PKR Problems with knee flex at 4 weeks only 65 degrees

[Knockknee8]

Hi,
This is my first post and relieved to find somewhere I can discuss with people that are going through this!
I was in hospital for 3 nights, having had a spinal anaesthetic for the PKR medial surgery. I had a few issues with low blood pressure and oxygen so not able to get about much 1st day . But pain managed well and could walk using sticks on 2nd day in the corridor and to toilet. However 3rd day I made mistake of taking a laxative suggested by Dr, and boy I certainly had practise going back & forward to the loo over next 24 hours!!! That, combined with surgery pain relief wearing out was not a happy place!!!
Anyway back home I have been slowly improving each day I think.. The pain at times have me reaching for the oromorph at night. However the swelling and stiffness through the back of knee and leg can get really bad. I don't seam to bend my knee as well as I did in hospital, probably about 60 degrees? I can potter around without sticks only needing them for stairs but can suddenly get whacked out with tiredness. Icing a lot. Seeing PT and stitches out Wednesday.

 

[Celle]

Hello @Knockknee8 - and

Please will you tell us the full date of your knee replacement and which knee it is, so we can make a signature for you? Thank you.

It sounds as if thins are going well. Good.

Here is some post-op reading for you:
Knee Recovery: The 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. Here is a week-by-week guide for Activity progression for TKRs


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

Please don't be overwhelmed by the list. The articles are not long and they and contain information that will answer many questions and help you make your recovery much easier on your knee and on you.

We are here to help in any way we can: answering questions and concerns; supporting and encouraging you from start to finish.

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.

 

[Knockknee8]

Hi Celle,
Thank you for your reply - my op date was 13th July 2018.
I have had a bad 24 hours with pain and quite depressed! Having to top normal pain meds with the oromorph, which I feel as a failure! Worried also about other peoples tales of having no pain after their ops! How can this be?!!! Also my knee bend seams to be getting worse - hopefully the PT can talk me through this next week. So glad I found this forum as you realise others in the same boat.

 

[lovetocookandsew]

Hello and welcome! Everything you're going through is quite normal. People go through bouts of tears, depression, frustration, sleeplessness and the rest. Take your pain meds on a regular schedule so as to stay on top of the pain. If you let them lapse, the pain will get pretty intense and it's harder to get it back under control.

Some people have more pain than others, some have less, but no one has no pain at all. Pain is not only when you are at the excruciating "just shoot me now" level, but is also swelling, stiffness, zingers and aching. Read the articles Celle left you and you'll understand. I hate to say it, but there are people out there who want to pretend they had a fast recovery with no pain at all, and were back on their bikes riding uphill for miles, or went back to work after a couple of days, etc. They are either forgetting the actual process, or their egos won't let them admit to pain, discomfort, sleepless nights, and the rest. I still have some pain, even though my recovery has been pretty unusual and miraculous this time around. But I don't have the excruciating pain that is more usual. I did for the first couple of weeks, but it was controlled so I didn't feel it, except one morning when my pain pump ran out and was about to be replaced. My previous recoveries were the polar opposite, so I know what you're going through. It will be hard at times, other times it will be less difficult, but the end result of getting your life back will be worth the process.

Your flex and extension will be better one day, and the next it'll be stiff again; and that's normal. This recovery is a roller coaster and a marathon, not a sprint. The entire recovery takes about a year, but somewhere around three months you'll be feeling and doing much better. Until then, keep coming here and reading, especially the recovery list Celle gave you above. I constantly re-read the activity progression one as it serves as a daily reminder not to overdo, and not to underdo. All of the articles are very helpful and don't take a long time to read. Ask questions, whine, share your successes and keep us up to date on your recovery.

As for PT, I'm at one month today and decided to totally forego formal PT with this recovery. I decided that allowing my knee the time it needs to recover from the assault that is a TKR was the wisest path. Allowing PT and their exercises to keep assaulting and stressing my knee just makes no sense. So, I am spending my days icing and elevating, and doing normal daily activities a little at a time, as I am able. I allow my knee to ache a little or get a little uncomfortable, but don't do anything that causes real pain or swelling. When I feel the tightness begin as I am standing, walking or sitting, I know that's my knee warning me, and I listen to the warnings. I am not able to take any narcotic pain meds, so have to be more careful not to let the pain ramp up as I then have no way to stop it. So, I am taking my recovery a little bit slower and more carefully than I would otherwise be doing, while still following the activity progression listed here on BS. I am walking in my garden and house, sorting and folding laundry, wiping kitchen counters, helping prepare dinner as I am able, making my own lunches, unloading the dishwasher, straightening my bedroom and bathroom, but not doing any heavy cleaning or chores. My next goal is to get the mail each day, but we have a somewhat steep driveway and I haven't done that yet, but plan to soon. Take it one day at a time, realize you'll have good days and hard days, but one day you'll look back and realize you have taken your life back!.

 

[Celle]

Hi Celle,
Thank you for your reply - my op date was 13th July 2018.
I have had a bad 24 hours with pain and quite depressed! Having to top normal pain meds with the oromorph, which I feel as a failure! Worried also about other peoples tales of having no pain after their ops! How can this be?!!! Also my knee bend seams to be getting worse - hopefully the PT can talk me through this next week. So glad I found this forum as you realise others in the same boat.

Thank you for posting your surgery date, @Knockknee8 . I've put it in your signature.

Good grief, it's only 10 days since you had this major surgery! Don't feel like a failure because you had to take Oromorph. You were given it because it was felt that you would need it. You're still in the stage where everything is painful and it's far too early to be cutting back on your pain medications. You need to keep taking them on a regular schedule, or you'll be playing catch-up with the pain, and that's not fun. Pain management: importance of managing pain after a TKR and the pain chart

Just in case you're concerned, there is very little chance that you will become addicted:
Myth busting: on getting addicted to pain meds


Try not to take any notice of other people's tales about their recoveries - you tend to forget things, especially pain, as time goes by. Don't believe the stories of miracle recoveries, either. They're mostly folk myth.

 

[Knockknee8]

I am really worried about the lack of flex after my PKR. I am 4 weeks post op, went to physio last week and she looked worried!! At the start it was only 54%, after the session went up to 65% & apparently this is not good! I had a really painful and swollen first 3 weeks, was so exhausted could only do minimum exercises. This week the pain is so much better, but flex is still not good - borrowed a friends exercise bike and can only nudge it forward and back a little. Have hydrotherapy this week so hopefully will help? Has anyone else had this problem?

 

[Pumpkin]

Welcome to the slow train to ROM, it will increase slowly as your knee heals, you cannot rush ROM.
Many of us gained ROM a year or more out from our knee replacements, including myself.
ROM: it's worth the wait for ROM
ROM: it's never too late to get more ROM!
ROM (range of motion) information

 

[Pumpkin]

@Knockknee8 ,
You'll notice that I have merged your newest thread with your original recovery thread. For several reasons, we prefer that you only have one recovery thread:

• That way, we have all your information in one place. This makes it easier to go back and review your history before providing advice.
• If you keep starting new threads, you miss the posts and advice others have left for you in the old threads, and some information may be unnecessarily repeated
• Having only one thread will act as a diary of your progress that you can look back on.

So please post any updates, questions or concerns about your recovery here. If you prefer a different thread title, just post what you want and we'll get it changed for you.
If you need an urgent response to a question, just tag a member of staff.
How to tag another member; how to answer when someone tags you

Here are the instructions on finding your thread, How can I find my threads and posts? . Many members bookmark their thread, so they can find it when they log on.

 

[skigirl]

It sounds like you have a lot of swelling. Why not take a day and spend the majority of that day in bed with your knees propped up with three pillows? Just rest and chill out with ice on your knees. Look at your knees at the end of the day? Better? then that is your answer, probably you are spending too much time up right now. At three weeks I was still spending 70% of my time flat on my back with the knees propped up.

Your muscles are not supporting your knee right now since they are not fully awake after surgery---so, If you are up on the knee, you are putting your weight on the joint itself which it does not like. Your knee tells you by swelling that you need to rest and elevate more. Once the swelling goes down you will see the rom.

 

[Jockette]

Have hydrotherapy this week so hopefully will help?

My surgeon told PT to put me in the pool at 4 weeks. My first (and only) pool therapy session was 50 minutes long and they had me do countless knee bending exercises, and walking frontwards, sidewards, and backwards My balance was still not good and I was so scared.

It took me 3 days of additional pain to recover.

Several days later I spoke on the phone with the therapist I had in the pool about the pain I had afterwards and she admitted it could have been too much for me (you think??) and they stopped the pool sessions and after that I only went once a week to the office, and I boldly cancelled some of those appointments. (Thanks to what l learned on Bonesmart!)

So be careful!

 

[TM1965]

I am almost 6 weeks out and until this forum I spent most of my time worried. Still do worry but feel good to have everyone here to ask questions and just chat. I worry about range of motion but I go back and forth, depends on swelling and pain. They say it gets better every day, even after set backs your bend comes back. I live with ice ice ice and elevation daily! I can see a knee now instead of all the swelling and with me it's been fear of the new knee. I am learning to touch it more kinda familiarize myself and get comfortable with it. That's just me but I hope this helps.

 

[kneeper]

With lots of swelling your knee is not going to bend. It sounds like things may be improving a bit for you now. Keep up with the ice and elevation and gentle motion. My bend took weeks to improve but began to as the swelling reduced.

 

[Knockknee8]

Thanks guys for your words of encouragement! I will have to be more patient and concentrate on resting and icing aswell as moving! Thank god for this website - I'll see how the hydro goes..quite looking forward to it in a way

 

[skigirl]

Just remember that it is easy to overdo in the pool. It feels wonderful to walk on the knee while you are patially weightless, but too many deep bends or squats or too much walking will result in more swelling.

 

[Spex10]

Try not to panic! I've had both knees replaced. The first one was problematic and I needed MUA but all was well after that. The second has gone very well in fact I'm a bit suspicious that it can't possibly last!
Pain was never a big issue for either knee. I hated oxycodone/Oxycontin and Tramadol. The most recent TKR I refused all opiates and only took Paracetamol (Tylenol?). It's not pain free I just know what's causing the discomfort and can live it. Sometimes I just have to get up and walk about. That helps.

 

[DIYSteve]

Hang in there. I was 70 flexion/10 extension at 3 weeks, now 90/4 at 5 weeks. Be patient. Recovery is measured in months, not weeks.

 

[skigirl]

Our fabulous posters have said it for me. It is a marathon not a quick jog, some knees take longer than others. Think of the swelling as a garden hose filled with water---can you bend it? No, of course not. The first think you would have to do is drain it. So, elevate, ice, rest.

 

[Minnie's knees]

Please be patient with your knee. I know it is frustrating because I was at 70 flexion at 10 weeks. It kept improving slowly. In my case my Rheumatoid arthritis was slowing it down. I eventually got to 110 flexion.

 

[CaliCat]

I'm a week or so behind you, and at my PT session four days ago measured at 77 - and since my worst reading post-op was 56 (at the worst of the swelling) that's pretty good progress. Keep taking the pain meds as long as you need them. It's slow going, but you'll get there!

 

[Celle]

In spite of what your PT therapists may tell you all, 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

While your knee is swollen, it can't bend more, no matter how much you try. Instead of doing exercises and worrying about the ROM, concentrate on reducing the swelling, with lots of rest, ice and elevation.
Knee recovery - Lose the Work Ethic!!