TKR Back Again!

[Bigbruce49]

Spent a bunch of invaluable time here 14 years ago after my left TKR. well that old “age related degeneration” caught up to me and I had my right knee replaced 8 days ago. So I’m back for some refreshers and confidence building.
So far all going reasonably well. Was only on the height test pain meds for a couple of days and thanks to stool softeners, Reatoralax and prunes managed to avoid any severe constipation. Now managing well with Extra Strength Tylenol and my Cryocuff.
Have been doing extensions, heel slides and leg drops (off my recliner) getting gentle stretching - muscles etc still tight and somewhat swollen. Walking around the house at least once an hour.
First PT appointment today. Therapist was happy with status - 95 deg flex. Didn’t get straight measurement.
Biggest problem is SLEEP - or lack thereof. Getting about 4 hours of the 8 or so I’m in bed. Just can’t get comfortable. Very frustrating, although I’m sure it will get better sometime.
Overall, while I’m sore - I know it will get better. Before my surgery, I was sore and knew it was only going to get worse!
Cheers All!
Bruce

 

[mendogal]

back @Bigbruce49!

So your R was on January 14?

Here's a refresher, with a reminder to not overdo things, especially during the initial 12 weeks while muscles, tendons, ligaments, and bone do their initial healing!

You are in the very early stages of an average of a yearlong recovery. I will leave you our Recovery Articles that have helped tens of thousands of other knee replacements. We are here to help you through this journey the best we can. The very best thing for your knee right now is to rest, ice, and elevate. Exercises can come later. There is no rush to achieve ROM because it will come naturally as your swelling decreases. Your OS was able to bend your knee while checking for movements during your surgery, so it will be fine. It just takes time.

Each person is different as is their recovery. Most find that the Bonesmart approach works best for them, but others find that a more aggressive therapy helps them more. It's your recovery and your choice on how you recover. As you read more on other members' recovery threads, you’ll get a better perspective of what to expect. The following are our basic guidelines and should help get you started.

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. 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]

Sleep issues continue to plague our members. Like many, I spent way more time napping and resting in the recliner than trying to sleep in bed for weeks post op!

Insomnia is a real bummer for many of us in the initial weeks after surgery. It's generally not the meds, it's... everything about the trauma, discomfort, energy drain!

Definitely sleep whenever (and wherever it's safe and comfy!) - many of us sleep and/or nap in a recliner, or surround ouselves with soft pillows.

Icing, elevating, napping.... All help, but you might also 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.

What finally worked for me: a mug of sleep tea with valerian followed by a 3 mg sustained release melatonin, immediately going into a dimly lit room and relaxing. When I got sleepy, turning off the light and lying down with my legs up on the Lounge Doctor. After a few hours I would wake, move the Lounge Doctor away, and sleep more.

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.

 

[Layla]

Hello and Welcome to recovery, Bruce. Thanks for joining us again!
Lots of pillows worked for me, one here, one there, providing the soft cushy comfort I needed to rest a leg on, or an arm. I also found Magnesium helpful to aid in falling asleep and staying asleep. I do hope you're able to get some restorative rest soon.

Best Wishes as you begin your recovery and with physical therapy.

We have created a signature for you, please let us know if it's incorrect and we will edit accordingly.
Have a great day!
@Bigbruce49

 

[Bigbruce49]

Thanks folks for the advice! Had another semi sleepless night last night, but now that I know this is not an uncommon side effect, I wasn’t as upset about it. I’m going to nap throughout the day to catch up and try Melatonin tonight.
…and wait patiently for the “this too shall pass” moment…

 

[benne68]

I’m going to nap throughout the day

Perfect plan. As we like to say: Sleep wherever you can, whenever you can during the first month of recovery!

 

[Bigbruce49]

Day 13 post surgery and turned a corner! Was able to move from the walker to the cane. I’m able to put almost all of my (considerable) weight on my new knee. Still some swelling and tightness but it’s gradually easing. Continuing to do gentle flexing and straightening exercises as well as lots of time with the Cryocuff. Down to four extra strength Tylenol a day.
Now - if I could only get a decent nights sleep.

 

[mendogal]

Great update! Slow and steady!!!!

 

[benne68]

Now - if I could only get a decent nights sleep.

I feel your pain! I had badly disrupted sleep for weeks after my TKR. It does get better, it just takes time and you are still early days.

 

[Layla]

Hi Bigbruce, Thanks for the update.
You're making steady progress and that's great. I do hope you're able to get some good sleep soon.
Enjoy the rest of the week!
@Bigbruce49

 

[Layla]

Happy One Month Anniversary, Bruce!
Hopefully your sleep is improving. Let us know how yore doing when you have the time.
Take care!
@Bigbruce49

 

[Bigbruce49]

Thanks, Layla. I’m doing great! Much better than I expected given I had been through this before. My recovery this time has been much faster than last. I’ve just come up from my basement gym having done 45 minutes cardio on my elliptical and recumbent bike. Also my week 4 exercises from my PT. Flex measured 115 on Wednesday; straight 109. Walking unaided since week 3 - albeit not long distances - we’ve got snow!
I’ve been sleeping well for over a week now. Still a bit of swelling around the joint and some issues with quads settling down - no doubt still angry from the tourniquet. Pretty much off all pain meds except for the odd Tylenol.
All in all very pleased with progress. Being able to walk without the arthritic pain is pure joy!

 

[Layla]

Hi again Bruce,
Thanks for the update. It's wonderful to read you're doing so well and it certainly sounds as if you are making fantastic progress. It has to be nice having an easier recovery than last time also. Better than the other way around. Enjoy the rest of the weekend!
@Bigbruce49