TKR Sleeping positions

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artisan02

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Hello all,
I have been reading this forum for some time, but have never posted.

I just had my first TKR 4 weeks ago. I was using a CPM at night, and got a fair amount of decent sleep. However, the CPM has now been discontinued, and I am trying to find a comfortable position in which to sleep.

I start out flat on my back, with my legs flat. It feels pretty good, for about 10 minutes or so, then the pain starts. It is sometimes relieved if I put pillows under the leg (positioned correctly). That too lasts for about 10 minutes before I start feeling a fair amount of pain.

I am medicating myself with 10mg Percoset at night, in hopes that this will help. So far, no luck. I am trying a Flexoril now...

If I get up and walk around or sit down somewhere, the pain goes away. I am wondering if this is just a reaction to the leg/knee being immobile while sleeping, after being used to the CPM?

Any suggestions?
 
Hi artisan02, artisan02;

Firstly welcome to BoneSmart, it is great that you have joined.

Soon all the 'knee' folk will be come to answer specific questions for you :)

Take care.
 
1. what dose of Percoset are you taking and how often?
I usually save my Percocet to take at night. During the day, I take Vicodin, which is now holding me about 6-7 hours. When I take the Percocet, I take 10mg every 4-6 hours.
2. how often are you icing your knee?
At least once a day. Most of the swelling is now gone.
3. how often and how high are you elevating your leg?
As often as I can. I cannot elevate it much higher than my hips, as I have also had bilateral hip replacements.
4. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping and PT?
Pt comes twice a week. Right now, minimal housework, minimal cooking, if that (prepared a lot for the freezer before surgery). I have a friend who helps me with shopping: the last time we went was 2 weeks ago. I stocked up enough before surgery, so that I wouldn't have to do much afterwards. I knew I wouldn't be able to do much post surgery and that includes cleaning, etc. I am able to load the dishwasher, and wash a few dishes by hand. I can load the washer and dryer. My friend helps with anything major...
And here's some reading for you - all essential stuff, I do assure you...

Thank you. I have already read much of that.
 
I usually save my Percocet to take at night. During the day, I take Vicodin, which is now holding me about 6-7 hours. When I take the Percocet, I take 10mg every 4-6 hours.
That really isn't enough for 4 weeks out, specially as I think your problem is more likely to be low grade, unmedicated post-op pain. It's the most common cause for sleep disturbance of this kind. I often hear members claiming they have little or no pain but what they are really doing is comparing their present pain with what they had pre-op. I'm pleased you read the articles but in the first one about pain, in post #2, you will find that pain comes in a lot of types and often take us unaware.
At least once a day. Most of the swelling is now gone.
So your leg is not stiff or tight in anyway at all?.
As often as I can. I cannot elevate it much higher than my hips, as I have also had bilateral hip replacements.
.Why should your hips stop you elevating one leg?
Pt comes twice a week. Right now, minimal housework, minimal cooking, if that (prepared a lot for the freezer before surgery). I have a friend who helps me with shopping: the last time we went was 2 weeks ago. I stocked up enough before surgery, so that I wouldn't have to do much afterwards. I knew I wouldn't be able to do much post surgery and that includes cleaning, etc. I am able to load the dishwasher, and wash a few dishes by hand. I can load the washer and dryer. My friend helps with anything major...
Pretty good but it's a little too much just yet, I do recommend you read this again Progression of activity for TKRs....
 
I had to get up in the night and ice my knee about 2 -3 times during "sleep" for the first 4-5 weeks. I also got up and walked a few minutes before icing. I felt my knee really stiffened up while trying to sleep. I am a side sleeper and that was not comfortable until around 6 weeks.
I usually would fall asleep while icing my knee. I stopped taking prescription pain pills at 2.5 weeks because I felt they were giving me insomnia. Around 3 weeks I called and asked my OS if there was something they could give me to sleep and he prescribed Restoral- which gave me welcome sleep . I am 9 weeks post op now and sleep is markedly more comfortable than 3-4 weeks ago. I still have a lot of swelling- and I ice several times a day. I have been too active with my knee- hence the swelling. :headbang:
 
WELCOME!
I slept in the recliner for 3 weeks and then off to bed. I'm a side sleeper. I use 2 SQUISHY cylinder pillows. When I'm on my right side, I put them between my legs. I like to bend my right knee and curl up. When I switch to my left side, I put the 2 pillows to my left and drape my right leg ove them. I am awakened several times at night with pain and my husband says that I moan a lot. I have Percocet 5/325 that I take when I get home from work. Only a few left, so I can't take another one at night.
 
I often hear members claiming they have little or no pain but what they are really doing is comparing their present pain with what they had pre-op. I'm pleased you read the articles but in the first one about pain, in post #2, you will find that pain comes in a lot of types and often take us unaware.

During the day, I am not having much pain at all. The Vicodin is now lasting about 7-8 hours and that is not pushing it. I disagree that this is unmedicated post op pain. I can go to bed feeling wonderful with no pain at all, and for the first few minutes it feels great. Then it is like the muscles start spasming. I get up and walk around and again feel great. Slide into bed, and feel good for a few minutes, then it starts up again. I think part of this is that I was using the CPM for the first 4 weeks: I ran it when I was sleeping.
I just ran out of Flexoril, so I am going to ask the doctor for a refill today.

So your leg is not stiff or tight in anyway at all?.
Not very much, and when it is, I do get it up and ice it.

Why should your hips stop you elevating one leg?
I can elevate my leg when I am lying down. When I am sitting up, the range of motion I have on my hips makes it uncomfortable to raise the leg above my hip.
Pretty good but it's a little too much just yet, I do recommend you read this again Progression of activity for TKRs....
I am doing things as I feel able to do them. I have been through many joint replacement surgeries, and I know how to pace myself. And not all TKRs are the same...
Yes, up until this last week, I would say I couldn't do much of anything. This week is much improved in that regard. I know it will be a long stretch before I can get back to pre-op activity. But the things I am doing are not very much at all.
 
Good for you. Sounds like you have it under control. It sure helps when we start feeling like that, doesn't it? I just got there myself. Took me longer, I think, but I'm here in a good place now, with more good days than bad. My PRE op activity was nothing at al. I had 2 severe bone on bone and messy knees, now I only have one bad knee. Happy healing. Keep us posted.
 
For all of you people that still are having trouble falling asleep, or dreading going to bed. Have you gotten one of those wedge pillows. I got me before surgery from Foot Smart and I actually look forward to going to bed. I have never been a back sleeper, always slept on my side. But with this wedge pillow I am so comfortable. I don't know if regular pillows stacked would work as well. Maybe if you tape them together they might. So glad I bought mine.
 
My preop activity wasn't bad. I couldn't walk very far, and I had limitations on what I could do with this knee. Aside from the arthritis, I had a congenitally malformed knee anyway: the groove that is usually there, is absent on mine, and my knee dislocated easily. It was getting pretty bad, and really interfering with my work. I had to stop work because of it.

I have been very pleased at where I am now. My energy level is still low, but I can tell it is more than a few weeks ago. Pain has markedly improved over the past week, except for the sleeping thing. Stiffness and swelling have improved also...I can tell a big difference.

It will still be a long road to where I can go back to work. I cannot go back to work at half duty: I am a NICU RN and I need to be able to go back at full speed. I won't have the luxury of being able to sit down much, if I wanted to...

My therapist and I are working at getting me ready to drive again in the next week or so. And I am transitioning to a cane next week as well. I can put full weight on the knee/leg, which is a big difference from the hip replacements. I am working on walking unaided, and can do so pretty well....but I usually do so in a small area where I can hang on to things if I need to. Next week, we will be working more on this, and walking more. My extension is very good, and my flexion is getting better every day.

Now, if I could just get past this sleeping issue, things would be fantastic!
 
Would you be a dear and put your surgery date in your signature like the rest of us do?
Please also remember that our membership is international and for clarity use the International Date system being 7th August 2000 rather than 2/8/00 or 8/2/00.
You can find the instructions here How to create a signature
That also applies to anyone else who is reading this.
Thank you.
 
I find that to sleep on my back I have to have my upper body somewhat propped up in addition to my legs propped up a little with pillows. Gives my body a slight curl rather than being flat. I can't sleep with my wedge pillow. I'm mostly sleeping on my side now and sometimes on my stomach.
 
Sounds like you're progressing pretty well. Finding a comfortable position to sleep in can be tricky early on. I guess all I can say is experiment. Also I would say it's pretty normal to get uncomfortable at night and have to shift around a bit as the night goes on.
You may want to think about how you're spacing the pain meds--make sure you are not letting the pain take hold before you take your next dose. It doesn't have to be excruciating to be pain--sometimes it feels more like stiffness and discomfort.
 
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