Bilateral TKR 4 Months Post BTKR

[Wednesday]

You're doing great!

 

[Jozilla]

Yes I remember being so cold after the surgery. I would pike extra blankets on. The good news is that it will pass shortly! Take care!

 

[Junebug2]

You are doing great. it just takes awhile for the functions to return to normal....Its been 15 wks for me and I still get cold. I always have a blanket close by when I'm icing. I Take my shawl every time I leave the house. I take at least one lortab every day. Usually one about 5pm and sometimes one before bed. I quit taking percocet after 2 wks because they were making me crazy. For constipation, I took 2-3 stool softeners at bedtime..I eat several handfuls of walnuts everyday.. The stiffness in my knee was almost gone but for some reason it has returned. Try to get plenty of rest every day. Even when you think you are at a certain level of recovery. The ole knee has a sense of humor and will prove you wrong...at least mine does and did...

 

[Wellness in Virginia]

Thank you for letting me know that you got very cold too. For now, like you, I just pile on the blankets. I even wear socks and gloves to bed. Once warmed up, I'll take the gloves and socks off.

It's drizzly outside all day today and the weather forecast calls for wet rainy weather all of tonight also. My knees, and quadriceps are quite stiff.

I've iced but the tightness and stiffness are still there. 24 days post-op BTKR so I understand that pain cannot be eliminated completely. I am just trying to manage the best that I can. I am still taking 1 Percocet every 4 to 5½ hours. And 1 Celebrex daily. I am already done with the blood thinner Xarelto. Can I add Tylenol to the Percocet I am taking? How many milligrams of Tylenol can I add? How about Aleve PM? Can that be mixed with Percocet?

Thank you again. I am sorry for whining.

I am NOT overdoing my PT exercises. I only do a few minutes of the PT exercises prescribed every couple of hours. I do stairs (one full flight up and down) 3 times a day and I get up to walk to the bathroom or kitchen once every 2 hours etc. That's about it for physical activities. So the pain is probably not from my physical activities I don't think. When sitting or lying, I still do ankle pumps and heel slides, etc.

 

[Phil75070]

As for adding Tylenol (Acetaminophen), I do know the limit is 4000mg/24hours and you really do not want to exceed that! You have to figure in the amount of Acetaminophen in the Percocet you take which is usually 325mg/tablet but can be as much as 650mg. You also have to watch the strength of the Tylenol you take as Tylenol Regular Strength is 325mg/capsule, Extra Strength is 500mg/capsule and Tylenol Arthritis Pain is 650mg/capsule. For example, if you are taking 10/325 of Percocet every 4 hours that is 6 in a 24 hour period. 6x325=1950mg of Acetaminophen. so I figure you could take 4 Extra Strength Tylenol (4x500=2000mg) in addition giving you a total of 3950 for the day.

I don't know about mixing NSAIDS which Celebrex and Aleve both are. I think you can mix NSAIDS with Acetaminophen though. However, @Josephine is probably the best one to address mixing pain killers and can hopefully confirm my math before you start changing your meds as I am not a doctor but I did stay at a Holiday Inn Express last night.

 

[Wellness in Virginia]

Thank you Phil. Your explanation is excellent. I will make sure I don't exceed 4000 mg of Acetaminophen from all sources. Thank you for doing the math for me. My Percocet is 325 mg in Acetaminophen per pill. FYI. I'll check my math and be sure never to exceed the 4000 mg of Acetaminophen.

 

[Phil75070]

@Wellness in Virginia I just double checked the Tylenol website and they have lowered the daily limit to 3000mg / day. I think that is because so many otehr drugs contain some levels of acetaminophen and by limiting the max dosage to of Tylenol itself to 3000mg/day they are trying totake that into account as the FDA is still saying a total of 4000mg/day:


Is there any additional information that healthcare professionals need to tell their patients?
Healthcare professionals should advise patients to continue taking their prescription pain medicine as directed. There is no immediate danger to patients who take oral prescription acetaminophen combination products. The risk of liver injury primarily occurs when patients take multiple products containing acetaminophen at one time and exceed the current maximum dose of 4000 mg within a 24-hour period.

Source: broken link removed: https://www.fda.gov/drugs/drugsafety/informationbydrugclass/ucm239871.htm

 

[jbucks]

@Wellness in Virginia I just double checked the Tylenol website and they have lowered the daily limit to 3000mg / day. I think that is because so many otehr drugs contain some levels of acetaminophen and by limiting the max dosage to of Tylenol itself to 3000mg/day they are trying totake that into account as the FDA is still saying a total of 4000mg/day:

@Phil75070 so basically you can take 2 (325mg) every 6 hours instead of every 4. I did not know that and thanks for sharing

 

[Wellness in Virginia]

Thank you Phil and Jbucks.

I've done the math and currently I am taking a total of 2600 mg of Acetaminophen a day from all sources. I will be diligent to stay under the 3000 mg to be on the safe side.

I had outpatient PT today. None of the exercises hurt me at the time that I was doing them. But on the way home from PT, I was a passenger in the car so I could prop my feet up but still the pain was aching and throbbing in both knees/legs, but much worse on the right knee. I am just going to elevate and ice for the rest of today. Except for trips to bath room, I will limit my physical activities. Hurt too much after PT. I learned a few new exercises.

Have a good night sleep and a great weekend everyone!

 

[Josephine]

Having read all through your thread, despite your great progress in ROM and activity, I am very concerned about you. You are only 4 weeks out and some of the things you've posted are a worry.

So first I'm going to ask you some questions and I need you to answer each one individually in as much detail as you can then I'll come back as see where you are ....

1. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine. And don't compare this with the bone-on-bone pain you had before surgery!

)

2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often? (note: what you've been prescribed and what you are taking might be different!)

3. how often are you icing your knees and for how long?

4. are you elevating your legs, how often and for how long?

5. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc.

6. what kind of PT/exercises are you doing? How much and how often? (and detailed details would be appreciated, please! Reps, sets and session and all that)

 

[Wellness in Virginia]

1. what are your pain levels right now?

Middle of the night and when I first wake up in the morning, 5.
Once up and moving around gently 5 to 10 minutes every hour, pain is only at 1 to 2.

2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?

Hydrocodone Acetaminophen 7.5-325 1 to 2 tablets every 4 to 6 hours prescribed. I am taking 1 every 4 hours. And I also take 1 Celebrex 200 mg daily prescribed and taken.

3. how often are you icing your knees and for how long?

I ice for 35 minutes every hour. At night if I managed to fall asleep, I may go 3 hours without icing.

4. are you elevating your legs, how often and for how long?

Yes, I elevate whenever I sit or lie down and I elevate properly following the photos in the article in Bonesmart library on how to elevate using 3 pillows so the ankles are higher than the rest of the legs. I elevate roughly 30 minutes every hour during the day. I elevate when I sleep at night.

5. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc.

Very light housework. I get up to change the ice packs every hour, make my own simple meals or coffee or tea. I live in a town home and the bathroom with showers is upstairs (top/3rd floor). So I do go up and down the stairs 3 times a day. Doing stairs hurts so I do not do this more than 3 times each day. I don't drive but I ride with someone to do light grocery shopping 2 to 3 times a week on the days that I have PT. I use a cane when I walk. Crutches tend to hurt the sides of my underarms.

6. what kind of PT/exercises are you doing? How much and how often?

1) Iso knee ext sit (quad sets) 1 set of 10. 2 sets per day, done for both legs.
2) Seated straight leg lifts, 1 set of 10, 2 sets per day, both legs.
3) AROM knee flexion uni supine with ball, 1 set of 20 per leg. do for both legs. the ball is 22 inches around, (put foot on it and roll the ball up to my buttocks then roll it back out).
4) AROM hip abductor uni sidelying 1 set of 10, do for both legs. (lying on side, bottom knee is bent, keep knee straight, raising the top leg upward).
5) AROM knee ext (LAQ) sit (sit in chair with knees bent to 90 degrees, straighten leg at knee, hold for a count of 5 then lower). 1 set of 10 reps, twice a day. both legs.
6) AROM hip abductor uni stand (stand, place weight on one leg, keep knee straight, move TKR leg outward then return to start position) do for both legs 1 set of 10 reps, two sets per day.
7) AROM stance uni balance eyes open (stand, lift right leg and balance on left leg, repeat on other side) I do this at the kitchen sink with one hand on the kitchen counter for safety. 1 set of 5 reps. Daily. for both legs.
8) AROM hip extension stand (stand hold on to sink or stair railing, extend leg backward, keeping knee straight then return to start) 1 set of 10 reps, 2 sets per day. do for both legs.
9) AROM knee flexion uni standing (standing hamstring curls, standing knee flexion). Stand on one foot, bend the other leg to bring foot to buttock. 1 set of 10 reps, 2 sets per day. do for both legs.

All of the above are prescribed to me by my outpatient PT and I do them exactly as prescribed and described above.

One bit of good news, last night was the first night post-op that I was able to sleep for 4 hours at a stretch. Only woke when alarm went off to take 1 Hydrocodone. It felt so great to be able to sleep for 4 hours straight. My BTKR was done on May 5.

Thank you, Josephine, for taking the time to review my recovery and providing advice guidance. If you think I am doing too much PT exercises, then I would be more than happy to scale back. I just want to do the right thing but not sure what it is!!!

Have a great day!

 

[Josephine]

Hydrocodone Acetaminophen 7.5-325 1 to 2 tablets every 4 to 6 hours prescribed. I am taking 1 every 4 hours. And I also take 1 Celebrex 200 mg daily prescribed and taken.

why are you only taking one at a time? You're only 5 weeks out - take two for pity's sake! Celebrex isn't much opf a pain med and I don't rate its performance as an anti-inflammatory this close to surgery. Ergo, it doesn't figure in the pain management issue.

I ice for 35 minutes every hour. At night if I managed to fall asleep, I may go 3 hours without icing. I elevate roughly 30 minutes every hour during the day. I elevate when I sleep at night.

I can never understand why people have to time the amounts they ice and elevate! Noting much is accomplished in a mere 30 minutes. You need to ice at least an hour at a time, more if your schedule permits it! All the time you are resting/sitting doing anything, elevate and ice. You can't do it enough.

Very light housework. I get up to change the ice packs every hour, make my own simple meals or coffee or tea. I live in a town home and the bathroom with showers is upstairs (top/3rd floor). So I do go up and down the stairs 3 times a day. Doing stairs hurts so I do not do this more than 3 times each day. I don't drive but I ride with someone to do light grocery shopping 2 to 3 times a week on the days that I have PT. I use a cane when I walk. Crutches tend to hurt the sides of my underarms.

Stairs are okay- good exercise. I also have an upstairs bathroom and had to go up and down several times a day but take it slowly and it shouldn't be a problem. Take more of your meds and ice more and you'll find it easier! Of course use a cane. Underarm crutches are evil! Crutches - warning on use of armpit crutches.
In the article about activity progression, you shouldn't be doing shopping so much. Or if you do, use the store's disabled karts. I did that all the time! BUT I didn't do out to shop until around 7 weeks. It's too much strain and don't forget the impact on the Energy Drain!

All of the exercises are prescribed to me by my outpatient PT and I do them exactly as prescribed and described above.

I understand - now for your exercises! (what does AROM mean?)

For a start I recommend you do exercises ONCE a day and rest at least one day a week
1) quad sets leg lifts 1 set of 10
2) Seated straight leg lifts, 1 set of 10
5) sit in chair straighten leg at knee, hold for a count of 5 then lower, 1 set of 10 reps
Aren't these all much the same? You only need to do one of these and you should only do 5 on each leg
8) hold on to sink or stair railing, extend leg backward with knee 1 set of 10 reps - whenever you're at a sink do a couple of these at intervals during the day, much less strain

3) knee flexion uni supine with ball, 1 set of 20 - unnecessary
4) hip abductor uni sidelying 1 set of 10 - unnecessary for TKR - it's a hip exercise!
6) hip abductor stand, place weight on one leg, keep knee straight, move TKR leg outward then return to start position 1 set of 10 reps - also a hip exercise unnecessary
7) stand, lift right leg and balance on left leg 1 set of 5 reps - bit soon for this. Leave it till about week 8 at earliest
9) stand on one foot, bend the other leg to bring foot to buttock. 1 set of 10 reps - Noooo! Leave these till week 8 at earliest!

In case you think I'm being too extreme I do suggest that when you are at PT you do as your PT requires.
Just cut back at home. You might like to read the potted version of my recovery to see how little exercising I did! Knee recovery - UK style

 

[Wednesday]

I can't agree more. I do very little exercising, and it hasn't hurt one bit.

 

[Wellness in Virginia]

Hi Josephine,

Thank you so much for taking the time to review my answers and for your advice. I am heeding all of your instructions starting with today.

I have no idea what AROM stands for. That is what is printed on the sheets describing the exercises that were given to me by my PT. I will ask her what AROM stands for tomorrow when I see her. Again, thank you for taking an interest in my recovery. I am most grateful.

I am going to add 1 500 mg Tylenol to what I am taking and will ice any time I am sitting or lying down etc.

Have a great day, Josephine!

 

[Josephine]

You too, my dear!

 

[Wellness in Virginia]

You too, my dear!

AROM stands for Active Range of Motion.

I asked my PT what it stands for and that's what she said it stood for.

Thank you, Josephine.

 

[Wellness in Virginia]

One month ago today, I had BTKR. I am almost pain-free today. Minimal pain meds. Only 1 Hydrocodone every 7 hours.

I still experience a lot of tightness around the knees and in the quads. Stairs is still very difficult. I walk without any assistive device but very slowly and carefully in order to have a normal gait. If I try to walk at a "normal" pace then I sometimes feel like the knees will "give" or wobble. I think this is due to weak muscles surrounding the knees. I need to keep with my PT exercises to strengthen the leg muscles. I have PT tomorrow so I will let my PT know all this and see what advice she has in store for me. I will post after my PT appointment.

Have a pain-free day everyone!!!

 

[Phil75070]

@Wellness in Virginia It takes a good long while to get strength back in those leg muscles, but it does seem you are well on track for a smooth recovery!

 

[Josephine]

I am almost pain-free today. Minimal pain meds. Only 1 Hydrocodone every 7 hours. I still experience a lot of tightness around the knees and in the quads.

Then you still need some pain meds. Pain comes in many forms including soreness, burning, stabbing, throbbing, aching, swelling and stiffness and tightness is indicative of both pain and swelling. You are only 4 weeks out on a bilateral TKR and I find it very difficult to believe you are totally free of all forms of pain.

I walk without any assistive device but very slowly and carefully in order to have a normal gait. If I try to walk at a "normal" pace then I sometimes feel like the knees will "give" or wobble. I think this is due to weak muscles surrounding the knees.

And this indicates you also need to use a cane. Again, it's far too early.

I need to keep with my PT exercises to strengthen the leg muscles.

Please, please remember that your muscles are not weak, they are injured. The very alst thing they need right now is more exercising! Rather they need the BoneSmart mantra and will need that for at least another 6 weeks. You are rushing ahead too fast and too far. Slow down!

 

[Javamama]

Tomorrow marks three weeks since my BTKR. I had a couple of setbacks in the hospital (not directly related to surgery) that I needed to overcome, but I'm home now, and recovering fine. I definitely stay on track with the meds. I take Norco around the clock and one Dilaudud first thing in the AM. I'm able to sleep about 8 hours straight (9PM to 5AM) and I faithfully do my therapy three times a day. I actually look forward to these breaks in the day. To help with constipation I eat two prunes every time I take Norco and thanks to that and the Colace, I am staying regular. I do small chores around the house like folding laundry and washing a few dishes, but my time is mostly devoted to rest and recovery. It also helps that I have an amazing and supportive partner who is a rock for me. I struggled with rather extreme emotions, especially when I first got home and he has been caring and compassionate through my outbursts. My daughter comes every Thursday so he can golf and that keeps EVERYBODY sane more or less. So far, so good!