friend needs help recovering from knee replacement

Posted by kneedhelp @kneedhelp, Aug 6, 2023

Hello -

A close friend (in her early 60s) is having a miserable time recovering from single knee replacement surgery that happened back in early June. She knew to expect pain during rehab, but she’s having severe pain and has been unable to make progress. The major issues:

#1:
She does not tolerate narcotic pain meds well. Nausea is one issue, but she’s able to manage that with Zofran. The bigger problem has been that after a few days of oxycodone or morphine, she felt like her brain was out of control. She was having panic attacks and was not able to properly direct her thinking toward being well. She also tried tramadol and said that it gave her the worst hangover of her life, even when pre-treating with Zofran. I haven’t had any joints replaced yet, but from what I understand, narcotic pain relief is virtually indispensable if one expects to make progress toward restoring anything near full range of motion. So without pain management, it shouldn’t be any surprise that she really hasn’t been able to make much progress at all.

#2:
She is experiencing involuntary muscle guarding (presumably because of the pain) that is making it virtually impossible to flex her knee.

#3:
A couple of weeks ago she underwent mobilization under anesthesia (MUA) to break up the scar tissue adhesions in her knee, which (as I understand it) resets the rehab clock to zero. But with problems #1 and #2, she still hasn’t been able to make progress.

#4:
Her mental/emotional state is deteriorating. She’s usually rock-solid and busy with life, but after many weeks of severe pain, immobility, and lack of sleep, she is bordering on suicidal. I mean no active suicidal ideation just yet, but she told me yesterday that she is “tired of existing” and said that if you told her she was going to die soon, she wouldn’t care and might even feel a sense of relief. The replaced knee is on her right, and so she can’t even drive herself anywhere. She’s got a great support network – her husband is wonderful, and her kids live nearby and are doing their part; together with her network of friends, they are all chipping in to help with daily logistics, e.g. meals, laundry, driving her to appointments, and so on. That’s all great, but the core issue is her severe chronic pain, inability to make progress with her rehab, and now severe anxiety and pessimism about whether she’ll ever really be able to walk again. For a long time (unrelated to her knee replacement), she’s been taking mirtazapine to help with insomnia. Last week her primary care doctor added Prozac on top of this. She said it helped a bit, but not as much as she needs; when I talked to her yesterday, she was a wreck, a lot of really heavy-duty crying. This is really not her style at all, and I’m worried.

It seems to me she hasn’t had good care following the initial surgery. She was never told that there was a limited amount of time (8-12 weeks, depending on who you talk to) in which she would have the opportunity to achieve maximum range of motion. She was never told that when using her hands and arms to bear most of her weight when getting up from a seated position, she should try to keep her wrists straight instead of putting her palms flat on the armwrests/seat; after doing this the wrong way for many weeks, she is now suffering chronic wrist pain.

I’m guessing she’s not the first person to struggle with an intolerance for narcotics, or the first person to deal with muscular guarding, or even the psychological complications that come with struggling through a lengthy and painful rehab. Does anyone here have any advice on what she can do to help tackle these problems? Any advice on what she can tell her doctor, PT, or surgeon, or what she can ask them?

Thanks for any help you can provide.

Interested in more discussions like this? Go to the Joint Replacements Support Group.

cindymattern | @cindymattern | Aug 7, 2023

I am 62 and over 10 weeks out on my TKR.....at 9 days I had to stop Oxycodone due to severe constipation and after 9 days had to do a bowel prep and I stopped all pain meds. I only used Tylenol and the occasional Tylenol 3 which she may try. I can tolerate Tylenol 3 but am careful to only take it if it's really bad as just one can constipate me for a few days but not nearly like all the other pain meds. Her PT is her best friend especially if it is a good one. It's going to hurt for at least a few months but you have to be faithful to exercise which sometimes I am not. My range of motion is 115 and it was done without pain meds mostly. I still have pain, stiffness and soreness because I will go too much as I'm really active, mow grass, walk lots etc...At night I take 900 mg Gabapentin and plan on weaning it back to 600mg soon. It does help with nerve pain and sleep. I am back in PT as now I have lower back pain and my feet hurt as well. It's definitely a process and I know she can get where she needs. Best of Luck

roxxxy2626 | @roxxxy2626 | Aug 7, 2023

Hello,
I just want to start out by asking a few questions. Does your friend massage her knee?
I am 54 years old and I just went through two knee replacements, one April 12th 2023 and the second one on May 31st 2023. I can totally understand her pain.
I found out what helps me a lot is massaging my knees with a pain cream that I got from Amazon called Village Naturals Therapy, Lotion, Aches and Pains Muscle Relief. She can use as much as this pain cream as she wants to but it's good for her to massage in the front and behind the knee, I do my calves also. Another thing she can purchase and it helps with the circulation and promote healing is and I also got this from Amazon ...
..FIT KING Calf Massager for Circulation and Muscle Recovery, Air Compression Device for Calves, Relives Muscle Soreness and Swelling Pain, Helpful for Edema and RLS. If you can get her to try these two things it might start the process of her being able to heal, also she needs to talk to her doctor about maybe gabapentin for any nerve pain, she could take at night to help her relax and help her sleep. And make sure that she is icing. That's very important for recovery. As far as the depression goes, it happens after surgery because we want to be mobile and our body is not letting us. It takes time to heal. I hope some of this can help your friend. I was on pain meds for 7 years and had to wean off in between my knee surgeries because my pain doctor left the clinic and no one took over for her. So I've been recovering from My second surgery with basically nothing but gabapentin and diclofenac. Diclofenac is for inflammation? I don't know if she can take that. She might want to ask her doctor about that too. Anyways, I hope this helps. Good luck!

judithh580 | @judithh580 | Aug 7, 2023

I am so sorry to hear what your friend is going through after her knee surgery. I had my right knee Robotic TKR on June 6th. I am 79 and have rheumatoid arthritis so my doctor was overly cautious because of the autoimmunity and my age. I had to take a ton of vitamins 6 weeks prior to surgery along with 6 weeks of PT to build myself up both internally and externally. I continue to take most of the vitamins. I had to go off my Enbrel for my RA 3 weeks during the surgery time and I was worried the pain of RA would return. Post surgery I was prescribed prednisone for the RA, Oxy for pain, Meloxicam for swelling and a medication for my stomach. Oxy also irritated my stomach so I changed to hydro codeine for the first week after surgery. Without the pain med I would have not been able to tolerate the physical therapy that first week. After the first week I just took Tylenol arthritis and it worked very well. I had a ROM at 135% after three weeks of PT. I only did 4 weeks of PT and was able to drive after 3 weeks. I did have insomnia for about 2 weeks and 5 mg of melatonin seemed to help. I have to say that I really pushed myself before and after surgery in PT. I was amazed that they had me walking up and down stairs the day of my surgery. I also have a recumbent bike in my home that I use 20 minute sessions twice a day along with all the other at home exercises prescribed by the PT.

Some people it takes longer to recover so I’m sure if your friend continues to listen to her PT she will improve after each session. I hope she will be able to one day say that she is glad she had her knee replaced.

Justin McClanahan, Moderator | @JustinMcClanahan | Aug 7, 2023

Hi, @kneedhelp, welcome to Mayo Clinic Connect. I moved your conversation to the Joint Replacements - https://connect.mayoclinic.org/group/joint-replacements/ - group. I can imagine not tolerating pain medications would make the healing process, along with the rehab, much more difficult to manage.

@roxxxy2626 and @cindymattern both brought up some good suggestions and questions. I'd also like to invite @noethewja, @dmk and @jw14450 to this conversation as well. They each have talked about their TKR's and the ups and downs of recovery, rehab and how to overcome setbacks.

You may also find the following discussions helpful as well:

– Scar Tissue Around Knee After TKR https://connect.mayoclinic.org/discussion/scar-tissue-around-knee-after-tkr/
– 8 Months after TKR Serious Grinding: https://connect.mayoclinic.org/discussion/8-months-after-tkr-serious-grinding/

@kneedhelp, Is your friend going to PT regularly?