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Bilat - second thoughts?

Discussion in 'Knee Replacement Pre-Op Area' started by nensi, Jun 4, 2017.

  1. nensi

    nensi Senior
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    Hello! Scheduled for bilateral tkr on June 30. Reading many posts from people having a second tkr 2-3 months after the first and starting to doubt my decision to have a bilat. I have instability, very limited bending angle and pain in both knees. My husband is elderly (87) and our three kids live at home (21,20,18). They are available to help this summer. I will have a good sleeping, bathing, eating arrangement in the main floor but I am getting panicky about the rehab I guess. I am pretty fit - lost 30 lbs I the last year to try and get my knee pain under control. I do 30 min elliptical 6 days a week and since the beginning of this year have been weight training to build up my upper body strength.
    I work full time in R&D so mostly sitting.
    So why am I having the jitters? Normal or listen to the doubts?
    Any thoughts out there esp from recent bilat patients ?



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  2. Roy Gardiner

    Roy Gardiner Forum Advisor Staff Member Forum Advisor

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    Hi. I'm not a recent BTKR, but certainly an advocate. It's tough I'll grant you, but it's only tough once. If you have one done, each day in recovery is just waiting for it to start again, if you have two then you're on the road home. If you can live on one level well you are good to go; I had to navigate stairs to my bed (once a day each way only) and that was hard work. Otherwise moving about on a level is slow but relatively easy. With three young adults to help, you should be fine.

    I can see absolutely no objection, and you'll be OK in three months, good in six.

    Please try to plan on as long as possible off work. Recovery takes energy from the brain as well as from the body.

    In short, go for it.
     
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  3. SusieShoes

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    I had my bilateral replacements on May 10, so I'm close to a month in. Like you, both my knees were shot going into this surgery, and I also lost some weight and did exercises to prepare. Almost from the moment I woke up in the recovery room, I've been glad I opted for getting both knees done.

    Is it rough? Yes. My OS called a bilateral recovery "intense" but also pointed out it is just one recovery. That's what appealed to me. I'm a world-class procrastinator (one reason my left knee was so horrible it was shredding tendons) and just figured I wouldn't give myself the option of procrastinating myself into a few more years of disability.

    Your recovery arrangements sound amazing. You have lots of help and a single floor setup, which is perfect. Like Roy, I had to go (at least, I preferred to go) upstairs every night to bed. I was able to do stairs easily, a little pain, but it had been painful before surgery too. But stairs were no problem. I had thought they might be, but like so many things in my recovery that looming obstacle turned out to be no problem at all. The replacement knees are rock solid and able. Just be prepared for lots of stiffness and pain (just as with a single replacement, but in both knees). And what Roy says about the energy drain is gold. That energy drain is real. Give yourself plenty of time off, all the time in the world to heal. You'll need a few months at least.

    I am just short of a month from my surgery and I am walking with one cane. Cooking simple meals. Letting the dog out for her breaks. Bringing in the mail. Emptying the dishwasher. Tidying the kitchen or bedroom. Getting antsy for the day I can wear less sensible shoes. I take naps. Life is moving forward in new and wonderful ways.

    Whatever you choose to do... two knees or one... life will do that. Both approaches will get you to where you need to be.
     
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  4. nensi

    nensi Senior
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    Thank you both for taking the time to share your experiences with me, it really does make a difference :)


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  5. sooz58

    sooz58 Member

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    It's been awhile since I've had anxiety, but I can tell you, it sure has been overwhelming me as I get closer. I wish OS would do the bilateral on me, so I don't have to go through this again. You will be fine and I think this is just a normal feeling regardless if it's one or both knees! Thinking of you!
     
  6. Pheebs52

    Pheebs52 Supremo

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    Welcome @nensi! Of course you have some jitters, who wouldn't? However, you'd have them even if you opted for doing one knee at a time! Both Roy and SusieShoes gave you the best possible encouragement to tackle both knees at once. That said, we're all different and choose the path that makes the most sense for our circumstances. Whether done together or separately, it's a long recovery.

    Your home set-up sounds just perfect with one floor living and so much built-in support, so take comfort in that as you proceed toward your big day! Best wishes going forward.:SUNsmile:
     
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  7. DavidNC

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    12 days out of bilateral and I questioned my decision both before and immediately after surgery. The pain is for real, and it is hard to have to rely on others for literally everything at first. However, while it's still hard at times, I can tell I am making progress. I've cut back on pain meds already and am able to putter around pretty much all over the house with my walker. My physical therapist gave me the go ahead to walk some without the walker, and my range of motion is already 120 in both knees.

    While I had no choice but bilateral due to both knees being too far gone, even if I had a choice I think I would have opted to do both at once. Good luck and keep us posted, if you have any specific questions please post.
     
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  8. nensi

    nensi Senior
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    Thanks David ! Tell me about sleeping - I am guessing that the only position is flat on your back ?
    Another question - how are you doing the elevation - pilllows, special cushion, etc ?
    I can really relate to the difficulties of relying on others, I am a do-it-selfer through and through. But I am going to let us (my family as well) be helped :)
    Just out of curiosity - did you do any kind of exercising to strengthen your leg muscles before your BTKR ?
    And a general question to others - when did you start using an exercise bike for rehab?
     
  9. Roy Gardiner

    Roy Gardiner Forum Advisor Staff Member Forum Advisor

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    Upper body strengthening is more useful, you won't be able to use leg strength for a while.
    As soon as you like; a stationary bike is a great help even if you can't make a single rotation!
    • Set the bike to zero resistance
    • If you can't make a rotation, set the saddle as high as possible and rock the pedals back and forth as far as you can with discomfort but no pain
    • If you can make full rotation:
    1. Set the saddle at a point where a single rotation is a challenge; difficult but not painful. When a rotation becomes easy right from the start, lower the saddle a max of 1cm.
    2. Gently turn the pedals.
    3. Continue until the knee is 'warmed up' and the rotation is now easy, or for 2 minutes, whichever is the shorter time.
    • Repeat whichever exercise you can do several/many times a day
    • Do not pedal fast or for more than 2 minutes, this is a stretching exercise, not training.
    Here is a bit more chat and some pix http://bonesmart.org/forum/threads/rom-and-extension-stretches.13159/page-3#post-423701
     
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  10. Want2hike

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    I'm almost 8 months out from my BTKR and couldn't be happier with my decision to do both at the same time. I just wanted it done and over with, so the single hospital stay and recovery was very appealing to me.

    I bought a cheap used recumbent exercise bike a few weeks prior to surgery and used it primarily to get a baseline for my bend. Because the seat was too close to the ground, I struggled to get up from it, so I really didn't start using it until 5 weeks post surgery (used one at outpatient PT at 3 weeks, since the seat was higher). I primarily used it to hold the stretch in my knee - the bike was easier for me than heel slides.

    Prior to surgery, I would recommend building upper arm strengthand doing straight leg lifts to build your quads.

    Good luck.
     
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  11. SusieShoes

    SusieShoes Forum Advisor Forum Advisor

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    You will need that upper body strength. I've done all right even though I didn't work my upper body in advance; I worked it plenty after! And I did do two months of daily quad exercises and leg lifts. I think those helped me after surgery, because my quads were strong enough I did not need to use a leg lifter to get in and out of bed.

    I will be starting on a bike this week, a month after surgery. Some people start sooner, others later. Your knees will let you know when a bike is a good idea.
     
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  12. DavidNC

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    Mensi, my surgeon said from my first day post op he doesn't care what position I slept in. That said, until yesterday, I could only lie on my back. And, the pain at night is for real, be prepared to wake up and take pain meds at first. Now I'm sleeping about 5 hours straight through, and yesterday I was able to sleep on my side for awhile. Make sure and place a pillow between your knees if you side sleep.

    I would recommend stretching every day prior to surgery. My biggest physical therapy pain has come from my calf muscles, so work them however you can pre op.
     
  13. DavidNC

    DavidNC New Member

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    Sorry, didn't address elevation. Rolled towels under the ankles are my surgeons preferred method of elevation. I also sometimes put feet higher at about a 45 degree angle but arranging pillows from under the knee upwards. I had pretty bad swelling in my right leg and ankle after surgery and the elevation seems to have helped.
     
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  14. Celle

    Celle Forum Advisor Staff Member Forum Advisor

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    Rolled towels under the ankles won't elevate your knee high enough. In addition, that position causes a lot of stress on the back of your knee and you will quickly find that it is painful.

    This article shows several different ways to elevate:
    Elevation is the key to controlling pain and swelling
     
  15. nensi

    nensi Senior
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    Thank you Celle and David. I am a veteran question-asker...
    How do you manage in and out of bed (or getting in the car) with a bilat? I understand from a friend here that the they teach you to do transfers using your good leg to support the wooden one - how does that work when you have two wooden legs ?
     
  16. Roy Gardiner

    Roy Gardiner Forum Advisor Staff Member Forum Advisor

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    Bed as high as possible is key. Books make good supports. I have lifted a bed using a plastic chair under each corner!
     
  17. SusieShoes

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    Agree about the higher bed. It really helps. I had no problems with moving my legs to put them over the side, but if your quads can't do the job at first, there is a handy helping tool called a leg lifter. Or you could use a belt or dog leash to help pull your leg over.

    I was taught in the hospital how to get into and out of a car. They had a mock car to practice on. My surgery was on a Wednesday and I left hospital on Friday, in a car. I went to rehab. A week later I went home in a car. Getting into a car the first time is a slow process.

    With both knees replaced, there is still a "good" leg. If both knees are equal, you simply designate whichever one works best for you. It becomes the "good" leg for things like stairs and curbs and walking with a cane. I happen to have one leg that was better going into surgery and was still better coming out of surgery. It's my good leg, even though it has a fresh knee replacement just like its companion.
     
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  18. DavidNC

    DavidNC New Member

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    Nensi, I was lucky to already have a high bed. I learned when getting on to slide butt back as far as possible, which allows me to pull left foot up then the right. For the first couple of days, my wife had to pull my feet up. Just had my 2 week post op and the pain, while still here, is much better. The therapist has me walking short distances with no walker or cane, and the surgeon ordered me to go to the grocery store with my wife and walk around. I did that yesterday, it turned me out and I'm sore today, but it was great getting out after 2 weeks confinement.
     
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  19. nensi

    nensi Senior
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    I think, aided by reading so many of your stories, advice and musings, that I am starting to have flashes of relaxing in this process - I said "flashes", brief moments where Incan let go of my never ending questions. Thank you for that!
    When our family, my elderly husband and three young adults laid out this path, we had 2 drivers out of the 5 of us and one of them was me - not good for a potential bilat tkr , right ? Well, a little more than 2 weeks out from the big day - I am very proud to say that my daughter and son have passed their practical driving exams ! It's very tough here in Belgium !
    That is going to make recovery at our home much easier :)



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  20. SusieShoes

    SusieShoes Forum Advisor Forum Advisor

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    Looks like your stars are all aligning! The more helpers, the merrier.
     
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