TKR Swelling and stiff knee

[Supersport]

Today will be 6 weeks post op and I’m still struggling with a lot of swelling and a stiff knee. I go to PT and it helps to alleviate the stiffness, but then the next morning it is like starting all over. The most I have gotten my ROM to is 80 and when I go back to PT is drops back down. My swelling has been a lot since my whole leg is swollen down to my foot which I feel plays a part I my not obtaining more bend. I continue to ice and rest and try to do some exercises at home but feel like it is a vicious circle. Is this normal or am I expecting to much?

 

[Jaycey]

@Supersport Sounds totally normal to me. You are only 6 weeks out of major surgery. Soft tissues and muscles need time to settle. I would go very easy on any PT. As you are seeing, it might ease stiffness at the session but the swelling it causes will continue to set you back.

Are you icing several times per day for at least 45-60 minutes? Elevating at the same time?

Do reset your expectations on this recovery. This is nothing minor.

Here are your recovery guidelines.
Knee Recovery: The Guidelines
1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now, they are almost certainly temporary

2. Control discomfort:

rest​

elevate​

ice​

take your pain meds by prescription schedule (not when pain starts!)​

don't overwork​

3. Do what you want to do BUT

a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you​

b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.​

4. PT or exercise can be useful BUT take note of these

the BoneSmart view on exercise​

BoneSmart philosophy for sensible post op therapy​

5. At week 4 and after you should follow this Activity progression for TKRs

6. Access these pages on the website

Oral And Intravenous Pain Medications​

Wound Closure​

The Recovery articles:
The importance of managing pain after a TKR and the pain chart
Swollen and stiff knee: what causes it?
Energy drain for TKRs
Elevation is the key
Ice to control pain and swelling
Heel slides and how to do them properly
Chart representation of TKR recovery
Healing: how long does it take?

Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

There are also some cautionary articles here
Myth busting: no pain, no gain
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds

We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery.

While members may create as many threads as they like in a majority of BoneSmart's forums, we ask that each member have only one recovery thread. This policy makes it easier to go back and review history before providing advice.

 

[Celle]

Hello @Supersport - and

I agree with Jaycey - Concentrate on doing lots of icing and elevation, to try and reduce the swelling, which is preventing your knee from bending further.

 

[Tykey]

Hi. Yes, quite normal!
You have already identified that the swelling goes up, and your ROM goes down following PT.

There's your answer

If you cut out all but gentle home exercises, the swelling goes down and the ROM goes up. It won't happen in a day, but over weeks it will come good.

Don't try too hard, it never works to your advantage

 

[sistersinhim]

The most I have gotten my ROM to is 80 and when I go back to PT is drops back down.

Do you see a pattern here? PT is too aggressive and causing inflammation which causes more swelling. Swelling worsens ROM. Back off of those exercises and ice and elevate more and you should see some improvement.

 

[Suz]

@Supersport Welcome to Bonesmart! I am in the midst of my second knee-replacement whereby I followed the advice given in this wonderful knee replacement support group. Reading & following the Recovery Guidelines gave me such a better outcome with my first replacement back in 2016. And now I'm 4wks out from my second replacement and I wouldn't think of recovering without this wonderful group!

There's no way around the slow, painful recovery. But if you 'Control the discomfort' per the recovery articles you were given, you will absolutely have a more comfortable recovery. That I can promise you!

These early days you are experiencing post-op are rough, but once recovered, you will have a strong, pain-free knee. That to me is worth any recovery mountain we're faced to climb!

Keep us posted as to how you're doing! My daily mantra is: 'This too shall pass'!

 

[Roy Gardiner]

feel like it is a vicious circle.

Nailed it. That's exactly what it is. Cut back on PT until you don't get a reaction the next day. It's very easy to do too much, almost impossible to do too little.

 

[lionsm13]

PT's always think that they have "whip that knee into shape"
It's all about ROM to them.
How can a hot swolen knee benefit from doing things it shouldn't be doing?
No pain = no pain.

 

[sistersinhim]

How can a hot swollen knee benefit from doing things it shouldn't be doing?

Exactly. It can't!