Night Pain: Using a knee wedge after total knee replacement?

Posted by connie1559 @connie1559, Jan 30, 2019

I had a right TKR on 1/21. Even in the hospital I couldn’t sleep at night because of knee pain.

Multiple sources, including a hospital issued post TKR book and my discharge instructions, warn against putting a pillow under the knee.

Does anyone know if a knee wedge would fall into the category of a pillow? Has anyone used a wedge with good results? Has anyone had their doctor or physical therapist tell them to not use a knee wedge?

I will ask my joint care coordinator tomorrow, but as I have been awake for the last 2-1/2 hours, I’ve had plenty of time to think about possible solutions to night pain. BTW, I am taking Rx pain meds, but pain still wakes me up every night. A knee wedge sounds good to me right now.

Thank you for any input.

@connie1559

Thank you for your reply. Tomorrow I am 4 weeks post-op. I’m happy to report that I am doing very well. My flexion is at 113 after being stuck at 95 for about 5 days. Once I got past that it’s been easier to make progress each day. I’m using Ibuprofen and icing and elevating for pain control. Now that I’m off the Rx pain meds I have resumed talking Rx sleep meds. Most nights now sleeping isn’t a problem, but some nights I wake up with discomfort that keeps me awake for awhile.

I love walking with my new knee! After 14 years of progressive knee pain, I’m amazed at pain free walking. Overall, my TKR has been a good experience.

I hope you have great results with your new knee. Be well!

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@connie1559 congratulations on your progress with your knee. It’s great to hear other success stories. I was thinking just yesterday, as I was walking rather fast, how wonderful to be able to do that, pain free.
JK

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@cotonmama

Night pain after total knee replacement

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Hi, @cotonmama Welcome to Connect.
I think night pain after a TKR is fairly common. How long ago was your surgery? I have had two TKRs. The first was long before the opioid crisis and I was using one, I think oxycodone, just one at night for about three months. The second was in 2017 and by then, doctors were much more conscious of not prescribing these drugs for long so I was prescribed something for a much shorter amount of time and that surgeon had me splitting pills to cut down.
Many people find the NSAIDs like ibuprofen to give them the relief they need. I unfortunately cannot take them so had to rely on acetaminophen which helped a little but not as much as ibuprofen would have.

There are many discussions here on TKRs. The first link here is for one about feeling a “tight band feeling”. The second one is about a burning feeling. Do either of these fit your pain, or is your pain different in some way?
JK
https://connect.mayoclinic.org/discussion/has-anyone-had-a-tight-band-feeling-after-total-knee-replacement/?pg=8#comment-356570
https://connect.mayoclinic.org/discussion/burning-after-total-knee-replacement/?pg=5#comment-344018

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Night pain after total knee replacement

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@cotonmama

Night pain after total knee replacement

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Hi @cotonmama, I add my welcome. You'll notice that I moved your message to this existing discussion about night pain and trouble sleeping after a TKR. Click VIEW & REPLY to see the entire discussion and read through past messages. I'm also interested in the same questions that @contentandwell asked "How long ago was your surgery? How would you describe your pain?"

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Neither the surgeon nor hospital personnel told me not to use a pillow under my knee post TKR surgery. My PT mentioned it, but I couldn't begin to sleep without it so basically ignored the advice. I use a small pillow in almost every sleep position and it helps a lot. I do have full extension and flexion at 120 degrees. I am 8 weeks post op today. Sleep has been difficult but getting better, although it is not a straight progression. The pain med situation is hard to understand. Take pain med before exercise or PT, OK to take at night, or so they say. But there were lectures about "weaning" and refills very limited. I discovered that Advil works just as well at this point. Tylenol was what the doctor recommended but it never seemed to do anything.

I feel I am progressing daily but I have to say that I thought at this point I would be farther along, i.e. no pain. The motions that are still difficult for me are:
1. going down stairs—non operative leg first, operative leg behind
2. kick backs with operative leg, trying to kick my foot to butt
3. lying flat with operative ankle on rolled towel, relaxing leg, holding for a minute or longer.

I do these several times a day, along with the other prescribed exercises. I also started keeping a sleep/pain journal.

Good luck everyone! I guess each person's recovery is individual.

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@connie1559 I also got the advice to not use a pillow under my knee when sleeping. However, I'm not sure about this advice – it's not as if I slept with my knee straight even without the pillow, as that was painful enough that I would move it to the side in my sleep and bend it slightly. Now, it is true that I am still working on straightening (at 2 deg for extension) at 5-6 weeks, and maybe others can sleep with their legs straight from the get-go. I could not.

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@jud

Neither the surgeon nor hospital personnel told me not to use a pillow under my knee post TKR surgery. My PT mentioned it, but I couldn't begin to sleep without it so basically ignored the advice. I use a small pillow in almost every sleep position and it helps a lot. I do have full extension and flexion at 120 degrees. I am 8 weeks post op today. Sleep has been difficult but getting better, although it is not a straight progression. The pain med situation is hard to understand. Take pain med before exercise or PT, OK to take at night, or so they say. But there were lectures about "weaning" and refills very limited. I discovered that Advil works just as well at this point. Tylenol was what the doctor recommended but it never seemed to do anything.

I feel I am progressing daily but I have to say that I thought at this point I would be farther along, i.e. no pain. The motions that are still difficult for me are:
1. going down stairs—non operative leg first, operative leg behind
2. kick backs with operative leg, trying to kick my foot to butt
3. lying flat with operative ankle on rolled towel, relaxing leg, holding for a minute or longer.

I do these several times a day, along with the other prescribed exercises. I also started keeping a sleep/pain journal.

Good luck everyone! I guess each person's recovery is individual.

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Hi @jud and welcome to Connect. It sounds as if despite the pain you are doing great. I always use a pillow between my legs when sleeping on my side, but have not had the need to when on my back — I have had two TKRs.
The typical stair method is "down with the bad", so your operated leg should go first. In time you will be easily able to go down the stairs bilaterally. That just comes with time so try to not be concerned about it
Kickbacks are for me history. I will never be able to get my leg very far back and I don't think it's expected after a TKR. I can barely get it far back enough to grab a hold of my ankle, but it's perfectly functional.
I don't recall doing your #3.
You are smart to start a journal. I regret that is not something I did for any of my surgeries. I wish now that I had so I could look back accurately.
JK

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@contentandwell

Hi @jud and welcome to Connect. It sounds as if despite the pain you are doing great. I always use a pillow between my legs when sleeping on my side, but have not had the need to when on my back — I have had two TKRs.
The typical stair method is "down with the bad", so your operated leg should go first. In time you will be easily able to go down the stairs bilaterally. That just comes with time so try to not be concerned about it
Kickbacks are for me history. I will never be able to get my leg very far back and I don't think it's expected after a TKR. I can barely get it far back enough to grab a hold of my ankle, but it's perfectly functional.
I don't recall doing your #3.
You are smart to start a journal. I regret that is not something I did for any of my surgeries. I wish now that I had so I could look back accurately.
JK

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Funny, just last night in the middle of the night it occurred to me that kickbacks aren't really a part of my everyday life and movement so why go through the pain of the exercise? I guess my theory was if an exercise is painful I should do it even more. So your advice on this is timely!

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@jud

Funny, just last night in the middle of the night it occurred to me that kickbacks aren't really a part of my everyday life and movement so why go through the pain of the exercise? I guess my theory was if an exercise is painful I should do it even more. So your advice on this is timely!

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@jud I suppose if you do them, it might help to increase your flex, even though you may never be able to get it far back like people do who have never TKRs. I think moving the seat forward on a recumbent bike so you have to flex more helps in that.
For me, the biggest advantage of increasing my flex would be to able to kneel more easily. When I try to kneel (on a cushion of course) I feel like I am going to topple forward because I can't bend my knee enough. When I spoke to my doctor about possibly getting the lysis which would hopefully increase my flex, I asked him what the advantage would be. He said if I lived in Japan I would need the flex! I am sure that is true, but it also prevents me from getting up and down from the floor easily so I am intimidated at the thought of trying to do yoga. I would not put myself in a great deal of pain to increase my flex, but that is my personal feeling. It all depends on what each individual wants to achieve.
JK

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i have posted about my night pain and want to share something that helped me. Two things really. Yesterday I was having day pain, inside right knee area. Ice, pain meds, elevation, compression…nothing helped. I finally decided to try the hot tub. I exercised my leg while in the tub for about 15 minutes. This was at 4:00 p.m.

My pain disappeared and stayed gone all afternoon and through the night. Wow! A good night's sleep finally.

The second thing that helped me sleep was following a tip from Healthline.com on how to fall asleep. The tip I used is the 4-7-8 breathing method. The entire article is called How to Fall Asleep in 10, 60, or 120 seconds.

I am 9 weeks post op and this was the best night's sleep I have had. Ten hours! Still no pain this morning.

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@jud

i have posted about my night pain and want to share something that helped me. Two things really. Yesterday I was having day pain, inside right knee area. Ice, pain meds, elevation, compression…nothing helped. I finally decided to try the hot tub. I exercised my leg while in the tub for about 15 minutes. This was at 4:00 p.m.

My pain disappeared and stayed gone all afternoon and through the night. Wow! A good night's sleep finally.

The second thing that helped me sleep was following a tip from Healthline.com on how to fall asleep. The tip I used is the 4-7-8 breathing method. The entire article is called How to Fall Asleep in 10, 60, or 120 seconds.

I am 9 weeks post op and this was the best night's sleep I have had. Ten hours! Still no pain this morning.

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Thank you @jud for letting others know about a treatment that helped you sleep. While it is true that not everything works for everyone, I think there are many of us who would be willing to try a hot tub in hopes of a good night's sleep. The breathing method does work for some. Mindful meditation helps others.

How long were you pain-free? Did you repeat the hot tube another time? Same results? Have comfort and ease. Chris

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@artscaping

Thank you @jud for letting others know about a treatment that helped you sleep. While it is true that not everything works for everyone, I think there are many of us who would be willing to try a hot tub in hopes of a good night's sleep. The breathing method does work for some. Mindful meditation helps others.

How long were you pain-free? Did you repeat the hot tube another time? Same results? Have comfort and ease. Chris

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I have remained basically pain free. Had my 2 month post-op (actually 9 weeks) and the doc thought I was doing very well. Full flat extension and flexion at about 125. So I have definitely turned a corner.

I told the doctor I was surprised at how long it took, 9 weeks, to have the pain ease. He said this was perfectly normal.

I have continued to use the hot tub and I stretch and flex while in the hot water. I think you could do the same with a hot bath. This has definitely eased…to the point of elimination… my pain.

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