TKR Question on pain and swelling six months post TKR

[Jockette]

I had PT today and she said we need to work on the bend.

At less than 3 weeks post op you don’t have to work on your bend. What you need to work on is being gentle with that recently surgically traumatized leg with lots of icing and elevating, and, to quote Josephine, “giving your knee the privilege of sorting itself out.”

 

[Jockette]

Regaining our ROM does not require forceful bending or painful exercises. That is counterproductive.

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.

 

[mendogal]

This PT isn't doing you any favors.
That swelling is totally counterproductive and you'll pay the price in more hours icing and elevating.
PT SHOULD NOT HURT.

The stretch should slowly go to the edge of your comfort zone, then as you do slow deep breathing, go just over the line into mild discomfort for a few seconds.
I hope the "stretches" are seated in a chair heel slides.
Those are the easiest to control and do this slow, not painful self-therapy with.
No PT needed. No counting reps and sets. Just doing about a half dozen at random times throughout the day.

 

[mendogal]

What is the general consensus on traveling post TKR? My mom wants the family to go on a cruise July 21st. That’s 7 weeks post op. I’d have to fly from NJ to Ft Lauderdale…stay in a hotel night before and then deal with boarding the ship etc. right now given my stiffness and pain I cannot imagine going. I’d be afraid I’d be miserable, and it’s not worth it.

Eek. At 12 weeks I wouldn't have wanted to do all that!

 

[EalingGran]

At 12 weeks I wouldn't have wanted to do all that!

Agree with @mendogal That trip sounds very tough for an early recovery knee.
I did a short flight and a few days away at about 4-5 months. I used a cane for negotiating the airport. By that stage I could manage but I wouldn't have enjoyed travelling any earlier.
A cruise also involves quite a lot of physical activity and being able to get up and down stairs and on an off boats. Even the big ships can rock a bit at times. Plus you may need to use tenders to visit sights with the big ships.
I know some people go on cruises who are pretty frail and they just stay on board- but that doesn't seem much fun to me.

 

[Onestepatatime]

Thanks. My mom is giving me a hard time about going with lots of guilt. She’s 82 and sees no issue with just staying on the ship and thinks I should do the same. I agree with you that at seven weeks I could run the risk of being very uncomfortable. I don’t even like cruising I was just going bc my mom wanted her kids on the trip.

 

[Jockette]

I wouldn’t have been able to comfortably do a trip like that at 7 weeks. I had a hard enough time visiting friends for a weekend when I was 4 months. I was up and down stairs many times that weekend, among other things, and my leg was quite swelled by the time I got home. The morning we left to go there I had second thoughts, but went anyway. I should have listened to my intuition.

 

[Onestepatatime]

Today I finally got a 90 degree bend at PT although it was really hard. They ordered me a Dynasplint to wear 8 hours min a day during passive movement time. Not so thrilled about that but if it takes an MUA off the table so be it. I’m exhausted today and it’s so gorgeous out. This recovery is really on my nerves now. My friends tell me all the fun things they are doing and in my head I’m thinking please just shut up and stop talking. And my ex bf texts to tell me everything he is up to. I told him I do not want to maintain any relationship with him. He wants to visit next week to make it up to me. I sincerely told him don’t bother, it will only annoy me with you here looking for me to do something I cannot do. He doesn’t get it, that all I wanted was for him to show up when he said he would. And now I’m done.
The feeling of loneliness and isolation is setting in especially with the weather so nice out and I am so limited. But I’m not lonely enough to settle to have him around now. Ok, thanks for letting me vent. Just feeling blue.

 

[Layla]

I’m sorry you’re feeling blue. No worries about venting here.
How about reaching out to a few different friends to stop by on different days of the week for coffee / bakery treats, or a light lunch, something easily prepared, or something you have delivered, or going out for coffee or a meal somewhere at an “off time” when it’s less busy. Any good books you’ve been wanting to read, or series you’ve wanted to watch on Netflix or any other cable channels? Catching up with old friends via phone call or email? Recovery can certainly get boring, it’s easy to feel trapped with limited mobility in the early days weeks, but as you know, it will pass soon. Hang in there!
Hugs and best wishes!
@Onestepatatime

 

[Onestepatatime]

Thanks @Layla I have a list of shows to watch but don’t have the attention span yet to read. I moved a couple of years ago to the beach but now I’m far from most friends and family. I never thought I’d have 7 surgeries since I moved here. Hard to make new friends bc I’m always in recovery it seems. I got my hopes up my ex bf would be with me but oh well:( I know this too shall pass.

 

[Layla]

Count it as a blessing that you were enlightened now rather than get heavily involved and feel abandoned at a later date. You deserve better in a relationship.

I understand the reading / attention span situation. Ugh! I hard a really difficult time. I’d begin reading, realize I wasn’t absorbing anything, start over, more of the same…give up! Maddening! Maybe you can get engrossed in one of the shows you noted to watch? I know there will be some entertainment on mainstream tv tomorrow night…without getting political or saying more, because it’s not allowed here. May be good for a few laughs though. I’m gonna make some popcorn and watch, lol

 

[mendogal]

@Onestepatatime

I'm sorry you're feeling down.
In addition to what's been suggested...
would it be empowering to finalize things with the ex and block him?

I want to reassure you that at less than a month out 90 degrees is fine!!!! You are well within the norm!

And for docs and PTs who say otherwise...

The "window of opportunity" is a myth. Here's why.

Some of our members have shared charts of their progress regaining flexion. As you can see, for each, it returned slowly but surely.

Campervan’s ROM history
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

Bertschb’s ROM history
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

 

[Onestepatatime]

Hi All, I think I need to vent and get a reality check. I am feeling at this point just so over this, and desperately want my old routine back. Yesterday was nasty out, and I wanted to straighten my place up. I did a small load of laundry, emptied the dishwasher, and to treat myself had someone come to my place to give me a mani and pedi. All sounds so simple. But by bed my knee was really hurting and I woke up swollen 2x its size. Today is beautiful out and I need to dedicate the day to ice and elevating, not getting out. But I do have PT in a few hours so that will be my big outing. I have had so many surgeries, and I forgot how much this sucks. Living alone is hard, I wish I had someone here to help get food, change ice for machine, and little things. I keep telling myself it is what it is, and this too shall pass. I have been seeing a therapist weekly to help me stay mentally on track, which I recommend for every patient.
About when can I resume some normalcy? I work from home and still cannot navigate a normal nights sleep and with icing, elevating and PT do not think I can return to work. I put in 5 weeks, and that was dumb on my part.
Thanks everyone for being such a great support system, I appreciate it!!!

 

[mendogal]

Patience is the most essential muscle to exercise, and for many the hardest.

I had a GOOD recovery. Yet it took me a full month to even find the combination of things that would give me a chance at decent sleep.

Re work, we recommend10 -12 weeks off, then resuming a phased return to work.
For return to work at 10-12 weeks as patient feels able, the following schedules are suggested

week 1: Tues, Thurs 5hrs
week 2: Mon, Wed, Fri 5hrs
week 3: Tues, Thurs 8-9hrs
week 4: Mon, Wed, Fri 8-9hrs
week 5: normal duties

The thing to remember really is that so often when people think of going back to work they just think of the work.

They forget
having to get up earlier in the morning
getting washed/showered, putting on the 'face',
getting dressed
getting a fast breakfast and eating it in about 5 mins instead of casually
getting out the car
driving to work
walking from car to office
actually being up and about and unable to take intermittent proper rests during the day
walking from office back to car
driving home
putting car away
making an evening meal
probably feeding pets and/or others
washing up and then finding it's almost time for bed!

All of that is pretty much equivalent to a day's work on it's own but then you've got to do the day's work as well!

HIPS
for a full time office/teacher/light worker as shown
for a part time office/light worker could possibly manage this over 2-3 weeks
depending upon hours normally worked
for a manual/heavy worker longer, 8 weeks perhaps

KNEES
for a full time office/teacher/light worker as shown
for a part time office/light worker could possibly manage this over 3-4 weeks depending upon hours normally worked
for a manual/heavy worker longer, 12 weeks perhaps
Bilateral knees, minimum of 12 weeks for all.

In preparation for your return, whatever your job, you might find it helpful to stock yourself with some coach's instant ice packs. You just crush the capsule inside the pack and a chemical reaction makes the pack go nice and cold - and it lasts for a couple of hours! No mess, you can keep them in your handbag or pocket. Very convenient and invaluable for a sneaky 5 minute ice during work! And they're fairly cheap.

Also remember that there is no such thing as "just" a desk job, like it's simpler/easier than a manual job. Well, physically it might be but it has it's own set of problems the principle one of which is called "the movie sign".

Read this for more information Knee pain after sitting for a while

 

[mendogal]

Insomnia is a real bummer for many of us in the initial weeks after knee surgery. Definitely sleep whenever (and wherever it's safe and comfy!)

Icing, elevating, napping.... All help, but you might also consider some nonprescription remedies....

If you're lactose tolerant, a glass of warm milk! If you're not diabetic, a teeny bit of honey makes it even more comforting... plus milk is high in magnesium! Helps us relax!

If you aren't a milk drinker, or want an easier way to, an evening magnesium supplement has been very helpful for some members.

OTC diphenhydramine, an antihistamine also used as a sleep aid (Benadryl) because it makes you drowsy; it's also included in some cold, flu, etc "nighttime" combination meds.

Low dose melatonin, sustained release - not for long term use but I have used for a week at a time without ill effect. It should be taken an hour to hour and a half before going to bed, and during that time stay in a dimly lit area to allow this hormone to activate.

Valerian root - an herbal remedy, it can be taken in capsule form but that dose might be high compared to my preference, herbal "sleep" blends that include a smaller dose of valerian and make me pleasantly drowsy. Plus the other tea flavorings make it nice tasting! Celestial Seasonings and Traditional Medicinals sell teabags by the box. Their sleep blends without valerian have never ever made me sleepy.

What finally worked for me: a mug of sleep tea with valerian followed by a 3 mg sustained release melatonin, immediately going into a dimly lit room and relaxing. When I got sleepy, turning off the light and lying dowb with my legs up on the Lounge Doctor. After a few hours I would wake, move the Lounge Doctor away, and sleep more.

Be aware: even benign herbals and supplements can interact with your routine or post op prescription meds, either making their effects weaker or stronger. If you're on meds you may want to check with your doctor or pharmacist, or even check online for interactions.

 

[Jockette]

Sending hugs! I know how hard my recovery was, and I had a husband to help. I’m sure being alone is everything you’re feeling. Vent here any time.

 

[Layla]

Vent away...we don't mind. We've all been there.
Post Op Blues, or frustration, seems common at one month post op and that's where you'll be on Wednesday.
I hope the swelling has eased up today with rest and icing. Great news that you were able to tidy your home, do laundry and get a relaxing mani-pedi! It's accomplishing the little things early on that make us realize how much we take fro granted daily. At least that's how I felt.

Hopefully getting out of the house today was a mood booster and you had a good PT session. Thankfully you have someone to talk to weekly to help you navigate the tough times. While this is only one of a number of surgeries you've endured, with any luck it's the last. You're already one month in and on your way!

Fingers crossed you're able to get more time off work since you're not feeling ready.
Thanks for sharing your journey with us!
@Onestepatatime

 

[Aydabunch]

Hi onestepatatime. Hope you are better today. You are only 4 weeks today. You should start to see small weekly improvements. One thing this blog helped me is the realization that this recovery takes time, the knees time, not yours. I did the same thing and overdid it about the same time you did and it took 3-4 days to fully recover the swelling and pain. Take your time and ignore people who tell you that it’s taking too long. I started taking short excursions, 4-8 miles from home, at around 4 weeks. Allow time to rest and ice. At 6 weeks felt like I was turning a corner. Now at 8 weeks feel about 70% of normal. Hit several goals, like making cycle go around backwards at 4.5 weeks and going forward at 5 weeks. When I did it felt stiff but no pain. PT should push a little but also support you. Be open with them on what you can tolerate, soreness versus pain. And BREATHE during harder exercises as this REALLY helps. Give yourself time! With my job doc said I could go back at 12 weeks. I definitely believe him now. Take care and realize next year you will be so glad you did this.

 

[Layla]

Happy One Month Anniversary!
I hope things have improved since you last posted on Monday.
Possibly your getting together with some friends for the 4th...maybe a bbq or something similar. If you're not feeling up to it, you'll always find company here.
Take good care, brighter days are on the horizon.
@Onestepatatime

 

[Onestepatatime]

Thanks @Layla Hope you and everyone had a nice 4th. I managed to get to the beach with a friend for a bit so that was great. I reached 105 at PT today, so slowly improving. Swelling is still bad, mornings are ok then gets worse as day goes on. Battling boredom, frustration, and feeling a bit cut off especially living alone. I am thinking in the next two weeks to start returning to work. Except I am still not sleeping great and am tired by mid afternoon. My mom still thinks I should be ok to go on the cruise:( I wish I could go but I will listen to all who think it is a bad idea and way too soon. I should start to plan a vacation though so something to look forward to.

Has anyone heard or tried a Dynasplint? Looking for feedbacks as I am getting mine Monday. But at 105, not sure I still need it.

Thanks!