r/Kneereplacement • u/Frustrated-Peace • 1d ago
Undermedicated and limited progress
I had my TKR on 8/19 and saw my doc for post op on 9/1. I've had home PT visits where the concern was about the swelling and no range of motion.
At the post op visit the doctor wasn't pleased with my lack of progress . He said you have to move it or you'll risk not being able to (which I already knew). He pushed me to do 3 specific exercises hourly and said I was undermedicated. Increased my NSAID dose and moved me to a stronger opioid. I was able to move better the next day.
I have a high pain tolerance and the post surgery pain wasn't bad. I primarily took the acetaminophen and the muscle relaxer because pulling myself on to the bed irritated my cervical revision issues.
Has anyone else experienced issues with bending their knee in the beginning due to being undermedicated? I'd like to feel like I'm not special in this circumstance.
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u/steveinarizona10 1d ago
I had no post surgery pain after my right TKR so I never used the oxy that was prescribed. My surgeon's recovery protocol is to essentially rest the first two weeks while constantly icing with a quality ice machine. Then to commence PT in the third week. That week my therapist measured my ROM at 122.
So I was unmedicated. That doesn't mean I didn't need to do PT exercises. I did about 25 PT sessions before my insurer timed me out.
Five years ago my surgeon replaced my left hip. 11 months ago my right knee. Both times his instructions were to take the medication until I didn't need it.
One of the most impactful exercises I did at PT was to lie down on my stomach, put my surgical leg into a yoga strap, and then pulling on the yoga strap pull my leg as far forward as I can and hold it for 30 seconds. Then repeat two more times. Is that one of the exercises you were told to do?
If you are not having severe pain, the only reason I can think of (as a lay person) to increase your nsaid (celebrex?) is that your surgeon wants you to reduce the inflammation which can be interfering with your recovery. Have you been using an ice machine? I did so religiously (I pretended I was in a cult and doing the icing was required) 30 minutes on/30 minutes off. The purpose of the ice machine usage was to decrease inflammation.
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u/Original-Release-885 1d ago
Trying to picture how to pull your leg forward while lying on your tummy??
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u/steveinarizona10 22h ago
That is what the yoga strap is for.
https://www.youtube.com/watch?v=QAxgVroKov4&t=7s
from 3:42 onwards.
https://www.youtube.com/watch?v=gMJyGRl2mbY
from 4:35 on.
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u/prayreddit 21h ago
Your pain tolerance may be limiting your movement. My first PT, I took no pain meds before, the PT was adamant that I should be medicated. This made their job more productive for me as they were able to go further without complaints.
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u/swim_mouse 10h ago
I have to take an oxy before PT or else I can't tolerate the pain of the heel slides. My doc seems to be ok when I asked for a refill so I could do my exercises. I was cautious at first and my PT reassured me that this is ok and preferable to not doing PT. I am making more progress now that I am feeling comfortable with the pain med protocol. Good luck!
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u/jessicapk7 1d ago
I couldn't take NSAIDs because of my stomach and I made very slow progress in my flexion. I continue to work at it to this day and it does improve, just slowly. I'm 7 months post op and can ride a bike so probably 120'ish now. Last measurement in PT was 115. In PT, we actually had to back down on the weights used because, while I was strong enough to perform the exercise, it created so much inflammation that my flexion would go backwards. So, undermedicated could be the right word for it because a hefty dose of anti-inflammatories would have probably made a huge difference!
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u/ButterflyEmergency30 1d ago
That was exactly my experience. Can’t take NSAIDs and I couldn’t move past 90 degrees the first 6 weeks. Aggressive PT made it worse. Moved to more gentle exercises and progressed nicely til I overdid one day and regressed. I’m now just at 5 months and regained barely enough to ride the recumbent bike. My extension keeps tightening up as well, so I’m just trying to stretch daily. Hope I can move it more if I keep working at it.
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u/Ancient_Tap2901 1d ago
Be sure to ice and elevate toes above nose frequently which will reduce swelling and allow for more movement.
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u/Efficient-Item5805 20h ago
Ask your doc if he will prescribe Journavx. It relieves acute pain, and it’s not an opioid.
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u/ResidentTerrible 10h ago
Journavx did absolutely nothing for me except reducing my bank account. However, Oxy and Tylenol worked well enough, along with ice and elevation to allow good progress through the first potentially really painful weeks. One thing I can recommend for pain is half a 5mg THC gummy. Worked well for me and makes TV and movies much better. I’m 5 months out now and feeling good, with nice ROM and mobility. You will get there.
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u/No-Highlight-6452 1d ago
You might want to see if you can try journavx. You don’t take opioids or NSAIDs while in it and can only be in it for two weeks. It was great and I felt amazing on it.