TKR Sept 25 - left knee

[KJ24]

I’m so glad I found this forum during my three week post-op. My first week was hell. I had an at home PT lady that was the devil. On the first PT appt, two days after surgery she forced my knee to bend past 90 degrees. I was screaming and I believe that this was how my recovery was going to go. By the three PT appointment I fired her firm. I was screaming so loud as she forced my knee to bend to 95 degrees that enough was enough, I wasn’t dining this any more.

I had arthroscopic surgery in 2022 so I called the PT company and had my prescription changed to there firm. I love my new PT specialist, she has me do my best but not once has she placed her hands on me and forced my knee to bend. She is always asking if I have pain and says “it should stretch, but not be painful.”

I just passed my fourth week. I’m still using a walker and can bend my knee to 90 degrees. If I leave it at 90 degrees for more than a few minutes it starts a spasm in my quad. My quad has not been working well on its own so PT has been giving it some stimulation each day. This seems to be helping as I can left my foot off the table two inches. There is a litte pain at the front of my knee cap if I go any higher than that but it is manageable because I only have to try to do it five times. If it hurts to much I can stop. It is so much butter having a PT specialist that isn’t in to forcing me into doing what they think I need.

After reading a lot of posts it made me realize that I’m not failing to get better. There are just a lot of unrealistic expectations for TKR recovery.

Major surgery is going to take major time to heal, not just a few weeks.

 

[mendogal]

to BoneSmart!

I'll leave some general info here then add a separate comment on how I woke up my quads.

Was it the Left or Right knee?

You are in the very early stages of an average of a yearlong recovery. I will leave you our Recovery Articles that have helped tens of thousands of other knee replacements. We are here to help you through this journey the best we can. The very best thing for your knee right now is to rest, ice, and elevate. Exercises can come later. There is no rush to achieve ROM because it will come naturally as your swelling decreases. Your OS was able to bend your knee while checking for movements during your surgery, so it will be fine. It just takes time.

Each person is different as is their recovery. Most find that the Bonesmart approach works best for them, but others find that a more aggressive therapy helps them more. It's your recovery and your choice on how you recover. As you read more on other members' recovery threads, you’ll get a better perspective of what to expect. The following are our basic guidelines and should help get you started.

KNEE RECOVERY 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.

If you want to use something to assist with healing and scar management, BoneSmart recommends hypochlorous solution. Members in the US can purchase ACTIVE Antimicrobial Hydrogel through BoneSmart at a discount. Similar products should be available in the UK and other countries.

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.

 

[mendogal]

Good for you, firing those dreadful PTs!!!!

There's a modest but, in my opinion, not fully appreciated exercise called quad sets.

My ortho team didn't want me to do much in the initial weeks. Their mantra was Less is Better.

Quad sets was on their list. I liked them from the start because it was clear that done in moderation they didn't stress my knee. I could do a few every now and then while resting and icing. They promote circulation and also start a little extension as a side benefit.

But they're really helpful to get those quads firing. That's a process - each of the individual tiny muscle bundles has to have the nerve stimulation to contract, and then the bundles have to be coordinated in order for the whole muscle (in the case of quads, all four muscles) to contract effectively.

I found I could easily target one small region of my quads by lightly touching my fingertips to it while doing quad sets (BTW, touching a target muscle is a great tool in muscle training) - it helps give the nerve-muscle system focus.

In terms of not tolerating 90 degrees for long - oh yeah!!!! Normal! It sure keeps us from sitting upright in a chair for long. I remember setting timers, first for five minutes, then ten, etc before having to go ice right away (early days) or get up and take a short walk (later on).

It sounds like you're back on the right track. Please come back regularly with any questions or worries (especially those late night ones... we have all had them and someone somewhere in the world will generally be online here) as well as sharing those little but important milestones that tell us we're getting better.

 

[Jockette]

Hi and Welcome!

I’m so sorry you had such an awful PT experience those first weeks. I truly don’t understand how anyone can think that is appropriate after such a surgery, at any time, but especially so early in recovery. I had a similar experience at one week post op. Never again!

Hang out here with us, Bonesmart has a wealth of advice, information and support.

We will offer helpful suggestions,

Cheer your accomplishments,

And send hugs when you are feeling down.

Best wishes!

 

[Layla]

After reading a lot of posts it made me realize that I’m not failing to get better. There are just a lot of unrealistic expectations for TKR recovery.

Major surgery is going to take major time to heal, not just a few weeks

Welcome to BoneSmart and recovery! Thanks for joining us, KJ!
I am sorry you had the PT experience that you endured. Thankfully you found a good match in a therapist now and you're doing much better. Yes, this is major surgery, a controlled trauma to the body. It is key that you realized that healing takes time and that too many stress over meeting unrealistic goals and timelines.
You're on your way. I will enjoy following your progress, so please stay in touch.

A belated Happy One Month Anniversary to you! Have a great week!

 

[WFD]

There's a modest but, in my opinion, not fully appreciated exercise called quad sets.

I have had very difficult recoveries from my surgeries, but found I could always do quad sets. They kept my quads working, and helped to eliminate the small extension deficit I had. They also never seemed to irritate my knee.

 

[ouchie!]

WFD can I just ask what exactly are quad sets? Is it where you lie stretched out on the bed and squeeze your quads, hold, then release?

 

[mendogal]

WFD can I just ask what exactly are quad sets? Is it where you lie stretched out on the bed and squeeze your quads, hold, then release?

Yes, but you definitely don't have to lie flat. I did them a lot while in my recliner, on the bed while my legs were on the Lounge Doctor, and later on in recovery, while sitting on the couch with my leg extended on a pillow on the coffee table.

 

[WFD]

WFD can I just ask what exactly are quad sets?

I did these lying down with a rolled up towel under my ankles, creating air space under my legs, so that as I contracted my quads I was attempting to straighten my legs. This was one of the things I did to get rid of the extension deficit I had, and it worked well.

This may not work for everyone, but it worked well for me.

 

[KJ24]

The worse time of the day is night time. It takes so much effort to try to get comfortable to sleep. I’m tired of sitting in the recliner so sleeping there hasn’t been successful in a few days. Try to sleep in a bed and can’t lay flat on my back because my back starts to ache. Then roll over on side and my knee starts to hurt. I’ve tried placing pillows between thigh, knee and calf. Before surgery my comfortable position was on my left side or my stomach. Now I’m miserable. I wake up four or five times a night.
How long on average does it take until sleeping in a bed is easier?

 

[Pat29627]

Now I’m miserable. I wake up four or five times a night.
How long on average does it take until sleeping in a bed is easier?

I’m so miserable at night. Surgery was five weeks ago. I have a wedge pillow with two flat soft pillows under my head. Then I either pile a couple thick pillows under my feet, or try to lie on my side with a soft pillow from thigh to feet. I have sleep apnea and have to use a Cpap, so being on my back isn’t the best for that.

Now the doctor’s office only prescribed 12 oxycodone last week when I asked, so I’m trying to quit. Last night was so restless and PT today was so painful. I took a Tylenol, melatonin, and my usual 100 mg Celebrex. Finally got up and took 1/2 Ambien. The physical therapist said it’s probably best to take something for pain. He keeps the exercises pretty basic and easy, thankfully. And I can do well on the recumbent bike.

 

[mendogal]

@KJ24 and @Pat29627
Insomnia is a real bummer for many of us in the initial weeks after surgery. It's generally not the meds, it's... everything about the trauma, discomfort, energy drain!

Definitely sleep whenever (and wherever it's safe and comfy!) - many of us sleep and/or nap in a recliner, or surround ouselves with soft pillows.

Icing, elevating, napping.... All help, but you might also consider some nonprescription remedies....

If you're lactose tolerant, a glass of warm milk! If you're not diabetic, a teeny bit of honey makes it even more comforting... plus milk is high in magnesium! Helps us relax!

If you aren't a milk drinker, or want an easier way to, an evening magnesium supplement has been very helpful for some members.

OTC diphenhydramine, an antihistamine also used as a sleep aid (Benadryl) because it makes you drowsy; it's also included in some cold, flu, etc "nighttime" combination meds.

Low dose melatonin, sustained release - not for long term use but I have used for a week at a time without ill effect. It should be taken an hour to hour and a half before going to bed, and during that time stay in a dimly lit area to allow this hormone to activate.

Valerian root - an herbal remedy, it can be taken in capsule form but that dose might be high compared to my preference, herbal "sleep" blends that include a smaller dose of valerian and make me pleasantly drowsy. Plus the other tea flavorings make it nice tasting! Celestial Seasonings and Traditional Medicinals sell teabags by the box. Their sleep blends without valerian have never ever made me sleepy.

What finally worked for me: a mug of sleep tea with valerian followed by a 3 mg sustained release melatonin, immediately going into a dimly lit room and relaxing. When I got sleepy, turning off the light and lying down with my legs up on the Lounge Doctor. After a few hours I would wake, move the Lounge Doctor away, and sleep more.

Be aware: even benign herbals and supplements can interact with your routine or post op prescription meds, either making their effects weaker or stronger. If you're on meds you may want to check with your doctor or pharmacist, or even check online for interactions.

 

[Layla]

Now I’m miserable. I wake up four or five times a night.

So sorry. I hope you're able to get some restorative rest soon.

Pillows certainly help me get comfortable in bed, multiples, making it easier to drift off.
I suggest making up the bed with your most comfortable bedding / blankets along with a few extra bed pillows of different degrees of firmness. Try to block out the light if it's daytime. Minimize noise unless you feel listening to calming relaxation music, a fan, or white noise may help lull you to sleep. Make sure the room temperature is not too hot or too cold. Try to disconnect from the devices at least an hour before the targeted nap or bed time, so it's easier to wind down. Limit caffeine throughout the day and consider natural sleep aids such as Valerian, Chamomile or, Magnesium, my personal favorite, which can assist in muscle relaxation and nerves and promote healthy sleep (falling asleep and staying asleep)

An article on Magnesium from our Library -
https://bonesmart.org/forum/threads/magnesium-is-a-star.20301/

Most large grocers carry a variety of teas such as Celestial Seasonings - Sleepytime Herb Tea,
Yogi Teas, Bedtime, Bigelow Cozy Chamomile, all of which may help you relax...at least worth a try.

 

[Pat29627]

This is all good advice. I take magnesium most nights, usually magnesium glycinate or mag citrate which are well absorbed, or now a blend with magnesium oxide which helps keep me regular. I also eat green leafy veggies in soups or smoothies.

I do find 3 mg melatonin helps. CBD oil helps a little.

I’ve never tried valerian. I’ll get some tea tomorrow! I can’t use chamomile since I’m allergic to ragweed and they’re related.

I wouldn’t like the milk, but it is almost eggnog season!

Tonight I started having extreme knee pain a finally took one of my few remaining oxycodone 5 mg pills. I’d been icing and elevating. I wonder if I can ask my doctor for a few more. And wonder if I’ll be better in a week. I do seem to be walking better every day…well, until a cold front came through yesterday and really knocked me down for a day.

 

[mendogal]

You have my sympathies on the chamomile - I can't use echinacea or lavender.

 

[KJ24]

Week 5 - My swelling is down but I still have a lot a stiffness. My knee always feels like I have a tight rubber band on it, even icing doesn’t easy the tightness.

I still am not sleeping well. It’s not because I’m having knee pain. It is I think due to the fact that I have always been a worrier. When my kids were little, I would wake up by the slightest noise. Now I think my mind is worrying that I will hurt my knee while I sleep so I wake up just to make sure it isn’t hurting. I probably only sleep for 30 or 40 minutes and I’m waking up so I can change positions.

PT was good this past week. I am able to fully pedal forward and backward on the recumbent bike, while it is not fast I have been successful. I can bend my knee to 90 degrees while doing heel sides and my quad is slowly learning how to left my foot off of the table a few inches during leg extension.

I am still using a walker as PT wants the leg stronger since the quad doesn’t work well, my leg doesn’t have a smooth nature rotation yet.

I have my PT evaluation tomorrow and have already been told that I will be having four more weeks of PT which is okay with me.

 

[mendogal]

Tight band feeling after knee replacement is one of the most common complaints I read from members, and it sure bothered me.The sensation is a combination of generalized swelling plus physical trauma to the thigh muscles due to both having had a tourniquet and to being moved around like crazy plus a response to internal tissues being cut. With all that... It resolves slowly.

Josephine, our Nurse Director Emeritus, explained the part about healing tissues nicely:
That tight band is caused by scar tissue but not the adhesions type of scar tissue. When the surgeon opens up the knee, he has to undercut the skin and superficial structures from that centre line to each side of the knee in order to get good access all round the bones. Part of the healing process is when those flaps reattach themselves to the main body of the leg. This healing creates a thin layer of scar tissue across the front and sides of the knee. But scar tissue isn't anywhere near as flexible as normal tissue so it feels like a tether or a clamp across the knee if there is any swelling and during later normal activity.

It will gradually reduce in size and thickness over the following months until it reaches a point where it's not substantial enough to cause this sensation, same way as does the incisional scar in the skin. But be warned that this can take several months to dissipate completely and sometimes or every time, lots of walking or standing can make it worse. It differs greatly for every individual.

This should be regarded as pain and treated as such. In the early days, take your prescription meds. In later days, take some otc meds like paracetamol (Tylenol).

 

[Layla]

I probably only sleep for 30 or 40 minutes and I’m waking up so I can change positions.

Please do give some consideration to Magnesium.

Magnesium supports the following:
Bone health
Healthy blood sugar
Cardiovascular health
Muscle relaxation and nerves
Promotes healthy sleep (falling asleep and staying asleep)

Wishing you some solid restorative rest this week!

 

[KJ24]

I probably only sleep for 30 or 40 minutes and I’m waking up so I can change positions.

Please do give some consideration to Magnesium.

Magnesium supports the following:
Bone health
Healthy blood sugar
Cardiovascular health
Muscle relaxation and nerves
Promotes healthy sleep (falling asleep and staying asleep)

Wishing you some solid restorative rest this week!

I cannot take magnesium as a blood test shows that mine is too high. My doctor wanted to put me on it for migraines but when the test came back he switched to a prescription medication.

 

[KJ24]

Has anybody had an issue with their fibula being tight after TKR. For the past few days I have been having pain on the outside of my leg below my knee. My PT specialist had to do a fibula manipulation this afternoon. I spoke to the PA at my doctor’s office and she said that sometimes the fibula causes issues and to have PT do a few more manipulations. “If it doesn’t quiet down in a week” to give them a call for an appointment.

Has anybody experienced a fibula issue and will it get better?