TKR What did I get myself into?

[WillB]

After suffering with left knee pain for some years, I finally bit the bullet and agreed to a TKR proceedure at 75. I am currently on day 19 with my first post op appt scheduled for Feb 1, which will be day 21. I totally underestimated the initial pain which was excruciating even with doses of Percocet. Sleeping still is difficult. I had several in home PT sessions where I embraced the “no pain no gain” mantra! Boy, that didn’t work as the day after PT was definitely a step back. I’ve been using a CM machine and am at 0 and 95 which I guess is acceptable at this point. But here’s whats frustrating. At day 16 I ventured out with my walker and rather comfortably walked about 1,000’. All in all, I felt pretty good. BUT, the next morning my knee was stiff, swollen and painful. Definitely moving in the wrong direction! And sleep is really tough even with 300mg of Gabapentin and a Tylenol PM. I know things will get better but my impatient nature makes all of this a little tougher than I would have imagined! So glad I’ve found this site!! Will update after my appt on the 1st.

 

[Jockette]

Hi and Welcome!

I think almost every one of us first timers underestimated this procedure and recovery, I certainly did! In my defense, I had a partial, promoted to be much easier than a total, but, it isn’t!

For most of us, the no pain, no gain doesn’t work, though it seems too many PTs don’t realize that.

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.

Just keep in mind all people are different, as are the approaches to this recovery and rehab. The key is, “Find what works for you.“ Your doctors, PTs and BoneSmart are available to help, but you are the final judge as to the recovery approach you choose.

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:

rest​

elevate​

ice​

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

don't overwork.​

​

If you want to use something to help heal the incision, ​

BoneSmart recommends hypochlorous solution. Members in the US can purchase ACTIVE Antimicrobial Hydrogel through BoneSmart at a discount. Similar products should be available in the UK and other countries.​

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 to these pages on the website

​

Oral And Intravenous Pain Medications​

Wound Closure​

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 the 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 the member’s history before providing advice, so please post any updates or questions you have right here in this thread.

 

[Jockette]

Myth busting: No pain, no gain

With rather blatant snitching from a couple of other sites, I give you the lie to this saying! Wikipedia No pain, no gain (or "No gain without pain") is an exercise motto that promises greater value rewards for the price of hard and even painful work. Under this concept, competitive...

bonesmart.org

Sleep deprivation is pretty much inevitable - but what causes it?

Time and again members complain about not being able to sleep and after a while, that it gets to making them feel frustrated, despairing, depressed and even ill. I thought perhaps a short treatise on the reasons for disturbance of sleep patterns was long overdue. It won't help you to sleep but...

bonesmart.org

 

[Jockette]

Please give us the date of your surgery and we‘ll make a signature for you.

 

[sistersinhim]

I know things will get better but my impatient nature makes all of this a little tougher than I would have imagined!

Your impatient nature will only cause you to do too much too soon and slow down that healing. Imagine exercising a broken leg, or doing situps after having abdominal surgery. Of course not. I knee replacement is a traumatic, major surgery. You had two bones that were cut off, your knee removed and the new implant pounded and/or drilled in. That takes a long time to heal from and is very easy to upset it.

Overworking your knee too soon will cause it to become even more inflamed. It will react with more fluid, (swelling), and pain. Then your knee has to recover from this added pain and swelling before it can get back to where it was before this added set back happened. Slow and easy = a better recovery.

 

[WillB]

Thank you for encouraging words! I realize everyone’s experience may be different. Not a one size fits all recovery. Not really sure how much therapy I should be doing if I’ve experienced a little setback regarding stiffness and pain. Anxious to hear my surgeons evaluation of my progress at 3 weeks.

 

[Jockette]

All you really need to be doing are gentle stretches to give your joint mobility and short walks.

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.

 

[Jaycey]

@WillB Good luck at your appointment. If your surgeon suggests that you are behind in your recovery please just nod and tell them "thanks for the input". There are no milestones for this recovery. You will gain ROM and get back to doing all the activities you love. It all just takes time and tons of patience.

 

[sistersinhim]

I was blessed to have a surgeon that never pushed PT. He gave me a prescription for it, which I threw away and never went. When I went for my 3 return checkups, all he was interested in was to see what my knee would do and never measured. He never even asked about PT! Of course, he knew I was a single lady that had to take care of myself and obviously trusted that I would not be just laying around all the time.

Because of birth defects, I've had to have 12 knee surgeries After all those I knew that I did not need formal PT, and neither do many others if they do their own daily activities and not just sit around all day and night. My knees recovered just fine all on their own with only my daily activities. I didn't have the terrible swelling or agonizing pain that so many have after taking formal PT. I knew the Bonesmart way worked before Bonesmart was even thought of. My surgeries started in the early 80s and I never went to PT even back then. I just didn't see the need for it. Bonesmart was formed around 2004. By then I had already had 6 knee surgeries and rehabbed the Bonesmart way!

 

[mac0939]

@sistersinhim Your story is amazing. All those surgeries and no PT? That is amazing. I have not kept a strict regime of exercises at home. I mostly rest and walk around the house doing my chores and today I was able to go down stairs with minimum discomfort on the operated knee. Time and rest with daily normal activities have worked for my recovery.

 

[WillB]

I have upped my icing which has helped with the pain and reducing swelling. Will be so glad to get my surgical bandage off. Hoping it will make my knee feel a bit better. My insurance delivered one of those constant motion machines which I have used several times. I’ve only gone to 95 with it and not sure if I want to push to 100 deg or even if I need it. Seems like these machines are a bit old school now. Haven’t read anything about them here. Are they recommended? L

 

[Jockette]

Seems like these machines are a bit old school now. Haven’t read anything about them here. Are they recommended? L

Many of our members have had this machine, just not any of our current ones. Those who did not use one had just as good an outcome as those who did.

Don’t ever make it go faster or bend more than is comfortable for you.

 

[benne68]

I’ve only gone to 95 with it and not sure if I want to push to 100 deg or even if I need it.

No, please don't push to try to get to some arbitrary number. Remember that you still have a lot of internal swelling from the trauma of surgery. That swelling will restrict your ability to bend. Pushing more than your knee can comfortably do will only serve to set you back.

You are doing great for less than three weeks out!

 

[beachy]

My rtkr about was the day before yours. I had my left knee replaced in 2018. Fortunately, I found Bonesmart before my first tkr. I did very gentle PT and waited til almost 4 weeks post op. And only went for 3 weeks.
I had perfect ROM by 3-4 months post op
Your knee is so severely swollen and painful in the weeks post op that you only need ice, elevation, and ADLs.

I haven't started PT yet and my flex is about 90°
If my knee feels better I will start very gentle PT in the next week or two.
These are the things the docs and physical therapists don't tell you.

 

[WFD]

I used a CPM machine after all four of my recent surgeries and it helped me so much I bought my own on eBay.

That said, the research shows that for regular patients there is no long term advantage to using them - you’ll end up with the same RoM whether you used one or not.

However the research also shows a benefit for people that suffer from arthrofibrosis (excess scar tissue formation), and that’s me with bells on. As a result it was helpful for me.

I read a lot on the use of CPM machines and they are usually used for motion but not for stretching. When you adjust the range of motion you should not feel any pain or even discomfort - the value lies in moving the joint to help move fluid out and keep scar tissue from forming (if you are prone to that). If you push it and feel pain you will probably set yourself back.

If your doctor prescribed it for you I wouldn’t stop using it without checking with him first.

 

[WillB]

Please give us the date of your surgery and we‘ll make a signature for you.

My surgery was January 12, 2023. Left knee total replacement.

 

[WillB]

Had my 3 week appt with my OS. They took off the bandage and I was surprised as to how well my incision looked. They are concerned with my extension which is at 5deg. Have a PT appt tomorrow but concerned about whats going to happen. My knee is still swollen and tight. Is it easier to get to full extension than to boost flexion number? I just want my knee to really settle down and do not want an aggressive PT appt.

 

[LemonCheesecake]

WillB, I didn't expect the painful PT and recovery for my total knee replacement either. I thought I'd be more resilient since I tolerated bone-on-bone for years. It is a long journey, but we will get there. I know we will be thrilled at six months when we get our energy back.

 

[Jockette]

I just want my knee to really settle down and do not want an aggressive PT appt.

You do not need aggressive PT. You stay in control of the session and say no to anything you don’t want.
Saying no to therapy - am I allowed to?

They are concerned with my extension which is at 5deg.

5 degrees is not a concern, it’s almost straight, so I don’t understand their concern. It’s actually a very good number considering your swelling and the fact you are only 3 weeks post op. Don’t let them pressure you, you’re doing fine.

 

[Jockette]

Most importantly, don’t ever let anyone push down on your knee to straighten your leg. That will cause more swelling and be counterproductive.