Bilateral TKR New pain 10 mths post op

[conroesin]

I had surgery 4 days ago, came home Wednesday. First PT in hospital I had near normal rom, a little worse day 2 and 3 because block had worn off and swelling got worse. Overall, I think I am doing great except for pain. In hospital, was never on IV pain meds, just 10 mg oxycodone every 3 hrs. At home have been on 2 Percocets 5/325 every 4-6 hours. I am able to walk around on walker, but pain is never really under control. Always around level 8. Is that typical? What pain meds are most people discharged on? On my way to first outpatient PT and dreading it since already hurting!

 

[Pumpkin]

Conroesin,
Welcome to Bonesmart, , glad you found us.
Pain level of 8 is too high and will set back you recovery, call your OS and let them know you need better pain control. Like you say you are doing great except for the pain.
Percocet is commonly used post op.
Other things you can do for pain conrol is follow the Bonesmart manta, Rest, Ice, Elevate, and Medicate on schedule.
Sounds like your ROM is being hidden by your swelling, when the swelling goes down, the ROM will still be there. Do not allow the PT push your ROM now, it will only cause more swelling.

Here is some post op reading that will answer many of your questions, the articles are short and will not take long to read.

First are the BoneSmart mantras ....
- 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!
- be active as much as you need to be but not more than is necessary, meaning so much that you end up being in pain, exhausted or desperate to sit down or lay down!

Next is a FAQ (Frequently Asked Questions) thread.

And here are some very crucial articles
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?
Activity progression for TKRs

Healing: how long does it take?
Chart representation of TKR recovery
Energy drain for TKRs
Elevation is the key
Ice to control pain and swelling

Home physio (PT) and activity progress: suggestions
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds
Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

And then some wise words from members who have shared their experiences ...
Where are you in recovery?? (TKR)
Five “P’s” of knee recovery
TKR: work “smarter” and not “harder”
Recovering a knee - from one who knows!
It's never too late to get more ROM!
It's worth the wait for ROM

Please post your surgery dates in your signature so we can better answer your questions, just hover over your user name top right, and a drop down menu will appear, click on signature and add your surgery date, and any other information you would like to add, Thank You!

Let us know how the PT went today, and keep us posted on how you are doing,

 

[tiredwife]

Hi, yes an 8 is too high. 3 or 4 is more doable, ask your doctor for something in addition to the Percocet. On hubby's second knee he had to have an additional long acting (12 hr. narcotic). He was having extra pain because of blood pooling behind the knee cap. After he was off the blood thinners it absorbed into his body. Elevation is really important. A swollen knee won't bend.

 

[skigirl]

I could not get rid of the pain with percoset either. I got 10 days of oxycontin and that made a big difference.

Also sometimes one pill every 2 hours instead of 2 every four hours gives you more pain relief.

 

[Shmi47]

Hi congratulations on your surgery. However an 8 is too high. I don't have a good tolerance and I was on extended release hydromorphone and immediate release. That was until last week (week 6). Now only taking hydrocodone at night.
I hope that you can find a way to manage your pain through your doctor.
Good luck. I am sure you will have a lot of comments here.


Sent from my iPhone using BoneSmart Forum

 

[mom2fencers]

Congratulations on your surgery and welcome home. An 8 is indeed too high. I came home on Gabapentin at night along with hydromorphone 2mg 1-3 pills every four hours for pain, and I took it. I also used it prior to PT. And my doctor gladly refilled as requested. I was at level 8 in the hospital on day 2 when the femoral artery block wore off (and I was happy to see my nurses were concerned) and I was an 8 one day at PT when I was hanging my leg from a little block at the ankle, going for a target of 2 minutes. I lasted 20 seconds... My senior PT came over and put his arm around me and said, "You sound like you are at an 8. This is not good. Stop." I did stop and I sat and cried. He told me to never go beyond a 3. Now I can hang from that little foam block for 5 minutes comfortably, but it has been a slow walk into it, gradually setting small goals like 10 seconds, and seeing progress. I ice alot and elevate at night and get rest. I hope you get your pain managed soon.

 

[kneeper]

I hope the pain is a bit better. Definitely ice a lot and call the doc to let them know the pain meds aren't helping much.

 

[conroesin]

Thanks for checking in. My doctor suggesting more frequent dosing on Friday, but that hasn't really helped. Talked to her again today. Tomorrow my husband will pick up a prescriptions for OxyContin with a stronger percocet for breakthrough pain. I hope that wil do the trick!

 

[tiredwife]

@conroesin Hope it works for you!

 

[icep707]

Most importantly is to properly elevate and ice that knee for as long as humanly possible. For me it was 16 hours a day for weeks. Also take medication throughout the day and night. Do not miss a scheduled dose. In hindsight after reading what people are getting sent home with as far as meds are concern , my OS must of been trying to kill me, get this 10mg oxycontin, 5mg oxycodone, tramadol , celebrex , Zarelto for blood thinner plus i had a fresh giant bottle of tylenol from Costco. i stopped taking any of the oxys after day 5 or 6. Too many side effects, nightmares, constipation , loss of appetite etc. Plus my GF was afraid i was gonna overdose as i was taking everything as directed. Got by excellantly without the oxy but increased elevation and iceing. However i was well versed as i immersed myself in bonesmart for 3 months prior to my surgery. Sleep is elusive, swelling inevitable and frustration common. Stick around , do not let a therapist overwork you and or hurt you. I had 2 therapist 1 was extremely gentle the other extremely rough. Do be afraid to put them in check, its your knee or knees. Best of luck , Iceman

 

[lunula]

Hi there - congrats on your new knee! I certainly hope your pain levels begin to subside very soon. Absolutely call your OS, as others have mentioned. I have issues with narcotics due to extreme itching (which becomes worse than the pain it masks) and I had a candid conversation with my OS about pain control and he assured me there were other options, and he would work closely with me to make sure we found something I could handle that worked. If what you are taking isn't working, try something else!

Good luck, please let us know how everything goes!


Sent from my iPad using Tapatalk

 

[ljrfrm]

An 8 is definitely too high and shouldn't be considered "normal". I was able to stay around a 2 or 3 once I was home, by taking Hydrocodone and Tramadol. Everyone reacts differently so pain meds, so what works for one person, might not work for someone else. So, continue to communicate with your doctor if your pain remains high once you get the new prescription. I found that constant icing really helped as well. Good luck with your recovery.

 

[skigirl]

I hope that by now your pain is under control---oxycontin was a wonder drug for me for the 10 days that I took it. Here is some into on elevating and ice--which are great pain relievers too

Elevating your leg to control swelling and pain
Using ice

 

[Roy Gardiner]

On my way to first outpatient PT and dreading it since already hurting!

See the mantra; PT should not be painful!

 

[conroesin]

Thanks for all the encouragement and advice regarding pain control. My doctor gave me OxyContin with percocet as needed, and that did the trick! It eliminated the ups and downs and gave me steady relief. I think I am progressing well now. Can climb a flight of stairs as needed, and notice my quads are getting stronger. I will be happy when I can start weaning off the meds so my head is clearer, but for now I am very grateful to have them!
On Tues 11/4, I have my 2 week follow up and get my staples out. yay! Will be so happy to be free of those!

 

[mom2fencers]

@conroesin, glad to hear you are doing better. I would encourage you to use pain medication as needed, and not try to wean yourself off too soon. Healing from a TKR is 3 steps forward and sometimes more steps forward, but other times it is 3 forward and a few (or more) backwards. It's the nature of the situation.

Once we see "progress" it can be easy to think we can do more, and also think about backing off pain meds. Then, when pain does come back, we are not mentally prepared. I still use Gabapentin before bed and sometimes hydromorphone, depending on how my day went. I have found that sometimes it is not an issue of pain but of stiffness, or I may have done more than I should have. All that to say, take it one day at a time, measure small step progress, and monitor your pain. I will be 6 weeks post-op this Wednesday; while I have made great progress and am even back to work, I continue to monitor pain/stiffness and try to plan to stay ahead of it. My ice goes with me wherever I go and I keep pillows for elevating in my van when my husband takes me out somewhere. Best wishes to you as you progress!

 

[tiredwife]

@conroesin Glad they finally got your pain under control! Now on with the healing! I believe our stairs are one of the reason hubby did so well, he went up and down them lots of time a day.

 

[Djbrund]

Hi !

I came home from the hospital with exactly what I was given in the hospital to finally get my pain under control : 20 mg's of oxicotin every 12 hours and for breakthrough pain I took oxicodone 1-3 tablets every 3 hours. When I say the OS at about day 10 he have me 12 hour Oxi but only 10 mg's in stead of 20 at my request. I was able to stop taking that during the day at about 6 weeks and last night was the first night of no Oxi at almost 7 weeks. I refuse to let my pain go higher than a 3. My OS is pro pain management... Get in front of your pain , don't chase it.

This is hard, but it gets better. - a Joni.


Sent from my iPhone using BoneSmart Forum

 

[conroesin]

Staples and Aquacel bandage are gone! I had a waterproof bandage put on my knees in the OR that stayed on until my 2 week checkup. The good thing is I could shower from day 1. But having those things taken off was not fun. I have never been a fan of leg waxing. Yikes! But it sure feels good to have it all off. Just have steri-strips now until they fall off. Pain is managed, but I sure know it when it's time for next dose, or if I forget a dose.

I am actually enjoying PT. I think getting out of the house and getting exercise is really good for my state of mind. Keeps me from going completely crazy, but I sleep lost of the afternoon after my appointments. I think I may switch from walker to cane soon. I can walk without it in familiar places with furniture to grab when needed. Any tips for that transition? As a bilateral, do I need 2 canes?

This may be a question for my PT, but how much walking should I be doing? It seems that doing ANYTHING wears me out, but seems like walking would be good for me. I know I should listen to my knee...but are there guidelines for increasing my distance and frequency?

Regarding work, I work from home, on computer and phone. Right now, the idea of working seems impossible because I am always tired and drugs prevent me from concentrating for more than 5 mins at a time. I need to give my coworkers an estimate so they can plan around me (very small consulting firm). Is there any way for me to project that?

 

[tiredwife]

@conroesin There are people who have gone to work early (mostly regretting it), I would think because it is home and computer and phone as soon as you don't need as many of the pain meds. 8 weeks for office type work would probably do, but everyone is different and their need for pain meds are different. Some people are off pain meds in a couple of months, some are on them a lot longer. Wish I had a clearer statement, but TKR doesn't follow a guide line.
Are you eating enough protein? Your body needs it to heal and for energy. Exhaustion is very normal.
You can practice with the cane in a place you feel comfortable and when it feels safe switch over. Some people use the walker in the mornings because they are stiffest then.