Average level of pain after TKR?

Posted by ellerbracke @ellerbracke, Mar 17, 2019

I had right knee TKR 6 months ago. Perfect ROM and extension (after hard work), functioning very well. However, I am fluctuating between what I would call “awareness” of the artificial joint - just a little sore - to aching, to moderate pain. Depends a little on activity level, weather, who knows, but it is always present, and I resent it. Some (many?) people are pain free at this stage. Should I be concerned, or will the magical 1-year mark fix this?

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@ssbionicknee I'm interested in your needing to have your L knee done. I'm in the same boat but I don't feel my R (surgical) knee is anywhere close to being ready to be the "good" knee! And our house has so many stairs! When do you think you will have your L knee done and why then? Thanks!

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@dkapustin

My advice to anyone getting a TKR is to get on pain management and make arrangements for pain meds for as long as you need them. I am 7 weeks PO and am still on Hydrocodone and I couldn't be doing my PT without it. Please bear in mind that I am not breezing through this surgery like some people. I'm struggling to a 110 ROM. It's awful and I NEED the pain meds. I"m smart enough to wean myself off when the time is right and so you are and most other people who get TKR.

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Thank you for saying this. I am 5.5 weeks out of my TKR and couldn't function without the Oxycodone. They are essential to PT and actually just getting around the house. I am doing well- 120 flexion and make steady progress. I too NEED the pain meds and have no interest in staying on them afterwards. They make me itch!!!

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@amytro

Thank you for saying this. I am 5.5 weeks out of my TKR and couldn't function without the Oxycodone. They are essential to PT and actually just getting around the house. I am doing well- 120 flexion and make steady progress. I too NEED the pain meds and have no interest in staying on them afterwards. They make me itch!!!

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@amytro Exactly. I don't know why it irritates me so much when people brag about taking Tylenol 2 weeks PO (I'm probably just jealous) but I want to scream from a rooftop "Well, good for you but I'll be damned if I even try to get off of my pain medication now" because I would give ANYTHING if my pain could be handled with an OTC medication. Trust me, I spend a small fortune on laxatives. I would gladly give that fresh new hell up any day if only I could. 🙂

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@dkapustin

My advice to anyone getting a TKR is to get on pain management and make arrangements for pain meds for as long as you need them. I am 7 weeks PO and am still on Hydrocodone and I couldn't be doing my PT without it. Please bear in mind that I am not breezing through this surgery like some people. I'm struggling to a 110 ROM. It's awful and I NEED the pain meds. I"m smart enough to wean myself off when the time is right and so you are and most other people who get TKR.

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Agree, 100%. My ortho expected me to be off all pain meds by week 5 and told me he’s never had someone need so much (which is bullsh**). I was still having 8-10 level of pain at times and forget going to therapy without. Fortunately I am well established with my PCP who agreed to manage my needs going forward. I am 21 weeks post TKR on the left and still need to medicate occasionally. My last refill of oxycodone 5 mg was written on Nov 16 for 1 every 8 as needed. I still have some left as most days I rely on ibuprofen (still have to take this routinely at least 600mg twice a day). But when I do more I need more. I have had multiple ortho procedures (3 foot and both shoulders) and have no problem getting off the pain meds eventually. My PCP knows this. Personally? I don’t care for them as they (pain pills) have their downside. I have to take a Vistaril with them to avoid nausea and the Vistaril makes me tired. But, having said that, the pain is worse. I have to have the right knee done but before that I need to have bilateral CMC arthroplasty (thumb joint) and therefore expect I will be on/off the Oxy for the next year.

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I had TKR in June 2022, so I am now a little over six months out from the surgery. I agree, it's so frustrating to hear others say they didn't have much pain after surgery. But I have learned that everyone recovers differently. So don't compare yourself to others who've had TKR. I had pain for many weeks after surgery! In fact, I took the pain meds as long as my surgeon would renew the prescription! With the last renewal, I cut the pills in halves and quarters to wean myself off, and supplemented with OTC meds as needed for pain. The last time I took prescription pain meds was at the end of September, so that was at least 12 weeks out from surgery. I'm still taking Tylenol and ibuprofen as needed. You say you still have pain in your knee, do you mean you have pain in the muscles and tendons around the knee? Because the joint itself cannot feel pain since it's artificial, right? I think it's not out of the ordinary for you to still have some pain. At six months out, most of the pain is gone but my knee still has stiffness, and one area around the incision is a little sore to the touch. So it's not perfect. PT was my ticket to recovery. It really strengthened my knee and helped me progress more quickly. Do it faithfully and finish the regimen. Above all, be patient. That was the hardest part for me, but it paid off. You can do this!

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I agree we all recover at our own pace …..I also had revision surgery in June , the surgery went amazing but I still had pain for while …. I took tramadol at least2 months after ….. now I still do Tylenol for stiffiness…. Even during recent setback I did just use Tylenol….I still do pool and mfr twice a week … I exercise at home also…. It does get better, like everyone telling you continue exercising and moving… best of luck to you to find some pain free moments, they help you get thru until you have hours of pain free

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@cisconurse

Agree, 100%. My ortho expected me to be off all pain meds by week 5 and told me he’s never had someone need so much (which is bullsh**). I was still having 8-10 level of pain at times and forget going to therapy without. Fortunately I am well established with my PCP who agreed to manage my needs going forward. I am 21 weeks post TKR on the left and still need to medicate occasionally. My last refill of oxycodone 5 mg was written on Nov 16 for 1 every 8 as needed. I still have some left as most days I rely on ibuprofen (still have to take this routinely at least 600mg twice a day). But when I do more I need more. I have had multiple ortho procedures (3 foot and both shoulders) and have no problem getting off the pain meds eventually. My PCP knows this. Personally? I don’t care for them as they (pain pills) have their downside. I have to take a Vistaril with them to avoid nausea and the Vistaril makes me tired. But, having said that, the pain is worse. I have to have the right knee done but before that I need to have bilateral CMC arthroplasty (thumb joint) and therefore expect I will be on/off the Oxy for the next year.

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I did not really get any pain relief from Hydromorphone.
It was Lyrica (Pregababalin) that was the game changer for me. It is more directed to nerve pain which is what I was experiencing. Don’t know what I would have done without it

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I had a tkr done a year and a half ago. Things were going good and then I fell on it at work landing directly on a concrete floor. That was 7- 8 mo after the surgery. Workmans comp hasn’t wanted to address it. I have had a tight band feel around it ever since. I don’t know what to think. I did secure an attorney for all of this since I did actually land on both knees. Should I still be feeling like this after this long??

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I am 4 1/2 months from having a total knee replacement, and still have the symptoms you are explaining. I really thought that I would be further along at that this point, but I suppose I was a little naive. I go to PT, do muscle strengthening exercises attend aquafit classes, ride my walking bike outside and my stationary bike inside but walking long distances can give me grief. And that I resent because the main reason for having the surgery was so I could walk without limping after half an hour.
I still have inflammation around the knee and a Bakers Cyst behind the knee so I know the swelling is making it difficult to weight bear. I started to wear an elasticized knee brace which helps and yesterday I got fitted for a compression stocking
But what I wanted to mention is that when I had extreme pain in the first 2 months the opioid I was prescribed did not bring me any relief. The only thing that helped was Lyrica, which focusses more on nerve pain. I can tell you it was a game changer for me and I don’t know why more orthopaedic surgeons do not prescribe it regularly. At the height of my pain I took 150 mg twice a day and then weaned myself down to 50 mg twice a day. Occasionally I might take one but I highly suggest that the people who are having extreme pain to ask their doctor for this medication rather than an opioid. The doctor might be more willing to prescribe this as well as opposed to an opioid.
Another consideration is to take Calcium and Vit D supplements for bone strengthening. Here is an article that supports the use of the supplements
https://www.lancasterortho.com/news/calcium-vitamin-d-your-new-knee.html

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Can’t take Tylenol and have tried Lyrica in the past with poor effectiveness. My pain is muscle/nerve and like others have mentioned it’s the length of standing time and endurance that are still not up to par (and sleeping! God how I wish I wasn’t a side sleeper!) I still work with my PT, but going to the pool has been the ticket for me. I mostly just walk and do ROM but it has been amazing (physically and mentally). When I need to take RX pain meds it’s not the operative pain so much but rather the pain in the other knee and my hands. I already take ibuprofen routinely and as you know, you can only take so much. I have the will most days to go farther, but limitations with my right knee prevent that. I’m scheduled to have a left hand CMC arthroplasty on March 2 and then will decide, depending on recovery, what next steps are. Right knee or right hand? 2023 is going to be as challenging as 2022 but I try to keep my eye on the prize! Fortunately (? Or not) arthritis is my only health issue.
I stayed away from the internet for the most part, but I will say that although my surgeon is well known and the best around here, I feel their attention to post op education ( weeks and months, not immediate) is lacking, I’m a nurse and know that there are so many variables associated with individual recovery and rehab that you cannot expect a one-size fits all response. Still, I never worked ortho and don’t personally know anyone who has had a TKR and found the posts on this board to be most helpful and reassuring.
Thank you.

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