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TKR Severe pain at 9 weeks and lumps

LynetteCly

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Good morning people. I can’t even tell you how happy I am to have found this forum. That is after a couple of connections in Facebook groups which only led me to a state of panic.

I am one week out from a complete replacement on my right knee. Prior to that, I had been walking with crutches for several years, the pain being so unbearable.

I am an inch taller now if I stand on my right leg (woohoo!), so I am looking forward to being balanced after my next surgery sometime this fall.
I completely underestimated what recovery would be like. I’ve always rebounded quickly from other surgeries, with minimal pain.

Comparing this to those others is like comparing a foot amputation to a pedicure.
That said, I’m doing well and against all directives of medical people, I’m taking a more gentle approach. Some of what I’ve been told is lunacy. Like “increase the angle on CPM by 5-10 degrees each day.” OMG. No. The single worst day I had was after my first increase and stopping that CPM session after 90 minutes felt like total failure. That was nothing compared to the agony of the next eight hours.

So much misinformation. It’s frustrating, to say the least, but what I’ve learned here in my short time reading is invaluable. Trust my body. Extreme pain isn’t required. It’s going to be okay.

Question: I was on 10 mg Norco (hydrocodone/Tylenol 10/325) coming out. I’ve cut that down to 5 mg 4 x day. Hate the grogginess. Does it seem that meds are necessary after week 2 or so?

Thanks for listening!
 

Jockette

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Hi and Welcome!

Your attitude sounds great! It won’t help you heal faster, but it will help you navigate this recovery better.

Yes, indeed there is so much misinformation out there. How can that be, when this surgery is done so many times. Thankfully, that’s where Bonesmart comes in. I was thrilled when I found this forum, also, but I was 4 weeks post op, and some PT damage had already been done, because I believed what I was told.


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.

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.
 

Jockette

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Does it seem that meds are necessary after week 2 or so?
We are all different so it’s hard to say. Some members are able to work well with extra strength Tylenol. I took 1,000mg of extra strength Tylenol, every 6 hours, including a dose during the night.

I also made sure to check any other medications that I was taking to see if they had any acetaminophen (Tylenol) in them, as that would take me over the maximum 24-hour dose of 4,000mg. Acetaminophen is in a lot of medications these days, especially those used for colds, flu and allergies, as well as some prescription pain relievers.

The labels in the US state 3,000mg as the limit, but that’s in case people don’t know to check their other medications to see if there’s any acetaminophen in them.

I took this dose on schedule for several months as I found I needed to keep a consistent amount in my system. It didn’t work for me if I only took it occasionally.
 

sistersinhim

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Welcome, @LynetteCly! Was your surgery on July 21, 2020? If so, I'll add that date to your signature. Knowing this will help us to know how to better advise you.

Jockette is correct. Each recovery is different and each person's pain needs are different. I stayed on Oxy around the clock for about 3 weeks, then weened off of it slowly. I then took Tramadol and Tylenol for the next month or so when I needed extra pain relief.
 
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LynetteCly

LynetteCly

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I had been using a long scarf under my right foot to help when lifting my leg to the bed. It’s been less painful the last day or two, so have been using less scarf, more painful thigh muscle.

This afternoon I noticed that a swelling on the front of the thigh, above the knee, which had been softening and reducing in size seems to have become substantially larger.

it isn’t terribly painful, hot, or discolored, it’s just much larger. I’m wondering if I’ve developed a hematoma there? Or maybe the muscle was just stressed more because of the increase of use? PT comes tomorrow so I will ask her but meanwhile I’m fretting a bit and wondering if anyone else has experienced something like this.

Thanks for listening
 

amynewleftknee

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Does it seem that meds are necessary after week 2 or so?
We are all different so it’s hard to say. Some members are able to work well with extra strength Tylenol. I took 1,000mg of extra strength Tylenol, every 6 hours, including a dose during the night.

I also made sure to check any other medications that I was taking to see if they had any acetaminophen (Tylenol) in them, as that would take me over the maximum 24-hour dose of 4,000mg. Acetaminophen is in a lot of medications these days, especially those used for colds, flu and allergies, as well as some prescription pain relievers.

The labels in the US state 3,000mg as the limit, but that’s in case people don’t know to check their other medications to see if there’s any acetaminophen in them.

I took this dose on schedule for several months as I found I needed to keep a consistent amount in my system. It didn’t work for me if I only took it occasionally.
Acetaminophen is part of Norco. That was my prescription!
 

sistersinhim

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Or maybe the muscle was just stressed more because of the increase of use?
Yes, I am pretty sure that is the cause of the extra swelling. You will notice as you do more things you'll have more pain and swelling. Since your knee isn't hot I think it's OK. Of course, if it gets much worse and hot then call your doctor.
 
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LynetteCly

LynetteCly

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How grateful I am that I found this forum. Because of reassurance from everyone here, I felt safe taking a couple of days off from a rigorous PT routine (after developing an alarming swelling over the knee).

That was the single best thing I could have done. I continued CPM and walking, just no more (modified) squats, lunges, etc. I started icing more routinely.

The reduction in swelling is dramatic and with that has come the ability to actually do all of those exercises that were so agonizing and difficult before my PT hiatus.

So grateful for the wisdom here. I’m actually beginning to think I might survive this thing. Woohoo!

A question for anyone further along: it is almost impossible to find a comfortable sitting position even with my leg up. Leg down is pretty unbearable within just a matter of minutes. This makes riding in a car a misery. Is that usual? Unusual?

Thanks to everyone who participates here. I (stupidly) thought that I’d be as immediately well and able after this as I have been after every other surgery I’ve had. All of the information was out there. I just thought I could he-man my way through as I always have in the past. I’ll be better prepared with the next one.
 

Roy Gardiner

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The reduction in swelling is dramatic and with that has come the ability to actually do all of those exercises that were so agonizing and difficult before my PT hiatus.
There you go, cause and effect. It is very easy to overdo exercise, almost impossible to underdo it. If it hurts or causes swelling, don't do it. No matter what a therapist might say.
 

Jockette

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It’s normal to struggle in the early weeks to find a comfortable position, your whole leg is just so upset.

Someone told me that she used a small pillow under her foot, in the car, that helped her. I did that and it did help get my leg up a bit. I also thought that maybe it helped to cushion the bumps in the road a bit. Obviously there isn’t much room on the floor in the front seat, but sometimes any height you can get does help. I kept that pillow there for months!
 

Mrs. Ciz

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Good morning people. I can’t even tell you how happy I am to have found this forum. That is after a couple of connections in Facebook groups which only led me to a state of panic.
I am one week out from a complete replacement on my right knee.
Question: I was on 10 mg Norco (hydrocodone/Tylenol 10/325) coming out. I’ve cut that down to 5 mg 4 x day. Hate the grogginess. Does it seem that meds are necessary after week 2 or so?

Thanks for listening!
Welcome, @LynetteCly! Was your surgery on July 21, 2020? If so, I'll add that date to your signature. Knowing this will help us to know how to better advise you.

Jockette is correct. Each recovery is different and each person's pain needs are different. I stayed on Oxy around the clock for about 3 weeks, then weened off of it slowly. I then took Tramadol and Tylenol for the next month or so when I needed extra pain relief.
I am a couple weeks ahead of you. I had bilateral TKR on 7/6/20. I also thought the whole recovery would be much easier than it’s been. I was limping in constant pain and inflammation before, so I figured how much worse could surgery be? Well... it’s a lot worse!!!!!

The pain meds will also depend on your doctor’s philosophy. I am struggling with a doctor who is stingy with the pain meds. The first week I took 2 Tramadol and 2 Tylenol every 6 hours. I also had oxy I could take every 4 hours for break through pain, but they didn’t give me enough to take it regularly. So I saved it for night time sleeping, PT, and really bad days. I ran out of both meds early and had to ration. At my 1 week post op appointment he gave me 1 Tramadol, 2 Tylenol every 6 hours (but not enough Tramadol to take regularly, I did take it every 6 hours in week 2, ran out, and had to get 30 more to take sparingly for weeks 3 and 4) and 5mg hydrocodone for break through pain every 8 hours but not enough to take regularly, and it does not last 8 hours; it lasts about 4 hours. So again I saved the hydrocodone for night time sleeping, PT and really bad days. 30 pills was supposed to last me 3 weeks. Throughout all this, I took 2 Tylenol every 6 hours like clockwork but it is often not enough.

So what is happening is I’m rationing my pain meds and not always taking it when I need it. I get very sore and don’t want to walk, shower, do my exercises, etc, which is counter productive. I am still having problems with pain behind my right knee. At my 4 week appointment this coming Tuesday, I’m going to ask for more Tramadol. I’d really like more hydrocodone for night time, but I kind of doubt he’ll give it to me. We shall see.

I have to say the lack of good access to enough pain medication had been my biggest complaint about this whole thing. I get it; there’s an opiod crisis, but doctors must give enough pain meds to their surgical patients. We have to heal! Ok, I’m off my soapbox now.

My advice is if you feel you need more pain meds, contact your doctor and get more pain meds. Don’t try to tough it out and make yourself miserable. Also ice and elevation works wonders too!
 

Starsfan22

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I'm not expert but as a person who believes excessive PT lengthened my recovery, please take it easy....there is no way I'll do any squats or lunges at the point you are at in recovery with knee 2.
 
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LynetteCly

LynetteCly

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Good morning people. I can’t even tell you how happy I am to have found this forum. That is after a couple of connections in Facebook groups which only led me to a state of panic.
I am one week out from a complete replacement on my right knee.
Question: I was on 10 mg Norco (hydrocodone/Tylenol 10/325) coming out. I’ve cut that down to 5 mg 4 x day. Hate the grogginess. Does it seem that meds are necessary after week 2 or so?

Thanks for listening!
Welcome, @LynetteCly! Was your surgery on July 21, 2020? If so, I'll add that date to your signature. Knowing this will help us to know how to better advise you.

Jockette is correct. Each recovery is different and each person's pain needs are different. I stayed on Oxy around the clock for about 3 weeks, then weened off of it slowly. I then took Tramadol and Tylenol for the next month or so when I needed extra pain relief.
I am a couple weeks ahead of you. I had bilateral TKR on 7/6/20. I also thought the whole recovery would be much easier than it’s been. I was limping in constant pain and inflammation before, so I figured how much worse could surgery be? Well... it’s a lot worse!!!!!

The pain meds will also depend on your doctor’s philosophy. I am struggling with a doctor who is stingy with the pain meds. The first week I took 2 Tramadol and 2 Tylenol every 6 hours. I also had oxy I could take every 4 hours for break through pain, but they didn’t give me enough to take it regularly. So I saved it for night time sleeping, PT, and really bad days. I ran out of both meds early and had to ration. At my 1 week post op appointment he gave me 1 Tramadol, 2 Tylenol every 6 hours (but not enough Tramadol to take regularly, I did take it every 6 hours in week 2, ran out, and had to get 30 more to take sparingly for weeks 3 and 4) and 5mg hydrocodone for break through pain every 8 hours but not enough to take regularly, and it does not last 8 hours; it lasts about 4 hours. So again I saved the hydrocodone for night time sleeping, PT and really bad days. 30 pills was supposed to last me 3 weeks. Throughout all this, I took 2 Tylenol every 6 hours like clockwork but it is often not enough.

So what is happening is I’m rationing my pain meds and not always taking it when I need it. I get very sore and don’t want to walk, shower, do my exercises, etc, which is counter productive. I am still having problems with pain behind my right knee. At my 4 week appointment this coming Tuesday, I’m going to ask for more Tramadol. I’d really like more hydrocodone for night time, but I kind of doubt he’ll give it to me. We shall see.

I have to say the lack of good access to enough pain medication had been my biggest complaint about this whole thing. I get it; there’s an opiod crisis, but doctors must give enough pain meds to their surgical patients. We have to heal! Ok, I’m off my soapbox now.

My advice is if you feel you need more pain meds, contact your doctor and get more pain meds. Don’t try to tough it out and make yourself miserable. Also ice and elevation works wonders too!
Wow, what an ordeal! Tramadol has never been much help for me. I see the doc Tuesday. I guess I’ll find out how stingy he is. I hope not. The pain can sure be an impediment to healing... so sorry to hear of your struggles.
 

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Hello LynetteCly!

I am sorry to hear about your pain but its one we all seem to share and finding stingy surgeons is another. My surgery was July 16th and with the problem with my stingy doctor, I recently spoke with my GP and ask if he would fill in the gap for pain meds if my surgeon stays this way. You may want to try that rather than be in pain.

Please feel better. Thank you for your support and I hope I can be for you as well.
Mamie
 
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LynetteCly

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Hallelujah, I am staple-free!!!! Joy! Because of the Bonesmarties, when a new PT came out Monday and said “this is really going to hurt when I push your leg back,” I just flat out said “nope.”

She looked surprised. “No?” I said that’s right and so we did the rest of my routine which went SO WELL because swelling is so much improved. Measured 87 degrees of bend. I’m thrilled with that because my knee has been at about 12 degrees flat and 60 bent for 8-9 years.

then she said to keep increasing CPM five degrees a day and I NOPEd her again, said I’m doing fine going up 2-3 degrees a day and that was that.

this group is so empowering. I’m so grateful.

so when staples came out, incision is a little red and warm. Doc said he thinks it’s still blood but in case it’s superficial infection, started antibiotic.

it’s covered in steristrips now and I’m counting on continued rapid improvement thanks to the gentle wisdom here.

That’s it. Just wanted to say THANKS and YAY! So happy.
 

Jockette

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allin1

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I NOPEd her again, said I’m doing fine going up 2-3 degrees a day and that was that.
Nope, your knee will be the decider of how much motion you get and how fast, and I doubt if it will be 2-3 degrees a day. Especially the last 10 degrees!
 
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LynetteCly

LynetteCly

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I NOPEd her again, said I’m doing fine going up 2-3 degrees a day and that was that.
Nope, your knee will be the decider of how much motion you get and how fast, and I doubt if it will be 2-3 degrees a day. Especially the last 10 degrees!
so why on earth do they insist 5-10 degrees a day on that CPM? It’s insanity. Can anyone do that?
 

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