Revision TKR Failure of TKR

[LTKR4Xmas]

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

Yes! I spend 95% of my time in my recliner with my feet up as that is the only way I'm comfortable! The leg lift has full support, no gaps, and is "straight", only a very slight "bend".

 

[Spex10]

I find it helpful to ice for far longer than 10-15 minutes per hour. I try to to 4 times a day for an hour. The longer the better really.

 

[LTKR4Xmas]

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

Welllll, I wish I could say I've been more diligent in this, but I haven't. What I have done is to do self assisted heel slides (using my other leg) just whenever I think about it through the day when I'm in a normal seated position. I probably do 20-25 throughout the day.

I also do a heel slide (of sorts) by simply bending my knee and pulling back, using my elbows on the chair arms as leverage. I've been lazy/depressed, but know I have to get busy!

Knee flexion stretch on a step --the only step have which will work is the threshold between my garage and house, so whenever I go in or out, I'll do 4 or 5 stretches.

I also just do a little stretch whenever I'm standing at the sunk of microwave, etc. by simply bending the knee and shifting as much weight as I can stand on to it.

Okay, okay. I know already.

I just stopped and did 10 real heel slides and 10 knee flexion on the threshold and am now icing.

 

[LTKR4Xmas]

I find it helpful to ice for far longer than 10-15 minutes per hour. I try to to 4 times a day for an hour. The longer the better really.

Spex, I'm listening, but I guess I'm missing something--if my swelling is minimal and my pain nominal, why do I need to ice that long?

Thanks.

 

[Spex10]

You say your pain level is 4 and you're taking pain meds. You also have trouble with sleep. I address pain with ice rather than meds as I find that the various pain medications mess up my systems including sleep. I'd rather ice a lot and take the odd paracetamol and sleep well than take lots of prescription meds.

 

[Spex10]

My pain level is max 2 then 0 after icing.

 

[LTKR4Xmas]

My pain level is max 2 then 0 after icing.

Which surgery are you referring to?

 

[Spex10]

TKR then MUA last week

 

[Josephine]

pain score 4

Is that an accurate score? Did you factor in other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness? I think if you did, your score would be more realistic.

Hydrocodone/Acetaminophen 10-325 mg (Norco) 1-2 tablets every 4-6 hours. Currently taking 1 tablet 2-3 times per day and 2 at bedtime

Did you actually read teh articles Pumpkln left you earlier in this thread? There was one on pain management which you should read again because it explains about how pain meds work. If you have some pain during the day, you won't find it very effective if you under medicate during the day and then take a bigger dose last thing. You also need to take a better dose during the day as well in order to suppress the pain and allow you to get a decent night's rest. However you may not need your prescription meds. It's possible (and worth trying out) that Tylenol 1,000mg 3-4 times a day might be adequate.

Slight to maybe somewhat moderate?

Well, you will notice from my first answer that swelling is a form of pain, so have any swelling means your pain score is more than 4 and needs to be medicated.

I'm real close to straight. I'm guessing maybe 15? But I don't know about my bend....not as much as I'd like. I think I'm at 45-50.

If you can get someone to take a photo of your leg I can measure it for you. You need to take it from above the hip and below the ankle. Like one of these - but NO 'assistance'!

And for extension, you can do this Extension: how to estimate it

Iced at least hourly when I first got home then gradually tapered off to "as needed" over the following week (usually at night). After reading up here, I started again yesterday, and plan to do so for 10-15 minutes once hourly.

You accomplish little or nothing in 10-15 minutes. Ice for at least 40-60mins and more than 4 times a day.

I spend 95% of my time in my recliner with my feet up as that is the only way I'm comfortable! The leg lift has full support, no gaps, and is "straight", only a very slight "bend".

That's a real cause of low grade pain. I know PTs stress the bit about keeping the leg totally straight but I don't agree. The human leg is not designed to do that and personally, I found it caused me quite a bit of discomfort. When you are resting, do have a moderate bend similar. This shows you the bad and the okay ways to have your leg elevated.

I wish I could say I've been more diligent in this, but I haven't.

You will be surprised at what I'm looking for!

My comments in bold
self assisted heel slides (using my other leg) I probably do 20-25 throughout the day - not bad but read this for extra detail
heel slide by simply bending my knee and pulling back. I've been lazy/depressed, but know I have to get busy! - heel slides are not something to do like that. Read this Heel slides and how to do them properly.
Knee flexion stretch on a step, whenever I go in or out, I'll do 4 or 5 stretches - that's not too bad but I think 3 stretches once a day is plenty
I also just do a little stretch whenever I'm standing at the sunk of microwave, etc. by simply bending the knee and shifting as much weight as I can stand on to it - okay but don't over do it. 2or 3 times a day is plenty.
I just stopped and did 10 real heel slides and 10 knee flexion on the threshold and am now icing - not like this. Good way to get extra pain! Read the answers I gave above about these two exercises

Okay, okay. I know already.

And what do you know already?!

What you need to know is that 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 does more harm than good. Normal activity is the key to success.

I suggest you also read this BoneSmart philosophy for sensible post op therapy

 

[kneeper]

I live alone but did have some housework help from my sister in the first weeks. Once I started doing my own housework I started by doing very minimal things and no more than 1 thing a day. For example, clean the sink and that's it for the day. I waited to vacuum quite a while as that is actually hard on the knee.

 

[Spex10]

I agree about vacuuming. Fairly early on I thought 'it cant be that hard' and the cat fur on the carpet was building up. Big mistake!! On top of that nobody noticed any difference.

 

[LTKR4Xmas]

No way I'm going to attempt vacuuming! I suffered bone on bone for a couple of years (sometimes in pain, sometimes not really), so I well know how difficult the task can be on a knee. Nope, not gonna do it!!

 

[LTKR4Xmas]

Is that an accurate score? Did you factor in other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness? I think if you did, your score would be more realistic.

Well, as I don't have 53 years experience as an RN, nor am I in any way a medical professional, there's a damned good chance I don't have the same understanding of how to interpret the 1-10 pain scale as do you. All I've ever been shown is a stupid little chart with happy or sad faces, or little descriptions such as no pain, minor pain, take me to the ER, etc. So, while I'm certainly intelligent enough to understand that soreness, burning, stabbing, throbbing, aching, swelling and stiffness are all words which describe pain, I obviously have no idea how to calculate them on a scale of 1-10. I'd love to learn though.

Did you actually read teh articles Pumpkln left you earlier in this thread?

And while I obviously joined this site to learn, no, I'm sorry to disappoint you that I have not yet read ALL of the information in the links Pumpkin sent to me only a day and a half before you asked if I had. However, as you posted your questions and didn't inform me that I should be sure to read all of Pumpkins' links prior to answering, I obviously made a mistake in thinking I should be polite and respond first, then go back and finish reading later. My apology. I'll be sure to have read them all prior to responding to any further inquiries!

As my original post indicated, I'm happy to have found this site and am anxious to learn. I do appreciate the information you and others have shared from your personal experience, as well as from your professional experience, but I don't anticipate I will be an expert within a week.

Thank you for the information you posted which was informative.

 

[Spex10]

Ooh nippy response there! I think she's only doing her best. Are you having a particularly sore day? That happens. I had a bad day yesterday out of nowhere. I can't estimate pain exactly either, no one can, all I know is that it was hot, sharp and there! Taking it easy, icing and resting helped. I also went back to paracetamol. One step forward, two steps back seems to be the rhythm of this particular dance!

 

[Josephine]

I obviously made a mistake in thinking I should be polite and respond first. My apology.

I never noticed how recently it was so MY apology. This is by no means intended as a 'boot camp' in knee recovery! So my apologies also!

So, while I'm certainly intelligent enough to understand that soreness, burning, stabbing, throbbing, aching, swelling and stiffness are all words which describe pain, I obviously have no idea how to calculate them on a scale of 1-10. I'd love to learn though.

That's okay - there is no science attached to this - your concept of your pain is exactly what you perceive it to be. Nothing more, nothing less. And while in hospital, it is a simple question of 'how much does it hurt', here I need to delve a little deeper because after the event, pain includes other manifestations than that. And I've often found that members tend to discount all those other types of pain which do have an overall effect upon the final score.

For instance, I know it's a difficult concept to see swelling as pain and you may be right but it also has an affect in that swelling is a sign of pain and itself is also a cause of pain. It's a nice little vicious circle.

Actually, you've given me pause for thought - maybe I should publish in a little article explaining all this in the Forum Library as I'm sure it isn't immediately obvious to most people.

 

[Lane47]

As you have discovered, this is an awesome support system. Do not hesitate to ask any question, they will help and support you.
I am single, live alone, and experienced some of the issues that you described. My surgery date was a week before you, so I am at 6 weeks since surgery. My sleep for first 4 weeks came in 2 hour blocks, and not always at night. I adjusted my expectations, yes, I want 8 hours of sleep / day, but it may not happen between 9 PM and 7 AM. That's fine, a normal schedule will return. The last 2 weeks, I'm sleeping longer at night, approaching normal. Reason for strange sleep patterns, the pain meds, the pain, the major surgery, add some stress, and you've explained it. It does improve.
My other input / advice would be that rest, elevate, and ice more than you think you should. I discovered this forum about 3 weeks after surgery, they suggested that I should rest, elevate, and ice more often, this is the single biggest change that I've made, and the reason for great improvement since the change.
Keep reading the info they provide, and asking questions, you are on the way to recovery!!!

 

[LTKR4Xmas]

Thanks, Lane. I'll follow your thread to watch as you progress ahead of me. Good to know the ice and elevation made such a noticeable difference for you. I've been doing more of both since reading here as well.

 

[ACDCJen]

@LTKR4Xmas

Welcome to the bionic side! I'm definitely not an expert, but I too have issues with sleep and depression. No matter when I go to bed or how much/little I sleep during the day, I'm usually still awake at 4,5, or 6 am! When I do fall asleep, I get anywhere from 30 mins to the rare 6 hours. I do nap sometimes in the afternoon. I basically listen to my body. If it wants sleep, I let it!

I have a history of depression, anxiety, and PTSD, but my surgeries since June 2016 have exacerbated my symptoms for a number of reasons (feel free to check on my thread if you want details!). I am prescribed Venlafaxie (Effexor) and Hydroxyzine (Vistaril), both for anxiety. The hydroxyzine is supposed to help with sleep because it's similar to Benadryl. I personally think that depression and/or anxiety is a stage of recovery. I'm a licensed mental health therapist and I believe that talking to someone and learning how to cope can really help, many times without pharmacological intervention. I'd be more than happy to chat about how you're doing if you would like.

I've also found that those of us with chronic pain have diffifulty quantifying it from 0-10. I think it's helpful, and a bit of a relief honestly, to remember that pain is subjective and your pain is different than the next person, and so on. It's helped me to learn to rate current pain based on past pain. Achille's rupture 15/10 (worst pain in my life that thankfully only lasted 12 hours). Kidney stone 6/10. Tkrs 3-9/10. (depending on when). Infected hole on my leg 8/10. I compare pain to previous issues I have personally had, that way, ONLY you know the right answer!! I don't let it bother me much. I also fully describe what it feels like too. For my recent infection issue, it was originally like a cave that was bigger past the entrance, and the deeper it was poked, it felt like someone was burning me with a lighter and poking it in long streaks with a scalpel. (I like to be imnaginative, sometimes it's better than a number!) We all kind of learn to listen to our bodies and are fully capable of asking for what we need!

I hope things get better soon! And to be honest, I did very few exercises outside of my PT sessions.

Jen

 

[LTKR4Xmas]

Why does my knee hurt/burn at the back of my knee, mostly on the outer edge?? The burning is such an unusual pain.

 

[LTKR4Xmas]

Oh, and did/does anybody else get muscle spasms in the affected leg? I did in the hospital (4 day stay), but now, at 5 weeks out, have had them again a couple of times.