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TKR Celebrate the little wins

babycatcher

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Hi everyone

I had a left total knee replacement on 12th August and came home yesterday. Had to stay in hospital an extra day due to bleeding coming from the wound. Since I've been home I've had some further bleeding and serous fluid leaking onto the dressing. Phoned hospital and they've suggested leaving dressing in place at present and let them know if it becomes soaked and needs changing. Anyone else have issues with a leaking wound? I had internal stitches and then glue to suture, plus some steristrips after the extra bleed.

Also struggling with mobilising - currently on two sticks but unsure how far to push myself. Was doing better in the hospital as my knee was less swollen - in fact my whole leg is pretty swollen now so feels heavy and I cant bend it as much.

I'm 53 and had surgery in the UK. I work in healthcare and am hoping to return to work in about 3 months - graduated return.

Thanks
 

Celle

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Hello @babycatcher - and :welome:

It's not unusual for a leg to get more swollen once you get home. That's because it's almost inevitable that you'll be doing more than when you were in hospital.
As you probably know, the answer is lots of rest, icing and elevation. That might also help to decrease the amount of oozing from your incision.

The hospital's advice is good. Don't let your dressing become soaked through. If that's happening, go back and have the dressing changed under sterile conditions. Don't try to deal with it yourself, even though you probably know how.

For one of my TKRs, I had to go back a couple of times to have the dressing changed.

Don't try to push yourself on mobilising. It's safer to keep using two sticks or crutches than to risk a fall.
Your knee will gradually let you know when it's ready to give up a bit of support.

About 3 months off and then a Phased return to work sounds about right.

It takes a full year for complete recovery from a TKR but you'll be able to do most things long before then.

I'll give you our recovery guidelines in my next post.

PS: Hi from a fellow midwife, now retired.
 

Celle

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Here are the promised recovery guidelines:
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. Try to 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.
 
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babycatcher

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Thanks, Yes I really don't want to change the dressing as I'm worried about causing an infection. I was given a spare one just in case though. Not being seen for dressing change until 2 weeks post surgery.

Hi fellow midwife!
 
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babycatcher

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So everyone talks about icing the area but what’s the best way to do it, correct equipment etc? I have just had my leg on a footstool but really that’s not elevation is it? Are the very expensive air cast things worth it? Currently have the bags that you squeeze and it turns to icy cold. Is the only way to do it to lie in bed?
 

Jockette

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Is the only way to do it to lie in bed?
Toes above the nose is good, but I had my limits to how long I could do that, especially in the early days. I compromised and used an elevating wedge when I was in bed sleeping, and when I was awake, I was sitting on the couch with my legs on an ottoman. It worked for me.

Here is an article about elevating:
Elevation: Doing It the Right Way.

I did not have an ice machine, but many of our members love them. I used gel packs that I kept in the freezer.
 

Mamie

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Hello babycatcher,

I read your story and saw the question about ice. I have a Breg Polar ice machine and it keeps my leg ice cold all day and night when adding more ice. Recently we began freezing water bottles and putting them in the Breg tank. My husband hooks me up about 8 in the evening and it is still ice cold at 10 AM the next day. I think Amazon sells them or one comparable. I am having a similar issue with bleeding but after 3-1/2 weeks. I believe it is the swelling from so much fluid retention and when trying to bend my leg that's swollen, it puts undue pressure on the leg. I am not sure that's the answer, but it makes sense. Celle and Jockette are brilliant supporting advisors and helped me a lot, along with many others. If you follow their lead, you will feel better without the stress of forcing your knee too early. There is a wedge offered by Lounge Doctor at the top of this page I am going to order. Many here say its design is what helps so much.
Good Luck,
Mamie
 
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babycatcher

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Thanks for the replies.
I needed the knee replacement due to OA but also Hypermobility of my knees and hips. It means that particularly on my operated side my hip tends to want to turn outwards to be comfortable which is comfy for the knee too but when I pull it back into alignment it hurts more. I need to buy a leg raise cushion so wondered if this might be any use as it will maybe hold my knee better.
 

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Jaycey

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@babycatcher if you go to the top of any page here on BoneSmart you will see the elevation cushion we recommend - Lounge Doctor.

I also used gel packs for icing. I bought a package of 6 and rotated them throughout the day.
 

Jaycey

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Sorry @babycatcher - I just wanted to show you an example of a good elevation tool. Perhaps you might find something similar available here?
 

Jockette

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The picture you posted of the foam wedge is not a good choice, it allows the knee too much bend, and doesn’t get your foot up higher on a continuous angle.

My wedge has the continuous angle, and allows a very slight bend, which is much more comfortable than the leg being totally straight. It also has a trough for my leg, like the one in your post. Unfortunately, my hospital sent it home with me, so I don’t have any details about who makes it, or where to buy it. I even called the hospital about it, as mine is wearing out (after 3+ years of every night use, yes, I still sleep with it because I love it!) and they were not the least interested in helping me locate another one.

However, maybe with extra pillows at the end, to get your foot up higher, the foam wedge you posted would work. If the cost is reasonable, it might be worth a try. What I really liked about the trough, is that it kept my leg in place all night and prevented me from tossing and turning.
 

Tykey

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In true British make do and mend, I didn't use any high falluting expensive icing machines.

A large bag of frozen peas or sweetcorn did the job fine for me.
 

WhenImOld

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Thanks for the replies.
I needed the knee replacement due to OA but also Hypermobility of my knees and hips. It means that particularly on my operated side my hip tends to want to turn outwards to be comfortable which is comfy for the knee too but when I pull it back into alignment it hurts more. I need to buy a leg raise cushion so wondered if this might be any use as it will maybe hold my knee better.
I have this one. I bought it before I found this site. It's pretty uncomfortable.
 

Celle

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You don't have to buy an elevation wedge at all. The article about elevation shows you how to elevate properly, using a pillow stack:
1597606747776.png


If you find the pillows move around too much, you can pin them together, using large safety pins, old-fashioned nappy pins, or kilt pins:
1597606813087.png

I elevated with pillows. I did find I sometimes needed help to position the pillows comfortably.
 
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babycatcher

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Thanks everyone. I’m going to try a knee rest and I’ve ordered the cryo thing too. Tonight though I’m in loads of pain and cannot get comfy at all. Have one more dose of tramadol and morphine for middle of the night but otherwise I’ve maxed out on everything! My whole leg is swollen and very sore on the inner aspect of the knee which worries me as that’s where my OA pain always was. I’m trying to elevate to sleep but it’s too sore. Any help appreciated! Husband back at work tomorrow too!
 

sistersinhim

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Ice and elevate, toes above your nose. Ice is a good pain reducer.
 

Jockette

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You are in the angry tissue stage. It will pass. :console2:
 
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babycatcher

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Thanks for your assistance overnight. Managed to elevate the knee on pillows and slept waking only twice - one for toilet and the other to take painkillers. I’m thinking I may just stay in bed today as every day I’ve been getting up and maybe I’m doing too much.
 

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