TKR BoneSmart Works!

[mendogal]

Hi all. I have lurked a few days and after getting a ton of reassuring info decided to join in.
I had had a LTKA in January (following a failure of a year of conservative treatment for an acute on chronic condition). My R knee has historically been my "bad knee" - posttraumatic osteoarthritis after a complete ACL tear with graft, etc 22 years ago, and I knew the stress of letting the left knee recover earlier this year would be the last straw for the right knee!
So because my range of motion has been so good...I overdid walking on a slight slope right outside my house on post op day 14 and have paid for it with minor increases in pain and swelling but mostly with intense fatigue - not helped by, yep, insomnia! I think we each naturally overdo it once in this process and at least I got it out of the way!
I feel like my surgical team set me up to succeed: software to guide the size, angle, etc of the implants, a four day reservoir of local anesthetic fed into the thigh, a glue strip instead of external sutures. Plus the anesthesiologist on this second one, because I'm an elder, didn't want to use propofol or versed, just spinal and fentanyl, so waking up and going home was much easier.
I am incredibly impressed with this site and look forward to participating.

 

[Jaycey]

@mendogal Welcome to BoneSmart! Indeed energy drain and sleep issues are all a part of this journey, unfortunately. Nap during the day if you can.

Are you icing that knee? Elevating? This should help reduce that swelling.

Easy does it on the activity. Baby that new knee. It will quickly tell you when it is not ready for activity.

You may have already seen these guidelines, but I will leave you a copy to refer to when needed.

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]

Hi- thank you yes icing with a pump; I had been doing so 45 minutes at a time to avoid rebound swelling, but initially only four times a day; after my Oops! Overdid it! I am icing pretty much anytime I'm in the recliner (which is most of the time if not walking or sitting at the dining room table).
Also set up a pillow stack on our guest bed and do that greater elevation (and relaxation) a few times daily at least a half hour.
It helps that my ginger tabby follows me from location to location, and when I settle in he does too.

 

[sistersinhim]

@mendogal, would you please tell me the exact date of your January surgery? I'll add that date to your signature and add you to the January Team Thread once I have that info.

 

[benne68]

I am icing pretty much anytime I'm in the recliner (which is most of the time if not walking or sitting at the dining room table).

Yes, that's the right way to ice. As you know, you are still very early days in this year-long recovery and your leg has lots of healing to do. I spent much of my day on the couch icing and elevating for well into month two of my recovery.

 

[mendogal]

@mendogal, would you please tell me the exact date of your January surgery? I'll add that date to your signature and add you to the January Team Thread once I have that info.

January 31 2023 - my husband joked afterwards we should always get any surgery on the last day of the month as it makes knowing your current post op day a snap!

 

[mendogal]

I had a totally sleepless night (this is normal for me probably once a month and often around the full moon, so it's not distressing) - relocated to the guest bed where I could spend the night both with head elevated for reflux and the new knee very well elevated (three plump pillows) literally all night except for walking to/from the bathroom and kitchen (for ice packs - the pump by necessity lives by the recliner attached to battery pack).
Because all the common rx sleep meds are cautious use with seniors (I am 68) and also very bad for reflux (especially zolpidem it turns out - retired nurses with insomnia spend lots of time on NIH Pubmed checking research!) I have ordered a camomile, spearmint, valerian tea.
(Please don't suggest magnesium; I use as routine anti leg spasm supplement and to get enough to make me actually sleepy I'd have the runs for days!)
BTW, peppermint is bad for reflux but all the sleep blends use spearmint... I found a legit double blind study demonstrating spearmint should be ok.

 

[sistersinhim]

January 31 2023 - my husband joked afterwards we should always get any surgery on the last day of the month as it makes knowing your current post op day a snap!

Hey, that's a smart man there!

Almost every one of us has had problems sleeping. It's not something that is easy to get over. I used prescription sleeping aids occasionally to help me get through the really bad stage. Walmart has a generic sleeping aid that's over the counter that I found helpful, too. I had to make sure that they didn't contain an antihistomine because that can raise blood pressure.

 

[Jockette]

You’ll find a lot of good information in the Recovery articles, including:
Sleep deprivation is pretty much inevitable - but what causes it?

 

[Layla]

(Please don't suggest magnesium; I use as routine anti leg spasm supplement and to get enough to make me actually sleepy I'd have the runs for days!

Ok, I won't mention it by name, I'll just make a suggestion
Your complaint is a common one, only wondering if you've tried it in the Glycinate form as it's supposed to be the easiest on the digestive tract. I hope your sleep improves for you soon!

 

[mendogal]

Sleep update... after Friday night's no sleep, I was out of it Saturday and couldn't even nap. I went to bed on the guest bed, slept nicely about 930 pm - 1130 pm, woke up.
Walked to the kitchen and stared at med bottles, upset as the codeine and the antihistamines would make my reflux unbearable... MDH suggested melatonin! Took two 3 mg time release and slept from 0100-0500! Yay!
Sunday was a better day except for a headache for which I split my last remaining Oxycodone (last used 8 days earlier) into fourths, took 1/4 = 2.5 mg and had a nice 2 hour nap in the recliner.
At bedtime Sunday still wasn't sleepy. Rested on the guest bed in the dark with ice, elevation, and melatonin and finally managed about 3 1/2 hours good sleep. Needing to keep upper body elevated is not helping!
I have just ordered a LoungeDoctor so at least in a few days I won't be wrestling pillows!

 

[mendogal]

UPDATE: Apparently writing this was a good gut stimulant!
Bowel issues (to cut to the chase, I have no signs of an obstruction, have taken Lactulose, and will be taking more... this is mostly for my self-reference though others' relevant experiences are surely welcome!)
I didn't expect severe constipation to arise on postop day 17-18 especially as I had been off Oxy over a week, off codeine over five days, and doing very well, with decent appetite, on a high fiber diet (cooked hulled barley, whole grains, fruit, veg) plus senna pills and docusate caps. Also I had not had a general anesthesia - just spinal and fentanyl.
The constipation (tiny balls reminiscent of prior occasional bouts of spastic colon, but without the painful spasms) added to the reflux, has created lack of appetite but I am managing very small bland high fiber and protein meals/snacks and feel my nutrition is adequate.
I did NOT take additional Lactulose after a small supper yesterday as my sleep is disturbed enough without being on the toilet all night! Will dose again later this morning and fully expect results.
Is it common to experience this so far removed from surgery and off of opiates?

 

[benne68]

I didn't expect severe constipation to arise on postop day 17-18

Unfortunately, surgery of any kind can throw all of our body's systems --digestive tract included -- out of whack. It just takes time for things to stabilize.

It certainly sounds as though your diet is right. Could you be dehydrated? (not uncommon for the first few weeks post-op). Perhaps try increasing the volume of clear liquids you are drinking during the day?

 

[Flashlight]

My GYN said never to do too much fiber when on narcotics. Staying hydrated is a must. Miralax I think is a powder form of lactulose and much easier on the stomach. I started out using it twice a day in my coffee with senna and colace. After a week or two I was able to go to once a day and eliminate the senna and colace. You aren't moving around like you were. I found codeine to be worse than oxy and dilaudid for constipation. I slept in my recliner the first 10 weeks and was up most nights. Nap when you can. It will get better!

 

[mendogal]

I found codeine to be worse than oxy and dilaudid for constipation. I slept in my recliner the first 10 weeks and was up most nights. Nap when you can. It will get better!

The documented individual response to opiates is hugely variable! Codeine triggers my reflux but the mild constipation it gives me is always responsive to low level senna and docusate, whereas oxy and vicodin pretty much shut me down.
I have the recliner in my bedroom by day, and at night retire to the guest room bed where I alternate between resting semi upright with a tv watching bolster and actually sleeping a few hours on a large graduated wedge (for reflux). I have ordered the Lounge Doctor because I'm sick of wrestling with the pillow stack!

 

[mendogal]

Post Op Day 21 status report!

KNEE: Knee stiffness and swelling present but much less than my January LTKR because of increasing the ice and elevation. My lifelong mild joint laxity has always increased my injury risk, but I suspect it's the underlying reason my ROM immediately post op on both knees is close to normal once I have iced, elevated, and done very mild rocking back and forth of the knee with zero weight bearing or stretching (I sit up in a chair and support the entire knee with both hands).

FUNCTIONAL: Using the walking stick for most walking. If I am puttering in a smaller space (asembling breakfast or lunch independently, ablutions in the bathroom, rearranging my bedding, etc) I don't use it. I watered the outdoor potted succulents with MDH fetching the watering can. I haven't felt up to community walking; IIRC that took 4-5 weeks to ease into. Still using the over-toilet commode and the shower bench for comfort and suspect I'll graduate off those within a week or two.

OTHER STUFF: Sleeping 4 - 5 hours (not continuous) most nights, in the guest room surrounded by bolsters, pillows, wedges. Most days napping in the recliner between 3 and 5 PM. Reflux slowly improving. I'm waiting for mail order herbals for sleep and reflux to arrive.
Eating small meals focusing on protein, veg, and fruit. Laculose (which is not the same as Miralax) has become a friend during recovery from both knee replacements.

THANKS TO BONESMART for validating my gut feelings about the benefits of "slow medicine" and for giving me the self confidence to decide to drop the formal outpatient PT and do my personal in home relaxed rehab! And to all of you sharing our journeys and voices.

 

[benne68]

So glad to read that the extra icing and elevating is working for you, @mendogal, and that you are doing well at three weeks out.

Slow and steady!

 

[mendogal]

Three week appt with the ortho PA today. Glue strip is off!!!!!!
She was surprised at reduced swelling and good ROM.
I told her my home regimen (45 minutes ice and elevation followed by walking and gentle ROM movement - not stretching) was more effective than the outpatient PT, where even though my ROM is good he feels compelled to manually stretch me and measure me, causing me to lose at least a day afterwards.
She wouldn't *officially * endorse quitting PT but admitted my home regimen was quite sensible and showed good results.
Doesn't matter, not going back to PT.

 

[mendogal]

Left knee - just over 5 months
Right knee - 3 weeks, glue patch off three hours ago.

 

[BionicMama]

She wouldn't *officially * endorse quitting PT but admitted my home regimen was quite sensible and showed good results.

I have myself been struggling with whether or not to quit PT. I’m 4.5 weeks post op and they seem generally unhappy with my progress. My flexion is 95 degrees and my extension is 7. It’s improved since the first week but when they measure it seems they get more aggressive and then I pay for it for days with increased pain, swelling and stiffness. I’m also a nurse, so in reading multiple articles, it seems the medical community doesn’t endorse the “rest and relax” recovery method which puts me at an impasse in which route I should go.