TKR Question on pain and swelling six months post TKR

[sistersinhim]

I am so sorry to read about your mom's broken leg. I'm glad she's getting along OK.

Do I push through the tiredness and walk every hour?

I wouldn't. It's your body telling you that it needs rest. That stiffness you get always works itself out. Listen to your body and your knee and your recovery should go along well.

 

[mendogal]

Oh no, I'm so sorry about your mom's fall and injury!

Re walking every hour: that's really an essential first couple of weeks prescription, when we aren't capable of doing much else!
I suggest getting up as needed to keep your knee from getting too stiff, but if it's just to use the bathroom or get a beverage that's fine on an off day when your whole body says REST!!!!

 

[Onestepatatime]

Thanks all. Question - has anyone had severe pain start at 6-7 weeks at the base of the incision? I have this burning sharp pain on the upper half of the incision. This started yesterday and had me up most of the night. Could it be nerve pain? Almost feels like a stitch is under the skin. It looks lumpy on the outside but not infected. Any thoughts?

 

[mendogal]

It could be a stitch or a bit of excess scar tissue (NOT an adhesion binding the muscle, just a little knot of extra tissue in the skin/subcutaneous tissue) - I had that at the very top of my R knee incision associated with a weird horizontal tuck. It was deemed scar tissue and I was counseled by my ortho team to massage it. It did slowly resolve!

However I didn't have any pain associated with it....

Sharp pain and burning in the absence of localized redness and swelling is indeed likely nerve pain. We can experience that post op. As traumatized sensory nerves start regrowing the talking with each other the signals can be wonky for a while.

Whatever is lumpy might be affecting sensory nerves or they may be two unrelated things. During my recovery this was the kind of thing where I'd put a non urgent call into my ortho team (his medical assistant's line) during their office hours just to double check. They might want you to email a photo.

 

[Onestepatatime]

@mendogal I will call in the morning. I cannot even touch the area where the pain is. It really feels like something is pinching and caught under the skin. If that is the case, what would be done?

 

[mendogal]

They would want to see a photo and very possibly to see you so they can diagnose it.

We have had members who have needed to have a small portion of the incision opened - just the outer layers! - to address a minor subcutaneous (literally "under the skin") problem but it's very possible they will decide it's not necessary and address the pain so massage can be done.

It honestly doesn't sound to me like it's more serious (or deeper) than that. I hope you're able to get comfortable tonight!

 

[mendogal]

@Onestepatatime What's new today?

 

[Onestepatatime]

@mendogal - thank you for asking! Dr Office said to try gabapentin. I have my follow up on Thursday with the surgeon so if it is still bothersome they can look at it. During PT today I almost jumped off the table when the therapist grabbed my knee there. My bend has not improved, seems stuck at 105. PT was concerned the surgeon would put manipulation back on the table. Also been using the dynasplint.

Maybe I am pushing myself too much during the day? At this point, how many times a day should I be icing and elevating? Seems after two hours I start to swell if I am out or doing chores.

 

[mendogal]

I was icing and elevating toes over nose four times a day, 45 minutes.

I was NOT doing two hours out in the world or chores!!! You're definitely overdoing things...

My notes then I'll follow up post BoneSmart activity recommendations.
-----
Here's a summary of milestones because I'm sometimes asked; it makes sense to have them in one place.

Post op day 1: independent in and out of bed, independent with hygiene.

Post op day 8: transition from walker to walking stick.

Post op day 24: puttering in place at home without the walking stick, tolerating 10 minutes sitting up on a chair (yes I used timers a lot!), graduated off of the elevated over-toilet commode.

Post op day 34: graduated off the shower stool, walked solo on our street with walking stick, got down on the floor and back up, tolerating 15 minutes sitting.

6 weeks: 1/2 mile non stop walking on our street with walking stick, up and down a flight of stairs sequentially, accompanied my husband to the Farmers Market and to a store (different days) and having brunch with a friend at a cafe.

8 weeks: graduated completely off the walking stick, driving.

 

[mendogal]

This is the recommended activity progression.
Some will progress faster, some slower, but two hours is way beyond!

 

[Onestepatatime]

@mendogal just to clarify I didn’t do two straight hours of chores. I did sit by the beach for a couple of hours with legs somewhat elevated. Did wonders for me mentally. I live alone so I try and break up getting small loads of laundry done, load and unload dishwasher. I walk 5 blocks with a cane which is 15 minutes total. I’m probably somehow overdoing it. I don’t really have someone to help with laundry etc.

 

[mendogal]

Oh, thank you for that clarification! Yes it's definitely harder when solo.
Getting beach air and the sound of the waves.... Relaxing for body, tonic for the mind!

 

[Onestepatatime]

I saw the surgeon today, and he felt I would find the MUA very helpful. He gave me a hug and said nothing with me is without complications and explained because my knee was in such bad shape prior to the TKR and I was walking all bent and guarded for months it made me prone to post op stiffness. It is scheduled for Monday. I feel optimistic, even though the first few days after will not be fun. The knee is so stiff, he even felt it. He said my knee was in such bad shape, and in so much pain and I was walking all bent and twisted which contributed to this.

I told my mom who is still in rehab, and she started to cry, saying she does not know how I keep having all these surgeries. Then I got all teary. I told her one day at a time. One foot in front of the other. I feel. bad I am not with her now.

 

[mendogal]

Oh, sending you a ((hug)), what rotten luck and timing for you and your mom.

This is an excellent article on Adhesions and MUAs.

While overall we tend to think some orthopedists rush their patients into them, there's been plenty of members who were totally thankful to have had a MUA and we always support our members' decisions.

Hoping it ends up getting you where you want to be!

 

[sistersinhim]

With all you are doing, you don't need to be going to PT, you're getting natural PT every day.

I'm surprised your doctor is doing a MUA when you have reached 105 already. That is a good bend at less than 2 months. Most surgeons won't do a MUA after their patient reaches 90 degrees. I pray you are happy with the results and have minimum pain. We are here for you when need us!

 

[Onestepatatime]

Thank you. It’s because I had so many issues with my knee prior to surgery I built up scar tissue. He is very conservative and an excellent doctor and said if I don’t do it I likely won’t progress where I need to be. So this is just a push to help me over this hump. I trust him.

 

[sistersinhim]

I trust him.

That is half the battle, and you will do great! He certainly knows you better than anyone else besides you.

 

[Onestepatatime]

Yeah, he’s done 6 surgeries on me already and knows that I always have a bump or complication…

 

[Layla]

I'm sorry you have to endure another procedure. Hopefully the set back is short lived and you experience the desired outcome. Hugs and best wishes!
@Onestepatatime

 

[Onestepatatime]

Awe you all are so sweet! Thank you. I can tell I’m stuck. I really hope this works once it settles down with the swelling and pain. I’m debating blowing off PT today but I guess I shouldn’t miss a session. It’s really nice at the beach now but the exercises do feel good at PT.