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TKR What to do ?

Jrwest100

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Hello, new here. Tkr left 11/27/19.for medial severe OA.
Finishing up phys . therapy, and still have to use cane, or else I feel very unsteady. Pt encourages it too.Have good ROM can straighten 0 degrees, and bend to around 120deg.
My problem is , still pain, still swelling (both of which ortho aware and says expected) and can’t hardly walk with out using a cane.i can shop maybe 2 - 3 hours, and that is it.
My 12 weeks is up for return to work. I am a floor nurse, and I’m going to be expected to stand and run for poss 8 hours straight. Can’t use a cane or crutch.
should I be able to do more at this point, or is there a problem that I’m missing ?PT says my situation is taking longer because of the condition I was in prior to surgery ( prob waited too long)
I’ll appreciate any comments/suggestionsThank you!
 
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Jrwest100

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Also, I am having the same nerve pinching sensation at the medial knee still! I thought the surgery would get rid of this ! So I’m actually almost in worse shape than when I went in. This isn’t supposed to be this way:(
 

NewToMe

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Your OS is releasing you back to work in that type of job with no accommodations?

I want back to work at 13 weeks post op very wobbly. I am fortunate that my restriction to office work only for additional 8-12 weeks was not only accommodated it was done so as a matter of course. I work construction.

PT is and was slow for me, I essentially had to relearn to walk. Now I can walk quickly on smooth surfaces and still working and testing myself on uneven ones...like grass.:loll:

Can't help with the nerve pinch sensation other than suggest maybe Lyrica? I was on that a month post op and was a godsend for the zingers.

I hope you can get a reasonable accommodation for your return to work!
 

Celle

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Hello @Jrwest100 - and :welome:

We usually recommend taking about 12 weeks off and then doing a Phased return to work , but some jobs require you to take longer.

With your job, working shortened shifts probably won't be possible, so you need to ask your surgeon for more time off. We've had several paramedics and a fireman on here in the past and they all needed to take longer than 12 weeks before going back to work. They did all get back to their jobs, though.

You probably didn't realise that complete recovery from a knee replacement takes a full year, although you'll be able to do most things long before that. But it does mean that where your knee is now is not where it's going to end up. It's not the finished product, as it's still a work in progress.

Your PT is probably right - your knee needs more time, because of the state it was in before surgery. If you can give it that time, you will be able to manage without a cane. You can't speed up recovery, though, and make your knee recover faster than it needs to.

Given time, the nerve pain may go away, too. If it doesn't, that will need to be investigated.
 

Celle

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I know it's been a while since your surgery, but I'm going to give you our recovery guidelines anyway, because there are lots of informative articles in them:
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
ice
take your pain meds by prescription schedule (not when pain starts!)​

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. Try to 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.
 

Josie1054

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@JRWest: I cringed when I read you’re about to return to work shortly. I’m a nurse as well but work PT in a Surgery Ctr. Is there anyway you can go back less than FT? Or is there another position you may prefer based on your recent surgery. Am concerned about pain, swelling and stamina. I have worked the floor and it can be brutal. Maybe re-think your next step? Concerned for you!
 

Josie1054

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I forgot to add, I too have had that
pinching sensation postop. Mentioned it to my PT. She asked me how I felt about a deep massage to the area and she explained. It was not comfortable, I squirmed all over the table, BUT from the next day on (and this was two weeks ago) have not had that discomfort since. She stated she felt two knots, above and below medial knee and that they were tight muscle spasms.
Perhaps that would help you? Best wishes!
 

Sara61

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Everyone one heals differently, lots of different factors to consider, so in this recovery there is no "norm" our own bodies will decide to declare us healed.
I would highly recommend talking to your surgeon about returning to work - nursing is a hard job with two healthy knees it would be brutal to subject your new knee so early in recovery to full time 8 hour shift work, look at the BoneSmart guideline on returning to work.
I'm a few weeks ahead of you and have been fortunate to get a good break from work plus my job is not at all demanding but if I had to do your job now, I know it would be impossible and at the end of the day you, would pay a hefty price in swelling and pain.
Pinched nerves are common at this stage with time they should ease however its always a good thing to double check with your surgeon or doctors.
 
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Jrwest100

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I want to thank everyone for your kind information. This has been such a long road (over 10 years) and I had gotten to the point to have the surgery as I could not stand one more day of incredible pain!Still wonder if I’ve made a mistake, but there were no other options left.
As for nerve pain, I have been on gabapentin for my back for 15 plus years- we’ve increased the dose, but it doesn’t seems to help the really sharp stabs,just the parenthesis . Tried Lyrica many years ago , it didn’t help , and wow, it took a month to get off that stuff.
My job doesn’t offer accommodations/ or restrictions I don’t think they are hiring part time(not that I could afford that anyhow as I pay for the health insurance and the mortgage) I did see a job offer for utilization review, which might be more desk based.I will have to see if my supervisor will approve of it (the supervisors are involved when you make a lateral move)
I see OS on Tuesday. I’ll report back . In the meantime , PT and trying to get back to normal
Thank you all again
 
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Jrwest100

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Haha parenthesis =paresthesia stubborn autocorrect
 
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Jrwest100

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well- hello. Thought I would give an update. Was able to RTW with a primarily sitting job that just so happened to open up temporarily.When I has seen the OS , he said , well , it needs more time. I still have swelling happening though- I found a neoprene type knee wrap/support, which does actually help for about 5 hours, or at least until the swelling starts to go over/under it. Otherwise the swelling is there within 15 minutes without the wrap.But I still end up taking it off d/t pain. Doc did mention complex regional pain syndrome?as a possibility of the continued pain/swelling/numbness.
So, what should I do now? Im worried this temp. job will be no longer, and then I will have to make a decision. I still dont feel safe with walkingsteady, and I still actually limp, which comes from the left hip from walking so odd.
Ive come to thing this was a very big mistake to have had the TKR, but then again at the time, I literally couldnt bear any weight on that left side .This is very depressing
 

Celle

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So, what should I do now? Im worried this temp. job will be no longer, and then I will have to make a decision. I still dont feel safe with walkingsteady, and I still actually limp, which comes from the left hip from walking so odd.
Ive come to thing this was a very big mistake to have had the TKR, but then again at the time, I literally couldnt bear any weight on that left side .This is very depressing
It sounds as if your knee was in a very bad way before you had the TKR. That does mean that it will need a longer time before it's recovered fully. It's only 5 months since your surgery - not yet half way through this year-long recovery - so there's still plenty of time for improvement.

I'm glad you managed to get a job with more desk time and I hope that continues for a while longer. Your knee still isn't ready to work a 12-hour shift, on your feet all the time, so I hope something easier turns up. It may be time to start making inquiries.

It sounds to me as if you didn't have any choice about getting a knee replacement, because you couldn't go on as you were. You didn't make a mistake. It was the only thing you could do.

Hang in there and try to remember that how your knee is now is not how it's going to end up. It's still working hard at healing itself. It could still end up being perfectly OK.
 
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Jrwest100

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Thanks for your reply Celle. Yes the knee was in very bad shape prior to the surgery.Its so hard to be patient, and I want to be out of pain.I cant take nsaids , so its hard to control the pain, And now the right knee is taking all the brunt of this and is having terrible pain. But I would never consider replacing it at this point- I don't want to go thru this again :(
I sometimes come to the realization I cant do things like i used to ( like walk???) much-less do work in the yard or house, or ride a horse again. Would you believe on the brochure for the knee replacement they have a lady probably in her 70's riding a nice thoroughbred horse after her joint replacements. Ugh that is such false advertising!!!
 

Celle

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It's probably not false advertising - we've had several people here who've successfully gone back to horse riding - but the picture was probably taken when the woman was much further into her recovery than just a few months.

We always advise that complete recovery takes a full year, and sometimes even much longer.
You still have plenty of time for your knee to improve a lot.
 

Seatides

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@Jrwest100, welcome! I had my left TKR in November too; I can't believe it'll be 6 months next week. I still have swelling and stiffness and a little pain here and there. But we have 6 months to go, we have to remember that. I saw my ortho surgeon yesterday for follow-up and he reinforced that it does take a year.

I hope you can continue in a desk-based nursing position. I agree with what others have said, that floor-based nursing would be brutal on you and your still-healing knee.

I can also relate to what you said about your other knee hurting so badly. I have that too; I want to progress with my new knee -- walk more and generally be more active -- but my old knee hurts much more when I do that. Still, it's great having one knee that feels steady and stable compared to the old one. Try to remind yourself how bad your knee was, how much pain you were in, how limited your activities were, before you had the TKR. It must be better now in a lot of ways than it was.

And I think it's not unusual to have setbacks and lingering issues. I still feel numb across my knee and down the outside of my calf. I tripped and fell on both knees a few weeks ago and they're really just starting to feel back to where they were, but I had to baby them both for awhile (and still do a lot of rest, ice, and elevation). A few days ago I dropped a full bottle of Swiffer floor cleaner onto my left foot and now have a big purple-blue hematoma (worse than a regular bruise) covering most of my puffy, sore foot.

My point is just this: try not to be discouraged. You're right; I think that TKR recovery is a much more challenging experience than we're led to believe. It is NOT easy. But I feel that I want to do it again, get my other knee done, once I'm satisified that the new knee and I are fully functional and recovered.

Good luck!
 

Sara61

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@Jrwest100 as our newly operated knees get stronger our non operated (old knee) gets weaker, I'm now at 7 months and still have niggly issues with my new knee ( numb on lateral side), occasional swelling / stiff knee especially after overdoing it - recently a set back due to a weird movement no idea how I did it - so really until we have passed the 1 year mark can we say we are healed and everyone and every knee heals at its own pace there is no normal time space for recovery.
My old knee is giving me a lot of grief but I'm hoping once consultations open up again I can proceed to start preparing for surgery again in the future. Try and stay positive, hopefully soon your knee will turn a corner and you can do all the things you want - even horseback riding :horseriding:- lol it was a horse that originally damaged my knee :heehee:
 

doodlebug60

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hi. jrwest 100; I feel the same as Sarah. I'm 3mths. ltkr and my good knee is a lot better than it was prior to surgery. at least now I don't have any arthritis in it. my right knee is getting worse and worse with the OA. can't wait to have my surgery asap. I realize I'll have to go through all this recovery again; but in the end it will all be worth it. sending you prayers for a speedy recovery.
 
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Jrwest100

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I just can not tell what is normal or not. My OS just looks at me with a blank face and says nothing. I mean , he is giving me the time off. It's just now that my manager is asking when you going to be back? I think she might have to hire someone to take my place :(.

The knee is still swelled up, still numb yet painful . Still clunks, and still catches.Is actually very flexable- actually loose when I walk.But painful at the end ranges. He wont drain it or give any cortisone shots in it. I am going to go ahead with doing a nerve block, but in the end that will cost me about 1000 usd .

Should I get a second opinion? is this just how some knees come out? we are now at the 6 month post mark. I think that should be enough time.One thing that the doc did say when I saw him last- ? is it CRPS?But he didnt say what one would do about it.

Btw , add more disappointment- had cortisone, then synvisc 1 month after that in the right knee ( the non operative one) . It failed too.

With these crappy knees and this covid stuff going on ,its incredibly depressing
 

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He won't drain it or give any cortisone shots in it
I think that's a good decision on his part. Your knee is still not even halfway healed. You don't want to take a chance of getting an infection by having something invasive going into it. I still had some swelling at six months and others have, too. Unfortunately, this surgery takes a whole lot longer to heal from than what we are led to believe. That bad word comes up again...patience!
 

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I didn’t really have good improvement until my second year, and it feels even better now in my third year post op.
 

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