TKR Recovery<

[trucka]

Hi I am recovering from my second operation done on the 21st of December. The first was done in July and is coming on fine.

From day one my second knee has been trouble. The surgeon said that you almost never have two the same. The pain from the knee itself wasn't too bad it was more like a nerve pain from my lower back right down to my foot. They gave me Gabapentin on top of the oxycodone that I was on but it never helped.

After 12 weeks it has eased quite a lot but is still there but bearable. The first few weeks I progressed slow with walking (much slower than the first one). I was walking half a mile without sticks by week five and was fine by my check up on week six walking without pain.

On week 7 the pain started to come back and I struggled to walk far. One day when I was out walking I fell on my operated knee quite hard. Not sure if it had done any damage, I phoned the hospital and they said to rest it for a few days and get back to them if it got any worse.

By week 9 I was unable to walk without a lot of pain and stiffness and phoned the hospital again and they said I should probably go up and see the surgeon and sent me an appointment for 20th of April but now on week 12 it's starting to improve again slowly.

I don't think the fall damaged anything just bruised the soft tissue. It's so frustrating when you have such a good result with the first op. I suppose this one will just take more time and patience to heal.

 

[Josephine]

The surgeon said that you almost never have two the same.

Not only would I concur with that, I would go further - they are NEVER the same! Having two knees done? Don't compare surgeries!!

They gave me Gabapentin on top of the oxycodone that I was on but it never helped.

Did you ever go back to your GP and tell him the gabapentin wasn't cutting it for you? It's quite usual for this to be started on a low dose which then has to be increased at least once if not more before it's effective.

But here's some helpful reading for you ....

Knee Recovery: The 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​

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.

 

[Josephine]

Also I'd really like to offer you some structured advice but in order to do that, I also need to ask you some questions. Are you willing for me to do that?

 

[trucka]

No I never said to the GP about the gabapentin. Just stopped taking it and stayed on the oxycodone. Yes its fine to ask me questions thank you.

 

[Josephine]

No I never said to the GP about the gabapentin. Just stopped taking it

Well I think if you had, he would have increased the dose and you would have found much more relief with a larger dose. When I took it, I was started on 100mg twice a day, then it was 200mg twice a day and finally 300mg twice a day at which point the pain was under control.

Yes its fine to ask me questions thank you.

Here y'go then!

It would be very helpful if you would answer each one individually - numbered as I have done - in as much detail as you can then I'll come back as see where you are ....

1. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine. And don't forget to factor in other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness).

2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?

3. how swollen is your leg compared to these?

4. what is your ROM - that's flexion (bend) and extension (straightness)

5. are you icing your knee at all? If so, how often and for how long?

6. are you elevating your leg. If so how often and for how long?

7. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and

8. are you doing any exercises at home? If so what and how often?
This is the most crucial question so please help me by using the format I have left as an example
(which means please make a list and not an essay!)

Exercises done at home
- how many sessions you do each day
- enter exercise by name then number of repetitions of each
etc., etc.

Anything done at PT
- how many times a week
- enter exercise by name then number of repetitions of each
etc., etc.

 

[trucka]

Yes you are right about the pain med, i should have contacted the GP,lesson learned.

1 pain level is usually around 1to2 in the house, goes to 6 after a 15 min walk. more of a thobbing ache like toothache.

2. I was on Oxycodone 50mg 2 every 4 hours but i was starting to feel terrible and could hardly get out of bed in the morning. I felt like I had a hangover until I took a dose. At week 10 I came off them and now on Tramadol 50mg the GP said to take as required. Some days I don't feel the need for them.

3. Moderate

4. Flexion is 110 Extension 0

5. Iced a lot in the past, just when it feels swollen and sore now for an hour.

6. As above but when I do elevate it brings on the nerve pain which is not there when i'm sitting normal.

7. Help my wife around the house, go shopping, been driving since week 6.

8. Exercise at home
Exercise Bike 5 to 10 mins twice a day
just everyday things around the house.

Saw the local PT at week 4 and week 6 after my checkup. Just one visit each time.
She said I was doing good and didn't need to see me again.
My Flexion was 95 then. She said to do the exercises the hospital had given me.
Heel slides x 10 x 3 times
Towel under knee and straighten leg x 10 x 3 times
Straight leg raise x 10 x 3
Towel under knee straight leg push downs x 10 x 3
Half squats holding on to something x 10 x 3
2 to 3 times a day

 

[Josephine]

1 pain level is usually around 1-2 in the house, goes to 6 after a 15 min walk. More of a throbbing ache like toothache.

But still pain!

2. I was on oxycodone 50mg 2 every 4 hours but I was starting to feel terrible and could hardly get out of bed in the morning. I felt like I had a hangover until I took a dose. At week 10 I came off them and now on Tramadol 50mg the GP said to take as required. Some days I don't feel the need for them.

Good! That's exactly how it's supposed to be. However, it sounds like you could be using a couple of paracetamol 2-3 times a day as needed instead of the Tramadol. Why don't you give it a try?

3. Moderate

Okay

4. Flexion is 110 Extension 0

Excellent!

5. Iced a lot in the past, just when it feels swollen and sore now for an hour.

and now?

6. As above but when I do elevate it brings on the nerve pain which is not there when I'm sitting normally.

okay

7. Help my wife around the house, go shopping, been driving since week 6.

Jolly good.

Exercise at home
Exercise bike 5 to 10 mins twice a day

Physio said to do the exercises the hospital had given me 2 to 3 times a day
Heel slides x 10 x 3 times
Towel under knee and straighten leg x 10 x 3 times
Straight leg raise x 10 x 3
Towel under knee straight leg push downs x 10 x 3
Half squats holding on to something x 10 x 3

You don't need to do any of these any more because you have excellent ROM already! And at 14 weeks, you no longer need exercises! Plus they are most likely causing the "a throbbing ache like toothache" you mentioned!

I think you'll find things much, much better if you ditch the remaining exercises.

 

[trucka]

Thank you for your advice Josephine, I will try the Paracetamol and see how it goes and cut out the home exercises. I still use ice gel pack maybe every other night for an hour.

I came across this site after my last op by mistake, nearly every time I put a question into Google about a problem Bonesmart came up. Reading some of the stories and advice helped a lot to see that someone else was going through the same as I was.

As my first recovery went so well I was frustrated when at week 8 I went back to the level that I was at week 4 that's why I decided to post. Since then I have seen other people have had similar problems so don't feel so bad.

Anyway things seem to be going the right way again and will continue that way. (fingers crossed). Came down the stairs normally for the first time this morning so something to something to tick off my to do list.

Thanks.

 

[robhunt3]

It sounds like a temporary blip from the fall @trucka, but otherwise you're doing really well. Take it easy, I expect it's frustrating to have had one knee go like a dream and have a few problems with the other.

I take paracetamol and find it to be the best pain med for the various aches that I have. Ibuprofen has no effect at all. Luckily I got off the stronger stuff (Oxycodone followed by Co-Codamol) fairly early on - they just zombied me out!

All the best.

 

[SusieShoes]

Your knees are individuals, so expect these differences. I had both knees done at once and they healed completely differently. One was an angel and healed quickly with no problems at all; the other was balky and cranky and pretty much healed two months behind its angelic sister. Both got to the same happy place in the end, just one a little later than the other.

Temporary setbacks happen quite a lot and most everyone gets to experience disappointment. Overall, it sounds like your recovery from #2 is going well!

 

[trucka]

Thank you rubhunt3 and SusieShoes for your input. Yes the Oxycodone was getting me down too.
The OS said to me that knee operations are like children and never get two the same lol.

As long as they end up the same it will be fine by me.

 

[trucka]

Now at 16 weeks post op, still can't walk far without soreness and swelling. When I put weight on my leg it is sore don't know if it's bone or tissue causing the pain. I have rested more over the last two weeks to see if that will improve things but can't see much improvement.
When i'm on the exercise bike if I put my palm in the outside of my knee I can feel a double click but it's not sore.
To me it feels like a tendon or something but doesn't seem to cause the swelling. Was just standing talking to my neighbour earlier for a short while and my knee started to throb and swell and had to come in and elevate it for relief.

Regards Peter

 

[Jockette]

Standing still causes pain for a while. 16 weeks is still early when you think of a year (52) weeks on average to recover.

Better times are coming!

 

[SusieShoes]

At four months post-surgery it's not unusual to still have some swelling and soreness. May I ask a question? What do you mean by "can't walk far?" Around the house. A shopping trip to the grocery. Five miles? People mean different things, so knowing that would be helpful. Resting is still the best thing for swelling and pain, and icing is even more helpful.

Standing in one place can cause pain and swelling fairly deep into recovery. I'm nearly 11 months out and was able to stand for a few hours, with very brief one or two minute sitting breaks, to cook an Easter dinner. That night... you got it. My knees were a little sore, and they were a little sore the next day too. Nothing bad, but they still let me know they weren't finished healing and I'd abused them. They got over it a day or so later. Your knees are younger than mine and it's not surprising if a long period of standing makes them unhappy.

Those knee clicks can be kind of fun, if you think about them. When seated I can move my knees in a way that makes them click audibly (usually they don't click) and have done so to freak out Mr. Shoes. He finds that alarming.

 

[trucka]

SusieShoes. The pain or more of an ache now comes on at about 200 yards and I try to walk through it. Yesterday I did the route that I used to do at six weeks quite easily ( around half mile) and was glad to get home and put my foot up. The clicking don't really bother me, it's a lot better than the clicking and grinding before the ops.
I used to do classes at the Gym and was glad the music was loud so no one could hear them .

 

[Josephine]

When I put weight on my leg it is sore don't know if it's bone or tissue causing the pain.

Since bone is a tissue there's no difference

I can feel a double click but it's not sore.

Clicking and knocking are of no consequence. Don't worry about it.

The pain or more of an ache now comes on at about 200 yards and I try to walk through it.

Bad girl! Worst thing you can do is to walk through it! Much better to cut your walk to 100 yards each way. Always rest pain.

 

[trucka]

Things are going in the right way again.
Went out on the bike yesterday and did 3 miles (taking it easy) right knee now nearly 9 months old was really happy.
I feel sorry for him because he wants to do more but his 4 month old brother is holding him back.
I was expecting it to complain about the bike ride but it was fine.
Still doesn't like walking too far but doesn't mind rotation, so will take advantage of that for now.

 

[sistersinhim]

#2 is doing great to do a 3 mile ride at only 4 months! You are having a really good recovery! It's nice to hear.

 

[SusieShoes]

That's really excellent! Nice you can take advantage of the change to good weather, too. It's fascinating how each knee has its own recovery. It's good that #2 is doing so well!

 

[trucka]

Thank you @sistersinhim and @SusieShoes.
did the same on the bike today, weather not as good but knees didn't complain.
Hope to get back to work on Monday if things continue this way. Light duties for a
while though.