TKR 4 days into recovery

[BeachGal714]

Hello All
I had my Left TKA on tuesday, 2/20, stayed one long night in the hospital and now I'm home. I've mastered the walker pretty quick. The home nurse will be coming today to assess my PT needs. The pain is moderate but not terrible. More annoying than anything else as I'm finding it difficult to get comfortable. I am finding that the cryo machine and the leg lifter are the two MVPs in this process so far. The only problem I've encountered is that the cryo machine covers the front of my knee but not the back where there is ALOT of swelling. So I'm having to use a separate ice pack for the back of my knee. All that aside, things are moving along as I'm sure they are supposed to. I really only use opioid pain relief at bedtime, trying to stick to ibuprofen during the day, that may change once PT ramps up though.
This is probably one of the chunkiest thread beginnings but it really is just the beginning. Looking forward to hearing any tips or tricks on relieving pain, getting good sleep, and getting my bowels moving!

 

[benne68]

Welcome to the healing side, @BeachGal714! Glad to read that you are home and moving on with your recovery.

I will leave you our Recovery Guidelines, which include lots of "tips and tricks" that will help you have a less painful recovery.

Just keep in mind we are all 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 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.

If you want to use something to assist with healing and scar management, 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.

2. Control discomfort:
rest
elevate
ice
take your pain meds by prescription schedule (not when pain starts!)
don't overwork.
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
the BoneSmart view on exercise
BoneSmart philosophy for sensible post op therapy
5. At week 4 and after you should follow this
Activity progression for TKRs
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.

Please note: While members may create as many threads as they like in a 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 history before providing advice.

 

[mendogal]

Hi! For bowels.....

It can be difficult to "wake up" our GI system after surgery plus taking opioids.

Adequate fluid and fiber is a start.

The combination used most often for people on long term opioid use is two meds: a "stool softener" (docusate) that keeps more fluid in the stool for easier passage, and a direct large intestine stimulant (senna, via tablet or herbal tea).

If something stronger is needed, there's a prescription med that is more effective and with fewer side effects than the common OTC remedies. It's a syrup called Lactulose. My ortho team prescribed it for me when nothing else worked and it was a life changer! I ended up using it every other day until I was totally off opioids.

 

[mendogal]

Insomnia is a real bummer for many of us in the initial weeks after knee surgery. Definitely sleep whenever (and wherever it's safe and comfy!)

Icing, elevating, napping.... All help, but for some of us it was endangering our mental health. Before it gets there consider some nonprescription remedies....

If you're lactose tolerant, a glass of warm milk! If you're not diabetic, a teeny bit of honey makes it even more comforting... plus milk is high in magnesium! Helps us relax!

If you aren't a milk drinker, or want an easier way to, an evening magnesium supplement has been very helpful for some members.

OTC diphenhydramine, an antihistamine also used as a sleep aid (Benadryl) because it makes you drowsy; it's also included in some cold, flu, etc "nighttime" combination meds.

Low dose melatonin, sustained release - not for long term use but I have used for a week at a time without ill effect. It should be taken an hour to hour and a half before going to bed, and during that time stay in a dimly lit area to allow this hormone to activate.

Valerian root - an herbal remedy, it can be taken in capsule form but that dose might be high compared to my preference, herbal "sleep" blends that include a smaller dose of valerian and make me pleasantly drowsy. Plus the other tea flavorings make it nice tasting! Celestial Seasonings and Traditional Medicinals sell teabags by the box. Their sleep blends without valerian have never ever made me sleepy.

Be aware: even benign herbals and supplements can interact with your routine or post op prescription meds, either making their effects weaker or stronger. If you're on meds you may want to check with your doctor or pharmacist, or even check online for interactions.

 

[BeachGal714]

5 days post op now. My leg, mostly knee and behind it, is very very swollen. I'm using the cryo machine religiously and elevating and also now strapping an ice pack to the back of my knee. My bowels woke up!! That's the best news ever. I will continue taking the stool softener as long as I am taking opioid pain meds just to keep it all going. Sleeping is still a struggle, albeit a minor one now. This morning I woke up extra early in an extra amount of pain inside the knee joint. Thinking it just means all of the nerve block and anesthesia have officially evacuated my body. I have to keep reminding myself that I am so early in my recovery that all of this is probably very normal and nothing to freak out about. Hope everyone else is also recovering well!!

 

[mendogal]

Yes, there will be ups, downs, and for most of us even small glitches...
And with members all over, even if you're awake and worried in the middle of the night, come ask questions or vent since the likelihood is you won't be alone!
Hang in there! It DOES get better.

 

[Layla]

You're right...all normal, nothing to worry about. Actually you seem to be doing very well!
Good luck on the journey!
@BeachGal714

 

[selketine]

Sounds like your recovery is going very well so far. How did the PT assessment go? I had home PT the first two weeks and she was very nice - but also gave me a giant list of exercises that I would have needed a personal secretary to keep trace of all the reps and sets. I'm several weeks ahead of you surgery wise and still finding new and weird pains or muscles and things that I didn't know I had but will act up on me. I think it's all fairly normal (of course really bad sustained pain wouldn't be). Resting is best - and walk some when you can - like when you get up to go to the restroom. I hope you had a good rest of your day!

 

[BeachGal714]

I had a home nurse come by yesterday. She was impressed by my ability to get up and down the stairs on my own. The only thing that bothered her was the swelling but she agreed that i was doing what I need to do thus far. PT will come on monday for the first time. That will make me nervous for sure.

 

[Jockette]

That will make me nervous for sure.

Here are some articles from Bonesmart’s Recovery Guidelines about PT:

BoneSmart philosophy for sensible post op therapy

You will have noticed there is a significant opinion here about the potential hazards of PT. You may feel that your therapists are experts and know what you should be doing. However, over the last several years I've been here, I have observed that the more intensive the regimen of exercising...

bonesmart.org

Myth busting: "window of opportunity" in TKR

This "six week window of opportunity" surgeons often speak about is little more than a myth. It presupposes that all patients have the ability to create adhesions which is far from the truth. It also ignores the simple fact that in the first 3-4 weeks after surgery, swelling reactive to the...

bonesmart.org

And, last but not least,
Saying no to therapy - am I allowed to?

 

[MSuki]

I think on the sleep issues the best thing is to not worry about it. Sometimes it helps to get up for a few minutes and walk around. It’s hard to get comfortable with the knee and you also can’t move a lot in your sleep without bumping it ever do slightly, and staying in the same position does not help with sleep. Sometimes doing something else for a bit and letting your other muscles move will relieve that tension. And you can always try and sleep some more later. I would sometimes sit in the recliner for a while and read before going back to bed. And of course adjust my ice as needed.

 

[Layla]

Hello and Happy Sunday BeachGal,
You may benefit in the areas of both sleep and constipation by considering Magnesium.
From what I've read, Magnesium Citrate specifically helps to draw water into your gut, a process that may help expedite the digestive process by targeting your intestinal muscles. It can help relax your intestines and support regular easy bowel movements.

For sleep - It may help improve sleep and increase overall relaxation. It helps promote your body's natural production of melatonin, the sleep hormone. It can also soothe and relax muscles to get your body ready for sleep. Something to contemplate...
I wish you the restorative rest you need and a great week as you continue healing!
@BeachGal714

 

[Layla]

Happy One Month Anniversary!
I hope you're doing well, found a good match in your PT, and you're enjoying steady progress.
Take good care!
@BeachGal714

 

[BeachGal714]

Hello!
6 weeks out and still moderately miserable. Saw the surgeon and he says I'm progressing well though so I guess everything is normal. PT is great, it sucks and they hurt me a little, but I am motivated to go. Sleep is still evasive, which is a bummer. Any tips for super sensitive incision? I've been wrapping loosely with and ace bandage at bedtime so it doesn't rub the blanket but I think that idea has run it's course. Wondering if maybe a silicon scar bandage might do the trick.

 

[mendogal]

We have had a staff member use a silicone scar bandage - @benne68 - not sure if it related to sensitive incision though.

Insomnia is a real bummer for many of us after knee surgery.

Icing, elevating, napping.... and consider some nonprescription remedies....

If you're lactose tolerant, a glass of warm milk! If you're not diabetic, a teeny bit of honey makes it even more comforting... plus milk is high in magnesium! Helps us relax!

If you aren't a milk drinker, or want an easier way to, an evening magnesium supplement has been very helpful for some members.

OTC diphenhydramine, an antihistamine also used as a sleep aid (Benadryl) because it makes you drowsy; it's also included in some cold, flu, etc "nighttime" combination meds.

Low dose melatonin, sustained release - not for long term use but I have used for a week at a time without ill effect. It should be taken an hour to hour and a half before going to bed, and during that time stay in a dimly lit area to allow this hormone to activate.

Valerian root - an herbal remedy, it can be taken in capsule form but that dose might be high compared to my preference, herbal "sleep" blends that include a smaller dose of valerian and make me pleasantly drowsy. Plus the other tea flavorings make it nice tasting! Celestial Seasonings and Traditional Medicinals sell teabags by the box. Their sleep blends without valerian have never ever made me sleepy.

I had great results combining sleep tea with a melatonin tablet.

Be aware: even benign herbals and supplements can interact with your routine or post op prescription meds, either making their effects weaker or stronger. If you're on meds you may want to check with your doctor or pharmacist, or even check online for interactions.

 

[benne68]

Any tips for super sensitive incision? I've been wrapping loosely with and ace bandage at bedtime so it doesn't rub the blanket but I think that idea has run it's course.
Wondering if maybe a silicon scar bandage might do the trick.

How about wrapping your knee loosely with plastic food (Cling/Saran) wrap? There's a video somewhere on the site demonstrating the technique, but basically you just take a length of saran or other plastic food wrap long enough to wrap around your knee 2x. It sticks to itself and protects the incision from rubbing again anything. Lots of our members have tried and recommended it.

At 6 weeks out, I would double check with your surgical team before putting anything like silicone strips on the incision. I used them, but not until about about 3 months post-op and after discussing with my doctor. They can improve the healing of scars -- but I don't think they help with sensitivity. In fact, I've read that some people find the strips cause irritation, so it might be counter productive in your situation.

 

[Layla]

Happy Two Month Anniversary, BeachGal!

I hope you've made some progress in the area of sleep over the past two and a half weeks or so.
Pillows help me get comfortable in bed, making it easier to drift off.
I suggest making up the bed with your most comfortable bedding / blankets along with a few extra bed pillows of different degrees of firmness. Try to block out the light if it's daytime. Minimize noise unless you feel listening to calming relaxation music, a fan, or white noise may help lull you to sleep. Make sure the room temperature is not too hot or too cold. Try to disconnect from the devices at least an hour before the targeted nap or bed time, so it's easier to wind down. Limit caffeine throughout the day and consider natural sleep aids such as Valerian, Chamomile or, Magnesium, my personal favorite, which can assist in muscle relaxation and nerves and promote healthy sleep (falling asleep and staying asleep)

An article on Magnesium from our Library -
https://bonesmart.org/forum/threads/magnesium-is-a-star.20301/

Most large grocers carry a variety of teas such as Celestial Seasonings - Sleepytime Herb Tea,
Yogi Teas, Bedtime, Bigelow Cozy Chamomile, all of which may help you relax...at least worth a try.

Hope you're feeling less miserable these days and making progress, without pain, in PT.
Happy Saturday!
@BeachGal714

 

[BeachGal714]

About 11 weeks out now. Sleeping is SOOO much better. My PT place doesn't measure my flexion or extension, they seem to go by feel and I heard one say that I am breezing past 90 and maybe even 110 degrees. I can walk with no limp at all, nearly, just not quite as long as I'd like to. But I'm sure that will come with time. I still use the cryo machine every evening.
The ace wrap around my knee did help with scar sensitivity but then got annoying. I tried a knee sleeve as well, also got annoying. And at this point, the scar is less sensitive so I really don't need anything. I had a screaming, tearing pain in the knee a couple times last week while going downstairs. PT said they think it was scar tissue loosening and as long as I don't open the incision, it's a good thing.
All in all, I think things are progressing pretty good. I suspect I'll be back to work in the next two weeks and hoping that doesn't bring any extra swelling or pain. But it'll be a good thing after being out for 3 months.

 

[benne68]

Sounds like you are doing really well, @BeachGal714! Glad to read that your PT is one of the enlightened ones who is evaluating your ROM based on function rather than constantly measuring!

Best of luck with the return to work. Remember to ice and elevate if you have new swelling or pain. I still get relief from it at 20 weeks out!

 

[Layla]

Great update! Best wishes for your return to work in a couple weeks. Ice and rest may be all you're interested in upon your return home from work initially. Fingers crossed it goes well and it's an easy adjustment for you!
Have a wonderful weekend!
@BeachGal714