TKR Post op swelling and stiffness<<

[Josh1303]

@grandma chris
Thank you so much for your quick reply.
Over this past week I have cut down on doing the exercises a lot.
My straight is 15 but to try and get it any better it really hurts at the back of my knee.
What exercises did you do?
Are you in U.K.?
I’d love to hear from you again

 

[Josephine]

Yes I did read the words...... I don’t understand at all

Sorry about that. seems I am blinding you with science!

Perhaps this article will explain it more ROM (range of motion) information

 

[beachy]

I'm not on facebook so I don't know about those groups.

Bonesmart is my group. I would listen to your knee and the good advice given here. Read the information given by the forum advisors about pt.

What worked for me isn't what might work for someone else. I was trying to let you know that aggressive pt doesn't always achieve ROM. Sometimes it does, many times it doesnt.

 

[sistersinhim]

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.

You have to have scar tissue to hold your tissues together! What they are talking about is adhesions. Yes, the number-obsessed PTs and other people will rattle on about it as if the big bad "scar tissue" is just sitting there, waiting to pounce if you don't do enough exercise.

Actually, it's quite the reverse. The infamous scar tissue (which is more correctly called adhesions) is very rare, and one of the easiest ways to develop it is to work your knee too hard. Over-worked knees get inflamed and hot, and hot tissues become drier than normal and more likely to stick together and form adhesions.

This article explains the difference between scar tissue and adhesions:
MUA (Manipulation under Anaesthetic) and Adhesions

You need normal scar tissue. That's what holds your incision together, and it's part of the normal healing process. Without it, you'd always have an open wound.

Also, I’m still worried about the swelling and the stiffness.

Your knee is a baby at just 2 months out of surgery. It is still healing big time! When you do aggressive PT, then your baby becomes more inflamed. Inflammation causes swelling and pain. When you are swollen your ROM, (extension and bend), is worse than it would be without that swelling. Think of a garden hose that it full of water with the nozzle closed off to keep the water in there. Can you easily bend it? Nope, not at all. That's your knee. Extension reacts the same way when your knee is swollen. There's no place to push that water out of the way. Very gentle movements is your best therapy. Your number one goal should be getting that swelling out of that knee. That takes rest, ice, and elevation. Please give the Bonesmart way a try for a month or so. You'd be amazed at how much better your knee will be.

 

[Josh1303]

@sistersinhim Thank you so much for your reply. It all sounds so sensible. I don’t know why here (I’m UK) they go on and on about exercises. They must be done!!! Thank you again

@beachy At the moment I am 9 weeks post op. My bend is 105-110 Physio gave me two measurements. Straight is 15

I still have swelling, stiffness and tightness but I am walking well without a crutch and I do about 3-4,000 steps a day.

 

[maryo52]

All sounds normal to me. There's this long plateau in TKR recovery. The stiffness is so persistent. I do not know all the reasons for it -- swelling is a big one. The knee is a very mobile joint, and the tissues around it got traumatized in surgery, and they just need months and months to "remodel" and feel normal and become stretchy. You will find that over time, without worrying or thinking about ROM, your range of motion will improve as these tissues become normal.

 

[beachy]

I agree with maryo52. My ROM was right around yours at 9 weeks and better now at 4 months.

 

[Josh1303]

@maryo52 Thank you for your reply.

I am also worried about not being able to get my leg straight. I am really trying to get it straight, but I just can’t get it straight. I get a pain in the back/side of my knee when trying. I also get this same type of pain when trying to bend my knee more than it already is.

I’ve taken advice from here about not overdoing exercises. In fact I’ve been a bit lazy over the last week and only do the bend and try to get the straight.

I haven’t been doing lunges anymore after my bad experience the day after doing them and I haven’t done anymore low squats.
I do go up and downstairs several times a day.
I feel that is quite good exercise for strengthening the muscles in my thighs.
I do still have swelling but since I’ve cut back on the exercises it’s not so bad. Only 3” bigger now instead of 5” bigger!!!
Is it right that given time the bend will get better and the straight will happen?
Many thanks

 

[Josephine]

1. My pain level is about 6

Okay

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

Is there any acetaminophen in the oxycontin? If there is, make sure you subtract what you take from your total paracetamol. You mustn't exceed 4,000mg per 24hrs.

3. Swelling moderate to high

If you looked at this guide Swelling/pain comparisons, you'd see that such swelling will add 4-7 points on your pain score!

4. Bend (flexion) is 105. Straight (extension) is 10

Is that extension plus or minus? Extension has extra measurements as shown here

As you can see, extension that is less than straight (slightly bent with knee off the bed) is a + (red flag) and if it is more than straight (with heel off the bed) is a - (blue flag). Can you tell me which it is?

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

You accomplish little or nothing in 20 minutes. Ice for at least 40-60mins and more than 4 times a day.

6. I elevate 4/6 times a day

Elevate while you are icing.

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

Very good!

Twice a day. Was doing them 3-4 times a day
Knee bends to count of 20 x 5 sets - I don't recommend these as they tend to make your knee swell more than bend more.
Stand on operated leg, push back and balance x10 x 5 sets - another exercise that is designed to cause problems
Legs liftsx10 x 5 sets - a tip: once oyu can do these, there is no need to d them any more
Lay in bed rolled towel under ankle, raise leg x20 x5 sets - that's a half leg raise and the same applies as previously
stair lunges hold for 10 secs x5 - contrary to popular belief, this does NOT improve flexion but it more likely to increase swelling and stiffness
Go up and down stairs 5-6 times a day - if you need to, all well and good. But don't do them as an exercise

No exercises fine at physio. She just asks me how I am. Measures ROM and watches me walk - right, that's exactly how my physio did with me!

I don’t know why here (I’m UK) they go on and on about exercises...... they must be done!!!

You have been unlucky if that's the case because no-one did that with me. In fact, it's not true and I'd just smile and let them assume what they wanted to! Basically, I did absolutely NO exercises whatsoever, not even so much as a single heel slide and cam out with excellent results!

If you are concerned about refusing to do therapy, you need to read this Saying no to therapy - am I allowed to?

 

[Josh1303]

@Josephine
Thank you very much for you last reply to me.
Just to confirm my extension is +10

Do you happen to be in U.K.?

It would seem I haven’t been icing for long enough.

Is it normal to have some tenderness underneath part of the swelling?

Just to remind you I also had a new knee cap
Kindest regards

 

[maryo52]

Did you mention pain behind the knee? I had that when trying to straighten, which puts a strain on the ligaments in back. It's OK to straighten or bend your knee to the point of tightness, especially in the course of everyday activities. Over time that will slowly increase your ROM. There's swelling you can see, and excess joint fluid which you cannot see, and both inhibit ROM. Doing less minimizes swelling, and icing even at this stage will help the swelling.

 

[Josephine]

Do you happen to be in U.K.?

Josh, you can see which country any member is in in their 'post bits', the blue panel in the left of a post. So you can see I'm in the UK and that my post is showing the Union flag!

Is it normal to have some tenderness underneath part of the swelling?

Did you forget that I said that there are "other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness"?

Just to remind you I also had a new knee cap

So did I. My first knee didn't but my second did. I noticed no difference between them whatsoever. Very few people are ever aware when they've had a patellar button inserted.

 

[Josh1303]

@Josephine
Thank you so much for all your answers.
I find them very helpful.

I have what I think is a tendon at the side/back of my knee and I am finding that this is still hurting and stopping me getting a better bend. It’s not muscle as it’s very taught. Does this get better over time.?

I had this problem before my surgery in that when I moved even my foot it hurt in the same place.

I’ve cut back on a of the exercises but I do still try getting the bend better and the straight but not pushing things as much as I was.

I am doing a fair bit of walking about in phases throughout the day.

Thank you so much for replying
Kind regards

 

[Josephine]

I have what I think is a tendon at the side/back of my knee and I am finding that this is still hurting and stopping me getting a better bend. It’s not muscle as it’s very taught.

Oh muscles can get very taught as well, believe me!

Show me where this pain is using this site

 

[Josh1303]

@Josephine

The bit that hurts is RB1 at the bottom of D.
It feels like the tendon in that area as it is like a length of string

Many thanks

 

[Josephine]

So like this?

This point is the hamstrings which are muscles. They are readily addressed with these Hamstring stretches

Every muscle tapers into a short ligament at the point where it is attached to a bone. But this is still a muscle!

 

[Josh1303]

@Josephine
Hello Josephine. I have in fact been doing those stretches for quite a few months (since September 2018 - prior to my surgery in December ‘18) as I was having trouble in that area since April 2018. I have told my physio about this pain at the back in that area as it hurts when I bend my knee. I can feel it with every step I take on the operated leg. It almost making me want to limp!!!! Which if it wasn’t hurting, I’d have no desire to limp.

Thank you for you advice.

You say you went to a chiropractor, what did they do to help you resolve this issue.

 

[Josephine]

He applies to the muscles along the entire length of the muscle which you can see here. They are big strong muscles and need a lot of work!

Acupressure massage

 

[Josh1303]

@Josephine

Thank you for your reply.
Did your chiropractor work on them a lot?

I only know of a sports therapist in my area

Also, do you know of infrared massage
Many thanks

 

[Josephine]

Did your chiropractor work on them a lot?

Only when I went to him which was about every other week.

I only know of a sports therapist in my area

Those are not the same. You need to do a search on the "Find a Chiropractor" site

Also, do you know of infrared massage

That won't do you any good. Though a TENS machine might