TKR Seven weeks post TKR

Wally07

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Hello, I am new here. So glad to find this forum Surgery was August 10 on the right knee and I did very well the first few weeks. After four in-home therapy sessions, I was pushed to start outpatient PT at three times a week. Lots of strength training and sometimes painful “massage” techniques. The pain would sometimes last until the next session! I am not sure so much pain is necessary in order to heal. I have iced, elevated, taken Advil as needed and eat a healthy diet. I do not “overdo” most days.

Over the last few days I became very stiff and swollen (both knees!) to the point I could hardly walk. They eased up on me in therapy but I am still scheduled twice a week through all of October. I am wondering if I should find another rehab center or ask the surgeon what he thinks. It just feels like I am going backwards, not progressing at all!
 

benne68

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Welcome to BoneSmart, @Wally07 ! Glad you found us.

Swelling and stiffness are a sign that you are doing more than your new knee is ready for and need to take a step back and spend more time icing and elevating until the inflammation goes down.

Have a read through 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 we 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.

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.

I'm sure other members will stop by to share their stories and suggestions.

Hang in there! We are here to help!
 

Jockette

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Hi and Welcome!

Your PT experience is one we read far too often. You can try to find another office more in tune with your preferences, or just do your own “rehab” at home, at this point. I was discharged from PT at less than 8 weeks, and that’s about where you are. It’s really not complicated to do your own, you just need to give your knee mobility. Activities of Daily Living (ADLs) will do that for you, as well as short walks, as tolerated, and increase, as tolerated.
I am not sure so much pain is necessary in order to heal. I have iced, elevated, taken Advil as needed and eat a healthy diet. I do not “overdo” most days.
You are very correct that so much pain is not necessary, in fact, it will hinder your recovery. What you are doing is very good.

Regaining our ROM does not require forceful bending or painful exercises.
Regaining our ROM is more about Time than repetitions of a list of exercises.

Time to recover.
Time for pain and swelling to settle.
Time to heal.

Our range of motion is right there all along just waiting for that to happen so it can show itself.

In the general run of things, it doesn't need to be fought for, worked hard for or worried about. It will happen. Normal activity is the key to success.

I have one suggestion. You might want to try Tylenol, if it agrees with you. The most effective way to take Tylenol is 2 x 500 mg tablets every 6 hours, to a total of 4,000 mg (4 doses) in 24 hours. You need to take it regularly, to keep up the levels in your bloodstream. If you just take the odd dose now and then, it's far less effective.

Check all other medications you're taking, to make sure there is no Tylenol/Acetaminophen/Paracetamol in them. If there is, scale back one or two of your regular Tylenol doses, so you stay within that safe 24 hour limit of 4,000 mg.
 
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Wally07

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Thanks so much for your suggestions. I think I can rehab on my own very soon.
Question: Why do you prefer Tylenol instead of Advil since Advil is an anti-inflammatory?
 

Jockette

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Extra strength Tylenol is very good for post op pain, if taken regularly.

I did also alternate with ibuprofen, so that I took one or the other, every 3 hours. I took the Tylenol 4 times a day, which included a middle of the night dose. I didn’t set my alarm for that does, I would just take it when I woke up during the night, and then that would set my next 3 doses. I did use an alarm on my phone for the 3 daytime ones. I took ibuprofen 3 times a day, also with an alarm on my phone, going by whatever time I took Tylenol in the middle of the night.
 
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Wally07

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I’ve now read other posts and it is true that everyone’s recovery is different. About a month before my RTKR I injured my other knee (small meniscus tear, perhaps) and the surgeon’s office gave me a cortisone shot. So now that I am 7 weeks post op and 2-1/2 months since the shot, guess what? It’s wearing off and my left knee has become swollen, making it more difficult to walk. I will be seeing the doctor next week for a follow up and hope they can give me another shot to control the pain so my TKR recovery can continue in impeded. I think my right knee is actually stronger than the left right now. Crazy! Anyone else have issues with their other knee?
 

Susie-Q

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Your left knee is taking the brunt of things and having to do extra duty while your right one is recovering so it's no wonder it's acting up now that your cortisone shot is wearing off. The same thing happened to me after my RTKR many years ago. I ended up having to get my meniscus repaired in the left not too long after my right was replaced. Once everything settled down my left got me through the next 10-11 years before it needed to be replaced. It's possible yours might settle down once the right is able to take up the slack as it recovers and gets stronger. Take care of yourself! :flwrysmile:
 
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Wally07

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Thank you! I am hoping to get some relief soon (and avoid a meniscus repair) as I hear that surgery can aggravate an already arthritic knee. My main concern is how it’s currently affecting my gait and ability to walk. The decline has been very noticeable over the last few days. Very unsteady at times. This phase is hard.. and makes me feel left out of life, like pedaling backwards.
 
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Wally07

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Is it typical to feel uncomfortable after standing for more than 10-15 minutes? My legs ache like there is bad circulation. Compression socks help a little. I wish I could do more.. I am always lying down to avoid the aches. Ugh!!
 

kneeper

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For the first few months standing for more than a few minutes often leads to stiffness and discomfort. I had it more in the knee area than aching in the legs.
 

benne68

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Hi @Wally07. I had difficult with standing for any length of time for quite a while after surgery. In fact, I found it more uncomfortable than walking. For some reason, if my legs were moving, they didn't bother me as much.

Definitely wear the compression stockings if they help.

:console2:
 
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Wally07

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Need support and advice! My other knee has continued to get worse now that the cortisone shot has worn off. I can hardly walk without a cane or grabbing onto something. To top it off I tested positive for CoVid last week so have not been to PT for 10 days. Everything is stiff and it takes five times as long to do the simplest things. My husband now seems impatient with my setback and I really try to do most things myself because he has taken card of me for two months. This coming week I will see the surgeon and pray I can get some relief on the other knee. The TKR knee is doing pretty well, but not being able to walk much is impeding my recovery. I had hoped to take our grandkids on a trip to the mountains in a few months but am losing hope. This sure gives insight into what it’s like not being able to move as we get older and it’s terrifying.
 

WFD

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This sure gives insight into what it’s like not being able to move as we get older and it’s terrifying.

I think about this every day and it scares me spitless. Meanwhile my 91 year old Dad is hustling around, busy as heck, like the Energizer Bunny...
 

benne68

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I'm sorry to hear you have COVID, @Wally07, and hope you don't feel too ill. But don't worry about not being able to go to PT. It sounds like your surgical knee healing well. It will continue to improve, even if all you do are ADLs (activities of daily living).

I wish I could offer you some advice for your other knee. Glad that you will be seeing your surgeon soon and, perhaps, get that second TKR scheduled so you don't have to suffer for too much longer.

I'm sorry that your husband is getting impatient with you. Sometimes people who haven't been through this surgery don't understand this is a year-long recovery. Perhaps he needs to be reminded?

Sending hugs :console2:
 
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Wally07

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Most people do not realize it can take up to a year. They believe two or three months and you should be back to all activities. The way I am walking now looks more like week one! If the other knee was not injured, I definitely would have more mobility. Generally the surgical knee seems strong at 8-1/2 weeks.
 
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Wally07

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Now at 10 weeks post op and feeling good after getting a cortisone shot in the opposite knee which had an issue. With the pain reduced, I’m able to walk so much better and do chores that I could not do two weeks ago. I can stand without pain and the squeezing sensation I was having is gone, thank goodness - which is a huge improvement.

Last week the surgeon lifted my restrictions and said I didn’t need to do formal PT any longer and should exercise on my own 4 times a week. The physical therapist had scaled back on my exercises anyway and didn’t seem to have anything new for me, it seemed like he and his assistant were just finding things to fill the hour. So, I notified him I was stopping PT. (I had been to 22 sessions over an 8 week period which seemed like a good amount). Well, he wasn’t happy that I am leaving and said he would leave my case open for a few weeks in case I changed my mind. It seems he wanted me to have another 3-4 weeks of PT.

Today I returned to my regular gym to ride a recumbent bike for 20 minutes and other mild leg exercises, plus upper body work. Being cautious of course but it feels great. Hopefully this is the best course of action at this time. I try to listen to my body!!
 

benne68

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It seems he wanted me to have another 3-4 weeks of PT.
You don't need any more PT. It sounds like you are doing extremely well for 10 weeks post op. Just be careful not to overdo it. Slow and steady wins this race!

:wink:
 

WFD

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It is good to leave your case open. PTs can be very helpful later on in your recovery. If you develop gait issues, back or hip problems stemming from your TKR they can be very effective in diagnosing these problems.
 

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