TKR Three years post TKR

[MtnSearcher]

Can you post a photo of that golf ball sized swelling you're talking about?

Apparently not.

 

[MtnSearcher]

@sistersinhim I finally figured it out, I think.

@sistersinhim To orient you, that is my left leg, and the photo is not reversed. The top of the scar is and inch to an inch and a half above the top edge of the kneecap. As you look at the photo, the lump is on your right, just below the knee cap. It might also help for me to post a picture of both knees. My right leg is smaller due to my original injury, and I think due to continued swelling of my left knee after replacement..

 

[sistersinhim]

I am going to tag @Josephine to give you her opinion of your photo.

 

[sistersinhim]

I can see what you are talking about, but will let Josephine comment on it.

 

[Josephine]

The pushups themselves didn't hurt my knees, but getting down on the floor and bearing weight on my new knee certainly did.

I think you made a bit of a oxymoron here. The pushups DID hurt your knees!

The lump on my knee is below the knee cap and just to the lateral side.

Okay, this lump. From what I can see it;s simply swelling and gross swelling at that.

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?

 

[MtnSearcher]

@Josephine Ask away. I'll try to answer.

 

[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.

 

[MtnSearcher]

1. Pain is at 0-1 for normal walking, but there are times during the day, especially after sitting at my desk or driving a lot, that it goes to a 3-4. If I put my knee down on a hard surface, pain jumps to 7 or 8. That's what I meant in the post about pushups. The exercise itself didn't hurt, but placing my knee on the floor before and after getting into the forward rest or plank position hurt a lot.

2. I have been prescribed 800 mg ibuprofen. Most days I don't take it at all but other days, when the swelling is especially bad or I have spent a lot of time sitting with my knee bent, I take it once at night.

3. I thought the swelling was moderate until I saw the picture.

4. I am not sure what my ROM is. It was 0 and 130 when I finished PT (active ROM), and the flexion is probably still about the same. I'd guess extension about 4°.

5. I haven't iced my knee in more than a month. The last time was early January after a hike for about an hour.

6. I use a recliner to elevate my leg whenever I am home, and if I have papers to read over at work, I sit on the couch in my office and elevate it. I probably do this three times a week at work for 10-20 minutes.

7. I am pretty sedentary because of the weather right now. At home, I cook three or so times a week, do dishes about the same, sweep, mop, change the bed, dust sporadically. My wife and I both work, so we share the household chores. We have a large dog that demands attention, so I play tug of war and fetch, and wrestle with her.

8. Ashamed to say, no scheduled exercise at home. Only when I think of them.
Walking - ½ mile- 1 mile three times a week.
Walking - 200 yards daily in addition.
No PT.

 

[Josephine]

1. Pain is at 0-1 for normal walking, but there are times during the day, especially after sitting at my desk or driving a lot, that it goes to a 3-4. If I put my knee down on a hard surface, pain jumps to 7 or 8. That's what I meant in the post about pushups. The exercise itself didn't hurt, but placing my knee on the floor before and after getting into the forward rest or plank position hurt a lot.

That sounds nasty. I can't believe you are having this at 7 months.

2. I have been prescribed 800 mg ibuprofen. Most days I don't take it at all but other days, when the swelling is especially bad or I have spent a lot of time sitting with my knee bent, I take it once at night.

Ibuprofen is a very poor medication, has almost no properties for pain, it's just an anti-inflammatory. Apart from that, these NSAIDs have some rather nasty side effects for which reason I do not recommend them. Read these
Medications: acetaminophen (Tylenol, paracetamol) and NSAIDs, differences and dangers
NSAIDs Diclofenac. ibuprofen increase risk of heart problems: new study

Given the level of your pain, I would suggest you take Tylenol 1,000mg 4 times a day at 6hrly intervals to a maximum of 4,000mg per 24hrs. Of course, if you should take any other medications containing acetaminophen, then this should be deducted from the 4k maximum.

3. I thought the swelling was moderate until I saw the picture.

Oh dear!

4. I am not sure what my ROM is. It was 0 and 130 when I finished PT (active ROM), and the flexion is probably still about the same. I'd guess extension about 4°.

And is your 4 degrees plus or minus? It makes a big difference which it is.

You can assess it using this technique
1. put your leg on a bench, seat, bed, floor or anything similar but preferably something fairly firm.
2. with not too much pressure, press the back of your knee down - use your leg muscles, not your hand!
3. slide your hand, palm down, under the back of your knee

a) if you can get your entire hand under easily, it's probably about +10 degrees
b) if you can get just your fingers under, it's about +5
c) if you can get your fingers under but it's a push, it's +0
d) if you can't get your fingers under at all, it's -5 or more​

Here's a graphic to explain the degrees involved

5. I haven't iced my knee in more than a month.

Perhaps you should start again. Ice for at least 40-60mins and more than 4 times a day.

6. I use a recliner to elevate my leg whenever I am home, and if I have papers to read over at work, I sit on the couch in my office and elevate it. I probably do this three times a week at work for 10-20 minutes.

Those are not the proper ways to elevate. The basic rule of thumb is "toes above nose" or very close to that. Putting your feet up on the settee is not adequate.

Did you read the Recovery Guidelines in post #3 of this thread (Aug 29, 2018)? I think perhaps you should go back and read them again.

7. I am pretty sedentary because of the weather right now. At home, I cook three or so times a week, do dishes about the same, sweep, mop, change the bed, dust sporadically. My wife and I both work, so we share the household chores.

Okay

8. Ashamed to say, no scheduled exercise at home. Only when I think of them.
Walking - ½ mile- 1 mile three times a week.
Walking - 200 yards daily in addition.
No PT.

No need to be ashamed of it. Many of us on the forum never did any exercising either and we all came through with excellent outcomes!

My philosophy is this: It's not the exercising that gets you your ROM, it's time. Time to recover, time for swelling and pain to settle and time to heal. One thing that seems to be missing from all the PT's protocols is that all your ROM is there right from the start, just waiting for all that to happen so it can show itself. In the general run of things, it doesn't need to be fought for, worked hard for or worried about. It will happen. Exercise as in strength training is counter-productive and in the early weeks does more harm than good. Normal activity is the key to success.

 

[MtnSearcher]

@Josephine Thanks. I will try Tylenol for pain rather than ibuprofen. I usually try to avoid it because of the liver and kidney problems it can cause. In answer to #4, extension is about +5 using your method of estimation. I will also go back to icing and elevating. At work, the elevation is toes above nose, but not so in the recliner at home.

 

[Josephine]

Very wise!

 

[rustic]

Hey @MtnSearcher
How is the hiking going?

 

[MtnSearcher]

I haven't been here in a while, but it's been 33 months since my left TKR, and I thought I'd update.

My knee is not stiff anymore, but my quad has never fully regained its strength, and my knee still feels loose, and it still hurts if I put it down on a hard surface, which made refinishing a hardwood floor last month a real adventure.

It still swells, and I guess it will for the rest of my life. I do function much better since the replacement. I have gone hiking, fly fishing, and I have done a lot of carpentry on a historic house we bought. All in all, I'm glad I had the replacement, but it's definitely not perfect.

 

[Pumpkin]

@MtnSearcher
Sounds like you are doing OK and are able to do quite a bit more than the last time you posted.
Has your surgeon suggested anything that might help stabilize your knee, a knee brace or a spacer exchange?

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. If you prefer a different thread title, just post what you want and we'll get it changed for you.
If you need an urgent response to a question, just tag a member of staff.

Many members bookmark their thread in their computer browser, so they can find it when they log on.
How can I find my threads and posts?

Thanks,
Chris

 

[rustic]

I haven't been here in a while, but it's been 33 months since my left TKR, and I thought I'd update.

My knee is not stiff anymore, but my quad has never fully regained its strength, and my knee still feels loose, and it still hurts if I put it down on a hard surface, which made refinishing a hardwood floor last month a real adventure.

It still swells, and I guess it will for the rest of my life. I do function much better since the replacement. I have gone hiking, fly fishing, and I have done a lot of carpentry on a historic house we bought. All in all, I'm glad I had the replacement, but it's definitely not perfect.

How would you describe the "looseness?"
I'm also curious about how much it swells, like would someone else notice it if you were wearing shorts? Mine gets puffy, especially on the lateral side, level with the top edge of my kneecap (one of the common places they give steroid shots).
We got our TKR's about the same time, and I remember talking about our hiking etc. Mine is also "not perfect," but maybe a bit better than yours. Mine swells a bit for a couple days after a long hike. It hurts mostly at night, and that doesn't change much whether I'm super active or having an easy week. After two years, I have started to gain some significant strength in my quads. I have a ways to go though.
I wish you well, and hope that you get some more improvements, even if they are small.