TKR Suggestions needed for “tight band” feeling

[Stiff knee NC]

My recuperation continues… I will post more in a few days but just had to share this.

A friend’s family member is a PT tech. Said if you don’t leave in pain after a PT session then you haven’t really had effective physical therapy. Mentioned this to my new PT and he completely disagreed. He stressed the need for “productive pain”… which lasts a few seconds…and whenever he does something that is uncomfortable he always does a counter move to kind of “shake it out.”

He has not, after 11 sessions, hurt me, pushed/pulled on me that made me feel faint w/pain and cry, or left me hurting. This is the way it should be. Thanks, Bonesmart, for educating me. I met w/my new PT BEFORE surgery and stressed that I did not ever want (nor would tolerate) being handled that way… I can honestly say I wouldn’t have felt empowered to say that if not for Bonesmart. It has made ALL the difference!

 

[sistersinhim]

A friend’s family member is a PT tech. Said if you don’t leave in pain after a PT session then you haven’t really had effective physical therapy.

That might be true for recovery from an injury, but it is not true for recovery from a joint replacement. That friend needs to go back to school and learn the proper way to rehab a joint replacement.

 

[Jamie]

@Stiff knee NC .... thank you so much for the positive feedback. This is what BoneSmart is all about. We want each member to listen to their body and work with their medical team to create the best recovery program for them. Usually this involves exactly what you are doing (and not doing!). It sounds like you have an excellent therapist who is actually willing to listen and respond accordingly. You should do just fine.

 

[Stiff knee NC]

Is the length of recovery from “only” a revision typically the same as a replacement?

I’m 4 weeks and 4 days from surgery. The good news: I’m at 108 degrees without having been pushed/pulled/or harmed during PT! My incision is a lot narrower and is healing nicely. I even did my first revolution on an exercise bike yesterday, and I went completely around with NO problem! Looking at me, I look pretty good

But! I have pain all day, every day, about a 4/10 that increases to 5-6/10 after doing my twice daily at-home exercises or standing for any length of time. I promise you I’m NOT overdoing it (I’ve learned my lesson!). I rest/elevate/ice every day and do ADL and some walking. I really thought I’d feel a LOT better by now. I DO notice that my “bend” is getting better and better as the days go by, but the pain, feeling of being swollen inside, warmth of knee, remain. My PT says all is normal… guess I’m getting impatient.

I take ibuprofen (400 mg) 2-3 times per day. Not sure what else to do. Ideas?

Thanks in advance for any suggestions and the reassurance I clearly need!

 

[Jamie]

Yes, recovery from a revision is usually just about the same as a primary joint replacement. You sound like you're doing just fine. My suggestions would be to ice and elevate more and to add Tylenol to the ibuprofen. It's better for pain and the two together generally work well. You would take 1000mg of Tylenol ever 6 hours on a set schedule through the day and night. There is a maximum dose of acetaminophen of 4000mg in a 24 hour period, so if you're taking and cold or sinus medications with acetaminophen in them, be sure and count that into your daily total and reduce each 6-hour dose accordingly.

 

[Pumpkin]

My PT says all is normal… guess I’m getting impatient.

Your PT is right, it is all normal. You are only 4 1/2 weeks from surgery, for the spacer exchange they had to open up your knee, then shave the patella off for the patellar button. It takes time to heal, keep on the slow but sure track you are on and give it more time.

"Patience, Grasshopper, Patience!"

 

[Stiff knee NC]

@Jamie: thanks for responding! Just need clarification re medication… you’re saying to alternate taking Tylenol with Ibuprofen, correct? (Not at the same time?)

So I’d take 1,000 mg of Tylenol 4 times per day (4,000 mg max). And then take the 400 mg of Ibuprofen when…and how often? And I need to take ibuprofen WITH food, correct?

I take one 81 mg baby aspirin as a preventative for heart issues (I have no heart problems). My doctor wanted me to wait an hour after taking the aspirin before taking anything for pain.

Just trying to figure out a schedule…

 

[Jamie]

You can take it either way depending on what works best for you. Just be sure not to exceed the daily maximums for either medication. It is good to take the ibuprofen with food to help ensure you don’t get any stomach problems. The baby aspirin is an NSAID as well, so you might want to take it with a cracker or other light food.

 

[Stiff knee NC]

Update at 6 weeks,1 day post-op: recovery continues. Happy to report I’m at 110 degrees and 3. And that’s with NO tugging, pulling, excessive bending by my wonderful PT!

Some other issues have cropped up: the top half of my scar is itchy and red/raised/thick compared to the bottom half. My PT even went so far as to use the word “keloid.” This concerns me. (as a reminder, the OS found a lot of scar tissue inside when he opened me up).

Additionally, I’m finding that my knee is frequently achy and I still can’t stand in one place for any length of time. Normal? (I’m elevating and resting throughout the day).

To relieve pain and aches, I alternated taking ibuprofen and Tylenol. It could be a coincidence, but I ended up having day-long headaches (never came close to maxing out on the amount I could take each day of either drug). I sure don’t want to go back to taking Dilaudid. Any other suggestions?

As always, THANKS for your feedback!

 

[Jamie]

You're still early in this recovery! You can expect aches and pains to be there now and then for months. What you're describing sounds perfectly normal and I'm so happy to hear that you are getting your ROM. It may also be a bit slow in coming, but this is a time for patience.

Please don't let the idea of a keloid scar worry you. That is surface skin scarring and not at all like adhesions. Some people have a tendency to get keloid scars. They may look a little less lovely, but it shouldn't impact how your knee functions. Actually your knee looks quite good to me for 6 weeks. It's very typical for it to still be red in the incision area. That should fade with time. We have an entire section on wound healing in the blue toolbar at the top of the page under Postop Care. Take a look specifically at the section on scar management.

 

[Stiff knee NC]

@Jamie: patience…not my best trait and in short supply this second go ‘round!

I probably shouldn’t have mentioned my scar. I (mostly) don’t care how it looks…I just want my knee to stop hurting. But I will check out the “scar management” section. Thanks!

Everyone comments on how “good” i look…scar looks great, you’re walking so well (no walker or cane)…. it is maddening because all I really want is pain relief. People focus on how my scar looks and how I walk and then figure—incorrectly—I’m feeling fine. Sigh.

Did some water walking today followed by 5 mins on the stationary bike. Knee almost instantly became tight (but a different type of tightness than the “tight-band” feeling I had before surgery).

I vow to work very hard on being patient with myself and this cursed knee.

 

[bs27]

Hi Neighbor ..... we compared knees a good while back. Congratulations on your latest surgery - sounds like good progress. My swelling finally went down last fall - over a year after the TKR & and broken leg and I gained maybe 10 more degrees flexion up to 95. I'm plagued by arthrofibrosis in my knee & CRPS in both feet though CRPS is back to a 'mild' form. Feels like a horse is always standing on top of my knee. Glad you found someone at ROC to work on your knee - my ROC doc still says No Way and I'm not disagreeing with him - can't take the chance of CRPS returning in full force. Anyway, wishing you well and I hope your long standing tight band feeling went away with this latest procedure and healing will go smoothly though it may take longer than we'd all like.

 

[Ghostpipe]

Hi @Stiff knee NC . Please do not stop posting! I am at 15 months from bilateral, and one of mine is a lot like yours has been. I am just beginning to start investigations, and your thread is most informative. Hopefully I can draw on your experience in decision making, I am so grateful that you have documented your recovery so explicitly.
Wish you all the best, and hope that you have found a resolution.

 

[Stiff knee NC]

@Jamie: the past 2 days have been very alarming…I’m starting to feel “tightness” similar to what I had BEFORE surgery (it lasts from when I get up in the morning to when I go to bed at night, just like before)…the only difference is that it isn’t straight across my knee (from side to side) so much but more concentrated at the middle of the front of my kneecap. You can only imagine how this makes me feel.

The only thing in the past few days that I’ve done that could have caused this is water walking one time, a few times on the stationary bike for 5 mins each time, and icing less.

My question: is an MUA even a possibility at this point? I’m 7 weeks out tomorrow plus I’m at 110 degrees. I don’t think they would do it because I’m bending so well.

I meet with the PA on Thursday and will definitely bring this up. Is there ANYTHING (cortisone shot, rest more, etc) you can suggest?

I’m feeling quite defeated. Tightness (scar tissue) prevented me from walking/standing comfortably before and I’m panicked it will do so again.

 

[sistersinhim]

I’m 7 weeks out tomorrow plus I’m at 110 degrees.

Why in the world would you even consider a MUA when you are doing this well? Most doctors won't even think of doing one once the knee reaches 90 degrees. Your bend is above normal for 7 weeks. Enjoy your success and don't worry about your tightness. Your knee is tight because it is swollen. Even if it doesn't look swollen on the outside, the inside of your knee is. There is not a lot of space inside your knee capsule so any amount of fluid would make it feel tight. I suggest you rest more and while resting you ice and elevate your knee above your heart level. This will help to get that fluid out and make your knee less tight. This is something that you will need to do for at least a month or more because as you use your knee more, it will continue to swell. Remember it takes as much as much as a year for full healing of your knee. This is normal and nothing to worry about.

 

[Stiff knee NC]

In my defense I was told at the 3, 6, 9, 12 and 18 month mark post-op the first time that it was just “swelling/inflammation” and it would “get better with time.” It never did. Tightness all day and pain when I walked or even stood in place, right until I had revision surgery 2.5 years after my TKR.

When I had the revision 7 weeks ago they found a higher-than-normal amount of scar tissue. They removed what they could.

Just concerned that it’s happening again.

 

[sistersinhim]

Are you overworking your knee? Overworking it can cause your knee to be too hot inside. Hot and dry tissues can stick together and cause adhesions. Normal activities don't. After having 12 knee surgeries I'm pretty experienced in what happens inside our knees. Staying away from excessive exercise will work just fine for your recent surgery.

 

[Jockette]

the only difference is that it isn’t straight across my knee (from side to side) so much but more concentrated at the middle of the front of my kneecap.

This is the area where you had a patella button attached this time. It’s going to be sore for a while.

You also had a spacer exchange, and LOA, which has upset the inside of your leg. Pain here, there, and everywhere is par for the course for quite a while.

Stiffness/Tightness is a normal occurrence after this kind of major surgery. Your surgeon did major carpentry work and disturbed every millimeter of soft tissue in this area. You aren't tight because your muscle is underused and needs to be stretched and rehabbed. You're tight because your tissue is healing...and full healing takes a full year or more.

 

[Jamie]

Please try not to let your mind run away with you. You have good ROM for this point in your recovery. You don't need an MUA. In fact, that might make your stiffness worse, as it's a pretty aggressive procedure on your still-tender knee.

You made a mistake by walking in the water and using an exercise bike afterwards. Your knee let you know that it was too soon for that much activity. It's going to take a week or maybe even two to get things back to where you were again - IF you take things easy. Please don't do a lot of extra exercising right now. All you need to do are bends and stretches every few hours during the day along with some walking around the house or in the yard. You need to let your knee settle down and heal itself for a couple of months. It's been through a lot with this last procedure.

Why are you icing less? I suggest that you get that going again as well. Stiffness is normal after any knee procedures. You can expect to feel it for months. It does not necessarily mean you are developing adhesions again.

 

[kneeper]

Water exercise is very deceptive. It may feel fine while you're doing it but it is easy to overdo.