

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 a 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 history before providing advice.

 

[redsta]

My scope was on the 20th of October, 2018 and it is my right knee. Thank you for your response. Do you know if any anti inflammatory medications are better than others post knee surgery?

 

[Celle]

Thank you for that information. I've added it to your signature.

We don't recommend anti-inflammatory medications. There are dangers associated with their use. The person to ask is your surgeon or doctor.


Icing your knee is a good anti-inflammatory treatment, though.

 

[NavyGunns]

@redsta, welcome to BoneSmart. I’m just getting caught up on a few posts and especially like to respond to new members who have had partials. The swelling you describe is typical for the times we push things a bit too far. You said you didn’t feel you did anything extreme, but apparently your knee feels otherwise. You are not quite 8 weeks out, so the soft tissues around your knee are still very sensitive to being stressed. It’s important to realize that your challenges these days are not with the new joint, but are with how much the soft tissues have healed and how tolerant they are to various activities.

Each of us heals at different rates and in different manners. While there was a lot of things I could easily do by 9-10 weeks, there were things I thought should have been easily tolerated but the tendons and other soft tissues felt otherwise. You are entering into that phase of recovery where you feel good, knee is beginning to feel a bit more normal, and you want to try new things. That is all good. Just be aware of how your knee responds. When it swells or gets stiff, that means to back off for a while to let it settle down. When you try again, go a bit easier. I had one activity that took me until after 6 months before I could do it without issues from my IT band.

Keep listening to your knee, ask questions here, keep us updated.

 

[Josephine]

I'd really like to offer you some structured advice but in order to do that, I also need to ask you some questions. Are you willing for me to do that?

 

[redsta]

Thanks NavyGunns and yes Josephine I am willing to answer any questions.

 

[Josephine]

Here y'go then!

It would be very helpful if you would answer each one individually - numbered as I have done - in as much detail as you can then I'll come back as see where you are ....

1. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine. And don't forget to factor in other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness).

2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?

3. how swollen is your leg compared to these?

4. what is your ROM - that's flexion (bend) and extension (straightness)

5. are you icing your knee at all? If so, how often and for how long?

6. are you elevating your leg. If so how often and for how long?

7. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and

8. are you doing any exercises at home? If so what and how often?
This is the most crucial question so please help me by using the format I have left as an example
(which means please make a list and not an essay!)

Exercises done at home
- how many sessions you do each day
- enter exercise by name then number of repetitions of each
etc., etc.

Anything done at PT
- how many times a week
- enter exercise by name then number of repetitions of each
etc., etc.

 

[redsta]

1. Pain varies a lot. It doesn't really get above a 5. Night time my whole leg aches but pain is not huge just annoying.

2. At the moment I am taking
1000mg of paracetamol 4 hourly
400mg of ibuprofen 4 hourly
Occasionally I take Tramadol if I have over done it.

3. Knee is moderately swollen.

4. Flexion and extension are both at what they were pre-surgery and have been since 5 weeks post surgery.

5. I am icing my knee using a Game Ready machine for 15 minutes every hour at the moment.

6. I usually sit with my leg straight on the bed so not really elevated as such.

7. My activity level is quite high due to having 2 children aged 2 and 4. I have employed a cleaner to come once a week but am doing everything else. We have also been moving house so demands are high.

8. I have actually backed off all of the exercises I was doing due to swelling and pain.
leg raises 10 x3
slides 10 x3
clams 10 x3
knee over a towel pushing down 10 x3
knee over a towel lifting ankle 10 x3
At the moment I am just doing slides every now and again.

9. I have been to physiotherapy twice since leaving hospital and both times they were really happy with my progress however I have not been back since it went downhill after week 6.

Thank you for your time

 

[Josephine]

4. Flexion and extension are both at what they were pre-surgery

Which is what, exactly?

 

[redsta]

I can get my knee completely straight on extension and I'm fairly certain when my flexion was measured last it was 120. Thank you

I have been making sure I elevate my leg when sitting now on a pillow stack which I think has been helping too.

 

[Josephine]

I can get my knee completely straight on extension and I'm fairly certain when my flexion was measured last it was 120.

Very good!

I have been making sure I elevate my leg when sitting now on a pillow stack which I think has been helping too.

Superb

 

[redsta]

Sorry I have a question - can anyone help? I have to keep overdoing it due to being a Mum and have been for quite a few weeks. I am 8 weeks post surgery and keep pulling up sore and am needing more pain medication just to get by. What are the possible long term consequences of this (for my knee - not the pain meds)? I am supposed to go back to work 2 days a week as a teacher next week as well which will mean being on my feet all day. Am I doing permanent damage or just prolonging my recovery?
Thanks

 

[Jockette]

You cannot be on your feet all day, even only 2 days a week, this early in recovery, especially with the pain and swelling you currently have. At this point in my recovery it hurt just to stand in line at the store for a few minutes. Please arrange more time off work.

I understand the reason you must overdo at home, but even there please try to do less wherever you can. Hiring cleaning help was excellent!

Yes, continually doing too much too early causes set backs which prolong recovery and in some cases can truly diminish your final outcome.

 

[redsta]

Thank you for your reply - off to the doctor to get more time off work!! I will get this sorted!

 

[Jockette]

I have a partial, also, a Patellofemoral, and it was not at all like I read about before surgery. What I read made partials sound minor. What a shock when my reality hit.

I hope your doctor will be understanding and agree that you need more time off work. Sometimes even they underestimate this recovery.

 

[Celle]

I have to keep overdoing it due to being a Mum and have been for quite a few weeks. I am 8 weeks post surgery and keep pulling up sore and am needing more pain medication just to get by. What are the possible long term consequences of this

I understand the pressures of being a Mum, but it is important to get the rest you need. Cut back the "Mum" work to the bare essentials and enlist the children to help, by doing things for you. It will be good training for them and even the littlest can do some jobs. My two-year-old was proud to clean the bath for me every day when I had a slipped disk.
Nurturing mother: how to let go and accept help

Your knee needs you to take the rest you need now, or it might end up with chronic inflammation.

I am supposed to go back to work 2 days a week as a teacher next week as well which will mean being on my feet all day. Am I doing permanent damage or just prolonging my recovery?

I'm glad to read you're going to take more time off work.
Teaching is particularly hard on a new knee.

Most likely scenario - by going back too soon you could slow down your recovery and also increase your pain and swelling.
Worst-case scenario - permanent less-than-optimum knee function.

 

[redsta]

Thanks everyone for your advice and support - I am a little worried my doctor won't give me more time off but am prepared to get stroppy if need be. I can also contact my surgeon who I'm sure will be more than happy to sign me off. I am teaching in 4 year old as well so the demands on getting up and down constantly are huge.

 

[FCBayern]

@redsta I went back to an office job at 6 weeks and realized it was too early even for that. At 12 weeks today I'm still working from home Tuesday's and Thursday's. I can't imagine even now trying to keep up with young kids all day.