TKR Something isn’t right..

[lovetocookandsew]

I agree that at just over 3 weeks out, your knee is at the very early stage of recovery. Give yourself a break and relax. Don't stress over every little thing, or worry about studies and the results. Instead, listen to YOUR knee and it's reactions. Pay attention to things that stress it out, causing more pain and swelling, and also to things it doesn't mind. Those things will change, sometimes daily, sometimes weekly, and so on. But listening to your knee, instead of endless searching for studies on what other people's knees did, is a much better use of your time. Because every single person is different, and their knees are also different, no study or recovery path is going to exactly match yours, even though there will be some similarities.

As for the cryo cuff's squeezing being too uncomfortable, can you turn off the squeezing part and just keep the ice circulation part on? If not, can you consider a different ice machine? I loved my ice machine, and used it as much as possible during the day, and all night long every night. It was my only outlet for pain relief as I can't take any narcotic pain meds, so had to rely on the ice for pain relief. It kept my pain to a minimum, so I was able to go through recovery with minimal pain, which most people are able to take pain meds to help. The ice machine also helped with swelling, which is also a cause of pain, so it was a life saver for me. As long as you keep a cloth between the ice wrap and your skin, plus get up every hour or two to walk around and do gentle stretches, and other light tasks as outlined on the activity progression I've linked for you, you can ice as much as you want.
Activity progression for TKRs

 

[dotski]

Definitely listening to that knee and constantly analyzing and trying to adapt and modify based on what it does. I think it’s human nature to seek answers to problems, and as a science-oriented person I’m definitely looking for objective findings to help guide what to do after listening to that knee.
But you make a good point in that no two knees are alike, this is my own journey; this is of course the weakness of scientific studies that need large numbers of people to be statistically valid. Getting a homogeneous group is near impossible. So I take the research with a grain of salt and always do ask what I do and don’t have in common with the study subjects.
These discussion boards are an invaluable resource of case studies to look for patterns in those whose stories are similar, and I very much appreciate the sharing others have done (why I’m documenting the recovery ups and downs here, appreciating the feedback and support!)

 

[dotski]

Oops, about the ice machine. It’s an Aircast brand cryocuff. My mom gave/loaned it to me. There is no option for a steady flow without compression. I wish I had a way to try out another model, but small town, no shops that sell nor rent. Same thing with personal reviews - could be glowing reviews but then it doesn’t work for me. I’d have to order online, blind.

I’ll see if I can find a thread about cryocuffs, but they would have to be available in Canada for me to avoid custom charges and shipping delays. I wouldn’t mind one that was more circumferential and quiet.

 

[JusticeRider]

Hi Dotski, I’m so sorry things are difficult right now. These knee replacements can make you crazy. Between the pain, the slow pace of recovery, the inactivity, and the conflicting advice, it is a perfect recipe for depression and anxiety. It also doesn’t help that because every experience is so different, it doesn’t even feel like there is a ‘normal’ baseline to compare yours to. There is no normal, and that is maddening.

Speaking of which…

I have had an autoimmune attack earlier this year

The patients my colleagues see all do traditional PT and are advised to medicate and tolerate some pain during stretches…..and they on average have more range than me at this point.

My PCP told me that many autoimmune disorders increase the inflammatory response. So any trauma to the body can cause an outsize reaction for those of us with autoimmune challenges. That means we get more swelling. Guess what swelling does (besides make you miserable?)…it inhibits ROM.

So maybe the average patient does have more range of motion than you (maybe not), but your knee is not anyone else’s knee. Your body is not anyone else’s body. We all bring our own unique challenges to this recovery. Some of us swell a lot! I’m sorry you’re struggling, and I want you to know you are not alone. From one sweller to another

 

[Katt]

Sleep deprivation does crazy things to my normal sense of optimism and hope. It doesn’t help that my tooth that I had root canal on last March has started to ache a bit again. I dearly hope it is inflammation, not infection (gums are still pink/healthy)….as I add obsessive oral hygiene to my daily routines.

I think I need to add re-reading my favourite poem “Desiderata” to the list too. “Many fears are born of fatigue and…”

For me, sleep deprivation made things much harder. I slept poorly until about 10 weeks and despaired daily. My ROM is still in the 90s at 12 weeks. While I would like it to be better, I also am still swollen plus having IT band issues. So I am forced to be more patient than normal. So thankful for all the people sharing their experiences on here making me realize knee replacement isn't one side fits all.

 

[Ladytwo]

It’s been painful for me reading about all you are going through! Triggering memories. It was rather awful for me too. Now, two and a half years later, all I feel is that tightness across the knee cap on one knee. No pain. You are coming up to four weeks, which has been labelled as a turn-around point. Hope it is for you, although I fear it may take a bit longer with all the trouble you had with meds. I still am sure it will come for you; it’s looking much better already. Remember not to assess based on today—look back two weeks, three weeks, whatever, and you will see the progress. Hugs. Mom.

 

[mendogal]

Oops, about the ice machine. It’s an Aircast brand cryocuff. My mom gave/loaned it to me. There is no option for a steady flow without compression. I wish I had a way to try out another model, but small town, no shops that sell nor rent. Same thing with personal reviews - could be glowing reviews but then it doesn’t work for me. I’d have to order online, blind.

I’ll see if I can find a thread about cryocuffs, but they would have to be available in Canada for me to avoid custom charges and shipping delays. I wouldn’t mind one that was more circumferential and quiet.

My machine compressed uncomfortably, so I used it without affixing the velcro straps. I don't know if yours secures with straps but just laying it around the leg will cool things!

 

[Mutti3]

@Ladytwo
Very sweet and encouraging!

 

[CatieViv]

OS prescribed 1-3 mg hydromorphone every 3 hours. Plus 1000mg Tylenol. I came home with 100 1 mg tabs, but at this rate I’ll run out long before I see the OS for staple

Wow! I was given 1-2 mg hydromorphone every 4 hours and only 5 days worth. Plus Tylenol. I had to give an arm and a leg to get another 5 days. And was told I shouldn't need opioids by day 10! Then had to fight to get tramadol as hydromorphone made me through up on Thanksgiving (Canada). I had my surgery September 29.

 

[CatieViv]

’ll see if I can find a thread about cryocuffs, but they would have to be available in Canada for me to avoid custom charges and shipping delays. I wouldn’t mind one that was more circumferential and quiet.

I got mine from OrthoMed. I'm in Canada too. This is the one I got.

New DonJoy IceMan Classic3 Cold Therapy Universal Pad System​

It's pretty quiet .

 

[dotski]

Right TKR Sept 27, almost 3 months ago. Prior to surgery was active in outdoor activity, hike, bike, XC ski. Used to scramble up mountains for fun. Nordic is my passion and got into recreational marathon races for fun. Losing ability to do all that, especially hiking with my kids, made me opt for surgery rather than live with it and become increasingly disabled by the knee (s). OS said my left X-rays are just as bad.

Rough recovery. Lots of bleeding into the tissues, tourniquet injury, quads shutdown. Posted here and received much emotional support, for which I am grateful. But left forum for a while to focus on rehab and family (kids at home). (And I also posted too much personal stuff in my drugged up state and would rather not dredge up the old thread). I got my flexion back after starting out with a very limited amount of bend (from about 20-30 when the bulky came off). Extension - still struggle with due to knawing pain back of knee any time I try to stretch. Also have some hamstring snapping (lateral side).
Pain and dysfunction is really my biggest issue. I’m pretty certain I have some degree of arthrofibrosis based on reading countless old threads (And wow, I didn’t realize back in the day you had orthodoc weighing in also - what a great thing that would be). And some autoimmune dysfunction. And my history of growing a very scarred plica that knawed the cartilage off my medial femoral condyle. It feels like my synovial tissue is growing back and not in a nice way - tight bands all around (which I realize is normal early on…but shouldn’t it start improving by now?)

And just noticed I seem to have a lax MCL…I notice more play on my right TKR knee than my left. I tore MCL when young and healed it conservatively in a brace and it was solid before surgery. I also “clunk” with every step and even just passively hanging my knee and letting it swing it clunks. I know some degree is normal …but every step?

Patella tendon has pain and sometimes a lump of swelling beneath(?) and beside it. Quads tendon and pain all around kneecap. Can’t yet sleep on my side at all and I’m constantly sleep deprived, often awake a few hours in the night, due to pain. I still have leftover opioids for when I’m desperate but it’s hit and miss and they make it impossible to function next day. Tylenol does nothing for me, never has.

Increasing activity increases inflammation so I am taking it super slow. Celebrex helps. But stressing about running out of sick leave. I can’t really sit, stand or sleep long enough to do any aspect of my job properly yet.

So of course I’m headed down rabbit holes of “what if…”
I’m thinking there could be some soft tissue balancing and alignment error in my knee (courageous conversation with OS coming …not sure how I will approach this gently). Like - how normal is it to be able to manipulate your knee into a bit of valgus and feel a clunk? How come my kneecap pain isn’t getting any better and is far worse than it ever was? Sure it’s great I can load a straight leg without it bottoming out and getting that sharp bone on bone pain…but at this price?

Improvements are very slow. My quads are seized like a rope and not helping my natural kneecap to not lose more cartilage due to grinding. but starting swimming has possibly helped them start to relax. I do a really weak flutter kick and front crawl and stretch - I need cardio. Anything else hurts in the pool so I don’t do it.
Stationary bike doesn’t feel great and knee has crepitus (I have my natural kneecap still and am questioning now my OS decision)….so I’m going slow. And trying to find the sweet spot of “motion is lotion”.
Tried short XC ski on totally flat tracks and it hurt a bit but I felt ok next day and the rest of my body needs it - so when conditions permit will do more. I was a cross between Bambi on ice and a sloth

Leg is weak, and I’m switching to isometrics strengthening (eg leg raise, etc) as anything moving it through full range irritates it. I had a disagreement with my PT over this …”no thank you I do not need open chain with weights”. Yes I know your textbook says research shows it activates quads best - but it hurts and it is a dumb exercise if you ask me, not a natural movement. A couple other things hurt me and I got sick of his mansplaining and constantly interrupting to talk over. My PT experience was great with all others otherwise. Win a few lose a few and sometimes it’s just not a good fit.

Sorry this is rambly and negative. I guess I figure it was time to start a thread and hope that some magical answer will appear. And hopefully one day if/when they do I can come back here to close the loop and maybe help someone else who sees themselves in my post.
I’m not really looking for “don’t worry, relax” responses. Maybe just some ideas on concrete things to try and questions to ask my OS in 4 weeks. I’m seeing a new PT starting next week. Hope I actually am just being too impatient, but my gut says otherwise. Knee feels too unstable and isn’t tolerating much more than 1500 steps in a day without being angry at night.
Thank you if you made it this far!

 

[Roy Gardiner]

You'll notice that I have merged your newest thread with your original recovery thread. For several reasons, we prefer that you only have one recovery thread:

• That way, you have all your information in one place. This makes it easier to go back and review your history before providing advice.
• If you start new threads, you miss the posts and advice others have left for you in the old threads, and some information may be unnecessarily repeated
• Having only one thread will act as a diary of your progress that you can look back on.

So please post any updates, questions or concerns about your recovery here.