Total Knee Replacement and Hyaluronic Acid Shot experiences?

Had quite an ordeal tonight. My doctor used an anesthetic pump into a nerve in my thigh for pain relief. Tonight was the night I was supposed to remove it. Instructions were simple - remove the tape sealing the Tegaderm wrap, remove the Tegaderm, and pull out the tube that was buried deep in my quad.

I already felt a bit squeamish about pulling out that tube - I had a stitch that needed to be removed years ago but it grew into my skin so strongly that pulling it out nearly knocked me off the table it hurt so much.

Had to be done, so I started to remove the medical tape. Only it wouldn’t let go. The tape was on all four sides of the 4x6 inch Tegaderm patch and it took the outer layer of my skin with it. That hurt like heck and created an injury like a burn. It blistered and bled, and that was just the first corner. My wife said to try some petroleum jelly on a q-tip to loosen the tape glue and it worked, sort of. After about 20 minutes and a lot of pain, I got the tape off but had three quarter sized areas where it took the layer of skin off.

Well, I thought the tough part was over, but now the Tegaderm was stuck at least as much as the medical tape. At this point, we looked up ways to remove the Tegaderm but none of those methods worked. I ended up being able to lift a corner and using about a hundred a-tips and petroleum jelly, eventually got it off with only the loss of about another two square inches of skin. By then, we had been working on it for 90 minutes and I still had to pull the catheter. It came out unwillingly, and I could feel my quad cramping as the muscle fiber adhesions had to be broken from the tube.

I then took my first shower only to discover how much it stings when you lose the outer layer of skin.

Sheesh! The bright side is that my wife and I will remember this experience forever and will probably laugh at it some time down the road.

The other good thing is my leg feels much better without the catheter. My foot and lower leg are now not swollen at all. The bruising is coming through so I’ll have a purple leg for a couple of weeks. But it feels really good and I’m walking without any pain and with a normal gait.

Injured Again said:

As expected, the swelling has really kicked in. My lower leg is not that swollen but my thigh is very tight. It hurts significantly to bend to the same range mostly because the muscles in my thigh are so fluid filled that tensing them like when walking, or when they are stretched, is painful. The knee joint itself is not that painful.

I can still pedal the bike and am doing that. Still walking but not as much. I can see why patients are hesitant to push through this level of discomfort.

It’s a process!

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I am so glad you are doing well after the surgery. Did they tell you to do the stationary bike that soon after surgery?

mctennis said:

I am so glad you are doing well after the surgery. Did they tell you to do the stationary bike that soon after surgery?

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My ortho and PT know I’m extremely motivated and the ortho says I‘m as fit of a knee replacement patient as he has had. Not too many TKR candidates were playing singles tennis and lifting weights up until the day before surgery, so he and the PT have okay’ed me to rehab aggressively. The ortho said if I can do it, to do it because there’s no way that rehab exercises can hurt the knee.

Today, I did six five-minute sessions on the bike and will try to do six ten-minute sessions tomorrow.

I seriously believe that because I get injured a lot, my body just seems to know how to heal quickly and I have a high pain tolerance. I think that’s probably true of many tennis players because tennis is a hard sport on the body and there’s always micro-damage that needs to heal in between playing.

Injured Again said:

Had quite an ordeal tonight. My doctor used an anesthetic pump into a nerve in my thigh for pain relief. Tonight was the night I was supposed to remove it. Instructions were simple - remove the tape sealing the Tegaderm wrap, remove the Tegaderm, and pull out the tube that was buried deep in my quad.

I already felt a bit squeamish about pulling out that tube - I had a stitch that needed to be removed years ago but it grew into my skin so strongly that pulling it out nearly knocked me off the table it hurt so much.

Had to be done, so I started to remove the medical tape. Only it wouldn’t let go. The tape was on all four sides of the 4x6 inch Tegaderm patch and it took the outer layer of my skin with it. That hurt like heck and created an injury like a burn. It blistered and bled, and that was just the first corner. My wife said to try some petroleum jelly on a q-tip to loosen the tape glue and it worked, sort of. After about 20 minutes and a lot of pain, I got the tape off but had three quarter sized areas where it took the layer of skin off.

Well, I thought the tough part was over, but now the Tegaderm was stuck at least as much as the medical tape. At this point, we looked up ways to remove the Tegaderm but none of those methods worked. I ended up being able to lift a corner and using about a hundred a-tips and petroleum jelly, eventually got it off with only the loss of about another two square inches of skin. By then, we had been working on it for 90 minutes and I still had to pull the catheter. It came out unwillingly, and I could feel my quad cramping as the muscle fiber adhesions had to be broken from the tube.

I then took my first shower only to discover how much it stings when you lose the outer layer of skin.

Sheesh! The bright side is that my wife and I will remember this experience forever and will probably laugh at it some time down the road.

The other good thing is my leg feels much better without the catheter. My foot and lower leg are now not swollen at all. The bruising is coming through so I’ll have a purple leg for a couple of weeks. But it feels really good and I’m walking without any pain and with a normal gait.

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I go away from tennis threads and this is what you do? New Christmas knee. After reading your posts I think we can safely say waterboarding would not work on you.

So question … why the DIY quad tube removal? They have doctors and nurses for this kind of thing.

This won’t make you feel any better about your tube encounter. I once had to take my mother to the doctor’s office to remove a stomach drainage tube that had been left in briefly after surgery. We were pretty stressed about it. Doc comes in … pops off bandaid, pulls tube out with fingers, new bandaid … done in a couple of minutes. Yeah … I can see how this little story isn’t helpful.

Good grief … maybe go for no broken body parts in 2024. You can do it. Heal quick.

Day 4. Had a very tough night. With the catheter removed, the area of skin gradually regained feeling and I had itching and a pins and needle feeling all night that I could not relieve with light scratching or rubbing. It’s almost like a phantom pain, so I couldn’t sleep much.

Fell asleep again about 8 am and woke up around 11 am. The leg felt fairly stiff but was able to loosen it up. The skin on my upper thigh is so sore and raw.

The flip side is I’ve just had my best rehab workout. Walked around a bit to warm up, then did six minutes on the recumbent bike at 85 cadence and resistance level 4 out of 8. Then did 20 body weight calf raises and 20 seated raises from a sitting position on a chair using both legs equally from a knee angle of about 80 degrees. Then got to 105 degree bend and held it for a good minute before using an ice machine for 30 minutes while had an ice cream.

I’m hoping to be able to get off the oxy completely now. I don’t feel I can safely ditch the walker completely yet, so will probably use it at least through the first PT session next Tuesday.

ByeByePoly said:

I go away from tennis threads and this is what you do? New Christmas knee. After reading your posts I think we can safely say waterboarding would not work on you.

So question … why the DIY quad tube removal? They have doctors and nurses for this kind of thing.

This won’t make you feel any better about your tube encounter. I once had to take my mother to the doctor’s office to remove a stomach drainage tube that had been left in briefly after surgery. We were pretty stressed about it. Doc comes in … pops off bandaid, pulls tube out with fingers, new bandaid … done in a couple of minutes. Yeah … I can see how this little story isn’t helpful.

Good grief … maybe go for no broken body parts in 2024. You can do it. Heal quick.

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Stupidity and stubbornness have gotten me pretty far in my life and this just continues to show being dumb and determined works.

All of the paperwork indicated the catheter removal would be a piece of cake. That piece of cake contained shards of glass and some Carolina Reaper peppers…. I was thinking of heading to urgent care but then thought they might just think I was a wimp and rip it off, like if I was waxing my leg.

Now I’m worried about the patch over the incision. It’s sealed up with Tegaderm!

I ask Santa every year for no injuries. He must still be waiting for me to be a good boy.

Thanks!

Injured Again said:

Stupidity and stubbornness have gotten me pretty far in my life and this just continues to show being dumb and determined works.

All of the paperwork indicated the catheter removal would be a piece of cake. That piece of cake contained shards of glass and some Carolina Reaper peppers…. I was thinking of heading to urgent care but then thought they might just think I was a wimp and rip it off, like if I was waxing my leg.

Now I’m worried about the patch over the incision. It’s sealed up with Tegaderm!

I ask Santa every year for no injuries. He must still be waiting for me to be a good boy.

Thanks!

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Hang in there. Things will improve. We are all pulling for you.

It’s middle of day 5. I tried this morning to go without the oxycondone and it just was a bit too sore to make sense. So it seems I need one in the morning to get over the stiffness from sleeping all night. I seem to be lucky that I’m not having much problem sleeping but I do have to get up once or twice to pee.

Range of motion seems stuck at about 105 to 110 degrees, almost solely due to pain on the inside of my quad. I’m not sure if the operation did something in that area but it does feel like it’s slowly improving. In that way, it’s pretty similar to when I tore my tricep and it seemed to take several weeks before I could stretch the tricep comfortably. It took about three months for the tricep to feel normal again.

Swelling is slowly decreasing. I can stand and do things like cook for 30 minutes without problems. I also feel like I can walk for 30 minutes or more as well but I haven’t left the house yet so I’m just doing circles in the kitchen. I’m riding my bike for six minutes at a time at 85 cadence with the resistance setting on four of eight.

First PT session is tomorrow. Overall, I’m feeling pretty positive.

A bit of a revelation this afternoon. I have the tightness in primarily one spot on my quad and I massaged it with my palm, and just generally massaged my whole thigh. Major improvement! I can reduce the tightness by about 80% by just massage and it helped me with being able to comfortably cycle. I also am thinking of applying a bit of heat to the quad area before doing my rehab. Using the ice machine feels good but the cold muscle is very stiff and I elastic feeling.

Lots of activity and rehab today and the knee was pretty tender near the end of the day. I still got in one last session, and here's a short clip of me pedaling my stationary bike here on day 5.

@Injured Again. Thanks for introducing me to this thread. Hi all, this is like reading about all the different procedures I've had for my knees over the last 12 years. Only 58, I just had bi-lateral TKR this last August. My recovery progress has been remarkable so far. Been lightly hitting since week 5 post surgery. Biggest issue holding me back as been a lower back issue. My doc and PT say hip and low back issues are common after TKR and will clear up.

Looking forward to following this thread and contributing positive input with my fellow tennis knee sufferers!

@andfor I will say again here, you are a warrior for doing both knees at the same time!

I just returned from my first PT session. Got to three degrees from straight and bending to 109 degrees on a leg more swollen from doing too much yesterday. I am cleared to stop using the walker, and should walk up stairs normally but for now still come down stairs leading with my operative leg.

Got a bunch of exercises to fully activate all the muscles in the legs. If all goes well, I will be starting resistance training in the gym after my next PT session on Friday.

My PT thinks my sole issue is going to be how much my leg can handle without swelling up too much. And the only way to know is to keep pushing that edge, then back off a bit. I like that approach.

There’s been a fair amount of discussion about playing tennis on an artificial knee in this thread that I started:


I’m curious what you were told about your possibility of playing singles after TKR. My ortho did not hesitate to say I should go for it, but that doesn’t seem like common consensus.

Injured Again said:

@andfor I will say again here, you are a warrior for doing both knees at the same time!

I just returned from my first PT session. Got to three degrees from straight and bending to 109 degrees on a leg more swollen from doing too much yesterday. I am cleared to stop using the walker, and should walk up stairs normally but for now still come down stairs leading with my operative leg.

Got a bunch of exercises to fully activate all the muscles in the legs. If all goes well, I will be starting resistance training in the gym after my next PT session on Friday.

My PT thinks my sole issue is going to be how much my leg can handle without swelling up too much. And the only way to know is to keep pushing that edge, then back off a bit. I like that approach.

There’s been a fair amount of discussion about playing tennis on an artificial knee in this thread that I started:

Appeal down due to knee replacement

62 year old who has not played much USTA the last few years (mostly because I’m a singles player, 55+ is just doubles, and with one singles on 40+ there is no room for an older singles player). Ranked top 100 nationally in 60 singles a couple of years ago, and had a total knee replacement...

tt.tennis-warehouse.com

I’m curious what you were told about your possibility of playing singles after TKR. My ortho did not hesitate to say I should go for it, but that doesn’t seem like common consensus.

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My ortho advised against tennis singles. Also against running, soccer, high impact stuff. But he's okay with doubles and pickleball. I mentioned in another post I know some guys who play singles on their TKR's.

There's some U.K. studies out there showing TKR's last on average 20-25 years. One study showed the timeframe to be the same regardless of activity level. I'll try to find that. Here's a study, don't believe this is the one I recall. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)32531-5/fulltext Just posting as a point of interest. As always, follow your doctors advice!

andfor said:

My ortho advised against tennis singles. Also against running, soccer, high impact stuff. But he's okay with doubles and pickleball. I mentioned in another post I know some guys who play singles on their TKR's.

There's some U.K. studies out there showing TKR's last on average 20-25 years. One study showed the timeframe to be the same regardless of activity level. I'll try to find that. Here's a study, don't believe this is the one I recall. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)32531-5/fulltext Just posting as a point of interest. As always, follow your doctors advice!

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How do hip replacements compare to TKRs and tennis movement etc? Sorry if this is off topic

SteveI said:

How do hip replacements compare to TKRs and tennis movement etc? Sorry if this is off topic

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I have not had one so not the best person to answer. I do have a tennis buddy who has had both done and he says it's easier than the TKR. He was a 4.0 before his hip replacement and is still 4.0 today. Hope that helps.

andfor said:

I have not had one so not the best person to answer. I do have a tennis buddy who has had both done and he says it's easier than the TKR. He was a 4.0 before his hip replacement and is still 4.0 today. Hope that helps.

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I also have a hitting partner that had one hip done. He was back on the court playing doubles in about 4 months.. he is playing singles again after about one year.

SteveI said:

How do hip replacements compare to TKRs and tennis movement etc? Sorry if this is off topic

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I know a few guys who have had both hips and knees done. I believe they have all said recovery from a knee replacement has been more difficult and less complete as far as a return to prior athletic capabilities.

Today is day 8. The new PT exercises have been tough because I can’t seem to fully straighten my leg no matter how hard I try. I definitely have adequate leg strength because I can walk up stairs unassisted with ease, and I can do multiple and consecutive sets of body weight squats to 90 degrees. It’s that last ten degrees of straightening that I can’t seem to do, and it’s painful in my quad above the knee and towards the inside of my leg. It almost feels identically to a muscle tear, so I wonder if they had to cut something during the surgery.

I also have made a mistake in not wrapping my leg. It just feels better to not have the compressive Ace bandages but that lets my leg swell up more and makes bending more uncomfortable. So I’ve been wrapping all the way to my upper thigh and it feels much better.

Second PT session tomorrow. I’ve been shadow swinging a racquet and can pivot on my left knee with no discomfort. It’s the progress that keeps things mentally manageable because the exercises and stretching sure don’t feel good!

Injured Again said:

Today is day 8. The new PT exercises have been tough because I can’t seem to fully straighten my leg no matter how hard I try. I definitely have adequate leg strength because I can walk up stairs unassisted with ease, and I can do multiple and consecutive sets of body weight squats to 90 degrees. It’s that last ten degrees of straightening that I can’t seem to do, and it’s painful in my quad above the knee and towards the inside of my leg. It almost feels identically to a muscle tear, so I wonder if they had to cut something during the surgery.

I also have made a mistake in not wrapping my leg. It just feels better to not have the compressive Ace bandages but that lets my leg swell up more and makes bending more uncomfortable. So I’ve been wrapping all the way to my upper thigh and it feels much better.

Second PT session tomorrow. I’ve been shadow swinging a racquet and can pivot on my left knee with no discomfort. It’s the progress that keeps things mentally manageable because the exercises and stretching sure don’t feel good!

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When you can, buy a stretch strap if you don't already have one. They are only $15-$20 on Amazon.

To help straighten the leg, does your PT have you doing "heel props". You just put you heel(s) on a yoga block and let the weight of your leg straighten the knee, you can also add light weight like a book over your knee. 3 sets of 3 minutes, can be spread out over the day. This looks easy, but is very uncomfortable to painful I know.

DM me if you want me to send you my PT recommended exercises.

andfor said:

When you can, buy a stretch strap if you don't already have one. They are only $15-$20 on Amazon.

To help straighten the leg, does your PT have you doing "heel props". You just put you heel(s) on a yoga block and let the weight of your leg straighten the knee, you can also add light weight like a book over your knee. 3 sets of 3 minutes, can be spread out over the day. This looks easy, but is very uncomfortable to painful I know.

DM me if you want me to send you my PT recommended exercises.

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Did those when I was doing PT on my knees last Jan-March. Worked great!

SteveI said:

Did those when I was doing PT on my knees last Jan-March. Worked great!

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Definitely. I still do them. Just not as long now. The straightening part, "heel prop" was the most painful to me. PT said its the hardest but one of the most critical parts of rehab. If it heels without getting to zero degrees, a surgery may be needed to fix it. Said much of knee flexen comes naturally, but not the straightening part.

Keep up the good work @Injured Again . Sounds like you're diligent with your PT, be patient progress will come daily and sometimes you may not notice it, but it will.

andfor said:

Definitely. I still do them. Just not as long now. The straightening part, "heel prop" was the most painful to me. PT said its the hardest but one of the most critical parts of rehab. If it heels without getting to zero degrees, a surgery may be needed to fix it. Said much of knee flexen comes naturally, but not the straightening part.

Keep up the good work @Injured Again . Sounds like your diligent with your PT, be patient progress will come daily and sometimes you may not notice it, but it will.

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Indeed, this helped the most with the rehab on my right knee. My PT who is a tennis player, watched me walk the 1st time I came in and saw I was not getting close to being straight. on that knee. I still do many of these to help me keep that flex going. It was a bit painful to be sure but it worked.

Today is day 10! Double digits at last!

Day 9 was my second PT visit. After some warm-up, stretching, and massage, I got to 0.5 degrees from straight and a bend of 115 degrees. I continue to struggle most with being able to muscularly straighten my leg. If I sit in a chair and attempt to straighten out my leg, I can’t get that last seven or eight degrees. However, if I lie on my back and straighten my knee, and then do a straight legged lift, I can maintain the straightness. So I’ve got a bunch of exercises to work that last ten degrees of straightening.

I’ve been cleared to start resistance training my knee, starting with squats and hamstring curls. The squats are very easy and the hamstring curls are not due to limited bending of the knee past 90 degrees so that's where I’ll be concentrating the exercises.

I’m off the oxycodone and while it’s painful and stiff in the morning, it takes about 20-39 minutes of moving, stretching, and a massage gun to make it feel fully comfortable.

Between doing three sets of all my PT exercises, plus all the stretching, cycling, and gym time, it’s about five hours a day and that doesn’t include icing or walking. I don’t know how this would have been possible if I were still working.

@andfor You are right - those “heel props” don’t feel good! It takes every fiber in my body not to tense up and bend the knee to relieve the discomfort. I’m doing that six times a day, two by five minutes, with ten pounds of weights resting on my knee. It seems to be either getting less uncomfortable or I’m just getting used to how much that hurts.

I have one of those stretch straps. Hamstring flexibility is good but the capsule behind the knee is what is most resisting the stretching, according to my therapist.

Next Tuesday, I meet with my ortho’s assistant. Primarily it’s to change the dressing on top of the incision, and as a follow-up to see how I’m doing. I can climb steps normally and can descend steps normally if I hold onto both rails. Walking down a grade feels weird and sketchy but walking up a grade is no problem. My walking gait is almost fully back to normal but I’m still taking steps slowly to ensure I’m not walking with a stiff leg, and I’m shadow swinging a racquet and working on restoring proper form on my forehand.

Time for exercises again!

@Injured Again Check out this youtube video, especially at 1:30. This exercise was amazing for me. Hurt like crazy but worked really well.

@ace18 I watched a lot of Dr. Rosen's videos both before and after my surgery. He and my ortho seem to share a lot of similiarities in terms of perspective. I'm almost to the point where I can start that exercise but I'm finding I'm so much more capable doing squat type motions than either fully straightening my leg or using my hamstrings to bend my knee. So I'm doing 15-20 sets of leg straightening (just the last 15 degrees) and leg curl exercises a day to try and catch this up and ignoring the deeper squat motions for now.

I'm on day 12 and other than those problems I mentioned above, my biggest challenges are that my knee gets stiff if I don't move it for 30 minutes or more, and then I can barely get it to 90 degrees without a lot of tightness on the lower front of my quad. After massage and stretching for 15-20 minutes, I then have an easy 110 degrees and a more painful 115-120 degrees. But not move the knee for just a bit of time and I'm back to 90 degrees.

I'm also exeriencing some clicking in the knee, like the pieces are developing a gap and then click as they make contact. It will be another question for the meeting with the ortho's PA tomorrow.

Otherwise, when warmed up, it feels pretty much like a knee! I get occasional times when I get the knee too straight and because I still have weakness that last 10 degrees, it almost feels like my knee hyperextends as it locks out, but I can both twist and bend on it with no pain, and so I've been shadow swinging a racquet and starting some very basic tennis movements in slow motion.

Day 13 and went to the ortho for a post-op checkup. They peeled off the dressing and said the eight inch scar looks good. X-rays also look good. Range of motion and swelling are both much better than typical.

I told the physician‘s assistant that I had been fully off painkillers for a couple of days and that everything ached more. He said getting off painkillers this early was “aggressive” and I should get back on them so I can continue the progress on range of motion. So Advil and Naproxen instead of oxycodone.

Went to PT afterwards and due to the discomfort only could bend to 112, two degrees less than last week. Yup, I need the painkillers. Both the PA and PT said to work my hardest to get to 135 degrees as soon as I can so I can restart the heavy athletic rebuilding work.

Injured Again said:

Day 13 and went to the ortho for a post-op checkup. They peeled off the dressing and said the eight inch scar looks good. X-rays also look good. Range of motion and swelling are both much better than typical.

I told the physician‘s assistant that I had been fully off painkillers for a couple of days and that everything ached more. He said getting off painkillers this early was “aggressive” and I should get back on them so I can continue the progress on range of motion. So Advil and Naproxen instead of oxycodone.

Went to PT afterwards and due to the discomfort only could bend to 112, two degrees less than last week. Yup, I need the painkillers. Both the PA and PT said to work my hardest to get to 135 degrees as soon as I can so I can restart the heavy athletic rebuilding work.

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Outstanding progress. Thanks for sharing updates and your journey.

I'm four and a half months in now and continuing to make steady progress. The knee is almost normal in terms of temperature and I have really good range of movement [140 degrees and when straightening I can get my heal off the ground when pushing the knee into the floor] I continue to just concentrate on the range of movement and my thigh muscle is not much smaller than the good leg. In terms of movement I have found the hotter the joint the easier it is to push the limits. I use a really hot cream and massage it into the knee and then get into the stretching. I also try and run a 'hot' bath each night, which stirs up the cream again, and I use the end of the bath to push my foot against and I hold it at 140 for as long as I can which currently is pretty much as long as I want. I also have a mountain bike that has a dropper seat post, so I can lower the seat easily until the pedaling becomes painful, which is getting pretty low now. I would guess the knee is pushing the 140 with the seat dropped down. The cream I use is called 'Finalgon' and I've just about run out of it and I'm having trouble trying to purchase some more. My Pickleball and Table Tennis movement is getting better as my confidence improves. I am thinking I might try to set up a little course at home that has some forward/backwards and sideways movements that I can do easily and concentrate on improving my speed slowly.

@sherpa That is excellent news and great progress! I hope to get where you are!

Today is day 15. I am at 120 degrees bending and 0 degrees straightening. The strength in the middle of my range of motion is excellent and doing body weight plus squats is effortless. However, I am really weak in the last five degrees of straightening so that I can’t lift my straightened leg without it bending a few degrees, and sometimes I will have a slight buckling as I drive my knee straight like when walking. My hamstrings are also not firing well yet and there is some discomfort in the back of the knee with hamstring curls.

I’m also having some problems sleeping through the night. If I wake up to go to the bathroom, my leg aching from swelling and inactivity will usually keep me awake unless I take some Tylenol. I do take some right before going to sleep but it doesn’t last all night, unlike the opioids which seemed to prove a good 12 hours plus of relief. However, I got off the oxy several days ago and am not going to start taking them again.

I’m walking a mile or more each day and it feels good. Starting to do rotational and twisting motions, which mostly involve internal and external rotation of the hip more than any actual twisting of the knee.

So it feels like I’m progressing well and that helps get through those times when I get frustrated with being unable to do something or being slower than I want to improve.

If I was happy not to do sports again mine would be satisfactory, I'm sleeping well, movement is very good , walking down slopes and stairs is pretty reasonable as well, getting in and out of cars is good as well. I think it all just takes time and no amount of exercise can speed the healing process

Injured Again said:

@sherpa That is excellent news and great progress! I hope to get where you are!

Today is day 15. I am at 120 degrees bending and 0 degrees straightening. The strength in the middle of my range of motion is excellent and doing body weight plus squats is effortless. However, I am really weak in the last five degrees of straightening so that I can’t lift my straightened leg without it bending a few degrees, and sometimes I will have a slight buckling as I drive my knee straight like when walking. My hamstrings are also not firing well yet and there is some discomfort in the back of the knee with hamstring curls.

I’m also having some problems sleeping through the night. If I wake up to go to the bathroom, my leg aching from swelling and inactivity will usually keep me awake unless I take some Tylenol. I do take some right before going to sleep but it doesn’t last all night, unlike the opioids which seemed to prove a good 12 hours plus of relief. However, I got off the oxy several days ago and am not going to start taking them again.

I’m walking a mile or more each day and it feels good. Starting to do rotational and twisting motions, which mostly involve internal and external rotation of the hip more than any actual twisting of the knee.

So it feels like I’m progressing well and that helps get through those times when I get frustrated with being unable to do something or being slower than I want to improve.

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Sounds like good progress … they need a pill for patience

Question on pain pill … don’t you need to reduce inflammation for x days? I try and take Tylenol instead of NSAIDs, but I discovered for somethings Tylenol Arthritis isn’t even close to Celebrix. One of those things is my mild arthritis ( hallux limitus ) in big right toe joint. Celebrex makes toe happy, icing after is better than the tylenol.

Are you suppose to ice knee after TKR? My mother had a knee replacement but I don’t remember.

They recommend ice to reduce the swelling, but I found it didn't do much for me. Monitoring the exercise was the key for me to keep the swelling down and as I have said before most of my focus was on the range of movement. I have a mate going under the knife in a few weeks time for a 'quadriceplasty' to improve his range because he barely has little more than ninety degrees.

ByeByePoly said:

Sounds like good progress … they need a pill for patience

Question on pain pill … don’t you need to reduce inflammation for x days? I try and take Tylenol instead of NSAIDs, but I discovered for somethings Tylenol Arthritis isn’t even close to Celebrix. One of those things is my mild arthritis ( hallux limitus ) in big right toe joint. Celebrex makes toe happy, icing after is better than the tylenol.

Are you suppose to ice knee after TKR? My mother had a knee replacement but I don’t remember.

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They do recommend ice after the surgery. I was very disciplined for about the first 3 weeks doing so at home, multiple icings per day. Also at PT 3 times a week for the first 3 weeks, they iced my knees for 10 minutes at the end of the session. Can't remember the timeframe for sure, somewhere around 3-4 weeks post surgery, PT said ice was option, didn't do much for inflammation, but would make the knee feel better, I still iced up through around 5-6 weeks.

ByeByePoly said:

Sounds like good progress … they need a pill for patience

Question on pain pill … don’t you need to reduce inflammation for x days? I try and take Tylenol instead of NSAIDs, but I discovered for somethings Tylenol Arthritis isn’t even close to Celebrix. One of those things is my mild arthritis ( hallux limitus ) in big right toe joint. Celebrex makes toe happy, icing after is better than the tylenol.

Are you suppose to ice knee after TKR? My mother had a knee replacement but I don’t remember.

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I’m currently taking Naproxen twice a day and Advil as needed, which is a couple of times a day as well. I think I could get away from both but it blunts the pain of the ROM exercises. My PA and PT both say there’s little sense in trying to be a hero - just take the pain meds through this four to six week phase before things heal and quiet down.

I’ve stopped icing. I have minimal swelling and the icing seems to stiffen up my muscles and make ROM exercises difficult until I get some heat back into the muscles.

sherpa said:

They recommend ice to reduce the swelling, but I found it didn't do much for me. Monitoring the exercise was the key for me to keep the swelling down and as I have said before most of my focus was on the range of movement. I have a mate going under the knife in a few weeks time for a 'quadriceplasty' to improve his range because he barely has little more than ninety degrees.

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I have minimal swelling and the icing doesn’t reduce what little bit I have. It just makes me take longer to warm up my muscles before I can stretch them.

Good luck to your friend!

Two and a half weeks. I seem to be slowly getting less stiff in the mornings though my quads right above my knee are very tight and are limiting my ROM to about 120 degrees.

I’ve started resistance training with leg presses and hamstring curls, along with hip abduction and abduction. I’m generally doing about half the weight for the leg presses and curls that I was doing before TKR and though it hurt the first time out, every time since has resulted in a lot less pain and quick increases in strength and range of motion that I can move against the resistance. When I am warmed up and loose, I can walk down steps one foot after the other with only tightness in the quad but no muscle weakness or instability. I’m walking two miles a day at 3 MPH and will be increasing that to an hour starting tomorrow. The hip abduction and abduction machines press against my knee sideways so there was some discomfort at first but it went away after a couple of days. I’m doing those exercises at 90% of my pre-TKR resistance level.

The absolute best thing about doing the resistance training has been how much it has helped my sleep. I can roll and turn pretty much any way now without discomfort, so I’m sleeping like a baby when I’m not having to get up and pee, which seems to be about three times a night now whereas before, it was either zero or one time just before my normal wake-up time. I’m guessing that because I’m not exercising strenuously and sweating the gallons that I usually do, I’m having to pee it out.

I’ve been shadow swinging and can pivot on my forehand with the weight fully on my knee with no discomfort and no instability. I still have problems getting that last bit of straightening but can shadow swing a platform serve without weakness when driving upwards. I can jump and feel like I could lightly run but will save that for my next PT on Wednesday.

My body’s tendency to keloid is pretty apparent on my knee. It’s a thick, ropey scar. One of my buds said it looks like I have a zipper on my knee. I’m doing vitamin E on it twice a day but it’s an ugly sucker. I just hope the amount of internal scarring isn’t more than normal as well.

So the main challenges are that I still can’t muscularly extend to zero degrees, and that my quad right above my knee feels incredibly tight when I try to increase my ROM. I understand that the tightness usually decreases more quickly by about four weeks - has that been everyone’s experience? And that about four weeks is when the quad is healed enough to allow full extension.

Injured Again said:

I’m currently taking Naproxen twice a day and Advil as needed, which is a couple of times a day as well. I think I could get away from both but it blunts the pain of the ROM exercises. My PA and PT both say there’s little sense in trying to be a hero - just take the pain meds through this four to six week phase before things heal and quiet down.

I’ve stopped icing. I have minimal swelling and the icing seems to stiffen up my muscles and make ROM exercises difficult until I get some heat back into the muscles.

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Great progress … and remember

ByeByePoly said:

Great progress … and remember

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Too true and too funny!

The lack of patience can either be a good thing or a bad thing. The good is that it makes me push hard. The bad is if I then do something that sets me back. Today was a fine example of both, though I escaped without hurting myself.

Two weeks and five days after TKR today. I started off mall walking three miles at a pretty good clip. Then, I came home, stretched and did my exercises, and then headed up to the tennis club to meet my son, who had a ball machine court. If you guessed that I couldn't resist, you're right....


And I also tried some volleys, which were harder because at my age, my ability to track the ball takes a beating. It took several very late contacts before I kind of got it going.


Then, I did a full hour of whole body resistance training, then came home and did range of motion exercises. It's now 7 p.m. and I'm headed to bed - I'm exhausted!

As bad as it probably was for me to hit some balls, I really needed it. Just the mental health benefits were worth it. Even the wife approved! Tomorrow, we're coming out of our deep freeze and I'm hoping to get some walking in outdoors while it's still sunny and before it starts to rain on Wedneday. The sun will really help with my SAD.

Injured Again said:

Too true and too funny!

The lack of patience can either be a good thing or a bad thing. The good is that it makes me push hard. The bad is if I then do something that sets me back. Today was a fine example of both, though I escaped without hurting myself.

Two weeks and five days after TKR today. I started off mall walking three miles at a pretty good clip. Then, I came home, stretched and did my exercises, and then headed up to the tennis club to meet my son, who had a ball machine court. If you guessed that I couldn't resist, you're right....

And I also tried some volleys, which were harder because at my age, my ability to track the ball takes a beating. It took several very late contacts before I kind of got it going.

Then, I did a full hour of whole body resistance training, then came home and did range of motion exercises. It's now 7 p.m. and I'm headed to bed - I'm exhausted!

As bad as it probably was for me to hit some balls, I really needed it. Just the mental health benefits were worth it. Even the wife approved! Tomorrow, we're coming out of our deep freeze and I'm hoping to get some walking in outdoors while it's still sunny and before it starts to rain on Wedneday. The sun will really help with my SAD.

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Yeah … I knew that patience thing wasn’t going to happen but I had to throw it out there.

No way PT guys could understand the healing power of tennis addicts hitting balls … congrats … today …. WINNING!!!

Injured Again said:

Too true and too funny!

The lack of patience can either be a good thing or a bad thing. The good is that it makes me push hard. The bad is if I then do something that sets me back. Today was a fine example of both, though I escaped without hurting myself.

Two weeks and five days after TKR today. I started off mall walking three miles at a pretty good clip. Then, I came home, stretched and did my exercises, and then headed up to the tennis club to meet my son, who had a ball machine court. If you guessed that I couldn't resist, you're right....

And I also tried some volleys, which were harder because at my age, my ability to track the ball takes a beating. It took several very late contacts before I kind of got it going.

Then, I did a full hour of whole body resistance training, then came home and did range of motion exercises. It's now 7 p.m. and I'm headed to bed - I'm exhausted!

As bad as it probably was for me to hit some balls, I really needed it. Just the mental health benefits were worth it. Even the wife approved! Tomorrow, we're coming out of our deep freeze and I'm hoping to get some walking in outdoors while it's still sunny and before it starts to rain on Wedneday. The sun will really help with my SAD.

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Amazing my man.. I live in the northeast. We know about SAD. Have to do what you need to do to get some sun on your face. Keep up the great work and with the updates. Congrats on the progress.

ByeByePoly said:

Yeah … I knew that patience thing wasn’t going to happen but I had to throw it out there.

No way PT guys could understand the healing power of tennis addicts hitting balls … congrats … today …. WINNING!!!

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I showed this to my wife and she said it was too true. She hoped I would listen to you, because there's no way that I would listen to a woman I've known for 44 years!

So today is three weeks! I was supposed to have a PT session today but the therapist wasn't available, so I'm not going until Friday.

The good. I am continuing to relearn how to walk properly. I'm finally upright, and am no longer sticking out my butt nor walking splayed legged that accentuated my bowl-leggedness. I did about 2 1/2 miles at 3 MPH, then finished up the last half mile walking about 4 MPH. That speed is relatively easy, though people in the mall are wondering why this sweaty guy is sucking all the oxygen out of the air. When I started mall walking a week ago, my knee would occasionally slightly buckle as my knee fully straightened and as I drove that leg back behind me. This has basically fully resolved.

I went to the gym after lunch. I used to squat on an inclined leg press machine with 150 pounds plus body weight, and that amount today feels very little different than I remember though I'm doing sets with less weight just to be safe. There's no knee pain even starting the leg press from just slightly greater than a 90 degree bend. Hamstring curls are weak. Prior to surgery, I was doing one-legged curls with 65-70 pounds and can now only do 35 pounds to a bend of right around 90 degrees whereas my other leg can curl to about 120 degrees. This gets easier every day so I expect to get back to my regular weights within the next three weeks or so, and the flexion will probably come when the quad muscles aren't as tight. I'm also doing the hip abduction and adduction exercises at my previous weight, which was 270 pounds on a machine limited to 290 pounds. The first times doing this, I had some discomfort from the knee pads pressing sideways on the knee but that has also fully resolved with just more repetitions of doing those exercises. The only leg based exercise I'm not doing are leg extensions, at the advice of both my PA and PT who both said a week ago to wait another week or two. I'm doing more sets than I used to do so that feels motivating.

I am working on internal and external hip rotation, and that lets me pivot more on my forehand swings. The shadow swings are getting close to the full rotation and loading that I want to have. Initially, stretching my hamstrings by sitting on the ground, spreading my legs, and bending forward, was really painful behind my knee where it was still swollen. By continuing to work this stretch, I'm now getting close to my previous flexibility with only some moderate tightness and no pain behind the knee.

I only had problems sleeping from about day three through about day 7-8. Though it was uncomfortable rolling over in bed through about week two, I found that discomfort really went away when I started doing resistance training. The strength building and just overcoming the initial pain from those motions seems to have really calmed everything down at night. Now if I can just not have to pee every three or four hours, I'm sure I can probably sleep for ten hours straight.

The bad. I seem to have reached a plateau with flexion. I'm stuck at somewhere around 120 degrees due to extreme tightness in my quads just above my knee. When I do stretch it hard and hold it, I swear I can feel individual fiber adhesions let loose. But overall, I don't seem to allow any better range than I did a week ago. I've been told that at three weeks, I should be 105-110 degrees so to just be patient. There's that darned word again!

I'm also still not able to fully straighten my leg doing a leg extension, or what the PT calls a "long arc quad". I can get to about five degrees from straight and then no amount of muscle activation can get my leg straight. If I lie on the ground with a fully straight leg and do a leg lift, my knee bends a couple of degrees but then I manage to hold that slight bend for the remainder of the set. I've been given an exercise where I place a resistance band around and behind my knee, and then I step back with a bent knee until the band is under tension. I then straighten my leg against that resistance. This is easy to do and I can achieve full straightening so I'm curious why this is so easy when a full leg extension is impossible.

I also am doing an exercise where I stand on one step and then I lower myself to touch the step below with my other foot, then raise back up and fully straighten the leg. The knee is only bent probably 15 degrees during this exercise and I'm having a hard time smoothly raising myself up and then fully straightening my leg. Also, after about six or seven reps, my quad gets really tired and then seems to loose coordination.

Once I've completed my exercises, if I sit for just ten minutes, my quads get tight and I lose about 20 degrees of flexion. It takes me five to ten minutes of stretching to get that back. And that stiffness returns every time I'm not actively bending my leg.

The skin to the outside of the incision is numb but I get these phantom itches and an occasional sharp shooting pain. I was told I'd get the zingers as the nerves find new pathways but the phantom itching is irritating because scratching the skin doesn't relieve it.

I've gained about six or seven pounds, and my left leg is noticeably smaller than my right leg. The incision is actually quite small and smooth in some areas, and very ropey looking in others. I'm using Vitamin E on it several times each day.

That's about it. Let's see what this coming week brings!

To get my good extensions I would really push hard with anti- inflammatory medication and with heat and massage. I would get to my maximum and hold it there for as long as I could handle the pain, wait a while and then back into it again. At one stage I even had my wife gently pushing my leg to straighten it. This was tricky to say the least as I just wanted more pressure/weight than I could supply. The good news is I got a Kidney stone on Sunday and have been in for two surgeries already with the last one booked for next Tuesday, man I've had a great year!

You're doing all the right things. Flexion and extension will come. You're still so early post op.

Like you I rehab and exercise daily. Improvements will incrementally be smaller as time passes. Doc reminded me couple weeks ago I'll see improvements up to 12 months. Probably stating the obvious.

5 months post op for me on 01/22 I'm 120 degrees plus flexion and zero on extension both knees. Wish I knew the number but haven't been measured in around 2 months post release from PT. I had a breakthrough on range of motion that just kinda seem to happen around the 3.5 to 4 month mark.

Hang in there! The daily improvements and realization the old pain is gone is amazing and so gratifying!

sherpa said:

To get my good extensions I would really push hard with anti- inflammatory medication and with heat and massage. I would get to my maximum and hold it there for as long as I could handle the pain, wait a while and then back into it again. At one stage I even had my wife gently pushing my leg to straighten it. This was tricky to say the least as I just wanted more pressure/weight than I could supply. The good news is I got a Kidney stone on Sunday and have been in for two surgeries already with the last one booked for next Tuesday, man I've had a great year!

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Ouch! I hope the kidney stone removal goes well. Is it an invasive surgery or is it lithotripsy where they use sound waves to break up the stones?

My knee is funny. If I lie sideways, I can fully extend my knee but as soon as I’m straight upright, I can’t do it. I can get to zero degrees easily so it really is just a muscle thing at this point.

Best of luck on Tuesday! The rest of the year will almost certainly be much better!

andfor said:

You're doing all the right things. Flexion and extension will come. You're still so early post op.

Like you I rehab and exercise daily. Improvements will incrementally be smaller as time passes. Doc reminded me couple weeks ago I'll see improvements up to 12 months. Probably stating the obvious.

5 months post op for me on 01/22 I'm 120 degrees plus flexion and zero on extension both knees. Wish I knew the number but haven't been measured in around 2 months post release from PT. I had a breakthrough on range of motion that just kinda seem to happen around the 3.5 to 4 month mark.

Hang in there! The daily improvements and realization the old pain is gone is amazing and so gratifying!

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Thanks again for the reality check! As @ByeByePoly said, I need PATIENCE and you just confirmed that. It’s that some things are going well so I expect everything to go well, but healing just takes whatever time it takes. Just knowing you got back to where you are and that you had breakthroughs around four months is super helpful. At least as far as patience, I guess I’m not virtuous…

Boy, I had a tough night last night sleeping. That phantom itching was driving me nuts. I wanted to take a piece of sandpaper to my knee where the skin is numb but that would have only made me bleed and wouldn’t have helped the itch.

Injured Again said:

Thanks again for the reality check! As @ByeByePoly said, I need PATIENCE and you just confirmed that. It’s that some things are going well so I expect everything to go well, but healing just takes whatever time it takes. Just knowing you got back to where you are and that you had breakthroughs around four months is super helpful. At least as far as patience, I guess I’m not virtuous…

Boy, I had a tough night last night sleeping. That phantom itching was driving me nuts. I wanted to take a piece of sandpaper to my knee where the skin is numb but that would have only made me bleed and wouldn’t have helped the itch.

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You're doing great. Guess our post op expectations were different. I thought I'd be off the walker around 3 months. LOL. Was walking on my own after 4 days, Frankenstein walking and indoors, but walking nonetheless. For me I was just amazed how well I was doing and how much better the knees felt each day. Maybe with mine being bilateral my expectations were lower. All good, each patients experience varies widely.

Sleeping. Ugghh! I get it. My restlessness was so bad my wife slept in the guest room for 3 months before it was close to normal again. Hips, low back and hammies just killed my sleep! Had to stretch often throughout the night. Along with being a stomach sleeper the first few months, that was a no go, sleep was tough. Never had the itchies, that's gotta be terrible!

andfor said:

You're doing great. Guess our post op expectations were different. I thought I'd be off the walker around 3 months. LOL. Was walking on my own after 4 days, Frankenstein walking and indoors, but walking nonetheless. For me I was just amazed how well I was doing and how much better the knees felt each day. Maybe with mine being bilateral my expectations were lower. All good, each patients experience varies widely.

Sleeping. Ugghh! I get it. My restlessness was so bad my wife slept in the guest room for 3 months before it was close to normal again. Hips, low back and hammies just killed my sleep! Had to stretch often throughout the night. Along with being a stomach sleeper the first few months, that was a no go, sleep was tough. Never had the itchies, that's gotta be terrible!

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I’ve been sleeping in our downstairs guest room since the surgery. I find there are times that my surgical leg is just really warm and I want to stick it out from under the covers, and it also feels good to wrap some of the blanket between my legs like a cushion so I can sleep on my side, which I have to do for my sleep apnea. I’m sure that if I tried that with a shared blanket, I’d get whacked across the noggin. Coincidentally, in our travels through Europe, about half of the places have had individual blankets for king sized beds rather than a single larger blanket. We subsequently read that is common in Europe and would make us sleeping together possible. Now if I can just cut down the number of times I have to pee at night down to two or less…

I cannot imagine having a bilateral TKR! So many things depend on having a good right knee, like going up and down stairs, or even getting up off the toilet. You are a warrior for having done that!

So first PT session in several days. I’m currently at three weeks, two days.

First of all, I had 125 degree bend with only moderate pressure. I think I could have gotten to 130 degrees by pushing it. Extension was below one degree. My PT was very happy with my progress in the gym, and also said I need to be patient with those last few degrees of active extension.

I’ve apparently progressed to the point that I’ve been given athletic movement exercises with the goal of getting me back on court. These are lunge type movements to the side and to the front, and they kick my butt because I don‘t have the muscular activation control yet. But he also says that once I can do sets of these and can actively extend to zero degrees, I can start running and also resume playing tennis, based on where I am at with my other exercises. So it feels hopeful but I also have a lot of strength yet to regain so I can move safely so this carrot being dangled before me is still a few weeks away.

My PT used a TENS type unit on me today as I did active extension and it seems to help. My swelling is fairly minimal but centered in the capsule behind my knee like a Baker’s cyst. He manages to massage it out but it returns after a couple of hours.

I need patience!

What a terrible night of sleeping. The sensation is gradually returning to the skin on the outside of the incision, and for whatever reason it flares up at night when I get phantom itching and some zingers which feel like small electrical shocks. I never had this with my other surgeries. Between it and having to pee five times (my son bought a yummy but salty Mexican dinner from our fave restaurant so I drank a ton), I think I probably only got sleep in 30 minute segments. I woke up with the blanket flipped inside out!

And now my neighbor is hammering on their shed outside!