TKR Question on pain and swelling six months post TKR

[mendogal]

I can't imagine needing a Dynasplint - you're doing great at a month out. Please let "tincture of time" do it's job.

The increasing swelling as the day goes on indicates you're slightly overdoing it every day. If you can figure out what it is (reduce exercises by 25%, or space out household chores with more icing and elevation between them, ?).

We generally recommend a phased return to work starting at 10-12 weeks. The fatigue is real, the need to rest, elevate, and ice is still present.

The cruise, um, no, but YES to planning a vacation!!!!

 

[benne68]

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.

Since you are still battling swelling and finding your pain gets worse during the day, I think you will regret trying to manage a cruise at 7 weeks post-op. I know I could not have done it that soon after either TKR.

Planning a vacation that you will enjoy is a GREAT motivator. I spent the first 3 months of my latest recovery researching for my recent trip to South Africa (which I went on at 6 months post-op, and did just fine). Plan something that you can get excited about!.

 

[Onestepatatime]

Thanks, I am thinking I am not icing and elevating enough. I realized this morning I was putzing around for 1.5 hours before I iced and elevated. And I am not elevating enough during my sleep so waking up stiff and swollen. I kinda thought I could scale back on icing and elevating but perhaps too soon. I think on Monday I am going to drive myself to PT vs Uber. It is about a 3 mile drive. Thoughts?

 

[mendogal]

Yeah, it's good to slowly increase activity, but for the first 8 -12 weeks most of us benefit from not cutting back on icing and elevating.

Three miles so depends on what kind of driving!!!!
There's no way, were I still living in San Francisco, that I would have driven halfway across the city (even at eight weeks!)
But now, three miles gets me from my sleepy neighborhood to the edge of "downtown" and a bit past to my favorite coffee roaster/cafe, using a quiet side street I live at the far end of.

Can you do a shorter test drive tomorrow and then decide?

 

[Layla]

I think on Monday I am going to drive myself to PT vs Uber. It is about a 3 mile drive. Thoughts?

Can you park close to the building and do you have to walk a long distance once inside the building? I do like mendogal’s idea of a test drive. See how you do. Something to look forward to tomorrow in the midst of these snooze fest days of early recovery, haha. Let us know how it goes, if you try it…

 

[Onestepatatime]

I will def take everyone’s advice and practice first. There’s two busy roads I’d have to take. I’m so appreciative of the constant support and great advice.

What about use of compression stockings? What’s recommended for swelling?

 

[sistersinhim]

If I were you, I would definitely bow out of taking that cruise. I think you'd be miserable. Not only that, the ship will sway a little, which will throw your balance off.

I found the best way to get rid of swelling was less activity and more icing and elevating. At your stage, I'd do a little job, then ice and elevate for twice the amount of time the job took. If I did a big job, I'd take the next day off and just do the necessary daily activities and ice and elevate the rest of the time. I iced for hours on end at the time with a cloth between my knee and the baffle. You can not over ice as long as you have a cloth between your leg and the ice source.

 

[Layla]

What about use of compression stockings? What’s recommended for swelling?

You can talk to your OS’s care team about this if it’s something you’re interested in. Many surgeons no longer prescribe wearing them, and guessing your OS is one of them? Can’t hurt to ask if you feel they’ll be of benefit.
I hope this week is a good one for you.

 

[Onestepatatime]

Hi, so PT and my surgeon felt I should use the splint for a few weeks and see. My knee is still extremely stiff. The rep from Dynasplint met me at PT today and showed me how to use it etc. It is very easy to use. It involves using it 4x a day for 20 min to start. Then work my way to 45 min 3-4 times a day. Feels a drop overwhelming but I will try. Next week on the 18th is my follow up appointment. I remain hopeful I will be able to be out and about some in August and enjoy the summer for a month. I am going to ask work if I can move to Florida since I work remote, and then travel to NJ as needed which will be probably every two months for 4 days. I cannot face another winter after all these surgeries, if I can help it. And my son and mom are down there.

 

[Layla]

Great that you have a plan in place. I hope you adjust quickly and achieve the desired outcome.

Hopefully you’ll be able to enjoy August as you’re wishing.
Your plan to move from NJ to Florida sounds like a good one! Closer to your son, your mom and more sunshine! Win, win, win!

Stay in touch and let us know how the splint is working for you.
@Onestepatatime

 

[Elf1]

@Onestepatatime the plan to move to FL doesn't sound too bad, definitely a lot warmer than NJ!

So how goes it with the splint? Did you end up driving.or taking an Uber to your appointment?

 

[Onestepatatime]

@Elf1 hi how are you feeling? I ended up taking an Uber. Today I saw I had a flat tire good thing my friend was around to get tire fixed. I’ll try driving tomorrow. The splint sucks! At 20 min I’m very uncomfortable. But good news! At PT with a lot of help I was at 114. I have the feeling of a hard cast under my knee though. PT said it’s tendon issues, don’t know what that means. I feel like while I’ve made a lot of progress there is still a big journey ahead. I started using a cane and feel exhausted. There’s a lot of atrophy PT said too. My right leg had 7 surgeries so I still have my work cut out for me on my good side. I think August will be a better month!

 

[Onestepatatime]

Oh wait she meant tissue not tendon. I’m really hoping it’s not arthrofibrosis.

 

[mendogal]

But good news! At PT with a lot of help I was at 114. I have the feeling of a hard cast under my knee though. PT said it’s tendon issues, don’t know what that means. I feel like while I’ve made a lot of progress there is still a big journey ahead. I started using a cane and feel exhausted. There’s a lot of atrophy PT said too. My right leg had 7 surgeries so I still have my work cut out for me on my good side. I think August will be a better month!

Flexion obtained with PT's "help" generally evaporates when you go home and the knee swells in response.

Congratulations on graduating to the cane! Some of us go through a transitional phase where we alternate between cane and walker simply because of that harder work being to tiring - if you find yourself limping or slumping, or unsteady due to fatigue, it's a prudent approach.

 

[Jockette]

At PT with a lot of help

You don’t need all this “help” to achieve more ROM, which as @mendogal says, evaporates later as swelling returns/increases. The only good thing about that is that you know your knee can bend to 114. So just let it heal and wait patiently for that 114 to happen without lots of help. It’s just a number.

I have the feeling of a hard cast under my knee though. PT said it’s tendon issues,

I’m really hoping it’s not arthrofibrosis.

It’s swelling, because you had major surgery about a month ago that caused a lot of trauma to your whole leg. It’s far too early to worry about arthrofibrosis.

 

[gia2cats]

I read most of your posts and want to comment on a vacation at 7 weeks. I’ve had 2 TKR’s, not robotic, 2 years apart. I was very lucky to have relatively easy recoveries. Went to outpatient 4 days post op, used the walker for 1 week and the cane for 2 weeks. My bend was 120 at 6 weeks. I’m not telling this to brag because everyone’s recovery is different. As I said, I was lucky.
There is no way I could have gone on a vacation at 7 weeks. That would have been brutal. We did take a cruise at 14 weeks and that was doable. I was able to walk through the airport and sit on the plane and walk the beach easily.
Please don’t let anyone make you feel guilty about saying no. I think your recovery would really be setback if you do this.
It will get easier as time goes on.

 

[maryo52]

Remember that recovery takes a year!

During one of the many sagas of my right knee, I developed what's called AMI or arthrogenic muscle inhibition. My PCP himself had it, suspected I had it, and confirmed his suspicion simply by grabbing my thighs and noticing the difference in muscle mass. It will never go away but I counteract it with strengthening exercises. My routine is pretty tame because if I step it up, the knee rebels by getting inflamed at various tendon and ligament attachment points. You'll hear over and over, this is not a spring, it's a marathon. Take it easy. Trust your body.

 

[Elf1]

@Onestepatatime sorry to hear about the splint making you very uncomfortable. Could you maybe try using it for less time to get used to it and then slowly up the amount of time you have it on?

I agree with switching between cane and walker if you notice fatigue, limping, etc. I know when I had my THR I used the walker for close to 3 months, my PT felt I wss just too unsteady. Then once I switched to cane I still used the walker at night, especially when getting up for those late night bathroom breaks.

My OS said that I had some atrophy going on as well. Plus PT noticed I still have weakness on my right side left over from THR. Just completed week 2 of PT, concentrating on stretching, balance and gait right now. A bit of a sore girl tonight but I've felt a lot worse so its just muscles and ligaments that have been lazy for too long being woken up.

 

[Onestepatatime]

So....the cruise is off. My mom tripped on her carpet and broke her femur. She had surgery yesterday to insert a rod and all went well thank goodness.
I have been feeling so fatigued. I had two days I was out and about more than usual. And now I am beat. I took a walk around the block with a cane, and quickly realized it will be like you all said, back and forth with the rollator and cane. I know on one hand I have come a long way since June 3rd, but today reminds me I have a long way to go. My right leg is not good, from all the glute tear repairs in the prior surgery. Feels very achy and very weak. Just feeling a little defeated today. Do I push through the tiredness and walk every hour? Sometimes I feel like all this resting makes me stiffer.

 

[Layla]

First…I am sorry to read the news about your moms fall. Thankfully the surgery went well, I hope she has a smooth recovery.

You realized that you weren’t in a good position to enjoy the cruise, so now that it’s canceled you won’t feel like you’re missing out on anything. Maybe you and mom can plan another cruise when you’re both stronger and feel you’ll be able to actively participate in whatever you choose, without ill effect. It will be something to look forward to.

Personally, I wouldn’t “push” through anything, but instead listen to your body as it’s telling you to rest. It IS early days in the entire scheme of things and feeling fatigued with energy in short supply is because your body is using energy for healing first.

If you feel resting is making you stiffer, make sure to get up frequently, if you’re not already and walk around or engage in the activities of daily living. Next time you go outdoors to walk, try a shorter distance for awhile until you feel you can safely ramp it up…a little at a time. As you know….it will get better, but unfortunately it feels like a slog some days.

Take care!
@Onestepatatime