Thanks for the welcome and advice
@Celle and
@Roy Gardiner.
Today I celebrate 8 weeks post TKR and I thought I'd share my experience to this point. Overall I thought I would be farther along by now - walking without assistance, or significant discomfort, and at times have been very frustrated and depressed that I'm not there. But thanks to the BS guidelines and member's stories I'm gradually coming to understand that recovery will be longer than three months, and I'm adopting more realistic expectations. I've organized my experience into Good, Bad and Undecided categories.
My surgeon practices a protocol designed to get you out of the surgical center in the least amount of time, eliminate or reduce the use of opioids for pain control, and get you back to normal as quickly as possible. The goals of the protocol are for 80% to go home same day, and 18% overnight, return to work in 2-10 weeks, limit narcotics to 0-7 days, be 90% healed in 12 weeks, and full recovery in 12-24 months.
The Good
1. Got home same day and had a two day honeymoon - It started off great. I went in at 8 am and I walked into my home with a walker at 1:30 pm that afternoon. The pain management protocol called for taking 6 naproxen and 6 extra strength acetaminophen starting the day of surgery plus 5 mg oxycodone as needed for 'breakthrough' pain. Thanks to the long lasting novocaine they injected into my knee I felt absolutely no pain until 6 pm the day after surgery.
2. Minimized the use of oxycodone. The novocaine wore off at midnight on day two and I needed the oxycodone every 4 hours for 3 days. I was happy to stop the oxy after using only 18 of the 28 pills I was prescribed and before I had any adverse affects.
2. No major complications like blood clots, infections.
3. I was able to care for myself early - the day after surgery I was showering, dressing, getting up and down the stairs, toileting. I started driving in week 3.
4. I got good results from my 6 week - twice per week outpatient PT. I started outpatient PT on day 16 (week 3) post op. My ROM on day 1 of PT was 101 deg, on day 2 of PT it was 120 deg. I was walking in the house with a cane for 10-15 minutes. PT consisted of short and log arc quads, straight leg raises, standing hamstring curls, and standing hip abductions with ankle weights starting at 2.5 lbs and increasing to 5 lbs. Other exercises were step ups, terminal knee extensions and the use of the leg press. Since my ROM was good the focus was on building leg strength. I 'graduated' from my 6 week outpatient PT program with a 0 degree extension and 128 degree flexion, with 'good' strength. I'm able to climb stairs normally, leg over leg, although I'm not able to come down yet leg over leg.
The Bad
1. Sleep disruption - In eight weeks I have not slept longer than three hours as a stretch. After three hours my knee invariably cries for attention whereby I have to ice it to put it back to sleep for another three hours.
2. Knee stiffness - Starting in week two to three of my PT my knee got notable stiffer, and my walking became uncomfortable making it difficult to maintain a normal gait. My PT and surgeon rule out scar tissue of fibrosis and tell me its due to swelling which will just take time to heal. They remind me that it may take a year to fully recover. So much for the 90% in three months. After spending some time reading the BS guidelines and member's stories, I'm beginning to think my knee stiffness may, at least in part, be due to my PT program being somewhat aggressive.
3. Elevated liver enzymes - In week 6 I had my routine 6 month checkup and found that my liver enzymes were 8 time normal! My internist had me stop the 6 extra strength acetaminophen and halve the dosage of naproxen to get my enzymes down. From a pain perspective I was not quite ready giving up all of the acetaminophen, but I realize you can't live without a liver. Repeat lab work is scheduled in two weeks.
4. Longer than expected recovery time - As I mentioned earlier, at this point I had hoped I'd be farther along - walking normally without discomfort, and not needing pain medication. I also expected the progress to be steady and significant from week to week. I realize this was probably an unrealistic expectation, and I will have to be far more patient going forward to relieve my frustration.
Undecided
PT - I'm still on the fence in deciding how aggressive to be with PT on my own going forward. I admit I've been of the "No pain, no gain" school, but I'm becoming more open minded to this being a myth, and slowing down either the intensity and/or frequency of the PT exercises.
Overall Merit of TKR - I obviously must suspend judgment on this until I'm farther along. In the meantime I have to trust the many who say that by 1 year I will be happy you had the TKR.
Bill