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[TKR] Post op swelling and stiffness<<

Discussion in 'Knee Replacement Recovery Area' started by Josh1303, Feb 11, 2019.

  1. Josh1303

    Josh1303 junior member
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    I had a RTKR 8 weeks ago including new knee cap.
    My knee is still very swollen and stiffens up as soon as I stop being active.
    I sit down and within minutes it stiffens up so that when I go to stand up the stiffness is painful.
    The swelling inhibits my exercises.
    I cannot get it straight no matter how hard I try.
    My bend is 105.
    I also have an area just at the top of the scar and above which is very tender to touch.
    I try to do my exercises 2-3 times a day but by the afternoon the swelling inhibits it.
    I thought about wearing a compression sleeve to try to get this swelling to go down.
    I sleep with my leg raised on 3 pillows so swelling isn’t too bad in the morning when I get up but swells very quickly
    Can you please advise. Many thanks
     
  2. Jockette

    Jockette FORUM ADVISOR Forum Advisor

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    Hi and Welcome to Bonesmart!

    At 8 weeks you are still very early in this year long, on average, recovery. The swelling you have is common for most of us, and as you said, it is inhibiting your bend. Don’t worry, as you swelling goes down, your ROM will improve. A flex of 105 at 8 weeks is very nice.

    The swelling doesn’t just inhibit flex , it inhibits extension also. The best way to improve extension is to get the swelling down first, then over time walking will help a lot, but not to excess. As I said, you are still in early weeks. Never try to force the leg to be straight or put weights on your knee, that will only upset it further and cause more swelling, further inhibiting the goal you are trying to achieve. In this recovery, less is more, and no pain equals more gain.

    I will leave you our Recovery Guidelines. Each article is short but very informative. Following these guidelines will help you have a less painful recovery.

    Knee Recovery: 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
    5. Here is a week-by-week guide for

    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 the 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 the member’s history before providing advice, so please post any updates or questions you have right here in this thread.
     
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  3. Roy Gardiner

    Roy Gardiner FORUM ADVISOR Forum Advisor

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    Don't worry, it's not exercise that produces healing, it's time. Gentle pain-free stretches are good, but don't try if your knee is swollen, nor should you push through pain. No pain, more gain!
     
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  4. sistersinhim

    sistersinhim FORUM ADVISOR Forum Advisor

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    @Josh1303, would you please tell us the exact date of your surgery? We'll add it to your signature for you. It helps us to advise you better.
     
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  5. Josh1303

    Josh1303 junior member
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    I had my surgery on 14th December 2018.
    Full total right knee replacement including a new knee cap
     
  6. beachy

    beachy post-grad

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    Hi Josh
    My tkr was in Oct and my extension has finally gotten to zero. Don't sweat it. It will happen. I didn't even do much pt to get it straight. It just came along from normal use. It sounds like you need to cut back on the exercise to allow the swelling to ease. You'll feel better in a week or two.
     
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  7. maryo52

    maryo52 Sr Bonesmartie

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    Are you icing while elevating at all? I still ice quite a bit, like 2 hours at a time after exercise or a walk. I had that amount of swelling with my original TKR so I know what you're talking about. I did go out and get an off the shelf compression stocking at that time. With this surgery, I was told to wear compression hose during the day and I like it quite a bit. The prescribed ones are more heavy duty. Maybe your surgeon or even your PCP would prescribe some.
     
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  8. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    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?
     
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  9. Josh1303

    Josh1303 junior member
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    Hi.
    Thank you for responding.
    Yes, if you’d like to give me some structured advice I’d be very glad to read it.
    Thank you very much
     
  10. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    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?
    ai63.tinypic.com_eta39s.jpg

    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.
     
  11. Josh1303

    Josh1303 junior member
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    @Josephine
    1. My pain level is about 6

    2. Pain medication Oxycontin 10mg st night 5mg morning. 1000mg paracetamol 3 times a day

    3. Swelling moderate to high

    4. Bend is 105. Straight is 10

    5. I ice my knee 3/4 times a day fior 20mins

    6. I elevate 4/6 times a day

    7. I do not do any of the activities you list

    8. twice a day. Was doing them 3/4 times a day
    Knee bends to count of 20 x 5 sets
    Stand on operated leg, push back and balance x10 x 5 sets
    Legs liftsx10 x 5 sets
    Lay in bed rolled towel under ankle, raise leg x20 x5 sets
    stair lunges hold for 10 secs x5
    Go up and down stairs 5-6 times a day

    No exercises fine at physio. She just asks me how I am. Measures ROM and watches me walk
     
  12. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    With the bend, can you get your leg completely straight on the bed or is it off the bed a bit?

    hyper extension-horz.jpg
     
  13. Josh1303

    Josh1303 junior member
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    @Josephine
    You say with the bend can I get it straight on the bed???
    Did you mean to say with the flat???
    If you meant the flat, then yes I can get the back of the knee touching the mattress, but obviously the mattress sinks under my upper body weight.
    Many thanks
    Rose
     
  14. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    Look at the pictures!
     
  15. Josh1303

    Josh1303 junior member
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    @Josephine
    The pictures look like they are comparing flat to not flat
     
  16. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    That's correct! Did you read the words in the photos?
     
  17. Josh1303

    Josh1303 junior member
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    @Josephine
    Yes I did read the words...... I don’t understand at all
     
  18. Josh1303

    Josh1303 junior member
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    @beachy
    Hi
    Thank you for your earlier reply.
    Did you do much in the way of exercises?
    I’ve just been told on a Facebook group that if I don’t exercise the way I had been then it will allow scar tissue to build up and it had got me worried.
    Also, I’m still worried about the swelling and the stiffness.
    I get the stiffness set in when I have stoped moving around...... even whilst waiting for kettle to boil.
    Can you please let me know
     
  19. Jockette

    Jockette FORUM ADVISOR Forum Advisor

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    Please beware of what you read on Facebook about knee replacement. There is no accountability for the truth there.

    Here on Bonesmart we have Josephine’s many years of experience, both on the medical side (in the OR assisting joint replacement surgery) and on the patient side (she’s had both her knees replaced.).

    We are all held accountable to what we say here, that it is correct information.

    There are people who do well with all the exercises that we are told to do. There are those who do well in spite of all the exercises they do. And there are many of us, me included, who didn’t handle the excess number exercises well and caused ourselves set backs by doing them.

    There is no one right way to do this recovery. We each have to find our own comfort zone within the many many opinions we are offered, from both the medical spectrum and the non medical spectrum.

    Swelling and stiffness is par for the course at 2 months. Too much activity can increase it. It’s your body’s way of telling you to slow down a bit and let it heal. And it will heal. In time.

    Try to keep in mind that this recovery takes an average of a year. You have lots of time to improve.:console2:

    Recently I compared this recovery to baking cookies. My chocolate chip cookies take 12 minutes to completely bake. If I take them out earlier, at 2 minutes, 4, 8 or whatever, they will only be partially baked, and not all that tasty, because they’re not done yet.

    The same is true of our knee at 2 months, or 3 months, etc. It needs time to finish healing.
     
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  20. grandma chris

    grandma chris graduate

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    @Josh1303 I just had to quit two Facebook groups that I tried for a while. Their insistence on doing a lot of exercise and pushing through the pain got to be too much for me. Also all the talk about scar tissue buildup. In fact only about 4% of people build up adhesions! I am just about three months out and I have a zero extension and I estimate about 120 or better flexion, depending on how swollen I am. I can go up and down stairs foot over foot and I can get in and out of my bathtub, which is quite deep. I did very little exercise, had very little pain after the incision pain was gone. The exercises you listed in response to Josephine's questions sound like way too much, but I'm sure she'll be around to tell you that herself. Good luck.
     
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