Bilateral TKR Week3 post-op

[TownieGirl]

Had bilateral TKR Friday April 8. I have stopped taking oxycodone for pain and gabapentin which really did not help. Tylenol does not do anything. Can’t take naproxen because I am on Blood thinner. Bruising has subsided, both knees still swollen and stiff. Able to get around with walker and can walk without walker but not real steady. Still don’t feel 100 % . Finally able to go t o the bathroom without laxatives. Still no appetite.

Nights have trouble sleeping but found out if I lay on my side and fall asleep wake up to pain up and down the backs of my leg. Tried slee ping on my back and that seems to have worked except not comfortable. Ordered the wedge pillow suggested by bonesmart hoping that will help at night.

Just beneath the. surface of skin everything is tender and lower legs get very itchy.? Ankles are sore don’t know why. Family was here first two weeks now I am here by myself, have support from friends but have to do most things on my own. PT comes 3x/week. ROM is about 75 degrees. Got it to 90 but it hurts and can’t be sustained. Everyday gets a little better.

 

[WFD]

Sore ankles are very common. If your knees were straightened as part of your surgery (very common), then the angle that your lower leg makes with your ankle has changed and the connective tissue etc., has to adjust. some people find they need new shoes after TKR as their old ones had worn in a way that was uncomfortable with their new knee.

90 degrees at 17 days is really very good - many surgeons don't expect to see it until six weeks. I am at 90° after four surgeries and 18 months of rehab, etc. - you are way ahead of me .

 

[Layla]

Hello and Welcome to BoneSmart. Thanks for joining us.
You seem to be doing well and 100% wil be a ways off since it can take a full year for recovery, even longer for some.

While healing you may experience sensations of tingling, pins and needles, itching, burning and even the feeling of a minor electrical shock. These are usually good signs that the nerves are spontaneously firing through the regeneration process.

As for your ROM, it will come as you’re healing, give it time, please don’t push it.
It’s good you have the support of friends when you need it and know that we’ll be here for encouragement and support also. I hope today is a good one!

Below you’ll find the BoneSmart Recovery Guidelines.

Knee Recovery: The Guidelines

As you begin healing, please keep in mind that each recovery is unique. While the BoneSmart philosophy successfully works for many, there will be exceptions. Between the recommendations found here, your surgeon's recovery protocol and any physical therapy you may engage in, the key is to find what works best for you.


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
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
the BoneSmart view on exercise
BoneSmart philosophy for sensible post op therapy
5. At week 4 and after you should follow this
Activity progression for TKRs
6. Access these pages on the website
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.

 

[TownieGirl]

Hi WFD, thank you for your encouraging words it means a lot. Liked your comment about sore ankles. I did have knock knees and my OS did say he would straighten them.

Thank you Layla for explaining the regeneration process and all the different feelings associated with it which I am experiencing. Thanks for your support.

 

[InkedMarie]

Welcome! i Assume you ordered the Lounge Doctor? If yes, it will be a big help. It allows me to sleep on my back and when I’m sitting....I’m elevating on it. Are you icing?

Marie

 

[TownieGirl]

Hi Marie,
Yes, I purchased the Lounge Doctor. I am having trouble sleeping in the bed, the backs of my legs start (hamstrings) throbbing after awhile. I have to get up walk around and ice them. Can’t sleep, hoping the Lounge Doctor helps with proper elevation. I do ice.

 

[lovetocookandsew]

Do you have an ice machine? I found that ice packs really didn't help me as they weren't cold for long, needed to be changed every half hour, and overall weren't helpful with my pain. I also can't take any narcotic pain meds, so icing was my only form of pain relief after the first week or so. I iced for hours and hours every day, getting up every hour or two to walk around a bit, then right back to the ice machine and Lounge Dr. I also iced non-stop all night. You can ice as long as you like as long as you have a cloth between your skin and the ice. If you don't have an ice machine, many people here have had good luck with Breg machines. I also used frozen water bottles in my machines, switching them up every 6 hours or so.

 

[glidefloss]

I did have knock knees

Hi @TownieGirl , my left leg was knock kneed while my right leg (now week 20 post-RTKR) was bowed ... as the good Dr said, I had "wind swept" knees. I think a lot of the medial pain in the left knee, quad and thigh are related to the leg now straightened ... as well as my left lower back ache (which doesn't seem to respond to Tylenol or Advil/Aleve.)

Hopefully the lounge doctor will do wonders for you! I've found that elevating my legs have made my left knee attain pretty good ROM and extension without having done any heel slides. (I've been using a stationary bike at the gym the past five in days as a way to gently get my knee to bend.).

All the best on your recovery!!!

 

[InkedMarie]

@TownieGirl I can’t sleep on my back without my legs being elevated. Pillows don’t work well for me but the Lounge Doctor does. I start my night with my ice machine running; I keep it off after my usual middle of the night potty break.

Marie

 

[TownieGirl]

Hi Lovetocookandsew, I do have an ice machine. I am not on any kinds of pain meds, so I’m like you. I think I need to ice more.

I did have knock knees

Hi @TownieGirl , my left leg was knock kneed while my right leg (now week 20 post-RTKR) was bowed ... as the good Dr said, I had "wind swept" knees. I think a lot of the medial pain in the left knee, quad and thigh are related to the leg now straightened ... as well as my left lower back ache (which doesn't seem to respond to Tylenol or Advil/Aleve.)

Hopefully the lounge doctor will do wonders for you! I've found that elevating my legs have made my left knee attain pretty good ROM and extension without having done any heel slides. (I've been using a stationary bike at the gym the past five in days as a way to gently get my knee to bend.).

All the best on your recovery!!!

hi glidefloss, I too have that lower back pain, hopefully it will subside once my body gets use to the new alignment of my legs. I was very impressed with your recovery. Loved “ windswept legs,”.

 

[TownieGirl]

@TownieGirl I can’t sleep on my back without my legs being elevated. Pillows don’t work well for me but the Lounge Doctor does. I start my night with my ice machine running; I keep it off after my usual middle of the night potty break.

Marie

Hey Marie, eagerly waiting for my lounge doctor to come. Pillows don’t work for me either. My refuge for pain is getting into the shower. The warm water is so relaxing and gets my mind off the pain. The pain is nothing like the first week, but It’s present.

 

[ski_bum]

@TownieGirl I can’t sleep on my back without my legs being elevated. Pillows don’t work well for me but the Lounge Doctor does. I start my night with my ice machine running; I keep it off after my usual middle of the night potty break.

Marie

Hey Marie, eagerly waiting for my lounge doctor to come. Pillows don’t work for me either. My refuge for pain is getting into the shower. The warm water is so relaxing and gets my mind off the pain. The pain is nothing like the first week, but It’s present.

The Hot Tub is my everything. 3 times a day and sometimes at night a little snooze. Best place to do exercises.

 

[TownieGirl]

@ski_bum I wish I had a Hot Tub!

 

[TownieGirl]

BTKR April 8, 2022. 4 weeks out. Left new is doing better than right knee. Wasn’t able to use my right leg much 3 months prior to TKR quad muscle is very week. Bruising was bad first 2 weeks entire leg and foot was purple. At week 4 bruising is gone however now the skin is flaking and itchy at times. First 3 weeks after surgery home PT was gentle. Started outpatient PT week 4 and PT said I started late and I have to catch or or my both knees will remain stiff.

Went to PT 3x this week (4) lower back aches, after PT knees get very stiff and ache at night. Did not have to take any pain meds but during week 4 had to take oxycodone at night for the pain after PT. Ice and elevate legs during day about 4x 20 minutes and elevate with lounge doctor. After outpatient PT ROM left knee 95 right knee 90 with PT bending back. Left knee is straight right knee is almost straight. Cannot do full rotation on stationary bike yet. Should I continue with PT?

I walk in my house unassisted most of the time if I stand in one place too long both knees start to ache, 10-15 minutes. I was given permission to drive so when I go out i use my Walker.

Since April 8 I have lost 10 pounds don’t have much of an appetite. Don’t get to sleep much at night either maybe 3 hours max and knees get sore and stiff when sleeping. I am always cold. During the day don’t take any medication knees are are just tight and stiff. Will be starting Celebrex today (may 7) 2x day 200 mg, hoping that helps with inflammation.

Been on this planet for 62 years and this by far is the hardest thing I have done both physically and emotionally. I pray a lot for myself to get through this and think this too shall pass. I had no choice I had to get this done because I had bone on bone in both knees, and I am thankful that I have health insurance for this process.

When does it start getting better when I don’t have to think about my knees? The tight and stiff feelings are constant reminders.

 

[Jockette]

First 3 weeks after surgery home PT was gentle. Started outpatient PT week 4 and PT said I started late and I have to catch or or my both knees will remain stiff.

Your knees will not remain stiff, and you don’t have to “catch up.” They are healing just fine on their own timeframe, they don‘t have to heal on your PT’s timeframe. Your ROM numbers are fine.

Should I continue with PT?

If it was me, I would not. By now you’ve had enough that you know what things to do, you can do some exercises that do not cause pain, either when you do them, or some time after.

Needing to go back on prescription pain medication is a sign that the PT you are getting is more then your knee is healed to do, and is increasing your pain. This is not only not necessary, it is not good for you.

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.

 

[Jockette]

During the day don’t take any medication knees are are just tight and stiff.

Tight and stiff is a form of pain. You might want to ask your doctor about taking Tylenol, and if you can take it with the Celebrex.

The most effective way to take Tylenol is 2 x 500 mg tablets every 6 hours, to a total of 4,000 mg (4 doses) in 24 hours. You need to take it regularly, to keep up the levels in your bloodstream. If you just take the odd dose now and then, it's far less effective.

Check all other medications you're taking, to make sure there is no Tylenol/Acetaminophen/Paracetamol in them. If there is, scale back one or two of your regular Tylenol doses, so you stay within that safe 24 hour limit of 4,000 mg.

 

[TownieGirl]

@Jockette was taking the Tylenol at 1000 mg every 8 hours (3000 mg/ day) for 17 days straight had to stop because I developed the side effect of bad stomach pain. As soon as I stopped taking the Tylenol the pain went away in about two days. The Tylenol did not take away the stiff and tight feeling. Hopefully the Celebrex will help.

 

[Jockette]

I’m sorry that you had such a reaction to Tylenol. I can’t imagine not taking any kind of pain medication at only 4 weeks post op. All the more reason to keep your PT gentle. There is no need for painful exercises. The movements your knees get just while you go about your day will give them all the gentle mobility they need to heal.

 

[Layla]

Hi there @TownieGirl

Ice and elevate legs during day about 4x 20 minutes and elevate with lounge doctor.

While it may be difficult to believe, icing and elevation will help with the tightness from swelling / inflammation, which you identified as constant reminders. I’m sorry for your discomfort, it is difficult when all you want is to feel better, and you will. You may consider stepping away from PT, you can always return at a later date. It may be aggravating healing tissue, holding you in the cycle you’re in. What do you have to lose but the discomfort? As far as icing goes, if I’m understanding correctly, you’re only icing 4 x daily for 20 minutes. You can ice longer and more frequently so please consider it. I did some research for BoneSmart on this topic and it’s interesting.

Why Does BoneSmart Recommend Icing for Longer Periods of Time Than Advised by My Physical Therapist?

Icing for up to twenty minutes only is what most of us have heard or been advised to do following an injury. Following joint replacement, ice is a critical part of pain management and should be used not only on the joint, but any surrounding areas of discomfort for as often and as long as you're comfortable doing so, always placing fabric between your skin and the ice source. Icing helps bring relief from the soft tissue trauma and internal swelling. Icing is a great natural pain reliever and best of all, it's free. While some care providers do put a maximum time on icing, others suggest you ice as often as you see fit.

Icing after therapy, exercises, or prolonged activity that challenge ROM and endurance should help ease any discomfort, or preventively keep pain at bay. You may find relief through icing for weeks to months post op.

I hope you find relief soon and you’re able to enjoy the weekend!

 

[JojoFitness]

@TownieGirl I can’t sleep on my back without my legs being elevated. Pillows don’t work well for me but the Lounge Doctor does. I start my night with my ice machine running; I keep it off after my usual middle of the night potty break.

Marie

Hey Marie, eagerly waiting for my lounge doctor to come. Pillows don’t work for me either. My refuge for pain is getting into the shower. The warm water is so relaxing and gets my mind off the pain. The pain is nothing like the first week, but It’s present.

My Lounge Doctor arrived yesterday, and I love it! A half hour here and there, and it's so comfortable. I'm so glad I finally ordered it - and it arrived so fast! I think you'll love it too.