TKR Powerhouse's Recovery

[Powerhouse]

Hi
I had my first TKR in 2015 and my second one 9 days ago.
I do not remember having any spasms, cramps or charley horses with the first TKR.

I stayed one night in the hospital this time and did not sleep more than 10 minutes at a time due to spasms that seemed to be under the knee. The nurse gave me 5mg oxy, then 10, then 15 and added some Sonata for me to sleep...nothing worked. But since I could walk, do stairs, etc., they let me go home.

Since being home I continue to have those spasms. But, also have been waking myself up with my own screaming in pain due to what feels like a charley horse taking over the whole inside of me knee. It freezes it in place and then aches/throbs for hours afterward.

The doc says this is "quite normal" but did prescribe a muscle relaxant that has done not a thing.

Hardest part is that I make progress through the day and feel like I'm healing "on schedule". Then this happens and it sets me back hours - plus almost afraid to go to sleep.

Any ideas of how to get rid of these spasms? THANKS!!

 

[Celle]

Hello @Powerhouse - and

How much exercise are you getting during the day? It sounds as if you're trying to recover according to some sort of schedule.
There is no schedule for this recovery, no time by which you have to achieve a certain target. It's a long recovery - as long as a full year before all your tissues are completely recovered, although you'll be able to do most things before then.

There's no need to rush to get ROM (Range of Motion) because it can continue to improve for a year, or even much longer, after a knee replacement. There isn't any deadline you have to meet:
Myth busting: the "window of opportunity" in TKR

It's still far too early to be doing lots of exercises. All the exercise your new knee needs at this stage is walking around the house every 90 minutes or so.

I suggest you cut back your amount of exercise and spend a lot of time resting, icing and elevating your leg, and taking your medications on a fixed schedule.

Talking of medication, has your surgeon or your own doctor prescribed Gabapentin? That often helps with nerve pain.


Please will you tell us the full dates of your knee replacements and which knee it is, so we can make a signature for you? Knowing the exact date will help us to advise you appropriately.
Thank you.

 

[Celle]

Here are our recovery guidelines to help you with recovery:

Knee Recovery: The Guidelines

People are all different, as are the approaches to this recovery and rehab. The key is, “Find what works for YOU.“ Your doctor(s), physiotherapist(s) and BoneSmart are here to help, but YOU are the final judge as to the recovery approach you choose.

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. Try to 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 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.

 

[Powerhouse]

Thanks for your reply, Celle! Interestingly, i am reading this at 1am because a very painful "Charley horse" in my knee just woke me again.

Yes, I am following a "recovery schedule" per the surgeon. It is basically the same one I did in 2015 for my first TKR...as did my husband for both his, my dad & others I know. (All different surgeons & therapists, but all follow similar agendas.)

At home:
Do 10 mins of some kind of movement every hour (walk the house, do any of the daily 7 exercises given)
Elevate and ice 30 minutes 6-8 times a day.
Make sure to do 7 daily exercises 2x day

PT center:
3x week first month, then 2x week next two months. They really push for ROM.

I love your outline of recovery process! Seems to make sense. But the threat of needing MUA if ROM isn't met in a certain time frame is always hanging over me.

I can't take gabapentin...but he gave me cyclobenzaprine 10 mg as muscle relaxant...so far no change.

I did not have these kinds of spasms with my first TKR, so researching the why & remedy because they are certainly scary, and so painful.

Thanks again.
Tina

Right TKR June 28, 2021
Left TKR February 16, 2015

 

[Jaycey]

Elevate and ice 30 minutes 6-8 times a day.

30 minutes is enough if you are trying to recover from an injury. However you accomplish nothing in that time frame when you are recovering from surgery. Ice for 45-60 minutes several times per day.

Make sure to do 7 daily exercises 2x day
PT center:
3x week first month, then 2x week next two months. They really push for ROM.

Most likely the reason you are having the spasms is all this exercise. Of course it's your decision. But that knee is telling you this isn't the right approach. And no one should be forcing ROM.

But the threat of needing MUA if ROM isn't met in a certain time frame is always hanging over me.

There is no time frame for needing MUA. We have members who continue to see improvement for literally years post TKR. And do remember that you are in charge. There is no threat of MUA. Far too early to even be thinking about that approach.

 

[sistersinhim]

I'm one of those on Bonesmart who never took formal PT. I've had 12 knee surgeries, 2 of them kneecap removals, and 1 tkr. Even after those I never took formal PT. But, I didn't just sit around doing nothing, I am not a lazy person and have to move! I used my knee as it was intended to be used by walking around to take care of my daily needs along with the necessary house and yard work. As I healed I was able to do more. Icing and elevation were a huge part of my recovery.

Listen to your knee. Your knee knows how to rehab itself without being told what to do. It will tell you if you're doing too much by increased pain, swelling, and those nightly Charley Horses you are having. Thank God I didn't get those but I did have pain and swelling. I found that resting, icing, and elevating helped those.

You are 4 years older than when you had your first TKR. That means your right, new knee had four more years of damage to repair. Your surgeon probably had more work to do on it, which causes you more painful reactions. Treat your knee like the newborn baby that it is and it should settle down.

 

[Freestyle]

I sympathize completely, Powerhouse. It's really hard figuring out what exactly is causing pain and how much you can do. My first TKR went perfectly--steady progress with no setbacks. My second TKR--and you would think I would be even smarter now--has required much more sensitivity to how much my baby knee can take. At one point, my hamstrings were on fire and I had to shut everything down for 24 hours. My PT and I have had to scale back my exercises significantly--and every day is a test to see how much I can do without overdoing it. As many people here have described, it's a strange cycle of feeling good, doing too much, and then having to scale back then feeling good, doing too much, and having to scale back.

I hope your cramps go away soon and that you are able to get some sleep!

 

[Sisterpat]

Welcome Powerhouse, and congratulations on your new knee! Sounds like you are pushing way too hard! An MUA is YOUR decision, not anyone else’s. Your ROM will increase with time, not force. Many members here gained ROM well after a year. You are very early in this process. Sleep was elusive for me for many weeks, just now starting to sleep at night. This is a long process that simply can’t be rushed. Keep posting and let us know how you are doing.

 

[Powerhouse]

Thank you, all!

My heart resonates with all you are saying!

But, how do I blatantly go against the doctor's orders? Their mantra is "move it or lose it". They even said in the pre-op class if we don't follow schedule and keep moving, if we rest too much,, they can't guarantee a good outcome.

If I show up for post-ops and haven't reached their goals for me I will surely be chastised.

I go for my 2nd PT appt in 2 hours. I am going to have a serious discussion about this.

Keeping the faith,
Tina

 

[Powerhouse]

Welcome Powerhouse, and congratulations on your new knee! Sounds like you are pushing way too hard! An MUA is YOUR decision, not anyone else’s. Your ROM will increase with time, not force. Many members here gained ROM well after a year. You are very early in this process. Sleep was elusive for me for many weeks, just now starting to sleep at night. This is a long process that simply can’t be rushed. Keep posting and let us know how you are doing.

Thank you, Sisterpat.... good reminder that I am in charge of my own recovery.

 

[Powerhouse]

I sympathize completely, Powerhouse. It's really hard figuring out what exactly is causing pain and how much you can do. My first TKR went perfectly--steady progress with no setbacks. My second TKR--and you would think I would be even smarter now--has required much more sensitivity to how much my baby knee can take. At one point, my hamstrings were on fire and I had to shut everything down for 24 hours. My PT and I have had to scale back my exercises significantly--and every day is a test to see how much I can do without overdoing it. As many people here have described, it's a strange cycle of feeling good, doing too much, and then having to scale back then feeling good, doing too much, and having to scale back.

I hope your cramps go away soon and that you are able to get some sleep!

Thank you, Freestyle!

My first one was pretty steady, albeit not without much pain. I followed PT schedule and reached great ROM "on time".

I don't remember having these horrible spasms and subsequent pain. They are truly scary. I am going to talk to therapist at PT today.

 

[Powerhouse]

I'm one of those on Bonesmart who never took formal PT. I've had 12 knee surgeries, 2 of them kneecap removals, and 1 tkr. Even after those I never took formal PT. But, I didn't just sit around doing nothing, I am not a lazy person and have to move! I used my knee as it was intended to be used by walking around to take care of my daily needs along with the necessary house and yard work. As I healed I was able to do more. Icing and elevation were a huge part of my recovery.

Listen to your knee. Your knee knows how to rehab itself without being told what to do. It will tell you if you're doing too much by increased pain, swelling, and those nightly Charley Horses you are having. Thank God I didn't get those but I did have pain and swelling. I found that resting, icing, and elevating helped those.

You are 4 years older than when you had your first TKR. That means your right, new knee had four more years of damage to repair. Your surgeon probably had more work to do on it, which causes you more painful reactions. Treat your knee like the newborn baby that it is and it should settle down.

Hi Sistersinhim

Wow, you are so right! When I had my first one, at 57, the doc said my other knee had 2 yrs left...I got 6 more years. When I got out of surgery (different doc) he told me that the arthritis inside was horrific and no wonder I've been in so much pain. And from all of the black and blue bruising all over my leg, I can tell he really went to town in there!

Now at 63, the doctor told me that he sees people over 60 with cover quicker and better than those under 60.

I love what you said, " treat your knee like a newborn baby"!

 

[Powerhouse]

Elevate and ice 30 minutes 6-8 times a day.

30 minutes is enough if you are trying to recover from an injury. However you accomplish nothing in that time frame when you are recovering from surgery. Ice for 45-60 minutes several times per day.

Make sure to do 7 daily exercises 2x day
PT center:
3x week first month, then 2x week next two months. They really push for ROM.

Most likely the reason you are having the spasms is all this exercise. Of course it's your decision. But that knee is telling you this isn't the right approach. And no one should be forcing ROM.

But the threat of needing MUA if ROM isn't met in a certain time frame is always hanging over me.

There is no time frame for needing MUA. We have members who continue to see improvement for literally years post TKR. And do remember that you are in charge. There is no threat of MUA. Far too early to even be thinking about that approach.

Hi Jaycey

Thank you for your in-depth response...much appreciated.

You said there is no time frame for needing MUA. How does one tell their surgeon this when he says differently?

I like your statement "your knee is telling this is not the right approach".... I'm going to start listening to my knee - and my gut - over the doc.

 

[sistersinhim]

When I got out of surgery (different doc) he told me that the arthritis inside was horrific and no wonder I've been in so much pain. And from all of the black and blue bruising all over my leg, I can tell he really went to town in there!

This means that you'll need more to heal from it and that takes patience. Oh how I hated that word, but this recovery really takes a slow and easy exercise program and lots of patience!

You said there is no time frame for needing MUA. How does one tell their surgeon this when he says differently?

We have had thousands of patient's experiences to know that the majority of the time all it takes is time for that swelling to reduce. Less swelling allows the bend to get better. If your doctor pushes it just tell him you'd like to give it more time before having a MUA. Remember that you are always the one in control. Your PT and OS are your employees and have to do what you say.

 

[Jaycey]

How does one tell their surgeon this when he says differently?

You just say that you don't want to take that approach and that you will continue to recover at your own pace.

Many surgeons push for MUA. And yes, they will try and scare you into that route. We have had thousands of members who listened to their knee and took the slow and steady way. It works - but maybe not a fast as your surgeon would like. In the end, it's your knee and you are in charge.

Here are some examples from 2 of our members who tracked their ROM development over many months.

Here is betrtschb's record of how his flexion developed over time:
"I'm 12 months out from my surgery and have some advice based on my experience:
1- Stop going to PT (all it will do is make your knee swell and reduce ROM)
2- Don't worry about your ROM
3- Be patient - VERY patient!!!

Here is my ROM history (more or less):
1 month - 60 degrees
2 months - 80 degrees
3 months - 85 degrees
4 months - 90 degrees
5 months - 90 degrees
6 months - 110 degrees
7 months - 120 degrees
8 months - 125 degrees
9 months - 130 degrees
10 months - 135 degrees
11 months - 140 degrees
12 months - 140 degrees

I spent waaaaay too much time worrying about ROM. I thought I'd be riding my bike a couple months after surgery but it took SIX months! Looking back on my surgery, if I knew then what I know now, I wouldn't have wasted my time with PT and I wouldn't have worried about ROM."

And another record, from Campervan - she discovered that her flexion had increased even at 6 years post-op:
"I had a slow recovery. Here's my flex measurements at various points:
92 - 8 weeks post op
105 - 10 weeks
107 - 5 months
110 - 6 months
112 - 7 months
116 - 9 months
119 - 11 months
118 - 1 yr
120 - 1yr 2 months
125 - 1 yr 8 months
128 – 6 years "

 

[Powerhouse]

Hi
I had my 2nd PT appt yesterday and asked her if we could have an honest discussion before proceeding. I explained to her all I've learned here at BoneSmart and yet know surgeons & PTs want a more aggressive PT.

She surprised me! She actually said she agreed with lot of what is found here and this forum - except for a couple things. She concurred that I should just take it easy for the next week....massage, rest, ice, walk around house, etc... and see if it eliminates the knee-in-a-vice-grip spasms that wake me up yelling in pain.

Thanks for loading me with knowledge!!!

Keeping the faith,
Tina

 

[Jockette]

I agree with Jaycey, it is far too early to be worried about MUA. Your body has barely begun to heal from this surgery. Take things at a decent pace and don’t overwork. Accept your body’s healing timeframe and most of all, try not to worry.

Regaining our ROM is more about Time than repetitions of a list of exercises.

Time to recover.
Time for pain and swelling to settle.
Time to heal.

Our range of motion is right there all
along just waiting for that to happen so it can show itself.

In the general run of things, it doesn't need to be fought for, worked hard for or worried about. It will happen. Normal activity is the key to success.

 

[Sisterpat]

Tina, which things did your PT not agree with?

 

[kneeper]

Hi
I had my 2nd PT appt yesterday and asked her if we could have an honest discussion before proceeding. I explained to her all I've learned here at BoneSmart and yet know surgeons & PTs want a more aggressive PT.

She surprised me! She actually said she agreed with lot of what is found here and this forum - except for a couple things. She concurred that I should just take it easy for the next week....massage, rest, ice, walk around house, etc... and see if it eliminates the knee-in-a-vice-grip spasms that wake me up yelling in pain.

Thanks for loading me with knowledge!!!

Keeping the faith,
Tina

I wouldn't say I got spasms in the knee itself, but for leg spasms my PT gave me some gentle stretches to do before bedtime.
Your PT seems to be pretty commonsensical.
With my second knee, my PT gave me various exercises--fewer at first and increasing as I healed. (And supported lots of icing and elevation.)
She also didn't focus on doing an exact number of exercises. She suggested doing things like a few heel slides (or other exercises) at a time in various installments. That worked for me. I didn't do stuff like "3 sets of 20." More like 5 here and 5 there that probably added up to 30 over the course of a day.
Some of our members have done quite well without PT. I liked having some PT, but also listened to my knee. My bottome line: movement is important, but this isn't boot camp.

 

[Powerhouse]

Tina, which things did your PT not agree with?

Hi Sisterpat

She said ice should be done for only 15 minutes at a time. When I told her what I read here about that being true for injuries but joint replacement icing should be longer length of time, she said that "after 15 minutes of icing it loses its healing properties".

She agreed for me to take a few days off of PT to calm down the knee from spasms. But she still believes that at least two days a week PT should be the goal. All though she did tell me she would work more on gentle healing rather than forcing ROM.

Right now I scheduled myself for once a week so I won't see her until Friday - I have first post-op wirh surgeon on Tuesday.

She also had me spend 15 minutes in darkened room doing "mindfulness"... Diaphragmatic breathing and then concentration on relaxing each body part from toes to top of head. It is supposed to get you to get out of fight or flight stage and into a more restful peaceful stage.