bilaterial TKR 11-26-07

[blondie42550]

Hi, I am so glad I found this site. I am a 57 yr old female and had bilateral total knee replacement 11-26-07. I am slightly obese due to almost 20 years of painful knees and not being able to exercise.
I have a couple of questions that I have not seen mentioned here. One issue is my left hand, the hand that the IV was in, has been totally different since surgery. If I hold on to something an extended period (like the hymnal at church), it will cramp to the extent that I have to use my other hand to straighten it. And worst of all, my thumb joint is like it is constantly out of joint and when I try to bend it, it hurts. I know they strap you down pretty good in surgery, and I suspect they were a little too agressive on my hand. I often feel like the bone between my hand and the knuckle is fractured. Does anyone else have any thing like this?
My other issue is, on my right ankle area, immediately after surgery, there is a knot and although it doesn't hurt as bad as it did at first, it is still a little tender, and the knot is still there. It was really painful the first couple of weeks after surgery. Initially I thought there might be a possibility that a bone fragment or some cement may have traveled somehow to my ankle.
When I was in recovery, I woke up with my left knee hurting really bad, apparently the femoral nerve block didn't exactly hit the nerve. I have been on Loratab 7.5first 2 every 4 hrs, gradually decreasing to now maybe once a day, if I am going to be up a lot, and at night to help me sleep. I am a belly sleeper and I can tell that is going to be a long time coming. I have a really hard time getting comfortable, going from side to side with a pillow between my knees. And to get from one side to the other and transfer the pillow too wakes me up so much it takes a while to get back to sleep. I get up after spending 8 hrs in bed trying to sleep. I never had a problem before, in fact I would wake up 6 hrs after going to sleep in the same position as when I went to sleep.
I still have quite a bit of tightness across the front of both knees. My left knee has less ROM than the right, they tell me that is common. The incision on my left knee had to curve to incorporate an existing scar from surgery in1980 to remove torn cartiladge. All my therapy has been done at home. They told me as long as I do the exercises they gave me 5 times a day I did not need it. I have missed few times but not many. I have increased my reps from 10 times each to at least 15 reps. As with most of you, I see a little improvment every day. And numbness, there is less on my left knee and it is mainily in the knee cap area than my right and it is down the outside of my calf. Anyone else having any numbness?
I drove my husbands truck on Tuesday. That was awesome. (not supposed to but had no problem) I had to follow him to Sears to get new tires and a battery in my car.(it was due and since it has been sitting for 7 weeks we had to jump it to get it there!)
Here is another question, my insurance papers have a claim for a surgeons assistant. I never saw him and I wonder if he may have done one of my knees while the main surgeon did the other and that is why the left one is not doing as good as the other? They did get done with the surgery in about 1 1/2 hrs which was quite a bit shorter than anticipated. I Googled the name of the assistant and as it turns out he was a graduate from Duke in 2007. Do they let them do on the job training without informing the patient?
Orders were to walk with a walker,no flights of stairs (I live in a three level house) and no driving for 8 weeks, my 8 week check up is next Tuesday. The hospital is a three hour drive from here and it is forcast to snow that day. UGH! I will NOT miss that appointment!
I know I am not ready to go back to work, that will take a lot of practice. (getting ready etc) I am hoping by the end of February I will be up to it. This past week I have been breaking the rules and walking w/o the walker. I try to concentrate on my gait to make it feel normal.
I will really be pleased when I can go upstairs to MY bedroom, sleep on my belly, and get in the bath tub!!!
Looking forward to your replies.
Blondie

 

[Josephine]

Hey, blondie and welcome to the site. I'll do my best to address your post point by point ...

One issue is my left hand, the hand that the IV was in, has been totally different since surgery. If I hold on to something an extended period (like the hymnal at church), it will cramp to the extent that I have to use my other hand to straighten it. And worst of all, my thumb joint is like it is constantly out of joint and when I try to bend it, it hurts. I know they strap you down pretty good in surgery, and I suspect they were a little too agressive on my hand. I often feel like the bone between my hand and the knuckle is fractured. Does anyone else have any thing like this?

I had to chuckled at the phrase "they strap you down pretty good in surgery" - the image it created in my mind was a really funny! However, I can assure you that while I understand what you meant, it's not quite true!! Tis true that sometimes for easy access we put patients' arms out on boards and use a bit of bandage to make sure they don't slip off, but it's not actually tying it down to that degree.

I think what may have happened is that your hand is complaining at the use of aids (walker, crutch or cane). I have known many patients who experienced that and, indeed, have suffered it myself!!

My other issue is, on my right ankle area, immediately after surgery, there is a knot and although it doesn't hurt as bad as it did at first, it is still a little tender, and the knot is still there. It was really painful the first couple of weeks after surgery. Initially I thought there might be a possibility that a bone fragment or some cement may have traveled somehow to my ankle.

Don't think you need to worry about bone or cement. I think what may have happened is a small blood vessel got clotted and the clot has become hard. It's not the kind of clotting you get in the major veins, so don't worry. The smaller veins in our legs often get closed off this way for a whole variety of reasons which are not that serious. But a blood clot can become as hard as a stone sometimes. The loss of that small vein is of no consequence either. You have dozens more that will carry the load!

When I was in recovery, I woke up with my left knee hurting really bad, apparently the femoral nerve block didn't exactly hit the nerve. I have been on Loratab 7.5first 2 every 4 hrs, gradually decreasing to now maybe once a day, if I am going to be up a lot, and at night to help me sleep. I am a belly sleeper and I can tell that is going to be a long time coming. I have a really hard time getting comfortable, going from side to side with a pillow between my knees. And to get from one side to the other and transfer the pillow too wakes me up so much it takes a while to get back to sleep. I get up after spending 8 hrs in bed trying to sleep. I never had a problem before, in fact I would wake up 6 hrs after going to sleep in the same position as when I went to sleep.

I think you have that right - it will be a long time coming. No point in telling you otherwise. Some of our members have invested in the hire of a recliner chair and report that they have found it of great benefit for sleeping

I still have quite a bit of tightness across the front of both knees. My left knee has less ROM than the right, they tell me that is common. The incision on my left knee had to curve to incorporate an existing scar from surgery in1980 to remove torn cartilage. All my therapy has been done at home. They told me as long as I do the exercises they gave me 5 times a day I did not need it. I have missed few times but not many. I have increased my reps from 10 times each to at least 15 reps. As with most of you, I see a little improvement every day. And numbness, there is less on my left knee and it is mainly in the knee cap area than my right and it is down the outside of my calf. Anyone else having any numbness?

It's common to have that numbness. Superficial nerves have been cut so it would be more surprising if you didn't have it.

Here is another question, my insurance papers have a claim for a surgeons assistant. I never saw him and I wonder if he may have done one of my knees while the main surgeon did the other and that is why the left one is not doing as good as the other? They did get done with the surgery in about 1 1/2 hrs which was quite a bit shorter than anticipated. I Googled the name of the assistant and as it turns out he was a graduate from Duke in 2007. Do they let them do on the job training without informing the patient?

Two things here - it is not possible for one man to carry out a knee replacement. It requires a second pair of hands to do many jobs such as holding back the tissues with retractors, holding the leg at certain times, keeping the surgical area free of fluids with swabs and suction, mixing the bone cement. Sometimes it need three people if the patient is very large!!

As for his doing the second knee at the same time, that is physically impossible. The instrumentation would get in the way and there would be any room for the (second) assistant!!

The speed of the op just means that things went swimmingly and also, the surgeon is very good at his job. That one leg is better than the other is not unexpected - at the beginning one knee was worse than the other, yes? So though he may have improved things, it's rarely possible to end up with two knees exactly the same.

I know I am not ready to go back to work, that will take a lot of practice. (getting ready etc) I am hoping by the end of February I will be up to it.

And what ever you do - don't rush it. A bilateral take a lot of getting over and a couple of extra weeks will make all the difference.

This past week I have been breaking the rules and walking w/o the walker. I try to concentrate on my gait to make it feel normal.
I will really be pleased when I can go upstairs to MY bedroom, sleep on my belly, and get in the bath tub!!!
Looking forward to your replies.
Blondie

You sound like you are doing really, really well, blondie. You have a nice, positive attitude and are willing to try things out. Keep it up. You'll be flying solo in no time!

 

[blondie42550]

Dear Josephine,
Thank you so much for the reply, it really helped to ease my mind!
It never occured to me that the thumb pain and hand cramping could be caused by the walker, but this morning when I woke up, it did not hurt as bad as in the evening. And now that I am not using the walker as much, it should progressivly get better. One bit of info, the weird thing, what was my worst knee before surgey is now the best knee, who woulda thought?!
Thanks again, u r the best!
Blondie

 

[referee54]

Hang in there! I had a bilateral on 11/8/07.andI am walking without a cane. The left knee stillgets stiff, but I go to the PT twice a week and tothe gym the four other days (Sundays off.) I wentfroma wlaker to crutches to a cane (for a week) and then to nothing. I still hurt like the dickens at night in bed, but that is par for the course. Samefthing for me---my worst knee is now my best knee.

Keep up the PT and the perseverance! Progress is measured not in days, but in weeks and months.

Tim C.