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TKR Zingers - after 2 surgeries

Meme273

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I had TKR on Mar 9, 2020, and was doing great. No pain when walking, doing great with PT, but had 2 areas that kept draining. The draining got so bad, needed an Imcision and Drainage (I & D). I was told be Dr. that it was due to too much activity that ripped inside stitches, on 05/19. Dr. also did 2 bone biopsies on Tibia which came back negative. Then had staples and stitches after second surgery (first surgery was surgical tape), and had them removed on 06/11. I am still having zingers and pain. Lots of pain at night. Was told by Dr. that he did lots of work and pain is to be expected for awhile. Stopped all PT and do not go back for 4 weeks. Is this normal??
 

Celle

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Hello @Meme273 - and :welome:

i'm sorry to read you had unexpected complications from your surgery. Which knee is it, by the way?

Did your surgeon send any samples of the drainage fluid to be tested for infection when you had the Incision and Drainage? I hope he/she did and they came back Negative. I'm glad the tibial bone biopsy was negative.

Were you treated with any antibiotics?

Your knee has been through a lot, with the two surgeries and it will need time and gentle treatment now, so it can heal.
I completely agree with your surgeon's advice not to go to PT. Your knee will get all the exercise it needs , just with your daily activities of living.

It's not exercising that gets you your Range of Motion (ROM) - it's time. Time to recover, time for swelling and pain to settle, and time to heal. Your knee has the potential to achieve good ROM right from the start, but it's currently prevented from doing so by swelling and pain. ROM and strength will come, as your knee heals.

Make sure that you ice and elevate your knee, to help with swelling and pain. There are articles about those in the recovery guidelines that I'll give you.

The zingers are little electric shocks from cut nerve endings. After two surgeries, those nerves will be trying hard to reconnect, or grow new pathways.

Pain at night is often caused by two things: over-activity during the daytime, and under-medication.
So, make sure that you aren't trying to do too much. You can check that against the article on Activity Progression. Count your second surgery as the start of your recovery, not your original surgery. Secondly, make sure that you're taking adequate pain medication, on a regular schedule.
 

Celle

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And here are the Recovery Guidelines I promised you:
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.
 
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Meme273

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Thank you! That relievers some of my worries! It is my left knee, and he never said that he sent drainage for testing. Yes after second surgery I was on Bactrim and Cipro for 14 days. I did get pain meds after surgery, but only have a couple left. So trying to use sparingly. Before surgery 2, i was given Tramadol, after surgery I was given Oxy. I also take Gabapentin 300 mg at night for Restless legs.
 

Sara61

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Zingers are common after a knee replacement and can appear out of the blue :flabber: anytime of the day and usually catch you unaware giving a startling pain which occasionally makes you :censored: I was told my surgeon that it is the nerves healing, I still get the odd one but not as frequent as the earlier months. I will ask @Jaycey to advise you better on medication, as pain medication should be constant and it's not a great idea to use sparingly as this just leads to a higher level of pain
Take a look at the article in the Library listed under Restless Legs after knee replacement surgery it's very interesting and will answer your queries. Hoping the zingers lessen soon for you xx
 

Jaycey

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Here's a link to the article Sara61 was referring to: Restless legs following knee replacement surgery

Still early days for you! If you are running out of pain medication please contact your surgeon's office or your family doctor. They can give you non-narcotic pain relief. It's important at this point to stay ahead of the pain so taking meds around the clock as prescribed is the best approach.
 
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Meme273

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Thank you for your responses!! It really helps to know that I am not alone in the way that I am feeling. I have a really good day and think that maybe this is the start of no pain and then at night the pain, throbbing, aching all comes back. Many sleepless nights with this. Thank you for the advise, I will contact my surgeon as I am now out of pain meds. You all have made an uncomfortable situation a little more tolerable!! Thank You!!
 

Sara61

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@Meme273 :tiredwheel:sleepless nights is common especially in the 1st couple of weeks, try not to think about them to much and whilst awake use the time to read, chat on BoneSmart or just use the games room, during the day you can cat nap and catch up on sleep, once you ge your pain under control you will start to sleep better and be able to do a little more each day, the wonderful thing I found with BoneSmart is that there is always someone online somewhere around the world willing to chat or advise whatever the time of the day or the night - here's hoping a better day for you xx:flwrysmile:
 

sistersinhim

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Increased nighttime pain is usually an indication that you are doing too much during the day. Try slowing down and resting more during the day and see if your pain at night will improve. Like Sara61 said, sleep whenever and wherever you can. It doesn't matter when. What matters is that you get some good sleep!
 
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Meme273

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Update - Went to surgeon yesterday (I had sent a note saying that I was still in pain at night and needed some type of relief), took 3 xrays, everything looks great, said that it is probably muscle related and I need to start PT this week. Gave me Indomethacin, medication to take to PT (a topical) that the therapist will use with a TENS unit type machine and temazapram to help me sleep. Night one with the new meds was not great, but better than before. Guess I need to give it a few days and start the PT and see what happens. Dr. also cleared me to start pool therapy which is great and will start today! Thank you all for your comments and suggestions, you truly are a great help!
 

kneeper

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It's worth a try. I don't know what your pool therapy will involve but be aware that activity in the pool can be misleading and you might feel it later. You might be cautious about how much you do on the first day.
 

Jockette

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I did not have a good pool experience, but I was only 4 weeks post op, to the day, my first (and only) pool PT. You’ll probably do better, since you’re 3 months post op.

They had me in the pool for 50 (fifty, that was not a typo) minutes and had me do countless bending exercises. Then they had me walk up the steps to get out of the pool foot over foot, which I had not attempted. It took me 3 days to recover.
 
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Meme273

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Update - I am now 4 months post op TKR and 2 months post op from I & D. My ROM and flexion is great, can do PT with not much trouble. The problem I am having is that after sitting and laying down, when I get up I can barely stand. It is painful for the first few steps then it seems to slowly get better. I am still using cane as there are times that the knee gives out. Dr. & therapist both say that I just need to give it time and problems should resolve. I am starting to wish I never had the surgery and dealt with the original pain. I am not overdoing it as I only have PT 2x a week and walk for approx 10-15 min a day. I ice 45-60 min several times a day. I am getting very frustrated thinking that it will never get better!!! I think I just need reassurance that I am not alone with these problems! I also tried pool therapy and could barely move after doing it. so stopped that also.
 
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Meme273

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And what is even more frustrating is that after first surgery, I was walking without cane and had no pain! The problem was the 2 parts of incision that would not heal which lead to the I & D. Sorry just had to get that out! I think my husband is sick of hearing me complain!! :sad:
 

Jockette

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You are not alone and it will get better!

At 4 months post op from TKR, and having had another procedure in May, your knee still needs lots of time to heal, and it will. This recovery takes an average of a year so you’re not even halfway through. Where you are now is not where you will end up.
My ROM and flexion is great, can do PT with not much trouble.
not much trouble.
“Not much trouble” might be the operative phrase. You may be doing too much for your particular knee at this point in your recovery. I suggest taking a break from PT and give your knee time to sort itself out. Just go about your day doing your regular activities for a few weeks and see how it feels.
 
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Meme273

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Thank you!! I am going to try that. It helps to know that it will get better!!!! I just needed some words if encouragement!! :thankyou:
 

WhenImOld

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And what is even more frustrating is that after first surgery, I was walking without cane and had no pain! The problem was the 2 parts of incision that would not heal which lead to the I & D. Sorry just had to get that out! I think my husband is sick of hearing me complain!! :sad:
I think we need a Super Spouse award. I know mine would get one! He's been my superman. :loveshwr:
 

Dizzy

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@Meme273. Sending positive, healing thoughts your way....and mine!!!!:angel::thumb:
 
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Meme273

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Thank you for all the positive feedback!! Needed this!! Thank you all! :flwrysmile:
 

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