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Bilateral TKR Struggling after 5 weeks—normal?

Jockette

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I was right about 4 weeks when my back went out, too. Ibuprofen helped, (I always took it with food) and I turned to my chiropractor. I saw her twice a week for the next month.

I personally don’t know about how tramadol works, so I can’t answer that.

Since your knee is coming along well, just do your daily activities and do what you need to to help your back. I have had back issues for years, and in my knee recovery my back issues came first, I didn’t do anything that my back didn’t like, and I told my PT that. His reply was “well we won’t rob Peter, to pay Paul” It worked for me.
 

Mrs. Ciz

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@CCatz
I’m so sorry to hear about your back! I hope your PT can help with it. I had BTKR on July 6th, so 6.5 months ago. I was 54 years old with 2 bone on bone knees and lots of arthritis. A very active life and sports injuries in my 40s did me in. It has been a long, slow recovery, but I have made progress.

Walker/arm crutches - I only used the walker the first day post op. Then the hospital PT moved me to arm canes. After 4 weeks I went from 2 arm canes to 1. Then eventually I gave up the one arm cane at around 6-8 weeks.

Pain meds - My doctor wouldn’t give me anymore after 6 weeks post op. I was bummed because there were times I still needed it. I still take the max daily dose of Tylenol every day and add in some Advil too. I can’t get through the day without it yet.

Ice or heating pad - I iced my knees several times a day for about 16-18 weeks. I also used (and still use) the heating pad when I’m experiencing soreness. I had a super tight right hamstring that caused (and sometimes still causes) bad behind the knee pain. The heat really helped with that.

Sleep - I slept in my bed with about 7 pillows from day one. I slept on my back at first with knees elevated by a wedge of pillows (saw the picture of a pillow stack on here). After about 2-3 weeks, I tried sleeping on my sides. Left side was most comfortable. But I have not slept well ever since my surgery. I went back to work as a school teacher at 12 weeks. I suffered for 1.5 months on little sleep until I asked my regular doctor for help. She prescribed Trazodone. I sleep a little better with that, melatonin and Benadryl. I’m still taking it.

Stairs - I could go up normally way before I could go down. I worked with my PT on getting comfortable with stepping down for the last few weeks of my PT. Once I got to school, a 3 floor building, I practiced going down a few stairs every day. Now I can go down a whole flight normally. I look a little Frankensteinish doing it, but I can do it.

PT - I went 2x a week for 12 weeks. I worked on strength, balance and a little on flexibility. I did home exercises every day for those 12 weeks. Once I went back to work at 12 weeks, I stopped everything but stretching. At work I walk about 8000-9000 steps a day and do some stairs. That is enough.

ROM - I have no idea what it is now. My left leg is way better than my right leg. Left extension is now zero I think. When I left PT, left flexion was 110, but it’s even better now. Right flexion was 100; right extension was not very good. Extension still isn’t very good. My right leg does not want to straighten. I think it’s that tight hamstring! I have to stretch it EVERY time before I get up to extended enough so I won’t limp. I’m worried it will never be as good as the left leg, which bums me out.

Good luck with your recovery. Try not to worry about it too much. It is a long slow road, but you will make progress!
 
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CCatz

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Jockette, I appreciate your experience. I’ve had back problems before, usually related to my gait, but never chronic. When I consider all the trauma my muscles are going through I suppose I shouldn’t be surprised that my back is flaring but wow, I did not see this coming. The last 2 days have been absolute hell.

PT this morning focused almost completely on my back. My surgeon’s office is calling in a scrip for a muscle relaxant and more tramadol. But if the back pain persists, I was told to see my regular doctor.

The complain of it is that my knees were finally feeling pretty good — stiffness and swelling had subsided a bit, I was moving around well — but they are now a secondary concern, all I can focus on is my back. I can’t lean forward to do stretches or rolling, everything from my hips down is sore, the ADLs I had no problem with are now difficult.

I do have a chiropractor I could call; also considered contacting a massage therapist, even before the back pain started. But so hard to arrange in COVID times and when I’m in such pain I don’t want to even think about getting in and out of a car.

Mrs Ciz, the timeline of your recovery surprises me, can’t believe you used a walker for only a day! And bilateral too! Certainly proves the point that everyone heals differently and at different speeds. I thought my progress was lagging but after two-three days of this back problem, it’s causing me to regress (in terms of ADL capabilities) and that worries me.

My mom thought I was 8 weeks out, not just 5 — I told her I’d like to be living on her calendar! Six months feels like an impossible dream at the moment. I’m glad your recovery is going well. Continued good luck to you.
 

Mrs. Ciz

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@CCatz
Don’t let my use of the walker for only one day fool you. I didn’t really have a choice because my hospital, surgeon, and hospital PT didn’t really like walkers. They preferred their patients to use 2 arm canes. I used these 2 canes instead of a walker. At 4 weeks my out patient PT told me it was time to drop to one arm cane, so I did. At 7 weeks he had me walking around the clinic with no arm cane at all. I figured if I could do it there, I could do it elsewhere. I still took the one arm cane with me everywhere I went just in case I got tired, but I didn’t end up using it again.

Your back needs to get better before you can think about leaving your walker behind.
 
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Update: Hubby picked up my scrips, I was given cyclobenzaprine 10 mg for muscle relaxer but after reading the drug info I’m scared to take it!! :unsure:

Turns out cyclobenzaprine isn’t usually recommended if also taking tramadol, which I have for two days now, as well as an SSRI I’ve been on for years. Plus the 10 mg is the highest dosage available, and the pill can’t be split. Drug info says dosages and/or schedule of the meds may need adjusting in this situation.

Seeing as the doctor has my med list on file, and a tramadol refill was requested at the same time, I want to assume these interactions were considered. (The other surgeon’s physician assistant is the one who submitted the scrips, not my surgeon’s PA.) She prescribed only 10 pills, which I expected. Of course their office is closed tomorrow. I’ll have to call the pharmacist in the morning and ask his/her advice. I don’t feel comfortable taking it tonight. That’s all I need, some horrible drug reaction on top of two surgical knees and a bad back.

The back pain is at bay for the moment but I’m also once again ensconced in the zero gravity recliner and not moving much. Will have to decide soon if I’m going to give the bed upstairs another shot tonight, means hubby has to move the toilet chair and my stuff AGAIN. He’s an early to bed guy, probably already dozing in his chair.

I know this whole situation is hard on him too. He is a creature of habit and routine and that has all been upended. But he’s risen to the occasion and says he’s focused on how much he’s looking forward to seeing me garden this year without constant knee pain, that not having to watch me struggle every day in debilitating pain will make this tough time worthwhile. (the last couple days have definitely tested that attitude!)

I’ve always been a very independent woman, I don’t like to ask for help so that facet of this recovery process has been/is difficult for me. All I can say is, God bless our caregivers. It’s no walk in the park for them either.
 
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CCatz

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Pleased to report I made it through the night and the cyclobenzaprine (aka flexoril) has helped. The sore area is still sore but not flaring, I’ve been able to get up from the chair without setting it off and do some walking. May even be able to do some gentle knee exercises today, but only if they don’t set off my back.

As for the drug interaction concern, talked with my sister in WI, she’s a nurse and EMT. She said not to take both the tramadol and cyclo at the same time, could cause oversedation. So I took the cyclo 12 hours after my last tramadol and since it’s working, I’ll stick with it and not take the tramadol. Definitely knocked me out, had about 5 hours of uninterrupted sleep. :happydance:

The journey continues....
 
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CCatz

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As I continue to recuperate my lower back (in my first thread), when I did get moving today, I felt something ‘mechanical’ in my left knee. Not a clicking or scraping sound or feeling, and not painful, but a disconcerting small thunk. First time it’s happened.

And just a while ago, my right knee incision tingled, felt like a small wave of cool water washed over it.

Are these sensations common? I have my 6 week follow up with the surgeon Monday and I’ll definitely ask, but I know the real firsthand TKR experts are right here!
 

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Hello @CCatz
You'll notice that I have merged your two threads together as it's best if members in recovery only have one thread. We find it much easier for everyone.
This is because:
  • That way, you have all your information in one place. This makes it easier for others 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.

Please keep all your questions and updates on this thread. We won't miss your new question as, between us, the staff read all new posts each day.
If you need an urgent response to a question, 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.

Here are the instructions on finding your thread, How can I find my threads and posts?

A helpful hint - Many members have found it useful to bookmark their thread so they don't lose it.
 
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CCatz

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Thank you for both the posting clarification and the article link. I should have known to check the reference library first!
 

hjh1869

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I can completely relate to this. Right TKR on 1/21. On the 5th day indescribable sciatic pain on the left side appeared. Couldn’t get comfortable because different positions were needed for each side. The knee hasn’t been nearly as bad as this. Outpatient rehab started this week after in home. Lacking some extension which had me a bit worried. I am current at -6/99. Each PT starts with a warm 10 pound heating pad to assist with extension. Half of PT is now dedicated to the sciatic pain since it hampers my knee exercises. My knee feels heavy, walked around the block yesterday and have been driving for 3 days. So discharged to have this sciatic pain. I had worked very hard up until the night before surgery to make sure it was in a good place because I worried about it. This has now caused my hips to hurt. I am relatively young and active (52) so this has really been a kick in the stomach. Hopefully things get better because this is pretty overwhelming.
 

Birdylane

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That’s why I feel like I’m starting from zero every time I get out of this chair, takes a couple minutes to stop hunching over the walker and get moving.
Because your traumatised muscle and tissue is reacting to what happened to you. Don't worry about it, take the time, relax, it won't last for ever.
I can live without having to do the stairs at all (except to shower) but my normal life is up there — office, bed, clothes, husband —and I thought it was time to try to reclaim it.
:scratch: Silly question, perhaps, but why not just stay there?

You are at the stage that for many is the worst, 1 - 2 months out. The body's reaction (WHAT was THAT??!!!) is fully kicked in, but the healing process is barely under way. The best therapy is to do nothing, pretty much (when you are icing and elevating and watching telly you are not 'dossing around' you are 'engaging a carefully considered proactively designed heuristically programmed dynamically structured recovery programme') because it's time that heals.

All you need to do is to keep moving a bit - getting out of your chair shows that - you can't do 100% nothing, just close to it.

I was lucky. I am bone idle, so staring at hugely complicated daytime telly (healing takes resources from everywhere, including the brain) was fine for me; you may have to learn this.

It's easy to do too much, pretty hard to do too little.
 

Birdylane

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I can completely relate to this. Right TKR on 1/21. On the 5th day indescribable sciatic pain on the left side appeared. Couldn’t get comfortable because different positions were needed for each side. The knee hasn’t been nearly as bad as this. Outpatient rehab started this week after in home. Lacking some extension which had me a bit worried. I am current at -6/99. Each PT starts with a warm 10 pound heating pad to assist with extension. Half of PT is now dedicated to the sciatic pain since it hampers my knee exercises. My knee feels heavy, walked around the block yesterday and have been driving for 3 days. So discharged to have this sciatic pain. I had worked very hard up until the night before surgery to make sure it was in a good place because I worried about it. This has now caused my hips to hurt. I am relatively young and active (52) so this has really been a kick in the stomach. Hopefully things get better because this is pretty overwhelming.
So is sciatica a ‘thing ‘ with knee replacement? I’ve had it in and off for years now and I’m hoping by hat it can be resolved soon with an injection of some sort . I couldn’t have one pre op . The day after op was excruciating.. I could use the frame and the crutches but as soon as I tried any kind of physio it hurt my hip/back never mind the knee . So I was eventually prescribed pregabalin which did help a little . But I’ve had to get them prescribed by my doctor because the hospital wouldn’t due to not being in for that particular pre existing condition ( worse than animal insurance ) . Hopefully I’ll get it sorted soon because I don’t want it to have a bad impact on my knee recovery .
 
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CCatz

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Sciatica by itself is no laughing matter; so sorry you are dealing with this, Birdylane, on top of the TKR recovery. Although my recent back pain has mostly resolved, standing any length of time makes my back ache, and I’m really careful when doing PT exercises that could throw it out (ie, donkey kicks).

Finding the balance between moving enough to keep making progress and doing too much is turning out to be tricky. I overdid it Wednesday and am paying for it now — horrible stiffness and deep aching behind my knees all the way down to my ankles. Cried a bit again this morning, something I haven’t done in a couple weeks.

Something really critical that I didn’t account for before surgery is the impact of the surgery on ALL my OTHER muscles, the ones that have for years been working however they had to in order to get me around on bad knees. My legs, esp the left, had begun to bow, and now that they are ‘straight’ my calf muscles are absolutely miserable. The loads on them are completely different, they are exquisitely tender to any touch and neither heat nor ice seems to make it better.

I have pins in both hips from a 40 year old surgery, never had any problems with them but again, with new knees and a completely different gait, I’m finding all kinds of issues with other muscles in my hips, back, thighs.

At 9.5 weeks out, I’m using a cane, going to outpatient PT 2x a week, no pain meds, icing at least once daily. I have not tried driving yet but am anxious to test myself in our driveway. (Unfortunately my husband hasn’t had it plowed and I’m unwilling to face snowy ruts on my first attempt.) It’s kind of a double edged sword—I’m doing well overall but this makes him think I’m ’recovered’ and able to resume all the house work and activities I did before. Not even close.

Being totally honest, this BTKR is the hardest thing I’ve ever done in my life, physically AND mentally. It’s challenged me in ways I hadn’t expected. Although I’m making good progress in terms of ROM and resuming some ADLs, the constant physical pain still messes with my mind. Friends who’ve had TKRs say there was a day they stood up and realized the knee actually felt pretty good — that day seems a long way off for me.

Then again, I look at where I was at when I first posted to this site and can see that it HAS gotten better, just like all you wise and kind people told me it would. So, I persevere, and hope my fellow TKRers can do the same. :)
 

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