TKR Dear Diary, Surgery Complete

[SnowHare]

Day 2 Post Op

So far things are going much better than last time (2019). Totally different pain control meds protocol. It seems to be working. Last time was 2 days in the hospital post op, this time I went home 7 hours post surgery.

Went for my x-rays yesterday. Normally, the x-ray is done in the operating room, but I had my surgery at a private clinic, which has no xray on site, so I had to go either on day 1, or day 2. Results are:

FINDINGS
Left knee arthroplasty is well seated with no periprosthetic lucency or fracture. No significant knee joint effusion. Anterior skin staples and extensive subcutaneous emphysema in keeping with recent postoperative status.

IMPRESSION
Uncomplicated left knee arthroplasty.

Yay. I love that the province now lets patients read their lab and/or imaging results.

This time round, my DH has been corralled into being my exercise coach - heel slides, chair pushups, leg lifting, etc. He's actually not very good with the support, but he's doing his absolute best. I know it's hard for him, but this time, I'm making my needs a priority.

The clinic told me to expect the first 3, or 4 days to be totally miserable, and I should keep myself distracted with things like Netflix.

Stairs are ok, except for the landing and the bottom, where there is a newel post. The only way I can manoeuvre is to turn around and take the last step backwards. For the time being, I'm staying upstairs.

 

[Layla]

Great news! So far so good.
Best Wishes on your healing journey!

KNEE RECOVERY GUIDELINES

As you begin healing, please keep in mind that each recovery is unique. While the BoneSmart philosophy successfully works for many, there will be exceptions. Between the recommendations found here, your surgeon's recovery protocol and any physical therapy you may engage in, the key is to find what works best for you.

1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now, they are almost certainly temporary.

If you want to use something to assist with healing and scar management, BoneSmart recommends hypochlorous solution. Members in the US can purchase ACTIVE Antimicrobial Hydrogel through BoneSmart at a discount. Similar products should be available in the UK and other countries.

2. Control discomfort:
rest
elevate
ice
take your pain meds by prescription schedule (not when pain starts!)
don't overwork.
3. Do what you want to do BUT
a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you
b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.
4. PT or exercise can be useful BUT take note of these
the BoneSmart view on exercise
BoneSmart philosophy for sensible post op therapy
5. At week 4 and after you should follow this
Activity progression for TKRs
The Recovery articles:
The importance of managing pain after a TKR and the pain chart
Swollen and stiff knee: what causes it?
Energy drain for TKRs
Elevation is the key
Ice to control pain and swelling
Heel slides and how to do them properly
Chart representation of TKR recovery
Healing: how long does it take?

Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

Nutrition is of paramount importance. Available here are dietary tips, nutrition basics and additional food supplements. These articles are both general advice on food and specific guidelines aimed at people both pre- and post-surgery.

There are also some cautionary articles here
Myth busting: no pain, no gain
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds

We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery. While members may create as many threads as they like in a majority of BoneSmart's forums, we ask that each member have only one recovery thread. This policy makes it easier to go back and review history before providing advice.

 

[benne68]

Welcome to the Healing side, @SnowHare! Glad to read that your pain is under control right now, but don't be surprised if it worsens over the next few days -- that's normal.

Since you've been on this journey before, you know what to expect. Take things slowly and give your knee time to heal.
Best wishes for an easy recovery.

 

[SnowHare]

@benne68
Thank you for your encouraging words. I have been warned about the first 5, or 6 post op recovery days being a bit of a complain. But this time around, it's been going so very much better. I can move much better already. The hardest part is doing my Level 1 post-op exercises. My quads aren't firing that well yet, but by the 5th rep of an exercise, they seem to get the message. Then they forget it.

I am in good spirits compared to my first TNK in 2019. They've changed the medication protocols, and apparently it has been really successful for so many patients. No more in the hospital for 2 days, just home the same day.

 

[mendogal]

Yes... quad sets seem simple but they are a potent exercise for waking our quads and promoting both range of motion and circulation.
Later on they can also play a role in knee-friendly strengthening. I still do them!
Something I have done for decades in order to signal a specific small muscle, or a zone of a larger muscle (like the quads!), is to gently place my fingertips on the area I want to activate and keep them there throughout the exercise.
I'm interested to know if this seems helpful for you!

 

[SnowHare]

@mendogal Are you pressing down with your fingertips? At what point of the quad would you press on? I am interested in trying this.

This is the third knee surgery I've had. The first one was over 50 years ago for a torn cartilage. It was a much more invasive surgery then. The year before that, I was in a car accident and had lost the ability to walk well. So this is my fourth time having to reactivate those quads.

 

[mendogal]

Just light consistent touch so the muscle has an external clue as to where you want activation.

For the quads, being so large, I would do several areas one at a time. The placement isn't important. My medial (inner quads) were firing fine so I focused on the lateral (outer quads). So to start with you can place fingertips of one hand on one side, the fingers of the other hand on the other side.

I would generally start with the lower quads close to the knee, fingertips maybe 3" above the top of the kneecap, and then after a half dozen strong contractions move to a spot 4 or 5" higher. It's not a scientific treatment, just a handy neuromuscular tool.

 

[SnowHare]

Janet, thank you for this. I am going to try this with this morning's exercise session.

 

[SnowHare]

Dear Diary,

Day 4, post-op

My appetite has returned. I'm feeling famished. Compared to my TKR in 2019, this year's surgery is like night and day. I am not in an incredible amount of pain. Discomfort? Yes. Pain trying to do quad exercise. My quads are just not happy. No puffiness in my feet. I can put weight on my operated leg. Not lots, just some. Just waiting for the bowels to get firing. Dear Daughter is making me Get Up and Go Cookies, because I never got around to it pre-surgery.

 

[NimbleKnee]

Congratulations on a successful surgery! Hang in there! Having gone through this before, you know there will be better and worse days, so you know to just keep plugging along. Glad to hear you are prioritizing your needs.

 

[Jockette]

Dear Daughter is making me Get Up and Go Cookies, because I never got around to it pre-surgery.

I have that recipe and they are quite tasty! I’m not sure they ever helped me but it was a good excuse to eat a cookie or two, guilt free!

Pain trying to do quad exercise. My quads are just not happy.

Then just wait on this one. Don’t do a painful exercise. Your quads will feel better in a week or two as they heal.

 

[SnowHare]

Dear Diary - caregiver expectations vs reality

Well, the blues has hit early. It seems to be centered around my expectations of my husband's ability to be a caregiver, his ideas about caregiving and the reality. He is more in love with the idea of being a caregiver, but not the reality of it. My expectations about caregiving are more about suck it up and get it done. It's not about you, it's about me.

Husband was expected to read the booklet on recovery. He didn't. He was in charge of coaching me with my exercises. Instead of doing my exercises 4 x per day, I was doing them 2 times per day. He emptied the honey bucket, but when I had a bm, I knew well enough to empty that myself, which meant carrying the bucket to the bathroom, emptying it, cleaning it. He would have made such a loud production of it. I don't need loud productions. I asked him to just move the commode to the bathroom, and I would manage there.

He will only do things on his terms, which for the patient is counterproductive. I told him that my sheets would need changed today, and maybe he might consider changing the sheets on his bed. He declined, and he asked me to ask our daughter to come over and do that. I asked him to be in charge of the medication. That lasted one day. I know his strategies. If he doesn't want to do something, he will either make a big production of it, or screw it up. I'm not even sure if he is aware he does this.

He likes the idea of being the perfect caregiver. Reality is more than he can handle. Care giving is hard work. I know this - I did a month of caregiving for my sister, while she was fragile after having her immune system knocked out. Washing floors daily, laundry daily, etc., is not glamorous, and it's bloody hard work. My husband's mother was a demanding hypochondriac. My mum told me, when I got married, that should my husband ever get sick, that he would be a terrible, self-centred, demanding patent, but should I ever get sick, I would be on my own. With my first 2 cesareans, I was expected to do everything, including nursing a new baby, within a week of delivery. I had no help. I'm good at doing what needs to be done, without complaint, even if its to my detriment.

With my husband, I should have known better to have high expectations. It's not in his DNA to be a caregiver, and I am not good for asking for help. I don't have friends to call on.

This has torn a hole in my fragile, depression safety net, and I feel I'm falling through this hole into a real funk.

This post is really just for me. I just need a place to vent, to have my voice heard. I am not expecting solutions. I can mostly manage. People do. I'm just expressing my disappointments.

On the plus side of the ledger, my recovery seems to be coming along much better than the last time. A fitter body, different pain control protocols seem to have made a big difference.

 

[Jockette]

Hugs to you, vent all you want with us.

 

[mendogal]

You're definitely not the only member to be very disappointed by their partner's inability to rise to the challenge.

Sending a ((hug))!

 

[Layla]

I am so sorry you're feeling neglected. I wonder if your husband simply feels overwhelmed or conflicted in his temporary role as a caregiver. Possibly it's more difficult for him to see you in a vulnerable state than he imagined. You mentioned you don't have friends to call on, but what about support from family, or close
neighbors?

It sounds like you're doing a lot on your own already, possibly his attitude will improve if you only call on him when you're unable to do something yourself. Certainly doesn't feel fair, but I guess if you lower your expectations you'll hopefully feel less disappointment. Wish we could physically help, but since that impossible we will be good listeners when you're in need.
@SnowHare

 

[SnowHare]

Thank you for your understanding and support.

I had a chat with each of my kids yesterday. My daughter said she would try and come over 2 or 3 times a week with the dogs, so I can have puppy therapy. She came over, stripped and changed the beds, and got the dirty sheets in the washer. One son, who lives half an hour away, said he would try and come every weekend and cook a supper. He would help with laundry. The other son lives half an hour away, works shifts, and he doesn't drive. He has always kept himself distant, so I might get a phone call from him once a week.

I have decided to manage the exercises myself. I/we misread the booklet. The exercises are to be done 4 times a day, not twice. I told my husband he doesn't have to coach, as it's 4 times a day, and that would mean that he would have to stop what he's doing and coach me. He asked me if I was punishing him. I told him that I was choosing to do it on my own, as I was looking out for his needs. Actually, I am being selfish - I don't need him grumpy and feeling hard done by.

I'm trying to look at this positively - that I am now in control of my recovery. Other people have nobody to do anything, and they somehow manage.

This too will pass.

 

[Layla]

How wonderful that you were able to make arrangements with your kids for the support that you need. Your kids sound like they will be loving and attentive caregivers. I’m happy you found the help you deserve. Love how you’re taking the high road, with hubs! Protect your peace. May it all work out for the best!
@SnowHare

 

[Jockette]

I/we misread the booklet. The exercises are to be done 4 times a day, not twice.

4 times a day is unnecessary and could cause a setback from overworking your new, healing knee. Actually, all you really need at this very early stage are non formal gentle bends and short walks.


Regaining our ROM is more about Time than repetitions of a list of exercises.

Time to recover.
Time for pain and swelling to settle.
Time to heal.

Our range of motion is right there all along just waiting for that to happen so it can show itself.

In the general run of things, it doesn't need to be fought for, worked hard for or worried about. It will happen. Normal activity is the key to success.

 

[SnowHare]

The exercises are mostly things like foot slides, foot pumps, quad strengthening, arm raises. the only range of motion exercises are to try and straighten your leg. The hardest thing to do is actually the shallow squat. My ice machine and I are really good friends, along with my lounge dr pillow I bought for my first knee replacement.

 

[Jockette]

The hardest thing to do is actually the shallow squat.

It’s way too early for even a shallow squat, as an exercise. You get that movement, in the course of a day, just sitting down in a chair.

It’s really ok to be gentle with yourself, your knee will thank you!