TKR Seems I am not progressing<

[Celle]

@Maryanne - It's not a good idea to go into heated pools for several months longer, because the warm/hot water is likely to increase your knee's swelling.

Do be careful, also, not to go into any public swimming baths if you have any scratches or open areas on you leg - just in case you introduce some infection.

 

[Bostonboy]

I do 1.5 hrs on legs and 2.5hrs legs elevated, but I am recovering from a double hip replacement.

Have faith and don't allow fear to creep in. Massage your knee and speak to it to heal. You can control your breathing. Control your healing with positive thoughts

Sent from my iPhone using BoneSmart Forum

 

[PegGar16]

Hi @Maryanne! I just read your thread and hope you are doing well. I also work from home on the computer and found that propping up the leg and icing while I was at the computer worked the best. Once I found a stool that fit under the desk it was even better (easier on th back). I am also progressing slowly this time around, it never seems to go fast enough. Just take it in stride, slow and steady and it will heal

 

[maryanne73]

Hi everyone, I just woke up to terrible pain and "spasm like" feelings. Also felt like I was burning up. Took my temperature and it was 96.5. This is week 10 in my recovery and once again I am asking if this is normal.

Because of a nickel allergy I have a Smith-Nephew Genises II implant but wondering if I could be having a problem with the plastic components. Thanks again for any insights. Maryanne

 

[Celle]

I've never heard of anyone being allergic to the plastic in the implant.
Your temperature was normal.
I see that you have had that burning pain before and I wonder if it is related to the amount of activity you do during the day. It's still quite early in your recovery, so re-read this article and check your activity against it:
Activity progression for TKRs

Ar you still taking any pain relief? .Many people still need it at 10 weeks.

If this doesn't settle down or it happens again, do go to you doctor and get it checked out.

 

[Jennszoo]

As I enter week 3, I've noticed a lot more random pains, esp shooting pains that seem to come out of nowhere when I'm just sitting, little stabby pains on/near the skin, dull aches, etc. I think it's all part of the healing process as all those tissues knit themselves back together.

 

[maryanne73]

Thank you jeans zoo for your post on the random pains to it probably is the strange healing going on.

 

[maryanne73]

Hi cells. I guess I didn't explain myself very well about the temperature. I realize it was normal but I felt like I was burning up. I still am taking oxy and naproxen as needed and noticed that I am able to spread the time out farther. I will see my regular doctor Monday for the first time since my surgery and he may have some insight into the burning. Thanks for your post.

 

[Celle]

I just got onto this thread and everyone seems to like the Tramadol and Tylenol plan. My TKR was March 3. My pain is now all nerve (burning) and stiffness. Don't understand why this is getting worse and not better. I take oxy 5mg every 4-6 hours.

@maryanne73 - You wrote this on Ozziegee's thread and I have copied it here, so we can talk about it without derailing his thread.

It sounds as if this is a nerve pain and Gabapentin can be very helpful for that. You will need a prescription from your doctor or surgeon.

I'm going to ask @Josephine to advise you, too. I believe she has been given Gabapentin and found it helpful.

 

[Josephine]

Celle is correct.

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?

 

[maryanne73]

Yes, of course.

 

[kneeper]

I had what felt like hot flashes while recovering from the surgery. I felt like my temperature control was out of whack. But no fever. I'm not sure if it was the pain meds or what.

 

[sistersinhim]

I also had those hot flashes and the burning of my knee. OS said it was nerves in it. It lasted about a month. Some times were better than others. Along with the burning, I had zingers. They felt like small lightning bolts going through my knee. I still get tiny ones in my numb area, but that burning sensation is long gone!

 

[Josephine]

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)

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.

 

[maryanne73]

Hi Josephine, sorry for the delay, we were gone for a few days. Thank you for your concern. This website is absolutely wonderful.


1. Pain levels vary from 3 to 6 depending on when I take meds and what a have done physically. The pain started about 6 week after surgery and appears to me almost all nerve paid. Often my leg is so stiff I cannot bend it and it seems pointless to go to PT.


2. Last Monday I saw my Internist for the first time since my surgery (March 3, 2017). I was relieved as he was understanding of what I am going through unlike my OS which I have only seen briefly once since my surgery. He had me up the gabapentin to 200mg three times a day and will try to ween my off the oxy. I currently take the oxy 5mg 3-4 times a day depending on the pain. I also take a naproxin 300mg 3 times a day but stop if my stomach becomes upset. And of course I take a stool softener and sennica.


3. Slight to semi-moderate depending on the day.


4.0 ROM 112 and extension 0


5. I ice and elevate for 25 min. or so 3 to 4 times a day again depending on pain level which is usually determined on what I am doing or have done.


6. I elevate when I ice for about 25 minutes 3 to 4 times a day. When I watch TV and sleep my leg is more flat.


7. Light cooking, shopping and household chores.


8.0 Ever since I read your two TKR experiences, I have not been doing any formal exercise patterns at home. Gentle heel slides when in bed, never to any pain. My house is large with lots of stairs and that seems like enough exercise to me. Oh, I also ride a stationary bike for 10 minutes 2 times a day.


I go to PT twice a week. At my demand (thanks to BoneSmart) he is very gentle. He does 5 heel slides to the count of 30 and ten measures. I have not budged off 112-114 in two months. Then is does several balance exercises and gentle stretching moves more for my back.

 

[Josephine]

1. Pain levels vary from 3 to 6 depending on when I take meds and what a have done physically. The pain started about 6 week after surgery and appears to me almost all nerve pain. Often my leg is so stiff I cannot bend it and it seems pointless to go to PT.

Well, that's certainly a good idea! But how do you define it as 'all nerve pain'? I knew mine was nerve pain because the standard pain meds had no effect on it whatsoever.

Have you tried these Night pain solutions using moist heat and clingfilm

2. Last Monday I saw my Internist for the first time since my surgery (March 3, 2017). I was relieved as he was understanding of what I am going through unlike my OS which I have only seen briefly once since my surgery. He had me up the gabapentin to 200mg three times a day and will try to wean my off the oxy. I currently take the oxy 5mg 3-4 times a day depending on the pain. I also take a naproxin 300mg 3 times a day but stop if my stomach becomes upset.

I took 300mg 3 times a day when I was on it. Doctors tend to start small and work up but it's not at all uncommon for the dosages to be even higher than I was taking.

3. Slight to semi-moderate swelling depending on the day.

okay

4.0 ROM 112 and extension 0

That's actually very good for 12 weeks out.

5. I ice and elevate for 25 min. or so 3 to 4 times a day again depending on pain level which is usually determined on what I am doing or have done.

You accomplish little or nothing in 25 minutes. Ice for at least 40-60mins and more than 4 times a day. Though of course, if it is neuropathy, then icing will have no effect on the pain at all and might even make it worse.

6. I elevate when I ice for about 25 minutes 3 to 4 times a day. When I watch TV and sleep my leg is more flat.

Same as above

7. Light cooking, shopping and household chores.

okay

8.0 Ever since I read your two TKR experiences, I have not been doing any formal exercise patterns at home. Gentle heel slides when in bed, never to any pain. My house is large with lots of stairs and that seems like enough exercise to me. Oh, I also ride a stationary bike for 10 minutes 2 times a day.

Well, quit the heel slides and the bike. You don't need them, your ROM is fine.

I go to PT twice a week. At my demand (thanks to BoneSmart) he is very gentle. He does 5 heel slides to the count of 30 and ten measures. I have not budged off 112-114 in two months. Then is does several balance exercises and gentle stretching moves more for my back.

Apart from your ROM is very good, I think as long as you are doing this, it will stay as it is. Quit the exercising PT and let your knee heal on it's own. You're only 12 weeks out. More than anything else, what your knee needs is rest and normal daily activities. You said you read my recovery thread but you're not taking it to heart. I did NOTHING and got excellent outcomes. Your normal activities are quite enough. You need to allow at least another 6-8 months before you get any improvement.

 

[sistersinhim]

I also did no pt or exercises, just the work around the house and yard. I did and am doing fine!

 

[maryanne73]

Thank you Jo.

What do you think of this plan.
1. up the gabapentin to 300mg three times a day
2. Try laying off the icing if it could be making the nerve pain worse.
3. Stop all PT.

That only leaves stiffness which I could continue to elevate for and just "wait to heal". Maybe a small amount of NSAID for inflammation?
Any thoughts

 

[maryanne73]

Forget to state the reason my Doc and I think this is neuropathy is the only to describe the pain is "burning" at times up my side,especially the gluteus.

 

[Josephine]

1. up the gabapentin to 300mg three times a day

Don't mess with gabapentin - only increase it as your doctor orders it.

2. Try laying off the icing if it could be making the nerve pain worse.
3. Stop all PT.

Excellent!

That only leaves stiffness. Maybe a small amount of NSAID for inflammation?

Do remember that stiffness is a form of pain so stop thinking of it as something apart.

the reason my Doc and I think this is neuropathy is the only to describe the pain is "burning" at times up my side

I thought that might be the case. I don't believe you actually said that before. But I totally agree.