TKR Post-TKR Hematoma

VeeLee

new member
Joined
Nov 19, 2022
Messages
9
Age
69
Gender
Female
Country
United States United States
I'm new to BoneSmart and hoping to find others who have had an experience similar to mine (altho I wouldn't wish this on anybody!). I had my second TKR Oct 28, 2022. Recovery was coming along nicely (less pain than with my first TKR) until I had sudden excruciating pain in my replaced knee. It took hours in the Emergency Room to control the pain. Turned out I had a hematoma in the knee. Also, my entire thigh and buttocks on that side were seized up in spasm in response to the knee pain. I had been place on a blood thinner after the TKR, because I had cancer less than 2 years ago. The drs think the blood thinner, plus "pushing too hard with my PT exercises" probably caused the hematoma. I spent 2 nights in the hospital and am now back to PT and working on recovery. The pain seems to be subsiding, but the swelling means I have little bend in my knee and I know it can't be pushed. Any advice? Will my recovery be slowed down much? I'm icing, elevating, doing gentle stretches, using pain meds, and resting.
 

sistersinhim

Staff member since March 20, 2017
BoneSmart Staff
Joined
Dec 4, 2015
Messages
28,072
Age
71
Location
Virginia
Gender
Female
Country
United States United States
@VeeLee, welcome to Bonesmart. It sounds like you have had a rough beginning with this knee. Please tell us about your other replacement, too. We will add this information to your signature. It makes it so much easier to advise you when we know these things. Please give the dates of your other knee surgeries.

Each person is different as is their recovery. Most find that the Bonesmart approach works best for them, but others find that a more aggressive therapy helps them more. It's your recovery and your choice on how you recover. As you read more on other members' recovery threads, you’ll get a better perspective of what to expect. The following are our basic guidelines and should help get you started.

If you want to use something to assist with healing and scar management, BoneSmart recommends hypochlorous solution. Members in the US can purchase ACTIVE Antimicrobial Hydrogel through BoneSmart at a discount. Similar products should be available in the UK and other countries.

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
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 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.

Try out our great new opportunity to improve your gait. It's OneStep. It's free and you will find it to be a huge help to you. Click here: OneStep
 

sistersinhim

Staff member since March 20, 2017
BoneSmart Staff
Joined
Dec 4, 2015
Messages
28,072
Age
71
Location
Virginia
Gender
Female
Country
United States United States
I don't think having a hematoma should slow down your recovery. The first few weeks should be spent healing and not exercising. This includes lots of icing, resting, and elevating. We believe pushing aggressive PT isn't beneficial for most patients of a joint replacement. Easy movements to the point of discomfort are the best for most.
 

Jaycey

ADMINISTRATOR Staff member since February 2011
Administrator
Joined
Jan 27, 2010
Messages
39,511
Location
Yorkshire
Gender
Female
Country
United Kingdom United Kingdom
@VeeLee How long are you icing? Ice for 45-60 minutes several times per day. This will help control the swelling that is limiting your knee bend.
 
OP
OP
V

VeeLee

new member
Joined
Nov 19, 2022
Messages
9
Age
69
Gender
Female
Country
United States United States
Thank you, Sistersinhim and Jaycey, for your replies. My first (left) TKR was May 2021. The one from which I'm now recovering (right) was Oct 28, 2022. The pain from the first one completely bowled me over, but I made the mistake of not keeping up with the DIlaudid, from fear of getting addicted. This time around, I've been taking it as directed, and the pain has been much more bearable -- except for the night the hematoma occurred. The first TKR has healed up okay. Still a little stiff, but not really painful. I used Vit E oil on the scar after it healed, and it's barely noticeable now.
I'm glad to hear you don't think the hematoma will slow my recovery. I had an 85 degree bend before the bleed, and a 65 degree bend 4 days after it. But I guess that will improve as the swellling goes down. My PT was pushing it to the point of pain and holding it there for about a minute prior to the bleed. The PT in the hospital (after the hematoma) said what you said: go to the point of discomfort and back off. I'm convinced that's the way to go and will try to be assertive about that with my outpatient PT. I'm icing about what you advise: close to an hour several times/day. Thanks for all the article suggestions. I'll take a look.
Thanks also for the reminder to REST! It's hard to allow that for myself, so the more I hear that advice the better!
 
OP
OP
V

VeeLee

new member
Joined
Nov 19, 2022
Messages
9
Age
69
Gender
Female
Country
United States United States
Feeling pretty down and alone, as my situations appears to be fairly unusual. While I'm 4 weeks out from my TKR, the hematoma that occurred 2 weeks ago has slowed my progress considerably. I don't know how long it's going to take for the swelling and blood trapped in my knee to reabsorb. That's what's preventing my knee from bending further. I feel like my leg is encased in cement from mid-calf to mid-thigh. I haven't taken any Dilaudid in almost 24 hours. I SORT OF tapered it, taking a little less each day. It was almost accidental that I took none last night, so this seems like my opportunity to be done with it. The pain is certainly less, but enough to make me grumpy. I'm just taking one extra-strength Tylenol every 4 hours and a Flexeril at bedtime, as painful tightening of my thigh has been a problem all along. My one-month post-op appointment is this week, along with more PT, so those should help me feel less likely I'm floating in dark space with no end in sight. Any words of encouragement would be much appreciated. Thanks!
 

Jockette

Staff member since March 18, 2018
BoneSmart Staff
Joined
Aug 29, 2017
Messages
32,454
Age
67
Location
Delaware
Gender
Female
Country
United States United States
This recovery does take a lot of patience, it’s very slow, and having a hematoma added to it makes patience even more challenging. :console2:

That’s good that your pain level is down. Since you have enough to become grumpy :console2:you might want to consider taking a bit more Tylenol.

The most effective way to take Tylenol is 2 x 500 mg tablets every 6 hours, to a total of 4,000 mg (4 doses) in 24 hours. You need to take it regularly, to keep up the levels in your bloodstream. If you just take the odd dose now and then, it's far less effective.

Check all other medications you're taking, to make sure there is no Tylenol/Acetaminophen/Paracetamol in them. If there is, scale back one or two of your regular Tylenol doses, so you stay within that safe 24 hour limit of 4,000 mg.

By the way, I merged your newest thread with your original recovery thread, as we prefer that members in recovery have only one thread.

This benefits you because all your information is in one place, easy to find, and maintains a nice journal for you.

This also benefits our staff, as your information is all in one place, and we often go back through your thread for previous details, so we know what you‘ve been through which helps us advise you better.

So, please keep all your posts in this thread. If you’d like a new title, let us know what you want, and we’ll change it for you.

Many members bookmark their thread in their computer browser, so they can find it when they log on.
How can I find my threads and posts?

Best wishes on your continuing recovery! :flwrysmile:
 
OP
OP
V

VeeLee

new member
Joined
Nov 19, 2022
Messages
9
Age
69
Gender
Female
Country
United States United States
Thanks so much for your reply, Jockette. Patience! I hear you. :0) I'll try changing the way I'm taking Tylenol from one 500 mg tab every 4 hours to two tabs every 6 hours and see if that makes me more comfortable.

Thanks also for the advice on keeping everything on this thread. I'm not that tech savvy, but I think I get it.

Btw, I really appreaciate all the helpful, informative articles you all offer on Bonesmart!
 

Flashlight

member
Joined
Aug 31, 2022
Messages
152
Age
70
Gender
Female
Country
United States United States
Did your OS say why the hematoma couldn't be drained?
 

Layla

Staff member since November 20, 2017
BoneSmart Staff
Joined
Jun 26, 2017
Messages
32,564
Gender
Female
Country
United States United States
Feeling pretty down and alone
You're never alone here and there is always someone around to offer support and encouragement.
I stopped by to wish you a Happy One Month Anniversary, but it seems you're feeling a bit anxious. I am sorry and hope your surgeon is able to offer you some reassurance at your appointment this week. Please let us know how it goes. Hugs and best wishes for a peaceful week. :console2:
 
OP
OP
V

VeeLee

new member
Joined
Nov 19, 2022
Messages
9
Age
69
Gender
Female
Country
United States United States
Thanks so much for the friendly encouragement, Layla. It helps, for sure. Today at PT, I discovered my knee can bend to 80 now, which tells me I'm beginning to make up for my setback. Right after the TKR it was 85, but after the hematoma it was only 55, so it's great to see that tangible sign of improvement. I wish you a peaceful week as well -- and cheers to everyone who is convalescing.
 

Layla

Staff member since November 20, 2017
BoneSmart Staff
Joined
Jun 26, 2017
Messages
32,564
Gender
Female
Country
United States United States
While your range of motion is currently limited, it will naturally increase as the swelling and trapped blood from the hematoma subsides. Give it time. You're on your way and you will get there!:ok:
@VeeLee
 

beachy

supremo
Joined
May 27, 2018
Messages
2,079
Age
69
Location
Maryland
Gender
Female
Country
United States United States
@VeeLee
As Layla said, your not alone here!
We all know anything can happen during recovery. But, its discouraging and tiring when you have pain every day. Hang in there! This recovery isn't for the faint (feignt?) of heart. We are all warriors!
 
OP
OP
V

VeeLee

new member
Joined
Nov 19, 2022
Messages
9
Age
69
Gender
Female
Country
United States United States
What wonderful support! Thank you! Today I had my one month followup from the TKR. The ortho PA is concerned that there is still so much fluid and blood trapped in my leg and everything is still so tender. Doing an ultrasound tomorrow to be sure there are no clots. Fingers crossed!
 

Layla

Staff member since November 20, 2017
BoneSmart Staff
Joined
Jun 26, 2017
Messages
32,564
Gender
Female
Country
United States United States
Best wishes for tomorrow. I hope the ultrasound confirms you are clot free.
Please let us know how it goes.
@VeeLee
 
OP
OP
V

VeeLee

new member
Joined
Nov 19, 2022
Messages
9
Age
69
Gender
Female
Country
United States United States
My ultrasound showed no blood clots! Yah! I can just get on with my rehab. Unfortunately, my ortho PA is telling me to push harder to get more bend, even if it hurts. It's hard to stand up to your health care providers who are supposed to be the "experts". I'm trying to listen to my body and let it guide me as to how much it can bend.
 

Layla

Staff member since November 20, 2017
BoneSmart Staff
Joined
Jun 26, 2017
Messages
32,564
Gender
Female
Country
United States United States
Yes! Wonderful news, VeeLee! I am happy for you.
my ortho PA is telling me to push harder to get more bend, even if it hurts.
Please refrain from engaging in movement that causes discomfort or pain. Do not allow anyone to forcefully manipulate your leg. While your range of motion is currently limited, it will naturally increase as the swelling subsides and the pain eases. Give it time.
It's hard to stand up to your health care providers who are supposed to be the "experts". I'm trying to listen to my body and let it guide me as to how much it can bend.
This is certainly understandable. Unfortunately though you are the one that suffers the physical effects of overdoing it, not your PT, so keep that in mind and trust your body and it's limitations. When you think about it, its good we naturally have those internal alarms that caution us to STOP. Please heed those signals and you'll be ahead of the game for it rather than side lined in the ODIC (Over Did It Club)
Have a wonderful weekend after that great news you received!
 
OP
OP
V

VeeLee

new member
Joined
Nov 19, 2022
Messages
9
Age
69
Gender
Female
Country
United States United States
Thank you, Layla, for the sound advice!
 

Layla

Staff member since November 20, 2017
BoneSmart Staff
Joined
Jun 26, 2017
Messages
32,564
Gender
Female
Country
United States United States
Hi VeeLee...Happy Two Month Anniversary!
May it be clear sailing form here on out. :capn:

Two new knees and a brand New Year right around the corner. Many blessings to you in 2023! Please stay in touch.
@VeeLee
:happy-new-year-smiley-emoticon-4:
 

BoneSmart #1 Best Blog

Staff online

  • Layla
    Staff member since November 20, 2017
  • djklaugh
    Staff member since December 30, 2020

Forum statistics

Threads
61,721
Messages
1,537,714
BoneSmarties
37,574
Latest member
Cal1100.
Recent bookmarks
1
Top Bottom