TKR post op 8 wks

[texasgal1966]

I am a registered nurse of 20 yrs.  I am 43 yo female and had a TKR 8 wks ago due to OA.  My concerns are the continued swelling and stiffness I am having and the continued need for pain meds. Immediately after surgery and for about 4 wks, I had this horrible stinging-type pain in my incision (nerve pain??).  This has resolved, thankfully. During this time I was taking two Norco 10/325mg about every 4-6 hrs PRN (as prescribed).  I have been on PRN Norco for about a year prior to the TKR but only taking it about once or twice per day.  

This all started with a torn meniscus in my knee . I had a meniscusectomy 12/08.  Pain continued in the lateral side of my knee.  This affected my gait and my knee began to turn inward.  I am a cardiac nurse that works fulltime on the floor doing 12 hr shifts.  I tried physical therapy, steriod injections, joint fluid replacement and finally a hinged brace that forceded my knee out.  Once I started driving home from work every night crying, I decided I had enough and consented to a TKR.  That was on Oct 14, 2009.

My concerns are my need for pain meds related to stiffness, aching/pain and swelling.  I wake in the mornings and walk around like I am 90 yrs old (no offense to the spry 90 yr olds out there!).  I am in therapy TID.  My prescription is for Norco 10/325mg one to two Q6hrs PRN.  I am on Ultram and take Motrin. Last appt with my OS was 2 weeks ago.  He was happy with my progress despite my reports of the stiffness, swelling and pain.  The Xray of my knee was aligned perfectly.

Pain goes from annoying nagging pain to a constant aching that is quite painful. Currently taking one Norco in the am and one in the pm.  I also take one prior to therapy.  Sometimes, I do take two at once if it is really bad. Next OS appt is in 2 wks.  I really do not notice a difference in the past 2 wks as far as taking less pain med.  I am getting worreid. I know I cannot be on Norco forever.  Am I on track? Suggestions? Thanks

[goggles9]

A related discussion, TKR pain was started.

[Abhijeet Ghosh]

Dear Friend,
You limp and high grade of pre-operative stiffness may contribute to the less achieved ROM of the operated knee.
I really have no -idea as what type of TKR was done on you (in context to the implants used). Now a days we have high flexion Implants also which gives upto 165 Degrees of Knee Flexion.
It's good that you are giving a thought about your future planing.
Regards

[texasgal1966]

Thanks for your response.  I am surprized that the 110 flexion is so bad at this stage.  I was limping and unable to bend knee for quite a while prior to TKR so I am not sure if that has any affect.  I will discuss the above with my doctor and therapist.  I do realize the amount of pain medication I take can be considered a lot.  However, 10 days and your patients are off meds?  Now I am really feeling like a wuss.  I am wanting to return to work in about a month so I realize I cannot take any narcotics while working.  You have given me things to think about.  New plan: I am going to continue my Motrin and only use the Ultram PRN.  I will be continuing my physical therapy, home exercises and going to the pool with the goal of 130.  I appreciate your time!

[Abhijeet Ghosh]

Dear Texasgirl,
It was good to know tat you are a nurse as i would be able to talk in more medical terminologies.
As you know, the main indication of TKR are -
1) Severe pain,
2) Marked decrease in Range of Motion
3) Knee instability
4) Any of which leading to a compromised lifestyle, provided all the medical management of the same has been exhausted.
The range of motion after 8 weeks of surgery is not too good.I am not too happy with your flexion of 110 degrees after this much time period.Extension , i won't comment upon.
You are taking too much of pain killers which is not good.We usually stop them after around 10 days of the surgery.The cause of this much dependence on pain killers needs to be known as it may cause other problems of pain killers.
I really would suggest you to do a proper work up on the physiotherapy aspect, because we might end up in restricted Range of motion.
130 degrees or above are considered satisfactory.
You really should sit and discuss with your doctor about the need of such high amount of the pain killers.I would not be able to pinpoint the exact cause of the same, as i have not examined you physically.
But i can attribute the high dependence on pain killers either due to  poor physiotherapy or due to pain intolerance, for which we really need to know the reason.
Feel free to ask more.
Regards.

[texasgal1966]

Oops, correction to my original post above:  I am in therapy three times per week (not TID!)  By the way, flexion is 110 and extension is -4