One year and counting

Hi, I honestly thought about putting it off but the pain in the knee comes on and it’s unbearable. Dr says X-rays are worse than last year and it is putting unnecessary pressure on new knee. I’ll tell you I’m sorry I ever did right knee but now I feel I have to do left knee to get relief. I have tried everything for pain already. It is past all that, the surgery is the only way. Maybe it is because I stopped the exercise, who knows. I just know I’m miserable. Like I said surgeon says new one is fine. I’m going to try exercising again. I’m going to ask Chico some questions. I feel he is the exercising guru. Thanks for writing back.

I wish you the best of luck and yes Chico gives great advice. The issue I have with exercising is that I might have Ehlers Danlos Syndrome which effects all of your connective tissue and joints. Regular stretching is off limits and so is yoga. I actually tore my Achilles tendon during a very easy yoga session. I always wondered why I hurt more after my pt sessions and now I know why. I wish I had known about this before getting my surgery. This limits my recovery and I have no clue how to make it better.

Hi

Thanks for replying. You say DON’T do same routine every day. I read all your other posts on exercising and am very confused. I am 71 and at least 50 pounds overweight. Just tell me what to do each morning and I will do it. I have no access to gym. So it has to be simple that I can do right here. Surgery is getting closer, Oct 29th. I live in Florida so walking out there is a kill between the rain and heat. Do you think you can just tell me what to do right here in the house. Any suggestions will be greatly appreciated 

Hope you’re doing well. Thanks

When you start the exercise program, all your stretching and cycling warmups can be done every day.  So can a SLOW walk on a treadmill to keep increasing your steps.  That's also cardio and it can be a daily thing.  Once you start on the no-weight reps for your endurance, those also can be done daily but only for a little while  Once you start adding weight, everything changes.

Trainers will tell you NEVER to exercise the same muscle group two days in a row.  Why?  The exercise breaks down the muscle tissue and releases lactic acid into your body.  That's why you hydrate a lot after a gym session...to flush the lactic acid.  If you don't, you'll hurt.  Simple fact.  The day off lets the muscle rebuild stronger...that's the way the body works.

So...  If you start the gym routine with weight for your legs, you do it EVERY OTHER DAY.  On the off days, you can still do cardio, biking, stretching and, if you are at a gym, work on your upper body.  Then resume the leg work the following day.  Or take the alternate day off.

This is all from my daughter Kate who is a graduate nutritionist from Rutgers University and a personal trainer for 18 years.  She is certified by the American College of Sports Medicine (2-year program) plus has 16 certifications from the American Council on Exercise in many disciplines (spinning, kick boxing, aquatic aerobics, etc.).  Kid's a total pro on this stuff.

The trick is to make it a routine...NO EXCUSES!!!  You will get there...

Chico, this is not a reply to the above, but have been meaning to get back on here. 

Of all your studies and knowledge, have you ever known of anyone that may have had something possibly go wrong during surgery of a left TKR and develop neuropathy?  My husband is this 1 in 100 person that would have something occur after almost any type of medical procedure. 

He is 14 mo post op and his ankle pain began 3 weeks after the surgery. Every doc says no, but after biopsy of nerve removed from ankle, the report leads to a possibility. He is being seen by numerous doctors at Mayo here in Jax.  It sometimes seems they find something more after every test. Crazy. 

This condition has robbed him of ever walking without some assistance for life. He is retired 52 yr police and it pains me daily to watch him go through such agony. 

What are your thoughts?

Stephanie 

Having a nerve damaged during a TKR is always a risk...but very rare to the level you describe.  Everyone feels numbness at the incision site which will never go away plus decreasing nerve issues, especially when kneeling on hard surfaces.  That may decrease over a long period of time or never fully resolve.  All of that seems to be normal as reported by many people.

However, developing neuropathy due to the surgery itself...I have not heard of anyone report that.  Yes, short term issues with calf, ankles and feet post-op as the nerves heal and imbalances in walking can cause stress on other body parts have been reported (just like the onset of sciatica)...but this is temporary and resolves by the end of year one.

This is from the National Institutes of Health, USA...

"It is reported that at mean 4 years after TKR 6% of the patients have pain of likely neuropathic origin[9,29]. The use of perioperative pregabalin reduced the incidence of NP at 0%, while placebo pregabalin didn’t seem to reduce NP."

This was not a direct study but a review of studies published in peer review journals.  I haven't read the whole thing...

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4539476/

...and I have no idea if any study cited controlled for other causes of neuropathy such as diabetes.  I would suggest some further research on the subject. 

Too bad you're not in New Jersey.  My cousin Greg has been a doc since the 60's.  He's semi-retired as he now, at a robust 74, practices as a "Patient Advocate" for people with tough cases involving unusual presentations and multiple other involved doctors.  He's kind of like that TV character "House"...but much nicer.  You might look into finding such an older doc to take a completely new view of the case, review the literature and provide some advice.

Everyone experiences their recovery differently and there is no specific timetable for any single individual.  Any statistics you hear from me or anyone else always apply to the POPULATION of TKR patients...never to one person.  You have to own your recovery and get through it with determination and strength.  Not easy.

You might try some Voltaren Gel (RX in the US, generic diclofenc elsewhere)...GREAT topical anti-inflammatory and pain reliever.  Use it during the day and especially at bedtime.  Works in 15 minutes.  Check with your pharmacist for interactions (very rare).

Also, you should be in the middle of your muscle rebuild.  If not, your pain may be the result of your body putting all the stress on the new knee instead of back on the surrounding musculature where it belongs.  This will definitely cause more knee pain.  Gotta rebuild those muscles.

Click on my name and then "See All Discussions".  The Post-TKR Exercising discussion is in there among the 30 I've posted.

I’d say ‘nornal’ Might not be right. People note likely to post if they have a problem so you can get a biased idea of normal from a forum  like this! Common isn’t the same as normal as in all is fine!  GP might be able to review meds and ask him/her refer you to a msk Physio for assessment and possibly some treatment.  

One possible reason your friend is still having pain could be that she never completed the muscle rebuild for her quads, glutes and core.  This is necessary to take the strain off the knee and put it back on the muscles where it belongs.  Failure to do so keeps all that pressure on the new knee.

Again, this is just my thoughts on this.  She could have other internal, structural issues that only her ortho can diagnose.  But if the knee is sound and aligned, I'd have her strengthen that leg before she does #2.  Just sayin'...

Yes she has not done her exercises as she should but she does go swimming daily she has to use a float and just kick her head as she can only do the breaststroke and been told she must not do that my problem is I too can only do the breaststroke but I’m not  allergic  To the  Clorane  So can’t swim any more 

First, the breaststroke is not recommended for at least 6 months by the accounts of many on this Forum.  It puts undue stress on the knee.  Swimming is great; better is to do the rehab exercises in water and then hit the gym...or use $25 exercise bands at home.  Plus, when back and hips are not aligned and the muscle rebuild is not done, other pain can persist...

https://patient.info/forums/discuss/other-pain-after-a-tkr-641040

Gotta take that stress off the knee and put it back on the muscles.  Cannot skip the rehab.  It doesn't get better on it's own.  Time, work and patience...