Miserable from TKR: What can I do to get better?

@tracy70: One more thing I wanted to mention: it would be super helpful if you had access to an indoor pool. At the 5 week mark I joined a small, local, senior fitness center with a pool, and the person in charge mapped out a knee rehab program to be done in the water. Basically targeting the same muscles, and same movements, but it is soooooo much less painful to do this in the pool. Of course, depending on where you live, you may not want to risk an indoor crowd. The pool I used is part of a retirement community, so there are strict protocols, very high standards regarding sanitizing, limits to the # of persons allowed in at any one time, and you have to disclose your vaccination status. Not a problem for me.........

I second this - heartily! Some options to check into (PT may have info for you) besides a senior community - some large rehab facilities (especially inpatient) have warm (88-93F) pools, and you can get a pass to use after a therapy session in them. Some Y's have a therapeutic pool (aka infant water class pool) available at certain hours. At our Y we can get a pass for a nominal fee with a PT referral & one pool session. I just was notified that ours is available again with Covid rules in place.
Sue

@tracy70 Hello, I'd like to validate the excellent advice and suggestions that appear in this discussion thread. It looks like you posted 5 days ago so I estimate you are two weeks post-surgery for TKR? Is that correct?

I haven't had a TNR but I did have rotator cuff surgery on my right shoulder 12 years ago. In that time I'm sure surgical procedures and rehab has changed but I recall what I was told many times. These smaller joints (knees fall into these categories) are more painful and require more healing time and PT/Rehab than larger joints such as hips. We all have our own pain perceptions and I hope you feel heard by your medical providers when you tell them what your pain level is. Has your surgical team checked in with you since your surgery? What do they say about your pain? Here is something I've been told many times in PT. You have to move every day even if it hurts. The more you stay in one place the stiffer the joint will be and that in turn will make the recovery and rehab more difficult for you. Were you given exercises to do after surgery? I had a total hip replacement two years ago and came home with exercises. I didn't like doing them and sometimes they hurt but I did them anyway.

I hope you will check back in with us @tracy70 and let us know how you are doing.

Helen

Thank you! Everyday I tell myself I shouldn’t have had this surgery! Tomorrow will be 3 weeks since surgery. It feels like forever. You can believe I will not be getting my other one done. Not sleeping more then a couple few hours is driving me insane. I’m so tired it’s ridiculous. I am hoping once I begin outpatient PT, that I will start seeing some improvement. I just didn’t realize how painful and hard this surgery was going to be on me, mentally and physically.

@tracy70 - I'm wondering if there is a reason that you are only starting PT more than 3 weeks after surgery? Was this your doctor's recommendation?
From my experience with my two TKR's, my first PT appointments were within three or four days after surgery, 3 times a week for a month. There was a PT evaluation the day of surgery, a few hours after the procedure where they tested my knee movement and gave me some sheets of exercises to do at home, some of which were similar to what the PT therapist had me eventually do. But I think I gained more from having my therapist's initial and constant guidance in pushing past what I might have thought were my limits. Especially with the first knee, I would not have known what to expect or how hard I should be working it. He also kept stressing the icing and elevation for the first month and even later. My PT home exercises took about 45 minutes and I was supposed to do them twice a day. At first it seems like you are not making much progress, so it's nice to have a cheerleader/trainer giving you motivation, and so gratifying when you find you can actually do an inch or two more of a movement. I think most of my recovery occurred in the first three weeks, and the rest was improving and fine tuning the leg strength and knee range of motion. I did keep going two extra weeks, for a total of six weeks of PT, but the last weeks I only went twice a week.

I sympathize with the lack of sleep, so hard when you can't get comfortable. Often I slept with the ice bag over my knee. That helped a lot the first couple of weeks. Eventually I used a pillow between my legs, maybe the wedge is too hard? It sounds though, that your surgery was more painful than mine. All I even felt was a big dull ache, no sharp shooting pains.

I hope you heal and recover your knee strength. I am glad I had both of my knees done, one year apart. We have a lot of stairs in our house, and the knee pain and grinding when coming down was awful. Going up and down stairs on my new knees as they healed was good therapy in itself, once I could manage the angle.

Good to hear from you. Glad you are going to PT. if I look back I can see the tremendous progress I’ve made. That doesn’t negate the pain and sleeplessness I’ve experienced through this. I assure you that you too will see improvement. Resign yourself this is not an easy journey. Right now I am with you in my resolved I will not get the other knee done. I can live with that so called bad knee. This good knee has been far more painful and limiting than I anticipated. I decided to try OTC Voltaren topical cream and CBD liquid. If they are helping, it’s not significant but neither are addictive so I’ll continue till their gone. Stay in touch.

Someone recommended a pool, but a pool is NOT going to help you flex your leg after a total knee replacement. Someone (the physical therapist) has to push your leg straight down, then manually bend your knee in order to get flexion in your knee. Taking some Tylenol before your PT session helps, but you really just have to clench your teeth and push thru it. By about week (4), you should be well on your way to having not such excruciating pain. I'm surprised you've had in home PT for such a long time. The Visiting Nurse Assoc. physical therapist, who worked on flexing my knee, came EVERY DAY (including Saturday & Sunday), but I'm told this is unusual. She discharged me when I could get in and out of a car. There's light at the end of the tunnel! Just be patient. When a PT is not working on your knee, do the exercises yourself, every day and several times a day if you can stand it.

Good evening @tracy70, Thanks for getting back to me. I can explain robotic surgery a bit. The surgery I had was called Mako Robotic. The advantage is that an exact model of your knee is made by a 3D printer from images. The surgeon studies it and decides just how the approach should be handled. Then, the robotic screen shows him/her where to enter the knee and how to move around the surgical area in a minimally invasive manner. If she/he goes outside the line, the robotic instrument stops immediately and waits until everything is on track again. This assures that the plan for your surgery is being followed exactly.

I also get the feeling that you underestimated your level of pain. Remember that this is major surgery. There is quite a bit of sawing and cutting away of bone and other tissue. A hip replacement is essentially a ball and socket. The knee replacement is much more complicated. And with that said, you can see how much effort you must exert to support the recovery. There are muscles and ligaments and other forms of tissue in the area. All of it needs to heal.

I don't know if you have seen the extent of the surgery. Did you have X-rays taken after the surgery? Here is what you might have seen. The white prosthesis area is the replacement that has been fitted in the space cleared out by the surgeon. This is much more involved than even I would have imagined.

The folks who can tell you step by step what exercises and equipment you are using and how it will help with your recovery are your PT folks. In my case, when my knee became painful from the exercises, they also knew that I would be going to an MFR (myofascial release treatment) to manage the pain.

What else can I do to help you cope with what appears to be a very difficult time for you?

May you be free, safe, and protected from inner and outer harm.
Chris

@labbadia1 I don’t want to come across as ornery, but while pool exercises may not do much for the flex or straightening of the knee, it does help with everything else. And no, my PT guy may have GENTLY pushed on my knee, or bent it, but never with any kind of force, causing pain. The heel slides, towel-roll push-downs etc. will get results all by themselves. A stationary bike helps with the knee bend as well. I ended up with about 135 degrees of flex after 12 weeks, and - finally - with zero extension after about. 5 months. I’m sure JK will echo the caution regarding overly enthusiastic therapists who force the issue.
My knee replacement came 11 months after a knee repair surgery, torn meniscus, loose cartilage floating under and around the knee cap, with disappointing results. Not sure if that had anything to do with my slow progress of getting the leg perfectly straight. The last 3 degrees took forever!

I am glad you had a good experience with your TKR. After reading all the comments, it definitely affects everyone differently. I was given stressing exercises a week or so before my surgery. Unfortunately I didn’t know. It was sent to me on a Get Well app to download to keep in contact with the dr. PT worked with me the day of my surgery, before I left the hospital. PT started coming to my house the day after my surgery. It is absolutely hard. Thank you for reaching out to me.