TKR Trinket’s Second Knee Replacement

trinket

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I had a right side TKR on December 5, so I'm about four weeks in. The first two weeks were miserable. I was totally unprepared for how bad it would be. I have an extreme amount of swelling which is finally starting to dissipate, but other than that seem to be doing well. Going to PT two times per week and my ROM is good. My question about icing is ...

I'm told how important it is ice frequently, and that would seem to make sense. However, every time I ice, my knee gets more stiff and uncomfortable than it was before icing. For example, yesterday I was walking around the house, did some stairs, felt great and then thought that I should elevate and ice. So I did, and after that my knee got very tight, stiff and remained that way for the rest of the day. I'm using gel packs with a towel between the pack and my clothes and only doing about 15 minutes at a time. Has anyone else experienced this?
 
@trinket Welcome to BoneSmart.
I'm using gel packs with a towel between the pack and my clothes and only doing about 15 minutes at a time.
Ice for 45-60 minutes per session several times per day. The stiffness you are feeling is inflammation - probably brought on by the walking around and stairs. Ice will reduce this but not if you are only icing for 15 minutes.

Here are some recovery guidelines for you:

Knee Recovery: The Guidelines
We are all different, as are the approaches to this recovery and rehab. The key is, “Find what works for YOU.“ Your doctor(s), physiotherapist(s) and BoneSmart are here to help. But you have the final decision as to what approach you use.

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

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
5. Here is a very general week-by-week guide. Activity progression for TKRs

6. Access these pages on the website

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.
 
Hi and Welcome!

I also found that I was very stiff after icing. I did it anyway, for at least 45 minutes, but I never liked it and I didn’t feel that I got any benefit from it. My body is extremely sensitive and I think for some of us, the temperature of a gel pack from the freezer just doesn’t agree with us. Maybe try keeping your gel pack in the refrigerator instead of the freezer. The cool might feel better for you than the cold. It may not work as well on your swelling as a frozen one, but it might help some. We are all different and sometimes we have to adjust the recommendations to meet our specific needs.

You might also want to adjust your activity level, you may be doing more than your knee is healed to do, including the exercises.

Regaining our ROM does not require forceful bending or painful exercises.
Regaining our ROM is more about Time than repetitions of a list of exercises.

Time to recover.
Time for pain and swelling to settle.
Time to heal.

Our range of motion is right there all along just waiting for 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. Normal activity is the key to success.
 
Hi, I kept the ice on pretty much 24/7 the first few weeks then decreased to a few times a day. I also kept it on while driving. The cover for my ice pack had Velcro straps. I find with the cold weather I can't tolerate it as well as I did before. At 4 1/2 months my swelling has gone way down unless I am really active as I was getting ready for the holidays. My OS said I could also try heat after 6-weeks. Jockette I will try keeping the ice gel packs in the refrigerator. As a side note I love your new photo! Beautiful!

 
At almost 4 months, I also wonder about ice. Sometimes I seem stiffer after than before. Maybe I will also try Jockette’s suggestion.
 
I used the ice water circulating machines that you can load frozen water bottles in. It took 4 of the standard-sized bottles, plus a few cubes, and some cold water to start up. This usually lasted 3-4 hours. It wasn't as cold as a frozen wrap but was really nice and cold. I used this cold water circulating machine for at least 4 months. The first month it was almost 24/7. As I healed more, I was able to cut back some. But, whenever I did anything extra, I would ice for at least an hour at the time for the rest of the day. This helped to keep my pain and swelling way lower.
 
Thanks for the suggestions. As Jockette said, I feel exactly that the ice is just too cold. When I iced today, I put two layers of towels between my pants and the ice pack. That seemed much better. Refrigerating sounds like a good idea to try and I now have one of my gel packs in the fridge. I get that ice is a good idea and why, but when it stiffens me up for the rest of the day, that just doesn't seem right.

Again, thanks for everyones help.
 
It's not unusual for your knee to be stiff at 4-5 weeks when you are not moving, when you stand too long or do too many stairs/exercises. You are applying the ice to decrease swelling and to decrease pain but when you get up it takes a few minutes to stretch and walk to decrease the stiffness. The internal swelling will take time to resolve. At 4 1/2 months the stiffness has decreased but if I go for a long car ride it's there and it takes some walking to loosen my knee up. At 4-weeks I would walk in my house with my walker back n forth many times a day when my knee felt stiff. Swelling will go up and down as your knee heals. My OS said by 6-months it should be better. Fingers X!!
 
Good luck with the icing. It may require some experimenting with letting the gel packs warm up a bit or just keep them in the refrigerator as Jockette suggested. I think the cooling would help the knee feel better.

But if none of that works you can see how you feel without icing. I think elevating is particularly important in the early stages, though, because gravity with your leg down tends to lead to swelling which leads to more stiffness.

Stiffness is also part of the pain process/ a form of pain. I realized my stiffness decreased a bit when I took my pain meds or just tylenol.

Let us know how it goes.
 
@trinket, I swear by my ice machine, it’s an Ossur Cold Rush. It has adjustable temperature control, so you can decide what feels best. It wraps around your knee, so you are icing front and back and getting a small amount of compression too. It has levels 1, 2, 3, and Max. I use it on 3 so I imagine 1 would be very mild cooling. I got mine on Amazon for around $150. It has lasted me through two hip surgeries and two knee surgeries, as well as a friend’s hip surgery, another friend’s shoulder surgery, and another friend’s ankle injury. Worth its weight in gold!
 
I think elevating is particularly important in the early stages, though, because gravity with your leg down tends to lead to swelling which leads to more stiffness.
I agree. I have an injury right now and my leg is best first thing in the morning, because I’ve elevated all night while sleeping. I’m not icing at night because the cold gel pack prevents me from falling asleep.
Stiffness is also part of the pain process/ a form of pain. I realized my stiffness decreased a bit when I took my pain meds or just tylenol.
I agree with this also.
 
Happy One Month Anniversary!
I hope you are doing well in this first week of 2023!
May this be a year of good health, peace and joy for you!
@trinket
 
Thank you everyone. I talked to my PT about icing and he said that if I felt it was not making my knee feel better to try not doing it and that's what I have done. I'm coming along nicely, my knee gets stiff, but I know that will improve with time. After four weeks of PT I'm at 122 and -2 for the numbers, although my PT says the numbers are just a guide and not set in stone. I've gone back to the gym and have started weight training, cardio and pilates reformer. Am going up and down steps fairly well. I definitely see the light at the end of the tunnel and am starting to think about when I would want to do knee#2. It's a pleasure to move my new knee and not feel the awful bone on bone scraping.
 
Hello, a bit late to start my thread, but here we go ...

My RTKR was December 5. Checked into the surgery center, prep was very comfortable and uneventful. Gave me some lovely relaxing drugs in the iv, did the nerve block and off we went to surgery. Woke up back in my room feeling very good. Had some juice and crackers, rested a bit, and got up on my walker with no problem. Took a short walk and thinking "this is great".

I opted to stay overnight in the surgery center to relax, give myself some time with my new knee and, most importantly, give my partner some time to acclimate before he had to take over my care. All went well, taken care of, well fed and rested. Off to home at 7am the next day with Oxycodone, Visteral, Tylenol, Aleve and baby Aspirin. The surgery center stay was awesome - highly recommend.

I had been warned that there would be more pain as the nerve block wore off and thought ... how bad could it be? Well, was I unprepared and naive for what came next. I had so much swelling my leg was like a cement pillar. The Oxy and Visceral worked well for the pain, but nothing helped the uncomfortable swelling. I had the TEDS and calf pumps to prevent a blood clot and they were hot and itchy. Total misery.

I had an appointment for PT three days after surgery. The morning of PT I called to cancel because I felt so awful. Luckily, my PT happened to be standing at the scheduling desk and she encouraged me to come in to talk about my PT plan and do some light stretching. I'm sure glad I went. She reassured me that my swelling and discomfort was perfectly normal, and showed me how to do some light stretching. It helped a lot. It felt good to move my leg and although I expected it to be very painful, it was not. It was very, very tight but not painful. It felt good to get some ROM.

I lasted for six days on the Oxycodone and quit it. It was fine for the pain, but made me shaky, anxious and jittery. I went to Tylenol, Visteral and Aleve. I think I had a bit of a withdrawal going and was happy to get rid of the Oxy. Slowly the pain got better, but the awful tightness due to all the swelling got worse. I had an impossible time icing. Icing just made the pain worse, and made my knee seize up so I could barely move it. Gave up the ice and went to elevation only. Much better.

Continued with PT. My therapist encouraged me to push to the point of a little discomfort, but not pain. I was pleased with my progress and attained 124 flexion and -2 extension after a couple of weeks. Still the swelling continued to be relentless and I have a lot of tightness in my knee.

Fast forward ... I started driving and went back to the gym at week three. Saw my surgeon for six week followup yesterday and he is delighted. My X-ray looks perfect, I have no restrictions on what I can do, and he released me from PT. He assures me the swelling will continue to come down and the tightness across my knee will resolve, although it takes time. I do see light at the end of the tunnel!!

Thanks for letting me tell my story. This is a great group with wonderful information.
 
Sounds like you are doing amazingly well.
The tightness will improve. I am 12 weeks post PKR and it is very minimal now.
Impressed that you are back to driving. I am still a bit nervous of this- but we live in a very busy suburb of London and there would be a lot of stop/ start braking and I just think it would aggravate my new knee.
 
Sounds like you are doing amazingly well.
The tightness will improve. I am 12 weeks post PKR and it is very minimal now.
Impressed that you are back to driving. I am still a bit nervous of this- but we live in a very busy suburb of London and there would be a lot of stop/ start braking and I just think it would aggravate my new knee.
I was nervous at first, but stayed very close to home and only drove at traffic "down" times. I was motivated to get back to the gym to do light workouts, and had to drive to get there.
 
Hi @trinket and welcome! I'm glad you found us. :welome:

It does sound like your recovery is off to a great start. You were fortunate to find a physical therapist who understands how to approach a TKR patient. Just remember that you are still early days in this year-long recovery. Keep up your process, butry not to overdo.

Please continue to share your story. It's so helpful for folks considering this surgery to read success stories like yours.
 
Thrilled that I was able to get up and down from the floor today in my Rollga class. I knelt on my knee (with a thick foam pad), used a chair to help me up and it felt just fine. It was wonderful to roll my quads and calves. I think it helped with some of the swelling. Also did some upper body TRX. Going to take it easy the rest of the day,
 
Awesome! It feels so good to be able to do things again that became excruciatingly painful, if not impossible, before joint replacement. Rollga? Interesting, never heard of it and will be doing a search to educate myself as soon as I'm done on your thread.
Have a relaxing rest of the day and evening. Thanks for the update!
@trinket
 

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