TKR When does the PAIN stop???

[jawndo]

Hello friends. I am sorry for dropping off the scene for a spell but I post from my phone and it was changed over and well no real good excuse no computer at home.

So things were calming down some during week 3 post op, I had moved to oxycodone 10mg every 4hrs and oxycontin 10mg every 8hrs which kept the pain less than if I had aspirin I suppose.

Any how I developed an infection after week 3 and my knee became hot, red, tender, swollen (even more so!!) and pus and blood began to ooze out of the area directly over my knee cap. I was running a 100.5 temp and not feeling well. Sent pics to the doc and he said put Betadine on 2x a day.

Wasn't getting any better in fact it was worsening with the pus and blood leaking out. I was scared! Infection is the devil to TKR's I was told. Anyhow I sent more pics and pressed the issue and the doc spoke to me and said it didn't look out of the ordinary. Since I had a previous knee reconstruction 30 some yrs ago the old scar was inhibiting blood flow hence the wound still open and leaking... I continued pressing the issue and finally got an appt after seeing it I was placed on antibiotics right away for 15 days. I'm 8 days in now.

I was given a week to get my flexion to 115 degrees or manipulation was next. The infection set me WAY back because the added pressure limited even the simplest exercises was KILLING ME! Well the antibiotics reduced the infection quickly which by the way seemed to stem IMHO from the stitches near the tom layer of skin. My skin was closed using glue but the interior stitches were a dissolveable material which my body seemed to have a problem with. There were about 5 places where the material was visable and pus coming out around those areas. It was nasty.

Anyway I made my visit on Thursday and could only reach 110 flexion so manipulation is scheduled for Tuesday morn. Doc said I had 0-145 after he closed the day of surgery. Hopefully I'll get 130+ when it's done. I have been constantly icing and elevating and respecting the process. Boy what a humbling and painful experience. I was taken off the oxycontin so just the oxycodone now and Tylenol. Glad I don't drink....

Thanks for ALL the prayers and concern and advise. You folks are the best!

 

[Celle]

I'm sorry to hear about this set-back.

I'm going to tag @Josephine for her comments.

 

[Pumpkin]

Sorry to hear about your infection. Thanks for the update. Hope things start going better soon.


Sent from my iPod touch using BoneSmart®

 

[chestnc]

Wow, @jawndo, I am so sorry you are going through all of this. Maybe that is whey you were having pain in the first place. A little infection was bring. I am so so sorry to hear about the infection post op. That is the last thing to even have to think about is infection in the post op site three weeks. Hope the antibiotics eradicate that infection. Afterwards the plan is MUA? Oh my. Hang in there and know that things will be better soon.

 

[hopefaith]

@jawndo
It is so good to hear back from you and so not good what you have gone through. I am so sorry this has happened to you. What a hard bunch of weeks!!
I am sure @Josephine will be by. She is very helpful!
~~hopefaith

 

[DogLoverx3]

Sorry to pop in like this, but your surgeon actually scheduled an MUA for you when you have 110 ROM at 6 weeks?!?!?! CANCEL IT!!!! Your ROM is excellent for only being 6 weeks out. I was stuck at @90 for close to 6 weeks and now have 140-145. Regardless of your excellent ROM, 6 weeks is too short a time to even consider doing an MUA. Your knee is still swollen, both inside and out and both of those things will affect your bend. I promise you that 110 (just short 5 degrees of his ridiculously random 115 expectation) is an amazing amount of bend for being so soon into recovery!

Also, I'm sorry to say, I'm concerned that your OS took so long to put you on antibiotics. He should have had you come in straight away! I'm in Arizona as well. Do you mind if I ask what part and which surgeon you went to? It's okay to post names on this forum, but if you're more comfortable, you can private message me.

Please don't get an MUA on Tuesday (or ever). It will set you back and you honestly don't need one with the amount of bend you are already able to achieve.

 

[Jozilla]

I agree totally with Dogloverx3. It is way too early for MUA and yes your Rom is excellent! After six weeks mine was 120 and another month later 130. I am sure you just have a lot if swelling both from the surgery and infection. Really consider canceling the MUA!

 

[sleenie]

I'm at 11 wks and your ROM is better than mine although it is improving daily. My OS said he wouldn't even consider MAY at this point. I was lucky to not have a great deal of pain because I couldn't't take the Icy at all. Took Tramadol for awhile but switched to Tylenol at 4 weeks. I am so sorry you are having so much pain. I agree with everyone, slow down and ICE. I still ice everyday after my PT/exercises and before I go to bed.

What you don't need is the stress they are loading on you. Take care of yourself first. Considering my ROM is improving in both knees, I truly believe 6 weeks is a myth that has been proven many times on the forum.

Hang in there. Take a break and ice. Get at swelling down.

 

[hopefaith]

Also an MUA after such a significant infection? That seems like insult on top of injury on top of another huge injury! Can you see another OS? The things I am reading here really are concerning.
~hopefaith

 

[Josephine]

and puss and blood began to ooze out

Glad you're back! Just a small thing but that yellow stuff is 'pus'. 'Puss' is a kittykat!

I was given a week to get my flexion to 115 degrees or manipulation was next. Anyway I made my visit on Thursday and could only reach 110 flexion so manipulation is scheduled for Tuesday morn. Doc said I had 0-145 after he closed the day of surgery.

What on earth is wrong with your surgeon?!! You have 110 at only 6 weeks - he should be DELIGHTED! No sane surgeon will do an MUA once a patient is over 100 degrees. Tell him you don't want it done and cancel it. General anaesthetics are risky things when they are necessary - to have one for no good reason at all is outrageous!

But you still have pain so I am going to see if I can help you there.

I'm going to ask you some questions and it would be very helpful if you would answer each one individually 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 compare this with the bone-on-bone pain you had before surgery!

)

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

3. how often are you icing your hip and for how long?

4. are you elevating your leg, how often and for how long?

5. What is your ROM - that's flexion (bend) and extension (straightness)

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

7. what kind of PT/exercises are you doing? How much and how often? (and detailed details would be appreciated, please! Reps, sets and session and all that)

Note:
If you're not familiar with this, it goes like so:
1 lift of a 500kg bell bar = 1 rep or repetition.
Doing 5 reps and then a brief rest = 1 set of 5.
And doing 5 sets and finishing = a session.

 

[jawndo]

Wow. One thing I did not expect was such a negative reaction to my post! Firstly I want to say is I did my homework when it came to choosing a surgeon to preform my TKA. I believe I chose the best one and I believe he has my best interest in mind. I don't think he is insane, or anything near that state. So I don't appreciate that comment. I was advised before I ever started the surgery that because of my age, sex, and previous surgeries I would probable need a manipulation. It wasn't 100% but a likelihood. I accepted that prior to the surgery so it was no surprise to me that at my 6 week visit it was deemed needed for me to have done. My doctors decision to do the MUA is to give me a greater ROM only. We discussed the process at length and agreed this was the best course of action for me. I can't believe I'm being advised to CANCEL like it will be the worst possible thing for my recovery possible. I know everyone here has more experience than I regarding TKA's and probably a million other things but I have to trust my docs opinion too right? That's all this guy does. Knees and hips. That's it. He's a pro and has no negative issues recorded with his work on patients who are mainly nurses and docs as well.
I read Josephine's articles and info regarding MUA and found nothing there to confirm or direct me to cancel the procedure. In fact I was more comfortable after reading it and felt it was the right decision to continue. Yes I have 110 degrees now but being younger my doc wants me to get that 135-140, which is my goal as well. Yes he believes in the 6 week window(which I know is not agreed with on the forum) and also believes I have built substantial scar tissue around my knee and that now is the time to break it loose, for one reason only to give me the most ROM POSSIBLE. What's to say the MUA won't help me now but I can still get more ROM later as well. At any rate I appreciate everyone's opinion and advise. Maybe I've given the wrong impression about my doc. I trust him and am grateful to him for the care I have received. If I have given the impression he is incompetent or negligent I apologize because he is not. I have complaints but pain tends to alter ones perception. At any rate I'm still in pain, not sleeping well, bouting with depression and having good as well as bad days but hanging in there with hope for a better tomorrow.
To Josephine
Here are the answers to your questions about pain

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 compare this with the bone-on-bone pain you had before surgery!

)
Right now I am icing so pain is about a 3. I can daily experience swings of 3-6 during the day. Greater while standing, after therapy and at night in bed.
2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?
I am taking 2ea 5mg tabs of oxy codone every 4 hours, 12.5 mg of promethazine every 6 hrs and around 2k mg of Tylenol thruout the day
3. how often are you icing your hip and for how long?
I had a TKA May 12 and I am using a Game Ready ice machine which uses ice therapy as well as compression. I estimate I use ice therapy for approx 6-8 hours a day.

4. are you elevating your leg, how often and for how long
Yes. If I am not standing or walking etc I am laying down with my leg elevated with ice. I elevate in bed too so if would say 12 hrs total a day. I read the mantra, Why stand if you can sit, why sit if you can lay down.....etc

5. What is your ROM - that's flexion (bend) and extension (straightness)
Extension is at -8 degrees and flexion is at 100-110 at very best after excersize.
6. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and
I have about 50 min of excersize every other day as well as 30 -40 min of walking. I am on my feet around the house for about 2 hrs max a day. Maybe less
7. what kind of PT/exercises are you doing? How much and how often? (and detailed details would be appreciated, please! Reps, sets and session and all that)
Ok here goes:
2x a week PT
Knee Excersize List
Bridges: Bridge hips with toes up to remove hamstring from excersize 3-4 sets of 10-15.
Limbo: Set string at knee + - height. 20-30 reps per excersize. 1. Feet over front. 2. Feet over behind. 3. Leg straight over front.
Ball bounces: 8-12 minutes on stability ball
Bike: 15 minutes
Quad sets: 60 reps per set. Place towel under knee and flex back of knee to ground. Hold 3-5 seconds each.
Mini squats: 30 per set very slight squat
Calf Extensions: 30 per set alternate with toe raise
Single leg balance: R leg solo for 1 min x 3
Leg raises: 3-4 sets of 15 w/lb ankle weight
Calf Roll: Roll out R calf till knot is found pause there for 30 seconds then pump ankle 10x. Do same on L calf the repeat once more on R calf
Monster walks w band: tie small elastic band around ankles. 2-3 sets x 10
1st. 10 steps forward at 45• then return
2nd. Wide stance 10 up and back
3rd. Side step 10 up then back
Step ups: R up R down x 10 L up L down x 10 rest 2 min and repeat x 3 sets
I try and ride the stationary bike 15 min each day no load so it's is for ROM improvement. I will try and do this list one day per week at home as well.
That's it.
Thank you.

 

[sleenie]

Obviously everyone's recovery is different, but to expect someone to be further along than you are just because of your age does not make sense. You are still very early in the healing process and healing takes time. And age?? Does that mean because I'm 66 I can't get decent ROM? I'm not sure age has anything to do with it. I know people much older than me who got great ROM and not in 2-3 weeks.

If you are happy with your OS, and trust him explicitly, then by all do what he says. But you did ask for help. I'm truly sorry no one told you what you hear. Not even sure what you wanted. You wanted to know when the pain would stop. Certainly not in the timeframe of 2-3 weeks. Your knee will heal at its own pace and all a MUA will do is add more pain. at least for a while. BTW, I have also had surgeries to remove adhesions in the past (not my knees though), but at 11 weeks, I'm not really concerned and neither is my OS. I wish you the best.

 

[DogLoverx3]

I'm sorry as well that you didn't like the responses you received. Everyone on this forum looks out for everyone else and when we hear about something that is being needlessly proposed, we speak up in order to make sure you're making a good decision. None of us meant to insult your intelligence.

To be blunt, considering the amount of exercises and activity that you are doing on a newly sawed in half leg/knee, I'm impressed that you're even able to get to 110. Even if your knee is not outwardly swollen, it certainly is inside. As the above poster pointed out, age has absolutely nothing to do with your recovery. I'm younger than you are and I've had a very slow & difficult recovery. Even when I was stuck at 90 for weeks, an MUA was never even considered and I was able to get to 145 on my own. Yes, more ROM can always be achieved. Along those same lines, an MUA can be performed far into the future if need be. I just don't agree with you having one done so early on, with such great ROM and so much more time to allow your knee to settle down and gain more.

As you didn't appreciate my 1st post, I'm pretty sure you won't like this one either, but I do think an MUA at 6 weeks is ridiculous, regardless of how great your surgeon is. I wish you well with your future procedures. As long as you go into it knowing the risks/rewards and having this procedure will basically set you back to step one needlessly, all we can do is give you advice from the perspective of people who have been in your shoes already and have learned from experience. Good luck on Tuesday.

 

[hopefaith]

I also had been very concerned for you when you first posted. I missed hearing follow up. This group of people present company included have your best in mind. I need to pipe in with the others that age has nothing to do with how long it takes someone to heal, what ROM each will gradually end up with, and what all of our goals are. You will see the full gamut of ages, speed of recoveries, and ages all mixed in.
I hear you really researched your OS. When we hear something that sounds "off" we will be concerned! I heard your concerns when your doc didn't respond quickly to an infection. OS's don't want their patients to get infections.....you had all of the symptoms and he didn't respond until it was really bad! That is scary to me and probably others here.
Maybe we don't express ourselves perfectly, and the care may get lost in the written word, but I have been on this site several months and I have never met a more supportive group. Please don't give up on this being one of your resources. You will really need it in the months ahead.
~~hopefaith

 

[Roy Gardiner]

I try and ride the stationary bike 15 min each day no load so it's is for ROM improvement.

No load is correct as it's a stretching exercise. But there's no need for 15min.

- Set the saddle low enough that your leg doesn't want to make a full revolution, it's uncomfortable (not painful).
- Pedal nice and slowly until, after a couple of minutes, the legs are turning easily
- stop as soon as this happens.

Repeat this as often as you like.

I, too, am surprised that your doctor thinks there's scar tissue after such a short time, and when you have such good ROM for this stage of recovery. I hope MUA works for you, but I will again be surprised. Pleasantly this time, which has got to be good.

The six week window IS a myth. Soft tissues can be stretched and ROM improved over weeks, months and years.

You seem to be doing a lot of strength training that puts force through the knee. Does it hurt, or cause swelling after? If it does I'd say stop it until all swelling has gone.

 

[Phil75070]

your doc didn't respond quickly to an infection. OS's don't want their patients to get infections.

My OS told me to come into the office, no appointment necessary, if I even thought my knee was infected. And, if he confirmed it, he would have me in the hospital THAT DAY to address it. For an OS to have to be pushed to look at a knee that has all the symptoms of an infection is really strange.

As others have said, an MUA at this early point seems counter-productive but if you have total faith in your OS's opinion and that's what you feel comfortable with, then by all means have it done. Being in a good mental state is as important as being in a good physical place.

 

[susanlondon]

Hi, jwando-Long time, no write, as I've been busy trying to regain some semblance of a "normie" life just shy of seven weeks post op. I read your post sbout the infection and upcoming MUA and subsequent posts and felt moved to respond, if for no other reason than I understand your sentiment about what others on BS have had to say.

However, I'll begin with your issues: infection and MUA, both of which were frightening prospects for me, though fortunately I didn't have to deal with either (2 tkr's in 2 1/2 yrs). I thank God for that, for both possibilities were incredibly frightening to me. My doc has been pretty laid back about my litany of complaints (fewer with this knee than the first TKR). He's been in the biz 30+ years, well respected, etc, but I know that even the suspicion of a possible clot in week 2, suspected by my PT, which turned out not to be a clot, was immediately attended to with the admonition to "come to the office immediately, no appt necessary." I'd like to think he'd act similarly if I'd called about a possible infection.

As far as MUA was concerned, I was afraid I might need one-my own paranoia-from the get go. I asked my PT constantly, to measure my ROM, and his opinion about needing that procedure. With 90 degrees ROM by week 2, he assured me that that certainly wouldn't be necessary. I've fretted about my 110-115 ROM at week 6, (I'm a very active woman-cycler, hiker, kayaker, snowshoer, camper, etc) and I worry that I won't get the ROM I need to resume those activities comfortably. Several BS experts reminded me, as did my PT, who I initially thought was pushing the ROM issue, that 3-6 months is the window for ROM. I was advised by BS not to worry, which I'm very good at doing, and to remember that each knee recovery has its own course of action. Now that I'm less frantic, I can see that this knee can " do" some things the other one may not have been able to do at six weeks, but b/c I didn't keep a diary of my other TKR, I cannot be sure.

I'd like to add a word about the folks on this site. Surprisingly, my doc, the med staff at the hosp, my PT haven't heard of BS. I am very glad I found the site as it has helped me sort out the finer details from the general and sometimes generic comments from those on charge of my care. That being said, I don't entirely disagree with your suggestion that some opinions offered here may be a bit straightforward and seemingly "gruff." On the other hand, I also agree with the recent reminder from a forum respondent that the folks here have been through the surgery and know the collective drill/score, whereas the med staff in charge of my knee recovery are advising and managing based on what they've read and observed, which is rather different than first hand experience.

You sound like a brave and courageous person, and I wish you all the best. Heading out soon for PT, feeling a little, but not too, guilty that I didn't run through ALL my exercises yesterday. Instead, I only rode bike, did squats, stretches, quad sets, and spent considerable time in my pool, walking to regain a normal gait. I also went berry picking and drove my standard tranny Honda. Depressing the clutch is exercise of its own! Interestingly, I woke up to feel pretty okay, less frantic and with a resolve to work hard at PT and let my knee let me know when it's time to rest. I'm trying not to fret the ROM and to repeat the mantra that over time, ROM will increase as long as I keep workin' it. Have a good day.

I hope all goes well for you. Please keep in touch.