TKR April 25, 2021 LTKR - Post op thread

[Farfields]

I'm posting for the first time post-op. It's been a challenging 7 days since my LTKR on Apr 25. I'm just starting to feel human again, but in a lot of pain. I'm taking 2 mg hydromorphone every 4-5 hrs depending on intensity of pain, and only doing basic exercises to straighten and bend my knee as recommended. I can straighten it quite well but bending it is a big challenge so far. Sleeping is really hard and so uncomfortable, even with pain meds on board. So tired! I was told to sleep on my back, but I'm wondering if it's possible to sleep on my side, with a pillow between my legs.
Does anyone have sleeping tips for someone in early post op? When does the intense pain start to subside, as it sure hasn't yet? I don't want to stay on the opiates longer than necessary.

 

[Jockette]

Hi and Welcome to recovery.

Ask your doctor if you can add Tylenol to your medication list. If yes, then
the most effective way to take Tylenol is 2 x 500 mg tablets every 6 hours, to a total of 4,000 mg (4 doses) in 24 hours. You need to take it regularly, to keep up the levels in your bloodstream. If you just take the odd dose now and then, it's far less effective.

Check all other medications you're taking, to make sure there is no Tylenol/Acetaminophen/Paracetamol in them. If there is, scale back one or two of your regular Tylenol doses, so you stay within that safe 24 hour limit of 4,000 mg.

I was a side sleeper before my surgery, but couldn’t after. I find it much more comfortable sleeping on my back if my legs are elevated, which also helped my swelling.

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.

 

[pjkopks]

I am three weeks out from tkr tomorrow. Recovery and sleeping has been difficult, much more so than I expected. I am still taking pain meds at night, as well a Tylenol and a Benedryl. (Fair disclosure, I did not ask my doctor about the Benedryl, but I have taken it almost nightly since coming home.) I'm still awake several times in the night, and sometimes I stay awake a long time. One thing that has helped me is using some bluetooth, small earphones which I can sleep in comfortably. When I awaken at midnight or 1 or 2, I put them in and my playlist on a very low volume setting, and that often lulls me back to sleep. Best wishes to you. The last three weeks have felt rather rugged to me.

 

[benne68]

Hi @Farfields and welcome to the recovery side!

The pain and sleep challenges you describe are absolutely normal. Most of us find the first few weeks of recovery miserable -- pain, fatigue, difficulty sleeping, etc. But, the good news is: it does get better!

For now, the best thing you can do is to stay ahead of the pain by taking your meds on schedule, plus ice, elevate and rest as much as possible. Your body has a lot of work to do to recover from the trauma of this surgery.

In the meantime, know that we are here for you to provide support and offer comfort.

You will get through this recovery with time.

 

[ski_bum]

I'm posting for the first time post-op. It's been a challenging 7 days since my LTKR on Apr 25. I'm just starting to feel human again, but in a lot of pain. I'm taking 2 mg hydromorphone every 4-5 hrs depending on intensity of pain, and only doing basic exercises to straighten and bend my knee as recommended. I can straighten it quite well but bending it is a big challenge so far. Sleeping is really hard and so uncomfortable, even with pain meds on board. So tired! I was told to sleep on my back, but I'm wondering if it's possible to sleep on my side, with a pillow between my legs.
Does anyone have sleeping tips for someone in early post op? When does the intense pain start to subside, as it sure hasn't yet? I don't want to stay on the opiates longer than necessary.

Do what they say, sleep anytime you can. 7 weeks out from my second knee and I have only had one night in bed. Hot tub has been my go to.

 

[Farfields]

I'm now 2 1/2 weeks post-op and doing better. Still quite reliant on the pain meds for pain, icing and elevating regularly, and sleep is a bit better. I use a long pillow under my leg from thigh to ankle for support while sleeping on my back at night. I keep trying to sleep on my side but no luck without pain and discomfort so far. I'm still using the walker as I feel unstable, and don't feel quite ready to progress to a cane.

I went for my second formal PT session today. I've been doing my exercises 4 x a day at home as well and today had a flexion of 97 and extension of -5. The PT seemed to be pleased with this. Is this good for 2 1/2 weeks post op?

 

[Jockette]

Yes, your numbers are very good for your timeframe.

Be careful doing the exercises 4 times a day, it really isn’t necessary to do them so often. If you find that pain and/or swelling increases, then cut some of them back.

Regaining our ROM is more about Time than repetitions of a list of exercises.

Time to recover.
Time for pain and swelling to settle.
Time to heal.

Our range of motion is right there all
along just waiting for that to happen so it can show itself.

In the general run of things, it doesn't need to be fought for, worked hard for or worried about. It will happen. Normal activity is the key to success.

 

[benne68]

Hi @Farfields and Happy 1 month Knee-versary!

Hope your recovery is going well. Please give us an update on how you are doing when you have a chance.

 

[Farfields]

Hi everyone, I'm now 6 weeks post op and doing ok. I do feel like its two steps forward and one back, and get frustrated easily, but overall I am making slow progress. My ROM from last week is reasonable, flexion at 115 and extension at 2 degrees, but I believe improving further. I am focusing on strengthening exercises as well. The pain is still significant and I'm relying on 4 tramacet and 4 extra-strength tylenol each day. I keep trying to reduce the tramacet further, but so far I cannot manage the pain with just tylenol. I see my orthopedic surgeon for an x-ray and my 6 week check up this Friday, so I'm keen to see what he has to say.

 

[benne68]

Hi @Farfields -- With a ROM of 115/2, you are doing just great!

The fact that you are still struggling with pain at 6 weeks is really not that unusual. Are you icing and elevating often during the day? As we start to get more active, they become even more important in pain control.

You might trying increasing your Tylenol dosage, because it sounds like you aren't taking enough. You can take 2 extra strength tables (500 mg each) every six hours (4 times a day) -- as long as none of your other medications contain acetaminophen. It's important not to exceed 4000 mgs/day.

Also, remember that it's important to stay ahead of the pain by taking them on a regular schedule. As a reminder, here is a link to the pain management chart https://bonesmart.org/forum/threads...ing-pain-after-a-tkr-and-the-pain-chart.7969/

Let us know how your appointment goes on Friday!

 

[Jockette]

I am focusing on strengthening exercises as well. The pain is still significant

I agree with @benne68 about the Tylenol, but in addition to that, you might want to back off the strengthening exercises, as it’s a bit early in your healing journey for that, and could be the reason your pain level is significant.

 

[InkedMarie]

115 for flexion is great! I’m six weeks but haven’t been measured in a couple weeks but was 107/0 then.

Marie

 

[Farfields]

Thanks for your responses! I'll ease off the strengthening for a while and focus on pain management as well as straightening and bending gently for ROM. I do elevate and ice regularly so I just have to be patient : ) I'll provide an update after my doctor appointment on Friday.

 

[hawk2go]

This chart borrowed from another Bonesmartie really helped my perspective during recovery. I personally found it to be all too true! I spend most days trying to calculate what is too little activity and what is too much. I suspect I'll be quite old when I discover the answer. One thing for sure, your knee will let you know when you've done too much on any day - either right away or a day or 2 after.

 

[Samsrf]

Hi @Farfields I am at 10 weeks and still take the max dose of extra strength Tylenol.1000mg 4x day every 6 hour… at 10 & 4, 10 &4. I don’t notice much pain at all anymore (less than before surgery) , but when it is time to take Tylenol, my knee let’s me know. It is like weird sharp shooting pains. I consider it my bodies reminder clock. My doctor has assured me that as long as I don’t drink alcohol (which I don’t) and don’t take more than 4000mg in 24 hours, my body will be fine. Hope that helps.

 

[Farfields]

My 6 week checkup was good. My surgeon is happy with how the knee looks, both inside (x-rays) and out. He's also not surprised with the pain continuing, and said that it's not unusual for it to take up to 3 months for a person to feel fairly normal, although full healing not for a year.

Love the chart that Hawk2go posted! so true about recovery.

I can't believe how much time I spend thinking about pain and its management. It's very important though! I hope to be easing back to just the extra strength tylenol soon.

 

[benne68]

Hi @Farfields!

Just checking in to see how you are doing, since it's been a while since you posted. Give us an update when you have a chance!