Total Knee Replacement: Swelling

Posted by mamndink @mamndink, Aug 11, 2019

7 weeks post tkr right knee. 0/120. Intermittent pain at top and bottom front knee when walking. Seems like the swelling never goes away. Icing 4x daily and resting in elevation. Out patient PT 2x week, gym for cycling and few stretching exercises 5x week. Shouldn’t the swelling go down?

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@jewlz1

I still have swelling from a LTKR done in December 2019. No pain, just swelling. It has gone down a little bit and I've learned to live with it. My thoughts on the Prednisone… I thought that drug was used to calm down inflammation plus it's a steroid. Is there inflammation somewhere causing the swelling? Did the doc take x-rays to determine the cause of the swelling? I would opt out of the Prednisone. If the swelling isn't causing any pain that's good! Recovery from TKR can take up to a full year, more for some folks. Hang in there.

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Thanks for your reply. Doc did not take x-rays. He says Prednisone may help. I don't have any inflammation other than the swelling. He really just said I had to live with it. I have no pain and good range of motion.

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I've learned to live with my swelling.

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I’m 10 days out from replacement and have a lot of swelling. How can you improve ROM if swelling prevents moving? I elevate, ice and compress multiple hours a day using the NICE iceless machine?

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@ginzy53

I’m 10 days out from replacement and have a lot of swelling. How can you improve ROM if swelling prevents moving? I elevate, ice and compress multiple hours a day using the NICE iceless machine?

Jump to this post

Good afternoon @ginzy53. Welcome to Connect. I am just one of a group of mentors who share their experiences with members. We are all patients or former patients and caregivers or providers. We believe that knowledge is power and will try our best to understand your concerns and respond appropriately so that you can make informed choices.

First of all….I think that for 10 days. you are right where you should be in terms of the road to recovery from a TKR. Swelling is a build-up of fluids that your body creates to help you heal. And I believe there is some inflammation going on.

Do you use a wedge to elevate your knee? I looked at some of the NICE machines and didn't see an "elevator" for that knee.

Have you started Physical Therapy at a special Orthopedic facility? I have been very impressed with the attention given to me and the manner in which they PTs reassure me that I am on the right path to recovery. They facilitate healing and increased use of the knee by changing up the difficulty, e.g. learning to get out of a chair without holding on. You first start with a seat at 16 inches. When you master that, they move the seat down to 12 inches which makes your knee work harder and get stronger. They ask you to learn balance and strength by standing on your surgery leg for 20 seconds at first. Now I do 3 sets of 20 seconds. This really improves the security I feel. Squats both in repose and from a standing position are also very helpful.

In reference to the angle measurements and your knee being too swollen…the PT folks understand. I have a set of 6 exercises that I do at home to keep the leg stretched out so that I can reach the extension goal of "0". Currently, I am at 137 ROM and I owe that success to this set of exercises. It's a lot…..30 repetitions twice a day. They also had me do the same exercises twice a day starting one month before surgery and they began post-surgery exercises 1 day after. Of course, they didn't expect me to do very many at that time. I graduated back up to 30.

And finally, have you heard of or tried MFR, Myofascial Release Therapy. I go for two sessions a week. They work on the swelling and any pain you may be experiencing. The swelling is reduced by moving the fluid up your leg where it can find its way to your bladder and be released when you urinate.

So at 5 weeks or 35 days, I am working on stairs. Last week, I just climbed up the stairs one foot after another. This week, I start going down the stairs one foot after the other. That requires more stability. I do this 3 times a day. And this was the week I started driving after passing my life partner's driving test. I practiced on our frontage road until I felt secure.

One of the things they don't encourage is moving too fast. They yanked me back from walking more than 1/2 mile at this point. And they said no Yoga practice yet because some of the poses may not be knee-friendly.

Please relax and do only what is appropriate for your recovery stage at this time. Be grateful for and excited about your new knee.

May you have happiness and the causes of happiness.
Chris

REPLY
@artscaping

Good afternoon @ginzy53. Welcome to Connect. I am just one of a group of mentors who share their experiences with members. We are all patients or former patients and caregivers or providers. We believe that knowledge is power and will try our best to understand your concerns and respond appropriately so that you can make informed choices.

First of all….I think that for 10 days. you are right where you should be in terms of the road to recovery from a TKR. Swelling is a build-up of fluids that your body creates to help you heal. And I believe there is some inflammation going on.

Do you use a wedge to elevate your knee? I looked at some of the NICE machines and didn't see an "elevator" for that knee.

Have you started Physical Therapy at a special Orthopedic facility? I have been very impressed with the attention given to me and the manner in which they PTs reassure me that I am on the right path to recovery. They facilitate healing and increased use of the knee by changing up the difficulty, e.g. learning to get out of a chair without holding on. You first start with a seat at 16 inches. When you master that, they move the seat down to 12 inches which makes your knee work harder and get stronger. They ask you to learn balance and strength by standing on your surgery leg for 20 seconds at first. Now I do 3 sets of 20 seconds. This really improves the security I feel. Squats both in repose and from a standing position are also very helpful.

In reference to the angle measurements and your knee being too swollen…the PT folks understand. I have a set of 6 exercises that I do at home to keep the leg stretched out so that I can reach the extension goal of "0". Currently, I am at 137 ROM and I owe that success to this set of exercises. It's a lot…..30 repetitions twice a day. They also had me do the same exercises twice a day starting one month before surgery and they began post-surgery exercises 1 day after. Of course, they didn't expect me to do very many at that time. I graduated back up to 30.

And finally, have you heard of or tried MFR, Myofascial Release Therapy. I go for two sessions a week. They work on the swelling and any pain you may be experiencing. The swelling is reduced by moving the fluid up your leg where it can find its way to your bladder and be released when you urinate.

So at 5 weeks or 35 days, I am working on stairs. Last week, I just climbed up the stairs one foot after another. This week, I start going down the stairs one foot after the other. That requires more stability. I do this 3 times a day. And this was the week I started driving after passing my life partner's driving test. I practiced on our frontage road until I felt secure.

One of the things they don't encourage is moving too fast. They yanked me back from walking more than 1/2 mile at this point. And they said no Yoga practice yet because some of the poses may not be knee-friendly.

Please relax and do only what is appropriate for your recovery stage at this time. Be grateful for and excited about your new knee.

May you have happiness and the causes of happiness.
Chris

Jump to this post

Thanks for the encouraging and thoughtful reply. I do elevate using pillows and have started twice a week orthopedic physical therapy. The sessions are very helpful but my range of motion is from 6 to 66 degrees at this point. Without their specialized equipment I find it much more difficult to incrementally increase the ROM especially given my swelling.

I am currently using a walker and am just beginning to take a few steps with a cane. My therapist said I am in the lower percentile for range of motion at this point but we all know everyone is different. He and I both I agree that my progress should be measured week to week against myself not others. We have discussed upping my visits from 2 to 3 per week but it is proving difficult as they are very busy.

I am aware of massage and it’s benefits. Does your PT person do this?

I guess my main issue is I have always been a very competitive and able athlete and it is very frustrating not to be able to steadily improve because the swelling prevents me from doing the exercises. It seems like if I exercise I swell and if I don’t exercise I swell. I’d hate to think how swollen I’d be had I not been using the ice machine hours per day.

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@ginzy53

Thanks for the encouraging and thoughtful reply. I do elevate using pillows and have started twice a week orthopedic physical therapy. The sessions are very helpful but my range of motion is from 6 to 66 degrees at this point. Without their specialized equipment I find it much more difficult to incrementally increase the ROM especially given my swelling.

I am currently using a walker and am just beginning to take a few steps with a cane. My therapist said I am in the lower percentile for range of motion at this point but we all know everyone is different. He and I both I agree that my progress should be measured week to week against myself not others. We have discussed upping my visits from 2 to 3 per week but it is proving difficult as they are very busy.

I am aware of massage and it’s benefits. Does your PT person do this?

I guess my main issue is I have always been a very competitive and able athlete and it is very frustrating not to be able to steadily improve because the swelling prevents me from doing the exercises. It seems like if I exercise I swell and if I don’t exercise I swell. I’d hate to think how swollen I’d be had I not been using the ice machine hours per day.

Jump to this post

Hello, I am sorry to hear that you are having a lot of swelling, but wow, 10 days is really early in the recovery process.

You have a wise therapist. I wish all of them would acknowledge that every body is different, and entitled to individual an individual treatment schedule. Ask the PT to show you strategies for increasing range of motion without their equipment. Most are very willing to show you how to improvise.

The hardest thing for me to believe, when I had my first hip replacement, was how many things were affected by "one little incision" – then I realized that my bones had been cut and hammered, muscles and ligaments moved and bruised, nerves cut and damaged, and blood lost – my body was in distress. For some people there is pain, swelling, numbness, weakness, muscle spasms, or all of these.
Everyone heals at their own rate, and it can be different with every surgery.

Apparently, your body has decided to slow you down by swelling, you just have to respect that and keep doing what you can. Just find that fine line between exercise/rest/ice and overdoing it.

One of the beautiful things about connect is that we are all walking the path back to health, and can encourage one another.

I'm wishing you lessmswelling and more range of motion in the coming week.
Sue

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@sueinmn

Hello, I am sorry to hear that you are having a lot of swelling, but wow, 10 days is really early in the recovery process.

You have a wise therapist. I wish all of them would acknowledge that every body is different, and entitled to individual an individual treatment schedule. Ask the PT to show you strategies for increasing range of motion without their equipment. Most are very willing to show you how to improvise.

The hardest thing for me to believe, when I had my first hip replacement, was how many things were affected by "one little incision" – then I realized that my bones had been cut and hammered, muscles and ligaments moved and bruised, nerves cut and damaged, and blood lost – my body was in distress. For some people there is pain, swelling, numbness, weakness, muscle spasms, or all of these.
Everyone heals at their own rate, and it can be different with every surgery.

Apparently, your body has decided to slow you down by swelling, you just have to respect that and keep doing what you can. Just find that fine line between exercise/rest/ice and overdoing it.

One of the beautiful things about connect is that we are all walking the path back to health, and can encourage one another.

I'm wishing you lessmswelling and more range of motion in the coming week.
Sue

Jump to this post

Much like The first reply to my post yours is very encouraging and thoughtful and I do appreciate it. I guess my ultimate concern is scar tissue. I have read stories suggesting that if you do not get your range of motion back relatively early in the recovery process scar tissue can form and it tends to be very difficult to break down and regain full range of motion. In other words, is there a time frame for getting back range of motion after which it becomes very difficult? Thoughts?

I have always been in tune with my body and it’s abilities and limits. Your comment that my swelling may be my body slowing me down is not unreasonable. I’m not interested in punishing myself for no reason. If however, there is a limited window for each of us to regain motion then I would be inclined to push my limits a bit.

Thanks,
Gordy

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@ginzy53

Much like The first reply to my post yours is very encouraging and thoughtful and I do appreciate it. I guess my ultimate concern is scar tissue. I have read stories suggesting that if you do not get your range of motion back relatively early in the recovery process scar tissue can form and it tends to be very difficult to break down and regain full range of motion. In other words, is there a time frame for getting back range of motion after which it becomes very difficult? Thoughts?

I have always been in tune with my body and it’s abilities and limits. Your comment that my swelling may be my body slowing me down is not unreasonable. I’m not interested in punishing myself for no reason. If however, there is a limited window for each of us to regain motion then I would be inclined to push my limits a bit.

Thanks,
Gordy

Jump to this post

Gordy – The formation of scar tissue can be a problem, and like everything else in surgery, it is very individual. As is when it is time to push limits and when to listen to your body. Perhaps it is time for a talk with your surgeon about your concerns?

You mentioned lack of specialized equipment at home – your PT can work with you on using common items in your home to substitute. After one knee repair surgery, I was taught to use a webbing strap around my ankle to gently pull my knee into a deeper bend. All I remember of the exercise after 25 years it how much it hurt – but it worked. (Just one of many tricks learned over the years.)

Also Chris (@artscaping) has talked a lot here about MFR (myofascial release) therapy, which keeps the fascia loose. I believe that process, with massage will help as far as preventing scar tissue formation. Also, lymphatic drainage massage, which can be done by you at home, can help move the fluid to reduce swelling. A good PT or massage therapist can show you how to use it in your specific case.

Those are my thoughts for the day – anything give you ideas?
Hang in there – this is a road race, not a sprint.
Sue

REPLY
@artscaping

Good afternoon @ginzy53. Welcome to Connect. I am just one of a group of mentors who share their experiences with members. We are all patients or former patients and caregivers or providers. We believe that knowledge is power and will try our best to understand your concerns and respond appropriately so that you can make informed choices.

First of all….I think that for 10 days. you are right where you should be in terms of the road to recovery from a TKR. Swelling is a build-up of fluids that your body creates to help you heal. And I believe there is some inflammation going on.

Do you use a wedge to elevate your knee? I looked at some of the NICE machines and didn't see an "elevator" for that knee.

Have you started Physical Therapy at a special Orthopedic facility? I have been very impressed with the attention given to me and the manner in which they PTs reassure me that I am on the right path to recovery. They facilitate healing and increased use of the knee by changing up the difficulty, e.g. learning to get out of a chair without holding on. You first start with a seat at 16 inches. When you master that, they move the seat down to 12 inches which makes your knee work harder and get stronger. They ask you to learn balance and strength by standing on your surgery leg for 20 seconds at first. Now I do 3 sets of 20 seconds. This really improves the security I feel. Squats both in repose and from a standing position are also very helpful.

In reference to the angle measurements and your knee being too swollen…the PT folks understand. I have a set of 6 exercises that I do at home to keep the leg stretched out so that I can reach the extension goal of "0". Currently, I am at 137 ROM and I owe that success to this set of exercises. It's a lot…..30 repetitions twice a day. They also had me do the same exercises twice a day starting one month before surgery and they began post-surgery exercises 1 day after. Of course, they didn't expect me to do very many at that time. I graduated back up to 30.

And finally, have you heard of or tried MFR, Myofascial Release Therapy. I go for two sessions a week. They work on the swelling and any pain you may be experiencing. The swelling is reduced by moving the fluid up your leg where it can find its way to your bladder and be released when you urinate.

So at 5 weeks or 35 days, I am working on stairs. Last week, I just climbed up the stairs one foot after another. This week, I start going down the stairs one foot after the other. That requires more stability. I do this 3 times a day. And this was the week I started driving after passing my life partner's driving test. I practiced on our frontage road until I felt secure.

One of the things they don't encourage is moving too fast. They yanked me back from walking more than 1/2 mile at this point. And they said no Yoga practice yet because some of the poses may not be knee-friendly.

Please relax and do only what is appropriate for your recovery stage at this time. Be grateful for and excited about your new knee.

May you have happiness and the causes of happiness.
Chris

Jump to this post

Your words were/are amazing. Im 8 weeks out on my TKR. I only wish I had found this Mayo Clinic Connect before my surgery.
I feel Im in a good place with where I am. However I have worried about my incision sense i started squats 6 ot 7 weeks ago. I can only hope this too will pass. Again thank you for the great reply to the comment made by another fellow patient.

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@sueinmn

Gordy – The formation of scar tissue can be a problem, and like everything else in surgery, it is very individual. As is when it is time to push limits and when to listen to your body. Perhaps it is time for a talk with your surgeon about your concerns?

You mentioned lack of specialized equipment at home – your PT can work with you on using common items in your home to substitute. After one knee repair surgery, I was taught to use a webbing strap around my ankle to gently pull my knee into a deeper bend. All I remember of the exercise after 25 years it how much it hurt – but it worked. (Just one of many tricks learned over the years.)

Also Chris (@artscaping) has talked a lot here about MFR (myofascial release) therapy, which keeps the fascia loose. I believe that process, with massage will help as far as preventing scar tissue formation. Also, lymphatic drainage massage, which can be done by you at home, can help move the fluid to reduce swelling. A good PT or massage therapist can show you how to use it in your specific case.

Those are my thoughts for the day – anything give you ideas?
Hang in there – this is a road race, not a sprint.
Sue

Jump to this post

My PT person has given me a number of home substitutes for their equipment including the idea you suggested as well as using a cookie sheet underfoot to do leg slides while on carpeting. Clever!

I have my 2 week post op appointment with the surgeon this Tuesday. Apparently all staples and sutures will be removed and X-rays taken. I look forward to the visit, his assessment of my healing and the chance to get some questions answered. At the top of my list of concerns: controlling swelling, range of motion, scar tissue formation and the most effective plan to manage those 3 simultaneously.

Being this is my first TKR my observations for success up to this point are:
1. Eat healthy meals and get as much sleep as possible.
2. Do the rehab! It hurts but is the only way to improve.
3. Take all your meds as prescribed. Drink plenty of water.
4. Get into a daily routine including, meals, meds, rest, rehab, ice, repeat.
5. Maintain a social life whether online or in person. Have friends over, go for car rides (as a passenger) etc. it’s a great diversion and very physically and mentally stimulating. You’ll be surprised!

Lastly, this is a marathon not a sprint. Listen closely to your body. Go slow but DO push yourself. Remember, the mind and body are amazing instruments and are often capable of far more than we understand.

Gordy

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I’m 12 weeks post op., lateral, femural portion remains swollen as does my ankle.

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@ginzy53

Much like The first reply to my post yours is very encouraging and thoughtful and I do appreciate it. I guess my ultimate concern is scar tissue. I have read stories suggesting that if you do not get your range of motion back relatively early in the recovery process scar tissue can form and it tends to be very difficult to break down and regain full range of motion. In other words, is there a time frame for getting back range of motion after which it becomes very difficult? Thoughts?

I have always been in tune with my body and it’s abilities and limits. Your comment that my swelling may be my body slowing me down is not unreasonable. I’m not interested in punishing myself for no reason. If however, there is a limited window for each of us to regain motion then I would be inclined to push my limits a bit.

Thanks,
Gordy

Jump to this post

Gordy I will share my experience with swelling. Be patient.
While essentially pain free and mobile at 4 weeks I still had A lot of swelling despite regular icing and elevating. My flexibility was only 65 deg despite regular PT.
At that point my surgeon prescribed a course of prednisone and it made all the difference – dramatically reduced the swelling.
Over the next 4 weeks I gained an additional 50 – 55 deg of ROM. I think stretching with heat followed by MFR was the most helpful.
Now 5 months out and enjoying my new knee while gradually increasing endurance.

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