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[BILATERAL TKR] 15month update....finally normal

Want2hike

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Monday 10/17/16
I had a bilateral TKR. I came out of surgery feeling great, and about 4 hours after surgery was able to get out of bed and walk about 60 feet (although it was difficult with 2 ports and a catheter bag).
Had pudding for lunch and steak for dinner.

Tuesday
Around 3 am the blocks completely wore off, and things rapidly changed. I nearly went into shock from the pain (uncontrollable shivering/shaking). The nurses/docs got the pain under control but the drugs made me too weak/woozy to try to walk. I was able to get from the bed to a bedside chair (still with the ports and catheter) but too lightheaded and dizzy to attempt to walk any distance during the day. I was able to eat normal meals during the day. I ate a hamburger for lunch and salmon for dinner. One of my ports wasn't draining and was removed Tuesday evening.

Wednesday
Pain was under control and I was feeling less dizzy. PT had me walk about 120 feet and showed me a few exercises. After the second PT (walked 150 feet and practiced going up a step) my other port and the catheter were removed. I was able to eat normal meals during the day (turkey sandwich for lunch and chicken fajitas for dinner). Before bed, I needed assistance using the restroom. This was my greatest challenge. A bedside commode was basically placed over the toilet. For my size (5'9", 225 lbs, BMI 33.2) it was just wide enough to squeeze into but too narrow for me to be able to easily get back up or wipe. I needed two nurses/techs to help me stand and wipe. My mom also arrived in town to help when I got home.

Thursday
Once again needed help with using the bathroom. Was able to walk 250' during PT, and practiced going up a step and getting in and out of bed and chairs. Was released from the hospital around noon. Husband and mom brought me home to recover. Husband went to get prescriptions filled but was unable to get the extended release pain pills. He spent most of the afternoon on phone with hospital, pharmacy, and insurance company. My pain started to spike. Doubled up on my regular pain pills before going to bed since I couldn't get the others.

Friday
Woke up in a lot of pain. Continued to fight with insurance company. Finally told husband to pick up prescription and pay full amount. Pharmacist called insurance company and finally got approval to only charge copay. Struggled with toilet riser at home. It was a little too narrow and had a channel in front. I didn't get far enough back on it and urine ran through that channel and spilled down my legs. My husband or mom had to clean me each time I went, which was frustrating and embarrassing. Finally worked out that if I got back far enough, I would hit the hole better and not make a mess, but I needed a footstool to support my legs, which meant I still couldn't go to the bathroom without assistance. When I moved off the toilet it would tip forward and nearly fall off the toilet. Somebody had to be there to hold down the seat for me to get off the toilet. I ate normal, did my exercises, and napped a lot. Mom or husband shadowed me every time I moved to make sure I didn't fall. Tech came to the house to set up the CPM machine. Used that and calf inflators (prevents DVT) as prescribed.

Saturday and Sunday
Pain much better under control. Still struggling with bathroom equipment issues. Took a sponge bath. I ate normal, did my exercises, and napped a lot. Mom or husband shadowed me every time I moved to make sure I didn't fall. Tech came and gave me aTENS unit. Used all equipment as prescribed.

Monday
Pain under control. after returning home from work, husband pulled out the bedside commode (minus the collection pan) that we use for camping to try that. He secured it with a tow clamp around the base of the toilet so it didn't move when I tried to get up. Finally! I was able to complete all bathroom functions on my own! I ate normal, did my exercises, and napped a lot. Mom or husband shadowed me every time I moved to make sure I didn't fall. Used all equipment as prescribed. PT showed up for therapy session. She was ok but not a good fit. Very unclear what she wanted me to do.

Tuesday
Pain under control. Bathroom equipment issues under control. I ate normal, did my exercises, and napped a lot. Used all equipment as prescribed. Mom and husband giving me more independence to move without them following. A friend came to visit for about an hour.

Wednesday
Pain under control. Bathroom equipment issues under control. Major problems with inflammation. PT was difficult because I was so swollen. Got a new therapist and really like her. She will continue my in home therapy. I ate normal, did my exercises, and napped a lot. Used all equipment as prescribed. Mom and husband giving me more independence to move without them following.

Thursday
Husband took mom to airport. He returned to help me change legs on the CPM machine and then he went to work. Still dealing with major inflammation. I ate normal, did my exercises, and napped a lot. Used all equipment as prescribed.

Friday (today)
Inflammation going down but still an issue. Husband helped me set up CPM machine before he left for work. Had PT and much better on exercises and ROM (80L and 67R) than Weds. Set up bonesmart account while on CPM machine.
 

referee54

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Welcome to the forum family!! We are very, very glad that you have found us, and we will endeavor to help you out and answer your questions and deal with your concerns.

I also had a BTKR---close to nine years ago.

Are you icing, elevating, and resting as much as possible? Icing and elevating and taking it easy will greatly help to reduce some of the swelling. Please consider that you had two bones sawed off in each leg, and there was much pounding, filing, drilling and gluing, and your two surgical knees sustained major surgical trauma. What activities and what exercises are you doing now?

A Recovery from a TKR or a BTKR ---a full recovery---can take upwards to a year---I was at 80%-85% at six months or so, and at eight months I was close to 90%-95%---I gained ROM in tiny increments well after my one-year BTKR anniversary.

A recovery like this can try our patience---but it is not about working harder---it is all about working smarter---let the surgical knees get over their "angry" stage and let the healing and recovery---gently---begin. The knees do set up the schedule, and I have learned that the "no pain, no gain" attitude will cause more issues---more inflammation, more stiffness, and more frustration---than taking it easy, doing gentle stretches and exercises, and icing and elevating as much as possible. The more you try to rush a BTKR recovery, the slower it is most likely to be.

We have a great forum library---the articles are rather short, but they contain great amounts of very, very useful information. Here they are for you:

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
Swollen and stiff knee: what causes it?
Energy drain for TKRs

Myth busting: no pain, no gain
Activity progression for TKRs
Heel slides and how to do them

Extension: how to estimate it and ways to improve it

Elevation is the key
Ice to control pain and swelling

Healing: how long does it take?
Chart representation of TKR recovery
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?

I am sorry to read of your issues with pain management and your prescriptions, but happy that it is all resolved now. Pain management in these early days of recovery---called the "Dark Days of Recovery" are very, very important.
 

referee54

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One thing that will help with your selling and stiffness ( and it is a slooooow recovery) is to ice for long periods of time. I would ice my knees for hours at a time. You can do this by placing a towel between the ice and your skin.

You have to be patient. You will find the patience inside of you that you did not know that you had---but this recovery can be much slower than we would like it to be, and much slower than we are prepared for---and there really is nothing we can do to speed it up.
 
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Want2hike

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Thanks for the info. Yes, Unless I am standing, walking inside the house, or doing exercises (about 5-10 mins every day time hour), I am icing and using the calf compressors.

Exercises have been ankle pumps, butt and thigh squeezes, straight leg lifts, and heel slides. Today the PT added tiptoe stretches and a raising one foot (to bend the knee...like a flamingo) while standing with the walker. My PT is great. She will help push me to my limit but not into pain.
 

Celle

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You really don't need to do those exercises every hour. Once a day, plus the ordinary exercise you get by walking around the house, is plenty.
Please don't do the tiptoe stretches (toe rises). They are very bad for such a new knee.

The important thing to know is that it isn't exercise that will recuperate your knee. It's time and gentle treatment. Time to heal, time for the swelling to go down, time for both your knee and your body to get over the trauma of a major operation.
Concentrate on reducing the swelling, with plenty of rest, ice and elevation and your knee will start to bend better, all on its own. Right now, the swelling makes it hard to bend, stiffening it rather like a hose-pipe full of water.
TKR: work “smarter” and not “harder”http://bonesmart.org/forum/threads/lose-the-work-ethic-while-you-are-recovering.20402/
Knee recovery - Lose the Work Ethic!!
Post-operative exercise – the BoneSmart view
 
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Want2hike

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I get my staples removed tomorrow. I'm a bit nervous. Do they use a numbing spray or anything? Does it hurt?
 

newlybionic

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At worse I felt some stinging. Once they were out my knee felt less tight than it did before.
 

Celle

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Do let us know how you get on having your staples removed.
 

Ronsgirl

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They didn't numb mine with anything. A few of them were pretty uncomfortable coming out, most were just a brief sting.
 

little red canoe

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No numbing here. It really was not as awful as I feared.. one stung a bit.. I was amazed that the wound was totally healed. 10 days later you can barely see it.
 
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Want2hike

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Thanks everyone. Getting the staples out wasn't nearly as bad as I imagined.only a few stung a bit during removal.

After I got back home, my couch called for me to lie down and take a nice long nap. I couldn't resist and had a delightful nap. The only problem was that it was too low and soft and I couldn't get back up again! Oops! It took me 15 minutes to finally get up from it. By that time, I needed another nap!
 

sistersinhim

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Your staple removal was really blessed. I was almost 3 weeks out and everyone of my 35 hurt, but 1! It sounds like you're doing well. Just remember they are infant knees and need to be treated as such. My experience is to follow the articles left for you. If you do, you'll have much less swelling, inflammation and pain. Good luck to you!
 
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Want2hike

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A close friend is getting married this weekend; it will be an outdoor wedding (golf course/resort) with an indoor reception immediately after. I really want to attend the wedding but am worried about the seating (wedding will likely have the wood folding chairs common for outdoor weddings; reception also appears to have armless chairs) and my ability to sit/get up and the comfort level.

The wedding and reception will both be short (less than 3 hours total) because both the bride and maid of honor have health issues where they need lots of rest. The venue is close to where I live so there isn't much travel time involved.

When I RSVPd, my surgery was scheduled for Oct 3, so I thought I would be 5 weeks post surgery. Because my surgery date changed, I will only be 3 weeks post surgery. Walking ( with walker) has been fairly easy for me, but It has been on hard indoor surfaces. Should I rent a wheelchair for the day?
 
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newlybionic

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I would suggest a wheelchair to get around easier. You don't want to be walking too far especially if the ground is uneven. If you plan on staying for the reception make sure you can put your leg up on another chair and bring some ice packs with you too.
 

Celle

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A wheelchair would be a great idea.
You may find that you need to leave before the end of the reception, as three hours is a long time to be up and doing things this early in recovery. Your stamina will still be low and you will get pretty uncomfortable after a while.

I think it would be wise if you talk to the bride and tell her that you will be there for the ceremony, but may have to leave the reception early. With health issues of her own, she should understand.
 
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Want2hike

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Today has been a struggle with my right knee. While the swelling/puffiness in my leg looks like it has gone down, my leg feels like a lead brick. I had been getting 65 degree bend in the right knee. Today I'm lucky to get 30 degrees. Have been icing and elevating all day but doesn't seem to be improving. I'm also getting random pains in my thigh (like I'm being poked by a cattle prod). The pain comes and goes at random and only lasts a few seconds, but it is enough to knock the wind out of me.

Husband picked up the wheelchair so I can attend a wedding tomorrow. Right knee wouldn't bend enough to comfortably sit on footrest. Adding 2 pillows to the seat raised me high enough so the leg could remain straighter. I hope tomorrow I have more flexibility again and this doesn't get worse.
 

referee54

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You are still very, very early in the grand scheme of recovery. Not quite three weeks out---as a BTKR recovery, these things take time.

I would advise you to give trying to figure out why lose ROM---I did very much the same---some good days, some bonus days, and then a real clunker here and there, and I could not figure out why. These recoveries can really test our patience, and with a BTKR, patience is a must.

Have you seen what actually happens to your knee(s) during a TKR or a BTKR? It is frightening to see all of the surgical trauma that occurs.
TKR surgery - WARNING: real life photos

I have to be honest---there is no way that I would be going to a wedding as you are---I hope that it is successful.
I think it would be wise if you talk to the bride and tell her that you will be there for the ceremony, but may have to leave the reception early.
I would be prepared to do just this.

You may find that you need to leave before the end of the reception, as three hours is a long time to be up and doing things this early in recovery.
I agree---take care.
 

Debbie_joints

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I hope you will be able to enjoy the wedding. I was only two and a half weeks out when we went to my daughter's surprise 40th birthday party. It was about an hour and a half away, so that was difficult. It was so funny when our daughter walked in and saw us, she said "what are you doing here, you shouldn't be here". The owner of the restaurant knew I had just had knee replacement. He made sure I had a chair to put my leg on and even got me ice. That helped. Then at 4 weeks, my sister got married. Now I couldn't miss that. We had to stay at a hotel too. I took my big wedge pillow along and my velcro ice packs. Nice that the hotel room had a mini frig with a little freezer. I hope you do well at the wedding.
 

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