TKR Something isn’t right..

[Mutti3]

Your incision looks good! When you shower just let the clear water run down your incision. Pat dry, leave open to air.

 

[sistersinhim]

Has anyone used such a product, have any suggestions?

We recommend this:

Just clink on it on the side bar. I always keep this on hand.

 

[dotski]

Has anyone used such a product, have any suggestions?

We recommend this:

Just clink on it on the side bar. I always keep this on hand.

Thanks! I’ve investigated and haven’t found a supplier in Canada, and it looks like it could take up to 4 weeks for international shipping. Any options anyone knows of available in Canada? TIA

 

[Cinders2023]

Anyone out there have a Zimmer-Biomet “persona” knee components? Mine is the posterior stabilizing one (replaces the PCL that he removed).

Methat is exactly what I have!

 

[dotski]

3 weeks out now. About 80, maybe 85 of passive flexion (active not great). Still short of full extension by about 10 degrees.
Still not sleeping. Some nights have been only 1-2 hours broken, most maybe 3-4. Last night over 6! I broke down and took a tramadol (trying to stop and I only have 2 left now)….but I think the muscle relaxant bigger dose helped more. It’s just discomfort - such a struggle to get comfortable hooked up to a cryocuff. And various other muscular issues. I can’t wait to not need it. I need to be an octopus to manage it all. But as soon as I’m without ice, my knee swells and gets very warm.

Yesterday had a phone appt with my family Dr. She is lovely/caring/kind. My labs are good but she wants to recheck some next week (including my Tylenol levels). I got the green light to try up to max 2g Tylenol per day (spread out)….with caveat of rechecking labs in a week to see how my liver is doing. It’s such a bizarre thing - I’ve always been healthy, hardly drink (half glass of wine and I feel a bit tipsy), don’t normally take meds, just some supplements (eg iron, mag, d, c, turmeric, probiotic), but not excessive.
She also happily renewed my muscle relaxant (cyclobenzaprine) to help me sleep at night. Also extended my celebrex as it has been helping a bit with knee…but mostly with my hands (which are getting a lot of use massaging, etc).

For anyone wondering about NSAIDS - I used to take naproxen(Aleve) (for years), then developed a bit of heartburn and had an episode of acute colitis (needed a med for it). All completely resolved within a few months of quitting all nsaids.
So far my body seems to tolerate the celebrex well! I would ultimately like to get off every med due to health risks, but can’t see that happening for months.

 

[mendogal]

For sleep.... you might try an herbal sleep blend that includes valerian, and/or low dose sustained release melatonin; they helped me immensely post op... IIRC my sister has used a combo that included both valerian and melatonin.

 

[Mutti3]

Sleep is always difficult after knee replacement. I guess it is the nature of the beast!
Seems like the most I can sleep is 7 hours straight. Sometimes take a nap mid morning. It will take time and patience to return to a good night sleep. Not quite there yet. My Fitbit “ tattles” on me, sleeping only fair. As @mendogal referred, melatonin very helpful. Is melatonin a prescription in Canada? I know in US , it is OTC.

 

[benne68]

3 weeks out now. About 80, maybe 85 of passive flexion (active not great). Still short of full extension by about 10 degrees.

It is much too early in your recovery to worry about your range of motion. Your knee is still very swollen from the manhandling during surgery -- even if the external swelling is down, it is still inflamed inside -- and you cannot bend and straighten with swelling in the way.

You might want to re-read this article: Swollen and stiff knee: what causes it?

Elevate and ice, ice and elevate as much as possible to help the swelling go down and you will see big changes to your ROM.

 

[dotski]

thank you all for the tips! I can get melatonin over-the-counter here. I’ve never actually tried it before. I’ve never really had trouble sleeping before surgery as long as I wasn’t in an acute OA flare. My issue with sleep is due to pain (sharp stabs of occasional pain around kneecap) and physical discomfort (muscle rigidity and spasm). Trying to roll over with cryocuff on and a leg that I can’t yet lift independently Did melatonin help anyone with those aspects of sleep deprivation?

Im pretty much icing and elevating around the clock whenever not puttering for ADL stuff. Lying down with leg nearly vertical a few times per day. Wearing compression thigh highs and occasionally add 6” wide tensor over knee for additional compression. Lots of massage.

But today, with difficulty, I manage to lift my leg a couple inches off the bed. I couldn’t hold it totally straight…but it’s a sign that hopefully the swelling is coming down enough to wake up the quads. I have skinny legs so my swelling may not look terrible to others….but the internal swelling is still there.

 

[Mutti3]

You can try melatonin, start at the lowest dosage.

 

[dotski]

I looked up melatonin on the Mayo clinic site and was optimistic when l first read about it…but then got to the part where they advise to not use it if you have an autoimmune condition (it can amp up immune system response). Since I have had an autoimmune attack earlier this year of what was felt to be mild crohns or colitis (the pain and symptoms were anything BUT mild though! I had to wait 3 months for a scope and was in remission by then thanks to Pentasa(5-ASA)….it doesn’t look like I should use it :(
I also had an elevated rheumatoid factor, in addition to inflammation in bowels showing up on the CT scan

 

[dotski]

It is much too early in your recovery to worry about your range of motion. Your knee is still very swollen from the manhandling during surgery -- even if the external swelling is down, it is still inflamed inside -- and you cannot bend and straighten with swelling in the way.

You might want to re-read this article: Swollen and stiff knee: what causes it?

Elevate and ice, ice and elevate as much as possible to help the swelling go down and you will see big changes to your ROM.

I have to say that despite I/E around the clock (exception is when up walking in house short distance for adl, fixing a snack, etc), I haven’t noticed any significant sustainable reduction in swelling in knee (only in the thigh). Last night I fell asleep with a gel ice pack on my knee and a couple hours later knee had puffed up more, and so then I put the cryocuff on. It verified I cannot stop the cryocuff at night. But that stupid noisy machine and constant squeezing of knee makes it hard to sleep anyplace other than my back. (Why I thought I’d try a gel ice pack last night to try to get some side sleeping in). So I’m also not getting anywhere close to the sleep I need.

I stretch gently several times per day but also whenever opportunity arises, eg bend knee while brushing teeth, etc. I wouldn’t say I make it painful; I stop at the point of discomfort. Then put ice on and foot up after.

I’m trying to activate quads but they are still so feeble and I feel like my leg will collapse if not careful. I can just barely lift leg off bed, but it causes pain around kneecap (tearing sensation above under incision).

I’m confused by the studies referenced in that link. The latest one referenced seems to contraindicate what Bonesmart says. Unless I’m reading it wrong, It seems to say evidence is showing that early manipulation before 12 weeks results in higher flexion gains. I know Bonesmart has years of anecdotal n = 1 case report stories that show ROM comes in time, and certainly would not meet criteria for even level C evidence standards. This only is capturing a certain subset of the population and there is inherent bias in these results. I am happy that the Bonesmart way has worked for some, but I’m afraid it’s not working for me so far.

Yes 3.5 weeks is still early…but acute injuries at this point are undergoing tissue remodeling and scar and adhesion can be forming now. 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. So I am of course very concerned that my knee has so little active movement. I am feeling my restriction in flexion at kneecap and just above, feels like a tearing sensation in muscles close to the quads tendon. And also generally tight all over.

ROM is critical to me for my quality of life. I’m active and need to be able to return to mountain biking, road cycling yoga, nordic skiing…and want to return to masters racing.

I have never been one to do well with not moving - I develop stiffness easily and the reason I had TKA in the first place was due to an irreversibly scarred/fibrotic tissue (plica) that wore the cartilage off my medial femoral condyle and impinged in the knee joint. OS said no scope, only TKA due to damage elsewhere. OS removed the plica and synovium.

Anyway, I know this is not the glowing report that people would like to see. Next week I start outpatient PT (I put it off a week thinking it might cause more harm than good and now I am questioning that decision, regretting not doing more earlier (I also had 2 home visits). And I am also returning to my chiropractor who did great work mobilizing my tissues pre-op.

Surely I can’t be alone in questioning who to trust and in wanting to go by the best available evidence from studies conducted with objective scientific rigour?

 

[Jaycey]

@dotski If you think aggressive PT is the way forward for you please go for it. We are not trying to dictate what you do. It's your recovery.

Our approach is backed by many surgeons as well as thousands of members who had successful recoveries. But the choice is yours.

All the best!

 

[dotski]

@dotski If you think aggressive PT is the way forward for you please go for it. We are not trying to dictate what you do. It's your recovery.

Our approach is backed by many surgeons as well as thousands of members who had successful recoveries. But the choice is yours.

All the best!

Thanks, Jaycey. I didn’t say aggressive PT is the way to go, just that I’m not seeing enough progress to be reassured I’m doing the right thing now. I’m just so torn and confused by all the contradictory info from all sources out there. I don’t know what is or isn’t the right way to go about it, and certainly didn’t intend to critique Bonesmart. I’ve appreciated the support so much. saddened and confused by how poorly my knee is doing

 

[sistersinhim]

I was blessed to have surgeons who never pushed PT. They gave me a prescription for it, which I threw away and never went. My TKR OS never even asked about PT when I went back for my 3 checkups! Of course, he knew I was a single lady who had to care for myself and obviously trusted that I would not be just lying around all the time.

Because of birth defects, I had to have 12 knee surgeries, so I've had lots of knee recovery experience. I knew from that experience that I did not need formal PT after my TKR, and neither do many others if they do their own daily activities and do not just sit around all day and night. My knee recovered just fine all on its own with only my daily activities. I didn't have the terrible swelling or agonizing pain many have after taking formal PT. I knew the Bonesmart way worked before Bonesmart was even thought of. My surgeries started in the early 80s, and I never went to PT, even back then. I just didn't see the need for it. Bonesmart was formed around 2004. By then I had already had 6 knee surgeries and rehabbed the Bonesmart way!

So, that is the personal experience that worked for me. It might not work for everybody, but it did for me. I think you need to do your recovery your own way and learn from your own experience. Everyone's recovery is different.

 

[Jaycey]

saddened and confused by how poorly my knee is doing

But your knee is not doing poorly. At only 3.5 weeks all that you are seeing is very normal. And the sleep issues are all a part of this recovery.

Perhaps reset your expectations. This recovery takes one year or even longer depending on how much the knee was damaged pre-op. Baby it for now and be good to yourself. All this is temporary.

 

[mendogal]

I found the way to activate my quads was not trying to lift my leg (OUCH!) but lots of brief sessions of quad sets throughout my waking hours while in the recliner, starting immediately post op. It was what my ortho team recommended despite their "Less is better" approach.

 

[dotski]

saddened and confused by how poorly my knee is doing

But your knee is not doing poorly. At only 3.5 weeks all that you are seeing is very normal. And the sleep issues are all a part of this recovery.

Perhaps reset your expectations. This recovery takes one year or even longer depending on how much the knee was damaged pre-op. Baby it for now and be good to yourself. All this is temporary.

Sigh, good reminder. Darn this patience thing. I had good alignment and full ROM (155 flexion. Knee to bum) prior to surgery. I opted to do it now in order to prevent deformity and further loss of function …in hopes of a better outcome. All the young people I know who had the surgery recovered quicker…so I do admit I had higher expectations. And have to remember the liver/heart issues/ a week of barely controlled nausea/vomiting did set me back.

 

[dotski]

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…”

 

[sistersinhim]

I hope your tooth is OK. Hopefully, it's just sympathy pains for your knee!