TKR SJW's Recovery

[SJW]

Well I am starting week 9 and it has been up and down. I am going to physio twice a week (started on day 14) but will stop this week as I think I can do a version of what I do there at home. I am having so much trouble sleeping - either I take a sleeping pill or I don’t fall asleep till almost morning. My knee feels so tight most of the time and I get pain occasionally on the inside and outside of my knee and am so uncomfortable. My physiotherapist insists I am coming along nicely and the surgeon’s visit at 6 weeks was the same but I wonder. It seems the discomfort is getting worse not better. I am elevating and icing, taking Tylenol Extra Strength or T3’s but nothing seems to be helping the swelling. (I also take Celebrex and duloxotine every morning.). I am just getting exhausted with thinking about my knee all the time. I know it’s a year long process but I just want my regular life back.
Thanks for listening!

 

[Layla]

Hello and Welcome to recovery! I am sorry you're struggling with sleep. If you prefer something more natural, consider Magnesium for sleep. Magnesium supports the following:
Bone health
Healthy blood sugar
Cardiovascular health
Muscle relaxation and nerves
Promotes healthy sleep (falling asleep and staying asleep)

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

You may want to back off from the PT for a few weeks and see if your knee feels better. It's likely it will. Continue icing and elevating also per the articles on ICE and ELEVATE that you'll find in the Recovery Guidelines I leave below.

Please notice that we started a recovery thread for you. Having your recovery information contained in one place will make it easier for you to reflect back on. It is also helpful for those stopping by to be able to review your history before advising or commenting. Please post any updates, questions or concerns about your recovery here.

I wish you all the best as you continue moving through recovery. Brighter days are on the way!

 

[Jamie]

Are you icing your knee both front and back? This is important. Also try icing during the night while you sleep. Many find this is comfortable and allows you to sleep. The tightness is swelling and unfortunately it can last for a while for many people. Be sure you aren't trying to do too much in the way of exercise or activity each day as that can increase your swelling if your knee's not quite ready for that level of activity. Also be sure you're not spending extended amounts of time with your leg down (either standing or sitting in a chair) as that also can cause swelling.

 

[Layla]

KNEE RECOVERY GUIDELINES

As you begin healing, please keep in mind that each recovery is unique. While the BoneSmart philosophy successfully works for many, there will be exceptions. Between the recommendations found here, your surgeon's recovery protocol and any physical therapy you may engage in, the key is to find what works best for you.

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​

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.

 

[EalingGran]

Also try icing during the night while you sleep. Many find this is comfortable and allows you to sleep

I still do this at 13 weeks post PKR.

am just getting exhausted with thinking about my knee all the time. I know it’s a year long process but I just want my regular life back.

Definitely agree and know what you mean. Every week I feel slightly better but it is very slow. I find recording what I am doing helps as it shows that although I am still getting some swelling/ soreness it is gradually improving and I am doing quite a lot more in terms of exercise. Also find it helpful and encouraging to follow the posts of people who are a month or two ahead of me.

 

[beachy]

Hang in there! At 9 weeks it is a drag. You've been dealing with recovery for so long and want it OVER.
I can't stress ice and elevation enough. For long periods of time, several times a day if you can.
The stupid thing about tkr is that it's not the kind of recovery where you see progress every day.
Sometimes (snd too often) its 1 step forward and 2 steps back.
No doctor or PT prepared you for that.
Its a mind trick that messes with you.
Just know that its normal and better days are coming!

 

[SJW]

As always thank you for the great advice - I really appreciate it. I peruse through Bonesmart every day and couldn’t imagine going through this without it. I will keep you posted.

 

[Arjay]

Not sure what Bonesmart policies are on rx talk/endorsements, but I was where you are with the NoSleep, even for a few months before my 11/8 surgery. Chronic issues had morphed into nights where I was wide awake for 4-5-6 hours. This pattern resumed after surgery (and after I was off the oxy which greatly aided my rest). I now have script for this med:

>>>Although trazodone was designed to treat depression and anxiety disorders, the medication is now widely prescribed as a nighttime sleep aid for patients who suffer from acute insomnia.<<< (excerpt from a google search)

I feel like it got me over the hump and back to a normal sleep pattern and now I'm taking it only once in a while. But - I fall asleep, stay asleep and no mental sludge hangover the next day. (PS - it's also vet-approved for canine use, to which my formerly anxiety-ridden pooch can attest)

Of course, A) you are in Canada - availability issues?? And B) you're still on 'other' meds - advisability?? But, thought I'd put it out there for consideration.

 

[sistersinhim]

Talk to your PCP about your lack of sleep. He/she can prescribe something short-term to help you over this hump. It doesn't matter when or where you sleep as long as you sleep! Catch many naps when you can.

 

[Jamie]

It’s okay to discuss medications here, as long as you have personal experience with a particular drug to report. So, @Arjay, your post is helpful and just fine. What we do ask is that any discussion about a treatment, medications, or therapy not be something you don’t have personal experience with….including things that might have worked for someone you know. It’s too easy to not have the full story in these cases. Thanks for being concerned about staying within our posting guidelines!

 

[Arjay]

Thanks!

 

[SJW]

Well, after 12 (sometimes long) weeks I go back to work tomorrow. . I spoke to my GP earlier and she said it was fine to take a sleeping pill every night for a short time as I am still healing so my sleep is better (although it didn’t seem to work last night - getting nervous I guess). Generally I feel ready to go back to work (I am a school secretary) but a bit worried about the intermittent pain and stiffness in my knee. I plan to ice and elevate (love my Lounge Doctor) before school, when I come home at lunch and after school so I hope that will be enough. Wish me luck!

 

[Jamie]

Sounds like you have a good, logical plan for returning to work. If you find that a full day is a bit much, even with your noontime resting, maybe they would allow you to work a half-day schedule for a while. I’m glad to hear your Lounge Doctor is helping with the recovery. We hear from so many people who love them and they do help promote good circulation in your legs.

Congratulations on your progress. Knees are a long term project, for sure. Best of luck as you return to the real world!

 

[EalingGran]

Good luck for working. Hope all goes well.

 

[sistersinhim]

Praying for a successful return to work without much complaining from your knee! You can take ice packs with you, too, and find a way to elevate during your work day. Anything would be a help.

 

[Jammy]

Hi, It has been a month (February is gone) since your post. I would like to know if you've had any improvement. It is exhausting, going through this. I have had similar experiences to yours. I am 10 weeks post-TKR (also known as the Dragon). One thing, I am in Florida so I don't know how different things are where you are in Canada, but after several talks with my doctor, she eventually prescribed a 6 day steroid pack methylprednisolone for the swelling. It did seem to help with the swelling. That said, I still have some pain and am taking tramadol or Advil. The tramadol helps more, but causes constipation more than Advil. With Advil I have to take it with a couple of crackers. Not only is this surgery a pain in the knee, it is a pain in the butt and the constant struggle can get depressing. That is why I joined this forum. My experience so far is there are good days (rare) and then the Dragon shows up and says, NO WAY, and you have several bad days, and the Dragon says GOOD! I have noticed that I hurt more during and after physical therapy and am tempted to stop that, even though it's supposed to be so helpful. I stick with it because I don't want to fail in my recovery and this is what my doctor wants me to do. I hope you are healing now. Let us know.

 

[Jamie]

@Jammy.....might I suggest that since you experience definite pain (and probably some swelling) with your therapy, that you not stop it, but instead take some control over what is done? You can tell your therapist that you want to not allow them to manually push your knee or, if you do prefer to have them manipulate it for you, insist that they stop at the point where you are experiencing mild discomfort and not actual pain. You need to let them know that you have pain after you're at therapy. This means you're overdoing it for this point in your recovery. Keeping your knee "hot" and inflamed from pain is not good. You should never have pain in the day following a session. It's your knee and you are in charge of what is done to it. Trust your body and the signals it is sending you. There is honestly no "one size fits all" recovery. You are actually very early in this process at just 2 months out from surgery, so it's very normal to experience for you to have some painful days. Be sure you're icing as much as possible (even at night when sleeping). Ice is good for swelling and it works on pain too.

 

[EalingGran]

Be sure you're icing as much as possible (even at night when sleeping). Ice is good for swelling and it works on pain too.

Agree with this.
I am at 4 months now and doing pretty well ( although it has been a bit of a roller coaster).
I use my Aircast Cryocuff at night even now. I just lay it loosely over my knee and refill the cool water jacket if I wake.
I still get a little sore and warm by nighttime and I find the iced water soothing.