PKR PKR Top of knee swelling

[Alpclimber]

Hi everyone
I have never been in an online forum before, but I need help. I am a 58 year old female college professor who used to be a long distance runner and alpine climber. I was hoping if I got my knee fixed I could go back to climbing this summer. I had a medial PKR 4 weeks ago. My recovery is slow and I'm getting frustrated. I am doing everything I am told to do including the exercises and resting when I need to rest. One thing that I can't seem to get under control no matter what I do is a swelling on the top outside part of the knee. Has anyone else experienced this and what did you do to get the swelling down? I have already done the "rest, ice, elevate, and compress, over and over again. It does seem to get worse when I am more active, and then I try to take it easy. My PT says this is normal and my doctor says this is normal, but it's frustrating because I was told I would recover from a partial in 3 to 6 weeks. I have read in some places online that people use special cuffs for compression. I'm not sure about that I've just been using compression hose. Any ideas?

 

[Spex10]

I think you've been slightly misinformed. 3-6 weeks seems extremely optimistic! This takes time and there don't seem to be any shortcuts. Sorry to say.

 

[Alpclimber]

Thanks, Senior. I know what you are sayong. I figured out now that my reknowned surgeon was overly optimistic to get my business. What a shame when doctors do that. Last week at my 3 week checkup he told me it will be more like 3 to 6 months. I asked him when did weeks turned into months? Obviously, he didn't have much to say about that. So I have accepted that I was duped. Now I'm just trying to make the best of it. I'm looking for new ideas to get the swelling down on the top outside part of my knee. If anyone has any suggestions I would be very grateful.

 

[fuzzybunny]

The 3-6 weeks is optimistic. I think that's a good estimate for being able to do daily activities without much difficulty. My OS was on board with me going back to work after 2-3 weeks until he found out I have a long commute so he said 6 weeks. When I had a follow up with his PA she was thinking more 9 weeks.

The only solution for my swelling seems to be ice, elevation and unfortunately time.

 

[Ronsgirl]

You said you are doing all the things you are supposed to, including exercises, icing, and elevating. It might make a difference based on how much of each of those things you are doing as to how much swelling you will have. I am also at 4 weeks with my second TKR and I still have some swelling, although not a lot. Even in my 19 week old knee swells a little when I have been up on it more than usual. How much exercise are you doing each day? How long are you icing at a time, and how many times a day? How much do you elevate? Those are things you might consider. You might need to do a little less exercise depending on what you are doing, or a little more elevating, or higher elevating, or more icing, all depending on how much you are doing now. In the end, it takes time, and unfortunately you were falsely informed on the amount of time it will take to heal.

 

[Alpclimber]

Fuzzybunny,
You are correct. At 4 weeks post op, I can walk without a cane, get around the house do some light cooking and chores. I have 115 degrees of flextion. I still have a lot of pain and can't walk very far at one time. I stop taking narcotic pain meds a few nights ago and I'm doing okay. I got a cold and switched to NyQuil and that seems to help me sleep. But I don't think I'll be climbing Mt. Ranier anytime soon!

 

[Pumpkin]

Alpclimber,
Welcome to BoneSmart, glad you joined us!
Best guess is you are doing too much too soon is this year long or more recovery, though you should start feeling a lot better around 3 months.
There is not any difference between healing from a PKR or TKR, everyone heals differently, some faster some slower.
Where are you in recovery?? (TKR)

First is the reading - everybody gets a free copy of the recovery reading!

Here are the BoneSmart mantras ....
- rest, elevate, ice and take your pain meds by the clock as prescribed
- if it hurts, don't do it and don't allow anyone - especially a physiotherapist - to do it to you
- if your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again
- if you won't die if it's not done, don't do it
- never stand when you can sit, never sit when you can lie down, never stay awake when you can go to sleep!
- be active as much as you need to be but not more than is necessary, meaning so much that you end up being in pain, exhausted or desperate to sit down or lay down!

Next is a FAQ (Frequently Asked Questions) thread.

And here are some very crucial articles
The importance of managing pain after a TKR and the pain chart
Swollen and stiff knee: what causes it?
Energy drain for TKRs

Myth busting: no pain, no gain
Activity progression for TKRs
Heel slides and how to do them

Extension: how to estimate it and ways to improve it
Elevation is the key
Ice to control pain and swelling

Healing: how long does it take?
Chart representation of TKR recovery
Myth busting: the "window of opportunity" in TKR

Myth busting: on getting addicted to pain meds
Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?
Your ROM is great, suggest you cut out all ROM exercises, and concentrate on taking it easy, and letting your knee heal. You are not weak, you are injured, you muscles will recover as you knee heals.

 

[Alpclimber]

Ronsgirl,
Thanks for your response. I exercise my PT prescribed exercises 2 times daily. They said to do them one two three times and I found three times was too much so I backed off. I ice and elevate the knee above my heart three to five times daily. On the worst days I do it as many as six or seven times. My doctor prescribed an inflatable brace with a pump that has an ice pack in it. It helps most of the swelling but the swelling above the knee on the outside is more firm and will not go down. I also wear come thigh high compression stockings when I will be on the knee more and that seems to help too. I'm just wondering if anybody else has had the stubborn swelling on top of the knee and if that ever goes down. You said your knee at 19 weeks still swells. Is that swelling mostly on the top of the knee?

 

[Alpclimber]

Thank you, pumpkin. I did do the reading before I joined and it helped some. I am however, confused by the medical practitioners who say continue to do the exercises unless I get worse pain, and the forums that say take it easy. What a conundrum this recovery is!

 

[FlaGranny]

Four weeks is really early for most people. I still, at approximately 4-1/2 and 6 months, elevate most of the time in my recliner. I still have some soreness in both knees and slight swelling in my newest knee. Surgeon says I am right on schedule. He informed me 3 months to feel better, 6 months to get back to doing anything I want, and 12 months before full recovery.

I bet you are doing too much, not elevating enough or icing enough. You should be elevating any time you are not active and icing most of the time you are elevating - at least 45 minutes to an hour. In any case you should not expect all your swelling to go away for quite some time yet.

 

[Pumpkin]

Alpclimber,
Many TKR programs are too aggressive and can set your recovery back.
It is hard to find the right balance, between healing and over doing. Tightness and swelling are also forms of pain, you need to pay attention to them, and cut back when they occur. Currently the Mayo Clinic is recommending no PT, there is no agreement about TKR recovery, even among professionals.
Listen to your knee, slow down when it tells you too. When your knee is ready slowly increase your activity and exercise.
You should start feeling a lot better in a few months and be able to progress to a more active life and exercise program. The challenge between now and then, is finding the right level of activity and rest, that will allow your knee to heal. And Patience!

 

[Alpclimber]

Thanks, Graduate and Pumpkin. I will take your advice and try to up my rest and icing. I need to work on my patience. Sigh.

 

[Celle]

It's a shame that some surgeons give the impression that recovery from a PKR will be faster than from a TKR. That sets you up for unrealistic expectations, because usually a PKR demands just as long a recovery time as a TKR.
There are a few people who recover faster, but they seem to be the exceptions.

Whichever type you have, a knee replacement is major surgery. It causes a lot of trauma and your body needs plenty of time to recover.

 

[Alpclimber]

I hope someone can help me as my doctor is 4 hours away. I am 4.5 weeks post-op for inside RPKR. I have a flexion of 5 and a ROM of 116. My sutures have healed nicely and I am able to control pain without narcotics. Walking with a limp but no cane. Sounds good right? Except I have a very stubborn HARD knot of swelling on upper outside of the knee. In fact all of my swelling is above the knee. After joining this forum and meeting with my PT I realized my doctor pushed me two hard on post op exercises. I was doing chair heel slides the day after surgery (outpatient), and walking too much. After reading this forum I have reduced my pain with more ice and elevation, and I cut way back on my activity. I am seriously stalled in my recovery again. My questions are: Is hard swelling on the TOP of the knee normal? Will massage or TENS help? Has anyone else experienced this?

 

[KarriB]

If you're walking with a limp you need to use your cane. That limp means your knee isn't ready for the work you're asking it to do. A cane will also help you to regain a more natural gait and longer stride.

You are very early in this recovery. My OS said I shouldn't think about returning to work until week 12 and I may not feel 100% for year. A TENS unit may help. Take a look at this article and see if this is your pain issue.

http://bonesmart.org/forum/threads/tight-band-feeling-across-the-front-of-my-knee.11734/

 

[Alpclimber]

Thanks KarriB
I'll try going back to the cane. I use it outside and did notice I walk better with it. Regarding the swelling it is not the front band. It is above my knee where the knee meets the thigh/quad, in other words where the femur meets the outside cartilage and ligaments. I have tried mega icing and elevation and it doesn't help. Should I be worried?

 

[KarriB]

At just 4 weeks I don't think there's a reason to worry. Swelling is normal for a quite a while, but let's see what @Jamie or @Celle has to say.

 

[bottomshollow]

@Alpclimber, You may notice that I have merged your two threads. We like to keep our members' recovery posts all in a single thread. That way it's easy for us to go back and read your history before responding to a question or concern. In addition, the thread becomes a journal of your recovery for those who come along later and want to read about you. So, please post in this thread from now on when you want to give an update or ask a question. If you have questions or concerns that need an immediate answer, please tag an admin, a mod, or other members or all three.

If you decide you'd like a different thread title at any point, just post what you want here and we'll get it changed for you. THANKS!

If you are having a problem locating your thread, here is a link with how to do it: How can I find my threads and posts?

 

[Alpclimber]

Ok. Sorry. I really don't know what I'm doing, but will post here from now on.

 

[newlybionic]

I had muscle spasms in that area after my surgery. It felt like I had a knot in my quads. My OS prescribed a muscle relaxer that I used to help it relax.

Do you think it looks more swollen after you use may be causing the problem? Try icing your knee and above with ice packs only for the next few days. Maybe it's just some extra swelling that is being blocked from draining that will go down when you stop using it. If you are wearing a surgical stocking on that leg I would stop that too. I hope you feel better soon.