TKR Aftercare issues

[Dedou]

Even though I knew about the BoneSmart approach my OS was all about PT and "whatever ROM you have when your scar turns silver is all the ROM you will ever have." He was the trained surgeon that has done many, many replacements, he must know what he's talking about right?

My surgeon said the same thing to me! After finding this forum, I realized that it was just another instance of one-size-fits-all medicine that wasn't working for me. I'm almost two months out from my surgery, have daily log leg, pain and swelling. Why on earth would I want to make it worse?!? Just doing the daily things, as already mentioned, is more than enough exercise for me. I can always tell when I overdo it; my leg goes to hugely swollen and painful. So glad you found this site and don't let anyone try to scare you into overdoing it! I had scheduled a PT visit, got on here and read horror stories and promptly cancelled the visit. I trust my body to heal on its own and in its own time. I'm still not back to work, but am trying tomorrow. I have decided that not even my job is worth hurting myself. Take lols a lot of trust that I'll be OK, but it is what it is. Best wishes on your recovery!

 

[BBCG]

Hooray, Aftercare! I’m so glad you found this group! I had similar pain issues after #1 TKR in 2016, so I’m thankful you will get the help really needed like I did!
I had to resist PT as it was too aggressive back then, but it was 2-3 weeks in before I found these angels!
After each PT session, I was much worse off: greater swelling, lots more pain, etc. and I actually canceled some PT sessions in fact.
So, you may do fine, and I bet you will, even without PT.
I’m headed back in for TKR #2 this week, so this time, I’ll have the Bonesmart way in mind from the “git-go” so I bet I’ll do much better!
My ROM of knee #1 is great, has been good since about 9 months post-surgery, but it took a looong time to get there!
Hang in there as we’re all here for you!

 

[AfterCare]

My TKR was the same date as yours, April 16th. It is mind-boggling how many mistakes like this happen. My surgery was outpatient, so I went home the same day. In my discharge papers it stated that I would get a call from Home Health and they would start in-home PT. Turns out my surgeon, who is top notch, messed up and sent the wrong discharge instructions.

Oh my goodness! I cannot believe that I am not the only one this happened to. Are you by any chance in California?

And I cannot even imagine having this surgery as an outpatient. I was in such agony on days 2 and 3 - nurses had to come in constantly and revise my pain meds. However did you manage that?

Another issue that boggles my mind is the lack of coordination of care. It appears that the hospital hands off the after-care to a completely different entity, which is required to perform their own assessment to get started with care. Well, in order to have the needed home-health care start when it is needed, it thus appears that the new entity would need to perform their intake while we are still in the hospital. However, it seems that even the order for after-care is only sent out while we are being discharged, the home health care then takes days to process the order and schedule then intake - leading to the home health aide to only become available a full week after this type of care is needed the most. My daughter, who is helping me here was ready to have an anxiety attack 2 days into this circus and I'm sure she is not the only one...

 

[Muse]

My TKR was the same date as yours, April 16th. It is mind-boggling how many mistakes like this happen. My surgery was outpatient, so I went home the same day. In my discharge papers it stated that I would get a call from Home Health and they would start in-home PT. Turns out my surgeon, who is top notch, messed up and sent the wrong discharge instructions.

Oh my goodness! I cannot believe that I am not the only one this happened to. Are you by any chance in California?

And I cannot even imagine having this surgery as an outpatient. I was in such agony on days 2 and 3 - nurses had to come in constantly and revise my pain meds. However did you manage that?

Another issue that boggles my mind is the lack of coordination of care. It appears that the hospital hands off the after-care to a completely different entity, which is required to perform their own assessment to get started with care. Well, in order to have the needed home-health care start when it is needed, it thus appears that the new entity would need to perform their intake while we are still in the hospital. However, it seems that even the order for after-care is only sent out while we are being discharged, the home health care then takes days to process the order and schedule then intake - leading to the home health aide to only become available a full week after this type of care is needed the most. My daughter, who is helping me here was ready to have an anxiety attack 2 days into this circus and I'm sure she is not the only one...

I'm in Florida.

They used a special extended numbing agent that stayed in my system for 4 days in addition to prescription pain killers. That made the pain tolerable.

My surgeon told me later that one of the reasons they stopped using home health care is that they were too unreliable.

In the end, my observation is this: it does not matter how good your medical care team is, you have to be proactive and expect at least some screw ups.

I'm 12 days out now and getting around quite well with a cane. Hope you're recovering well!

 

[kneeper]

I had a nurse come with my first knee to change the bandage and make sure the incision looked good. It really turned out to be more for my reassurance than a real "need."

Very true about being proactive, @Muse --some offices are more coordinated than others but you do have to look out for yourself too to make sure things are "lined up."

 

[AfterCare]

Didn't know there are numbing agents that last that long. I will have to ask my PA about that this afternoon at my 2 week appointment.

Totally agree about the proactive part. The doctor hald told me a long time ago that he'd be prescribing home health to come in 3 times during the first week home (and even wrote this on my disability paperwork), but had initially been a bit cagey about revealing the name of companies my hospital works with. After learning their names I did call the companies (2) and was reassured that things would be in place and care would start upon discharge. Of course that turned out not to be true.

I'm much more able to get around now My new knee itself doesn't hurt at all on walking - but the right knee is twice as angry! Thankfully I have a PT who is quite gentle as well. One issue that is becoming increasingly troublesome is that my hamstring is still asleep. I can do all the motions with my left leg EXCEPT lift it. That still makes me dependent on another person to get into my bed. The muscle to the left of it is also getting increasingly numb and tingly. It feels like it is on fire more and more. Last night it woke me up 3 times at random intervals. Nurse told me that Gabapentin is used to resolve this - but I'm already on it. Looking forward to what PA has to say about this this afternoon...

 

[lovetocookandsew]

After my surgeries, my quads had varying times of waking back up. I used a leg lifter to get into bed until I could lift my leg again myself. There are many different kinds of leg lifters you can use; whatever works best for you is the way to go.

 

[sistersinhim]

I used my old leg to lift and let down my new leg. That worked fine for me.

 

[AfterCare]

Here I am with round 2. It's amazing how different these surgeries/recoveries can be. Even though the meds I am given are the same, my right leg is reacting very differently - cramping up a storm at everything exept for the simplest exercises. So far though, the nerve block seems to be working on the knee this time. And I keep getting dizzy - so waiting for my iron levels tomorrow...

 

[Jaycey]

Welcome to the other side again @AfterCare ! Easy does it if you are dizzy - we don't want any falling!

Yes indeed, every TKR is different - even on the same person. I look forward to following your second recovery!

 

[Sisterpat]

Welcome again, AfterCare. Our cases are similar in time. Yep, both knees react very differently. Keep us posted as to your progress. Follow the BoneSmart guidelines. You can’t fail!

 

[Jockette]

Here’s a refresher course for you, I will leave you our Recovery Guidelines. Each article is short but very informative. Following these guidelines will help you have a less painful recovery.

Just keep in mind all people are 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: The 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
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​

6. Access to these pages on the website

​

Oral And Intravenous Pain Medications​

Wound Closure​

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.

While members may create as many threads as they like in the 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 the member’s history before providing advice, so please post any updates or questions you have right here in this thread.

 

[MerlinWizard]

As I read through these forums I am finding out just how awesome my experience is with my surgical team and aftercare.

I can't imagine going through some of this stuff. Everything I was told happened when it was supposed to happen, like clockwork. I was even allowed to skip out on the last two appointments because everything was going so well. I only need to go back if there is a problem. The only problems I have I do to myself!

I look back at having the BKTR and I am so glad I did it. I can't imagine doing this twice, even that close together. Recovery is a bear with the BKTR but here 18 weeks out now and I am sooo happy with the results.

Even having a BKTR, both legs act like they aren't part of the same person! They most definitely have minds of their own. This exercise for that one, that exercise for this one, do I take medication because of one or wait until both? And on and on and on!

It sure sounds like everyone experience each leg differently!

 

[Taoquest]

@MerlinWizard, I totally agree. I am only 15 days out, and yes the mobility after bilateral was more challenging, but the pain has been well controlled, and I will follow the BoneSmart way to recovery. My sister has been fantastic as my caregiver, but she laughed and told me today that she would be on vacation for the next knee if I had opted to have separate TKR’s. People can’t believe I would do this, but my surgeon was confident I could handle a Bilateral, and I am so grateful I had such an excellent surgical team. There have been some dips in the road, such as my sciatica nerve getting angry today, but other people on the site have had this and I will follow their advice. (Oh how I love “Search”)!!!

 

[AfterCare]

Thank you so much everyone!

I am surprised to hear about knees acting that differently even with a bilateral. Although, they still must have had different experiences coming in, so...

I had some terrible problems with pain control once again, but hopefully we are getting a handle on it now. My incision is Very particular about what position it's in.

 

[MerlinWizard]

Thank you so much everyone!

I am surprised to hear about knees acting that differently even with a bilateral. Although, they still must have had different experiences coming in, so...

I had some terrible problems with pain control once again, but hopefully we are getting a handle on it now. My incision is Very particular about what position it's in.

I've had to actively change some of my "learned behaviors". My right knee was the worst one in the years leading up to the BTKR. But the 6 months to a year leading up to the BTKR, my left one was the one that gave me the most trouble.

I now have to actively catch myself putting my weight on my left leg rather than my right. My right one is the one that's lagging right now. It has the most pain, although not nearly what it used to be and it's also the one I tend to do stupid things to. So it's no wonder that my brain still tries to favor the left.

I actively when standing try to stand on both and stand in a good posture. That has been the most amazing thing to see change, walking upright for the first time in I can't remember how long.

At my daughter's wedding people noticed later in the night I was limping. Little did they know it wasn't because of my knees but because of my feet! I was on my new knees for about 14 hours that day wearing dress shoes no less! My feet were literally killing me. While my knees were "stiff" from all of that walking and standing, my feet were where the pain was. I've never spent that much time on my feet in those shoes in my life.

It was a great feeling knowing that I could and I am always thankful for the things I am able to do today that I wasn't able to do for a decade or more.

Now, if I can manage to stay on my knees on the floor for extended periods of time, that would be most helpful. I never knew how many times I got on my knees in a day until I couldn't get on my knees. I kneeled at Church for the first time on Sunday and although it was for 30 seconds or so and it was uncomfortable, I know I will continue to chase that until I can!

Merlin

 

[Ginger1210]

Hi there aftercare my surgeon and physio never pushed my PT i think a pedaled a stationary bike for couple of revolutions and walked up and down to check my leg. I was given some home exorcises to do but only until my knee began to complain. My surgeon and physio both said time and rest are more important, daily living will help your knee strengthen. Its a long road to recovery.

 

[AfterCare]

It feels like my recovery for my right knee only started in earnest this weekend. The after-effects of the inner ear infection I dealt with (dizziness) finally began to recede mid-week last week and the issues I experienced from the removal of the breathing tube a couple of days after that in a rather dramatic fashion. I woke up, couldn't stop coughing for a while and coughed up pinkish-orangy clots on Thursday and a rather large amount of whitish phlegm on Friday. By Saturday my throat finally started to feel better and only at that time it looks like my healing really got started. I had a PT session this morning and the PT commented that it looked like she was working with a different person!

In that relationship I noticed that so far I have not been able to decrease my pain medication, especially my long acting oxy and that is quite concerning to me now. Given the improvements over the weekend, I did not take my night-time dose (my surgeon wants me to be off it altogether by now) and woke up 5 hours later in a world of pain that I had considerable trouble afterwards getting off of. Wondering whether there are any alternatives for long acting pain meds to the oxy...

 

[AfterCare]

At my daughter's wedding people noticed later in the night I was limping. Little did they know it wasn't because of my knees but because of my feet! I was on my new knees for about 14 hours that day wearing dress shoes no less! My feet were literally killing me. While my knees were "stiff" from all of that walking and standing, my feet were where the pain was. I've never spent that much time on my feet in those shoes in my life.

That must have felt like quite the validation for having had this surgery! Looking forward to having such an experience myself at some more or less distant point in the future :D

 

[MerlinWizard]

That must have felt like quite the validation for having had this surgery! Looking forward to having such an experience myself at some more or less distant point in the future :D

I will do you one better - I attended a concert last night, an hour or so on my feet, singing, swaying, foot moving, foot stomping, good old fashioned good time music with my wife.

I don't know how long it's been since I have been able to do that. It's been long enough that I don't remember when.