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Bilateral TKR Bilateral TKR - It does get better!

Fran55

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I am a 65 year old female. I had a Bilateral TKR on May 12 2020. I discovered Bonesmart a month or so after my surgery and have read a great deal on it and it has set me off to read more widely to assist my recovery.

My surgeon initially commented in the first few weeks that I was doing better than most people but overall I really didn’t maintain that. At just over 16 weeks post surgery my recovery has been okay – nothing spectacular but improvements every week and I am happy with that.

I was fortunate that my surgeon does not believe in aggressive physiotherapy after surgery. The hospital I was in is only 5 years old and therapists in the rehab ward said initially that my surgeon wouldn’t let them provide any therapy to his patients. They apparently convinced him they could offer some help but his protocols meant I wasn’t doing several of the exercises others were doing -no squats, no step ups, only rising from sitting by using your hands and arms. I was two days on the surgical ward and 10 days in the rehabilitation ward (I am in Australia and I am grateful I can afford private health cover). On discharge I was given a sheet of exercises approved by my surgeon but was not allowed to attend on going therapy. The nursing staff informed me that my surgeon’s patients make the same progress as others that do have formal therapy. I think my surgeon would like Bonesmart!

I still have some pain but it is not unbearable. It is mostly when I stand up after sitting , particularly getting out of the car after driving. The pain now though tends to be brief and it is really just momentary stiffness as I start walking. If I have had a couple of busy days I occasionally still require a strong painkiller but really get by on paracetamol and ibuprofen.I have the tightness around the knees many people seem to suffer from and still have some swelling. The latter IS going down though, as over the last couple of days I have noticed I can actually feel part of my new knees through the skin!

For me one of the surprises of my recovery has been the lack of sleep and the fatigue. My surgeon said the about 90% of his patients complain about the sleeping issues . My sleep quality has improved a little now that I can manage to lay on my side with a pillow between my knees. That has only happened in the last few weeks. The sleep problems would go some way towards explaining the fatigue but it also amazes me how exhausted I can be from very little activity.

My post is really to address those starting out on their knee recovery journey particularly those who have had both knees replaced. A bilateral TKR is a BIG operation. You have no good knee to rely on. There will be pain and discomfort. We are all different and so are our recovery journeys but it DOES get better. I try to concentrate on the improvements no matter how small.

I am grateful to all who have contributed on here – the information and support it provides is amazing. Thank you.
 

Jaycey

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@Fran55 Welcome to BoneSmart! Congratulations on your bilateral knees. I'm sorry you didn't find us until after your surgery but it sounds like you followed our approach on your own.

Your surgeon is a gem! Well done for avoiding aggressive therapy.

I'm sure your post will encourage many who are still deciding about moving forward.
 

Roy Gardiner

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Welcome to BoneSmart. I too had BTKR, and now, years later, get zero trouble from my knees. It's a winner.
 

Jockette

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Hi and welcome!

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.

Included is an article about the energy drain after surgery which will explain how tired you get.

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
ice
take your pain meds by prescription schedule (not when pain starts!)​

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

5. At week 4 and after you should follow this

6. Access to these pages on the website

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.
 

leejaa

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Hello and welcome to bonesmart. Thank you for sharing your recovery journey with us. I hope you share more of it as it progresses. Have a peaceful day.
 

bikinglynn

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Welcome to Bonesmart! The lack of sleep and fatigue are common complaints. Both will get better, soon. I'm almost 8 months out, and notice small changes every few weeks. I used to have pain from the sides and back of my thighs, especially when driving. I realized, the other day, that I don't have that pain anymore. My knees seem to be loosening up with time, also. I walk a lot, and try to take long strides. I think the walks have been so helpful for my knees, general fitness, and mental health.

It sounds like you are doing well and have a good attitude. Keep it up!
 
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Fran55

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Thanks @bikinglynn. A few days after coming home the pain and discomfort were really bothering me and I gave myself a talking to! I told myself this would getter better and attitude was everything. For a couple of weeks after that my mantra, when things were a bit tough, was to repeat "attitude, attitude" over and over in my head :).
 
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Fran55

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I am now 4 months post my bilateral TKR. Due to having things to do and going out to lunch with my husband, today was the first day I haven’t done any exercises nor have I gone for a walk ( apart from around the house, inside and outside shops, restaurant etc). My knees are no worse for it! My knees still hurt a bit when I stand up and I have the tight band feeling around the knee I tend to have ( tight not stiff) but today my knees have not suffered from lack of formal exercise.

This, I might add, has come after driving 240km on Thursday to a funeral and 240km back on Friday ( yes I drove). My knees hated me on Saturday but bounced back by today.

It really makes me reflect on my surgeon’s protocols re not doing aggressive therapy . It also reflects the advice given on here. Do too much it hurts. Let your knees do their “recovery thing” - listen to them.

A good night’s sleep still eludes me but I am not as uncomfortable in bed as I have been.

I am getting through this YAY !!!
 

Jaycey

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Sounds like you are doing really well @Fran55 ! Well done! I'm sure your post will inspire other members who might be contemplating TKR.
 

Mrs. Ciz

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@Fran55

Thank you for checking in and updating us. I’m 10 weeks post op from bilateral TKR today. It is slow going. I just want to feel normal again but I am making small gains every day. It’s good to know it does get better!!!
 

leejaa

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Wonderful update. Thank you for sharing for all those still wondering if it will work.
 
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Fran55

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As I have said before I am happy with the progress of my knees. My ROM hasn't been measured since I was in hospital due to no post hospital therapy, but is certainly well over 100 and 0. I was actually able to straighten both knees very early on. I still have some pain but overall at 4 months post op they have improved a lot (when you consider what they actually DO to your knees during this operation :loll:).

I have a question today for those who are further along in their recovery journey - how long did some of you have

1) the fatigue and

2) the lack of good sleep that comes with this ?

This is the part that is getting to me. I thought by now it would have improved. I commented to my husband this morning that I have been so pleased that I have not suffered the post op blues so many others have had. However that is starting to change a bit and I know it is simply that I am tired.
 

Gramalita98

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I am one month RTKR and my biggest issue is lack of sleep. I can be almost pain free during the day but as soon as I get in bed here comes the throbbing pains in different areas of the knee and lower leg. I had insomnia for years but this is way worse. I usually wind up taking a muscle relaxer just to get maybe a straight hour or more. I have cried pretty much every night in bed. It seems to be a pretty normal thing for people with TKR. I know where you are coming from. Take care..
 

Mrs. Ciz

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@Fran55
Oh no. At 4 months post op you’re still not sleeping well at night? I’m almost 11 weeks out, and I’m exhausted too. I started tracking my sleep and my steps with my fit bit a couple of weeks ago. If I stay in bed for 10 hours (11:00 pm to 9:00 am), I may get 7 or 8 hours of very interrupted sleep. I wake up more during the first 5 hours and then sleep more soundly the last 5 hours. But I go back to work on 9/28 and will have to be up at 6:00 am every morning. I’m really stressed about this! I am most comfortable side sleeping with pillows between my legs. But after a couple of hours everything aches, and I need to change positions. This morning I woke up on my back with neither leg hurting. I wish I could fall asleep while on my back. It’s a struggle for sure.
 
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Fran55

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@Mrs. Ciz

Normally I am a side sleeper and a restless one at that! This is the part that has been hard. All the information I read before my op said sleep on the "good" side with a pillow between your knees . I couldn't find anything for what to do when you didn't have a good side! My surgeon said there was no problem with sleeping on my side - its just that my knees wouldn't like it! In the early weeks I would try it for a short time just so I could lie in another position but then it would hurt and I would have to struggle to get back onto my back. I can now lie quite happily on my side (still with a pillow) and nod off to sleep. The restless part of me kicks in at some point and I will have rolled back and my knees will twist a bit, hurt and I wake up! This is the annoying part because my knees are good during the day. I just wish I could get a reasonable stretch of uniterrupted sleep. I think you are right about the better sleep coming in the latter part of sleep time. I would kill for 5 hours of solid sleep though! I think my record may be 4.

I don't envy you having to go back to work you poor thing - that is only next week???? Thank goodness I am retired. My knees themselves would have been ready by now if I was still working but I would have been so tired just from lack of good sleep. How accommodating will your workplace be?
 

Mrs. Ciz

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@Fran55
The lack of a good night’s sleep in what I’m most worried about when going back to work on 9/28. I cannot get comfortable for long, and when I do get comfy and fall asleep, I’m awake and hurting 1.5 to 2 hours later. Sometimes I wake up on my back, but I haven’t been able to fall asleep while on my back. If this keeps up much longer, I think I’m going to contact my GP for prescription sleep meds. I’ve never taken them before, but I can’t teach middle schoolers with no sleep!!!
 
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Fran55

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@Mrs. Ciz -I came home from hospital with Targin (extended release oxycodin) and Endone!. My GP also gave me repeat scripts for both. I asked my GP about sleeping pills at one stage and she said no (wisely) because at that stage I was still on Endone. On my next visit to the surgeon I asked the surgeon about coming off the Endone and taking sleeping pills instead . I didn't find Endone particularly conducive to sleep although they were good for pain. Targin - extended release oxycodin did make me sleep but I was concerned as they are quite strong. He told me addiction wasn't an issue as I was only taking them at night. He was worried that I might wake up in the night without pain meds and move suddenly and be in even more pain. He gave me a script for Tramadol as well as did the GP later . I used the Targin and Tramadol sparingly (not together !!) and 4 1/2 months later I still have Targin, Endone and Tramadol left! I think now I don't take them, like you, I am going to ask the GP about sleeping tablets again. I hope you have success.
 

Mrs. Ciz

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@Fran55
I had Oxy and Tramadol in the hospital and for the first week post op. Then my doc changed the oxy to hydrocodone and also kept me on the Tramadol. He kept cutting back the dosage and extending the time between pills at each refill. I was really angry with the stingy pain meds I was given during the first 3 or 4 weeks. I had to ration my meds to make them last. I ran out during week 7 post op. My doctor was happy with that because he wants his patients off pain meds at 6 weeks. Now I just take Advil and Tylenol on a schedule so it’s in my system around the clock. I had a few Tramadol left that I would take if I had a really bad day. I really wish I still had some left for the days when I overdo it. But the US is so freaked out by the opioid crisis that people who legitimately need pain medication can’t get it.

I’ll let you know if I go the prescription sleep med route.
 
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Fran55

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Well I am getting close to 5 months post op ( in 12 days). The knees get better each week. They still hurt a bit on standing. I have to make sure I don't sit for too long. I pay the price then. The wonderful thing is though that once I get moving it is SO different to walking in the pre - op days. Before having the knees replaced I would struggle to stand and would be still be limping for some time with that bone on bone pain. I only do a few stretching exercises when needed and mostly just go about my life. I try to walk most days and am up to almost 3km. I am working to get back to the 4km I was doing most days until mid last year prior to my left knee going down in a heap to match the right and I knew I was staring down the barrel of having BOTH knees done. While I know I was determined going into this I am coming through it far better than I hoped.

I still struggle to get an undisturbed nights sleep. It takes a while to get to sleep. I will wake after an hour or two having rolled on to a knee or twisting it a bit ( I am such a restless sleeper anyway). I manage to drop off again only for the same thing to happen. It is not unbearable pain just annoying :loll:

Today I had a routine visit to my GP. She thinks I am doing very well and as I said on another thread not bad for an overweight 65 year old! As well as my normal prescriptions I came out with one for something to help me sleep. Yay! Hopefully they will help me get into a routine and I won't need them for long. She also gave me another script for Tramadol for the days when I stupidly do too much. She has been our GP for over 20 years and knows me well and knows I will only use them when needed.
 

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