TKR Ray's LTKR, Sept 28,2023

Feeling better is great news! Yippee!
 
Yes, it does. But anyone who has gone through this process knows it isn't linear. There will always be ups and downs along the way. Another milestone today: I walked down my ultra steep front outside concrete steps today one foot in front of the other for the first time even though I have been doing the less steep carpeted inside stairs like that for awhile. I could only do this with the knee warm from that recent bike ride. No way I could do it after it cools and stiffens up. I guess that is the goal for all the PT... first to regain that ROM and then, finally, to retain it 24/7. That last part is going to take awhile.

And I can still only dream of sleeping 6 1/2 hours straight like Msuki. I can barely get those dreams in during my 2 and 3 hours of uninterrupted sleep.



Feeling better is great news! Yippee!
 
I found that as I gained more function, the bend would follow through. One helps the other.
 
Congrats on that staircase!!!! Every little bit like that reminds us it gets better!

My experience is also that a good warming up, like the bike ride, helps ROM.
 
Congratulations on the stairs! I have gone upstairs at my house a few times when I needed something but doing the good leg up/bad leg down method plus holding on the handrail.
 
Just a quick update as I approach the end of week 10 post op... I'd love to report stunning progress but as many of you know that is not usually how this works. My knee still seems to be a little stiff and ouchy grouchy most days. My ROM is still about 0/120, which I have had since about week 3 1/2 and I continue to do my PT exercises and stretches at home several days per week, walk most days, and ride my indoor bike trainer. I have played with the mix, duration, and intensity of these activities as well as throwing in some rest days to try to figure out what works best and what would make my knee feel better. But TBH, there is just no consistency or correlation. I have done a few bike rides getting up into the moderate aerobic range and a couple of longer hilly walks (3 miles) and felt great during and immediately afterwards... but then get that ouchy grouchy feeling again later that is not relieved by rest days. So, who knows?

One example that puzzled me is that I got up in the middle of the night to go to the bathroom on the day I did one of those long walks and my knee felt fantastic. No pain, no stiffness, almost like there was never any surgery. I got up again a few hours later (that's what us old guys have to do) and the same. I went back to bed thinking maybe I had really turned the recovery corner. But when I woke up for the morning that old nagging ouchy grouchy feeling was back. Sigh.

Not to whine, because I know there are folks here dealing with far more difficult recoveries, but the articles on the recovery blues are accurate. I really crave being able to consistently get some good solid aerobic exercise, but I am just not ready to go there yet. :-( Patience, patience, patience...
 
Objectively.... you're doing really well!!!!

Not much help when the blues hit, I know. Especially if you're one of those people who really needs that regular aerobic workout as a stress buster and mood conditioner.

Sometimes there simply isn't an obvious correlation between activity and outcome. Waking up randomly feeling like it's a normal knee is sort of like an unexpected moment of grace...walking three miles could easily put one person over the edge into the OverDid It Club but leave another unscathed.

Hang in there. Be kind to your baby knee. And to yourself.
 
So, when I had my 6 week check and reported a popping on the lateral side of my knee the PA told me it was the IT band. This was one of the worst pains just after surgery and kept me from sleeping on my side. We got onto other topics so I forgot to ask her about the prognosis. Fast forward to now at 10 weeks and the pain is certainly less than immediately post-op, but still annoying and it still pops under certain specific postures and pressures.

I just found a good video that describes the cause... IT band shortened over time due to disappearance of joint space... space that was instantly restored by the new knee. Of course the remedy is patience... and hip and glute strengthening. Interestingly the doc in the video says that stretching the IT bad may indeed be counterproductive. I have already developed good strength, so I guess I need a double dose of patience.

Anyone else here dealt with IT band pain and popping following TKR and can share what worked for you?
 
IT Band pain is a common complaint after this surgery. Many suffer from it for quite a while. Here's an article from our library: IT Band Info
 
I am going to take a few days off from riding my indoor bicycle trainer and doing long walks in order to try to get the IT band to settle down... just stick to ADL's. I'll also ice it and maybe try some Voltaren rubbed right on the lateral side of the knee around the joint line where it is sore. Then maybe go back to those activities gently. But the way it pops... it is almost like it isn't totally happy with the small changes in geometry caused by the surgery. I am not sure that rest is going to cure that. After my rest period I'll try some of the IT band rehab exercises, I suppose, and maybe seek formal PT for it. IDK yet. And I am also still not happy with how warm my knee feels and measures at 10 weeks post op, like 3-4 degrees C... even 5 degrees C in some spots sometimes... warmer than the non operated knee, measured with IR thermometer below. Seems a lot to me, but IDK. I am seeing my primary care Tuesday to discuss.

IMG_5077.jpg
 
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Hi raylo,
I understand your concern, but the info below is readily available online, multiple sites -

"Typically you will notice a temperature difference between your surgical and non-surgical knee. You will experience warmth in the knee due to the healing and increased blood flow to the area. This can last for approximately 6-12 months in most patients."

Hopefully you can take comfort in this, or your PCP offers you the reassurance that all is normal and well when you visit on Tuesday. Wishing you a peaceful Sunday!
 
Yes, I understand. The question I have is the magnitude and the fact that it hasn't decreased in the 4 weeks or so that I have been tracking it. The only reference I found online that discussed magnitude showed smaller temperature differences and decaying down over time to even smaller deltas, well before 10 weeks post-op. Granted that was just one study and the measurement techniques would be more sophisticated than my HVAC tool. It also doesn't help that my brother is currently undergoing the 2 step surgery procedure for infection in his older TKR. I have to admit I am a little rattled. Before I had my TKR I just looked at the top line infection rates and felt good. But I had not looked deeper to understand fully the implications if you became one of those unlucky 1 or 2%. I had assumed that it could be treated in situ. But if I had known that was not the case I might have deferred the TKR and lived with my limitations for awhile longer. Having a TKR is an "interesting" risk/benefit decision.

Hi raylo,
I understand your concern, but the info below is readily available online, multiple sites -

"Typically you will notice a temperature difference between your surgical and non-surgical knee. You will experience warmth in the knee due to the healing and increased blood flow to the area. This can last for approximately 6-12 months in most patients."

Hopefully you can take comfort in this, or your PCP offers you the reassurance that all is normal and well when you visit on Tuesday. Wishing you a peaceful Sunday!
 
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Having a TKR is an "interesting" risk/benefit decision.
Yes, I agree and usually the benefits outweigh the risks by far. I understand you also likely have a heightened awareness due to your brothers misfortune. Knowing someone personally, especially a loved one, dealing with a complication would cause anxiety. I only hope you feel better after your appointment with your Primary on Tuesday. Please let us know how it goes. We all learn through others experiences.
 
And I am also still not happy with how warm my knee feels and measures at 10 weeks post op,
As long as your knee isn't red, hot, and very swollen, a warmer knee is nothing to worry about. I understand your being extra cautious because of what your brother is dealing with. But, he is far from normal.
 
It's not red hot and super swollen. There is some swelling but that could also be normal at this point in rehab. And I have no constitutional infection symptoms, like a fever. It's just that I have never seen one of these in person, including my brother's since he is not local to me.

But the temps are higher than what I am reading in the studies. And logically one could assume that if the temps were higher than they should be and/or not going down that an early infection could be masked by assuming it is just within the range of normal rehabs.

I searched again and found more info. I am still above the mean skin temp differences reported in these studies but maybe not out of the range of some of the data scatter that isn't shown. And the knee is functioning OK with the exception of my IT band issue... which may have been prolonged by me doing too much activity. And maybe doing so much pedaling on the bike not only has aggravated the IT band but all those repetitions of the kneecap sliding under the incision and other disturbed soft tissue could also a factor. IDK.

Sorry, I restored the link before reading the admin message that posting outside links is not allowed. So I removed it again. Very strange rule. If anyone is interested in reading about this google TKR skin temp differentials and see the PubMed articles.



As long as your knee isn't red, hot, and very swollen, a warmer knee is nothing to worry about. I understand your being extra cautious because of what your brother is dealing with. But, he is far from normal.
 
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To update this with some info that may be useful to the community... I had been worrying about how warm my 11 week old TKR knee is as compared to the non operated knee, as much as 10 degrees F in some spots at some times of day as measured by IR thermometer. I understood that the knee could be warm for 6 months or even more, but that warm?

So, I visited my primary care doc to get the basic bloodwork to look for markers of infection before trying to get back in to see the knee surgeon, which would have taken longer. He didn't have the background or was unwilling to really weigh in on the "how warm" issue so he ran CBC, CRP and ESR tests to look for indications of infection.

My CRP was 1, which is slightly elevated but essentially normal. I have previously read that CRP spikes immediately after TKR surgery due to inflammation, but gradually decays back to baseline over 9 months. So my CRP of 1 seems normal, especially when they say that levels of 10 or more would indicate acute infection... and the case studies I have seen of TKR infections the CRP was much higher, like 50 to 60.

And my ESR was very low at 2, whereas the literature says that acute infection would spike levels to >35. In addition, the CBC captured my WBC level and it was normal and identical to before my surgery.

These 3 markers combined pretty much confirm that there is no acute infection. So, barring any worsening of temperature, pain, swelling, function, etc. I am going to stop overly worrying about this... for now. But I really hope this thing starts cooling off a bit sometime.

I hope this information is useful some of you. Good luck, all.
 
I am going to stop overly worrying about this... for now. But I really hope this thing starts cooling off a bit sometime.
Glad to read that you feel more confident about this after the blood work.

Many of us experience a warm knee for months after this surgery. If you scan other Knee recovery threads, you will find numerous comments about this. In my case, my operated knee was still warmer than the non-operated knee at four months post op, but my doctors said it was a normal sign of recovery -- and, sure enough -- if disappeared with time.

We are all different and our bodies recover at different rates. Try to patient a bit longer. I'm sure it will improve with time.
 
I’m with you on the warm knee and about the same timeline in recovery. I use my knee to warm up my chronically cold hands, and my husband does the same lol - I want something cool on it all the time!
Infection worries can creep in but then I remind myself of data on infection rates - very low risk for me not being diabetic/other chronic conditions nor having significant previous antibiotic use. Plus my pain is not constantly high - more just annoyingly there in a low grade way (from people I’ve known who have been through infection, it can be very intensely painful, often as painful as acute post op pain).
 
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I don't have any risk factors either, except maybe this one that I have never heard before? I had lyme disease back in fall of 2002 and the doc wanted to take a wait and see approach in spite of the classic bullseye rash and the fact that I had had a fever and night sweats from an unknown cause... that happened before the rash appeared. He was ignorant, obviously. I returned about 10 days later with amoeba shaped rashes all over my body and then he treated me. But that was by then pretty late so I ended up taking doxycycline for several months.

nor having significant previous antibiotic use.
 

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