TKR Total knee replacement - despairing

[Layla]

the rest of the going leg going down including my foot is also a purple tinge. I've googled this and it says this can be due to trauma, circulation, not enough oxygen in the blood.

What about the Apixaban? I looked it up and one of it's common side effects is increased bruising. Because it prevents blood clots even minor bumps or injuries can cause larger or more frequent bruises. Does the discoloration on your leg appear to be bruising? If so, report it to your physician.
I hope your PT appt today went well. Let us know when you have time.

 

[Dolphin5]

Hi All, and again thank you for your comments and encouragement.

The tight band feeling is a new one for me. It's not a problem, not painful or even uncomfortable but I haven't experienced it before 2 nights ago. Is this a good thing? Perhaps showing healing taking place?

I have not done any bends (heel slides) for about 10 days. Part of me wanting to avoid the pain I've been told to avoid and in my mind that several people on this forum have said they recovered without doing any exercises, just doing normal day to day activities. When I started another walk around the bungalow a couple of days ago my knee was hurting so I stopped. I'm not sure whether I should've continued. Was it pain or discomfort??

So yesterday....Oh My Goodness, what a difference this PT was. He actually LOOKED at my knee/leg. He appraised it. Asked me questions. So he said my leg, knee downwards, is definitely a darker colour than the other knee, and more swollen, and warm to the touch. He was concerned a blood clot was causing this. I'd already told him a blood clot had been found 6 weeks ago and I was on blood thinners. He was making lots of notes which he said he'd send to my surgery and that he would ring them to get a scan done. He wanted me to ring them too.

He watched me walk without the crutch and told me I was very stable and to stop using the crutch. I've only been using it in the garden which is on a slope, and to go to the loo in the night. It was good to hear him tell me this. It's easy to become welded to a crutch!

On the couch I showed him how far I could bring my heel back. He measured this (something the other PT never did) and told me it was 45o and should be 90o at this stage. He pushed my knee back very gently, with my permission, and reached 50o but this was painful. I didn't mind him doing this as a one off. He gave me only one exercise to do, towel under the knee and pushing the knee down whilst lifting the foot off the ground. 2/3 times a day, 10 repetitions, and holding only for a few seconds. Walking fine but nothing else until a blood clot problem was eliminated.

He has made an appt to see me again next week.

At home I rang the surgery. No slots available for a scan and I was told to ring 111 which I did. Lots of questions, was I bleeding, my chest cold, breathing difficulties etc etc and she said she'd contact the surgery and get them to ring me. The GP rang me 8pm. She checked the dosage of the Apixaban I'm taking and said that the blood clot (the scan was on 4 February) should settle down after about 6 weeks which is about now. I'm not quite sure what she meant by this. She said the Apixaban will stop any further blood clots and will deal with the current one. She didn't seem to think another scan was necessary but would request one. She said it may be rejected.

At this stage I'd sort of been hoping that another blood clot, or the existing one, could be stopping me from getting rid of the fluid in the knee and that perhaps by increasing the blood thinners my problems would be solved. The GP sort of dashed these hopes.

So that's where I'm at. Waiting to hear about having another scan.

The floodgates have opened a bit this morning. First time. I'll await the call about the scan, whether that'll be today, tomorrow..... and in the meantime carry on with the elevation and icing. I'll also try a few gentle knee bends. I know I'll be upset if I don't get a scan. It would be good to at least see the status of the blood clot, whether it's the same size etc.

 

[Layla]

Good Afternoon Dolphin,

The tight band feeling is a new one for me. It's not a problem, not painful or even uncomfortable but I haven't experienced it before 2 nights ago. Is this a good thing? Perhaps showing healing taking place?

The tightness is normal, but it's also important to continue stretching and movement to improve flexibility

I have not done any bends (heel slides) for about 10 days. Part of me wanting to avoid the pain I've been told to avoid and in my mind that several people on this forum have said they recovered without doing any exercises, just doing normal day to day activities.

I am wondering what a typical day looks like for you? How do you usually spend your time...are you able to move around easily enough or engage in any activities?

Hopefully you're able to get outdoors for at least one of your walks at this point. Even a short walk in the fresh air and natural light boosts our mood, reduces stress and improves all over well being. The sunlight helps with Vitamin D production which is important for bone health as well as our immune function. It will also prevent stiffness and improve circulation. Since you had a tough morning, a break from being indoors can be like hitting the refresh button making a difference in how we feel, and it doesn't have to be a long walk either. Walking indoors will keep you mobile but, stepping outdoors can give your body and mind a bigger boost which we often need in early recovery.

Wishing you brighter days!

 

[Layla]

When I started another walk around the bungalow a couple of days ago my knee was hurting so I stopped. I'm not sure whether I should've continued. Was it pain or discomfort??

Differentiating discomfort from pain -

Discomfort may feel like mild to moderate tightness / stiffness / soreness. Likely after movement, but goes away with rest. Feels more like a nuisance than intense.

On the other hand...Pain can be sharp / intense / throbbing. Doesn't easily go away with rest and may even worsen as time goes on. It can limit you from engaging in normal activities.

Hopefully this helps you have a better understanding.

 

[Layla]

One more thing -

So he said my leg, knee downwards, is definitely a darker colour than the other knee, and more swollen, and warm to the touch. He was concerned a blood clot was causing this.

Since he saw your leg and we haven't, did the PT mention the possibility of bruising? Or only blood clot?
I ask because many mention their op leg looking "pinkish" post op, I experienced this also. It is not uncommon and can be due to increased blood flow to the area to aid in the healing process and is noticeable in the first few months post op. This can include warmth also... but I am assuming your PT is aware of this.

 

[Jockette]

I have not done any bends (heel slides) for about 10 days. Part of me wanting to avoid the pain I've been told to avoid and in my mind that several people on this forum have said they recovered without doing any exercises, just doing normal day to day activities.

Here is an article from the Bonesmart Library about No Exercises. It was written by Josephine, who was a very experienced orthopedic nurse, in and out of the operating room/theater, with many years of experience. She is retired now from her work and from Bonesmart, but she was quite the advisor here on Bonesmart for many years. She trained me well for helping others recover from their knee replacements. You can read more about Josephine’s qualifications here if you’re interested.

https://bonesmart.org/forum/threads/no-exercising-what-does-that-really-mean.54805/

 

[Dolphin5]

Hi Layla and Jockette. Thank you for your comments. A bit of drama yesterday. The previous day, in the afternoon, I was hit with excruciating pain in and around my knee, especially at the back of the knee which was unusual and is where the blood clot was. I increased the strong painkillers but was back to having to use the crutch, leaning on it heavily. It was like being 2/3 weeks after the op. The pain continued during the night but had eased off when I woke about 7am. I decided to ring 101 and was surprised when I was told to go to A&E within the hour. I had excellent treatment, including the much wanted scan which, amazingly, showed that the blood clot had dispersed. It can take months for this to happen. I felt better mentally for knowing I no longer have the blood clot but do need to continue with the blood thinners for another nearly 5 months.

Prior to the pain I'd done one exercise. Rolled up towel under the knee, pressing the knee down and lifting the foot off the bed. I did 10 of these and must've pushed my knee down too hard. It's the only explanation.

So my daily routine with the new regime (started 9 days ago). Up about 7am. See to the animals and go back to bed with coffee and the ice pack. Get up half an hour later. Back to bed with cereal and another ice pack. Get up 45 minutes later and get washed, dressed etc. stroll round the garden, wash up etc. Then back to my bed for elevation 45-60 minutes with ice pack on. After that 10 minutes walk around the bungalow and to back to bed with coffee and relax (with ice pack). Up about an hour later. Go on computer, do a few bits and pieces, have lunch in chair with legs on stool for about 45 minutes. Perhaps another short walk and then back to the bed for the second elevation. Again 45-60 minutes. I then sometimes go back to bed and relax for an hour (with ice pack). 4.30 onwards it's preparing evening meal, feeding the animals etc.

Eat about 6pm and spend the evening in chair with legs up on stool, getting up every 45 minutes or so for movement. Do the ice pack 2 or 3 times in the morning evening.

I'm now incorporating the stretching and bends exercises in between, as and when. I'm also doing ankle pumps and the gluts exercises.

It does sound a bit lazy doing back to bed but to me it is preferable to rest in bed than sit in a chair.

I'm going to start doing a diary of the exercises I do each day and monitor the pain/discomfort the next day. There is still NO improvement at all in the range of movement. I'm seeing the physio again next Thursday. I hope when he measures me there will be even the tiniest improvement.

 

[beralc]

Good that you’ve had the reassurance of the scan and that’s given you peace of mind.

So reading through, you’re doing 2x elevations a day? Is there any reason you couldn’t incorporate elevations each time you ice too? In fact any time you’re sedentary? I know you said you have back issues, as do I, but I just tried different things until I was fairly comfortable. I set up pillows on a a forestall and they stayed there. In bed at night I made a 3 pillow stack and slept that way. It meant getting a whole night of elevation. I’m not saying it was supremely comfortable but I knew it was going to be so helpful. Quite often the pillows felt hard under my gradually recovering leg but I still kept it there.

Despite some big set backs in the first 6/7 weeks post surgery one thing I did religiously was elevate, literally whenever I was sedentary my leg was elevated toes above nose, with and without ice packs. It was my default position through the day and night.

The fact that I wasn’t able for large portions of time to do any exercises beyond ankle pumps, knee presses and quad tightenings/lifting (I wasn’t even able to do a huge number of daily living activities consistently at times), I am convinced the elevation has been key in now bringing the improvements I’ve seen over the past 1-2 weeks.


Less than 2 weeks ago I had a little nagging doubt that I’d ever recover, but suddenly things are improving, so you’ll get there. The idea of you keeping a journal is good, because it’s hard to remember things sometimes and as you say you can use it to monitor things too.

 

[Layla]

Hello and Happy Friday, Dolphin! Nice to hear from you, thanks for the update.
Thankfully the pain you had dissipated and what wonderful news that the blood clot is history! That news had to be such a relief.

At this point, two months post op, you do want to reduce swelling with icing and elevation, but it is also important to work on strength and mobility rather than long periods of rest with an ice pack. Icing will be beneficial after activity, or PT. Laying in bed too much, icing, can reduce circulation which is essential for healing. Try to prioritize movement over lengthy bed rest. Some discomfort is normal at this point. Get outdoors and walk regularly, using an assistive device if necessary, do any prescribed exercises, within reason, and increase your daily activity.

It does sound a bit lazy doing back to bed but to me it is preferable to rest in bed than sit in a chair.

I understand because bed is tempting and comfy, but spending too much time in bed, even for icing and rest can slow down your recovery rather than helping it. Moving more will prevent stiffness and improve your ROM. Icing does help with swelling, but as you walk and your muscles contract, fluid is pumped out of the joint more efficiently. Your muscles need use to regain the strength needed to support your knee. Lying in bed too much can lead to muscle atrophy which will make your activities more difficult in the long run.

I understand the chair is not as comfortable as the bed, but try it several times a day to avoid the temptation to lay in bed. Don't get me wrong, it is okay to rest when needed, but the key is not to let comfort (bed) override the activity your knee needs to heal properly. Your goal should be to be more upright and active throughout the day. Test your limits, go slowly and increase activity as your body allows.

Journaling your daily activity and how you feel the next day is a great idea so you're able to see improvements, no matter how small. I hope today is a good day and the weekend a pleasant one, Dolphin.
Best Wishes!

 

[Dolphin5]

Hi Beraic and Layla. Thank you for your comments. Beraic what is your current rom? Mine is a mere 45o and should apparently be about 90o at this stage. I'm trying to imagine doing toes above the nose during the night. It would mean an uncomfortable nights sleep? I'm currently using a suitcase with cushions on it which works. I may try and give this a go, at least try it.

As for doing toes above the nose every time you're sedentary I don't know how one can do this whilst sitting in a chair. It's a very unnatural position and surely is going to put a strain on ones back and hips......

Layla I understand and agree with you about keeping moving but if I'm going to rest surely sitting in bed is just as good as sitting in a chair? It's never more than an hour before I'm up and moving again. If resting in a chair I'll put the TV on, if resting in bed I'll read my book. And it's more comfortable in bed though again I agree it's tempting to be in bed.

Yesterday: apart from doing 2 X elevations of 45-60 minutes each, I strolled round my garden twice for a few minutes. 10 mins walk round the bungalow twice. Heel slides in a chair twice, 10 repetitions, holding for about 10 seconds. Two knee presses into the bed and lots of ankle pumps throughout the day. But my knee is more painful and stiff this morning. However, before bed I jerked it. Excruciating pain but to my surprise the pain went within a few seconds. But could this unfortunate jerk have made my knee worse today or the exercises?

Having initially decided to do half the exercises today, I've now decided to do exactly the same as yesterday to see what the knee is like tomorrow. I've a feeling you may disagree and advise rest today? I find getting this balance REALLY hard. Feeling negative...,

 

[Dolphin5]

A possible tip for those recovering from surgery who have dogs and want to be able to walk them asap safely. One of my dogs doesn't walk very well on the lead. Tends to pull in all directions. My other dog sometimes reacts badly to certain breeds and goes a bit berserk. I remembered something I used decades ago on one of my dogs. It's a Halti or Gentle Leader. It basically goes over the dogs head and nose, looks a little like a muzzle, and the lead attaches to this. Dogs have no strength to pull from their head or nose unlike a conventional collar/harness which means they pull with strength from their shoulder. Dogs don't particularly like these BUT they are worth using if it means you can walk safely with them.

I have just ordered them for my dogs which should help me get out walking them sooner rather than later. Only 7/8 minutes to where they can be let off the lead and run freely. It's given me hope that I'll be able to walk them soon which will open up my world substantially.

 

[Layla]

As for doing toes above the nose every time you're sedentary I don't know how one can do this whilst sitting in a chair. It's a very unnatural position and surely is going to put a strain on ones back and hips......

Elevating your feet is better than letting your legs hang down, even though your toes aren't above your nose. It can help reduce swelling and improve circulation, aiding in healing and reducing discomfort. Using a footstool or ottoman, with legs propped at hip level is better than sitting with your feet down which can increase swelling.

Layla I understand and agree with you about keeping moving but if I'm going to rest surely sitting in bed is just as good as sitting in a chair? It's never more than an hour before I'm up and moving again. If resting in a chair I'll put the TV on, if resting in bed I'll read my book. And it's more comfortable in bed though again I agree it's tempting to be in bed.

At two months post op, try to avoid time in bed other than for a nap, or overnight, unless your OS has advised this for a specific reason. It's best to be as mobile as possible to improve your strength, flexibility and your circulation.

I know you've been doing great walking inside, but I do believe if you're able to step it up a little, even a short walk outside on pavement, a sidewalk, trail or path, it will help your knee strengthen in ways walking indoors or in a garden can't.

I understand it's difficult for you to go for a walk outdoors without your furry friends, but prioritizing your recovery now means you'll be in better condition to walk with your dogs once you receive the lead you ordered. In going alone, you'll be able to focus on your gait without distraction. A walk outdoors is different than stopping and starting indoors. Outdoors provides more of a continuous stride. It will help build stamina so you're feeling strong and ready to roll by party time on April 12th. Only three weeks to go..Woohoo!

 

[Jamie]

There comes a point where you have to consider the mental aspects of recovery as much as the physical ones. Our suggestions to get up and out of bed are given with that in mind. Yes, being in bed is comfortable. But spending lots of time in your bed even if you’re healthy and well sends a mental signal to your brain that is counter productive to getting back to life again. I agree with Layla that you might want to try some outdoor walks on your own with no dogs, just to have a different perspective, Walking outside is a bit more challenging than walking around your house, so it will do a good job of working your knee. Make sure you are comfortable walking down to the dog park on your own BEFORE you leash up the pups.

You’re still really early in recovery and you’re going to experience ups and downs with aches and pains. Are you taking any medications for the pain you’re having?

 

[Dolphin5]

Hi Layla and Jamie

Yes, you're right about the mental aspect of getting up and dressed and I do feel better when I do this. And again, I'll try and start doing a short walk outside. Rain forecast today so I will give it a go tomorrow.

Unfortunately for the second evening in a row I jarred my knee last night. Yesterday the knee downwards was swollen and painful. Again, I persevered with the same activities as mentioned and in addition actually hung my washing out. I had to make 3 separate trips to the rotary line as my garden is on a slope so a bit of extra exercise. It helped in making me feel normal again BUT did I do too much? The knee was not good yesterday. I did the elevations. I did the ice packs. Today it's not good again. I know it's difficult for,you today but do you think these two days setbacks could be due to the jarring of the knee?

So what do I do today? Daily activities and resting? Short walks but no exercises? Exercises but no walking? Sometimes I still find it hard to differentiate between pain and discomfort. Perhaps i have a high pain tolerance and am actually in pain but think it's only discomfort......

My regular painkillers are 2 Dihydrocodeine 30mg about 9pm. Two paracetamol 9am (my son insists that these will help with my mobility in the daytime. We did argue a bit about this as I don't want to mask pain but he may have a point in me moving better with this small amount of help). Last night I took an extra 2 Paracetamol.

I do have my feet up on a stool during the evenings.

I will DEFINITELY start walking outside from tomorrow. Thank you both very much.

 

[EalingGran]

Using a footstool or ottoman, with legs propped at hip level is better than sitting with your feet down which can increase swelling.

Agree with @Layla
I found a rocking stool ( left over from my daughter nursing my grandson- but widely available cheaply online secondhand) a real Godsend.
It combined elevation with gentle movement which was great for developing ROM. I used it all the time I wasnt exercising/ sleeping. Really pleasant for watching TV/ reading.

 

[Dolphin5]

Thank you Ealing Gran. I'll take a look.

 

[Dolphin5]

I've been using a suitcase, lengthways, with cushions on top when doing elevation. It's worked ok but I've just ordered a foam proper leg elevation cushion. I'm going to try using it during the night. Delivery 5-7 days.

 

[beralc]

@Dolphin. I know it all seems so confusing for you. Should I do this should I not do that, will I make things worse, why am I not improving???
The fact that it feels backwards and forwards is because it is. I don’t know of anyone on the Forum who has followed a straight line. You won’t know the answer to anything, but trying and then reviewing things is the way to find out.
As I said several posts ago decided on a routine in the morning of activities and exercise you’re going to do. Write it down at first in the journal you spoke of, its amazing how much more in control you will feel by doing this. At the end of the day or at the time write down how it felt, the good things that you felt or achieved and decide on things you need to change. The following morning you write a new routine (or do the same or less) based on how you feel this morning.

Jarring your knee is going to cause a reaction but I think that will be short lived, because there’s nothing wrong with your knee anymore. I came to this realisation last week, my new knee is probably the strongest joint in my body.
I had my surgery 5 days before you my ROM is now a steady 100 most days and 110 on very good days ie when less swollen. I really wouldn’t compare though because everyone’s situation is different. I also have the advantage of having my husband here who is doing the lion share of everything with me coming in doing some of the tasks and him taking up the slack again. So when I’ve needed rest and elevation I’ve really been able to do that. You don’t have that luxury so things are going to be different for you.

I agree with @EalingGran I have a rocking chair I borrowed from my daughter and have found it a really good tool, along with elevation, for improving ROM.

Lastly it’s normal to feel negative about things when you’re not in control, try and accept what you can’t change for now, but in the sure knowledge that all the efforts you make now, will be going towards all the improvements you will make in the long term.

 

[beralc]

. I'm trying to imagine doing toes above the nose during the night. It would mean an uncomfortable nights sleep? I'm currently using a suitcase with cushions on it which works. I may try and give this a go, at least try it.

As for doing toes above the nose every time you're sedentary I don't know how one can do this whilst sitting in a chair. It's a very unnatural position and surely is going to put a strain on ones back and hips......

While your leg is elevated overnight, it’s important to try and stay elevated , so for the night time you need to make your top half stable so you’re more likely to remain comfortably in position. I’ve added a drawing of what we nurses used to call the armchair pillow arrangement.Pillow 1 is laid crossways followed by 2and 3 in an upside down V then lastly Pillow 4 acrooways.
It takes a bit of tweaking to get your leg arranged but if you have a support cushion coming for your leg, that’s great. I actually ended up having both legs elevated in the end because I found the lopsidedness (of one up one down) put a strain on my lower back. You sort of remain in a semi recumbent position overnight and although at first it feels odd it’s definitely worth trying. I find it really comfortable now, but in the beginning it wasn’t.

With regards your second point are you sitting in an upright chair? A recliner or a couch?
I sort of replicated the bed arrangement on the couch I sit on and it works fine. Again it takes a bit of getting used to, but it feels very natural to me now. As you say give it a try.

 

[RunA42K]

Hi Dolphin5, I have been reading through your thread and wanted to tell you not to despair. I spent many years on Bonesmart with one TKR and two revisions all on the same knee. One of the things that you said that jumped out at me was the tightness around your knee. That I hated so much. I thought of it like a metal clamp that was just squeezing me. I had not thought about that for such a long time but I am happy to tell you that it will go away - not quickly but after many months mine went away. This is referring to my very first TKR. Also to this day and even as I type I always have my legs up on an ottoman, it is still so much more comfortable than legs hanging down as that will make your legs swell for sure. My last revision was 11/5/2015 so yes the ottoman still feels best. Even now after all of this time when I sit for a while or like driving the car for 45 minutes, legs down, knees bent I still have start up pain upon getting up and moving but that disappears after about 3 or 4 steps.

I used to say that the first thing I’d think about when I woke up was my TKR knee and the last thing I’d think about as I got into bed was my TKR knee. It consumed my life. I don’t think about it that much anymore, just if I do something I should not do and it reminds me that it is there! One day you will feel that way too.

I plan to check back in on your thread and see how you are doing. I have been gone from here for about 3 years but just came back yesterday. This forum is full of caring helpful people that you can learn so much from. They were my life saver for sure.

Take care, Bonnie