PKR Something is not right

[tejubeha]

So I made it to the "other side" and it was quite an adventure. The surgical staff struggled a little bit with pain management for the first 24 hours. I am not sure if it was related to the nerve block (that I never really felt was working) or something else but they figured it out and I was up moving on post-op day 1 and was discharged post-op day 2. My PT has visited me twice and is very pleased with my progress so far, I wish I could get my knee to bend a little more. I am only at 70 degrees and there is still a great deal of swelling. So far I guess things are progressing as they should. I know I have a long way to go, I am just an impatient type A who thinks I can speed up the timetable, although in my heart I know I cannot.

 

[Pumpkin]

@tejubeha ,
Welcome to the other side!

Sounds like you are doing well, your ROM will come around as your swelling resolves.

I am just an impatient type A who thinks I can speed up the timetable, although in my heart I know I cannot.

Your heart is right, you cannot speed up this recovery, though you can slow it down by doing too much too soon.

Here is your copy of the Knee Recovery Guidelines, the articles are short and will not take long to read.

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
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​

6. Access these pages on the website

Oral And Intravenous Pain Medications
Wound Closure​

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.

 

[Denny39]

Hi @tejubeha
Day 2, 70 degrees of flexion, still a “great deal of swelling”, and you wish you could move it more? You and I have a common challenge. In my early days, one member posted, “This recovery is NOT for the impatient among us”; we are both in that group apparently. Patience is not one of our strong points; we cannot speed the time table up; so we may as well relax and enjoy the show. I am of course being a bit facetious when I use the word “enjoy”.

But you are right it seems. Things are probably progressing just as they should, and will continue to at their own pace. We are all different, and the challenge is to let our bodies talk to us and guide us through our own individual path to recovery. I thought pre-op that I would be up and running full-speed again at 4 - 6 weeks. Nope! I am at 13 weeks now, and doing well. Short-term recovery is considered to be 8 - 12 weeks; long-term recovery 3 - 6 months; full recovery 1 - 2 years.

Following the Bonesmart guidelines in the articles Pumpkin sent you is the most effective way you can speed up the process. How long a minute is depends on which side of the bathroom door you are on. TKR also has a way of slowing time to a crawl, but these weeks will pass, and you will be active and on-the-go again.

I say that as one Type A to another. Welcome to the club.

 

[Lilli215]

@tejubeha it’s certainly a recovery that wasn’t designed for the impatient amongst us!! It’s even worse for me coz this is my second knee (first was two years ago) and I’ve got it into my head that this recovery is way slower than my first, everyone assures me that it’s not but tell that to my subconcious. Please take it easy and dont try to do too much, all you’ll do is lengthen the recovery process and that is a no no for us Club Impatient membersi

 

[Lindylee]

Great advice from Denny and Lilli. If you have a great deal of swelling you're not going to be able to bend your leg well. Ice and elevate to get the swelling down and try doing just 2 or 3 gentle heel slides every hour or so, but not to the point of pain.

I'm quite a patient person, but the slowness of recovery has got to me from time to time and impatience put me back at least a week, so don't make the same mistake I did and overdo it. Take care now.

 

[maryo52]

I am just an impatient type A who thinks I can speed up the timetable

I think we all belong to that club!

I had to wear a knee immobilizer for a week because my wound was hard to close. When that came off I was at 70. It was really tempting to push my knee because I was quite fearful of developing adhesions, which happened after my original TKR. But I was good, I only ever bent my knee to the point of tightness and not pain, just did it consistently and now I'm at 120. That and quad sets are about all I did for 6 weeks. I arranged to have projects I could do while resting (+ icing and elevating). I just totally babied myself. And already I hardly think about my knee, it feels that good. BTW I am not only Type A but have A+ blood and did earn my share of As in school growing up.

 

[Irish471]

@tejubeha, how is your recovery going? I hope things are moving along nicely

 

[tejubeha]

Hi @Irish471, things are moving along nicely. PT was here again yesterday and I was at 78 degrees. Today is a "light exercise day" and I am resting most of the day. The pain is tolerable and I am relying less and less on pain medication. It feels like most of the pain is coming from the medial femoral condyle where I had the cartilage graft. It is a "Catch 22" situation I want to be able to bend the knee more to get my ROM back but bending the knee puts the cartilage graft in contact with the tibia which creates pain. I know this will get better over time and I have to remind myself that I am just nine days post-op. I know your surgery is Monday, prayers going up with your name on them. My best advice, based upon my 10 days experience is to move as much as possible. My knee feels much better when I am up and moving versus sitting.

 

[Irish471]

@tejubeha, that's great to hear that things are moving along nicely! And yes, I totally agree, moving around made a huge difference to me when I had my other surgery. I just got the call this morning. I am first up on the surgery schedule. We have to be at the hospital at 5:15 a.m. and surgery starts at 7:00 a.m. I think I'll probably be going home by dinnertime if all goes well! Thank you for the prayers...I appreciate that very much!!!

 

[tejubeha]

Two weeks ago was my surgery and things are progressing well (I think). Although I was only at 78 degrees on Monday (the same as Friday) my PT is very pleased. The goal by the end of this week is 82 degrees. The pain is manageable at a 4 or 5 with spikes at 7 when exercising. I have kneecap pain with straight leg raises and medial when bending the knee. I hope this is due to quad strength (kneecap) and the bone and cartilage graft on the medial femoral condyle. I am hoping the pain gets better over the coming weeks. I follow up with my OS on Friday and the staples will come out.

 

[sistersinhim]

The goal by the end of this week is 82 degrees. The pain is manageable at a 4 or 5 with spikes at 7 when exercising.

That might be your goal, but maybe not your knee's goal. You should not be experiencing that much pain while exercising. If so, your baby knee isn't ready for that and it will keep your knee inflamed. It's best to do just gentle exercises that don't go over the discomfort pain scale. Over exercising just slows down healing by keeping the knee inflamed, swollen and painful. Take it easy and let your knee be your guide.

 

[tejubeha]

Preparing for an 18 month follow-up with my OS following my PFJ replacement in March 2019. Everything felt good until this summer. It feels really tight and is catching and very painful going up and downstairs. The pain is on the inside and outside right around the kneecap. I had x-rays done last week for the appointment (posted below) and it does not look like the kneecap is in the groove. Has anyone experienced this issue? If so, what needs to be done?

 

[Celle]

Hi @tejubeha ,
I'm sorry you've had to come back with a problem.

Unfortunately, patellofemoral joint replacements do sometimes have a problem with patellar tracking.
Talkto your surgeon about it.

It may be possible to improve the patellar tracking by strapping but, in the wort cases your surgery may need to be revised.

By the way, you'll notice that I have merged your two threads together as we prefer that members in recovery only have one thread.
This is for three reasons:
1. if you keep starting new threads, you miss the posts others have left you in the old threads
2. it often ends up that information is unnecessarily repeated
3. it's best if we can keep all your recovery story in one place so it's easily accessed if we need to advise you.

Please keep all your questions and updates on this thread. Don't worry that we won't see your new question as, between us, the staff read all new posts each day.
If you need an urgent response to a question, just tag a member of staff.
Tagging other members and answering tags

If you prefer a different thread title, just post what you want and we'll get it changed for you.


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