TKR Feeling week 3 struggle.

[corvettejanie]

I am 3 1/2 weeks post right TKR. My Left TKR was done Dec 27, 2023. I had great success with the left knee recovery, I achieved 120 at about 6 weeks post op, and continued my going to pt and 2 x daily exercises at home until my rt knee surgery, March 26th 2024. At 2 weeks post op, rt knee I was at 95 flex. My straightening is at 0, So thrilled. But being a very independent active person, I have a tendency to overdo, and have been struggling with reduced flex this (3rd) week. Today @ pt I was at 85. I don’t have much swelling but my knee just feels a lot of pressure inside. My pain is double or more at night so I’m up 2-3 hours at night, where I continue to ice at least twice. I was taken off oxy this week, and am on Tramadol 50 HCL every 8 hours. It’s managing the pain during the day, but just not at night. My pt wasn’t concerned, they feel I just need to back off on my activities and concentrate on icing and exercises. I have been faithful to 2 x a day pt exercises, and I have the attitude of “ no pain, no gain”. I ice probably every 2 hours for 20 min + each time. I’m discouraged, and worried. My son is having their first baby in 4 weeks and I just wanted to progress with this knee as well as I did the left one. Any suggestions you have would be appreciated, Is this normal for someone to take a step back at this point, and should I be concerned. Or am I just being a nervous Nellie?

 

[mendogal]

Welcome to BoneSmart!

You're not a nervous Nellie but you're also doing just fine!

My entire ortho team warned me: don't expect your second knee experience to be like your first. They were right, and every member who's had both knees replaced will agree.

You write "I don’t have much swelling but my knee just feels a lot of pressure inside" ... that is indeed swelling. There's really not a lot of open space in the knee joint, so it doesn't take much inflammation, aka swelling, to both cause pain and "tightness" AND to restrict our range of motion.

Basically anything that creates more swelling will reduce your flexion numbers. So YES, there is a direct relationship between overdoing things and having a temporary "setback."

What to do? First, cut back on exercises and other direct challenges. At under four weeks, all you need is regular short walks, gentle stretching, and slowly resuming some activities of daily living. It's still to early to work on strengthening; your muscles haven't healed enough.

Second, increase time spent both elevating "toes over nose" and icing. We recommend icing at least 45 minutes at a time (as long as there's a layer of cloth between the ice pack and your skin, it's fine). I iced near continuously the first several weeks - anytime I was in the recliner it was on.

Third, please abandon "no pain no gain." It takes 6-8 weeks for a basic athletic sprain or strain to heal, and working it through pain causes chronic injuries. Well, a knee replacement is more like a car wreck than a sprain. You invested a lot of time and energy on these new knees. Please respect them when they say something causes pain. Give them and yourself the TLC needed to heal.

 

[Jockette]

My pt wasn’t concerned, they feel I just need to back off on my activities and concentrate on icing and exercises.

Hi and Welcome!

You have a rare and wonderful PT to realize you need to back off a bit on the exercises. Please do so. You’ve had 2 major surgeries within 3 months, so a lot of your energy is focused on healing.

Increased pain at night often indicates you are doing more than your knee is healed enough to do during the day. Also, doing more than you are healed to do can increase your swelling, which will reduce the ROM number. And remember, the ROM number is only one of many ways, to measure this recovery.

This recovery does take an average of a year, so even with your first knee, you’re still somewhat in the early stages of healing.

 

[Roy Gardiner]

To echo what has been said:

and I have the attitude of “ no pain, no gain”

Imagine exercising hard in recovery for a broken leg or a sprained muscle; counter-productive, obviously, and would worsen the damage. It's much the same with TKR, you have damage needing healing, not unfitness needing training.

All you need is to help retain mobility (not fitness or strength) until healing is complete. This is done with gentle stretching exercises, without pain.

Read full details here

 

[corvettejanie]

I can’t thank you all enough! So what you’re saying, it’s swollen inside where it’s not visible. Also that i will get it back once I get the interior swelling down. elevating is an issue, in that I can’t get comfortable…either the hot of my knee is too high or the pillows are.. so do you recomend a specific “ pillow” to use to achieve the elevation but not bend the knee. There are several on Facebok, but one in particular that is rounded which looks like it would be good

 

[corvettejanie]

So if you have one you recommend I’d be happy to get it. I am so thankful for your advice

 

[Jockette]

Elevation: Doing It the Right Way

Updated September 11, 2022 by Jamie Proper elevation is one of the best ways to help with pain and swelling following either hip or knee surgery. Many people elevate improperly, which can dramatically lower the effectiveness. In the weeks following your surgery, make sure you elevate your...

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I will leave you our Recovery Guidelines. Each article is short but very informative. Following these guidelines will help you have a less painful recovery.

Just keep in mind all people are different, as are the approaches to this recovery and rehab. The key is, “Find what works for you.“ Your doctors, PTs and BoneSmart are available to help, but you are the final judge as to the recovery approach you choose.

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​

elevate​

ice​

take your pain meds by prescription schedule (not when pain starts!)​

don't overwork.​

​

If you want to use something to help heal the incision, ​

BoneSmart recommends hypochlorous solution. Members in the US can purchase ACTIVE Antimicrobial Hydrogel through BoneSmart at a discount. Similar products should be available in the UK and other countries.​

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

​

the BoneSmart view on exercise​

BoneSmart philosophy for sensible post op therapy​

5. At week 4 and after you should follow this

Activity Progression for TKRs​

6. Access to these pages on the website

​

Oral And Intravenous Pain Medications​

Wound Closure​

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.

 

[Layla]

Happy One Month Anniversary, corvettejanie!
I hope you have a wonderful weekend and stay in touch. We'd love to follow your progress.
All the best!
@corvettejanie