TKR Bionic's final op - fingers crossed<

[Bionic]

@Josephine yes definitely, go ahead


I didn't mean to scare anyone about the staples removal.

I have had staples removed in the past, and there were many more than I had this time and I never really felt anything.

As Josphine said above I think mine got a bit sticky. For some reason I also seem to be getting more squeamish as I get older. I didnt even want to look at the wound this morning when my husband took the dressing off permanently. I did look at the dressing itself and could see there were just a couple of small weepy bits from yesterday but he said its all clear now

 

[Josephine]

Here y'go then!

It would be very helpful if you would answer each one individually - numbered as I have done - in as much detail as you can then I'll come back as see where you are ....

1. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine. And don't forget to factor in other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness).

2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?

3. how swollen is your leg compared to these?

4. what is your ROM - that's flexion (bend) and extension (straightness)

5. are you icing your knee at all? If so, how often and for how long?

6. are you elevating your leg. If so how often and for how long?

7. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and

8. are you doing any exercises at home? If so what and how often?
This is the most crucial question so please help me by using the format I have left as an example
(which means please make a list and not an essay!)

Exercises done at home
- how many sessions you do each day
- enter exercise by name then number of repetitions of each
etc., etc.

Anything done at PT
- how many times a week
- enter exercise by name then number of repetitions of each
etc., etc.

 

[Jolease]

@catkins69 I’m sleeping ok and do same thing put ice on it and fluff up pillows and can usually get back to sleep. My first partial removal of staples didn’t hurt at all the second time stung! I get mine out on Wednesday.

 

[Bionic]

@Josephine

1. pain level 3 now, but about 6 when trying to sleep or elevate legs

2. taking 2 500mg paracetamol 4 times per day. Codeine 30mg could take 1 or 2, 4 times a day but only taking 1 4 times a day. Oramorph if required. I haven't taken it as it makes me nauseous but could take half a dose as I was ok on that in hospital.

3. swelling moderate

4. Physio said last Tuesday ROM is 60. Not sure about extension but leg doesn't go straight

5. Icing the knee a couple of times a day for about 60 mins

6. Leg is always elevated when I ice but also elevate at other times when watching TV

7. Activity level - not much. potter about from room to room and go upstairs (16 stairs) 2 or 3 times a day

8. Exercises at home -
foot pumps, x25 6 times a day
heel slides x10 3 times a day
flexing to get back of the knee touching the bed, x10 3 times a day
buttock clenching, x10 3 times a day
Nothing actually done at PT just discuss what to do and how many

My biggest problem is when the leg is flat/raised as opposed to walking or sitting. Its very difficult to lay with the leg straight as the back of the knee hurts and also difficult to move the knee away from straight as I have a continual pain at the inside of the knee which is very tender.

 

[Josephine]

1. pain level 3 now, but about 6 when trying to sleep or elevate legs

I'll address this under Q6

2. taking 2 x500mg paracetamol 4 times per day. Codeine 30mg could take 1 or 2, 4 times a day but only taking 1 4 times a day. Oramorph if required. I haven't taken it as it makes me nauseous but could take half a dose as I was ok on that in hospital.

You should take your full allowance of codeine, being 30mg 4 times a day. So take paracetamol 1,000mf plus codeine 60mg 4 times a day, both together. Especially since you are only 2 weeks out. However, this much codeine will make you constipated so you need to take stool softeners on a regular basis. Also read this Constipation and stool softeners

3. swelling moderate

I trust you did notice that swelling is another form of pain which means that should be counted in. Moderate swelling is equivalent to an extra 4 points on your overall pain score. Swelling/pain comparisons

4. Physio said last Tuesday ROM is 60. Not sure about extension but leg doesn't go straight

That's okay - you're only 2 weeks out after all.

5. Icing the knee a couple of times a day for about 60 mins

You accomplish little or nothing in 60 minutes twice a day. Ice for at least 40-60mins and more than 4 times a day.

6. Leg is always elevated when I ice but also elevate at other times when watching TV. My biggest problem is when the leg is flat/raised as opposed to walking or sitting. Its very difficult to lay with the leg straight as the back of the knee hurts and also difficult to move the knee away from straight as I have a continual pain at the inside of the knee which is very tender.

I bet you've been told that you have to elevate with your leg totally straight, yes? This is not only wrong but bad for your knee. The point being that it is unnatural for the human leg to lay totally straight for any length of time. It causes an awful lot of pain as you are finding. The correct ways to elevate are these

You will notice that all three of them are slightly flexed which is okay but not dead straight like this

Nor very bent like this

7. Activity level - not much. potter about from room to room and go upstairs (16 stairs) 2 or 3 times a day

Hmm ... okay


Exercises at home -
foot pumps, x25 6 times a day - if you're doing what you say in the last question, you don't need to do these any more as they are only for the first few days when you're not very mobile at all
heel slides x10 3 times a day - I suggest you don't do these. Check out my comment at the end of this post.
flexing to get back of the knee touching the bed, x10 3 times a day - do you really mean sitting on the bed and pressing your knee down? I don't recommend that at all! It actually does more harm than good and it NOT going to improve your extension
buttock clenching, x10 3 times a day - don't recommend this either. It's non-productive and pointless!
Nothing actually done at PT just discuss what to do and how many - good!

In Summary:
1. adjust you pain meds - you're not taking enough for two weeks out. If you can, I suggest you ask your GP if you can change to Tramadol to be taken with the paracetamol as I found this by far the best pain meds going. If you succeed in this, tag me and I'll give you a great schedule I worked out for Tramadol+paracetamol.
2. adjust your elevating as suggested. Trying to elevate with a dead straight leg will cause swelling and pain that will impact on your extension and not in a good way!
3. I suggest you stop all your exercises. Many, many of us on here have found that exercising is counter-productive to getting good ROM. Because it's not the exercising that gets you your ROM, it's time. Time to recover, time for swelling and pain to settle and time to heal. One thing that seems to be missing from all the PT's protocols is that all your ROM is there right from the start, just waiting for all 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. Exercise as in strength training is counter-productive and in the early weeks does more harm than good. Normal activity is the key to success.

If you are concerned about refusing to do therapy, you need to read this Saying no to therapy - am I allowed to?

 

[Bionic]

@Josephine
Thanks for all that info. I will up the codeine and take some stool softener.

I will speak to the Dr's office on Monday about change of meds.

 

[Bionic]

@Josephine
I have spoken to the DR and he is writing a prescription for some more paracetamol and reluctantly some tramadol. He would prefer I continue with the codeine but will give tramadol to try.
Can you give me your pain med schedule please for the paracetamol/tramadol mix please.

 

[Josephine]

That's good! Here y'are. Two routines to choose from.
I swapped around between them both day by day as it seemed appropriate

 

[Lindylee]

@Josephine As someone who had virtually no discomfort and just one that stung coming out, it's a big thank you from me. It was such a different experience to having staples removed in the past.

 

[Bionic]

As my wound was weeping a bit after the staples removal I haven't wanted to go to bed without a dressing in case it rubbed. So for the first few nights I used the last of the dressings I was given by the hospital and then removed it the following morning.
On Thursday night I decided to use the cling/plastic film method instead. Friday morning I got up and dressed, intending to have a shower later, but the knee was a problem all day. I haven't got a good range of movement but even that was far less than usual. I could get little bend when doing the heel slides and I was very discouraged. Fast forward to bed time. I got undressed last night only to find that I had left the cling wrap on all day. No wonder the bend wasn't good

 

[Mojo333]

I'm sorry, but poor Bionic...that is a hoot. I needed a smile to start my day...sorry it is at your expense.
Reminds me of an old Doris Day song...
Que seran seran
Sending healing hugs and good mojo your way.

 

[catkin69]

That did make me chuckle @Bionic I am assuming your bend became much easier when you removed it

 

[Bionic]

Yes, definitely easier today thanks @catkin69

 

[Lindylee]

It made me laugh too. You must have wrapped it quite tightly. Mine was much looser and fell down my leg when I stood up. Celle posted about not using it if there were still open areas or scabs. I didn't know that, as the video stated you could use it with sutures as long as you wrapped kitchen towel round to absorb any moisture, which is what I did.

 

[Bionic]

@Lindylee
I have found that not all cling films are created equal. I have one that isn't very good and needs micropor tape to hold it on. The other one is much more clingy and just sticks to the leg.
I might have a couple of small scabs but I don't like looking at the incision so not sure. Anyway the cling film episode doesn't seem to have done me any harm.

Did you moisturise your scar first? I haven't plucked the courage to massage mine yet.

 

[Lindylee]

I didn't start moisturising until all scabs, except one tiny one that I managed to avoid, were off. I wouldn't have wanted to massage it at 3 weeks. I used Bio Oil and gently massaged it in at 6 weeks, It's really improved the appearance of it. It was quite lumpy before.

Might be an idea to use kitchen towel next to the skin if you use more clingfilm.

 

[Celle]

You're probably safe if you use the kitchen towel beneath the cling film, as the video advises.
I have heard that some people use a moisturiser beneath the film, but you definitely should not do that until your incision is completely healed.

 

[Bionic]

Thanks for that info @Celle.
I think I am a few weeks away from using cream on my scar. Definitely don't want to cause any harm.

 

[Josephine]

A kind member from here sent me two big rolls of Gladwrap which is co-hesive (sticks to itself). In fact to the point that with my second knee, I was able to cut out a patch and stick it on the painful spot on my knee. And it would stay there all night!

 

[Bionic]

I've not heard of Gladwrap. I will have to investigate.