TKR Arjay’s TKR Recovery

Arjay

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Ok, my first BIG question after today's surgery: despite the way the ad pic is portrayed, with pillow support under the back of the knee, i was told by the nurse today that I def did not want to do that…like a hamstring stretch,, you want the muscles to flatten out for healing. But of course, with any kind of elevated stretch, that is not very comfortable.

Thoughts?
 
Had my surgery at 930 this morning…and home by 730. (That was a surprise!) And I appreciate just now reading this reminder so I just took some'due' meds. So much to learn, keep track of!
 
@Arjay Welcome to Recovery!

I moved your post over to the recovery forum and started a Recovery Thread for you. I’ll answer your wedge question in the next post.

I will leave you our Recovery Guidelines. Each article is short but very informative. Following these guidelines will help you have a less painful recovery.

Just keep in mind all people are different, as are the approaches to this recovery and rehab. The key is, “Find what works for you.“ Your doctors, PTs and BoneSmart are available to help, but you are the final judge as to the recovery approach you choose.

Knee Recovery: The Guidelines
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

2. Control discomfort:
rest
ice
take your pain meds by prescription schedule (not when pain starts!)​
If you want to use something to help heal the incision,
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.​

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

5. At week 4 and after you should follow this

6. Access to these pages on the website

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?

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 the 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 the member’s history before providing advice, so please post any updates or questions you have right here in this thread.
 
You will get many conflicting suggestions and advice in this recovery. The following is Bonesmart’s recommendation for elevating:
 
As stated above, you’ll get a lot of different suggestions. Your recovery nurse will tell you something totally different than your PT tells you, and bo5 may be different than what your doctor tells you. In my opinion, not having support behind the knee this early on is very uncomfortable and not good for your recovery. Your knee will flatten out in due time. There is no rush to make it flatten out right now.

Good luck with your recovery!
 
Thanks Jockette (and Panammaniac)! Helpful clarification and the pics a big help!
As it happens, i got a check up call from the RN just a bit ago….he did recommend the 'gradual slope' approach for knee elevation as included here.

The Day Two 'back to reality' adjustment is def underway. The nurse also gave me a more comprehensive explanation about the how's and why's of the pain meds - they sent me home w meloxicam, oxy, and tramodol. So, getting a handle on that. He also recommended more electrolyte replacement in these early days - which was GOOD, cuz by the time I got off the phone w him the slight 'tipsiness' I'd been feeling had escalated to full-blown - and scary - near faint-feeling, light-headedness. My son is here but he was erranding. I remembered I had a bottle of fortified water in the house, got to it - sooo carefully - and started chugging it. Also texted my son to bring back some sports drink type of thing. It was a scary experience and a reiteration of how much caution is needed in these days.

I'm learning - everything is a learning experience. Onward
 
I drank so much Gatorade for the first two weeks. I don’t usually drink that stuff but it did help a lot post surgery. I also found myself setting alarms to take pain meds on schedule, and sometimes that meant 2 or 3 in the morning. Taking those pain meds on schedule instead of letting the pain wake you up an hour past your scheduled time is a key.
 
Along with more fluids, try to get more protein into your system. It not only helps with healing, but it also takes longer to digest so you have less negative stomach reaction from the pain meds.
 
@Arjay
Gosh, I remember those early days of recovery.
I had a thirst and guzzled water for maybe a week. I now use electrolyte drops in a glass of water...maybe 2x / day because I eat low carb. It really helps restore and replenish without the sugars in sports drinks. I got it on Amazon.
Best of luck with your recovery!
 
Day 6 with several thoughts: Bless whoever it was in the past week who said 'Set the alarm' and stay on the med schedule through the nite. Genuis!!

And despite how much I've read here prior to surgery and in the days since, I let that 'stay on the Tylenol schedule' slip past me and was getting 'casual' about it. I intend to be better.

I am worn out - had my kids here one after the other since I got home; my daughter left 2.5 hours ago and have been/will be alone. 'Help' is kind of a mixed blessing, I find. The help is def appreciated/needed, but the necessary 'social interaction' and the giving directs, etc…starts getting tiring. Plus, they operate on a much faster wavelength than I do at this 'stage of my age' and the whirl is wearying. (But I also see myself, 30 years ago, making the same mistake when helping out my Mom, just not realizing I should be going at her pace.)

So paying the price in swelling and tiredness. And am going to be really good going forward.

'Weary drifting' taking place. Gonna give into it.
 
One other thought….came across something today that mentioned the high level of sodium in the electrolyte beverages….which kind of fights the water retention/swelling issue????
 
@Arjay
I use Keto chow electrolytes...Amazon. 1- 5 drops in 16 oz water. No taste. It will help you pee out the fluid retention. And give you a little ADL movement getting up and going to bathroom.
 
I have rehab appt tomorrow - first was last Friday after Tuesday outpatient surgery. (A little quick, maybe?) And I'm feeling a fair bit of anxiety - in part because of some of the PT stories here, along w concern that my doc, along with the PT practice, may share a pretty vigorous approach. Somewhere along the line, I acquired the following printout -which is from my OS's office - and only took a real look at it this evening. Is it just me…or does it sound pretty aggressive?

I know it is my knee and my recovery and up to me to be in charge. I think I may just be blathering on here to be my own sounding board and bolster my intent. Despite my icing/elevation attempts, I have what seems to me to be a lot of swelling - I am all on my own and so up and around probably a lot more than is recommended. So I'm pretty much dreading tomorrow's encounter.
 

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Despite my icing/elevation attempts, I have what seems to me to be a lot of swelling - I am all on my own and so up and around probably a lot more than is recommended.

That list of exercises are not good for you at one week post op. Since all PTs are different, there is no guarantee that they will ask (remember, it’s a request, not a command) you to do those. That paper is a one size fits all print out that they give everybody and very out of date, not that it was ever appropriate.

Movement for your knee is important and that happens when you are up and around, especially if it’s more than recommended. Because of that, and all your swelling, you don’t need to do a list of exercises. Being up and around is what I like to call “natural PT” and it’s all you need.

I started outside PT 36 hours after surgery. I now know that was way too soon. I should have been home icing and elevating, not forcing my unbendable knee into a car, then a long walk into the building, spend 45 minutes there, then reverse the process to get home.

If you don’t feel up to going to this appointment, cancel. If you do go, ask for treatments to address your swelling. Do Not let anyone bend your knee, it’s not necessary.

Try not to be intimidated by your PT. They are just people and your opinion about how it goes is the most important.

I don’t plan on going to PT if I ever do another replacement. My body will heal fine, and better than this first one I have, on my own at home.
 
I was encouraged just to try the heel slides and knee extension exercises after discharge to home. I did not do them perfectly or for the required time, but I tried every day. I think getting in and out of the car at this time is going to hurt trying to bend that knee especially with your swelling. Can you ask for home PT? I wouldn't go until after the dressing is removed. During that appointment you can ask questions. After the swelling goes down you will be surprised each day at what you can do! Give yourself some time.
 
I'm one of those who never took formal PT. I've had 12 knee surgeries, 2 of them kneecap removals, and 1 tkr. Even after those I never took formal PT. But, I didn't just sit around and do nothing, I used my knee as it was intended to be used by walking around to take care of my daily needs along with the necessary house and yard work. As I healed I was able to do more. Icing and elevation were a huge part of my recovery.

Listen to your knee. It will tell you if you're doing too much by increasing pain and swelling. When that happened to me, I found that resting, icing, and elevating helped. Your knee knows how to rehab itself without being told what to do.

I was blessed to have a surgeon that never pushed PT. He gave me a prescription for it, which I threw away and never went. When I went for my 3 return checkups, all he was interested in was to see what my knee would do and never measured. He never even asked about PT! Of course, he knew I was a single lady that had to take care of myself and obviously trusted that I would not be just laying around all the time.

After 12 knee surgeries, I know that I do not need formal PT, and neither do many others if they do their own daily activities and do not just sit around all day and night. My knee recovered just fine all on its own with only my daily activities. I didn't have the terrible swelling or agonizing pain that so many have after taking formal PT. I knew the Bonesmart way worked before Bonesmart was even thought of. My surgeries started in the early 80s and I never went to PT even back then. I just didn't see the need for it. Bonesmart was formed around 2004. By then I had already had 6 knee surgeries and rehabbed the Bonesmart way!
 
Thanks for the input! When more rested by this morning, I managed to take a more reasoned, less adverserial (in my mind) approach. I did keep the appointment and felt it was going ok. Did not feel I was being asked to exceed my limits - tho a couple times right up to it - and I would say 'enough.' Nonetheless, the swelling - which was starting to come down decently this morning - is back up and bad. The ice machine and separate cooling paks (from my hip surgeries) are not enough to reach all the spots that are craving ice. If I still feel not good in the morning, I will know I need to really take the reins and cut back.

One thing that concerns me is that my surgeon, who I chose based on enthusiastic recs from people I respect but have, myself, spent less than a total of 30 (waking) minutes with is, I think, quite the zealot on PT. Not that I have much to go by, but from the look of my leg and the nearly complete lack of pain (when following dosing instructions), I'm suspecting that he may be a very fine surgeon, but not the person for me when it comes to PT philosophy.

I have worked with a therapist in the past with whom I had great rapport and respect. And am feeling really sorry for myself cuz he took off for his annual Florida sojourn the day after I had my surgery.

I'm impressed by those of you who had the chutzpah to forego rehab altogether. Tho I do think fulfilling the daily acts if living should certainly be the guide as to where we want to be able to end up. Thanks to each of you for taking the time to share what you've learned. This forum is a great place.
 
@Arjay I’m sorry about your surgeon. It doesn’t sound like he’s been there for you. I’m very lucky....there have been times I’ve sent a patient portal message and he is the one to respond....by phone!

Your surgeon did your surgery. IMO he did his job....use him for what you need him for: post operative care and drugs (if needed). Go to PT if you want and YOU set the pace, literally. Say no when you need to. Too much swelling? Skip the next PT. It’s your body!

Marie
 
there have been times I’ve sent a patient portal message and he is the one to respond....by phone!
Wow, you are so blessed to have such a personable doctor. From what I've learned, they are very few.
Too much swelling? Skip the next PT. It’s your body!
So true. When PT causes more pain and swelling, then it's not good for your healing knee. You will have to take time to heal from the PT before you can get back to the normal surgical healing.
 
The support/encouragement here is SO important. Especially as we have all been inurred to the whole 'It's supposed to hurt - do it anyway' therapy dogma. 15 years ago, when my husband had a traumatic quad injury (4 month recovery), his very respected OS cautioned against the 'many PT's who go too far too fast.' (Another pro I wish were here now…) I don't question that some therapy, by very careful therapists, doesnt have a place. In some situations. But…..

I am better pain/swelling-wise overnight. I figure to go to tomorrow's appointment and make clear to the (new to me) therapist that yesterday's level was unacceptable - just the mere making you swollen and painful when you are trying so hard to bring down the swelling…is lunacy. We can try some very gentle, basic moves - NOT a 45 minute workout - and see how it goes.
 

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