TKR I Feel Like the Tin Man these Days

@Niftyknee
Unfortunately in the US it is all about making money, and pushing for outpatient for knee replacement. Patients do suffer. Very sad state of affairs.
 
:badspidy:Laurenkate,
Sounds like this time around was quite different! With my first one (2014) I went home in three days. With my most recent (May 16) I went home next day. My doctor said I could go home the afternoon of my surgery as I’d passed all the requirements but I wanted to have one “test” night in the hospital for pain before going home...in our area some patients do go home same day. I liked the staff and food there too!!

I think one stay over night is wiser. There’s so much involved in a TKR that staying at least one night gives some quick help if there are issues not yet noticed. My pain needs were low so I decided home was an ok place to be...
 
I’m in the UK and the normal stay is 3 days but I was in for 9 because I needed two blood transfusions and then had a temperature. I can’t imagine coming home the same day! I still felt really ill when I came home - although I was glad to be back in my own bed! Hopefully you’ll start to feel a lot happier now you’re home and can get on top of your pain relief.
 
I'm in the UK too. I couldn't imagine being discharged the same day or even the day after. I had 4 nights in hospital both times and was glad, but ready, to go home after that.
 
Being discharged the day after surgery or the day of is not for the ‘faint of heart’. Not easy,but doable.
 
I was in for two nights, mostly because my insurance didn't get straightened out for rehab in time to kick me over there the day after surgery. I think I could have gone home the same day and done... all right. Cautious me, though, was glad to be overnight in the hospital. TKR is a major enough surgery I would think they'd want to watch the patient for longer than a few hours. Infection (the medical reason most cited for sending people home) is not the only risk. But, as I said, I lean toward caution.
 
I had a drip, oxygen, a catheter and was having antibiotic injections and blood thinning injections for several days as well as medication. I couldn't stand at first and couldn't eat. It would have been sheer negligence to discharge me!
 
I figure the sooner they discharge me, the less I have to deal with their non Bonesmart ways.

However, at least one overnight is good I think. That’s what I had. And at about 4 am they realized I needed a catheter because I couldn’t “go” and my stomach was getting big and hard. They said it was most likely due to the anesthesia. What would have happened if I’d been home with that situation?
 
(...) staggers me how they think this surgery can be done asan outpatient. I can’t believe people are going home the same day or next day and that they don’t have strong pain meds.

I had my TKR as an outpatient surgery in last February, and it was fine. I was their "pilot project" - it had not been done here until then. They set three conditions for same-day discharge: First, I had to be able to use the bathroom. Second, I had to have eaten a meal. And third, I had to be able to go up and down a staircase (because I have one at home). I arrived at the hospital at 6 a.m. and was the first patient on the surgeon's list for the day. Had the operation at 8 a.m. Had lunch at about 1:30 p.m. (juice, sandwiches, cookies), followed by a visit from the PT, who got me out of bed and using the walker. I was able to get dressed (on my own, including shoes and socks) at around 3 p.m., did the stairs shortly afterwards, and had a visit from the surgeon and anesthesist to make sure everything was ok. They e-mailed my pain med prescriptions to my husband, who went and filled them, then came to collect me at around 6 p.m., and I ate dinner sitting at the table with the family that evening. I was able to go upstairs to bed unaided.

Here in Canada, the entire process, including pre-surgery exams and tests, PT and all follow-up, including medications, is paid for by the State system, so it's essentially free for the patient, who has nothing to pay and no insurance claims to manage. The morning after surgery, I was visited at home by a district nurse, who checked the dressing and made sure I was taking my pills. Then the PT came and showed me some gentle exercises. In the two weeks following the surgery, I had three more visits from nurses (the last one was to remove the dressing) and four more visits from the PT. I then started going to the PT unit at the local hospital. I also had 24-hour access to a resource at the hospital where I had the operation, in case I had questions.

I will say that pain management was challenging. I was prescribed Oxycodone, but I knew after a couple of days that it wasn't right for me: I was a depressed, zombie-like, weepy mess. The surgeon had also prescribed Tramadol as a "Plan B", so I tried that, but it made me feel sick. In the end, after a week or so, I quit all the meds except Tylenol, plus one Tramadol at night to help me sleep. It hurt more, but I was better able to cope with the pain. It was about a month before I felt comfortable.

Before the surgery I adapted my home to give me some independence: for example, I added a shelf to my walker, so I could transport drinks and meals on it, and I organized a backpack so I could carry my phone, computer and medications up and down the stairs. I also did exercises to strengthen my leg, and I practised things like putting on socks and shoes without bending my leg, so I would be independent. If I had to do this again, I would definitely do it as an outpatient surgery. It was wonderful to be able to eat what I wanted, when I wanted, and to be in my own home with my family and dogs.
 
Last edited:
Sounds like a comprehensive outpatient care plan was in place. I did all the same pre op planning as you but no way could I have been discharged on the day.
I'd also checked my hospital's infection rate and was glad to see that it was clearly AOK so I wasn't wanting to rush home for reasons of avoiding HAIs.
 
@Ceegee The hospital I use has basically the same program so most of their TKRs now go home the same day. It's fine for those who pass all the criteria and wish to go home the same day, but some people need to stay a day or more. As long as that is still possible, which it is at my hospital, I don't have a problem with same day discharges, even though my personal opinion is No Way!. But if it's the only way a hospital will do it, now or later on, I think it's ludicrous and would run fast and far away. I needed to stay a full week, due to pain issues, but it was planned for ahead of the surgery, and it worked well for me. I was actually mentally ready to go home before the week was over, but physically I needed the week.

I also had the option of two weeks or so of in-home PT, plus some home nursing visits, but I allowed only one visit and then turned down any more. I also turned down out-patient PT, although if I decide I need help with my gait later on I will go a time or two, or more, as needed. I also don't pay for any of that, and don't have insurance claims to deal with. Nor do I, or my doctors, have to fight bureaucrats for care, nor do I have long wait times for care. I also always have a private room; my hospital only has a few shared rooms and I suspect they'll eventually make those singles also. But I've never had to share a room there, which is wonderful in a lot of ways.

People here in the USA have different coverages, and some do have a harder time of it. I am blessed with great coverage, of my own choice, that I've had since about 1976, doctors who are free to practice medicine without fighting to get care for their patients, etc. I've had the same OS for well over 10 years (poor guy) although I did change to another for a short time before I had my first TKR. But, I went back to my OS as I really do like him and he's one of the best. I've also had the same PCP for somewhere around 10 years.
 
I agree with you that outpatient surgery isn't for everyone. There was a guy there on the same day as me for a hip replacement, who should have gone home the same day, and he stayed overnight at the hospital instead because things hadn't gone as smoothly as anticipated. The hospital doesn't force people; I met the criteria, was offered the possibility, and jumped at it. It is, I think, likely to remain the exception, not the rule. FWIW, my mother, in England, was horrified when I told her I was choosing outpatient surgery (she's had a hip replacement).

And I also understand that health coverage varies greatly in the US. My comments about the Canadian system were meant as information only; they certainly weren't intended to imply criticism of any other system. No system is perfect. Here, we do sometimes have to wait; for example, I waited well over a month for my initial appointment with the surgeon, and a further seven weeks after that for my surgery. There are people who would say it is our health system that invented the word "patient" to describe the people who benefit from it, since patience is sometimes needed ...! On the other hand, the system is efficient and thorough once you're in it.
 
I wasn't saying the hospital forced you-but my comment about that was based on what we may see in the not-too-distant future. There are already some outpatient facilities doing these, and I think that's where they're heading. While I won't have to worry about it, as I need special care for pain control, (but I am not planning to ever go through this again!) I do feel for those who may be stuck with no options one day.
 
Are you able to manage your pain at home?
I decided to give up the oxycodone this morning because it felt like my head was going to burst last night because it hurt so much. Using lots of ice and 2 Tylenol every 6 hours which, surprisingly, and so far, seem to be working. Swelling is starting to set in so we'll see how that goes.

The other good news is I've completely lost my appetite - don't even want my afternoon Sonic co-cola with all that yummy crushed ice - and boy, my husband is shocked. Eating a little bit because he's forcing me to do so and he's going to the farmer's market tomorrow to get lots of veggies, peaches and cantaloupe. The fruit sounds good but nothing else is especially tempting.

Overall, and other than the stay at the hospital, I'd say this has been a little easier than the first time. Maybe it's because we knew what to do and expect or because this leg didn't get as bad as the first one.

Oh - and here's another idea which has been very helpful for all of you anticipating this little adventure. We rigged up a rope system around the bed frame which the visiting physical therapist and nurse must have thought was very odd until we explained it. He tied a rope around the frame at the foot of the bed and then tied another one in the middle of it so it's t-shaped. It's useful to pull yourself up those first couple of days at home when it's difficult to do that.
 
I was in the hospital 4 days/nights before I went home due to some issues. If I have to do the right knee it might be a sooner discharge but OS likes his patients to stay 2 nights for the pain control monitoring.
 
I could have left after the first night, but chose to stay because of being light headed. I was fine after the second night.
 
I doubt anyone will ever be left with no options because there are numerous issues that could demand and extra night or even more. No sensible hospital or surgeon would ever make discharge mandatory under those circumstances.
 
Well, last night was miserable. After thinking a recliner wasn't necessary after a TKR - and they really aren't - I would have written a big, big check to get one delivered in the middle of the night. The pain really kicked in about the same time my poor husband's exhaustion kicked in. I couldn't get comfortable, couldn't get my body temperature regulated (either freezing or burning up) and when I did finally fall asleep, I was awakened by the young couple who recently moved in next door. Don't know WHAT their problem is but they like to stand under my window (houses are close together) and fight on Friday nights or he's just drunk and screams obscenities on Saturday night - or vice versa - and again, right under my window. If I'd had the energy, I would have opened it and dumped a bucket of very cold water from the ice machine on his head.

The good news is I'm ordering a lounge doctor even after figuring out a comfortable pillow stack. It'll be one less thing for my husband to deal with and will make life a little easier.

Two questions for everyone.

It's hard to keep my leg straight and straight up (knee facing the ceiling). It wants to roll to the right and is much more comfortable that way. Is that going to create some type of problem? I hold it straight with a leg lifter when doing my "exercises" and it seems straighter than the other one at the same point. Can feel the bed on the back of my knee when I press the heel down into the bed and tighten my thigh.

Got to call the doctor's office on Monday to get something other than the oxycodone. What did you take and did it cause any unpleasant side effects? It seems I took Tramadol after the first TKR but may be confusing that with the medication we had to give our dog when he blew out his acl this spring. (Who knew dogs had to have ACL surgery?) Thanks for any and all suggestions.

 
It's hard to keep my leg straight and straight up. It wants to roll to the right and is much more comfortable that way. Is that going to create some type of problem?
Not at all! Just let it be comfortable! And do make sure you are elevating the correct way. Read these to the yes and no of it all! Elevation: the do's and dont's
Can feel the bed on the back of my knee when I press the heel down into the bed and tighten my thigh.
:scratch: Does it hurt when you do that? If so, don't do it!
It seems I took Tramadol after the first TKR
A rattling good pain med in my opinion, provided you take it with Tylenol. I have this chart

aa Tramadol routine 1.JPG


(Who knew dogs had to have ACL surgery?)
Vets perform almost every kind of surgeon that humans have! Did you know it's now quite common for animals to he hip and knee replacement? That's cats, dogs and many other animals! Look up "The Supervet" on Youtube. It's a programme that runs regularly on UK TV and its awesome!
 
Thanks Josephine for reassuring me about the way my leg wants to rest and for the info about Tramadol. I seem to remember it worked very well and hope the doctor will prescribe it again on Monday.

Oddly enough, it doesn't hurt to do a couple of the exercises. Vaguely uncomfortable but they don't hurt. I'm not doing the ones that do hurt; it's only been a few days since the surgery and my body needs some time to rest and recover.

Will add "The Supervet" to my list of things to watch in the next couple of weeks. I didn't know dogs have hip and knee replacements! That must be very strange for them....

Getting my room ready for tonight and trying to convince my husband he doesn't have to get up every time he hears me stirring around. It's just too uncomfortable to stay in bed all night but I hate waking him up too. The good news is that he's earned lots of weekends on our ancient sailboat with all the time he's putting into being the nurse/cook/housekeeper/dog walker, etc.
 

BoneSmart #1 Best Blog

Staff online

Forum statistics

Threads
65,167
Messages
1,596,863
BoneSmarties
39,356
Latest member
JanieMarie
Recent bookmarks
0
Back
Top Bottom