Bilateral TKR BTKR

[Dep]

Got BTKR last Thursday, 24/9. Came home yesterday. Reasonably ok, very stiff and tired. Any similar out there?

 

[Mrs. Ciz]

I had BTKR 12 weeks ago. Hang on for a wild ride!!! You will experience a lot of highs and lows over the next several weeks. Keep your pain under control by taking your meds on a schedule. And take it easy!!! Rest, ice, elevation are your friends!!! You will get better but this is a long slow recovery.

 

[Roy Gardiner]

to BoneSmart. Well I had BTKR almost 10 years ago, working fine

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​

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​

6. Access these pages on the website

Oral And Intravenous Pain Medications​

Wound Care In Hospital​

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.

 

[Dep]

Thanks guys. I was hoping to reduce meds as soon as possible. Any advice?

 

[Oregon mom]

@Dep
Congratulations!
I am in Week 4 of BTKR. It's been challenging, but I'm seeing improvement and feel way better than I did Week 1. No regrets!
I totally understand the desire to get off the medications as soon as possible. This is an intense couple of surgeries, though. Pain control is very important in the early stages to help you cope, sleep, ambulate. I had a very hard time in the beginning getting my pain under control, and it made life not fun.
I've found that when I feel like I've got my pain under control, not masked but tolerable for at least 72 hours, I can try taking a little less of just one med and see how it goes for the period before the next dose. I learned the hard way not to try this experiment at night (what was I thinking?) If I feel the pain creeping back, I immediately take the rest of the dose and the next dose as scheduled. You might be able to take less during the day but not at night for a while. You will hear from others besides me that it's much easier to keep your pain under control if you're in front of it, rather than trying to catch up to it. It's early yet, so please use caution. A bilateral is basically a planned very bad car accident, so allow yourself some help with avoiding that pain. The meds can be a useful tool.

 

[Fran55]

Hi @Dep
I am getting close to 5 months post Bilateral TKR. Yes it will be a bit of a rough ride but I am proof you get past the worst ! I was on Endone and Targin (slow release Endone) when I came home. I had 2 days on the surgical ward and 10 days in the rehab ward. Here in Australia if you have it done as a private patient this is generally what happens.

So - for almost the first two weeks I was on strong painkillers plus paracetamol and voltaren for a few days. I dropped the Targin a few days after I came home. By Week 4 I was only talking Endone at night to help with the pain and managed. During the day I took Panadol Osteo (665mg) and Iburofen. At my second post op visit with my surgeon also gave me a prescription for Tramadol to ease down from the Endone. I didn't find Endone conducive to sleep and ended laying awake at night even on Endone. If I had a bad day I still had some Targin and as they were slow release they did help ease the pain and let me get some sleep.

Today my GP gave me another script for Tramadol as she knows I only use it when absolutely necessary. She thinks my progress has been really good. Not bad for a 65 year old overweight female !

My issue has always been the lack of sleep. Even at this stage I struggle. I am happy with the progress of my knees. They hurt on standing a bit (a lot if I have been sitting for too long) but other than that apart from a tight feeling across the knee that many of us get my knees are good. I try to walk most days and am almost up to 3km.

As others have, and will, tell you keep up the medication regime to start. It is a HUGE operation. It will hurt for a while yet! I found the time I really needed pain relief was at night.Others may have needed it more at other times. I am a side sleeper but all the advice about sleeping on your side after a TKR says lay on your good side - but what do you do when you don't have a good side? . I struggled and slept on my back and with the help of Tramadol managed a few broken hours.

Perhaps when you feel you are ready you could drop a dose through the day and see how you go? Are you taking paracetamol and an anti inflammatory regularly. I think some on here found they were eventually okay with just those.

Follow the the advice you will be given here about avoiding aggressive physiotherapy. I am fortunate in that I have a surgeon who doesn't believe in it. On discharge other patients went on to attend outpatient therapy. Not me. I went home with a few stretching exercises. I simply added more of my regular previous activities as I was able. I still get tired but it is a 12 month recovery and I am only just over a third of the way through.

Good luck with your recovery. The admin, advisers etc on here will give you lots of support as will others. You can do this!

 

[Dep]

Hi Fran55 and Oregon mom
Many thanks for your very informative posts.
I’m writing this on a beautiful crisp Autumn morning in Ireland and I’m looking forward to being able to go for a walk someday soon! I’m on oxy twice daily along with paracetemol, anti-inflammateries and aspirin. I stopped taking laxatives as I’m nearly ok there thankfully. I’m 61 and have had knee trouble for over twenty years. Today, one week after surgery, I feel ok, can get around the house reasonably well on crutches and really lucky to be married to a brilliant nurse who’s looking after the meds for me. Your posts are the best roadmap for what’s ahead of me so thanks again and best wishes to you both for continued successful recovery.

 

[Roy Gardiner]

Just do a little bit at a time, and a little bit more each day if you can. Listen to those knees, they will tell you when you overdo it.

 

[Dep]

Cheers Roy

 

[Starsfan22]

@Dep In my opinion you are way too early to even consider backing off meds. I want to say if you do you'll be sorry but it's not my place. It's your body, your pain tolerance and do whatever feels right. I was three weeks in when I stopped narco and tramadol cold turkey. Hate the side affects! I did ok and have not taken any since. There has been a couple of times I considered it, always after exercise. Good luck for a terrific recovery!

 

[Dep]

Starsfan22
Thanks for that. Yes I accept it’s too early. The meds were causing a lot of nausea in hospital. It’s getting better since I came home. I hope to follow a similar trajectory to yours. Had a good day today.

 

[JayFromMN]

My surgeries were staggered by about 12 weeks, so I only had to deal with the pain of one knee at a time. I found that with a commitment to frequent icing, I was able to manage the daytime pain without any of the prescribed narcotics (my stomach didn’t appreciate them when I had back surgery a few years prior). I relied on Ibuprofin, lots of short walks and gentle stretching. It wasn’t bad. But nights weren’t as good. I had a really tough time sleeping because while I wasn’t in pain, I was also never able to get comfortable. I believe if I hadn’t been so stubborn about the pain meds, I would have likely had better nights. It worked well for me. But you need to do what’s best for you. Pay attention to what your body tells you, stay connected to your doctor & PT. Happy healing!!

 

[Dep]

To be honest I’m drinking so much water that I’m up almost every hour during the night. I’m getting some good quality sleep during the day and yesterday stayed ahead of the pain for the entire day. That’s week 1 of recovery over and I’m due back in the hospital on Monday to have staples removed. This forum is great, learned yesterday that my thighs hurt because of tourniquet? Thanks for posting hope you’re well

 

[Oregon mom]

@Dep A beautiful warm Fall day in Oregon with clean air... I wish it would start raining so I would've be pining so much to get outside.
Oh my gosh, the tourniquets! No one mentioned that to me prior to surgery. I would've remembered that. My legs felt like I'd run a marathon. The bruising was incredible. I looked like a cadaver.
My quads mostly fell ok now, but there is incredible muscle tightness right at the base of the quad above the knee, so I'm guessing there was some work there.
At the end of week 4 post op BTKR. I just finished with oxycodone two days ago and it was not pleasant even with a slow titration. I'm glad I had opiates to help with the pain and I'm glad I'm done with them now. I'm on moderate doses of acetaminophen and ibuprofen every 3 hours and it's satisfactory.
I drove my son to the playground today and yesterday and I'm paying for it now. Even with an automatic transmission, the ankle rotates and that woke up the sleeping bear of my right knee. It really hurts. I need to figure out how to do things in even smaller steps. When is this going to be something I wish I'd done sooner?
I hope you are doing well and healing up!

 

[Dep]

Oregon mom you paint a nice picture of Oregon this time of year. Not that I’ve ever been - couple of trips to NY the closest I’ve come!
Same story in Ireland blue skies and leaves changing colour. The tourniqet sore but at least we know what caused the damage and that it will improve. I’ve great time for my surgeon - he told me after the op that I was his first BTKR - but there’s so much about the procedure I don’t know about. Maybe I’m better off not knowing. Day 13 feeling ok but last night was rough. Well done for getting back on the school run my kids have long flown the nest. Best wishes for continued recovery.

 

[Dep]

Sorry reread your post and see it was a playground not school but well done all the same.I’m on that Oxycodone as well. Hope to cut back to just Paracetemol soon

 

[Roy Gardiner]

On another thread:

Right knee bends smoothly and straight but the left goes to the side and it clicks a bit! @Roy Gardiner can you remember anything like this?

Clicking yes, but not angled bending. I'd say keep doing stretches and it'll improve.

 

[Dep]

Hi folks,
Anyone know how long should I spend in an exercise bike 6 weeks post BTKR?

 

[Roy Gardiner]

Using a bike to gain ROM is pretty simple:

• Set the bike to zero resistance
• Set the saddle low enough so that 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.
• Gently turn the pedals, through discomfort but without pain.
• Continue until the knee is 'warmed up' and the rotation is now easy, or for 2 minutes, whichever is the shorter time.
• Repeat several/many times a day, but don't go mad. Diminishing returns will apply; my guess is that half a dozen reps would be enough
• Do not pedal fast or for more than 2 minutes, this is a stretching exercise, not training.
• And if you get any pain or swelling in the 24 hours after doing this, cut it down until you don't

Here is a bit more chat and some pix and how 'healing' and 'training' are different

If you are actually training, then let your knee be your guide; if it causes swelling or pain, do less.