TKR Powerhouse's Recovery

[Powerhouse]

UPDATE...19 days out from right TKR (left TKR done in 2015)

For 8 nights I had those horrific off-the-charts painful "spasms" inside my knee that woke me screaming in the middle of the night. I shared with you above about the honest conversation I had with the PT a week ago Fri.

My surgeon was out of town, but I saw his PA this past Tues. She was intrigued because it's very rare thing to happen, she said. She also told me the muscle relaxants my surgeon prescribed for it aren't working because they are not actually spasms. She said the inside of my knee is actually still gory and like raw meat and until that heals and the swelling goes down it's not going to get any better. So she told me to just walk around the house, ice a lot and do a little bit here and there but don't do any formal PT for another 10 days. She also was very pleased with my ROM at 2 weeks out!

YAY ....I had told her about BoneSmart's counsel and she agreed!!!

I have gone 4 nights without the horrid waking....so glad. But, today it happened while I was napping....woke up crying out in pain.

I believe I've been taking it very easy. I walk around upstairs several times a day with the walker and I do some of the little ankle pumps. But yesterday I tried out my cane and it actually was working really well. I also went down the stairs which was quite easy to do and then back up last night. So my husband says he thinks I've overdone it. To me, I feel like a lazy slug.

Anyway, just wanted to update you on how nice it was to have PT and the doc in agreement with the advice I've gleaned on this wonderful forum!!!

Two other issues:

Elusive sleep...aye. I understand it's common but I would kill for even a few hours at a time...vs 15 mins, or 45 mins at a time.

Brain fog...I own my own accounting firm. I had let my clients know I would be away from my computer for a couple weeks. But since I work remotely from home I was sure that by now I would be able to work a few hours each day. But I find that I can barely type without having to correct every few words and it's difficult to concentrate......even just watching TV or reading a book. I am off the "hard" Rx, just tramadol & tylenol, so not sure why lingering brain fog??

Keeping the faith,
Tina

 

[Sisterpat]

Powerhouse, sounds like you’re improving on the whole. Sleep di come for me for about 3 months! So nap while you can and try not to stress about it.
i was also totally exhausted for several weeks which probably is causing your brain fog. Also, those pain meds take a while to completely dissipate. What kind of anesthesia did you have?
Sounds like you have a great PT - lucky you.

 

[FourCats]

It sounds like you’re doing fine. The sleeplessness is normal and I still have nights that I toss and turn, finally getting up and finding something to do. I often take a nap during the day usually while resting in my armchair. And brain fog! I’m not on anything for pain so I tend to attribute my brain fog to the lack of restful sleep. I don’t think I have reached the deep sleep which is necessary for our bodies and especially our brains for well over a year because of the pre op pain I was experiencing. Keep on visiting here!

 

[Gardenplotter]

Getting a good nights sleep is not easy, takes a long time to get back to. I still do a lot of tossing and turning. In one of the posts here someone compared it to feeling like being stuck on rotisserie, that’s exactly it. I will wake up with a twinge and turn to the other side, wake up again and turn on my back…. and so on. But overall sleep will improve and even though I wake up, I can fall back asleep again after adjusting positions.
As for the brain fog, it’s early days for you yet, that will get better with time also. When you sleep better and have your ”hard” pain meds all out of your system that will improve too. After stopping the Oxycodone at week 2 I only took Tylenol, but I still felt like I was on a stronger med., took a while to get out of my system.

 

[kneeper]

UPDATE...19 days out from right TKR (left TKR done in 2015)

. So my husband says he thinks I've overdone it. To me, I feel like a lazy slug.

It sounds like you're doing well. It's ok to embrace your "inner slug!"

 

[Powerhouse]

It sounds like you're doing well. It's ok to embrace your "inner slug!"

Too funny!

I feel so unproductive....such a strange feeling. I really thought by week 3 I would be able to concentrate enough to read a book, watch a movie and do some simple client accounting.

This to shall pass, eh?!

 

[Powerhouse]

Powerhouse, sounds like you’re improving on the whole. Sleep di come for me for about 3 months! So nap while you can and try not to stress about it.
i was also totally exhausted for several weeks which probably is causing your brain fog. Also, those pain meds take a while to completely dissipate. What kind of anesthesia did you have?
Sounds like you have a great PT - lucky you.

Sisterpat,

The sheer exhaustion from lack of sleep DOES make sense as a cause of brain fog!

Re anesthesia:
I had an epidural and a nerve block just above the knee (he used ultrasound to find the exact spot to inject)....also what they called "the best margarita" inserted in IV.

 

[Powerhouse]

(Not sure if I should post this question here in my recovery thread or in a more general thread?)

20 days out of right TKR.

The past two days my right hip has been agonizingly painful.... currently it hurts worse than my knee.

The only thing different I did was try out my cane (successfully) a few times & went down & up the stairs 2x (also successfully).

I have iced the hip and used a heating pad on it but the pain is still there.

Grateful for any insight!

Keeping the faith,
Tina

 

[Jockette]

(Not sure if I should post this question here in my recovery thread or in a more general thread?)

Once you are in recovery there are no general threads, as we prefer 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.

We get all kinds of aches, in different areas, after this surgery. The body goes through a lot during the surgery, and in recovery we walk different, sit different, lie down different, etc. As we heal it all sorts itself out.

Try icing your hip, or heat, whatever helps it feel better. (But don’t put the heat anywhere near your knee) If nothing helps, try to give it time, sometimes that’s all we can do.

 

[Lark]

When you go to PT tell them about your hip. They should be able to give you some stretching exercises and also do some manipulation to help.
At week 12 my hip has mostly stopped hurting and I can actually sit for more than 10 minutes before squirming.

 

[Powerhouse]

When you go to PT tell them about your hip. They should be able to give you some stretching exercises and also do some manipulation to help.

Thanks for the reminder! I totally forgot that when I had my left knee done in 2015 my hip used to get out of whack and PT gave me some hip flexor stretching exercises. They really helped. I just don't remember how to do it.

I see them on Tuesday and it will be the first thing I asked. Thanks again for your reply!!

 

[Powerhouse]

Try icing your hip, or heat, whatever helps it feel better. (But don’t put the heat anywhere near your knee)

Thanks, Jockette....yes, I did both heat & ice today on hip &;upper thigh....helped a bit.

 

[Celle]

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.

Your PT and surgeon can threaten you with an MUA, but no one can do anything without your consent. Your surgeon cannot perform any operation on you without your fully informed consent.

It's your knee, not theirs, and you are the only one with the right to say what happens to it.
They can advise, but you have the right to choose whether or not to take their advice.
Saying no to therapy - am I allowed to?

Not all surgeons think the same way as yours.
My surgeon doesn't allow any formal PT at all for the first month after a knee replacement. He says your knee needs that time, to start on its journey of healing. For that month, we rest, ice and elevate our leg, and walk around the house. The walking is our exercise and we increase it a little each week.

After that month, we just go to PT once every 2 weeks, where we are shown a few new exercises to do at home each day.

His patients all do well and achieve good ROM, as I did, and he hasn't had to do a manipulation to help with ROM for the past 4 years. I think that speaks for itself.

I'm glad your appointment with the PA went well. And I'm glad you've cut back the extent of your exercising.

 

[Geoffa]

Powerhouse,
With a new knee it's possible you also have newly straightened leg. As you become more active you will load muscles above and below in a way that is hard to predict. With my LTKR, 10 years ago I got horrible pain in my ankle, realignment. With my RTKR nearly 12mth I had a lot of pain in my right quads and groin this is now almost gone, just some stiffness after a lot of activity.

I will write a 12 month post after my final OS visit and predict a 0 to 145 ROM and have zero discomfort in my knee, all my minor issues remain in my upper leg.

Lots of little things to work thru, the 12mth nature of a TKR recovery!!

 

[Sisterpat]

Powerhouse, as others have said, and I agree, the whole body has to readjust to a new joint! You know the old song, ”the hip bone’s connected to the thigh bone, etc” . Everything in our body is connected and each joint has an impact on another joint. Once your knee really settles down and your hip gets used to a new way of walking, bending, etc, it will all fall into place. Try to be patient. This too shall pass.

 

[Powerhouse]

Well, even though feeling pretty cruddy (so tired, needing sleep that is lost somewhere), I spent 45 minutes at my home office desk to meet some clients' accounting deadlines.

It felt more like 3 hours and like my brain was mush, but it didn't hurt - and needed to be done.

I see PT tomorrow, first time in 11 days. Should be interesting...she promised me: "my job is to help you heal not to hurt you".

 

[Powerhouse]

Still so big, swollen 3 weeks out.....

 

[Powerhouse]

If anyone here has time to read, I hope you will let me know your thoughts......(and be proud of my BoneSmart-learned gutsyness)!!!

Email to my PT gal & my surgeon late yesterday...and subsequent responses......
-----
Hi Sarah

I am cc'ing Dr S so he has documentation for my file.

After 11 days of no formal PT (to let my knee heal, per mutual decision between PA Ama, you & me), I saw you again on Tues this week.

It was actually pleasant and after I left I noticed all the extension I had lost was back! YAY. I had virtually no pain...went downstairs for dinner...used my cane once around the house. Probably best day since surgery!

To my dismay, I woke up at 3am Wed screaming in pain to another one of those fierce inner knee seizing attacks. I had not had one in over a week, since taking pause from PT.

In wee hours of today (Thur) I woke again crying out in pain from yet another one. I had 4 more smaller ones thruout the night, waking me each time.

Good news, my renewed extension is still here, but my whole leg is throbbing in pain. I took a 45 min nap today and woke to another vise-grip like seize-up.

Needless to say, these are scary and debilitating, wakes up whole house...never happened with my previous TKR. It's getting to the point that I'm afraid to go to sleep.

Is it happening again from the PT and inside of knee still too raw/gory, needing more healing before doing more PT?

Please let me know your thoughts/advice.

Tina
-----

Tina,
I would not skip PT at this point. While your knee may hurt more after PT, skipping PT could be very detrimental to the long term function of your knee. I’ve never hear of a postop knee replacement being too raw for PT.

Skipping PT now greatly increases the odds of having range of motion deficits and needing a manipulation down the road.

Ice, Tylenol, and tramadol are the mainstays at this point for getting through PT and working on maintaining motion.

Dr. S
-----
Thanks for your reply, Dr. S.

FYI I am not PT averse and do quite a bit each day.

However, your email did not address the middle of the night, #10 on the pain scale, horrid vice grip pain that locks up my knee, and has me yelling in pain til it unlocks.

I need to know what is causing this as it seems very abnormal - and results in hours long debilitating pain afterwards. .And also, how to prevent them from continuing?

Thanks.
Tina
-----

Tina,

I agree with Dr. S. At this point continuing PT is necessary to increase range of motion, strength, and down the line - function. As we talked about on 7/20, these exercises are not aggressive in the beginning and should be to your tolerance, and as you noticed you felt better afterward! It is typical to have some pain after PT and after increasing the amount of activities you do, but the pain medications prescribed to you can help with this.

Physical therapy is to help you heal and get you back to the activities you like to do! As far as the pain afterward, continue taking the medications as prescribed. Icing several times post PT can be helpful as well.

Best,
Sarah PT, DPT
-----

Dr. S and Sarah,

I am glad you both agree I should continue PT (which I am doing at home), but you still didn’t let me know what these horrific episodes are at night.

You both have stated, it is typical to have some pain after PT and after increasing the amount of activities I do. I know this, I expect this – as I have been though 3 surgeries & PT on my other knee before, as well as my shoulder.

But, these nighttime horrid experiences are NOT “normal” after PT pain. When I spoke with PA Ama on Tues 7/13, she agreed and said the knee needs time to heal more inside before doing more, and you agreed, Sarah.

I am beginning to think there is something seriously wrong with the implant or nerves around it or whatever could cause these excruciating episodes and would greatly appreciate a definitive answer and solution.

And a side note – if you guys really think Tramadol & Tylenol helps with this kind of pain, I just don’t know what to say because it doesn’t even touch it when these attacks happen. (And, I have only 5 Tramadol left.)

Perhaps a phone call with you, Dr. S, would help clarify.

Thank you,

 

[Jockette]

I’m sorry that you’re not getting help from your surgeon regarding this awful pain you are experiencing. I have no answers for you, but to keep contacting your surgeon.

Skipping PT now greatly increases the odds of having range of motion deficits and needing a manipulation down the road.

I disagree with this statement, manipulations are designed to release adhesions, and adhesions are rare, so please don’t even consider worrying about this. ( just in case you were worrying!)

 

[Geoffa]

What's that old expression "Can't fight town hall"!!