TKR Second knee replacement June 11, 2021

[Jewlz1]

Day 10, post-surgery. These are the dog days of recovery. I've improved enough to feel good about my progress but now the long slog is beginning to wear on me. I'm in a cycle of feeling pretty good, doing some exercises and a little walking and then feeling sore for the rest of the day and having to back off. My PT recommended short walks in the house 3x a day to help get the blood flowing and reduce the swelling. I'm a pretty patient person but all this sitting around is maddening.

I know most of you have been here and mostly I am writing this down in order to be able recollect the process. So that I remember what was "normal" and can pass it along to my friends who are going to go through TKR.

Hi Freestyle-I found myself very bored this afternoon, about 1-2 hours before dinner until around 7pm and watch some TV. I need to get up and walk around the house a bit. I got lost in a new for me Netflix series and didn't move for about 2 hours. I was pretty stiff. Tonight I'm hoping for a good rest. Hoping the same for you.

 

[kneeper]

Day 10, post-surgery. These are the dog days of recovery. I've improved enough to feel good about my progress but now the long slog is beginning to wear on me.

IT took me longer than 10 days to get there but it is so true. Easier said than done, but as you're learning, taking the long view helps you get through this recovery. Every few weeks you'll see how much progress you've made since you last "checked in" with yourself. ;)

 

[Freestyle]

Freestyle, I believe I have blisters on my rump from sitting so much since Jan 31st! Hang in there. Your beautiful new knee will take you far in the future.

LOL. I haven't reached the blisters stage yet, but I know what you mean....I get my staples out tomorrow at my GP's office--and I'm looking forward to it because it means getting out of the house and off my bum!

 

[Freestyle]

Day 16 - Ay caramba! Is there a IRODC? (I REALLY overdid it club).

I had a really good week and was progressing well. On Wednesday, I did my stretching, went for a doctor's appointment with a cane, then got my second vaccination shot. The remainder of the day I rested. I was really pleased that it all went so well and that I wasn't experiencing any effects. Thursday, I did my stretching and strenghtening exercises and did 3x 5 minute walks around the house. Friday I did my stretching and noticed that when I bent my knee, somewhere around the 30-70 degree mark I would consistently hear a pop and feel a stab of pain. Did anyone else ever experience this?

I explained this to my PT and he immediately said I should contact my OS. We went through our usual session and I told him when I was experiencing the pop and pain and the PT shut down the session. MY PT guessed it might be a strained hamstring but urged me to call my OS. Since it was Friday, I decided to wait until Monday to call my OS and to rest in the meantime. (In the event of an emergency, I would have to go to an ER anyways.) However, I didn't want to cancel my appt with my GP to have my staples taken out and went ahead with that. By Friday evening, I was flat on my back, couldn't put any weight on my operated leg and was in pain (and sobbing).

I decided to spend the entire day on Saturday in bed to see if my knee would improve--no exercises of any kind, not even stretching. Took all my meals in bed and elevated and iced as much as possible (though, as with my first TKR, elevation has been weirdly uncomfortable from the start.). Only got up to go to the bathroom-which happens pretty frequently, LOL.

So today is Sunday and my leg seems to be improving, though nowhere near where it was in Week 2. It seems clear that I really overdid it and I didn't heed the sharp pains when I first felt them. After my first TKR, I really babied my knee and went very slowly--I consistently did much less at home than the PT recommended. I stretched twice a day at most. This time around, I felt so good that I thought I could speed up the process a little. I had a 0 extension from the start so I thought I was doing much better this time around. Silly, silly me.

So my question to the forum is does anyone know what I am talking about with the "bend and snap" sensation on the outside of right knee? I had a minor version with my first TKR but it never blew up into a lot of pain.

I still plan to call my OS tomorrow but I think waiting the weekend made sense because I have more information to provide him.

I would like to resume gentle stretching without pushing the ROM exercises to the point of the "bend and snap".

I wish I had a better, more dramatic story to tell of how I joined the IRODC--something along the lines of "I hiked in the woods for an hour" or "I rode my mountain bike outside today". But, alas, my story shows how little it takes to join that club.....

 

[Freestyle]

Day 18, Week 3. Well, I didn't see that one coming. I called my OS yesterday (Monday) and spoke to the administrative assistant. Language is everything. I said that my PT advised me to speak to my OS and that the thinking was that it might be a hamstring strain. I emphasized that my knee was feeling better since Friday. Since my surgeon is off for the week--and there was no panic or urgency in my voice--the AA advised me to take it easy. She made a judgment call, based on my description, that it wasn't an urgent issue that required speaking to the OS.

Today, I wanted to talk to my PT about what I should be trying to do and he was very unhappy that I hadn't called the OS immediately on Friday and waited until Monday. He said "what you are experiencing isn't normal" and told me he won't work with me until I have spoken to my OS. I called the office of the OS, the AA sent the OS an email and we have an appointment for July 7 (in 9 days). The OS ventured to guess that it might be adhesions and that I should continue PT.

After I got off the phone, I realized that--again--my description of what was going on was totally inadequate. I have a sharp pain at 70º but my ROM is actually 100º (and my extension is 0). My knee isn't getting stuck--it really feels like a ligament/tendon issue. If I apply a little pressure to the back of my leg, I seem to be able to mitigate the pain at the 70º point. It is a sensation I have felt before, with my other knee, just not so acutely.

I have to say I'm pretty upset but would be scared witless if it wasn't for BoneSmart. The words "this isn't normal" are chilling. I am shocked at how easily my PT cut off the conversation because I didn't call the OS immediately after our session on Friday. (I had wanted to talk to the PT about the last three days and what had improved and what hadn't.) He may not have intended to sound as harsh as he did. But he did cancel the session. And I certainly felt like I was being punished for not following orders and not going into a panic on Friday.

In the meantime, I've put in a call to my local PT who I have worked with for a couple of years (I elected to do PT online through the hospital because of the convenience). I think it would be useful to have someone examine my knee in person before I visit my OS. My local PT is very gentle, I can show him what's going on, and I trust him to help me figure out how to describe my sensations more accurately. He has done lots of TKR rehab so will have a good sense of what is "normal".

 

[sistersinhim]

Friday I did my stretching and noticed that when I bent my knee, somewhere around the 30-70 degree mark I would consistently hear a pop and feel a stab of pain. Did anyone else ever experience this?

I had something very similar in my early recovery. As I healed it got better, but not overnight. I suggest that you bend gently and not force through the pain. Be patient. It will get much better. Right now everything in your knee is still traumatized and stretched out some from the surgery. It will tighten up as you use it in your daily living.

 

[Freestyle]

Thank you for this, sistersinhim. Now I don't feel so alone. I've spoken with my original PT and we agreed that I would do very gentle stretching and nothing that causes pain. That is exactly what I was thinking.

 

[ihavetwins]

Howdy @Freestyle Both of us have had our knees replaced at roughly the same time! I haven’t experienced the pain you are describing but I’ve had other pains that I didn’t have the first time around. I’ve had (and still have to a certain extent) a lot of tightness in my hamstring area, which I didn’t have after my first TKR. It really seems to be slowing down my progress but, as with most issues on this site, it’s just a waiting game and being patient, which is not my usual style.

It is distressing to hear how quickly your PT cut you off at such a vulnerable moment. I hope you get an answer soon.

Take care.

 

[eaglemom]

As you are well aware, it doesn't take much to upset your baby knee. Cut back on everything and take it easy. Yes, to you it seems like a setback, to the knee its time to recover and heal.

 

[Jamie]

I'm sorry you fell into that trap of thinking you could "hurry recover up" because things were going so well. That happens so often. But it will get better. I'm glad you were able to see a therapist in person that could ease your concerns. You didn't hurt the implant. It's way too strong to be bothered by anything you did. But your tender soft tissues are another matter. They can get angry for all sorts of reasons.

The OS ventured to guess that it might be adhesions and that I should continue PT.

This doesn't make any sense to me, I'm afraid. IF you were to have adhesions (which is most likely not the case this early in your recovery) and you did something to break them loose, the consistent pain wouldn't still be there. Also, your comment about not feeling any restriction at the point of pain when you move doesn't sound like adhesions to me.

The words "this isn't normal" are chilling.

Please try not to let this comment get to you. I'm sure whoever told you this was making the comment from the perspective that the pain you're describing is not a part of a normal, uneventful recovery. Soft tissue injuries can take a while to get better, so you'll need to be patient and keep on your light schedule for activity and exercise until things start to improve. Be sure you are icing the area as much as possible and taking something such as an NSAID (if appropriate for you) or Tylenol if you have pain.

I am shocked at how easily my PT cut off the conversation because I didn't call the OS immediately after our session on Friday

Try not to get upset with your therapist. From your description of how he handled the incident on Friday, I'd say you have a very good therapist on your team. He was concerned and wanted to get you some help right away. This is a good thing. He probably could have had more tact when you spoke with him today, but I suspect his unhappiness comes from concern for your welfare. His comment about not working with you until you've seen your surgeon is totally appropriate. You wouldn't want him to try and work around the injury and risk doing additional damage. Please try to see the situation from the perspective of a caring professional and not look at it like you're being scolded.

I would do very gentle stretching and nothing that causes pain.

This sounds like perfect advice. You do need to do some movements for at least short periods every day. But by using caution and stopping or cutting back on the movement if there is any pain is the right approach. Be mindful of when you take any pain medication so that you're not letting it mask the pain to the point that you might push a bit too hard.

These things happen in recovery and normally it's nothing that won't resolve with a couple of weeks of lesser activity and gentle treatment to your joint. It's important to keep inflammation and swelling at a minimum, so the ice is very critical.

I hope you'll start feeling better soon. You'll be back on track in no time.

 

[eaglemom]

Something that I've just thought of, where you are icing the knee. Maybe try to rotate the ice to the back of the knee for awhile. Just a thought.

 

[BBCG]

Freestyle, the slog of being patient really IS a thing! I’m about at 9 weeks out and if I have what would normally be a normal day, I’m pooped by late afternoon! The energy drain, as it has been called, is a bigger deal than I think any of us anticipate… and this IS such a warm and caring community to be a part of!

I’ve had some similar issues behind my knee, feeling pain like a tendon isn’t moving correctly in its normal pattern of movement, feels like it’s catching somehow. I’m fortunate to be in an area with lots of good, highly skilled medical and orthopedic massage therapists and one such person helped me get “unwound” last week. It did sort of feel like an old fashioned phone cord got all twisted up and needed to be stretched and unwound! She was able to make a big difference in my leg, and I’m much improved now… and the pain behind my knee is so much less. I don’t know if you are where such folks may practice, but perhaps that’s also an option …

 

[Freestyle]

Thank you for all the good advice and concern. Jamie, you gave me some much-needed perspective--my follow-up conversation with the PT was much more amiable. Once I set up the appt. with my OS, the PT really got back on board. (p.s.I don't think it's adhesions either.) And BBCG--you described my sensations exactly (phone cord). I talked to my local PT and he gave me the best way to describe the feeling--it's a TWANG (like a guitar string being plucked). Eaglemom--yes I now ice the back of the knee too.

I am now at day 20 and the acute pain associated with the TWANG is gone. I'm back to doing gentle ROM exercises and I can feel a much milder TWANG but it doesn't hurt to push past it gently. (I'm not pushing it, just doing a little exploring.) The most useful thing I got out of this experience was permission to go much more slowly. I'm actually feeling quite hopeful again.

 

[BBCG]

Oh, hooray!! I’m so glad you found exactly the help you needed! Yippee!
For a ling time, I’ve thought the folks here are really angels since there is so much support given to us all!

I love your word: twang! Exactly! Am so glad to hear of your progress! Yay!

 

[Jockette]

The most useful thing I got out of this experience was permission to go much more slowly

I think most of us go into this recovery, especially if it’s our first joint replacement, totally trusting our medical team to advise us properly. I certainly did. Unfortunately, due to a lot of differing opinions, we don’t always get the best advice for us as individuals.

People are all 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.

I‘m glad to read that you now have more confidence in choosing the rehab approach that does work for you. Go with your own common sense instinct.

 

[Freestyle]

Yes, this is my obsession with language and describing the sensations exactly. "Twang" is a long way from my original description--"click and a stab of pain". Words carry a lot of weight.

 

[Freestyle]

I think most of us go into this recovery, especially if it’s our first joint replacement, totally trusting our medical team to advise us properly. I certainly did.

I have to confess something--my surgeon and the PT take a pretty aggressive approach. They had me doing strength training three days after my first TKR. With my first knee, I never was able to do the strength training every day as they wanted me to do--my knee would start aching after a session and I would shut things down. I had discovered Bonesmart right before my first TKR and my mantra was "I'm healing, not training". I babied my knee and spent a lot of time icing and elevating. So I did my stretching but only about half of the strength training they wanted me to do (if that much) and my knee healed wonderfully. Within four months of my surgery, I had recovered enough that I was no longer thinking about my knee. (Ironically, I began doing a lot of strengthening exercises AFTER six months.)

This time around, as Jamie put it so well, I "fell into the trap" of thinking I could speed up my recovery because it had gone so well the first time and seemed to be going even better with my second TKR. I had 0º extension immediately after the second surgery. In my mind, I was "ahead of schedule"--and I was absolutely bored with doing so much sitting around. So when I began experiencing pain, especially in my hamstring, I tried to push right through. It didn't take much for me to crash. It's a simple lesson, really. Except I had to learn it in reverse order.

I think the world of my surgeon and the medical team and, in retrospect, I'm glad my PT took my pain seriously. By mutual agreement, I'm not doing any strength training for now and that takes a lot of pressure off. I am still scheduled to go see my OS in a week but I am not waiting for him to fix anything--it feels like I am already on the mend again.

 

[BBCG]

Ah, true confessions, eh?! Well, an aggressive session of PT occurred to me, in my first weeks following this TKR, when I first was seeing the initial surgery-center-based PT when my usual PT was rafting the Colorado. The substitute PT was not very engaged with my care, was bored or looking at things on her computer while she directed my session... in general, they seem to have a standard TKR protocol they follow, very formulaic, not personalized at all. Had I seen her at first, I'd have canceled and just waited for my PT to return!

But, she set me up to do leg presses on a supine press and then just let me keep going! I was pretty happy I could do it, as both legs seemed to do a reasonable job at pushing the base away quite handily. But, she never stopped me, just let me keep going! I probably was doing it for 7-8 minutes when I asked if I should keep going. She then lightened the weight and had me only use my new knee leg! Then, she went back to her reading. I finally said to her, "I think I'm done. This is a bit too much this soon, I think." And that was the end of my session!

And, yup: I joined the ODIC that day, for sure! I spent the next 2 days icing it, keeping it elevated, took an extra dose of Tylenol, etc. I cancelled the final appointment with the main PT there, called her to explain why, because I did have a good working relationship with her.

 

[Freestyle]

I remember reading about your experience, BBCG. I know that feeling of joy that you can do something you didn't think you could do....followed by two days of regret and icing.

My confession gets worse--you know the list of exercises on Bonesmart that you shouldn't do? That's pretty much my prescribed daily strength workout--sit to stands, hamstring curls with a theraband, quarter squats, etc. With my first TKR, as long as I did them twice a week, not every day, it was manageable.

 

[Sisterpat]

Freestyle, we absolve you from your “sins” - now “go and sin no more”!
Sounds like you have learned your lesson. Remember the BoneSmart way: slow is the new fast!