TKR Two Steps Forward, One Step Back

[nlthomp]

Thanks for the feedback, speccybecky. I'm planning to discuss this with my GP. Is there a recommended time to start weaning off?

 

[LinZee77]

Hi nithomp-
I can so relate to your title, I think it took me close to 5 1/2 weeks before I didn't wake up with a moan and groan, it's really because of being immoblle for so many hours straight ! I usually have to go to my "icing settee" where I keep my cryo-cuff, and slap it on for the first twenty or so minutes after waking up before I can get on with the day. But remember this process takes a while, and just remember to measure the smallest things in terms of progress, say if you are using the cane less, can walk for a longer time, do some simple meal prep, or throw in a laundry load. Regarding pain med weaning, first do this : see if you can go maybe six hours between doses of pain meds (and when) rather than four. I have myself on a maintenance dose (say 10 mg oxy, 1000 mg tylenol 3x a day) at six weeks out, not yet decreasing the amount, but trying to see how long between doses I can go (if the directions say every six to eight hours, try to go to seven hours, or if it is every four to six try going to five or six). It may be too early to taper yet if you still can't even go longer between doses without your pain levels going beyond a 3. Just a suggestion, everyone has their own method.
Best of luck and it will get better, I promise ( I have one knee replacement from two years ago which is taking alot of slack lately with the newest knee, but doing super through all this)

 

[brs0660]

Good question about weaning pain meds. I personally took pain meds for three months. I did begin to back off a bit around two months. Then may I add, nights were tough for me, so I would save my meds for bedtime. It is really personal. Check the library for the information on Tylenol. Very interesting.

 

[Roy Gardiner]

The standard advice is to take your pain control drugs as long as you need them, and not to worry about them. You will stop taking them when you forget to because you're not in pain. You don't have to work at it.

 

[Nanners]

I have to agree, WAY too soon to be weaning off your pain pills!

 

[gami]

Hi nithomp.. I'm a bit further along than you but can relate as most TKR's can to how you feel, it's slow process allowing our bodies to heal and earning to live through each new day post op.

When I think of my sleepless nights, swelling and discomfort and dealing with my own and others expectations of how 'recovered' I should be it, along with learning how this whole recovery ride works..it reassures me of the true value of this forum for all joint replacement patients.

The support encouragement and wisdom of helping you chart your own way through this is all here...work through the articles in the library and sharing on the posts, it's here for you.

I remember my first trip to the supermarket..limped in laughing...crawled out crying...too much too soon. Last week I'd driven over to the market, taken my mother to the hairdresser, did some shopping, hooped back in the car and my husband said with a smile...do you realize just how far you have come in the last few weeks..I was smiling too.

It will come...but everything including your meds..in it's own time and it's not you that decides it's your body...soon you'll join the peloton and be peddling long with Fairy and Tooth Fairy on the great Tour de Bonesmartie

Hugs Gami

 

[nlthomp]

Thanks for the feedback, everyone. It's greatly appreciated! Going on week 5 now and feeling like I've crossed some hurdles. New PT is listening to me (yeah) and has changed the therapy to more exercising, stretching and gentle bending. She also massages the knee and hamstrings, which feels heavenly I'm riding the bike so much better. No more pain getting over the top of the pedal. After reading the articles and all the invaluable feedback I've received here, my mental state has improved, as well. I'm taking my recovery one day at a time. Not to say there haven't been days that are tough, but seeing what all of you have accomplished has inspired me tremendously!!

I surely can relate to your posts, Gami and Lin Z. Thanks so much for sharing your experience. Not quite sure what I would have done without your support. Many thanks to all and please know everyone is in my thoughts and prayers.

Most importantly, I'm finally learning that TKR is a not a sprint, but a marathon. If you can adjust your way of looking at your recovery, it can make your experience a lot easier to tolerate

 

[1ELISEA]

Six weeks is the unofficial time when people truly start feeling better, so you are almost there!!
Wishing you the best!

 

[jancat]

Congrats on your new knee, nlthomp!

You are in the 'why-did-I-do-this' stage and soon you'll be in the 'I-am-so-glad-I-did-this' stage, so hang in there! I was in the midst of a nasty case of post-op blues last year at this time when I luckily found Bonesmart.
I didn't start to wean off pain meds until 9 weeks out, so if you are in pain, please don't try. Yes I did have a rough time for about a week or so, but I followed Jamie's weaning schedule and it took about 3 weeks to be free of the 'icky' feeling. I had been on dilaudid, then ocycontin, then percocet. But don't start to wean yet! You are way too early in recovery to not need them.
As for PT, I never had pain, just always gentle stretching,bending and strengthening exercises. He always put heat wraps on the knee for about 10 minutes before we started PT, and at the end we iced.
Good luck and keep us posted.

 

[nlthomp]

Thanks very much, 1ELISEA! I feel it coming

Greatly appreciate your encouragement. Hope your's is all you had hoped for and more!

Best,
Nancy

 

[nlthomp]

Hello @jankat! What an encouraging note. Don't know what I would have done without this site. You're right about the meds. I think trying to cut back too soon is a big mistake. I've received so much wonderful advice that I don't feel alarmed now at every little pain or cramp. Hard to believe how quickly 5-weeks can go by.

Sounds like your PT was fantastic! It took a few heart-to-heart talks to get mine on the same path. We're good now and are working very well together. Communication is key.

Your feedback is greatly appreciated. Thanks so much for stopping by and all the best to you

Nancy

 

[nlthomp]

Happy Memorial Day weekend Bonesmarties!! I hope everyone is finding some relaxation this holiday weekend! After hitting a few bumps in the road, I have a question for those with extension problems. Long story short, I had been doing very well with an extension of 2 after 6-weeks of PT. Prior to my TKR I had been at 8 for about 9-months, ever since an arthroscopy last year. At the 6-week checkup, my OS was concerned about pain meds I was still taking; Oxycodone 5-325, 1-2 every 4-6 hrs. He said that most patients don't have this level of pain and that I should wean off ASAP, substituting Tylenol. I explained that we were working very hard at PT to regain my extension and that after PT and the following day were very uncomfortable. We were making great progress and I have a wonderful PT. My OS said I may never regain the full extension. I was so upset and can't imagine anyone going through this surgery thinking that would be the case. So... without pain meds, my improvement has been slowing down. I can't get thru the same exercises and the extension has lost a few degrees, as has overall progress. And I'm still in a lot of pain!! Can't take anything other than one NSAID, as I'm on Celebrex twice a day. Has anyone regained full extension after 10-weeks? I'm doing all the exercises, hanging leg off bed, etc. Although it's only a few degrees, it prohibits locking of the knee and also causes a limp. It just seems stuck there and it's exhausting not being able to lock your knee. Any suggestions and/or feedback would be greatly appreciated. Thanks so much. This site has been so helpful. I don't know what I'd do without it

 

[Roy Gardiner]

So... without pain meds, my improvement has been slowing down. I can't get thru the same exercises and the extension has lost a few degrees

I am rather baffled. In my own case, and I thought this was general, the calves and hamstrings and tendons at the back of the knee were largely unaffected by the surgery trauma. The removal of bone spurs meant they could reach full movement, only inhibited by the level of shortening they'd undergone over the years because of those bone spurs. Doing gentle stretches many times a day (see my stretches thread from the sig) solved the problem.

Stretching exercises should not hurt, should not need drugs to do, and should work really well. Even walking with a proper stride will give a fine stretch at the back of the knees.

All I can imagine (and I may not be correct, of course!) is that you're doing too much or too strenuously. Stretches done too aggressively hurt and are counter productive as the body reacts against them. I have always regarding this hanging the leg off the bed with a weight on it as a prime example.

 

[nlthomp]

Hi Roy. Thanks for your feedback I've been stretching, using the chair and a belt to lift the leg, pulling back on the ball of the foot. I also stretch the calves by using the belt. I can feel the hamstrings and calf muscles stretching, and nothing has noticeably swelled. My knee is still very stiff and my gait is unsteady. Maybe I'll try to concentrate on more heel-toe walking, even though it's way off balance. Possibly I'm not stretching often enough. I'll make a point of following your thread suggestions several more times a day. I've had this problem for almost a year and maybe I'm just expecting too much, too soon. When my OS said extension may never reach 0, I assumed I would be stuck like this. Not a happy thought.

Thanks again and enjoy the weekend

 

[Roy Gardiner]

OK, it sounds like you're doing it right then (sorry for assuming otherwise).

When my OS said extension may never reach 0

So I don't get it . It's only tendons to stop it, and they do react to stretching. What's to stop you???

A stretch my OS told me needs a 2nd person. Sit on the floor, leg out straight, heel supported on a cushion or book or something maybe 2" clear of the floor. Partner places one hand on lower leg, other one on the thigh, about 4" above and below the kneecap so it's comfy for you, and gently pushes down until it almost hurts. Hold for 10-20secs. Repeat as often as you like. Sorry, can't find a pic of it to show you.

 

[nlthomp]

You know when he said it, I thought he was referring to atrophy that had taken place over the last year. I assumed that not all muscles, tendons, ligaments, etc. are able to regain their original flexibility. I had also read that extension was much harder to regain than flexion. So... his words were somewhat defeating, as I think he is a good OS and I tend to believe what he says.

Now you have given me some motivation to work more on stretching. I'll have my husband work with me to push down on the leg. We will start today!! Thanks so much, Roy

 

[Roy Gardiner]

You are welcome, I hope it works.

I can see no reason why flexibility shouldn't go to wherever we want it, look what astonishing things ballet dancers and gymnasts do. We are no different, and our artificial knees to the best of my knowledge don't impose limits on ROM.

Atrophy will certainly happen to unused muscles -- I know this, my ability on a bike is so bad now! I suppose it might happen to tendons too, although I've never heard of it. But what is certain is that atrophy is reversible with training. I am slowly getting better on the bike, for instance.

Oh and don't expect instant results with the knee stretch thing, it takes weeks before anything really noticeable happens. Sorry...

 

[kimejen]

Hi nlthomp. We had our TKR's on the same day. I left the hospital after 5 days with a prescription for 20 Oxycodone tablets and 20 Panadeine Forte (higher strength paracetamol + codeine) when that ran out I was given no more repeats. So therefore I took over the counter meds, to help me. Here in Brisbane you don't get anything very strong over the counter! Probably due to this fact of not being on strong medication I was never able to work very hard at PT, I could only manage what I could "feel". If it was sore I didn't do it. I have extension of 3 and 124 bend. I'm not worrying about pushing to get the ROM because if you're on the road to success, which you are, and on reading fellow bonesmart's threads who have gone before us, ROM will come. My PT was wanting me to do my 12 exercises, 10 times each, 3 times a day. I started doing that and my knee just was not managing. So I cut back to what helped my knee, and what do you know, so much better. PT has given me some gentle lunges to do this week, not bending past the toes, and I'm finding that's strengthening. I do believe concentrating on heel-toe walking has helped me. I have a short walk every day and really concentrate on walking properly, and find each day is better than the day before. Remember what they say on here "THE KNEE IS THE BOSS". If your knee is sore and tired, stop and rest, otherwise you just go backwards a day or two. Don't panic, slow and steady wins this race. It will take time for that tendon to stretch, it's been in an awkward bend for quite sometime. Just keep on keeping on. Have a great day. Jenny

 

[tashia]

I found that when I hurt I need pain medicane. Please don't let the knee hurt. Its not worth it. It makes you get sad and stop your recovery. I know taking pain medicane is a pain but I would rather have this pain than the real pain. You need to listen to your knee. Its in charge and it will win. I know that this takes time and taking the time does pay off. I am about to celebrate my one year birthday of my left knee and enjoying the freedom I now have. I sleep thru the night and wake up and move it without saying OW. I am a little slow in full recover but I am getting there. Remember to take a easy and do not hurt that new knee. Take care. Tashia

 

[bottomshollow]

nlthomp, I have changed your thread title as requested.