TKR When will the swelling end?

[smcsmc727]

First a correction – my wife, who is my brain trust, read my posts and informed me that my surgery was actually last Thursday February 9th. I had posted it was the 8th. Let the record show that today is the 7th day following my right knee replacement.

I had my 2nd Physical Therapy session yesterday, and following that, despite icing, elevation, and playing several versions of “Lets Make A Deal” (Lord, please get me through this and I promise you I’ll devote my life to charitable works, and always put the seat back down on the toilet), despite all that, my knee took on the shape of a baby “Hindenburg.”

I believe it was the German philosopher Friedriche Nietzsche, who along with Kelly Clarkson co-wrote the hit song “Whatever Doesn’t Kill You Makes You Stronger.” Apparently, neither Freddy or Kelly ever had a knee replacement. If they had the song title would have been, “Whatever Doesn’t Kill You Makes You Wish You Were Dead.”

Lest you think I’m feeling sorry for myself, I’m not. Okay, just a little. I knew what I was signing up for. I knew ahead of time I was about to take my own personal journey through Dante’s Divine Comedy.
If you’re not an English Lit major let me break it down for you. In his poem, Dante’s Inferno is an all expense paid vacation for one to, wait for it – HELL! His tour guide, Virgil the Poet, leads Dante through the 9 rings of Hell.

“And on your right are Walmart shoppers, whose punishment is to be forced to stand in the 10 items or less line behind other Walmart shoppers that have full shopping carts, screaming children, and exposed butt cracks.”

Does this clarify for you how I’m feeling this morning? Everything hurts. Everything that’s not supposed to be swollen is swollen. Sleep? What’s that? A fading memory.

Last night I got one good 2 hour chunk of sleep. It ended with a nightmare and cold sweats. I couldn’t get comfortable. I normally sleep on my side and despite multiple experiments with a wall of pillows, I only managed to doze a little.

I know that I have only just begun my descent, I have only encountered one “Ring of Hell.”

Good thing I brought some chips and dip with me, the show’s only just begun.

Come Walker! Time to hasten thee back to thy bed, perchance to sleep. If only…

 

[Debdoub]

Let today be the day of naps...and lots of them!

 

[Kathi 777]

@smcsmc727. Well.... I too was pushed into PT at this stage and my knees ( yeah silly me did both of them) hated me. I backed off the pt, once a week I go. I do heel slides and many of the exercises but at home, my own pace and if the knees are bad we stick to basics. Maybe a thought... for you to wait out this swelling and you will gain your movement then. Sleep you say? Ha even at 5 weeks my knees woke me up rudely and told me 4 am was pain pill time.. it will be a day of naps! Bring them on!


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[Roy Gardiner]

Lord, please get me through this and I promise you I’ll ... always put the seat back down on the toilet

and you can get your own back without breaking this promise in fact or in spirit by putting the lid down as well.

 

[luvsmts]

I also had total knee surgery on 2/6/17 & went home 2/8/17. I loved your remarks to the nurses!
I want to thank this group for helping me understand that it's ok and important to put healing 1st.
So much emphasis on PT.. which is important but giving yourself a break & being patient is also important.
ROM will become easier as you heal. I had my right knee replaced years ago & it was unsuccessful because the surgeon did not use cement. It had to be re-done. My range of motion is great in that knee now. I like to hike and cross country ski - & look forward to resuming those activities in the future.




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[Mireille]

@smcsmc727 Stu! You had me laughing out loud. Great way to convey your feelings.

Sleep can be elusive for many weeks. It does get better with time. In my personal experience, too much PT early on was counter productive. I was going 3 times a week and it was hell. I eventually found a balance between PT and my own daily living activities. In the very early days, resting, icing, elevating, meds and gentle stretching exercises will be your best friend. We are all so different, you have to find what works best for you. Best of luck!

 

[Celle]

I had my 2nd Physical Therapy session yesterday, and following that, despite icing, elevation, and playing several versions of “Lets Make A Deal” (Lord, please get me through this and I promise you I’ll devote my life to charitable works, and always put the seat back down on the toilet), despite all that, my knee took on the shape of a baby “Hindenburg.”

That PT session was too much for your knee. I'm sorry you're in pain now.
Tell your therapist to back right off the exercises. All he/she should be doing is checking your mobility around the house and giving you maybe one or two gentle exercises. No hands on, no pushing, no long list of exercises. Just walking to and from the bathroom is all the exercise your knee needs right now.

Remember this, from the guidelines that we gave you on Pager 1?
- if it hurts, don't do it and don't allow anyone - especially a physiotherapist (PT) - to do it to you. Exercise only gently
- if your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again

 

[Kathi 777]

@Celle i agree they are pushing too hard to fast... i listened when you told me this and am now at 5 weeks out, and getting 110 degrees for my bend and am 5 degrees to get straight on my left knee and have done most of my pt at home and when i was tired i iced, then would nap, do a few laps around the yard, and more heel slides.. i haven't went crazy and YES the range of motion is there... my swelling went from 49 cm to 43 cm. so yes... the guidelines WORK


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[smcsmc727]

Thank you all again for your supportive remarks and helpful suggestions. I've had fun being creative in describing what I'm going through but today my mind is clouded by pain and fatigue. All I did yesterday was one run through of 5 at home exercises, and walking a little around the house trying to get back to a semi-normal routine. I elevated and iced. Today I'll try to set up the pillows as suggested in one of these posts. I had the roughest 24 hours yet. Even more swelling and at one point I couldn't even sit up at the table to eat dinner. I had to do a customized on the fly arrangement of pillows on a 2nd chair that supported my knee. I set up my cell phone to give me alarms at regular intervals to remind me to take my pain meds. I didn't mention I also have acid reflux. Last night after finally drifting back to sleep I awoke with a bolt. I had an occurrence, the kind that makes you sit straight up as bile rushes up your throat, and as you know, that kind of sudden jerky movement is really hard on an already traumatized body. YIKE! I was scheduled for P.T. today at 7:30 AM but at 6:30 AM I'm going to call and cancel. I still have to go out today to get my blood tested since I'm on thinners.

TKR-Right Knee: February 9, 2017
Charisma By-pass: August 3, 1948


Stu

 

[Roy Gardiner]

Yes, you are entering really the worst bit. Your body is in full reaction mode to the very serious assault of TKR. The lesson is, don't repeat those exercises that caused all the pain and swelling. Your knee will continue to heal even if you do nothing.

 

[L.I.T]

@smcsmc727, I'm so sorry - weeks 1 and 2 were *the hardest* for me - the clock couldn't tick fast enough. Somewhere just after week 2 things got noticeably better, as my swelling decreased. It was a welcome change!

I'll tell you a few things that helped me in weeks 1-4. We are all different, so take them as you will.

Standing and sitting - vertical (of either ilk) was not my body's position of choice. Sitting in a chair (even elevated) or standing for more than a few minutes ALWAYS resulted in my leg swelling to sausage size! Hence, meals in bed were perfect! Tell your wife all these years that you wished you could have been a kid and eaten in your bed like and uncivilized animal have come to fruition! It won't be forever, but it might make you feel sugnificantly better.

PT - sounds like you and I came out of the gate with decent ROM. Since I knew my OS would 'hope for' 90° at 6 weeks, and I already had it, I would only do my exercises on the days that either PT came to the house, or I had it outpatient (PT for me was 2x a week). The other days, once a day, I would do one (non-forced) stretching attempt at extension, and one (non-forced) knee bend to make sure I didn't lose ROM. This gave me enough time to get the pain and swelling down before the next session. I tried it the other way at first, and I was so swollen, my leg was useless.

For those of us (me) with a propensity for adhesions, keeping the swelling under control is key to prevent them. And, at least according to my PT, to healing better. He called the first 4 weeks the swelling and tissue healing phase. (he's been doing PT for 30 years and said he's really found that whether or not you do aggressive PT or just gentle PT, all the patients tend to come out the same.)

Rest up those first two weeks - take sleep when it comes b/c too often it doesn't. 'Normal' activities won't be on the plate for a while. Week 1 and 2, just showering, brushing your teeth, getting up to use the restroom are enough to make your knee angry

I'm a sweller (not to be confused with I am swell ), so let me tell you where I am now at 8 weeks.... I can stand for around 30-45 minutes without knowing I will be set back for days. I can sit at my desk (granted, iced and somewhat elevated) for 4-6 hrs at a time with some slight swelling. I can do household tasks like dishes, taking out the trash, and cooking meals. I can walk *almost* at a normal pace from my car to a building. See what I'm getting at here? 'Normal' daily activities won't be an option for a little while - hopefully in your case, a little earlier than me.... But just don't rush it.

Bide the time with Netflix, books, crosswords, or whatever will keep time moving because it feels like it goes SOOOOOOOOO slowly those first four weeks.

And I've heard some people have passed their midnight hours watching the good ole infomercials (but wait! There's more!).... Just be careful, I hear they are much more persuasive these days

Good luck to you sir! BTW, if you are not a stand up comic, you may have missed your calling. Perhaps a book "TKR for Dummies" is in your future!

 

[Celle]

@smcsmc727
I'm sorry you had such a rotten day yesterday. I hope today will be better.

You did right to cancel PT. 7:30 for PT on such a new knee? That is inhumane! At that time of day, you should still be in bed (or wherever you sleep), not rushing out to have some exercises. In my honest opinion, it's too soon to be going to outside PT anyway. Your knee doesn't need it yet. Just walking around the house is sufficient exercise for it right now.

I sympathise about the reflux. I suffer from it, too and the acid has gone down my airway and scarred my vocal cords. Do you have a recliner, where you could sleep and still have your upper body elevated a bit? That's what I do when the reflux is bad. You can still elevate your leg, with pillows added to the foot rest. Pin those pillows together, so that your elevation stack doesn't fall apart - like this:


So, for today, rest, ice, elevate, and take your medications on time, including the meds for reflux.

 

[smcsmc727]

These posts are really helpful although at times I'm conflicted. Today I felt guilty about cancelling therapy and after talking to my cousin in law, who had 2 knee replacements I ended up doing another "light" work out. His point was that in order to avoid "scarring" and limited mobility you need to do a minimal amount of movement.

So after "Sausage Boy" shrank enough to fit through the doorways, my "light" work out resulted in a return to my former Michelin Man state.

I had an appointment with my doctor for Monday but I called his office this afternoon and he's squeezing me in (if I blimp up any more he will LITERALLY be squeezing me in) tomorrow at noon.

He seems like a reasonable man so we'll see what he says.

On a completely different note, to those that find my posts mildly amusing, I did do stand-up in another life time. I performed for about 10 years in the 80's under the name Esther Shapiro.

 

[KarriB]

Your cousin is wrong about the scar tissue. That's an old myth the PTs like to scare you with. I didn't bend my knee for an entire month, I was in an imbolizer brace. Just Tuesday the PA at my ortho office was amazed at the bend my TKR has now 3 years out. I gained ROM a year after surgery with non aggressive therapy and biking with 0 resistance.

 

[Celle]

I agree. Your cousin was misinformed about the "scar tissue". That's an inaccurate name the PTs like to give when they really mean adhesions.

You need normal scar tissue. It's what holds your incision together, and without it your wound would open up again. What those PTs mean is abnormal scar tissue (adhesions).

Now, in spite of what the PTs tell people, adhesions are actually quite rare. They aren't just waiting to pounce, if you don't exercise enough.

There's even a danger that, if you do too much exercise, you will increase your chances of getting adhesions. That's because overworking newly wounded tissues leads to them getting angry and inflamed. Inflamed tissues are hot and hot tissues become drier than usual - and dry tissues can't glide over each other readily, which means they stick together and form adhesions.

Don't do any more exercise than walking around the house for now. It's much too early. Your knee isn't lazy - it's wounded. You should be spending almost all your time resting, icing and elevating your knee. It's probably even a bit too soon to be getting up for all your meals. Getting back to a normal life isn't on the cards just yet.

My surgeon doesn't allow any formal PT for at least a month after a knee replacement. He says that your knee needs that time, to start on its journey of healing. His patients just walk around the house every couple of hours.
At the end of that month, we start PT, but only one session every two weeks. In that session, we are shown a few, gentle exercises, which we do at home.

None of his patients have developed adhesions and he hasn't had to do a manipulation to help with ROM for the past 4 years.

I followed his advice for both my TKRs. My knees are strong and reliable. They straighten fully and bend to over 125 degrees. I can do anything I like with them.

 

[L.I.T]

@smcsmc727, that you were truly a comedian is just awesome in and of itself - I've always pined for that kind of quick and witty mind. Anyhow, it's easy to see why you are successful!

As for your knee, good for your for getting your doc's opinion. From *my understanding* based on what my physical therapist said, adhesions seem to be some sort of chemically encoded predisposition.... Aka, you basically are either going to get them, or you are not. He didn't believe that aggressive PT worked any better than gentle PT. Here at Bonesmart, you'll find those who did no PT, those that did aggressive PT, and a litany of us who did something in the middle. You have to find what works for you.

I will say this - I developed adhesions in another surgery (non-joint related), but did not develop them in this knee replacement. So even a predisposition doesn't mean they will definitely happen.

So do what you think is best - of course, remember that if sausage knee gets too big, you won't be able to bend it either - that there just be simple physics

Let us know how it goes tomorrow! Good luck!

 

[Roy Gardiner]

So after "Sausage Boy" shrank enough to fit through the doorways, my "light" work out resulted in a return to my former Michelin Man state.

So there's a lesson. Remember this

- If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it.

All you need is very gentle mobility stretches that don't hurt. You don't need any kind of 'workout'.

 

[weasel52]

I asked the first pt lady I saw in hosp if she had been in the Spanish inquisition?
I wondered to her how people managed who had bilateral knees done, she replied, no one has 2 done at the same time , that's very rare. Having read lots of posts on here about those who have btkr, I choose to discount everything she said. Apparently you shouldn't disconnect a cuff from the bucket , you only ice 15 mins 4 x day and never use a leg lifter. All of which " advice "I have studiously ignored. How do these people get qualified.

 

[Celle]

Someone always has to pass bottom of the class.

 

[Kathi 777]

oh sure.. bilateral is rare.... ha i had it done and there was an 80 yr old lady who was gutsy enough to do bilateral then next day. i would say it's becoming more common for a few reasons... insurance is allowing it ( its cost effective for them) and people without other health issues don't want to be down for any longer than necessary. [emoji12] the down time is enough to make a busy person stir crazy!


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