TKR Amazingly better experience with knee #2!
- Thread starter BBCG
- Start date
BBCG,
I'm enjoying all your info and experience. I wonder if you mind saying a bit more about your drug regimen. I read briefly about Tramadol and what makes it better than hydrocodone. I had a TLKR on 5/3 and they had me using oxycodone, meloxicam, and Tylenol. It made me nauseas and loopy, groggy all the time. Plus did not seem to be touching the pain much. I was afraid to take too much and increase the chance of losing my meals. So yesterday I got it switched to hydrocodone which I tolerated well after a hip replacement last November.
This knee pain is so much worse than hip replacement, which I expected. But I expected the pain meds to help somewhat. Kind of wondering if I need another change! I'm walking without a walker, have 90-100 ROM, and icing and elevating tons.
Glad you're having such a good experience this time around! Oh, and my hospital worked out a plan with a delivery pharmacy that brought my meds a few hours after our arrival home.
I'm enjoying all your info and experience. I wonder if you mind saying a bit more about your drug regimen. I read briefly about Tramadol and what makes it better than hydrocodone. I had a TLKR on 5/3 and they had me using oxycodone, meloxicam, and Tylenol. It made me nauseas and loopy, groggy all the time. Plus did not seem to be touching the pain much. I was afraid to take too much and increase the chance of losing my meals. So yesterday I got it switched to hydrocodone which I tolerated well after a hip replacement last November.
This knee pain is so much worse than hip replacement, which I expected. But I expected the pain meds to help somewhat. Kind of wondering if I need another change! I'm walking without a walker, have 90-100 ROM, and icing and elevating tons.
Glad you're having such a good experience this time around! Oh, and my hospital worked out a plan with a delivery pharmacy that brought my meds a few hours after our arrival home.
OP
OP
BBCG
Former BoneSmart Staff Member
Yes, Mar! You can avoid the Dreaded MUA this time!
I was “threatened” with that option last time, too, told it was going to be “necessary” in order to get my knee to bend enough to drive, walk, etc.
But I was fortunate to have found Bonesmart! So, I just said I’m not ready to go that route yet, that I’m going to give my knee more time to get there. Pretty much verbatim, that was my stance. So, within the first 6 months I had only gotten to a 90 degree bend and to about 9 degrees straight.
I was supposed to go back again to my doc at the 9 month date but I never made the appointment!
Of course, I did eventually get a perfectly fine bend at about a year, but could do everything I needed to do way before that, too. So, had I not held firm to my giving this knee more time, I would have had the MUA.
I am progressing much faster this time, at 13 days today I was at 90 degrees bend and 6 degrees straight.
But my PT said I needed to get to 120 by 6 weeks ideally, so we’ll see how fast and far I do get this time, too!
My PT this time has some creative and novel tips for getting the bend and my knee responds well to them... I hang my knee off the edge of my bed, letting it slowly, softly bend a bit more each time, not pushing it, just breathing with it and relaxing it. I hang it there for a few minutes each time. That seems to be helping... plus there’s a maneuver on a short step...one that’s about 2.5” in height...just like the steps into my utility room to the garage. So, I put my right foot on the step from below, left foot on the ground, then move my upper body forward without bearing weight yet, so that the knee bends more. No bouncing movements, just soft, gentle stretch movements. I then hold it in that more stretched position for a count of 5. If I do this about 6 times with a short break in between, the knee is more willingly to bear weight on it as I walk slowly through a full range of walking moments afterwards. I’m doing this several times a day, and the stretch is actually somewhat pleasant now.
I seem to have an interesting autonomic reaction to any force in the bend, too! Last time at PT I did the stepper device stepping up and down in a recumbent position for 9 minutes then moved to another station where I also stressed the knee bend as well. I began feeling slightly light-headed, which surprised me as it wasn’t painful really since there was no force behind it. So, now we know to watch for that reaction and I just take a brief break to let that reaction fade. She suspects it’s my body’s way of protecting my knee from injury, because if I didn’t stop, I could pass out and then I would stop harassing my knee!
We discussed my moving from the crutches to a cane today, too and she explained how to make sure the cane is correctly set for me. I’m only 5’ tall, so the cane’s adjustments are likely to need setting to the shortest length, of course! I have a cane at home though I loaned my real one to my daughter who is dealing with a hurt toe. I ordered a new bird-decorated cane which should come on Friday, but I did find one of the old ones here that I’ve been using inside the house. I think I’ll still crutch it outside though, for sake of things that can affect balance more out there!
Heading out for a neighborhood walk... trying to go one more house-length a day!
I was “threatened” with that option last time, too, told it was going to be “necessary” in order to get my knee to bend enough to drive, walk, etc.
But I was fortunate to have found Bonesmart! So, I just said I’m not ready to go that route yet, that I’m going to give my knee more time to get there. Pretty much verbatim, that was my stance. So, within the first 6 months I had only gotten to a 90 degree bend and to about 9 degrees straight.
I was supposed to go back again to my doc at the 9 month date but I never made the appointment!
Of course, I did eventually get a perfectly fine bend at about a year, but could do everything I needed to do way before that, too. So, had I not held firm to my giving this knee more time, I would have had the MUA.
I am progressing much faster this time, at 13 days today I was at 90 degrees bend and 6 degrees straight.
But my PT said I needed to get to 120 by 6 weeks ideally, so we’ll see how fast and far I do get this time, too!
My PT this time has some creative and novel tips for getting the bend and my knee responds well to them... I hang my knee off the edge of my bed, letting it slowly, softly bend a bit more each time, not pushing it, just breathing with it and relaxing it. I hang it there for a few minutes each time. That seems to be helping... plus there’s a maneuver on a short step...one that’s about 2.5” in height...just like the steps into my utility room to the garage. So, I put my right foot on the step from below, left foot on the ground, then move my upper body forward without bearing weight yet, so that the knee bends more. No bouncing movements, just soft, gentle stretch movements. I then hold it in that more stretched position for a count of 5. If I do this about 6 times with a short break in between, the knee is more willingly to bear weight on it as I walk slowly through a full range of walking moments afterwards. I’m doing this several times a day, and the stretch is actually somewhat pleasant now.
I seem to have an interesting autonomic reaction to any force in the bend, too! Last time at PT I did the stepper device stepping up and down in a recumbent position for 9 minutes then moved to another station where I also stressed the knee bend as well. I began feeling slightly light-headed, which surprised me as it wasn’t painful really since there was no force behind it. So, now we know to watch for that reaction and I just take a brief break to let that reaction fade. She suspects it’s my body’s way of protecting my knee from injury, because if I didn’t stop, I could pass out and then I would stop harassing my knee!
We discussed my moving from the crutches to a cane today, too and she explained how to make sure the cane is correctly set for me. I’m only 5’ tall, so the cane’s adjustments are likely to need setting to the shortest length, of course! I have a cane at home though I loaned my real one to my daughter who is dealing with a hurt toe. I ordered a new bird-decorated cane which should come on Friday, but I did find one of the old ones here that I’ve been using inside the house. I think I’ll still crutch it outside though, for sake of things that can affect balance more out there!
Heading out for a neighborhood walk... trying to go one more house-length a day!
OP
OP
BBCG
Former BoneSmart Staff Member
Hi Newmect!
We are indeed close in time as to our new baby knees... First of all, I am in Oregon, so I have access to some carefully crafted hemp/based medical salves and such, and I have used that to address break-through pain. Not everyone has such access, I know. But the magnesium gel also has helped lots with that deep neural ache that I sometimes get between medicine doses.
Initially, out of hospital I was given Tramadol (50 mg) and Tylenol (1000 mg), alternating every 3 hours. In between for breakthrough pain I had a small number of Hydrocodone too. Hydrocodone does really nothing for me but the Tramadol and Tylenol interval system worked very well for pain.
Last time I also had Oxycodone, meloxicam snd Tylenol, too. Like you, I was terribly loopy, felt horribly drugged, couldn’t eat (though I never actually unloaded a meal!), and they did nothing for the pain either! It was a cruel hoax!
So, after that experience, when the doctor’s office gatekeeper refused to get me through to anyone to change the meds, I researched side effects of the oxy and others and realized my reactions were essentially allergic reactions, although perhaps technically they aren’t called that? At any rate, my medical record showed allergy to Oxycodone so I was never given it this time!
And this has made all the difference, I suspect! What I don’t yet know is what was different about my anesthesia this time. I had a spinal last time and not this time; did that impact how I felt afterwards? To what percent? Probably won’t ever know, but it might factor in.
Right now, 13 days out, I am in a 6-hour alternating cycle with Tramadol (1 - 50 mg pill) at 2 pm and 2 am & Tylenol (2 - 500 mg pills) at 8 am and at 8pm.
In between I ice often, elevate my leg sitting in my recliner, apply magnesium gel or the locally-made CBD salve when the knee feels irritated or has nervy-pain, and I take a few drops of the herbal/CBD tincture prior to PT or a walk.
My pain is not bad at all with this system of tools. Very do-able and I feel “with it”, alert, sense of humor intact, appetite reasonable, wanting protein maybe more than sometimes, but within a range of normalcy.
Thanks for reaching out as I would love to give back to others here in thanks for so much help I got last time!
Sandy11
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Hi Barbara,
Your detailed and analytical recovery posts are very encouraging.
I have my LTKR in a week, next Wednesday. I am ready to get it done with. I have been prescribed with Celecoxib 100 mg twice daily and Oxycodone 5mg 1-2 tabs every 4 hours.
This is my first ever surgery in my lifetime, so I am not sure how am I going to react and recover.
Have my first PT appointment on 5/28. Will decide to go or not depending on my knee condition then, based on Bonesmart posts.
I don't want to exert it more than necessary.
I am in Seattle area, not far from you. so I reach out for hemp/based medical salves if found necessary.
@Mar
Happy for you that you are recovering well.
Your detailed and analytical recovery posts are very encouraging.
I have my LTKR in a week, next Wednesday. I am ready to get it done with. I have been prescribed with Celecoxib 100 mg twice daily and Oxycodone 5mg 1-2 tabs every 4 hours.
This is my first ever surgery in my lifetime, so I am not sure how am I going to react and recover.
Have my first PT appointment on 5/28. Will decide to go or not depending on my knee condition then, based on Bonesmart posts.
I don't want to exert it more than necessary.I am in Seattle area, not far from you. so I reach out for hemp/based medical salves if found necessary.
@Mar
Happy for you that you are recovering well.
OP
OP
BBCG
Former BoneSmart Staff Member
Sandy11, my first ever surgery was my first TKR in 2016, too, so I can understand it’s all a new thing!
Just to revise my earlier comments, I’m also taking Celebrex (Celecoxib), too, for just 2 weeks, as well as aspirin to prevent blood clots.
The protocol you will be on is very similar to my first TKR, although they added Meloxicam later on due to the nerve pain.
Some people do just fine with that protocol, and since I didn’t know I would be allergic to Oxycodone, I had no clue it wouldn’t work! I am very hopeful it will work well for you!
Starting PT about a week out is what the protocol here is as well. I think the main thing so many of us here in the states deal with is overly zealous PT protocols. The “must be at 120 degrees by 6 weeks”, etc. demands are unrealistic for so many patients that it’s unfair for their bodies to meet that requirement. Finding a PT who is reasonable and won’t do that may be tricky because they seem to all be under orders to meet certain objectives. My usual PT has her own practice so doesn’t have rigorous overlords, but their may be insurance requirements to meet the official objectives, but I’m not sure.
For me now, having been through it twice, I would have no hesitation walking away from PT if they insisted on using force. There is no need to do so, and your knee will definitely heal in ITS OWN timeframe.
So, last time, under the oxy, I was a basket case! So, I wasn’t able to stand up and advocate for myself. I think going in, you can know that “basketcase-ness” means the wrong meds are not helping you! The Tramadol and Tylenol will do the job, assuming the others are problematic.
But, I am betting I’m just weird, and I’m fine with that! I have every hope your body will respond correctly and you’ll do really well! And we are all here for you when you need us!
Just to revise my earlier comments, I’m also taking Celebrex (Celecoxib), too, for just 2 weeks, as well as aspirin to prevent blood clots.
The protocol you will be on is very similar to my first TKR, although they added Meloxicam later on due to the nerve pain.
Some people do just fine with that protocol, and since I didn’t know I would be allergic to Oxycodone, I had no clue it wouldn’t work! I am very hopeful it will work well for you!
Starting PT about a week out is what the protocol here is as well. I think the main thing so many of us here in the states deal with is overly zealous PT protocols. The “must be at 120 degrees by 6 weeks”, etc. demands are unrealistic for so many patients that it’s unfair for their bodies to meet that requirement. Finding a PT who is reasonable and won’t do that may be tricky because they seem to all be under orders to meet certain objectives. My usual PT has her own practice so doesn’t have rigorous overlords, but their may be insurance requirements to meet the official objectives, but I’m not sure.
For me now, having been through it twice, I would have no hesitation walking away from PT if they insisted on using force. There is no need to do so, and your knee will definitely heal in ITS OWN timeframe.
So, last time, under the oxy, I was a basket case! So, I wasn’t able to stand up and advocate for myself. I think going in, you can know that “basketcase-ness” means the wrong meds are not helping you! The Tramadol and Tylenol will do the job, assuming the others are problematic.
But, I am betting I’m just weird, and I’m fine with that! I have every hope your body will respond correctly and you’ll do really well! And we are all here for you when you need us!
OP
OP
BBCG
Former BoneSmart Staff Member
Checking in at 2 weeks post-op!
Am coming along well... in my PT session today, my current PT had me use the recumbent stepper to warm up then a few stretching and strengthening machines and such and when she went to do the obligatory measuring toward the end, I was able to get the ROM to 89° and the extension to 3° so I was jazzed!
It seems that soft exercise gradually increasing the bend gets my knee warmed up nicely and its much more cooperative with the measuring idea after that. But, I still have to watch my PT like a hawk!! She will try to sneak in and push my leg a bit! I caught her doing it today and just surprised myself: my baby knee brakes worked great! Hah! But, afterwards I realized I need to psyche myself into being on high alert and ready to defend the baby knee at every moment in that place.... too bad it can't just be a collaborative effort!
I was reading other posts tonight and one person had gotten a massage and that sounds great! My left shoulder and arm are not happy because I'm using that side so much more than I used to... pulling myself up, single crutching, etc. I could use a massage for the arm, too!
I'm now completely off the prescription pain meds and only taking Tylenol and the tincture for breakthrough pain now, too. So, technically I could try driving, but I think my bend needs to be a tiny bit more predictable....
Yesterday, I went for a walk with my friend who drives me because I can't drive yet, and I walked 0.52 miles! I had not planned to go so far, but the short cut side path back was under reconstruction so I'd either have had to go back or around the longer way. I made it, but joined the ODIC this morning for half the day.
Tomorrow afternoon we are planning to do a 0.4 mile walk in a really nice place, called Delta Ponds, along the river where there are always lots of birds singing and ducks, baby goslings, Bald Eagles overhead stealing fish from Osprey, etc! I'm excited to be able to get back over there... I asked my PT today if it would be okay for me to do the sloped walk down to the path from the parking lot, as I didn't want to mess up things on the slope, maybe a 3%... she said I should be fine given that I'm as strong as I am. (I guess my baby knee's brakes impressed her!)
Tomorrow afternoon we plan to try that walk, as there are benches along the way for me to rest on as I go... and my husband's walker will allow him to sit, too... often necessary for him with his compromised balance and vision. It's only 0.4 miles and since we'll be able to rest at the benches I don't think it will put me back in the ODIC club!
Am coming along well... in my PT session today, my current PT had me use the recumbent stepper to warm up then a few stretching and strengthening machines and such and when she went to do the obligatory measuring toward the end, I was able to get the ROM to 89° and the extension to 3° so I was jazzed!
It seems that soft exercise gradually increasing the bend gets my knee warmed up nicely and its much more cooperative with the measuring idea after that. But, I still have to watch my PT like a hawk!! She will try to sneak in and push my leg a bit! I caught her doing it today and just surprised myself: my baby knee brakes worked great! Hah! But, afterwards I realized I need to psyche myself into being on high alert and ready to defend the baby knee at every moment in that place.... too bad it can't just be a collaborative effort!
I was reading other posts tonight and one person had gotten a massage and that sounds great! My left shoulder and arm are not happy because I'm using that side so much more than I used to... pulling myself up, single crutching, etc. I could use a massage for the arm, too!
I'm now completely off the prescription pain meds and only taking Tylenol and the tincture for breakthrough pain now, too. So, technically I could try driving, but I think my bend needs to be a tiny bit more predictable....
Yesterday, I went for a walk with my friend who drives me because I can't drive yet, and I walked 0.52 miles! I had not planned to go so far, but the short cut side path back was under reconstruction so I'd either have had to go back or around the longer way. I made it, but joined the ODIC this morning for half the day.
Tomorrow afternoon we are planning to do a 0.4 mile walk in a really nice place, called Delta Ponds, along the river where there are always lots of birds singing and ducks, baby goslings, Bald Eagles overhead stealing fish from Osprey, etc! I'm excited to be able to get back over there... I asked my PT today if it would be okay for me to do the sloped walk down to the path from the parking lot, as I didn't want to mess up things on the slope, maybe a 3%... she said I should be fine given that I'm as strong as I am. (I guess my baby knee's brakes impressed her!)
Tomorrow afternoon we plan to try that walk, as there are benches along the way for me to rest on as I go... and my husband's walker will allow him to sit, too... often necessary for him with his compromised balance and vision. It's only 0.4 miles and since we'll be able to rest at the benches I don't think it will put me back in the ODIC club!
Jo Wo
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Being out and enjoying nature helps with healing, I think. Glad to hear it is going so well.
Getting out in nature is always uplifting to most people. Enjoy your careful walk!
Sisterpat
Former BoneSmart staff member
Enjoy your walk, Barbara, but be careful. These days I am watching an eagle cam that has 2 eaglets hatched and will soon fledge. It’s on 24/7 and is so entertaining and endearing to watch these critters and their wonderful eagle parents. And just yesterday I found an osprey cam with a pair of birds sitting on 3 eggs. Fascinating!
OP
OP
BBCG
Former BoneSmart Staff Member
Indeed, SisterPat, the nest cams can be really fascinating to watch! In our store (Eugene’s Wild Birds unlimited) we have a tv with internet behind the counter and this time of year, we usually have it on one of the best cams. Customers love it, and some come in when they’re in the shopping center just to check the babies, even if they don’t need anything from us! Along my river path, there is an eagle nest in a park at one end of the path, then Osprey nests at the other end, so there are sometimes exchanges between the birds as they hunt for their fish. Rarely does it affect us, unless we point the birds out to those fellow path users that are unaware. I often bring binocs, in case there’s something interesting!
Please be very careful with these machines at only 2 weeks post op. If it was me I would decline to use them until much later.
OP
OP
BBCG
Former BoneSmart Staff Member
Yes! Me, too! I learned a lot from #1 AND from everyone here!! These folks saved me, I tell you!!
Sisterpat
Former BoneSmart staff member
Amen! I told you on another thread, Barbara, that’s friend graciously provided the funds to purchase an adjustable bed frame. It should be delivered Monday or Tuesday. I’m hoping it helps me as much as yours did you. Thanks for the advice!
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OP
OP
BBCG
Former BoneSmart Staff Member
Oh how wonderful, SisterPat! I know it will really help you!
When I’m in bed, I have my new knee leg resting in one of those foam pillows with an indentation down the long side middle, so a person has the support on their neck but their head falls into the crevice or through, then once I raise the bottom of the bed, voila! I do get those twitches sometimes but I just pull out the magnesium gel and that quiets the nerve twitches down. My leg is pretty happy in the pillow as support, and my ice machine hums away in a little table beside the bottom of the bed...
I certainly hope it works as well for you! When I had knee #1 done, I was sleeping in a fold-out sofa in my living room, because after my husband had his stroke, he was up so much in the night I could never sleep... so, this bed has been so helpful and health-aiding!
When I’m in bed, I have my new knee leg resting in one of those foam pillows with an indentation down the long side middle, so a person has the support on their neck but their head falls into the crevice or through, then once I raise the bottom of the bed, voila! I do get those twitches sometimes but I just pull out the magnesium gel and that quiets the nerve twitches down. My leg is pretty happy in the pillow as support, and my ice machine hums away in a little table beside the bottom of the bed...
I certainly hope it works as well for you! When I had knee #1 done, I was sleeping in a fold-out sofa in my living room, because after my husband had his stroke, he was up so much in the night I could never sleep... so, this bed has been so helpful and health-aiding!
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OP
OP
BBCG
Former BoneSmart Staff Member
Well, tonight I joined the ODIC! Saw a different PT yesterday, as my usual one there at the surgery center was away to attend her son’s college graduation. Basically, the sub had me do about 5 minutes on the recumbent stepper, then about 20+ minutes on the “shuttle”, a reclining leg press machine. But 20 minutes was too much! My entire leg is aching and that began about 3pm... woke me up in pain, so applied more of my magnesium gel, swapped the room temperature ice pack for a freshly frozen one, took my Tylenol an hour early, and will now try to get back to sleep! I hear the swallows twittering their dawn song, too, so morning is coming! The magnesium gel, ice pack and drops of tincture have helped so new knee has calmed down a lot now...
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Jo Wo
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what is an ODIC?
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