TKR Tightness around knee?

[Kelleytoons]

Folks,

First of all, I know everyone heals differently but I'm trying to just get some ideas on what I can expect. Last week, at six weeks post-op, my surgeon released me to "pretty well do what you want". Knee rotation is 125 (132 with "help") and pain free (I get some aching when I do squats and twisting my knee hurts but not in an awful way). My big goal is to be able to play tennis again (senior doubles -- no huge running or pounding, which my surgeon says will be fine) but my doc recommended I wait until 12 weeks because he thinks the hot weather here in Florida will cause my knee to swell (I'm perfectly fine with waiting another five weeks, even though I'm dying to get out there).

But the only thing that still really bothers me is the tightness I feel around the knee. It's as if I am still wearing a bandage when I bend the knee. This "awareness" kind of throws off my gait, particularly when I'm moving fast (haven't tried running yet, but I bike as fast as I can and do walk at top speed). (I have a secondary issue with my bones "clicking" but I can deal with that).

Does anyone have experience with this tightness going away? I guess if I have to learn to live with it I will, but it would be nice if I knew. And is there anything I can do to help? I've been icing pretty regularly and still ice whenever I work out (twice a day) although at this point it doesn't seem to do much other than numb the area up. Any ideas other than this?

 

[Roy Gardiner]

to BoneSmart.

It's early days, your recovery is wonderful for 6 weeks (I wasn't back on the bike at 6 weeks), just relax and things will improve with time. The clicking and the tightness will just go away.

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 Care In Hospital​

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.

 

[_Annie_]

Yes, that tightness feeling went away. I am almost 7 months out from my 1st TKR and no tightness at all in that knee. Hang in there, one morning you will wake up and realize that tight band feeling is gone.

 

[amynewleftknee]

I’m six weeks out, too and still have tightness and it’s warm at times. It also still hurts around patella.

 

[doodlebug60]

Kelleytoons; hi and welcome. I just had my 2nd tkr on 30 July. I had my 1st one on February 13th. I am 6months. out and tight feeling is almost gone. It seems to go away in most people around the 6 to 7 months time frame; but remember this is a year long recovery and everyone heals different. Hang in there it will get better; Doodlebug

 

[Kelleytoons]

These are all helpful replied, thanks! (I need to visit all the threads the mod has linked to and do a lot of reading).

I plan to be playing tennis LONG before six months (my doc says October will be fine and that's three months for me). I guess I'll just try and deal with that tightness until then.

 

[Celle]

Hello @Kelleyoons - and

Please will you tell us the full date of your knee replacement and which knee it is, so we can make a signature for you? Knowing the exact date will help us to advise you appropriately..
Thank you.

I get some aching when I do squats and twisting my knee hurts but not in an awful way

SQuats are very hard on a new knee, particulalry such a new knee as yours. I suggest you stop doing those until at least 12 weeks.
Just because you can do them doesn't mean you should.

My big goal is to be able to play tennis again (senior doubles -- no huge running or pounding, which my surgeon says will be fine) but my doc recommended I wait until 12 weeks because he thinks the hot weather here in Florida will cause my knee to swell (I'm perfectly fine with waiting another five weeks, even though I'm dying to get out there).

Please be patient.

Your knee has been through one of the most major surgeries it could have. It's a surgery from which complete recovery of all your tissues takes a full year. This recovery is a marathon, not a sprint. Try to pace yourself. If you try to do too much, too soon, you will get increased pain, tightness and swelling.

But the only thing that still really bothers me is the tightness I feel around the knee. It's as if I am still wearing a bandage when I bend the knee.

The tightness is normal. It will fade gradually, but some people find it lingers for months. That's because your knee is still healing internally. It isn't healed at 6 weeks. It's still a work in progress.

 

[Kelleytoons]

I had my left TKR done on 6/30.

Honestly, the squats I do don't hurt my replaced knee any more than they do my "good" knee (my right leg is fine -- not even a trace of pain. I realize that can always change, but my left leg has been bad now for almost five years, so I'm hoping I can get through life without doing anything to the other :>). If you truly feel I should stop doing them I will strongly consider it, or at least reduce the depth (right now I'm squatting just about as far as possible, which is to say butt nearly on the ground - I don't feel ANY pain at all until the last foot or so).

I also WANT to be patient with tennis, but at my age (69) I don't have many years of court time left. So this fall I cannot waste (to be realistic, I doubt that I will play even another 15 years -- so I'm counting my autumn prime tennis times on the fingers of both hands). I know I'll be out there when it really starts to cool off (in Florida that can be unpredictable -- some Octobers are as warm as most people's Junes but the last week or so will definitely be primo weather and I want to be at least competitive then). I thought I'd start hitting the ball against the backboard the last week or so of September and go from there. But to put this in perspective -- I play against old people. We're all about the same skill level and while it's a decent level (4.0) it's also doubles where "YOURS!" is a common cry. For the last two years or so I've just stayed in the same spot and perhaps taken a step or two and STILL was competitive. I was in agony, and so doped up it was hard to drive, but I could still compete. So even if all I can do is move a tiny bit this time I'll be fine and I certainly won't overdo it to start (think of it as perhaps as a slow bike ride where you are also swinging a racquet from time to time :>).

And on that subject -- riding my stationary bike at the medium resistance (about what I was doing prior to surgery) for 15 minutes twice a day doesn't hurt one little bit. It definitely stresses my cardio, which is why I'm doing it (I do sprints on it). I really honestly can't imagine playing doubles (where about 70% of the time you are just standing there) would be more difficult than that. Other than the extreme heat and humidity (which is why I'm waiting). But -- you folks here have a TON more experience at all of this than I do, so I welcome any advice and will certainly pay attention.

 

[Kelleytoons]

Okay, if I understand it I'm only supposed to post one thread, so let me finish out here (even though it has nothing to do with my original topic per se).

Today was my last day of PT and at 7 weeks out my rotation was measured at 140, which I guess is good. My PT guy said I was about as healed as anyone he had ever seen, but I guess I'll still wait until the end of September before hitting the courts (sigh).

My plan is to get out there and hit against a backboard. And then after a day or two I'll play some "server out" (for those of you unfamiliar with tennis, this is where you have more than 4 players and one or more sit on the bench and the server comes out and the next player comes in). This allows me to play as little or as much as I'd like, so it will be a good way to get back in (plus I'm likely so much better than these guys it won't be too difficult anyway -- these are folks who live in my community and I was already too good to play here before my surgery).

I'm also going to continue to ride my bike and do my basic stretching stuff they gave me at PT, at least three times a week. I assume I'll do that the rest of my life, right? I also need to hit the weight room and build up my quads and calves by doing squats and leg lifts on our machines there. That will keep me occupied the next six weeks.

Thanks for all the info here and I wish everyone the best of luck.

 

[kneeper]

I think you're right to experiment with hitting against a backboard and see how you do before playing outright.
One thing about this recovery is that the knee and tissues are healing for a long time. It's not that your knee is flabby and lazy and needs a good workout. ;) Figuring out your activity/exercise level requires a lot of trial and error. A good rule of thumb is to build up gradually.
Exercising too hard, too fast can lead to a nasty case of tendonitis and needless pain.
You're doing quite well. If you listen to the knee rather than a self imposed schedule you will do fine. You know what they say about best laid plans. ;) The knee is ultimately the boss.

 

[Kelleytoons]

Thanks, I will try and do that. I was a bit luckier than most (I guess) in that right up until the day of surgery I was riding my recumbent bike for 30 minutes a day, pretty hard (it hurt my bad knee like hell but my surgeon said I couldn't damage it anymore than it already was so I went for it). So I'm not sure how completely out of condition my legs are, but I will take it slowly because at my age I have to take everything slowly <g>.

The tightness I feel in the knee (the reason I came here and started this thread) may well cause me to take it slowly anyway. That's what I really feel anytime I move -- no pain, just a grabbing that makes me aware I'm not completely out of the woods yet. As long as I feel that (and I guess it might be even a year) I'm sure I will be cautious and not overdue things. But thanks to all for the advice here - it was really helpful.

 

[sistersinhim]

That tightness you are feeling is more than likely swelling. Even if you don't see much on the outside of your knee, the inside is still full of fluid. That's a small area in there and not much space for it to move around in, thus you fill the tightness. Icing and elevating will help to cut down on the fluid and make your knee feel less tight. For some, it takes almost a year for others not nearly that long. It all depends on your own body's reactions.

 

[Kelleytoons]

Thanks, that's good to know -- so, just to be sure, I should STILL ice and elevate my knee, even though my surgeon and PT folks have released me? And, is there any particular time to do this? I don't feel any pain anymore (so it's hard to get feedback about when to do this). I definitely want to get that remaining stiffness out and if I could get it out sooner than a year that would be great.

 

[Jockette]

In addition to swelling, another reason for tightness is that it 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.

I definitely want to get that remaining stiffness out and if I could get it out sooner than a year that would be great.

Your tightness may very well end, or at least become much less noticeable, well before a year. When we talk about healing taking a year, we are talking an average. We all heal at different rates, so the time varies. Some members feel much better within months, and some take the full year or longer.

 

[Celle]

I'm afraid there's really nothing you can do about that stiffness except to wait for it to go away on its own. It's a normal part of recovery and sometimes it can linger for months.
Stiffness is also one way in which people feel pain.

Doing too much exercise will increase the stiffness. You can't exercise it away.

Complete recovery from a TKR does take a full year, even though your knee may look recovered on the outside. Recovery really is a marathon, not a sprint, so try to be patient, even though it's hard.

 

[doodlebug60]

Kellytoons; I am 6.5 mths. out from my 1st tkr in February. I have good Rom and straightening. I still have the swelling and tightness when I work it to much. It's just the healing process under the skin. I don't have any pain just stiffness. Try not to worry it will keep getting better as time passes. Prayers for a great recovery; Doodlebug

 

[Roy Gardiner]

I also need to hit the weight room and build up my quads and calves by doing squats and leg lifts on our machines there.

The key is what works for YOU. Most people would not be able to do deep squats (I surely can't), but if YOU can and it doesn't cause pain or swelling then it's kinda OK. The only caveat I would have is on the shear forces going through the knee. I would worry that, over time, they might affect the cement.

I'm also going to continue to ride my bike and do my basic stretching stuff they gave me at PT, at least three times a week. I assume I'll do that the rest of my life, right?

Yes to both. Cycling is ultra low stress. No impact forces from running, no high forces (even sprinting!). I would strongly support the case of cycling as hard as you like. I do .

 

[Kelleytoons]

Yeah, deep knee squats is about the only thing where I feel... not exactly "pain" but discomfort for sure. But I also feel it in my right knee at the same level, so I suspect it's just that my body shouldn't do that (nor do I particularly need to do them that deep -- I just want to work my quads so they are strong again. When I was younger - back when dinosaurs ruled the earth - I was a gym rat and used to squat 200+ pounds free weights. And I was a dancer for many, many years -- my legs are tree trunks and that's not a brag because I kind of hate them).

I will keep riding my bike a lot but I think, if I understand everyone here, I may also take it a bit more slowly and even 'rest' a day or two here and there. I was so focused on getting ROM right that I got obsessive about doing a lot, perhaps even too much. But now that I have 140 and both my surgeon and PT folks have released me, I think I'll just slow down (but not stop -- just slow).

My biggest challenge now is in five weeks, when I want to get back on the courts. I will be VERY careful and may not even move any quicker than I did right before surgery (when the words "yours!" were used almost constantly to my partner). That way I can at least "audition" the tennis moves I need albeit in slow motion. The transition to really playing may take three months or so but I'm pretty confident by the end of the year I'll be able to compete the way I did a year or two previously.

 

[doodlebug60]

hi. Kelleytoons; glad to hear that your revision is doing well. Sorry to hear that you overdid it a little. Like you said time to ice and elevate. My 1st tkr is doing good. My 2nd one is giving me a fit due to all the swelling and fluid buildup. My knee feels like a marshmallow on top of incision. I'm having a lot of trouble sleeping now because of the tightness behind my knee. I didn't have this with my 1st surgery. I don't want to take up all your space so I'll close for now. Prayers for a great recovery. Doodlebug

 

[Kelleytoons]

I think we got a bit confused here -- seems like you thought I was the one with more swelling as noted above by someone else. I don't think I've overdone it at all -- indeed, my swelling is almost non-existent (except for the tightness around my knee, which I *guess* is still swelling and/or just surgical recovery). In fact, I'm more worried about the fact that I *might* overdue things because, at seven weeks with no pain and 140 degree rotation, there doesn't appear to be anything I couldn't do.

Today, in fact, we got some cooling here in Florida (I guess due to the tropical storm coming our way tomorrow) and if it had happened yesterday (on a Friday when they play drop-in tennis in my community) I would have been hard pressed NOT to go out there and try. It's taking everything I can NOT to start tennis again, even though my surgeon said to wait until October. But the incredibly hot weather (in the 80's with high humidity even at 7am) has kept me from wanting to do so. At 74 degrees this morning, at around 8am, I felt "geeze, I REALLY should be out on the courts!"

So far the weather predicted seems to be hot and humid through the end of September, so I think I'll be able to stick to my schedule (plus -- dear wife will most likely kill me if I put my tennis clothes on before then. Unfortunately she was in the same room with me when my surgeon released me, and she's desperate for me to be a good boy, knowing how much I tend to push things).

And I'm hoping for even more lessening of the tension around my knee -- oddly enough (perhaps due to the cooling weather) after I got out of our pool today (where I didn't do much but some simple stretching and gentle swimming) I could feel a LOT less "tight" around my knee. Even as I sit here, at least in my mind, it seems around 50% less than it was yesterday. That can't be right, of course, but even if it's just getting better that would be great (I would SO love to have it gone by the start of October -- then again, perhaps it would better if it's still there to remind me to take it slow).