TKR Recovery room nightmare and in the middle of a pain crisis just 36 hours out

[Roveranger]

What a blessing to have found this forum!

I am currently lying here in bed, postoperative 36 hours, with unbearable pain not knowing what to do. My surgeon's staff is ignoring my online messages that I wrote this afternoon. So I tried calling before they closed this evening and someone with no authority said she's tried calling them and they're not responding. Told me to go to the ER tonight if it gets too bad. Um, no thanks. I'd rather just lie in my bed weeping and gnashing my teeth all night. Seriously.

I had RTKR done 10 months ago in Feb 2022 with no problems. I am a 50 y.o. healthy female former college athlete. 2 ACL blow outs and repairs in 1995 & 1996, and several arthroscopic procedures on top of each over the years.

I am an absolute health nut that never takes a medication unless its to save my life. I am a plant based vegan who has put health and lack of toxin consumption at the top of my priorities list.

Just had my LTKR done yesterday morning December 19, 2022. All was well until..

Immediately following surgery, I suddenly "came-to" in the recovery room at a 10+ (which I have never been in my life) on the pain scale. I didn't even know my name, didn't know where I was, and believed I had been a pedestrian who had been nailed by a car while crossing in a crosswalk.

The nurse quickly took action and was able to get my pain down to a 6/7 in about 15 minutes. With my entire face and neck still clenched, eyes squeezed shut, and tears slowly leaking from the corners of my eyes, a doctor came in and injected some kind of pain blocker medication into the top of my leg. I know they did this for my previous TKR as well, but they did it BEFORE I went to the recovery room that time. Anyway, this finally brought my pain down to a 0/1.

However, once this pain blocker wore off at about 2 am this, my vacation was over. I was never able to go back to sleep and now it is almost 7 pm.

I have had several major ortho surgeries over the years (my ankle even involved several pins and a 1 week hospital stay as it was broken into many pieces) and I have NEVER had anywhere close to this kind of pain... in the recovery room or at home.

I don't know what to do from here and am concerned about my surgeon's lack of concern (he is officially retiring at the end of this week coincidentally), and I have a PT appointment scheduled for Thursday which is in about 36 hours from now.

In general, I don't trust the medical system. I don't distrust individual doctors or personnel per se, but I am hyper aware that they no longer are making the decisions regarding patient care as this is now all being done by the insurance companies. So, I don't mean to sound like I think any doctors are doing anything with malice (in my case anyway).

I am taking the prescribed medications: 2 x 5mg Oxycodone every 4 hours (which again, i didn't need NEARLY this much of this medication during my previous TKR recovery) and 2 x Extra Strength Acetaminophen every 6 hours. My pain is hovering between a 5-7 and have had no actual relief since the blocker wore off at 2 am this morning.

My surgery leg is 3 times the size of my non surgery leg, which also didn't happen after my other TKR. I am not experiencing any signs or symptoms of infection at this time.

So I have 2 main questions:

1 - Any ideas as to why I ended up in that condition in the recovery room? I am still in a bit of shock as I believe it was very irresponsible for them to allow me to even get into that kind of a pain condition. It makes me a bit worried that I might by experiencing phantom/sympathetic pain at this time.

2 - I see a lot of responses in here about not letting PT work on your knee prematurely as this could actually hinder the process. I am concerned about ROM of course because I don't want to end up in an MUA situation. But I am dreading this appointment in 36 hours. Not only am I unsure as to if my relatively straight elephant leg will even fit in the car, but I can't imagine someone pushing on it without the stitches popping at this time. It already looks like its about to explode just lying there!

Any thoughts or advice are much appreciated, thanks so much

 

[Layla]

Oh my! I am so sorry to read this. The fact that you're struggling with pain and receiving no response is awful.You shouldn't have to go to the ER 36 hours post op for medication. Are you icing at all? If not, please try and see if it helps bring some relief. I would call the surgeon's office as soon as they open tomorrow morning to speak with a member of his care team seeking better pain management.

Naturally you will compare this recovery to the last, but please know that no two recoveries are alike even with the same person. The heaviness you are experiencing is referred to as Log Leg.

The first stage of healing is the inflammatory phase. During this time it is very common to notice swelling. After lower extremity surgery, or trauma involving bleeding and inflammation, there will be fluid in the leg causing the sensation of heaviness. Gravity pulls the fluid downward and since the patient is less mobile the fluid is not pumping back through the heart as quickly. The swelling gradually eases, but can persist for up to 3-6 months in some cases. Regular movement will assist in the reduction of swelling, as will elevation and ice. Your surgeon may prescribe compression stockings for a short period of time.

Following joint replacement, you may benefit from the use of a Leg Lifter. The Leg Lifter is a mobility aid that can assist in getting in and out of cars, wheelchairs, beds, recliners and much more. The Leg Lifter is an inexpensive option that helps provide safe movement in the early days, to weeks, of recovery.

I would not recommend PT this early on, What you need now is rest, ice, elevation and adequate pain control.
Please refrain from engaging in movement that causes discomfort or pain. Do not allow anyone to forcefully manipulate your leg. While your range of motion is currently limited, it will naturally increase as the swelling subsides and the pain eases. Give it time.

I will leave our Recovery Guidelines with wishes for your comfort. I hope you're able to connect with someone tomorrow to adjust meds and get the relief you deserve.
I hope you're able to get some restorative rest overnight.


KNEE RECOVERY GUIDELINES

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.

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​

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.

 

[Jockette]

I am concerned about ROM of course because I don't want to end up in an MUA situation.

It is way too early to even think about ROM. It will come along fine, if you give it a chance.

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


Right now the main thing is to get the right pain medication. Can you call your own GP tonight to enlist his/her help?

Ice will help right now, and also elevating your leg, unless it causes you too much pain.

If it was me, I would not go to a PT appointment while you are in anything close to this condition. I did go to an outpatient PT appointment 36 hours after surgery and it was not pretty at all! Like you said, I could barely get my leg in the car. I know better now! Some of our members what at least a couple of weeks after surgery before starting any PT, so they can begin to recover from the ordeal that this surgery is.

Just remember, many decisions in this recovery are your choice. Do what you feel is best for you.
Saying no to therapy - am I allowed to?

 

[Layla]

Not only am I unsure as to if my relatively straight elephant leg will even fit in the car, but I can't imagine someone pushing on it without the stitches popping at this time. It already looks like its about to explode just lying there

This may, or may not help you accessing the car, try placing a trash bag on the car seat to hopefully help you swivel into a front facing position with greater ease. Good luck!

 

[Cjackso21]

In order to help my pain, my last doctor sent an ice machine home that compresses the ice water to your knee. Using this while elevating using a 0 gravity chair reduced the pain immensely. If you can’t get an ice machine, conformal type ice packs work. Sorry you’re having such a hard time!

 

[Flashlight]

Hi, I'm sorry this is happening to you. If your OS is retiring, he should have signed you off to another surgeon in his practice. Call and ask for that information and ask to speak to his PA. or email the office. If you don't get any relief, try your PCP. As others have said, the swelling is causing you to have more pain. I'm sure what you had done in the past probably has added to your discomfort. We don't know what position they put us in during the operation. The ice really helps 24/7 and a wedge to elevate your leg. Don't think about therapy until you get the swelling down. Just going to the bathroom is helping. Give yourself some time.

 

[sistersinhim]

I agree that you forgo PT until your pain and swelling is under control. Just getting ready to go to PT will cause extra pain and swelling and you don't need to add to that! Just remember to do your ankle pumps and very small bends as you can. Allow yourself to slowly and carefully walk every few hours. That is natural PT. When you go to the bathroom, brush your teeth, wash off, etc, that is also natural PT. That's all your knee needs for the first month or so. Right now, the important thing is to heal. Doing too much too soon slows down that healing.

Oh, and try not to worry about that ROM. That will come naturally as your pain and swelling go down. You don't have to do a thing to assist the bend or straightening. It will come all on its own in time.

 

[Roveranger]

In order to help my pain, my last doctor sent an ice machine home that compresses the ice water to your knee. Using this while elevating using a 0 gravity chair reduced the pain immensely. If you can’t get an ice machine, conformal type ice packs work. Sorry you’re having such a hard time!

Thank you, that is all great advice. I ordered an ice machine from Amazon today (my doctor/insurance does not provide one). Your advice reminded me that I was issued one of those back in the 90s during my recovery for an ACL repair and it was extremely helpful, so thank you for that! ❄

 

[Roveranger]

I agree that you forgo PT until your pain and swelling is under control. Just getting ready to go to PT will cause extra pain and swelling and you don't need to add to that! Just remember to do your ankle pumps and very small bends as you can. Allow yourself to slowly and carefully walk every few hours. That is natural PT. When you go to the bathroom, brush your teeth, wash off, etc, that is also natural PT. That's all your knee needs for the first month or so. Right now, the important thing is to heal. Doing too much too soon slows down that healing.

Oh, and try not to worry about that ROM. That will come naturally as your pain and swelling go down. You don't have to do a thing to assist the bend or straightening. It will come all on its own in time.

That is SUCH helpful information. And it makes sense too. I remember after my previous TKR and going through PT after that, I was kind of wondering as to WHY. So your advice makes a lot of logical sense in comparison to my previous experience. Thank you SO much!

 

[sistersinhim]

I was addicted to my ice machine for at least 6 weeks or so. My pain level would go up as the ice thawed out and the water temperature warmed up some. It's amazing how much pain relief is in plain ole ice!

 

[Roveranger]

Hi, I'm sorry this is happening to you. If your OS is retiring, he should have signed you off to another surgeon in his practice. Call and ask for that information and ask to speak to his PA. or email the office. If you don't get any relief, try your PCP. As others have said, the swelling is causing you to have more pain. I'm sure what you had done in the past probably has added to your discomfort. We don't know what position they put us in during the operation. The ice really helps 24/7 and a wedge to elevate your leg. Don't think about therapy until you get the swelling down. Just going to the bathroom is helping. Give yourself some time.

Thank you SO much. All of these responses have been very reassuring to me. And yes, I will contact my surgeon's office tomorrow to get the name of who will be absorbing his case load. That is an excellent idea.

I agree that you forgo PT until your pain and swelling is under control. Just getting ready to go to PT will cause extra pain and swelling and you don't need to add to that! Just remember to do your ankle pumps and very small bends as you can. Allow yourself to slowly and carefully walk every few hours. That is natural PT. When you go to the bathroom, brush your teeth, wash off, etc, that is also natural PT. That's all your knee needs for the first month or so. Right now, the important thing is to heal. Doing too much too soon slows down that healing.

Oh, and try not to worry about that ROM. That will come naturally as your pain and swelling go down. You don't have to do a thing to assist the bend or straightening. It will come all on its own inhat just makes way more sense. I love that phrase "natural PT" and will bow be keeping that on the forefront of my mind.

I agree that you forgo PT until your pain and swelling is under control. Just getting ready to go to PT will cause extra pain and swelling and you don't need to add to that! Just remember to do your ankle pumps and very small bends as you can. Allow yourself to slowly and carefully walk every few hours. That is natural PT. When you go to the bathroom, brush your teeth, wash off, etc, that is also natural PT. That's all your knee needs for the first month or so. Right now, the important thing is to heal. Doing too much too soon slows down that healing.

Oh, and try not to worry about that ROM. That will come naturally as your pain and swelling go down. You don't have to do a thing to assist the bend or straightening. It will come all on its own in time.

That just makes way more sense, and I love that phrase "Natural PT". I will keep that on the forefront of my mind throughout the remainder of my recovery. Yes, I am not intending to compete in the Olympics in 6 months or anything like that, so whats the rush?
The PT places tend to be pretty pushy about it though. I remember that during my last TKR recovery there was a lot of "selling" going on to try to convince me the need for extra/additional appointments. I had already been attending for 10-12 weeks and wasn't making any additional progress, but it was almost as if they had a "credit" on their books from my insurance company and so they desperately wanted me to use that up. Thanks again!

 

[sistersinhim]

had already been attending for 10-12 weeks and wasn't making any additional progress, but it was almost as if they had a "credit" on their books from my insurance company and so they desperately wanted me to use that up.

Oh yeah, I believe that money has a whole lot to do with it. Most of us can do at home what we do at the clinic. But, they like for us to keep coming as long as they can get paid for it. The copays can really add up.

 

[thneed]

I am so sorry you went through that level of pain in the recovery room. It will get better every day, just like it did with the other leg. As for your swelling, I had the same experience. My second TKR, which was about 3 months after the first, the leg was not only super swollen but bruised all up and down and all the way around the leg. It was a sight to behold for sure! Nothing was different about the surgery or recovery, but it was definitely a LOT more beat-up looking than the first leg. However, the recovery has been similar.

Also, I felt the same way about going to PT after the second surgery. I love my PT folks, they are very encouraging and helpful. But after seeing all the swelling and bruising on that second leg, I felt there was no way I could bend it or do anything without the stitches popping open. I did end up going to PT 2 days after the surgery as planned, and it all went well. The PT I saw that day suggested elevating as much as possible to relieve the swelling, and I did, using a wedge while lying in bed, and every single day the swelling got less and less.

 

[djklaugh]

@Roveranger One of the things I did with each of my joint replacements was to go in for PT visits every 2 weeks to stretch out my benefits. I did the exercises they gave me diligently between visits and go tne exercises at each visit. Yes it may have taken a bit longer to get things back to new "normal" but I did prefer to slower pace and my insurance benefits did last long enough to get everything back to working order. Just a suggestion.

 

[Roveranger]

@Roveranger One of the things I did with each of my joint replacements was to go in for PT visits every 2 weeks to stretch out my benefits. I did the exercises they gave me diligently between visits and go tne exercises at each visit. Yes it may have taken a bit longer to get things back to new "normal" but I did prefer to slower pace and my insurance benefits did last long enough to get everything back to working order. Just a suggestion.

That's a great idea! Maybe that's what I should do now: stretch-out the appointments so they last longer. That makes a lot of sense! I appreciate you letting me know this!

 

[Layla]

Happy One Month Anniversary!
I hope you're doing well since you last posted, progress has been steady and the New Year is off to a good start for you.
Let us know how you're doing as time allows. We'd love to hear. Until next time, all the best!
@Roveranger

 

[Roveranger]

Happy One Month Anniversary!
I hope you're doing well since you last posted, progress has been steady and the New Year is off to a good start for you.
Let us know how you're doing as time allows. We'd love to hear. Until next time, all the best!
@Roveranger

Thanks so much Layla and everyone!

At the 3 week mark I finally started making progress. Lots of unbearably painful, sleepless nights up until then (and even a few now).

My surgeon's office warned me not to compare my first TKR to my second TKR, and although I understood that intellectually; I guess it's human nature to do so. Even now, if I don't have my leg elevated for at least 20 hours a day it swells up into a telephone pole; and I hadn't experienced anything of this nature during my first TKR. It's been very frustrating, to say the least. But I am finally able to see the light at the end of the tunnel as I make slowly progress. I will get there and I feel blessed to have avoided infection and many of the other complications that some experience. My heart goes out to you all.

I am eternally grateful for all of the information, tips, and encouragement that this forum offers. You all are amazing and greatly appreciated. Thank you!

 

[LD of Michigan]

My surgeon's office warned me not to compare my first TKR to my second TKR, and although I understood that intellectually; I guess it's human nature to do so. Even now, if I don't have my leg elevated for at least 20 hours a day it swells up into a telephone pole; and I hadn't experienced anything of this nature during my first TKR...

Yes, I too do the comparison, despite knowing I should NOT. This TKR my left knee was black and blue in splotches down to the ankle. Had nothing like that for RTKR. Just had to stop looking and slowly the bruising is fading. Hang in there. We're here for you.

 

[beachy]

@Roveranger
I've been reading your recovery thread and its a darn shame that you didn't get some help.
My second tkr is more swollen than the first, as well. I have a recovery thread from first tkr here on bonesmart. I am able to go back and read how my knee was doing at this same time 4+yrs ago. Lots of ice and elevation these days!
I've had some painful nights in spite of the pain meds but hope that's behind me now.
Best of luck with your recovery!

 

[Layla]

Another month has passed. Happy Two Month Anniversary!
I hope your sleep has improved and the swelling has eased for you. It is great you're feeling optimistic, even though you expressed this recovery has been more of a challenge than your first. Hopefully you're gaining strength and noticing steady progress. Hang in there, you'll get there.
A wonderful week to you!
@Roveranger