MUA RTKR

[Birdie23]

I had TKR surgery on Oct 31,2023 (Halloween) haha!! Now, 12/28, still struggling w/pain & stiffness. I had some in-home PT & will be going to out-patient PT on Jan 8th. My surgeon prescribed Tylenol 2-3x/day max 3000mg (I can't take other pain meds); Celebrex 200mg- 1x/day; Voltaren Gel 3x/day, Salonpas strips @ night - 8 hrs; Ice during the day, and gentle home exercises, which I can barely do once a day. I can't find any comfortable sitting or sleeping positions. I do elevate my leg, as properly described to me on hospital & rehab discharge. I feel so frustrated. How will I be able to do any PT if I'm in so much pain? I can barely bend or straighten my knee. I use a walker in my apartment because I have arthritis in one hand, so it's easier than a cane.
I want to cry all the time. My day is full of medication scheduling. I live alone. I have to do everything myself. It's such an effort to do anything.
When will the pain, stiffness & swelling end?

 

[mendogal]

Welcome to BoneSmart!
The things you describe are not unusual at two months post op.

It sounds like you've been pushing that new knee way too hard.
I hope that in addition to elevating you're icing almost continuously - it's safe if there's a soft cloth between ice pack and knee. Most of us ice and elevate like crazy.
Paradoxically, too much PT too soon can create an awful lot of swelling, which creates pain and inability to flex or straighten.
My ortho team was firm in telling me that initially "less is better" - walk a little every hour and just some very gentle stretching and range of motion - no manipulation or repetitive exercises until that knee has had a good few weeks to establish healing.
It's not too late to start feeling better!

Here are some handy links....

KNEE RECOVERY 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.

If you want to use something to assist with healing and scar management, 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.

2. Control discomfort:

rest​

elevate​

ice​

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

don't overwork.​

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​

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 a 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 history before providing advice.

 

[mendogal]

It's really hard being unprepared for a normal recovery process - many of us find our surgeons downplay how difficult it is and that it's a year long process. Plus you're on your own...
I note you're a senior. If you do a search for your county and state name plus "senior information and referral" you'll find (after the ads and sponsored links) resources in your area. It might be via county government or via a contracting area non profit....
but every county in the USA has a federally mandated free info and referral line for seniors. There may be some local resources you can access for in-home support.

 

[Jockette]

I feel so frustrated. How will I be able to do any PT if I'm in so much pain? I can barely bend or straighten my knee.

I’m really sorry that you are still in so much pain. Since you live alone and have to do everything yourself, that means you are moving around often enough to give your knee the mobility it needs to heal, so, a list of reps of exercises is not crucial. When you go to out patient PT next week, ask them for modalities to help reduce your swelling and pain. Do not let them force your knee to do anything, even if they tell you it’s necessary. Painful PT is not necessary, your ROM will return, all by itself, as you heal.

I want to cry all the time.

We all felt like this as a result of this major surgery. Pay special attention to the following article from the Recovery Guidelines:

Post op blues is a reality - be prepared for it

Post op blues is feeling depressed, weepy, nervy, shaky, fearful of the future, anxious, overwhelmed by what is happening to you, convinced it's never going to get any better and finally, uttering that most intense of all cries "I wish I never had this done!" It arises out of a variety of...

bonesmart.org

Take some time to read the rest of those articles, they are fairly short and have a lot of helpful information in them.

Also, take some time to read other threads from other members and you’ll see you are not alone in what you’re going through. These early months are hard, but recovery is temporary. Hang in there, we are here for you.

 

[Layla]

Hello Birdie and Welcome to BoneSmart. I'm happy you joined us!
I am sorry you're dealing with pain and feel like crying most days. That's sad. Please don't lose sight of the fact that you are recovering from the trauma of a major surgery and it takes time to feel better. Slowly, but surely, you will get there, so hold that brighter future as your focus.

If you're feeling lonely or isolated, do you have family, friends or neighbors nearby you can lean on for some company, or for help when / if you need it? Are you able to get out of the house to run quick, easy errands, or meet someone for lunch or even only coffee? It may do wonders for your sense of independence, causing you to feel better afterward. It isn't good for anyone's mental health to sit in their home doing the same thing day after day, so hopefully you're able to get out and engage in life. Pain seems to be minimized when we're busy or our minds are occupied. I'm sure you've noticed this yourself. Starting PT in a little over a week will likely help your mental outlook as well as your physical strength.

As far as getting comfortable for sleep, what really helped me, was bed pillows. Lots of them. I surrounded myself with them and felt coddled in a sense. It felt soothing to rest an arm, or a leg on one and it really raised the comfort level for me. If it sounds at all appealing, try it and see if it helps.

Also, consider searching online for hand grips for your walker if you feel it will help with your arthritic hand. I know Amazon carries a variety if you care to check.

The pain, stiffness and swelling will ease with time, continue the meds, icing, elevation and don't over do it in PT.
It may help to journal once a week and note any improvements you made over the past week, it's difficult to notice progress some days, but I'll bet you're growing stronger month by month. Once you get over the hump, and you will, I'll bet 2024 will be a good year! Hang in there and stay in touch. We're here for you!
@Birdie23

 

[Birdie23]

Thank you all so much for your thoughtful support. I will keep everything you say in mind. I know that some of the problem is focusing too much in the pain as I have very little distractions. I'm 71. I have friends & neighbors. They're helpful, but I don't see them much. Also, the weather here in NY is not great, so I can't really even go out to take a walk with my walker. I do have Access-a-ride and plan to use them for my PT as well as some errands.
I like the suggestion about not letting the PT push me too far, and surrounding myself with pillows.
I'm very ambulatory, and move all day. I get exhausted because I have to do everything myself. But, I do have grocery delivery and laundry pick-up, and apartment cleaning.
My Orthopedist reminds me that I'm recovering from major surgery, and that it will take time to heal, and that it's normal to feel this pain, swelling & stiffness.
I think Outpatient PT will be good for me to get out of the house, too. There's a Library right across the street, too.

 

[sistersinhim]

I library might be a good place to rest up after PT!

 

[Layla]

Thankfully you have friends and neighbors and I'm guessing some would be happy to come over for a cup of coffee and a visit if you're ever interested in inviting them. You sound like a friendly lady.
I do understand you not wanting to navigate the streets if the weather is undesirable. It's a blessing you have grocery delivery, laundry pick up and apartment cleaning! I do hope you enjoy getting out for PT and find it helpful. Maybe on a nice sunny day you can make your way over to the Library and find a comfy corner to sit and page through a book for a time. Or, just people watch.
I hope you have a peaceful night of restorative rest, Birdie!
@Birdie23

 

[Itsabear]

Hello! I had my RTKR on 11/09 - I had a frozen knee for 23 years and have been in so much pain that this week has been - probably the only week I didn’t cry at night. I can honestly say it’s the most painful surgery I’ve ever been through. I know I’ll have many more days of crying to go through. Everyone heals differently - I have to take pain medicine - and I can’t imagine how you’re getting on without the strong stuff. I do ice my knee constantly - more than any PT person had advised - I’ve gone by what’s been suggested here and I truly believe it’s helped me. I also use the wedge my PT person has given me pretty religiously. I am sorry your alone - try to have someone swing by once a week at least - you have to put yourself out there - which for me is hard too - but this is temporary and sometimes people like to feel needed so - try to ask for some help if you’re needing it. I don’t know how long the pain lasts - I’ve read some people get on pretty quickly - and some don’t - I hope you are one of the lucky ones and all your moving around will help you heal faster! Know you’re not alone in the pain department - and I hope you’re out of pain soon!

 

[Layla]

Happy Two Month Anniversary, Birdie!
Thinking of you and hope you're having a good day today!
Happy New Year!
@Birdie23

 

[Birdie23]

It's now Jan.16, 2024. A new year. No real improvement in my knee since TKR Oct 31, 2023. Since I'm on some medications for another medical condition, my Orthopedist can only prescribe Tylenol, Voltaren, Salonpas. Physical Therapy has been challenging & painful. I'm at an impasse where I haven't been able to get past a certain ROM in bending & straightening my knee after a certain degree. I started PT last week, 3x/week. The therapists have been trying g different modalities to get my knee moving. But, I think I need to discuss w/ my psychiatrist to take me off my bi-polar meds so I can take Aleve to reduce the pain in order for PT to work. I cannot take NSAID's w/my current bi-polar meds.
What should I do?

 

[sistersinhim]

Physical Therapy has been challenging & painful.

Could it be that this is your problem? Painful PT keeps the knee inflamed. That makes it swell, which reduces your ROM. It's worth a try to stop all PT and exercises for a month and just use your knee normally in your daily activities. That should bring your swelling down and improve your ROM. What you are doing now isn't working. Why not try this? You won't lose any ROM and more than likely you'll see an improvement. Many do.

 

[Layla]

But, I think I need to discuss w/ my psychiatrist to take me off my bi-polar meds so I can take Aleve to reduce the pain in order for PT to work. I cannot take NSAID's w/my current bi-polar meds.
What should I do?

I encourage you to speak with a medical professional, your psychiatrist or PCP about adjusting meds so you're able to remain comfortably mobile.

I agree with, sistersinhim, that your PT may be causing you more pain than it's benefitting you currently.
If you're not already, make certain you're icing and elevating which should help with the pain. We advise against medicating right before PT in an effort to get through the session. You don't want to overdo it and medicating before hand makes it easier for that to happen.

Go easy when you return to PT and please don't allow them to manipulate your leg or force you to do anything that hurts. Stay in touch and let us know how you're doing. Best Wishes!

 

[MSuki]

I agree with @sistersinhim and @Layla. Too much PT is a very likely culprit causing you pain and also the easiest thing to rule out. If you could take just a week or so off of formal PT, doing only gentle movements that do not hurt, you will be able to see whether or not this is the case. If not you can look for a different answer, but rule out overdoing it first. I am just a little over a week behind you, and the way I feel after too much PT is miserable. If I don’t overdo things, I feel pretty good.

 

[mendogal]

I recommend talking with both your psychiatrist AND your ortho surgeon, because I suspect you're expecting too much gain from trying NSAIDs.
In my experience they can't really reduce the kind of swelling that happens post op, not to the degree rest, ice, elevation, and GENTLE movement do.

 

[Birdie23]

Thank you all for your insights. I will take your suggestions and discuss with my medical team.
I've canceled my PT session for this Friday due to bad weather, so I won't have any sessions until Monday. But, I'll do exercises at home.

I only take Tylenol & Voltaren about 1-hour prior to exercise. Would Aleve make much difference in pain management anyway?

Why do I still have so much pain when I bend my knee after 4 months post-surgery?
Thanks again for your support. This is truly a great group of knowledgeable and supportive people.

 

[sistersinhim]

Why do I still have so much pain when I bend my knee after 4 months post-surgery?

Even though the outside of your knee is all healed, the inside is only about 1/3 of the way healed. Pain at this early stage is normal. As long as your knee isn't hot and overly swollen, then you shouldn't have anything to worry about. It is a long recovery and takes lots of patience.

 

[mendogal]

Taking acetaminophen (Tylenol) on a schedule rather than "as needed" provides a more level therapeutic level in your bloodstream.

Taking two extra strength acetaminophen every 8 hours = 3000 mg day (assuming you're not taking other meds that happen to contain it, like cold remedies, prescription pain pills, etc) which is within the recommended maximum of 4000 mg/day for adults with healthy livers.

Voltarin is a NSAID and in larger topical doses could be a problem for people who shouldn't be taking NSAIDs. Definitely consult with your psychiatrist and your primary care/internal medicine doc!

 

[Birdie23]

My doctor said to try Aleve (Naprosyn ). I felt it relieved my knee pain a little better than Tylenol. I'm icing my knee as well and using Voltaren. I try to do some of the PT exercises at home, but I'm not that motivated.
One thing I do want to do is to start exercising my upper body. I found some good videos of upper body seated exercises without using weights. I can't get to my gym yet, so home exercises are doable. I think k it will help in my healing process, also in taking some focus away from my knee pain.
Also, I think I need to start focusing on my nutrition as well. Been eating too much comfort foods & carbs (especially in winter months now).
It's so easy to blame my knee pain on slacking off on the rest of my health needs.

 

[mendogal]

Just in case your doctor wasn't clear:
Because acetaminophen and the NSAIDs work totally differently in the body, it is 100% safe to use them at the same time. In fact the two together are often recommended by doctors because many people can get better relief that way than from either med alone.