TKR TKR 4 weeks post op

[carrie56]

I had my left TKR done 4 weeks ago tomorrow. I've had my right one done 2 times, once at 35 and then again at 50... basically all a result of a car accident when I was 20 breaking both femurs and compound fracture below right knee. Arthritis caused by trauma.

I thought since I had been through this before a couple of times I knew what to expect, maybe I forgot. It just seems so hard and there are days I get very depressed. Maybe things aren't moving fast enough and still painful. I seem to have good days, where it feels pretty good, although still stiff, and then days like today, where it really bothers me and feels unstable and very sore.

I am walking gingerly without aid and I have 120' and 0' so I think I am doing well with the ROM. I got to PT 3x a week. I still take pain killers (Norco 2x a day). Having a really hard time at night, can't get comfortable, not much sleep, a deep ache that goes from mid thigh to mid calf and pain killer doesn't seem to help this.

Am I expecting too much too soon? Is it reasonable to be taking pain killers at 4 weeks out? I feel if I push too much I pay for it with pain and swelling, so am taking it easy.

I did try and go into work but only lasted 1½ hours at my desk..this is after taking an hour to get ready and then driving in..so was already feeling bad when I got there. I can work at home, so I do right now, I might attempt it next week.

For those of you experiencing this now, am I at the right stage 4 weeks out?

I really like this forum, great support and information.

 

[bottomshollow]

carrie56, so pleased that you have joined us here on the forum. Well, no two recoveries from TKR are the same---and it's been 6 years---and we do forget. I have some reading for you! The first set is essential reading, the second and third are useful and the fourth is just good information, but you will need it all.

Group A
The importance of managing pain after a TKR and the pain chart
Myth busting: no pain, no gain
Swollen and stiff knee: what causes it?
Progression of activity for TKRs

Group B
How Long Does Healing Take ......
Chart representation of TKR recovery
Energy drain for TKRs
Elevating your leg to control swelling and pain
Using ice
Constipation and stool softeners
Sleep deprivation is pretty much inevitable - but what causes it?

Group C
Knee Replacement - Where Am I in Recovery?
So What Is It Going to Take? The Five “P’s” of Knee Recovery
Work “Smarter” and not “Harder”
About recovering a knee - from one who knows!
Some suggestions for home physio (PT) and activity progress
Myth busting: The "window of opportunity"

Group D
MUA (manipulation under anaesthetic) and adhesions
It's never too late to get more ROM!
It's Worth the Wait for ROM
Myth busting: on getting addicted to pain meds
Post op blues is a reality - be prepared for it

Please don't be overwhelmed by the list. The articles are not lengthy and contain information that will answer many questions and help you make your recovery much easier on your knee and on you. I have put the ones you should read immediately in bold type.

I also want to share the BoneSmart mantra with you. Following it to the letter will assure you of the best possible recovery.
- rest, elevate, ice and take your pain meds by the clock
- if it hurts, don't do it and don't allow anyone - especially a physiotherapist - to do it to you
- if your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again
- if you won't die if it's not done, don't do it
- never stand when you can sit, never sit when you can lie down, never stay awake when you can go to sleep!

We are here to help in any way we can: answering questions and concerns; supporting and encouraging you from start to finish; giving you a place to vent, whine, complain if you need to; sharing experiences with one another; and having fun and some laughs along the way.

Take care and keep us posted. We care.

 

[kimejen]

Carrie, I think you're doing amazing for 4 weeks out. Don't push yourself too hard, you are still in the very early stages of healing. A lot of work has been done to that knee of yours, it has to be allowed to heal. I went back to my OS at just over 7 weeks for my check up and he said "it's still early days, give it at least 12 weeks." I'm 9 weeks post op and only just feel like I'm turning the corner. I can't drive, because the lifting of the foot from excelerator to brake isn't working 100% just yet, so have to wait til I feel confident I can brake in an emergency. Far too early to be thinking of going to work. Do the reading that Judy B has given you and you will see it is a long road to recovery. This cannot be rushed. Learn to be patient - that is certainly something most of us have had to do here, and take one day at a time. Take care, and you, like all of us on this journey, will get there in the end. All the best. Jenny

 

[Roy Gardiner]

Hi, Carrie, welcome to BoneSmart.

Everything you say is absolutely typical of 4 weeks out. It seems like it 's been going on forever, and that there's no end to it, that nothing's happening. Here's my analogy; think of moving a pile of 1,000 bricks, one at a time. You work for ages, you are tired, you've moved loads -- and that stack to be moved looks just the same. That's what's going on here, your body is healing like mad but it has so much to do that it's hard work.

You'll get there. Your ROM is very good for the length of time post op. Relax, follow the mantra, you'll be fine.

 

[Josephine]

Well, in some things you're way ahead, like your ROM - 120/0 at 4 weeks? That's amazing! Gee wiz!

However on others your expectations are way too high. Let me quote a few for you

I am walking gingerly without aid

If you can't walk with confidence then you need aids. Their purpose is to develop confidence not to mention a normal gait. Very important. Don't drop the aids until you find yourself walking away and forgetting them! That's the signal. Until then, use aids.

I still take pain killers (Norco 2x a day). Having a really hard time at night, can't get comfortable, not much sleep, a deep ache that goes from mid thigh to mid calf and pain killer doesn't seem to help this.

Is that all you are prescribed, 2 Norco a day? Are they extended release? What dose are they? Because the rest of this quote tells me your pain is seriously undermedicated!

Is it reasonable to be taking pain killers at 4 weeks out?

Most people take pain meds for around 12 weeks or even longer. This is a very painful procedure and a good recovery is totally dependant upon good pain management.

I did try and go into work but only lasted 1½ hours at my desk

Well forgive my directness but I think you now realise that was a rather stupid thing to do!

In my spare time outside BoneSmart, I am an Occupational Health Nurse and often get called upon to clear employees back to work after major surgery or illnesses. The OH policy in the UK is 12 weeks off then then a Phased return to work. No if's, and's or but's! And most employees are very pleased and grateful for the policy. Now I know things are a little different in the US as you don't have the NHS benefits system when you are off sick, but going back to work at 4 weeks is really not an option after a TKR.

So what's the arrangement you now have with your boss about returning to work?

I have some more questions to ask you:
1. how often are you icing your knee?
2. how often and how high are you elevating your leg?
3. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc.,
4. how much PT and exercising do you do on a daily basis?
(and 5. have you read the articles Judy left for you? )

 

[1ELISEA]

Welcome to the forum.
Appears to be a normal recovery, except you are ahead in several areas such as ROM. Slow and easy does it on walking and working, give everything a chance to heal.

 

[puffin]

You are doing very well - but you may be tending to overdo it which is making you pain and exhaustion worse

 

[referee54]

Am I expecting too much too soon? Is it reasonable to be taking pain killers at 4 weeks out? I feel if I push too much I pay for it with pain and swelling, so am taking it easy.

Welcome to the forum! Many of us were taking pain meds for some time---please realize how traumatic the TKR surgery is---slicing, sawing, pounding, manipulating, manhandling, etc---it is not gentle---so it will take some time for the knee to relax and get over its "anger."

You are wise to realize that if you push too hard that you will pay for it! Taking it easy and taking it slowly is the correct course of action. Fight the temptation to work harder! Work smarter, instead!

I did try and go into work but only lasted 1½ hours at my desk..this is after taking an hour to get ready and then driving in..so was already feeling bad when I got there. I can work at home, so I do right now, I might attempt it next week.

I went back to the classroom at eight weeks---and that was much too early---I should have waited another four weeks or so. It was do-able, but it really did slow down my recovery. Try to take as much time as you can before returning to work---you will be thankful that you did. Even if you say that you have a"desk job", you will be amazed to see the logistics of getting to and from work, and the amount of waling around you do.

t just seems so hard and there are days I get very depressed. Maybe things aren't moving fast enough and still painful.

Feeling down in the dumps or depressed is all perfectly normal, too. The pain meds, the isolation, the lack of mobility, the lack of spontaneity, and the lack of independence all contribute to it.

As for things moving fast enough--you are doing fine! Please be patient...you will, like myself and many, many others, find a great deal of patience that you did not know that you have.

 

[carrie56]

Thank you all so much for all your responses, what a great forum! Everyone is so supportive, it hard to explain to people who haven't experienced this just how really hard it is, physically and emotionally. I read all the links, great information. I go back to OS on Thursday for my just over 4 week checkup. Senseless days are really good, but a lot are bad, knee feels weird and clunky. I'm not sleeping at all, and that itself is making everything else harder. I got up this morning, and got in the shower thinking I'm getting out of the depression and feeling sorry for myself today. Took the shower, took a pain killer and Got back in the bed

I Did manage to get more motivation and went to the grocery store with husband while the pain killer gave me the "window of opportunity" as I like to call it. I absolutely dread the nights and one is approaching.

Thank you all for listening, sometimes it's just good to vent to peeps who truly get it!

 

[referee54]

I absolutely dread the nights and one is approaching.

I also dread the coming of night---after I was no longer taking the Oxycontin, I had trouble sleeping. It was not that I was in pain---I just could not get comfortable. Three of my friends who went through TKR's before me told me of this issue, but I did not believe them.

I wandered around the house like Diogenes, but instead of looking for one honest man, I was looking for one good night's sleep. I finally gave in and listened to my OS---he prescribed some Ambien, and that did the trick. Are you in pain at night? are you taking the pain meds on the clock prior to the pain setting in?

Take a look around the forum---others will chime in and help you get through these nights and give you suggestions as to how to get some sleep.

 

[carrie56]

To answer a few of Josephine's questions...i just need to take the painkillers more I think, and at regular intervals again, and the funny thing is...my husband said the exact thing about going into work..stupid! So ya...not doing that for a while. I bought one of those ice machines that moves the cold water around the knee, and love it, use it 3-4 times a day. Probably haven't been elevating as I should..I started to do that more today from reading those links. I have formal PT 3 x a week that I drive to, and do it myself the other days 2 x strengthening and bending, but not to the point of pain. My activity level is minimal I think..I go up and down the stairs a couple times a day, don't cook or clean..I should..but standing for any length of time makes my knee feel like a melon in a matter of minutes. I do try and get out 1 x a day..short trips to grocery store..or out to dinner where I can put my leg up. I figure the walking to and from car is good exercise. Like I said some days are better...it's the days that aren't that get me down, and like I'm sure everyone on here have been dealing with chronic pain for a long time...and it just gets old.

 

[carrie56]

My husband wants me to call and get some ambien also, so I might try that. Its not stabbing pain, but really a constant painful ache that goes from mid thigh to ankle...just a burning ache. Can't move without waking up.

 

[maryo52]

I wish instead of prescribing "1-2 tabs every 4-6 hours," physicians would teach their patients how to titrate their medication.

First, the aim is to get your pain to an acceptable level (to me, that's under 3 or under on the 0-10 pain scale). Is one pill doing that? If not, take 1.5 pills -- or 2 if necessary. Do they last 3 hours? 4? 5? 6? You find out by trial and error.

At four weeks I took one percocet every four hours round the clock. When I needed less, I told a half tab every four hours. As I got better it was a half tab every 6 hours, and so on.

When you brush your teeth and change into your jammies at bedtime, time to take whatever dose makes you comfortable enough to sleep. I'd go to bed with my knee packed with fresh ice packs. For the first two months an alarm woke me in the middle of the night to take that dose, and sometimes I put on another ice pack then, depending on my swelling. Ambien makes some people weird. Nyquil, benadryl, unisom are some OTC options. You might not need anything if you can rein in your pain level.

Hope this was helpful.

 

[referee54]

PT 3X a week sounds like a little much---I did 2X a week after a BTKR, and then I did my own stuff on top of that, but it is vitally important to let the surgical knee rest and heal---strength and stamina will come in time (albeit slowly) and it is better to error a=on the side of being gentle rather than over--exerting.

I would also stress icing, elevating, and resting after your daily routines---and inbetween, to boot.

When I d finally did return to work, I did absolutely nothing on Sundays. I went to church, and then I came home and iced, elevated, and rested the rest of the day. That seemed to help greatly.

 

[skigirl]

Carrie when I was at four weeks, the doc told me to have one hour down in bed with elevated knee for every two hours up. I work in my studio and that advice did help me from doing too much. Also, if you have to take a norco at 8 and at 12 so what? try to get a good night's sleep and everything else will seem easier.

 

[carrie56]

Carrie when I was at four weeks, the doc told me to have one hour down in bed with elevated knee for every two hours up. I work in my studio and that advice did help me from doing too much. Also, if you have to take a norco at 8 and at 12 so what? try to get a good night's sleep and everything else will seem easier.

That is great advice! I going to try and do that, I am working from home pretty much F/T right now, but can do it from my little computer table in the bed with leg up, I think sitting at a desk too long right now would be disastrous, I might try to work at a table for a bit at home just to get used to it, but being home, then I can easily ice and put it up when I need to. And am going to take my pain killers more frequently to try and get through a night with some sleep, I think my whole outlook would change if I had decent rest.