TKR Trouble sleeping after LTKR

[TurtleKnee]

Pain level after 1-2 hrs in bed is probably about a 4. Otherwise, little pain other times during the day, just a little sore or irritated. Overall better as time goes on.

 

[Celle]

Still have inflammation which I understand can be slow to resolve in some people. Taking naproxen for that at night. I am thankful for the progress I have made, albeit turtle style.

@TurtleKnee , you're still only just over 4 months into what is normally a year-long recovery. I'm afraid that inflammation and stiffness are still par for the course, and so is some sleep disturbance.

The reason your knee is so stiff when you wake up is that it hasn't been moving while you sleep. Movement stimulates the production of synovial fluid in your nee, which lubricates the joint - it's a bit like putting oil on a rusty hinge. One you start moving again, synovial fluid again starts to lubricate the joint and it starts to feel less stiff.

Please be careful with the Naproxen. It's an NSAID and those medications can cause gastric bleeding. Always take it with food, and make sure you stop taking it if you have any stomach symptoms at all.

In general, I have cut down on physical activity like 30 reps of my home PT to 10 or less; the swimming appears to really help, as I have been doing that all my life. It seems though I need to balance the amount of physical activity in order to retain mobility against doing too much that it causes more inflammation and swelling.

It's good that you've cut back your exercises, but at 4 months post-op you could probably cut the exercises out completely. Just going about your normal Activities of Daily Living (ADLs) should be enough exercise - and doing too much causes the pain that disturbs your sleep.

It's not exercising that gets you your ROM - it's time. Time to recover, time for swelling and pain to settle, and time to heal. Your knee has the potential to achieve good ROM right from the start, but it's prevented from doing so by swelling and pain. As it heals and the swelling goes down, your ROM (both flexion and extension) will increase spontaneously, whether you do formal PT or just let your normal Activities of Daily Living (ADLs) be your exercise.

 

[Triker]

A point about my pain management, I stopped taking narcotics my second day after surgery and have been relying on tylenol as my main pain relief. So a plan that includes them may work better for someone.

 

[TurtleKnee]

Update: I am at 5 months and counting. Sometimes my leg feels almost normal. I am only using a cane when having to go into a shopping area or across a large parking lot.

As suggested, have quit most of the home PT except for some basic stretches and movements that I have done all my life prior to swimming workouts. Swimming helps big time. Also, as suggested, walking helps...doing small amounts of that several times a week. Icing every day which always helps, using Coriflex ice and compression that my doc ordered.

Also sleeping better, now up to 2 hours in bed without a pillow under my leg and 2-3 hours with a pillow (pillow is a small relatively flat pillow), and alternating through the night. Also most of the pain after lying in bed is with no support, and almost no pain now with the pillow.

Starting to feel like there is a light at the end of the tunnel. Still a little shy about not using a cane going outside as far as being caught off balance or somewhere with nothing to grab onto. I hope this will also continue to improve as I gain more confidence.

Thanks for your support.

 

[FCBayern]

Sounds like you are doing well @TurtleKnee. There's no rush to get rid of the cane, you should use as long as you feel more comfortable with it. I always liked that it seemed to give me a little more space in public so I had less worry of someone else knocking me down. It's always nice the day you discover that it really is a light at the end of the tunnel and not a train coming the other way! Keep us up to date about how you are doing.

 

[TurtleKnee]

As this stage, I would like to get your input on these actions at 5 months regarding my LTKR:

• Kneeling - Is it OK to kneel on my knee, when cleaning or getting down to pick something up?
• Crossing my leg - Is it OK to cross my leg to take shoes on or off?
• Stairs - Should I stay away from stairs or use them when I can instead of elevators?

 

[TKRsharon]

@TurtleKnee and FCBayern - So glad that you can se the "light at the end of the tunnel" and it is not a train! I can not wait for that day! So far, and it's only 1130 am, I am doing ok today. I did my routine walk around the block and it took me 8 minutes instead of 10! Sounds like a BIG milestone. I have found that using heat before walking or stretching and ice after is helpful, most times.

I am wondering - when can I try going up and down steps foot over foot? How will I know I am ready to try?

 

[FCBayern]

@TurtleKnee at 5 months the structural part of your knee is pretty solid, and like most of this recovery it's all about soft tissues. As soon as you are comfortable with foot over foot on the stairs you are fine, your knee will tell you if you are ready. I found if you can find somewhere with shallow steps to try it at first it doesn't put as much stress on the knee as a steeper step. Crossing your legs shouldn't be an issue if it doesn't hurt. As far as kneeling I don't actually remember how far along I was the first time. I hadn't been able to kneel on my bad knee for a number of years before TKR, so I was not in a hurry, but it didn't hurt at all when I finally tried.

 

[sistersinhim]

• Kneeling - Is it OK to kneel on my knee, when cleaning or getting down to pick something up?
• Crossing my leg - Is it OK to cross my leg to take shoes on or off? I
• Stairs - Should I stay away from stairs or use them when I can instead of elevators?

Some choose to not kneel of which I'm one. Others do OK kneeling. It's something for you to decide on your own experience.

I have no problems at all crossing my legs.

Using stairs fairly often shouldn't cause any problems. They should help to build up your muscles. But, if you find that they cause pain or swelling, stay away if you can.

 

[TurtleKnee]

I continue to improve. Sleeping better at night, 2-3 hours at a time without and with a pillow, but more relaxed. I am walking up and down 2 flights of stairs several times a week at the pool I swim at 6 days a week. Almost feel normal sometimes, doing most stuff without a cane. Stiffness is still an issue with some minimal pain off and on, but had stiffness and arthritis before the replacement.

Question #1? Does icing still help 6 months after surgery? I have been icing daily and while it is freezing cold outside, not easy. I am not sure it is really helping at this point?

Question#2? To help arthritis and stiffness and further healing of my knee, which is a better drug to take, the Naproxen that my doc gave me to help swelling and inflammation (causes upset stomach sometimes) or Meloxicam that was recommended by my primary physician and several nursing friends for arthritis (have not tried this yet)?

 

[Pumpkin]

TurtleKnee,
Glad you continue to make slow but sure progress.
#1 At this point it is up to you if icing helps use it, if not don't. You may find it beneficial on days when you are more active that normal.
#2 With medications, everyone is different, you will have to try both and see which helps you the most.

Keep us posted on how you are doing,

 

[TurtleKnee]

This is my 8 months update. I am about the same as 6 weeks ago. I am feeling discouraged as I thought I would be able to keep my leg extended longer without pain. I am doing most of what I want to do (except travel in a pandemic), but still sleeping about the same as 6 weeks ago, only 1,2 3, hours at a time then waking up uncomfortable with knee pain and pain on area outside of my leg, and tired the next day. I get up and walk around then get back in bed to do it all over again. Also pain if keeping leg extended in a recliner watching TV after an hour or so.

I did look back to my original postings and I have improved since then, but now feel I am in a stalemate, and worried I will not improve any more.

I will have to make an appointment for my 8 months checkup with the doctor, and not sure what to say. I am just hoping I do not have to have another surgery or procedure; I am worried about what he might do or not do.

 

[Pumpkin]

@TurtleKnee,
Let your surgeon know what you have told us in your post.
Knees do not like to be perfectly flat, do you have your knee slightly bent when you are lying on a flat surface?

Let us know what your surgeon says after your appointment.

 

[TurtleKnee]

I had my 8 month follow up yesterday. The doc said that I am doing good and he does not treat good. I continue to have trouble sleeping, but a lot of it is being uncomfortable with the arthritis all over my body and not just my total knee, waking up and feeling stiff and uncomfortable; I was only sleeping 4 hours anyway before my total knee, so this is not too bad.

He had me do a lot of movements and manipulated areas all around my leg and knee and said everything looks good. So, I was told to come back for my 1 year check in 4 months where they do x-rays and some more tests. He also reinforced that although patients feel much better after so many months after surgery, it does take a whole year to feel "normal" again.

 

[Sisterpat]

All sounds good, Turtle! I think we all just need to be patient - easier said than done, I know. I’m not yet able to sleep in my bed. I know eventually, it will come. Hang in there.

 

[TurtleKnee]

I am at 11 months now after my left TKR. I have one month to go before my one year evaluation and x-rays with my doc, and I am terrified.

Although my sleeping has improved in very small amounts over the last 11 months, my knee (mostly the outside of it) starts hurting and is stiff after several hours lying in bed. I get up and walk and then use a pillow for the length of my leg and sleep for about 3 hours or more, and then walk, and back to bed without the pillow for 1-2 hours. The last several months I have remained about the same.

I am worried as several of my friends (two of which are retired nurses) think there must be something wrong with me if I am having the problem above still after 11 months. One of them has had 3 replacements, with none of these problems.

My concern is that there might be a problem and the doc would want to do more surgery or MUA. I am not sure MUA would help as I have had this problem from day 1 and it has got better instead of worse. I do not want to lose my mobility I have now..... being able to do most of what I did before and swimming, walking, shopping, stairs, etc. with no pain or problems. I do not want to risk having another procedure and lose what is most important to me....being able to function during the day with the only problem being at night. I could live with that if I have to.

Any idea what my problem could be? I know we say it takes a whole year to feel normal again, but with little progress the last several months, I am feeling that this is it for me. I either have a problem or this is the best I will ever be. I have really been worrying about this and hope that you can provide some insight to what might be going on with me and what to do about it.

 

[Jockette]

Although my sleeping has improved in very small amounts over the last 11 months, my knee (mostly the outside of it) starts hurting and is stiff after several hours lying in bed.

In what position are you sleeping? I was always a side sleeper but was never able to return to that.

You could try elevating your legs while you sleep, and see if that helps, that’s what I did, and I still sleep that way.

I do not want to lose my mobility I have now..... being able to do most of what I did before and swimming, walking, shopping, stairs, etc. with no pain or problems.

It sounds like in all these areas you have done very well.

Here on Bonesmart we’ve seen a lot of members who just have some problem areas that take longer to heal. I saw a lot of improvement in my second year post op, as did @FCBayern Just because your nurse friends didn’t have this issue doesn’t mean you have a problem, you might just need more time, like some of us did. I know it’s hard, but try not to worry.

Discuss this issue at your one year check up and see what your surgeon says. If your ROM is good, which it sounds like it is, if you’re back to all those activities, then he/she won’t recommend an MUA, as that is done if ROM is very poor.

If he/she recommends any surgery, get a second opinion, from someone who doesn’t know your surgeon, and think about it carefully. Just because they recommend a procedure, that doesn’t mean you have to do it, it’s your choice.

I hope that given more time, and maybe a change of sleeping positions, will bring you relief.

 

[Jamie]

Please try not to worry so much about your knee. If you are doing the things functionally you say during the day, things are likely just fine with your knee. Soft tissues can be very contrary sometimes and take a long time (like years) to feel more normal. You say you have arthritis in other areas of your body and this is likely contributing to your discomfort when lying still at night.

You could try icing the areas that hurt. Or, at this stage you can also use heat if that works better. Try a heating pad at the small of your back as that is the place where there are lots of nerves that can get jumpy or achy at night.

You also haven't mentioned taking Tylenol. It can work wonders for pain and general discomfort. Try taking up to 1000mg at bedtime or when you wake up during the night. I use it and it will let me sleep soundly a good 4-5 hours when my body is restless. You can take this 1000mg dosage every 4 hours if needed as long as you don't take more than 4000mg in any 24 hour period and assuming you don't have kidney problems.

Also try not to listen to your "friends" who are telling you there is something wrong. It's great that the one person has had good and quick recoveries. But her experience isn't necessarily yours. And, unless she's an orthopedic expert, her opinions are just that - a guess based on no training or experience. On the other hand, those of us on BoneSmart over the years have seen many knees that take longer than the norm to get back to a more normal state. Try some of the things I suggested. Talk to your surgeon at your one-year appointment. Don't worry about additional surgery. If your ROM is good and your implant looks well seated in the x-rays, there aren't surgical options for what you're describing. It's more a case of continuing the gentle exercise you're doing and lots of time.

 

[FCBayern]

As Jockette mentioned I saw significant improvement during my second year @TurtleKnee. I was only at 120 degrees of flexion and 4 degrees from full extension at one year. By the end of the second I was 1 degree past full extension and ~140 degrees of flexion, and all of my nagging pains went away. Some of us just take a little longer, and the worse a knee is before surgery, the longer recovery seems to take.

 

[TurtleKnee]

Update on one year follow-up exam today. X-rays showed that everything was normal and doc was pleased with all the activity that I was doing. When I mentioned again the stiffness and pain after lying in bed 2-3 hours, he said some people take longer than others to get through this, and the fact that I was getting better month by month was fine. He did a knee cap massage and showed me how to do it several times daily to loosen up the area around my knee cap to help stiffness and the pain. He also is having me continue the Naproxen at night for the inflammation and pain. All and all good news.

One women in the waiting room said she had a similar problem but as time went on, had no pain or stiffness at night and no problem sleeping. That only happened with her first knee; her 2nd knee had no such problem and she is just 2 weeks after surgery. It was encouraging from you guys who posted comments here that sometimes it takes longer than a year to get back to normal as far as mobility and sleeping at night. At least I have the mobility part licked, so working on the night part. This last month things have improved a lot, sleeping normally 2-3 hours a night, then 3-4 hours with a pillow under my leg, then the rest of the night normal. Thanks for your encouragement.