TKR Right total knee replacement 4/29/2022

substrate

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I'm 53 years old, 280 pounds, and had my right knee replaced on 4/29/2022. I underwent the surgery with a spinal anesthetic, a nerve block, and sedation as opposed to general anesthetic. In the recovery room my pain level was 2/10. I was brought to my room for my overnight stay and gotten up for a walk with a walker. This was pretty easy for me. My gait was reasonable, and my pace was good as well. I could bear full body weight on my surgical leg without difficulty. I've been religious about the exercises, icing, and elevation. My current pain level is 0, except maybe a 3-4 at the incision site.

I can actually walk normally without a walker or crutches, but try to use the crutches.

This is great, but... I'm not getting feedback to say if I'm overdoing things. I'm worried that I'll damage myself because of this lack of feedback. I do have sensation, but my pain tolerance has always been high.
 
My medication list (which I also follow religiously) is asprin, meloxicam, acetominiphen, gabapentin. I have filled prescriptions for oxycodone and tramadol for pain control if it prevents exercise and I haven't had need to use them.

My knee flexion is very diminished right now, but based on the amount of swelling I am not surprised. Extension seems to be almost full.
 
Hi and Welcome!

What do you mean by feedback? Do you mean pain when you do something, or feedback from your medical team about what kind of activity you should do?

That’s really great that you have little pain. Just be careful. Even with little pain, your body is healing from a major surgery that causes a lot of trauma to the whole leg, just a few days ago.

Exercises are good to give your knee necessary mobility, but you don’t have to be religious about it. Once a day is plenty. You are not in training right now, you are healing. Just keep this in mind as you go through the exercises. Don’t do any that do cause pain. Also, be careful taking a strong medication so you can do an exercise. Pain is your body’s signal that your knee is not healed enough for that exercise. A pain medication can mask that pain, and you could have a higher than necessary pain level later that day, night, or the next day.

I will leave you our Recovery Guidelines. Each article is short but very informative. Following these guidelines will help you have a less painful recovery.

Just keep in mind all people are different, as are the approaches to this recovery and rehab. The key is, “Find what works for you.“ Your doctors, PTs and BoneSmart are available to help, but you are the final judge as to the recovery approach you choose.

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
ice
take your pain meds by prescription schedule (not when pain starts!)​

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

5. At week 4 and after you should follow this

6. Access to these pages on the website

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 the 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 the member’s history before providing advice, so please post any updates or questions you have right here in this thread.
 
Thank you! I don't get the physical feedback. If I leave the crutches behind, other than noticing the stiffness I don't feel any pain. The only pain I really feel is at the incision site, and I've even relieved that when I re-dressed it by applying the dressing to my bent knee.

I've known since I was 26 from the surgeon who did my ACL reconstruction that a TKR was in my future. At the time I already had no cartilage and osteoarthritis... but I still played football, weight lifted, boxed and up until it became obvious that the time for replacement was "now" did HIIT, occasionally boxed, hiked with thousands of feet elevation gain etc.

I did call up my surgeon and he didn't seem too concerned. I am working the list of exercises I was given (mostly stretching)

I could probably walk a couple kilometers with no pain, but I don't test that in case it's actually a bad thing to do.
 
Just take things slowly and you’ll be fine. Add new activities gradually. Take a lot of rest times, too. Don’t look at resting as doing nothing, look at it as giving your knee the best opportunity in which to heal.
 
I accidentally posted this in the wrong thread...
I just got back from my first physiotherapy appointment, it's been 5 days since my surgery, and my recovery progress is about the 3 week mark. I'm cleared to walk without a crutch unless it's a long distance. Next week they will start me on the bicycle. I talked to my physiotherapists about my pain threshold being very different than most peoples, and she assured me that if I worked into the 2-3 zone for whatever muscle I would be fine.
Therapy was all the prescribed exercises, and she took measurements of how straight and how bent I would be. She massaged parts of my leg, and we finished with ice and electrical stimulation.
 
My physio therapy visit at day 6 went well. I'm at 103 degrees of flexion in my knee. I wasn't sure how it would go, the night prior I had done my first dumb thing. I was raising my leg onto a foot stool, which was awkwardly placed because of the dog. I twisted my surgical leg to maneuver it around the dog and stool and got a sharp pain and noise. I was a little tender after that, but the next morning things seemed fine.

I'm happy with my recovery, but understand there may be bumps... I'm at the 90th percentile for recovery at this point. I walked outdoors with a single crutch (didn't really use it, I time my rhythm so my surgical leg takes a full load) about 1.2 miles. I could have gone farther.
 
I walked outdoors with a single crutch (didn't really use it, I time my rhythm so my surgical leg takes a full load) about 1.2 miles. I could have gone farther.
Take note of how your knee feels in the next day or so, that's a long walk, for most of us, at 6 days out. I wouldn’t do it again without a day or 2 between. Pain can suddenly happen well after the fact, if we overdo, and it takes a lot longer to reduce it, than it did to get it.
 
You're doing great, and it's definitely unusual. I had mine done March 15th and have had a similar recovery. No pain pills needed, I had 90 degrees on day 3, walked early, etc. Two things have been interesting. I'm still doing well, but the pace of the recovery has slowed. Based on my first 2 weeks, I thought I'd be fully recovered in a couple of months. That hasn't happened, and it was probably pretty unrealistic. I got to a good point early, but have been a little bit stalled there since. Nothing I'm worried about, and it may not happen to you, but if it does, don't sweat it. Second thing is I've had a couple of days when I overdid it, felt ok at the end of the day, but the next day or two felt absolutely terrible. One was at the 3 week point. Just pushed too hard in PT, and the next day my pain was at an 8 or so, when it had been pretty much 0 every day since the operation. That lasted 2 days, but thankfully went away after that. Same thing happened earlier this week. Way overdid it 2 days in a row, and on the 3rd day I paid the price. It's going away like before, and I'm sure I'll be fine tomorrow, but just keep this in mind. When you're feeling great you're going to want to push it. Once you push it too far you'll know your limits. Good luck.
 
I'm happy with my recovery, but understand there may be bumps
Hi @substrate , looks like you're doing great! Hopefully it'll stay that way ... but it's also a good thing you're aware that there may be bumps! As many here on the forum have noted, recovery is like a roller coaster - ups and downs galore! Pretty amazing that you were so quickly able to go 1.2 miles!!

All the best!
 
I've had my first post-surgical visit with my doctor. We are both really happy with my progress at day 13 post op.

My flexion is at 116 degrees, my pain level is usually near zero. All bruising is gone, and my swelling is down considerably from it's post-surgical level.

The bike has been added to my repertoire at physiotherapy and that went well. The only setback I had was on the 'total gym' squats. I'm used to doing 315 to 340 pounds for 20 reps of back squats, so at the recline and only using body weight I did overextend my surgical knee a bit. I iced it a couple extra times yesterday and by morning it was fine. My proprioception didn't tell me that I was over straightening.
 
@substrate , you are making amazing progress.

I am also a fan of back squats, and a former powerlifter from years ago. I suggest you lay off any leg presses or any leg strengthening for a while, so all the soft tissues can heal. Your knee went through massive amounts of carpentry, and needs to heal before you push the strengthening exercises. You don’t want to end up with complications such as scar tissue, as I have.
 
@WFD, thank you! Yeah, I’m not going to add any weight, I’m keeping my team closely in the loop because I have been so pain free. I am concerned about doing damage by accidentally doing something that ought to have hurt a lot! The Total Gym overextension was at physio, my therapist didn’t let me know when I should stop, and all the carpentry has made a mess of my proprioception, I thought I was at soft knee extension until I hit that point.
 
You aren't taking pain meds before physio are you? You need to feel the pain an exercise causes. This tells you that your knee isn't ready for it and that you should stop. Not feeling that pain can cause you to have a setback, something no one wants.
 
As great as you're doing, you've learned how easy it is to overdo. Give the knee some tlc and then go a little easier next time.
 
You aren't taking pain meds before physio are you? You need to feel the pain an exercise causes. This tells you that your knee isn't ready for it and that you should stop. Not feeling that pain can cause you to have a setback, something no one wants.

I'm not taking any pain medication prior to physio, my pain tolerance is just very different than most people. I take my scheduled acetaminophen, and scheduled low dose aspirin, but never had to take anything stronger. My general pain level right now is less than 1 (an annoying ache in my quadricep is the way I would best describe it).

The over-extension resolved itself. My extension is at 0 degrees, and my flexion is around 116. All bruising is gone. We're trying to relieve some swelling in my quadricep. New exercises added are weighted long arc leg extensions, weighted leg raises, bicycle.
 
You are very fortunate that you have had such little pain. Do take it slow, however, you might overdo it and not know it until later. I hope your recovery continues to be so smooth! :flwrysmile:
 
@substrate You’re like me regarding pain, or lack of it. I’m jealous that your bruising is gone. I’m a week ahead of you and my tibia and 3/4 of my calf is still bruised. I can’t see much of it due to my lower leg being tattooed but I sure can feel it!

Marie
 
Today is my 3 week anniversary of my TKR. I’m still making good progress, physiotherapy had added body weight squats, mini-lunges on the stairs, and the balance board. My body reduced the swelling dramatically on my surgical leg. I had one problem area… it turned out my compression sleeve kept rolling at it’s edge and slowing blood flow at that band… accidental somewhat gentle tourniquet. I’d massage that weird swelling away and it would come back. I finally put two and two together when I woke up with a sore leg around the restriction.
 

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