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PKR What is normal pain?<

terri1972

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I am 3½ weeks out of a patello-femoral replacement. I have done very well so far, except for pain in my quad muscle and then random stabbing pains in my knee. I have almost full range of motion back already.

However when I bend my knee, it hurts to straighten it out. I don't know what is normal. There are times I am almost in tears.

I try not to take painkillers unless absolutely needed due to allergy to NSAIDs. My quad muscle hurts almost constantly. Is this normal? I have trouble sleeping and seem to be getting depressed due to this.
 

lovetocookandsew

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Hi, and welcome to BS! Please could you let us know your surgery date(s)so we can add it to your signature? It helps to know what surgery you've had, and when, so we don't have to go back through your posts to remember.

I haven't had the same surgery as you, so I'll tag our forum admin @Josephine as I'm sure she knows exactly how to advise you. But I am sending good wishes for a speedy recovery your way. Please keep us posted!
 
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terri1972

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Sorry! I had a left PKR (patella femoral replacement) on May 22, 2019.
 

Jockette

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Hi and Welcome to Bonesmart!

I also had a Patellofemoral. I don’t remember any thigh pain past the first couple of days, and mine was from the tourniquet used during surgery.

The only time I had extreme discomfort when straightening my leg was when I was improperly doing the heel slides. My PT told me to use a sheet to pull my foot as close to me as I could, and hold it there. Then when I straightened it out, it would catch and I’d feel a clunk right on top of my knee and it was an awful feeling.

I learned here at Bonesmart that that was a bad way to do heel slides, that I shouldn’t be using anything to pull my foot in, and that I shouldn’t force it to pain.

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:
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
5. At week 4 and after you should follow this
6. Access to these pages on the website

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.
 

Josephine

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I don't know what is normal.
Let's see if I can help you. I'd really like to offer you some structured advice but in order to do that, I also need to ask you some questions. Are you willing for me to do that?
 

Josephine

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Here y'go then!

It would be very helpful if you would answer each one individually - numbered as I have done - in as much detail as you can then I'll come back as see where you are ....

1. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine. And don't forget to factor in other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness).

2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?

3. how swollen is your leg compared to these?
ai63.tinypic.com_eta39s.jpg


4. what is your ROM - that's flexion (bend) and extension (straightness)

5. are you icing your knee at all? If so, how often and for how long?

6. are you elevating your leg. If so how often and for how long?

7. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and

8. are you doing any exercises at home? If so what and how often?
This is the most crucial question so please help me by using the format I have left as an example
(which means please make a list and not an essay!)

Exercises done at home
- how many sessions you do each day
- enter exercise by name then number of repetitions of each
etc., etc.

Anything done at PT
- how many times a week
- enter exercise by name then number of repetitions of each
etc., etc.
 

Celle

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I try not to take painkillers unless absolutely needed due to allergy to NSAIDs. My quad muscle hurts almost constantly. Is this normal? I have trouble sleeping and seem to be getting depressed due to this.
I think you still need to take pain killers. They will ease your pain, which could also help you to sleep better at night.
Most people still need pain medication at your stage of recovery. You'e had a surgery that will need quite a long recovery.

NSAIDs are primarily anti-inflammatories, not pain killers. If you have pain killers prescribed, take them. If not, contact your surgeon or your own doctor and ask for some.
Failing that, try taking extra-strength Tylenol, 1,000 mg (2 x 500 mg tabs) 4-6 hourly, to a total of 4 doses (4,000 mg) in 24 hours.

You will need to check that there is no Tylenol (Acetaminophen) in any other medications you take, such as cold cures. If there is, reduce one or two of your regular doses, so you stay within that safe daily total of 4,000 mg.
 
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terri1972

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1. My pain levels are usually 3-4, but can get up to 7.

2. I have hydrocodone but my surgeon said I shouldn't need to be taking it now. I take it only when the pain is real bad, usually or 2 times a week. Otherwise I take 2 Aleve. I take Extra strength Tylenol at night.

3. Three past few days the swelling had been moderate. It feels very warm to the touch.

4. I don't know my exact ROM. Last week it was at 129° at the Dr. I can extend it past straight, but not sure how much.

5. I have been icing my knee with cryocuff. I am not doing it as much as I was in the beginning. I would say 2 or 3 times a day for about 20 min each.

6. I spend most of the day in a recliner with my feet elevated or laying in bed. Usually it is in bed with pillow under my foot.

7. My activity level includes about 700-800 steps daily. I can load and unload the dishwasher. I sometimes cook something quick like heating up soup or putting something in the microwave or oven. My husband and daughter have been doing the cooking and cleaning the past month.

8. Heel slides 5 reps 3 times a day.
Knee extensions 5 reps 3 times a day
Straight leg raises 5 reps 3 times a day
Hamstring stretches 5 reps for 30 sec 3 times a day
I only go to the PT once every weeks and he gives me exercises to do at home.
 

Josephine

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I have hydrocodone but my surgeon said I shouldn't need to be taking it now. I take it only when the pain is real bad, usually or 2 times a week. Otherwise I take 2 Aleve. I take Extra strength Tylenol at night.
I did also ask "how much are you taking (in mg please) and how often?"

Knee extensions 5 reps 3 times a day
And here, can you tell me how you do this exercise?
 
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terri1972

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It says hydrocodone- acetamin 7.5-325. I take it maybe once or twice a week.

The knee extension is sitting in a chair, slowly extend your knee. Briefly hold then slowly lower. Use the opposite leg to bend the knee back

Hope this helps.

I only take one hydrocodone at a time.
 

Josephine

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The knee extension is sitting in a chair, slowly extend your knee. Briefly hold then slowly lower. Use the opposite leg to bend the knee back
Sorry, I have no idea what this means.
 

Josephine

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1. My pain levels are usually 3-4, but can get up to 7.
That's high and you're only 4 weeks out!
2. I have hydrocodone .5-acetaminophen 325 but my surgeon said I shouldn't need to be taking it now. I take it only when the pain is real bad, usually or 1 or 2 times a week. Otherwise I take 2 Aleve. I take Extra strength Tylenol at night.
Your surgeon is not being very kind to you. It is well known that the critical time the worst pain is 6 weeks out.
But since he is so unsympathetic, I suggest you try Tylenol 1,000mg 4 times a day at 6hrly intervals, being 8am, 2pm, 8pm and 2am. Aleve is also known as Naproxen, one of the better NSAIDs which you can take as prescribed (perhaps 2-3 times daily whatever dose is stated).
3. Three past few days the swelling had been moderate. It feels very warm to the touch.
Okay
4. I don't know my exact ROM. Last week it was at 129° at the Dr. I can extend it past straight, but not sure how much.
That all sounds really good
5. I have been icing my knee with cryocuff. I am not doing it as much as I was in the beginning. I would say 2 or 3 times a day for about 20 min each.
You accomplish little or nothing in 20 minutes. Ice for at least 40-60mins and more than 4 times a day.
6. I spend most of the day in a recliner with my feet elevated or laying in bed. Usually it is in bed with pillow under my foot.
Are you feet really elevated or are they just up on the leg flap? You need to be "toes above nose" like one of these positions
elevate 2-horz-horz.jpg

7. My activity level includes about 700-800 steps daily. I can load and unload the dishwasher. I sometimes cook something quick like heating up soup or putting something in the microwave or oven. My husband and daughter have been doing the cooking and cleaning the past month.
Good to hear it. I hope that Fitbit number IS 700 and not 7,000!


Heel slides 5 reps 3 times a day.
Knee extensions 5 reps 3 times a day
Straight leg raises 5 reps 3 times a day
Hamstring stretches 5 reps for 30 sec 3 times a day
I only go to the PT once every weeks and he gives me exercises to do at home.
I think that since your ROM is so good, you really don't need to do these any more and you don't need PT. They could account for a considerable amount of your pain.

If you are concerned about refusing to do therapy, you need to read this Saying no to therapy - am I allowed to?
 
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terri1972

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I went back to the dr/pt last week. My ROM is back to normal and very similar to my good leg. He started me on stationary bike for 5 min and leg press 3 times a week. I can increase the bike by 5 min each time.

He said my pain was caused from atrophy of my quad muscle. It is only 13% as strong as my good leg. When he check how much pressure I could push with my good leg, it was around 168.

Prior to surgery, my bad leg was around 76. 4 weeks post op, my bad leg was at 21. Stairs and squats are my enemies. I have noticed my knee my knee is always swollen and hot. I am hoping that’s normal.

My incision is healing nicely, but is it ever sensitive! Even the cats tail rubbing across it hurts. I can’t wait until the nerves are all healed.
 

sistersinhim

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leg press 3 times a week.
The leg press is too much for a knee as young as yours. It will keep it inflamed, swollen and painful. Squats are a no no, also. A warm knee is a sign of healing. A hot knee needs to settle down. Too much activity is much worse and not enough activity. Let your knee's reaction be your guide. It sure sounds like you're doing too much for it right now.
 

kneeper

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I think it's too early for leg presses and squats. I know PTs want to build strength but this early the tissues are really sensitive. It is easy to exercise yourself into needless pain. (I know because I listened to my PT with knee #1 and had that experience.)

What I did with knee #2 was to do some stairs but take it very incrementally. Once I could do foot over foot (with some difficulty) I'd just do a few steps (not whole flights) a day. Then I'd maybe add one or two steps and so on.

Simply getting up and down from a chair (using your arms less and less as you're able to) will also strengthen your quads more naturally.
 

Josephine

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Stairs and squats are my enemies. He started me on leg press 3 times a week.
That truly does not make sense! Apart from leg press being a more severe form of squats, that machine requires you to apply torsional pressure which could very easily cause your implants to become loose. It's very strongly counselled against in knee replacements so please don't do it.
 

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