Extreme Pain After Total Knee Replacement in 2019
an interview with Tom Jurewicz from Michigan
Below are highlights from Tom and Mary’s conversation. To listen to the interview click the Play button above.
Hi, I’m Tom. I’m 59 years old, and I’ve been an athlete my entire life. I played pretty much every sport that you could play as a kid, and I ended up being a scholarship football player out of high school and played a couple of years in college and continued to be active my whole life. I took up skiing later in life and loved that. I used to run, work out six days a week in the gym, lift. I’ve been very active my whole life. I coached basketball. I have two daughters, and I was their basketball coach for most of their young adult life. During one ski session, I tweaked my right knee probably about 20 years ago, not too bad.
In 2003, during a basketball practice, I was being a ‘defensive mannequin’, and I turned the wrong way and I tore the cartilage in my right knee, and that caused an arthroscopic surgery where they took out 30% of the cartilage. For the past 16 years, my knee has slowly deteriorated until I was bone on bone. Basically, I went in and the doctor said, “Your only choice is to have knee replacement surgery.”
I had no idea that I would be managing extreme pain after knee replacement surgery.
I had gone through that experience with the scope, and I honestly thought that my recovery was going to be very similar to the recovery that I had being scoped. That was about five weeks of therapy, which started seven days after the procedure. I was up almost 100% at the end of that period of time and it was very easy. My mom also had knee replacement surgery about a year and a half ago, and she went through it in a breeze, and she had no complications, and she didn’t suffer any discomfort, and her therapy went like clockwork as well. Because of those two personal experiences, I was expected, because I was active, to sail through therapy, and I didn’t think it was going to be a big deal at all.
The Knee Replacement Surgery
I was told, the doctor said everything went great. I had a surgery on the 28th, Friday, and after surgery, I was fine that day. I felt good. They put a blocker in my knee. I didn’t even think I needed the pain medication that night because my knee felt fine and the swelling wasn’t that bad. I was all set to be released from the hospital the following day on Saturday. They were preparing the discharge papers. Saturday morning at about 10:30, a physical therapist came in and said, “We have to do some certain standard tests to see that we can discharge you. You have to be able to go to the bathroom and you have to be able to get in and out of a car.” They said, “Just come on down.”
I was in a room with another patient who had knee replacement surgery, who was in his 80s, and the physical therapist just literally had him stay in bed in the room and had him sit in a chair and did a very minimal amount of therapy in the room. My therapist said, “Okay, let’s get out of bed.” He had me walk from my room down to the physical therapy room in the hospital, which was about 150 feet. When I was there, he had me basically get on a table. He bent my knee to 90 degrees. He had me do leg lifts. He had me do leg extensions. He had me getting up and out of a car. They had a fake car there. He had me walking up and down stairs. It lasted a good 20 to 25 minutes. Then, he asked me to walk back to my room.
Starting Physical Therapy
Between the time I started to the time I was finished, it was about 35 to 40 minutes of a physical therapy session. That was about 11:30, and I had called my wife, telling her to come pick me up. Within 45 minutes of having the physical therapy session, my knee bloomed three times the swelling. My whole leg, my ankle, my foot, my calf, it completely swelled up, and the pain level went to about a seven and would not subside.
The doctor and the physician’s assistant came into my room and said, “Wait a minute. You can’t be released.” For the next 48 hours, I was basically at a seven level pain, could not bend my knee at all, and I was not released from the hospital until the following Monday. I had extreme pain after total knee replacement.
When I was released, it wasn’t that much better. I was supposed to start physical therapy out … at home. The therapist came to the house that first day. The nurse came to the house that first day. They looked at my leg and they said, “Oh my, gosh, Tom. I never seen swelling in the leg quite this bad before. I never had a patient.” John McKay, my X10 Coach, came out to the house to take a look and he said the same thing. He said that, “I’ve never seen swelling quite that bad on the knee before either.”
For 12 days, I could do nothing. I couldn’t put any pressure on my leg. I couldn’t walk to the bathroom. I was using a walker and basically lifting my leg up off the floor because anytime I put my leg down when it wasn’t elevated, it throbbed and it hurt. The pain was 24/7.
A Very Dark Place
That was a very dark place. I had been prescribed oxy, the pain killer, and I was told that one of the effects of that was depression. I don’t think there was any doubt that I went into a depression. My whole outlook changed and I basically quit. I didn’t think I was going to be able to walk again. I questioned myself. I didn’t understand why I couldn’t move my leg. I thought it was a weakness that I had. I didn’t want to move my leg because of the pain. I thought I was condemned to having a leg that I couldn’t use the rest of my life. The people around me, my wife, my mom basically said they had never seen me like that before. I’m a positive person usually. I’m a person that says let’s get this done. Let’s do what we’ve got to do to resolve it. That was not me at all.
The Three Things
Then three things happened.
On July 9th, Dr. Green called my wife and basically said, “How is it going?” She told him what condition I was in. I had not moved the leg. He basically said, “You have to move the leg. If you want to regain use of your leg, you have to use it.” He told me that I had to get up on a hard surface and she had to push my leg and bend it eight times a day. I just didn’t see that happening.
At the same time that happened, the day after that, on the 10th, John and Erin from X10 came out because they had been calling me throughout the 10-day period that I was suffering and just asking how … John would call me every day asking me how it’s going. When Erin came out, Erin got me and said, “Have you been able to use the X10 machine?” I hadn’t been able to get on it. I tried one time to sit in it, and just putting my foot on the foot pad of the machine caused a pain that I simply had to get out of the chair. I couldn’t even sit in the chair.
The third thing is my daughter is a fourth year medical student at Michigan State. She came out and looked at my leg and she started doing some muscle manipulation on the leg. She tried to encourage me and she said, “Dad, you have to move the leg. The surgery was successful. Yes, you overdid it, but you’ve got to start getting movement in the leg. You’re not going to hurt your leg by moving it. You’ve got to do it.”
Recovery on X10™
Erin and John from X10 got me in the machine on the 10th of July, and for five minutes, we set the flexion at 47, and she just had me get on the machine for five minutes. She said, “I want you to talk to me about your favorite vacation.” I experienced a great deal of pain for those five minutes, but Erin talked me through it. Jeannie was there talking me through it, laughing, trying to get my mind off of it. I got through it. When I got off of the machine, the pain went away a little bit, and it felt a little bit better. Kelsey came out the following day and stayed with me and helped show how to bend my leg a little bit. I started bending it, and I made the commitment to myself that I’m going to do this. Every day thereafter, three times a day, I would go one minute longer on the X10 machine, and I would do one degree more flexion on the X10 machine. After about a week, I had gained 20 degrees, and I was up into the 60s.
I spoke with John on the phone and he said, “Tom, you’re still behind. Why don’t you try going two degrees more workout to see if you can get there?” I was doubtful because every workout that I did, every single degree was just as hard to get as the previous degree. Going from 47 to 48 and going from 78 to 79 was just as hard for me, and it hurt just as much. The mental strain of day in, day out, every day, 24 hours a day, trying to get it better is not an easy thing to get through. Everybody around me helped. Everybody encouraged me, and everybody kept saying keep going.
I got off the oxy, and that helped a great deal. I didn’t have to take that anymore and I became more myself and then the momentum started happening, and the two degrees progression started working. I realized that after I did my workouts, after I did the X10 machine, I was able to recover and my knee was getting better. I progressed. I did 105 on the X10 machine in August and I caught up ground. After 12 days of doing absolutely nothing, within five weeks of surgery, I had gotten to 105.
It was just simply all of the encouragement that I had gotten from everybody around me, and also my daughter because I trusted her that she knew what she was doing, and she had a way of doing muscle manipulation in the back of my leg as I was bending my knee that allowed my muscle to relax a little bit in a way that no other therapist helped me with. Kelsey really, really gave me the confidence that I could bend my knee. For two months, the entire month of July and half of August, it’s a challenge. It still is a challenge. It hasn’t eased up.
Emerging from the Extreme Challenges of Knee Recovery
When I got in that 90 to 95 range of the flexion, I started being able to put on my own shoes. I was able to get off the walker and start with the cane. I got to 100 and I started to go back to work. In that range, in that week’s time, that’s where really the mental outlook changed.
Yes. I did not expect nor my wife expected what was going to happen and how incapacitated and I felt like a burden. I felt I couldn’t even go to the bathroom myself. I could not reach down to bring my shorts up after going to the bathroom. It’s very humbling, very humiliating, and I didn’t want to be a burden to anybody.
Dr. Green had told me that he believed that I would regain 130 degrees flexion. I may be an outlier and get a little bit more, but he thought I should be able to get back to 130. Last Monday when I was in physical therapy, I reached 120, and I was only 10 degrees away, and it was like I’m almost there. I’m back to where I couldn’t do 40 degrees and in a month’s time, five weeks’ time, I did 104. I left physical therapy that day saying I’m going to make it and I can’t wait. I’m going to get normal, coming back faster only to wake up the next morning and realize that that wasn’t the case.
The Pain Strikes Back
I started having the pain back again. I had pain, sharp pain in three areas of my knee, on the outside front right of my knee, on the back of my knee on the right side and on the left side. What ended up happening when I went back into physical therapy on Tuesday, they said that my muscles have spasmed. I irritated the tissues underneath the kneecap where all the muscles attached and that the muscle had pulled the patella medially to the left and it was displaced and it was causing all of that discomfort. They could not bend me. My flexion decreased to a 105. For the past four or five days, I called the doctor’s office and they told me to do muscle massage and try to get the muscle loosened up using a heating pad and a cold pack and ice, elevate the knee and go back to therapy on Monday and see how your knee is feeling.
I’m in a holding pattern right now. I’m a little more philosophical about it. I still have made great progress, and maybe this is just a temporary blip in the road and everybody says it’s going to come back. Don’t worry, this happens. I’m taking it that way. I’m taking it as a temporary blip and things will get back on track.
The One Constant: X10
I think in my mind the X10 was the one constant that I knew that was safe. It was a safety net. I could get on that machine, and I know the machine would go and move my knee to the degree that was on the screen. It wasn’t going to do it any more or any less. It wasn’t going to apply more pressure or less pressure. Every day before I started the machine, I was thinking to myself, how in the world am I going to bend it one degree more today than I did yesterday because it hurt to get to where I was? The process of being on the machine for 40 minutes, it was like that machine just gently moved my leg over that 40 minutes every day, and it would loosen up over that 40 minutes every session, three times a day. Eventually, I’d get there, and I’d get to that last two minutes where I would go one degree farther than I did the previous workout.
I can’t explain how the machine did it, but it worked, and I got one degree farther. Over a period of time, that confidence that the machine was not going to hurt my leg and that I could do it was invaluable. There was a great deal of comfort and of security knowing that I was getting better. The machine was taking care of my leg and my knee and I was improving. I was now managing extreme pain after total knee replacement surgery.
An Emotional Side to Knee Recovery
It was incredibly emotional. There was also one thing too that happened. You send out emails of stories and of people’s life story. At one point when I was at about 78 or 79 degrees, I received an email with an X10 story of a woman down in Miami who was a dancer and she had had knee replacement surgery. But she didn’t have the X10 machine until six weeks after her surgery. She explained the fear and the pain and all of the things mentally that she went through. It hit me really hard. It was very emotional. It gave me courage, too. That was another big thing. Reading that person’s story, that she went through it and she was at the same dark point where I was, but got through it. That helped a great deal.
Just hopefully you’re blessed with people around you who will support you because you need to lean on them, and they’ll be there for you. You can’t do it by yourself. You need other people to help you, to rely on them.
The X10 Meta-Blog
We call it a “Meta-Blog.” We step back and give you a broad perspective on all aspects of knee health as with this article on ‘Extreme Pain After Total Knee Replacement’.
In this one-of-a-kind blog we gather together great thinkers, doers, and writers. All our work is related to Knee Surgery, Recovery, Preparation, Care, Success and Failure. Meet physical therapists, coaches, surgeons, patients, and as many smart people as we can gather to create useful articles for you. This is for you if you have a surgery upcoming, or in the rear-view mirror. Or maybe you just want to take care of your knees to avoid surgery. Executive Editor: PJ Ewing
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