TKR Something isn’t right..

[Mutti3]

Did others find that increased elevation increased pain? I have it up a wall (in bed headboard) reasonably straight at about a 50-60 degree angle on pillows and wonder if it’s just the downward pressure of fluid making me hurt more. Putting it back down on 1 pillow with knee a bit higher than hip bit foot level with knee was a lot more comfortable.

Do what makes you comfortable! I used 3 stacked pillows pinned together. That was very comfortable. Legs up a wall sounds like torture. You had a very rough post op so far.
You are so early in your recover to even think about ROM! It will come back when swelling subsides. Now the need to care for yourself and the baby knee!

 

[dotski]

My PT thinks the foot peddler is what I will need to help move the fluid out. I know from past experience that gentle spinning on my bike helped lubricate and get tissues softening up. The cranks are short and I hope I have enough to turn them around without pain! It really helped my mom who had bilateral TKA a few years ago. Seeing PT in just over an hour.

 

[Jockette]

As much as I don’t want to obsess over ROM, it is very important to me to help get back to yoga, squatting, xc skiing, etc and I need a flexible knee to get up from a fall on skis.

The best way to get back to all that is to not rush these early days. You need time to heal first.

Here is an elevating wedge I bought from Amazon that my knee is happy with. I took that screen shot a while ago, so the price may be higher now.

 

[Layla]

I’m well versed on positioning to reduce swelling, as I’m often positioning patient limbs at work to get swelling down and measure/fit for compression garments (I wear compression myself and swear by it for vein/lymphatic vessel health and believe just about everyone can benefit at some point from it’s help in aiding circulatory return).

Jamie from admin once explained that it is our lymph system that rids the body of fluid (swelling). So you want to get the fluid to the lymph nodes in your torso area so your body can more quickly process it. The lymph system works rather slowly on its own and much more efficiently with the assistance of gravity. The fluid isn’t draining into the hips, but contained with the lymph system and moving to the torso and lymph nodes located there.

BoneSmart FA, CricketHip, is involved in Therapeutic Massage and has shared this exercise to assist in manual lymph drainage. This gentle, yet effective therapy will help prime your lymphatic system to move fluid and inflammation away from your leg, which in turn will help your range of motion and pain - you may want to give it a try and tag her if you have any questions.

While lying supine, take deep breaths...deep, as in breathing in to a count of 5, 4, or 3 seconds, whatever is most comfortable for you. Hold that breath for another count of 5, 4, 3 then blow out completely, still using the count that's comfortable for you. A series of at least 6 reps may help get the excess swelling to move. To ensure you are taking proper deep breaths, place your hand on your naval and watch while taking in your breath, if doing this properly you should see your hand move up. Repeat this whenever you feel up to it during the day or night. Lying flat (supine) is best as the lymph nodes seated in your groin are less restricted, allowing for better lymph flow.

In addition, after the breathing exercise, place your hands lightly on your upper thigh, at the crease in your groin and lightly stroke upwards towards your naval. Be patient because it can take the body time to respond.

I read this recently - After a sports injury or surgery, lymph vessels can become overwhelmed with the demand placed on them. When tissues are swollen, deep tissue techniques may actually cause damage to the lymph vessels and surrounding structures. Lymphatic massage is often the treatment of choice, because it helps the body remove proteins and waste products from the affected area and reduce the swelling. This helps reduce pressure on cells and allows them to reproduce faster to heal the body.

Best Wishes, dotski!

 

[dotski]

As much as I don’t want to obsess over ROM, it is very important to me to help get back to yoga, squatting, xc skiing, etc and I need a flexible knee to get up from a fall on skis.

The best way to get back to all that is to not rush these early days. You need time to heal first.

Here is an elevating wedge I bought from Amazon that my knee is happy with. I took that screen shot a while ago, so the price may be higher now.

That’s a much more reasonable cost. Thanks for that!

I’m well versed on positioning to reduce swelling, as I’m often positioning patient limbs at work to get swelling down and measure/fit for compression garments (I wear compression myself and swear by it for vein/lymphatic vessel health and believe just about everyone can benefit at some point from it’s help in aiding circulatory return).

Jamie from admin once explained that it is our lymph system that rids the body of fluid (swelling). So you want to get the fluid to the lymph nodes in your torso area so your body can more quickly process it. The lymph system works rather slowly on its own and much more efficiently with the assistance of gravity. The fluid isn’t draining into the hips, but contained with the lymph system and moving to the torso and lymph nodes located there.

BoneSmart FA, CricketHip, is involved in Therapeutic Massage and has shared this exercise to assist in manual lymph drainage. This gentle, yet effective therapy will help prime your lymphatic system to move fluid and inflammation away from your leg, which in turn will help your range of motion and pain - you may want to give it a try and tag her if you have any questions.

While lying supine, take deep breaths...deep, as in breathing in to a count of 5, 4, or 3 seconds, whatever is most comfortable for you. Hold that breath for another count of 5, 4, 3 then blow out completely, still using the count that's comfortable for you. A series of at least 6 reps may help get the excess swelling to move. To ensure you are taking proper deep breaths, place your hand on your naval and watch while taking in your breath, if doing this properly you should see your hand move up. Repeat this whenever you feel up to it during the day or night. Lying flat (supine) is best as the lymph nodes seated in your groin are less restricted, allowing for better lymph flow.

In addition, after the breathing exercise, place your hands lightly on your upper thigh, at the crease in your groin and lightly stroke upwards towards your naval. Be patient because it can take the body time to respond.

I read this recently - After a sports injury or surgery, lymph vessels can become overwhelmed with the demand placed on them. When tissues are swollen, deep tissue techniques may actually cause damage to the lymph vessels and surrounding structures. Lymphatic massage is often the treatment of choice, because it helps the body remove proteins and waste products from the affected area and reduce the swelling. This helps reduce pressure on cells and allows them to reproduce faster to heal the body.

Best Wishes, dotski!

This is very helpful info, thank you! My PT today said something similar about using breathing to help.
It was such an encouraging visit. I can’t do a full turn on foot peddler but got it going back and forth and I noticed a difference right away. I’m about -15 and got up to 65 by the end of session. she was very optimistic about getting a little bit more every day. Said I’m well on track for my ultimate functional goal of 135 (I was full knee-bum prior to surgery - stretched religiously to get that after meniscus injury).

Got some tips on when to let it sit and slow stretch (pain free, and as long as not in spasm)- basically when I feel the pull in muscle. But I have a lot of swelling deep inside joint and for that she said the repetitive gentle ROM (eg back and forth on foot peddler, or other similar motions that gently engage the calf/quad/glutes ) is the best way to get deeper level fluid milking out of the joint. Every hour or 2 if tolerable and should see a tiny bit of progress as the day goes on. Elevation alone isn’t often enough for that. She said the surface stuff like compression, massage is good for the fluid close to surface, but that the deeper stuff needs the ROM. She also said to not be discouraged if every morning feels like a scene out of Groundhog Day (movie reference, lol) and I’m back to being more stiff. Just aim for a tiny bit more by end of the day. She was confident the patient and persistent approach would work. Once staples come out I will be able to let it stretch more.

Oh - and I finally felt my kneecap today! It had all but disappeared into a sea of muck until today.
I’m expecting a bit of rebound swelling so have leg up with ice on it now.

 

[EalingGran]

Also wondering what others’ OS’s had to say about using NSAIDs like Aleve/ibuprofen, etc.

My OS was fine with me using Naproxen pre and post- op. I found it helpful in the early months. I also took it for my lumbar arthritis. I didn't want to take it long term due to kidney/ heart risks but I don't think it slowed my recovery. I don't take any painkillers now at 11 months.

I know the philosophy here is go slow to go fast so I’m trying hard to keep ROM to gentle. I’ve hired private PT (whom I trust and know already) to see me at home today to get going on a foot peddler. As much as I don’t want to obsess over ROM, it is very important to me to help get back to yoga, squatting, xc skiing, etc and I need a flexible knee to get up from a fall on skis.

I think if you had really good ROM before then that is a good indication of post op ROM.
I have great ROM (150 flexion) and I never pushed my knee or did anything painful. I used pilates as my main rehab and my knee is both strong and flexible.
I can squat and get up from deep flexion ( pushing up to get out of the bath). I have slight pain (1-2 out of 10) doing this- but I had a PKR and still have a bit of arthritis in my unoperated patellofemoral compartment.

 

[dotski]

POD10 and the fatigue is overwhelming today! I’ve only been out of bed to go to bathroom (and thankfully a BM with a little help from dulcolax). Had a better sleep and milestone of tolerating sidelying was hit - hoorah! Taking tramadol/gravol/cyclobenzaptine at night for sleep and naproxen (nsaid) daytime for swelling. I’ve lost weight and need to up my nutrition - hence easing off daytime opiates so I can eat.
Still very stiff and swollen knee, but I think the naproxen helps a bit.
Heartrate still abnormally high for me. I’m avoiding caffeine.
Yesterday was a painful/swollen day, went backwards a bit. Tears a few times wishing I could go back in time. But on a positive note, ate more than I have in a while and being able yo finally tolerate sidelying with pillow support is helping my minor bedsore on tailbone heal (acquired in OR and recovery - I broke it I think when I was young and it has always been prominent and prone to pain when pressure on it).
But today…the fatigue! Can’t get out of bed. My last hemoglobin was 94 (pre-op 127) so I think that is maybe part of the strain on the heart/fatigue. I had some minor ecg changes that were attributed to the stress of surgery, etc. and emerg doc and Internist were not overly concerned once they ruled out a lung clot or heart attack.

 

[dotski]

Mods, probably worth changing title of thread to Slow Recovery of a Youngster. Sorry I don’t know how to do that. Thanks!

 

[sistersinhim]

I changed your title for you.

Heartrate still abnormally high for me.

I imagine this is because of the stress of the surgery and some blood loss. Every time I donate blood, my resting heart rate goes up for a few weeks, then comes back down to normal. I bet yours will, too.

Yesterday was a painful/swollen day, went backwards a bit. Tears a few times wishing I could go back in time.

You are on a rollercoaster recovery, which every one of us has gone through and will go through. Your up and down days are all part of the normal recovery. As time goes on you will have more up days than down days.

 

[mendogal]

@dotski the fatigue, swelling, pain and accompanying despairing "what have I DONE!?!?" .... you're in good company here.

My best advice is to literally breathe deeply and surrender to your knee basically running the show for now... kind of like a 10 day old infant but without the adorability factor. The good news is your baby knee responds well to consistent meds, rest, ice, and elevation, and will start maturing faster than a baby... and you needn't save for summer camp or college tuition!

 

[Mutti3]

Fatigue is huge! I stayed constantly in that state for 5 weeks! Will be six weeks Monday can feel that terrible weight of fog and exhaustion finally lifting. Lost of bit of weight( will try to keep it off). Mentally exhausting to worry. Trust and be kind to yourself.

 

[dotski]

Aw, thanks everyone! Such a helpful supportive community here. It’s almost dinner time and I think I will get out of bed now . Been doing a lot of reading of others journeys, wiggling around and massage. I am hoping swelling will go down as the muscle tension subsides. The muscles were always the driver of any swelling I had pre-op, and once I found the right ball, theracane, roller (aka torture devices), I could often loosen things up to lessen the grinding. I’m definitely not doing any aggressive digging now though- just trying to get the muscles to wake up and relax.

 

[mendogal]

A caution: muscle tension is NOT creating the swelling now. Many of us essentially had near flaccid muscles immediately postop, with massive swelling. Post injury and post op swelling is due to tissue trauma. Any form of pressure work at this point will aggravate things.

 

[dotski]

A caution: muscle tension is NOT creating the swelling now. Many of us essentially had near flaccid muscles immediately postop, with massive swelling. Post injury and post op swelling is due to tissue trauma. Any form of pressure work at this point will aggravate things.

Good point. The muscles are so ropey and sore. The top of my knee is so puffy. I assume it is ok to sleep with my Aircast cryocuff running all night giving cold compression to the area? It seems to help numb the pain a bit, but I’m so sick of having to sleep on my back with this sore tailbone. I tried to go on my side again, but it took what felt like 10 minutes to get there only to feel like the kneecap was getting torqued sideways. Another sleepless start to the night..

 

[Mutti3]

I used ice 24/7 the first 2 weeks. Do you have a foam layer on top of your mattress? Like a pillow top mattress? That might help the sore tailbone.

 

[CricketHip]

@dotski Please continue the deep breathing with the hand compressions as @Layla mentioned on post #44. Most of our body’s lymph nodes are in our abdominal area and doing this is much less traumatic than trying to did rotations on the bike pedals.
Gently massaging with light compressions over the lymph nodes in your inguinal/groin area helps too.
I hope this helps!!

 

[sistersinhim]

I assume it is ok to sleep with my Aircast cryocuff running all night giving cold compression to the area?

Yes, it's fine. I did the same thing. When the ice melted and the water warmed up, I'd wake up in pain, refill the ice container, and then shortly go back to sleep.

 

[Susie-Q]

There is a theory I've read of for several years: that inflamation itself, being a part of the normal immune response to injury (not as in an allergy or autoimmune response that is clearly disproportional and counterproductive), aids in healing by increasing vascular flow (and coincidentally getting us to slow down).
I believe this is why a current forum participant was specifically told by her OS to avoid icing and elevating.

I would think this would lead to people needing more pain meds since ice is a natural pain reliever. I can't imagine not having ice with my two TKRs.

But today…the fatigue!

So totally normal. This is why you don't want to push yourself doing too many exercises, house chores or activities in these early days. Your body needs all its energy for healing! Make sure to allow yourself as many naps as you can during the day.

I slept with the ice machine wrap around my knee all night and bags of crushed ice during the day for weeks and weeks! For those that use an ice machine, put 4 frozen water bottles in with the water, it will stay much colder for much longer than cubed ice alone.

One day at a time, @dotski! From one "youngster" to another.

 

[mendogal]

Can you get a cheap eggcrate matress overlay (used?) and cut out a depression or hole for your tailbone?

 

[JusticeRider]

@mendogal, great idea! @dotski I relate to much of what you’re going through. The opioids made me very sick also, and I think like you my body was just angry about ALL the drugs and trauma. I couldn’t keep anything down for the first week, was sick, blacking out, and hallucinating. The nurse on call the second evening had my husband call 911 because she thought I may be having a stroke! My first time having an ambulance come to my house…yikes! Fortunately I was not having a stroke. The very kind and handsome EMT’s determined I was very dehydrated and weak and my blood pressure was quite low. They advised changing medications but two other drugs we tried also made me sick, so I had to bare knuckle it on Tylenol.

I also struggled with sore heels lying on my back in bed. They would hurt so bad at times it was almost worse than my knee! Like you, I could only tolerate lying on my side for 5 minutes or so the first few weeks. I hope you find a solution to your sore tailbone. If you do, please share! Maybe I can try it for my heels next time. Tylenol PM helped me quite a bit, how I wish you could take it! Although it sounds like you have a med combo that is helping with sleep at least somewhat.

As for the ice, I too read (somewhere?) about the possibility that ice could delay healing due to suppressing the natural inflammatory response that aids in healing. In my case, I had no problem deciding to use ice copiously because it was my main pain killer in the absence of opiates. The risk vs benefit for me tipped heavily in favor of ice! Based on your sensitivity to drugs, it seems like it makes sense for you too.

Also, it is an unpopular opinion, but I don’t believe being younger is necessarily helpful in joint replacement recovery. It certainly didn’t help mine, and I was very conservative with my activity, etc. I also think we are given unrealistic expectations, ie. “You’re young! You’ll heal quickly!” Then if you don’t you feel something is wrong and there are even more people ready to tell you that it’s your fault you’re not doing better. We all get enough of that as it is, and it is very harmful to mental health. Anyway, so sorry to leave you a novel, but I just have so much sympathy with what you’re going through. You are not alone. This community is amazing and you can always come here with your highs and lows and find support. Rooting for you, @dotski !