TKR Swollen 9 months post op<

[Celle]

Hi there, the issue is that you can’t bookmark in an app only on The web itself - that I’ve now done.
I do find navigation difficult on this site and I am pretty technologically savvy.

It really is better to use your web browser and ask it to take you to https://bonesmart.org/forum/
Using the web browser, you can see some things that aren't visible when you use the app - such as signatures, that tell you when people had their surgeries and what they have had done. You can then bookmark your thread, too.

This area may help you to navigate BoneSmart -
https://bonesmart.org/forum/view/how-to-use-this-forum.74/
Lots of useful "How to . . . " articles there, but they are all written for using the web browser and Xenforo, not the app.

BoneSmart takes a little while to get used to, but once you get the hang of it, you'll wonder why you had a problem at first.

 

[cannygirl]

Thank you, Celle.
I am really grateful to you all for the help and encouragement through this site. Everyone seems to expect that at 5 months, I should be back to normal as I suppose I did too especially when I had a few weeks pain free with virtually full movement...so I got a bit ‘gung-ho’. Why shouldn’t I do everything/anything now? Now I am cross with myself and feel I’m going backwards again.

 

[Celle]

Don't be cross with yourself. Doing too much because you feel so much better is very easy to do, and I think almost all of us have made that mistake.

Take comfort from knowing that things are going to get better and you will start to move forward again.

 

[kneeper]

I did too especially when I had a few weeks pain free with virtually full movement...

You had it once, you'll have it again.

so I got a bit ‘gung-ho’.

I think we've all done that at some time and whoops...

 

[sistersinhim]

Oh yeah. I hated those times when I thought I was well, overdid, then the knee let me know I wasn't there yet! I bet we've all done it! Just let the knee stay in control and you'll be much better off!

 

[cannygirl]

I am now nearly 9 months post op and unsure how to get the persistent swelling down. I have had excellent recovery, good ROM from early in recovery, little pain - certainly not in need of medication but persistent swelling. My knee has always been slightly warm but never hot. I cycle a lot, try to take regular exercise and for the last few months have not elevated, iced etc. Am I now too late? I need the exercise as my well-being depends upon it! What can I do?

 

[Celle]

Hello again, @cannygirl
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, we have all your information in one place. This makes it easier to go back and review your history before providing advice.
• If you keep starting 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.
Don't worry that we won't see your question because, between us, the staff read all new posts every day.
If you need an urgent response to a question, just tag a member of staff.
How to tag another member; how to answer when someone tags you

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? . Many members bookmark their thread, so they can find it when they log on.

 

[Celle]

Now, to address your question:

Complete recovery from a knee replacement takes a full year, or even longer. So, your knee is not yet completely recovered and it will still swell if you do too much for it. I understand that you need to be active, but you also need to consider that your nee is not yet 100%. You still have to make allowances for it, as you would for a small child.

Be as active as you like, but try to restrict most of your activity to things that don't impact your knee. Maybe cut back the cycling for a few more months and replace it with some upper-body exercise? Your knee still being warm is a sign that healing is still going on beneath the surface.

No, it's not too late to elevate and ice your knee. Resting in the evening, while you ice and elevate, would be a good thing to do.
It's not unusual for your knee to continue to swell for at least 15 months after your surgery.

 

[cannygirl]

Celle, I am sorry about the problems with posting. I use my iPad and the app and can never find the way back to my thread. I guess that Ill just have to go back to the laptop.

Be as active as you like, but try to restrict most of your activity to things that don't impact your knee.

I have a problem in that I have encouragement from a research project that is following my progress to measure my muscle recovery following surgery. In order to build the muscles (quads) I need to exercise them. Also I need to exercise as I easily put on weight BUT I do want to get the knee fully recovered.

I have been cycling a lot from about 3 months and have been impressed by how much I could so. I have strength better than before my TKR! However my knee has continued warm and swollen, never returning to 'normal'. I guess that what you are saying is that I need to choose between vigorous exercise and 'recovery'!

I am grateful to you and the other experts in the forum as I can raise what is really such a minor problem, without feeling foolish or judged.

 

[sistersinhim]

I guess that what you are saying is that I need to choose between vigorous exercise and 'recovery'!

Yep, that's what I say. Your knee still isn't healed yet. All that exercise is keeping it inflamed and that is why it's swollen. I am going to tag @Josephine, our forum director and nurse, to see what she thinks about it.

 

[cannygirl]

Oh dear, once the pain reduced, I decided to work my knee. From about 3 months I was pushing it, particularly on the bike and have started to get back the fitness that I had lost over the years of a failing knee!

It has continued a little swollen and warm but I thought that would resolve in time anyway but didn't expect that it would continue this long. Have I now irreparably damaged it? I so don't want to be an inactive 69 year old which would be quite natural to me as I love doing sedentary occupations.

I feel so sad as I have been beginning to enjoy the great outdoors. I even bought an electric assisted bicycle to aid my recovery but then pushing myself not to use the boosted power to see how far I could work the knee without the boost!

I feel a bit of a pratt. I also wish that there was clear instruction 'on the ground' for what we need at this latter stage of recovery. At least I have had fun with emojis!

 

[Josephine]

Cannnygirl, you have to make a decision about how you are going to go from here. ON the one hand, you say you "need the exercise as my well-being depends upon it". But on the other hand, you're complaining that you have swelling and probably some pain.

Why shouldn’t I do everything/anything now? Now I am cross with myself and feel I’m going backwards again.

You also said this. I really don't understand what you problem is.

So to get to the bottom of it, I'd really like to offer you some structured advice but in order to do that, I also need to ask you some questions. Are you willing for me to do that?

 

[cannygirl]

Hello Josephine,
Yes I am quite happy for you to ask me questions. I have obviously not got this right and I need help.

 

[Josephine]

Here y'go then!

It would be very helpful if you would answer each one individually - numbered as I have done - in as much detail as you can then I'll come back as see where you are ....

1. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine. And don't forget to factor in other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness).

2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?

3. how swollen is your leg compared to these?

4. what is your ROM - that's flexion (bend) and extension (straightness)

5. are you icing your knee at all? If so, how often and for how long?

6. are you elevating your leg. If so how often and for how long?

7. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and

8. are you doing any exercises at home? If so what and how often?
This is the most crucial question so please help me by using the format I have left as an example
(which means please make a list and not an essay!)

Exercises done at home
- how many sessions you do each day
- enter exercise by name then number of repetitions of each
etc., etc.

Anything done at PT
- how many times a week
- enter exercise by name then number of repetitions of each
etc., etc.

 

[cannygirl]

1) I guess 1-2. no real 'pain' heavy, swelling, stiffness

2) not prescribed anything. At 6 months, I was considered better than most and I have not seen my GP since BEFORE surgery! I am married to a medical consultant (Infectious Diseases) retired and come from a medical (not surgical!) family so I am happy to take pain meds when necessary. At the moment about 1000mg Paracetamol at night most nights

3) Middle - medium and slightly warm - has been all the time

4) about 130 (more when pushed) and 5

5) I haven't done Icing for a few months*. I have been trying to cope with my mother's death and traveling back and fore to sort things out for my family. It just has been a matter of keeping going as you'll understand.
* started again recently - with relief

6) I have my leg up quite a bit - several hours in the evening- but not elevated properly - (elevating now again)

7) Full normal cooking, shopping, gardening, digging etc I have cleaning help

Exercises done at home NONE (gave up about 4 months when I started back at gym)

Outside Bicycle 4 times a week
about 40 mins - 60 mins hilly terrain

gym 2+ times a week
elliptical trainer 10 minutes level 6
power plate 30lb individual legs 4x12 reps each leg
leg extension 10-15lb 4x12 reps each leg
leg curl 15-20lb
Upper body: chest press, shoulder press, crunch
Walking machine incline 10 minutes rapid

I really want to get better but there is no local guidance and full expectation by all including surgeons etc that anything I can do, I should do. I am a competitive person and push myself to do better each time. Seems like that is possibly counter-productive!

 

[Celle]

I have a problem in that I have encouragement from a research project that is following my progress to measure my muscle recovery following surgery. In order to build the muscles (quads) I need to exercise them.

I really think you have to choose which is more important - the statistics for a research project, or your own recovery.
Your knee and your leg muscles are naturally going to get stronger as your recovery progresses. You need to find a balance between exercising and letting your knee heal. Remember that complete recovery from a knee replacement takes as long as a full year, so your knee is still on that recovery journey.
Josephine will have more to say about weights, so I'll limit myself to saying please stop using them. They are bad for a new knee, particularly the amount of weight you are using on the power plate. It just made me cringe to read the weight you are lifting.

I have been cycling a lot from about 3 months and have been impressed by how much I could so. I have strength better than before my TKR! However my knee has continued warm and swollen, never returning to 'normal'. I guess that what you are saying is that I need to choose between vigorous exercise and 'recovery'!

Yes, that's what we're all saying.
There will be a time for vigorous exercise, but it's not in the first year of recovery.
Your knee is warm because healing is still going on beneath the surface. It's swollen because you are asking too much of it. Ease off all those challenging exercises and spend more time elevating and icing your knee, to help it to calm down and decrease its swelling.

I use my iPad and the app and can never find the way back to my thread. I guess that Ill just have to go back to the laptop.

I have an IPad and also a tablet. While I can access BoneSmart on either of those, there are so many things I can't do on them. I much prefer using my laptop when accessing BoneSmart.

 

[Jockette]

As far as finding your thread, if all else fails, use the search tool near the top of the page, type your user name into that and it will find your posts and you’ll find your thread.

 

[Josephine]

1) I guess 1-2. no real 'pain' heavy, swelling, stiffness

If you read the notes accompanying my questions, you would have seen that soreness, burning, stabbing, throbbing, aching, swelling and stiffness are all also forms of pain. So if you have heaviness, swelling and stiffness, then you have pain! So by that, in my judgement your pain score is about 5 or 6.

2) At the moment about 1000mg Paracetamol at night most nights

I suggest you take the paracetamol 4 times a day which is every 6hrs.

3) Middle - medium and slightly warm - has been all the time

Well often we would say that warmth is a sign of healing but you are 8 months out now so this is no longer true. I would say the warmth is inflammatory. But more about that later ...

4) about 130 (more when pushed) and 5

Do not ever allow your leg to be pushed. The only numbers which count in ROM are those you do in your own strength.

5) I haven't done Icing for a few months. Started again for at least 40-60mins and more than 4 times a day.
6) I have my leg up quite a bit - several hours in the evening- but not elevated properly - (elevating now again)

Elevate when you ice.

7) Full normal cooking, shopping, gardening, digging etc I have cleaning help

Jolly good!

Exercises done at home NONE

Excellent!

Outside Bicycle 4 times a week
about 40 mins - 60 mins hilly terrain
gym 2+ times a week
elliptical trainer 10 minutes level 6
power plate 30lb individual legs 4x12 reps each leg
leg extension 10-15lb 4x12 reps each leg
leg curl 15-20lb
Upper body: chest press, shoulder press, crunch
Walking machine incline 10 minutes rapid

I really understand that you are accustomed to this level of gym work but please understand, your knee is not! It's your knee you have to be careful of rather than you and it's not good for your knee to be doing all this aggressive stuff. And it IS aggressive - for your knee. You may well be 8 months out but you are still healing. Healing can take upwards of a whole year and damage you do to your knee even now can last even longer. Please consider this before you dismiss my advice.

I really want to get better but there is no local guidance and full expectation by all including surgeons etc that anything I can do, I should do. I am a competitive person and push myself to do better each time. Seems like that is possibly counter-productive!

You got that right! It's all too easy to cause damage by trying to do 'good'

 

[cannygirl]

Oh Josephine
I DO accept your advice. I feel thoroughly ticked off (like a naughty wee girl). In my defence I really was trying to do the best to get my strength back. I had been told just to do whatever I feel like and of course my strong ‘oughts’ meant that I’m not good at making judgements about what my body needs as opposed to what I think I need.
Thank you. I’ll stay plugged in to Bonesmart - I thought I’d ‘graduated’!

 

[Josephine]

I feel thoroughly ticked off

Oh no! I tried so very, very hard not to make it sound like a scolding! It upsets me sop much when people say things like that! So long as you get better, that's all I ask.