TKR Purple swollen leg 5 days post-replacement

[nell41]

Thank you, Celle.
My swelling is less now, and the bruising has already faded from what looked like a new bleed. So I’m not worried anymore.
I took pictures, but they got Error: they are too large, and dinosaur me doesn’t know how to do pixels.

It’s OK.

Best to all,
nell41

 

[nell41]

 

[Celle]

I'm glad you managed to post the photos. Well done!

Yes, nasty as it looks, that amount of bruising is normal. Gravity is working there, and the blood has gone to the lowest areas - behind your leg and down to your ankle.

That's a good degree of bend for such a new knee.

Is that a real cat? It looks like a marbled Bengal.

 

[Pumpkin]

I agree with Celle, normal leg for less than a week from TKR, in fact it looks pretty good.

 

[nell41]

Thanks, Celle and Pumpkin,
I had a cyber-smarter friend help me get those photos fewer pixels for me. The light in the photos shows the bruises much lighter and browner than the purple they are, but I can tell there’s no new bleed since Sunday, so all’s well.
The swelling does puff right up as soon as I get me a soup or even small things in the house, so I’m aware and just default to elevate/ice.
I was lucky to have my TKR before I reached immobility or weakness, so this recovery will go fine, I bet.

Celle, haha, no cat here! Are you looking at my little laundry bag, to the left in the middle picture? I have a stuffed big “Wolfie”, but he’s not in that scene. Lol.
Cheers,
Nell41

 

[Josephine]

Thanks Celle for clarifying Josephine's article on the compartment syndrome

What I said was correct - compartment syndrome is the biggest hazard in knee surgery but at the same time. it's also extremely uncommon. In my 55 years in orthopeadic surgery, I have never once seen a case!

 

[Celle]

Celle, haha, no cat here! Are you looking at my little laundry bag, to the left in the middle picture?

Yes, that must be what it is. It sure looked like a cat to me, though!

 

[nell41]

Hi folks,
I’m wondering if I should call my surg team in the morning and ask about a clot. They might have me take a Lyft in the snow and get a 2nd U.S.
Deep, mid upper calf, boring, burning constant pain, tender to pressure, which awoke me 2:00 a.m. I have my leg up all night on a soft pillow as a routine now, but today when this woke me up, I want to hold it up in the air to relieve even that pressure. This pain is close to the same place I noticed before discharge Day 2; they did U.S. and all was clear then. But it is worse, constant and tender, while now the rest of my pain is reducing. Incisional/knee itself pain is a piece of cake even with bending 103, because that’s temporary “surgical ouch” compared to this, as this is constant. Ice on the knee after exercise settles that flare of pain, whereas this doesn’t even want to rest on, touch, the pillow no matter. I’ve felt a soreness close to this place when I flex/extend the ankle all the time, but those go away at rest; this does not.
No change in color (mirror and light), it’s full of purple bruise still. Not more hot to touch or swollen than that whole leg still is, all slightly improving.
I’m doing well in less general swelling, walking just as needed to get around home. Second PT yesterday went well, angles 0/108, I mentioned deep persistent pain behind knee then which was more tightness, seemed to her part of adjusting to new leg length, needing ham stretches, etc. I’m not needing as much Tramadol for incisional/front of knee pain (25 mg. about 3 times yesterday and I was fine).
I continue on aspirin 81 mg. chewed twice a day, and they had me stop my replacement estradiol since prior to surg.
My PT says I overthink, and I’ll agree, guilty as charged, lol! I do have a low threshold for alerting possible complications. I’m a health provider, by the way. Still, in general I usually conclude “no big deal” for minor stuff, carrying on fine as a 70-year old semi-retired, don’t call docs. frequently, and when I do they see me and agree it’s real concern.
What think you? Worth calling them today?
thanks!
nell41

 

[Lindylee]

I'm no medic, but I don't think it would hurt to call. Hope it improves soon.

 

[nell41]

Thanks, Lindylee, for your encouragement. I don’t want to become a pain for the team.
I just called and talked with my PA, and he listened and said not to worry, they haven’t seen a clot in years due to this level of activity post-op. I told him that
calf pain kind of subsided anyway, now not different than lots muscle crampy aches up and down the leg and SI Joint from PT exercise and re-alignment.
Then a couple hours ago I was woken up after flexing exercise by sudden, sharp, burning, and new pink patch beside the incision site that lasted about an hour and reminded me of the complex regional pain syndrome I had got with L wrist surgery and repeat with L little finger injury. I ran that by him too and he said it’s also par for the course, pain is often worse at night, will wake you up, and likely will subside. The pink reaction is just angry knee stuff, he’s seen it all and it subsides.
So, I can ride this roller coaster fine now that I know I’m safe enough.
He’s great, because he said to call anytime, and he, the PT, and I agree I’m overthinking things: guilty as charged, lol!
Cheers,
nell41

 

[nell41]

Day 9 Update:
Those sudden new pains last night I wrote about are present but have subsided. Live and learn.I still have lots of muscle ache from the new exercises which is fine.
I could get my sock on both feet today, and so far I haven't fallen, which is my biggest risk. Holding a walker or a counter-top when upright at all times, I have to remind myself!
And with less swelling today, my leg actually looks like there's a knee in there, the patella moves when I do the quad isometrics. Compared to purple elephant leg just yesterday!

Thank you all for being there!

Warmly,
Nell41

 

[sistersinhim]

Yay. It sounds like you are doing very well!

 

[Lindylee]

Glad the pains have subsided. If I get up in the night I resort to 2 sticks to get to the bathroom. I figure I'm more likely to fall over if I'm half asleep. Better safe than sorry!

 

[nell41]

I just looked at the Do's and Don'ts of Elevation info, really useful! I found out myself that elevating long with a straight leg strained the back of the knee, and that jives with Josephine’s guide as well. I might order that Lounge Doctor for an ideal bend.
Now a new problem late today: My whole L leg fell asleep. Laying flat partially helps, the leg elevating worsens it, though helps my swelling of course. I’m way too early with my knee to go prone, but from my experience prior, I expect that would help this back issue. Side lying is out due to back or hip issues.
At best I can still feel, move with full motor control, but there is a baseline of heavy, dead, feeling and some tingling.
I’ve had this exact thing happen temporarily for years, if I lay on my L side, since a 2008 L4-S1 fusion for severe lat. scoliosis. The fusion was successful at stopping a progressive lateral translation, which had caused L radiculopathy with L foot drop, now resolved. I had a L leg shorter than R (CT scan measured, mostly in tibia], which likely set off that scoliosis, and DDD, plus foraminal arthritis. After both THR settled, (2005j, the PT arrived at 1/2 inch elevated sole in all my L shoes, which had worked great since.
So now, my L leg is clearly less short since L TKR than prior, and of course my gait is in new alignment. The PT and I discussed this yesterday, so I expect the sciatica, SI joint flare, funny walking, but hadn’t yet had the whole leg go to sleep like this. She planned to give it all 3 months to settle, and we’ll then determine any changed sole Rx.
I plan to sleep with more gentle elevation tonight, and see PT tomorrow.

Any other thoughts? I see @Roper1218 had a similar thing after TKRs.

Thanks to all!
nell41

 

[nell41]

Hi helpful folks,
Today is Day 12, and I regret I posted such boring detail on mu whole low back/sciatica stuff which isn't relevant for most forum people. I did share all that with my PT, we're going with just socks, instead of the sole-elevated L shoe, and I'm gentling down on hip flexion, all of which help that partially.
I'm overall feeling less ill and queasy, and more strength each day, and the good news is much less dizzy spells, so I'm starting to forget to drag the walker with me while I walk. No falls! But I have to be more diligent.
The hard part is not knowing quite where between the "push" vs "rest" I should be in doing the exercises, and I hope to just go by the status of my knee following exercises. After PT 3 days ago, with a "push" there, I blew up a pretty pink, hot, effusion, and have been coping with that since. When I elevate and haven't done a tough bending or the 5 lbs. on the knee for extension, then the fluid and redness do go down. As soon as I stand it pops up pink, hot, and big.
I did order the Lounge Doctor, and I'm looking forward to that. I have venous insufficiency anyway, and when I go back to work, that's sedentary, so I need something long-term to handle that. I am finding that with the pain in the back of my calf, knee, and thigh, I am very sensitive to the pressure even elevating on the soft pillow stacked.
I had to start taking omeprazole, as I was having such stomach burning, and some GERD from the oral NSAID and aspirin. I had had a gastric ulcer in the past from Rxed NSAIDs (much longer though), and I don't want that to happen again!
I don't have any complaints, since I'm so early on, am on low dose Tramadol, and I thank all you in the forum who've pitched in with such help and support!

Any suggestions on the "happy middle ground" between push and rest would be welcome.

thanks,
Nell41

 

[Jockette]

Any suggestions on the "happy middle ground" between push and rest would be welcome

For starters, get rid of the 5 pound weight on the knee for extension. Never put a weight on your knee, and especially not at only 12 days. The surgery has caused a lot of trauma to your knee and that’s why it’s swollen and won’t bend. It needs gentle treatment to heal, not forced bending or heavy weights put on it.

There is no date by which you have to have a specific ROM number, it will come along naturally as you heal.

It’s not exercising that gets our range of motion back, it’s Time:

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. Exercise as in strength training is counter-productive and in the early weeks does more harm than good. Normal activity is the key to success.

 

[sistersinhim]

Many of us never took formal PT or did exercises. I am one of them. I had 11 knee surgeries, 2 of them kneecap removals and 1 tkr. Even after those I never took PT. But, I didn't just sit around and do nothing. I took care of myself, my house and yard as my knee allowed me to do. As I healed, I did more. But, my knee was always in control . This was enough therapy for me and would be for any tkr patient. All the awful pain of PT is so unnecessary.

All you have to do is use it in your daily living. Your knee knows how to rehab itself and doesn't need anyone telling it how. Just use it and it will come back like new. You have to be patient, though, it doesn't happen quickly. ADL,(activities of daily living), going to the bathroom, brushing your teeth and bathing, fixing a light meal, getting something to drink and or a snack, those kinds of things will be all the exercise your knee needs. If you just use it daily in your living, you can have a less painful recovery. We know what works, we've been there.

 

[Celle]

I had to start taking omeprazole, as I was having such stomach burning, and some GERD from the oral NSAID and aspirin. I had had a gastric ulcer in the past from Rxed NSAIDs (much longer though), and I don't want that to happen again!

With that history, you shouldn't be taking NSAIDs at all .

Even a short course of NSAIDs can cause catastrophic bleeding from the stomach.

If you're taking Aspirin to prevent blood clots, I think you should ask for a different medication.

 

[nell41]

Thanks, I appreciate all your responses and input.
@Celle, I do plan to talk with my PA about going off oral NSAIDs, as he and I agree my history is a relative risk. The omeprazole, plus eating more, give me relief. I have Addison’s, and managing the stress doses for that has been one of my biggest challenges post-op! So, my idea is to inch up as needed with my supplement of 1 or 2 mg. prednisone on top of my routine hydrocortisone 15mg, daily, divided, which may meet both needs. Not puffy, never got Cushinoid in 12 years of managing Addison’s, so I’ll see what he thinks of this plan to help reduce extra inflamm. for this early post-op time.

@Jockette and @sistersinhim ,
It has truly been a trip to see the battle of ideologies play out between extremes of this forum vs. my info from experience over decades of my own ortho team, by whom I’ve been followed and impressed by their judgment and outcomes, for years.
This has stretched my brain way beyond what I had expected to deal with.
It is fascinating to see the “slow benders club” be successful and I’m sincerely glad for you all where it’s worked fine to avoid painful pushings, for flexion, weights for extension, etc. I agree totally that it can get weirdly adverse to chase the goniometer readings like prizes. I’ve heard some people are more scar-prone than others, and I’m not knowledgeable on best practices in PT or ortho.
I had a long talk with my PT today about all of this, and was pleased to see she understood everything, was not at all defensive, pushy, or ideologically dug in. She flexibly cut back, given my inflamm. response to the last session, and did some back of the knee massage along with a much gentler session of balance practice and strength maintenance, which were fine. We pulled back on the bike to rocking only for 5 min. vs. full rotations for 10 min. She was informative from her experience, from many years with numerous post-knee patients from all the range from kinesiophobic ones with terrible stiffness results to go-getter overdoers with injuries and complications.

I am pleased.

I feel generally more well and energetic each day, and functionally am doing more each day naturally. My balance is better, and I feel ready to put the walker in the closet in a few days, as it’s a hindrance more than necessary. I never used it to put weight on, just keep it nearby to prevent a fall with dizzy spells from the meds. I’m nearing the end of the hardest 2 weeks, and I’m reassured my knee’s strength and mobility are improving along a good prognosis. Tramadol I use 25 mg. once or twice, especially to help through the night.
I have a good sense my team, PT, PA, and OS, are flexible and responsive to the unique individual.
While it’s been confusing and threatening to be strongly told « should’s » by this forum, I know you mean well.
I’m curious if you have any links to the literature of comparison data, or even meta-analyses, of comparing your approach to ones that flexibly include some vigorous early activity, for safe and effective outcomes? I am
open to being wrong!
My mantra now is “ moderation, openness to revise, persistence.”
I’m excited that I’m on this course, and looking forward to learning more, and getting back to the therapy pool, driving, and work, in due time.

Best regards,
nell41

 

[kneeper]

I had to start taking omeprazole, as I was having such stomach burning, and some GERD from the oral NSAID and aspirin. I had had a gastric ulcer in the past from Rxed NSAIDs (much longer though), and I don't want that to happen again!

I am amazed they're letting you take aspirin and an NSAID--particularly with your history. That's how I got my ulcer. (and I was already on something like omeprazole.) Doc said no more aspirin or NSAIDs for me ever.
FWIW, with my second tkr once I was off the narcotics I had only acetaminophen and things progressed at the same rate or better than when I was on nsaids.