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TKR When will the swelling end?

[Bonesmart.org] When will the swelling end?


I'm exhausted! I didn't realize there were so many boxes of "Pity Party" decorations to get down from the closet for our big gala on Thursday. The last time I actually put up all of the black crepe paper, and blew up all of the balloons was in 2009 when we both lost our jobs and bought a worthless bed and breakfast in Avon Park, Florida. You should have seen the turn-out for that PP when we realized we had lost half our retirement savings. But that's another story altogether.

In any event, I gave my knee the day off yesterday, if you can call a 1/8 mile walk from the parking lot to the doctor's office and back again, being "off." Originally, my first follow-up appointment after my surgery was supposed to be on Monday, but on Thursday my knee had swollen, the pain increased, and I wasn't thrilled with the Physical Therapists after two visits to their gym. They were able to squeeze me in yesterday.

Basically, I wanted to talk to my doctor about two issues. First, making a switch to another P.T. group. During my 2nd appointment they had the receptionist take over for the therapist and she went to work with another client. Throughout my hour session she'd come back and check on me, but it left a bad taste in my mouth, like when you think you're about to drink a root beer and it turns out to be Dr. Pepper instead. Also, while my wife was waiting for me in the receptionist area she heard some of the staff make some very unprofessional remarks about someone else in their group.

The 2nd thing I wanted to discuss with my doctor was achieving the balance between an enthusiastic approach to physical therapy that didn't go beyond the point of diminishing returns. I was concerned that I could push myself too far and the result would be a response from my body in the form of swelling and pain that would make subsequent efforts that much harder.

I have read dozens of threads here and many common elements run through them all. There are people that have enjoyed great success in range of motion with a gentle gradual physical therapy program, and others who achieve similar results with a slightly more aggressive program.

I think for me the important thing is not to allow myself to be pressured into meeting a physical therapist's expectations at the expense of my own comfort factor. Like others here, my tendency is to "suck it up" and push myself. I have to remind myself this isn't a race. Also, whatever I'm going through now, I'll be doing again, more or less, when I have the other knee done in the
Spring.

My doctor instructed one of his super competent office staff to cancel my remaining appointments with the first physical therapy group, and to set it up for me to go to a different group in the area. My first appointment with them is on Monday.

While was I was at the doctor's office he looked at my knee and decided to remove the 20 staples, something originally scheduled for Monday. He said "It looks good." I braced myself for some short term pain, but honestly, I didn't feel much pain as he took them out one by one. He placed strips of tape across the wound and told me I could shower now without a vinyl boot, and to leave them on until they fell off of their own accord.

Today is a relatively good day, but owing to the bi-polar nature of total knee replacements, I know that the process is one filled with peaks and valleys. That's why I am leaving the Pity Party decorations in their boxes in a readily accessible location in the corner of my bedroom. If I need to stage another PP, I want them to be handy.

Stu
TKR - right knee, February 9, 2017
 
For sure, there'll be good days and bad days no matter what. I also switched PT groups and was so happy I did. Having the same therapist each appointment was beneficial. You also may want to set boundaries right off the bat, explain you'd like a non-aggressive approach and NO ONE pushing/pulling the leg which will only antagonize the soft tissue, causing more swelling.
 
Update: Yesterday I hit the two week mark following my TKR of my right knee on Feb 9, 2017. After having switched physical therapists following the first week, I'm really enjoying (if you can apply that term to what we go through at P.T.) the new therapist, Jen.

I'm starting to do a few minutes on the stationary bike, and working with resistance bands. I go the P.T. 3 times a week and do a half dozen exercises at home on my off days. My knee is still swollen, tight as a drum, but I'm walking with a cane or nothing at all. I use the walker when I do "laps" around the house from the kitchen to the dining room to the living room back to the kitchen. It keeps my stride and pace more even than the cane.

Sleep - Would love some! Seems like I can only get about 3 hours a night. The rest of the time I'm doing the post-op "rotisserie" shuffle among multiple pillows. Before my surgery an afternoon nap was a regular thing for me as I never could sleep well even before this. But now, naps don't happen too often either.

I come to the table and sit up for all 3 meals, and a couple of times a day I walk up and down 11 stairs to my basement office to use the computer there.

We've had unseasonably warm weather here in St. Louis for the past week or so and I've enjoyed sitting on our patio tossing tennis balls to our dogs in 70 degree sunshine.

Because my stomach is sensitive - had ulcers a few years back, I have to avoid aspirin, IBUprofen, etc. and I'm on the blood thinner Warfarin and have to have my blood tested twice a week.

I got cabin fever and drove our car around the block just to see if I could this week. No problem with a short drive. My wife was with me.

I'm using an ice water circulator, ice packs, and a tens unit to assist with pain management.

At night I watch TV sitting in a recliner. Before my surgery I mounted two 2'x4' skids on each side to elevate it a little. I place 3 pillows at the end of the seat cushion to elevate my leg and while I'm reclining I use ice packs on my knee. I've had no problem getting in and out of the recliner. I usually get up once an hour to go to the bathroom.

In my shower I have a chair and had installed a shower head with a hose, but yesterday I put the original shower head back on. I no longer need to sit while I shower. My staples were removed on the 17th.

That's where I'm at after 15 days.
 
That's a very good report! You are doing well. If you are not walking with a normal gait using a cane it may be a little too soon to make the switch from your walker. If it is because of pain at night that you aren't sleeping make sure you take your medication as prescribed. You can also try some Benadryl. You can take Tylenol DM which contains it if you want to help with any pain you may have.
 
Because you're saying the knee is very swollen I'd say forgo dinner at the table for now unless you're propping that leg up while eating. The most important thing is to get the swelling down, so the more time elevating the less swelling you'll have. Spending the majority of your day elevating is very typical this early in recovery. If the weather's good, elevate and ice outside, especially with cabin fever setting in.
 
You cracked me up!
I'm a day ahead of you so will enjoy comparing progress.
Hubby is a pretty good cook, so I probably won't starve.
I didn't think a TKR was exciting enough so next Saturday our new puppy arrives and shortly after that the builders are coming to do some renovations, there may well be tears , watch this space..
 
This past Thursday was 4 weeks since my right knee replacement. To review, I switched physical therapist companies after the first 2 sessions and was very happy with Jen, my new therapist. Things were going pretty smoothly and then she had a baby 6 weeks early! So circumstance created the need for a 3rd physical therapist. Michelle took a more aggressive approach than Jen and seemed to be in competition with her. This past Wednesday she actually said she was and wanted me to improve my numbers. She literally told me if I couldn't reach 108 with my knee bend she was going to push it to that. I didn't want her to do that and somehow I managed on my own to get 116.

Yeah, my wife would tell you I'm a classic "over-achiever" often to my own detriment. Michelle, added a bunch of new exercises that hurt me later. I saw my doctor and took with me a report from Michelle. Based on my numbers and the fact that I told him I was planning on using my gym membership to bike and walk, and later swim, he said after the 10 PT sessions I had had I was done. Good, I didn't have to return to Michelle.

Later this past Wednesday night my right foot hurt from some of the exercises we did and my knee was mega-swollen again. I have been elevating and icing several times a day. I only sit at the table 10 minutes at a time. Sometimes I watch TV in a recliner with a pile of pillows under my knee to elevate it.

Yesterday I went to the gym. I thought I was taking it easy. I used the stationery bike and did a very relaxed 8 minute mile. It didn't hurt as much as when I did it at the PT place. Since I was feeling good I walked just 3 laps. After that my knee and foot started to hurt so I stopped.

Last night was the worst night since my first week. Massive swelling, pain in my foot and knee. My doctor had cut me back to ½ a hydrocodone I was on but I had to take a full one to get any sleep at all. I also take Tylenol PM extra strength.

This morning I could barely walk, so I guess I'm going back to bed with my knee elevated and icing it.

My "will" exceeds what my body will tolerate and it's been a very hard lesson to learn restraint. I was looking forward to that emotional lift that the 3rd-4th week should have brought as I have read many people see a noticeable improvement by then.

I am just hoping to get to the point where I can gently guide my own rehab and not suffer set-backs like this recent one, but I suspect this will be the pattern for at least 2 more months.

The hydrocodone has diminished my appetite and I've lost 20lbs. My wife hates me for that. It also leaves my mouth dry. All of this will pass in time I'm sure.
 
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This morning I could barely walk, so I guess I'm going back to bed with my knee elevated and icing it.
Your knee is telling you loud and clear it needs time to heal, let the swelling and inflammation go down, then you can start doing more. If you knee talks to your again, step back and slow down.
I was looking forward to that emotional lift that the 3rd-4th week should have brought as I have read many people see a noticeable improvement by then.
Some do feel better this early, most of us start feeling better around 12 weeks, if they give their knee half a chance to heal.
First article has photos that will give you an idea of why you need to let those injured soft tissues heal before increasing activity or pushing yourself. Second article contains wise words to follow.
TKR surgery - WARNING: real life photos
TKR: work “smarter” and not “harder”
Of course this was true, you had that awful arthritis pain, :dead:. Give your knee half a chance to heal and settle down, eventually you will have a pain free knee and a real zest for life back. :tennis::swim::biking::vespa::upright::kayak::realing::surfer::bicycle1::driver::capn::tennis2:
 
That's the problem/risk - too much too soon is the recipe for swelling and keeping things stirred up in there so you don't heal.

I feel great at 8 weeks. I have all my range of motion and very little swelling even if I am on my feet.. The bonesmart way of waiting and icing the knee works, I can attest to that and being in control of your PT at home is key to a good recovery. Good luck!


Sent from my iPad using broken link removed: https://r.tapatalk.com/byo?rid=75543
 
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I agree with everyone else---you need to slow down and let the inflammation settle down. When you stress the knee, the muscles that hold it up are weak after surgery. So, the joint itself has to bear the full weight of your body. Obviously the knee joint is not ready for that right now.

I think you need a week of lying down with your leg elevated on three pillows. Cut the exercise for this week and then start back slowly. Ride the bike for 5 min---fine? then ride it the next time for 10 min. If not fine----then ride it for 3 min. You need to get those muscles back into condition so that they can help support the knee. That is not the work of five minutes---you can not beat the muscle into submission. You will have to slowly build up the muscles and then the joint will be supported as well.
 
This is the hardest part of recovery - the up and down from day to day as to what you can do and what you can't do. Yesterday I did a few "extra" things meaning I did 3 easy, light chores as opposed to 1 or 2 and am paying for it today. One day, the new knee will be fine with doing something and two days later, it rebels if it has to do the same thing. So frustrating.
 
I am just hoping to get to the point where I can gently guide my own rehab and not suffer set-backs like this recent one, but I suspect this will be the pattern for at least 2 more months.
You can guide your own rehab right now, if you want to.
Saying no to therapy - am I allowed to?
Excessive exercise can actually slow down your recovery, by inflaming your healing soft tissues and making them sore and swollen.
Anyway, it's not exercising that gets you your ROM, it's time. Time to recover, time for swelling and pain to settle and time to heal. Your ROM is there right from the start, just waiting for all that to happen so it can show itself.

You really only need just a little, gentle exercise to rehab your knee. It's not a case of "if a little is good, a lot must be better."
Ordinary walking is the best exercise of all for your knee and you could easily do your own therapy, by using these exercises:
Heel slides and how to do them properly
Extension: how to estimate it and ways to improve it

The hydrocodone has diminished my appetite and I've lost 20lbs. My wife hates me for that. It also leaves my mouth dry. All of this will pass in time I'm sure.
I guess your wife is envious of your weight loss?

Your appetites will come back, as your recovery progresses. The dry mouth is a common side effect of the pain meds. I used to suck barley sugars for that.
 
What I have gleaned from all of the great feedback is that I'm rushing things, not giving my poor little knee a chance to heal before I lay so many expectations on it. I can see now that I am pushing myself way too fast for where I'm at in the recovery process. I'm not bragging, more like I'm stating how foolish I've been. Only one month past surgery and I've already driven myself to the store, shopped for 20 minutes, roasted a brisket and made a full dinner for myself and my wife, and began to take on some of my former lighter chores like feeding the dogs, paying bills, etc. I am going to give my knee several days rest and then slowly ease into a routine of moderate exercise. Thank you all for you input. I appreciate it very much.
 
You have not been foolish....you are full of wisdom in seeking the advice of others who have gone through a similar surgery and lived to share their experiences. I am almost 6 weeks post LTKR and looking toward my RTKR in just over two weeks. Everyone's home and family situations are unique. In my case, I recently retired and can take as long as I need to for recovery. I spent my first 4-5 weeks resting, elevating, icing and taking meds by the clock....even wake myself up during the night to take meds. I didn't drive for 4 weeks, and got friends and family to take me to and from my three out-patient physical therapy sessions each week. Came home and started the whole rest, elevate, ice, and take meds by the clock process over again. At 4 weeks I was released from PT sessions, but continue to do my exercises at home, for both my new baby knee and the one that will be replaced in two weeks. I can drive now and get out on my own for short lunches with friends or quick runs to the store...just to get me out of the house.

All that said, I just want to encourage you to let your body advise you on what you can handle and what is just too much. What you "can" do and what you "should" do are two very different things. I "can" do stairs, but if there is an elevator....that is what I'm going to do. I "can" cook dinner and pick up the house, but it may be wiser on a busy day to have hubby bring home Chipotle. I have the future in sight, and slowly recovering from surgery now may ensure a more satisfying tomorrow. Good luck....you can do this!!!
 
@smcsmc727 you joined the ODIC! Finding a balance can be difficult, but this early in recovery it's wise to keep it down to 1 activity a day. If you cook a meal, don't clean it up, leave it for someone else and don't take on anything else that day. If you go out to lunch or dinner, rest and elevate the rest of the day. This recovery is a roller coaster ride and finding the right path can be challenging.
 
I am going to give my knee several days rest and then slowly ease into a routine of moderate exercise.
Jolly good! I am so pleased you've seen the light here!
But .... (oh, you knew there had to be a 'but', didn't you?!) .... I have two caveats for you
1. several days won't do it, more like 2-3 weeks
2. why don't you consider no exercise at all? Lots of us have done that and still got excellent results
@Celle @sistersinhim for just two and me! Perhaps you should read my recovery thread to see how little exercising I did for either knee! Knee recoveries UK style Parts I & II (Josephine)
 

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