TKR Recovering from TKR 4/18 with NSAID allergy

niccisix

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I'm about 2.5 weeks into TKR recovery, which has been challenging without being able to take NSAIDs (or aspirin) to say the least. I did Lovenox injections instead of aspirin the first 10 days, so the risk of clotting has been mitigated with that and the compression stockings & calf massager thingys. I bought an "ice therapy machine" at my surgeon's recommendation to try to help with inflammation (and it just makes icing easier).

Basically, the first 3 days post-op were fine - but on day 4 after PT, my leg just blew up with swelling - especially my knee of course, but also my ankles and foot. The doc adjusted my meds several times to deal with the extra pain due to the level of inflammation, and PT barely did anything with me other than measure ROM (which of course wasn't great). That bought me a round of medrol dose pack - which helped, but I seem to be stuck in groundhog day anyways. Feels good in the morning, I try to work on ROM straight and bent, and by midafternoon I'm miserable with swelling again. THEN the doc's office screwed up my pain med scripts as I entered week 2, cutting me short so I didn't have oxycodone for almost two days. That set me back even further.

So now I'm about 2.5 weeks post-op, still on a walker, still fighting the swelling to some degree daily, pain is pretty well managed - but I'm already back to work full time this week. Even though I work from home - the one week the doc said I'd need off from work was not enough, I wound up taking a second week after attempting a couple of half days, but would have preferred at least 3 or 4 weeks. Since I didn't have the opportunity to plan for that, more time off is not an option for me.

Anyways - I feel like I'm stuck on Groundhog Day. 1 step forward, 2 steps back DAILY, which is incredibly frustrating. Feels like I make good progress on stretching and working on ROM the first half of the day, but by late afternoon I'm stiff as heck, swollen and really freaking tired. Start over the next day, still stiff but slightly less swollen. Doc is already talking about knocking me out and "making it bend" if I don't have better ROM by the end of week 4. Based on what I've read here - there's not much benefit from that.

Anyways - I keep reminding myself that this is all temporary, I'll get there - just slower than "normal". But I'm just getting soooo frustrated... :(
 
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Layla

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Hello and Welcome to BoneSmart! We‘re happy you’re here. I‘ll leave the BoneSmart Recovery Guidelines. Pay special attention to the articles on Icing and Elevation, as I believe it will help with the swelling you described above. Good to read you’re using an ice machine. Wishing you comfort and all the best on your healing journey. Stay in touch!

As you begin healing, please keep in mind that each recovery is unique. While the BoneSmart philosophy successfully works for many, there will be exceptions. Between the recommendations found here, your surgeon's recovery protocol and any physical therapy you may engage in, the key is to find what works best for you.

KNEE RECOVERY GUIDELINES
1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now, they are almost certainly temporary
2. Control discomfort:
rest
elevate
ice
take your pain meds by prescription schedule (not when pain starts!)
don't overwork.
3. Do what you want to do BUT
a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you
b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.
4. PT or exercise can be useful BUT take note of these
the BoneSmart view on exercise
BoneSmart philosophy for sensible post op therapy
5. At week 4 and after you should follow this
Activity progression for TKRs
6. Access these pages on the website
Oral And Intravenous Pain Medications
Wound Care In Hospital


The Recovery articles:
The importance of managing pain after a TKR and the pain chart
Swollen and stiff knee: what causes it?
Energy drain for TKRs
Elevation is the key
Ice to control pain and swelling
Heel slides and how to do them properly
Chart representation of TKR recovery
Healing: how long does it take?

Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

There are also some cautionary articles here
Myth busting: no pain, no gain
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds


We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery. While members may create as many threads as they like in a majority of BoneSmart's forums, we ask that each member have only one recovery thread. This policy makes it easier to go back and review history before providing advice.
I wish you comfort and all the best on your healing journey!
 

Jaycey

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@niccisix Welcome to BoneSmart! How long are you icing and how many times per day? We recommend icing at least 45-60 minutes several times per day. Icing will help decrease the internal swelling that is causing this pain.
 

sistersinhim

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Feels like I make good progress on stretching and working on ROM the first half of the day, but by late afternoon I'm stiff as heck, swollen and really freaking tired. Start over the next day, still stiff but slightly less swollen. Doc is already talking about knocking me out and "making it bend" if I don't have better ROM by the end of week 4. Based on what I've read here - there's not much benefit from that.
This Groundhog Day seems to be coming from your morning exercises. Don't do them for a couple of weeks and just do your normal daily activities. I bet your knee's swelling and stiffness won't be as bad. I think you are doing more than your knee is ready for you to do and it's reacting with more inflammation bringing on that increased pain, swelling, and stiffness. You don't have to do exercises every day. Many of us here never did formal PT or exercises and recovered just fine without the pain and swelling that comes from working the knee more than it was healed enough to be doing.

Your #1 job for the first few months is to heal, not doing a bunch of exercises. By the way, your doctor can't do anything to your knee that you don't want to be done. Tell him that you'd like a little more time for the bend to come in naturally. He has to agree to that. You are his boss!
 

lovetocookandsew

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There's no actual "normal" recovery. Each of us is different, and each of us recovers at a different pace. Even two knees on the same person will recover differently. I'm one who recovers at the front end very slowly, then I pick up steam and move a little faster on the back end. I used a walker for around three weeks, then went to a cane for another three weeks or so, then kept the cane around to use as needed. Some people need their walkers for longer than three weeks, or other walking aids for longer, and that is perfectly okay. When you are ready to switch from your walker, maybe going to a cane, you will. When you are no longer limping and are steady on your feet, you'll find yourself naturally forgetting to grab your cane, and that's when you'll go from a full time walking aid, to a sometimes needed aid, and at some point you won't need it at all.

As for the MUA your doctor has threatened, it's way too early to even be thinking about forcing your poor knee to bend. When your knee has recovered enough that the swelling is gone, or nearly gone, you will find that you have a good bend. But as long as you're in these very early days, your knee is less likely to have a lot of bend due to external swelling you can see, internal swelling you can't see, or both. Spend as much time icing and elevating as you can, keeping a cloth between your skin and the ice to protect it, and you can ice for long periods of time.

Since you must work, and you work from home, if your work is on the computer, you can (if you have a laptop or tablet) do your work on a recliner or bed so you can ice and elevate as you work. I have a portable standing bed desk for my laptop so I can use my computer in bed, or I can take it anywhere I want to go. The stand can be beside me in bed or over my legs as a desk. I was able to use my computer as much as I wanted with this desk, and still use it all the time.

Just remember, this is your knee, your recovery and your decision on how you want that recovery to go. Listen to your knee and be patient, over time things will improve. No one, not your doctor, a friend, a family member or PT, can tell you how to recover. They can suggest, but in the end, the decisions are 100% your own. Only you make the decisions, while listening to your knee's reactions, and only you can consent to any more procedures. I would never consider an MUA at this early stage, and, personally, I would ignore the doctor's recovery timeline and let my knee dictate the recovery it needs. We don't want you to be a couch potato, but we also don't want you to overdo it and end up causing more pain and swelling. It's a fine balance, but patience is the key.
 

TownieGirl

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Hi there @niccisix
“So now I'm about 2.5 weeks post-op, still on a walker,” I am four weeks out. I still use my Walker when I have to walk long distances because my quad muscle in my right knee is still not strong. I don’t want to chance falling. In my home I just started walking without assistance. At 2.5 weeks I was still using a Walker too, so don’t worry that you are. The strength will come.
 

Samsrf

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@niccisix Be gentle with yourself! We all heal differently- I am sorry the doctor said you would only need a week off. I know it is probably overwhelming right now. I feel for you! I have honestly found that icing & elevating is the best pain relief. Hang in there!
 

Nomorelimp

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My doctor told me that I would need to take at least 6-8 weeks off work though I have an office job. He said pain is biological and it’s hard to predict how anyone will react to surgery.

I’m just over 2 weeks past surgery and can’t imagine going back to work in 4 weeks- never mind actually being back now. Only now have I felt enough energy to shower every day! I don’t get what your doc meant by one week off to recover- have you even got over the anaesthesia?
Best of luck with your recovery.
 

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