Revision TKR Two Year Post Recovery - New Swelling and pain

[cammot]

I am convalescing after my December 3rd TKR revision. I am feeling fine, and experiencing what might be normal at this stage of my recovery. My question is “How Much Can I” extend myself with normal walking. With just under four weeks complete, I can walk without the support of a stick around the house for a couple of minutes, maybe about five minutes or so. I do not want to over do it, for the risk of doing any damage. Should I limited my walking without the support of stick at this early ?. I want to heal the right way, and doing PT twice a week now. My concern is - is there any risk of over walking at home ?, at this post one month stage.

A couple of other questions: I am able to drive comfortably locally, and want to ask if there is any harm wearing a knee sock while driving and walking to help with compression?. The other question is weaning myself of the controlled pain medication, I have been prescribed Tramadol and Oxycodone, and take either one with 1000mg Tylenol every six hours - but now the nurse says that I should be weaning myself off the Tramadol and or Oxycodone. Any suggestions how I best tapper off these two meds ?
Many Thanks for your shared thoughts.

 

[Jamie]

It would be pretty difficult to damage your prosthesis, so that shouldn't be a worry. However, your knee is still healing and it's possible to put strain on tender soft tissues if you should overdo the walking or any exercise. You don't necessarily need a lot of walking at this early stage. For most people getting up and walking around the house for 5 minutes or so every couple hours is fine. If you're attempting your walks without any walking aids, be mindful of how difficult this is for you. Do you limp? Do you have any pain while walking? Is there pain or swelling afterwards or the next day? Those are all signs that you still should probably use some type of walking aid for now. Continuing to use it as you heal and strengthen won't be detrimental and it does give you added support so you can take longer and more normal strides. A good, long stride with a proper heel-to-toe gait is the goal. You might want to consider using the OneStep program either by itself or with your regular therapy to better achieve that goal. The OneStep program uses daily gait analysis to keep you on track and help you better reach your goal.

 

[eaglemom]

Something I'd like to piggyback off Jamie's post. Does your physician know that you are driving while still taking those medications? Most surgeons don't recommend you driving while taking any pain medications. Isn't there a warning on the pill label?

The concern is you think you can drive, which you probably can. However, your reflexes are very much affected when taking these medications. Meaning your reaction time will be hampered. Personally, and this is me, personally I wouldn't do it. I'm the only driver in our house so I either called an Uber or friends helped me out. But again that's me.

 

[lovetocookandsew]

I am concerned about your driving while still on pain meds. Plus, it was your right knee, so your reaction time will be greatly reduced, both from the meds and the surgery. If you were to get in an accident, it is highly probable that your insurance could/would refuse to cover you as it is illegal to drive while taking pain meds. There are many things that could happen if you were driving while impaired, so please speak to your OS and see when he recommends driving. But, at the very least, don't drive while you're still on pain meds. Even if it's only "locally" it's still driving, and you could still have an accident.

As for weaning yourself off pain meds, it's not up to the nurse as to when that should happen, it's up to your knee and the pain level it's experiencing. As you heal, the pain will lessen, and you'll naturally take less and less until you find yourself not needing anything, or maybe you'll just need an occasional Tylenol. Some people don't need it after a few weeks, some need it a little longer, so if you're in pain and need pain relief, then you need pain relief...........until you don't.


I will leave you our Recovery Guidelines. Each article is short but very informative. Following these guidelines will help you have a less painful recovery.

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:

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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

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the BoneSmart view on exercise​

BoneSmart philosophy for sensible post op therapy​

5. At week 4 and after you should follow this

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Activity progression for TKRs​

6. Access these pages on the website

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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.

 

[Roy Gardiner]

You'll notice that I have merged your newest thread with your original recovery thread. For several reasons, we prefer that you only have one recovery thread:

• That way, you have all your information in one place. This makes it easier to go back and review your history before providing advice.
• If you start new threads, you miss the posts and advice others have left for you in the old threads, and some information may be unnecessarily repeated
• Having only one thread will act as a diary of your progress that you can look back on.

So please post any updates, questions or concerns about your recovery here.

 

[cammot]

Firstly, I do very much appreciate all the responses above to my question and I thank you. I was not aware that I should not or not allowed to drive while on opioids, and appreciate the alerts and concerns. This said, I am now completely weaned off the two opioids, i.e Tramadol and Oxycodone and only taking Tylenol 1000mg as needed, but not more than three times a day. I am getting better each day, and my physical therapist says that I am doing better than most at this stage (one month post revision surgery) tomorrow. I am being more caution and using a walking aid while strengthening my strides. My current issue is I feel as though I have a tight strap tied around the affected knee, its not particularly painful, and could be stiffness. Clearly the PT and time is helping, and it looks like my progress is heading in the right direction - I just wish it were back to normal sooner !!.
Thanks again for all your responses.

 

[Jockette]

Here is an article from the Bonesmart Library:

Tight Band feeling across the front of my knee

That tight band is caused by scar tissue but not the adhesions type of scar tissue. When the surgeon opens up the knee, he has to undercut the skin and superficial structures from that centre line to each side of the knee in order to get good access all round the bones. Part of the healing...

bonesmart.org

 

[Ghostpipe]

I had bilateral, and didn’t use any walking aids from day 7, because I didn’t feel unstable or wobbly and likely to fall. That’s the criteria. . I only did circular walks, in the early days many small circuits, because I never knew when my knee(s) would have had enough on any given day and didn’t want to get stuck too far away from home. Ice and elevation straight afterwards.
A lot of that awful tightness comes from swelling, it does improve eventually, and that which remains after many months is eased by a few steps.

 

[cammot]

I seek advice and help in understanding a recent issue with my knee, I am two years post total knee replacement (TKR). Everything has been fine until two days ago when my affected knee suddenly swelled, causing pain and difficulty putting weight on it. The incident occurred as I awkwardly squatted during a car wash, bending the knee slightly uncomfortably. Though I didn't twist it, I felt minor pain. Hours later, upon standing after a prolong seating period, the pain increased, leading to a gradual worsening with swelling. I suspect a strain from the awkward bend, possibly aggravated by prolonged sitting. While I can walk, there's pain and swelling. Any insights or suggestions on what might be happening and what to expect?

 

[MSuki]

Hopefully it’s a soft tissue injury. That is more likely than not. I would ice, elevate and rest for a few days. Avoid sitting in one position for hours though, you need to move it gently to avoid that stiffness. If it doesn’t start improving in a few days, I would call the doctor and have it checked out. Since it’s swollen, the swelling itself might be causing the additional pain.

 

[Jockette]

@cammot It might just be upset from an accidental forced and awkward position. If it was me I’d give it some time to see if it settles down. It could take anywhere from days to something longer. As always, get it checked out if you’re really concerned, or if it gets worse, or just for peace of mind.

Last year I fell on my almost 6 year old PKR and wow did my knee get upset! It swelled up quite a lot and I lost a lot of ROM. I waited about a week and a half before getting X-rays, and they were fine, and I saw an Ortho about 2 weeks after that. Nothing wrong other than soft tissue damage. I my case, it took 2 months for it all to settle down back to normal, but my knee is known for its dramatic responses. Hopefully yours will improve much quicker than that.

By the way, I merged today‘s new thread with your original recovery thread, to keep all your history in one place.

 

[cammot]

“

Hopefully it’s a soft tissue injury. That is more likely than not. I would ice, elevate and rest for a few days.

You well be correct -

Hopefully it’s a soft tissue injury. That is more likely than not. I would ice, elevate and rest for a few days. Avoid sitting in one position for hours though, you need to move it gently to avoid that stiffness. If it doesn’t start improving in a few days, I would call the doctor and have it checked out. Since it’s swollen, the swelling itself might be causing the additional pain.

“Hopefully it’s a soft tissue injury. That is more likely than not.”l

Thank You - Question: if it is a “soft tissue injury”, which it most probably is - what does the healing process involve? and how long can it take to fully recover. I am getting some pain relief with 600mg ibuprofen every 8 hours. But without ibuprofen its painful and difficult to walk!.

Would using a compression knee sock help, and could sone gentle massage help spied thing up? I feel could benefit from using a walking cane.

Thank You

 

[cammot]

“Hopefully it’s a soft tissue injury. That is more likely than not. I would ice, elevate and rest for a few days.”

Thank You for your reply. I hope I can recover quickly!, i.e. a few days, rather than week !!.

 

[MSuki]

Wish I could tell you, it just depends on how much you upset the knee and your own healing speed. Could be anywhere from 2 days to longer as Jockette mentioned. My last “overbend” took 2-3 days to feel better, Jockette’s fall which was more severe took 2 months.

 

[sistersinhim]

if it is a “soft tissue injury”, which it most probably is - what does the healing process involve? and how long can it take to fully recover. I am getting some pain relief with 600mg ibuprofen every 8 hours. But without ibuprofen its painful and difficult to walk!

No one can tell you how long it will take you to heal since you are you, and different from everyone else. I would continue with the icing and elevating as long as your knee remains swollen and painful.

I fell on my TKR knee a little less than a year out when I stepped in a hole and broke my foot and ankle on the same leg. My knee swelled just as bad, and hurt almost as bad as my broken bones did. It took a couple of months for it to settle down. I was non-weight-bearing on my breaks and my knee hated it. It wanted to be used. Do easy knee bends while sitting to keep your knee limber. It might be a good idea to use a cane to help it out until it calms down from your 'sprain/strain'.