TKR FC Bayern's House of Healing

[FCBayern]

Well everything went really well the day of surgery. Surgery was at 7:30 this morning and I was home in my chair with 'toes above nose' and the ice machine running by 1:30. Due to the nerve block I was in very little pain. In the I meantime was careful not to do too much or to do anything stupid to aggravate my baby knee.

Day 2 continued to be good, I did take my first couple of doses of Norco, but pain was still well controlled.

Day 3 the nerve block ran out and the pain is really bad. On top of that the Doctor called and really wants me to take the narcotics only at night to sleep! Not gonna happen when I hurt this much. and I can't even think about even gentle stretches when I'm at an 8-9 on the pain chart. I can see we will be having a battle about meds.

Day 4 today and things are a bit better. Not going completely without the Norco but single doses spread out further are working for the moment, hopefully things continue on this track.

 

[Jockette]

Welcome to the Recovery side of Bonesmart!

I’m going to tag @Josephine to give you some advice.

I will also leave you our Recovery Guidelines. Each article is short but very informative. Following these guidelines will help you have a less painful recovery.

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
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. Here is a week-by-week guide for

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 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.

 

[Dolly Girl]

Ooooo. Hang in there, yep, you need adequate pain meds. Forget stretching for now, just rest, ice, elevate and take meds. It's gonna get better.

 

[sistersinhim]

Be sure to ice and elevate as much as you can. The two together are a great pain killer. It's a crying shame how doctors are cutting back the pain meds so early in recovery. Make sure also that you don't do anything to create extra pain. If it hurts, don't do it! If PT hurts, don't do it! Doing daily activities is all your knee needs to rehab itself!

 

[Jaycey]

@FCBayern I hope things are easing for you. The first few days can be tough until you get your pain managed. If your doctor does not want to give you the heavy duty medication please ask for an alternative. And as suggested, ice and elevate as much as you can throughout the day.

 

[Josephine]

I'd really like to offer you some structured advice but in order to do that, I also need to ask you some questions. Are you willing for me to do that?

 

[FCBayern]

Absolutely! I'll happily take all the advise you have to give.

 

[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.

 

[FCBayern]

1. Pain level is about a 7 untreated, 2-3 with pain meds.

2. Hydrocodone 10mg/acetaminophen 325mg. Taking 2 pills every 4 hours when doing exercises, one every 4-5 if just resting.

3. Moderate swelling

4. 90 flexion, 5 extension.

5. Using an ice machine 24/7 unless/until I have to get up.

6. elevating 24/7 unless/until I have to get up.

7. Very little activity, my wonderful wife is a huge help. Mostly up only to exercise, go to the bathroom and shower.

8. As shown by in home PT: standing at sink extension stretch with a short walk after each, repeat 5 times three sessions per day. Sitting on table hanging leg using gravity for flexion, 5 minutes three times a day.

Home PT has recommended a muscle relaxer in addition to refilling my pain meds, still waiting for a return email from OS.

 

[Josephine]

Some detail I need - if you will oblige me

4. 90 flexion, 5 extension.

Extension comes with a plus (not quite straight) or a minus (more than straight) - which is yours?

5. Using an ice machine 24/7 unless/until I have to get up.
6. elevating 24/7 unless/until I have to get up.

The question included "If so, how often and for how long?"

8. As shown by in home PT: standing at sink extension stretch with a short walk after each, repeat 5 times three sessions per day. Sitting on table hanging leg using gravity for flexion, 5 minutes three times a day.

This question also included these directions:

which means please make a list and not an essay
how many sessions you do each day and
enter exercise by name then number of repetitions of each​

 

[FCBayern]

4. Extension is +5.
5. Ice machine 4 hours at a time, then 1/2 hour exercise and back to the Ice machine, using it about 22 hours a day.
6. Elevation 4 hours at a time, then 1/2 hour exercise and back to the elevation, keeping it up about 22 hours a day.
8. 3 sessions a day
table sit leg hang 1 rep
Standing leg extension, 5 stretches followed by short walk
3 reps

 

[Josephine]

1. Pain level is about a 7 untreated, 2-3 with pain meds.

Okay

2. Hydrocodone 10mg/acetaminophen 325mg. Taking 2 pills every 4 hours when doing exercises, one every 4-5 if just resting.

Do not ever take pain meds in order to cope with exercises. Pain has a function which is to warn you when you are overdoing things. Mask the pain and you risk causing yourself harm.

Home PT has recommended a muscle relaxer in addition to refilling my pain meds, still waiting for a return email from OS.

I don't recommend that. These drugs are really for depression and can be addictive

3. Moderate swelling

Okay

4. 90 flexion, +5 extension.

Good

5. Ice machine 4 hours at a time, using it about 22 hours a day.

okay

6. Elevation 4 hours at a time about 22 hours a day.

Good but be active as well. You need to be fairly active.

7. Very little activity, my wonderful wife is a huge help. Mostly up only to exercise, go to the bathroom and shower.

Lucky you!

3 sessions a day
Standing leg extension,
5 stretches followed by short walk
3 reps

I don't understand this at all. This is ALL the exercising you are doing? If so, you are bang on what BoneSmart recommends! Many of us on this forum went through our recoveries doing NO exercises at all and yet we came through with excellent outcomes! I suggest you follow suit!

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.

 

[FCBayern]

Thanks Josephine. The home PT guy is just looking for ROM, he agrees that strength exercise is detrimental until ROM is achieved. He has wanted to "push" the ROM by him helping but I have read enough on this site to tell him that wasn't happening now or later.

 

[FCBayern]

A little frustrated today. My ROM has gone from 90 to 88 and from plus 5 to plus 9 extension. The home PT wanted to force the knee both ways and I told him no thank you. Kept telling me how far behind I was and if I didn't get the ROM soon I never would. Thankfully I've been reading this site for a while now and instead of freaking out I know he is wrong about regaining ROM and didn't let him force my knee. I told him we were done with home PT. On top of that it took me three times trying to get my OS to renew my pain meds before he responded. He refilled the prescription with a smaller amount of pills and stated he would not approve more. Being 7 days out today that seems like a really short time frame for meds, I'll likely make them last 1 more week, I'm not looking forward to what I will fell like when they run out.

 

[Celle]

So your ROM decreased a little bit. Possibly your leg was a little bit more swollen.
Don't worry about it.
In the overall scheme of this year-long recovery, it's unimportant.

I don't believe it when a PT measures flexion as 88 and says you've gone backwards from 90 degrees, because measuring isn't an exact science. That apparent difference could be because he placed part of the goniometer in a fractionally different place.
I only believe numbers in jumps of 5 or more.

If your flexion is anywhere near 90 degrees at less than 2 weeks post-op, you are doing marvelously. Most surgeons don't expect 90 degrees until about 6 weeks post-op. Your home PT wants it early, so he can show he's done good.

You already know there's no need to rush to get ROM, because it can continue to improve for a year, or even much longer, after a knee replacement. There isn't any deadline you have to meet:
Myth busting: the "window of opportunity" in TKR

Extension often takes longer to achieve than flexion, too, so don't let that PT worry you. In fact, tell him not to bother coming again. He's just causing you unnecessary worry.

My surgeon doesn't allow any PT at all for the first month after a knee replacement. He says your knee needs that time, to start on its journey of healing. For that month, we rest, ice and elevate our leg, and walk around the house.
After that month, we just go to PT once every 2 weeks, where we are shown a few new exercises to do at home.
His patients all do well and achieve good ROM, as I did, and he hasn't had to do a manipulation to help with ROM for the past 4 years. I think that speaks for itself.

 

[Txmomgmom3]

Sorry your dr is being so stingy with your pain med refills. I'm nearly 4 months out from my 2nd tkr and he still refills mine albeit I'm only on tylenol with codeine (cant tolerate Tramadol), but it helps especially at night.

 

[Josephine]

My ROM has gone from 90 to 88 and from plus 5 to plus 9 extension

I had to chuckle at the 90 to 88 degrees of flexion! It's possible to get a change of 5 degrees just by moving the goniometer a few millimetres! After all, what's 2 degrees! It would be the same for the 4 degrees of extension. It's nothing and could just be positioning of the tool!

 

[FCBayern]

Can anybody chime in on how long to use a walker after surgery? Obviously everyone is different but I was wondering how long others used a walker. I feel like I could switch to a single crutch or perhaps a cane but my wife is freaking out. I'm encouraging her to go back to work next Tuesday, I will be almost 2 weeks out from surgery. She works close by so will still be able to help me before leaving in the morning, and come home to fix us both lunch. Still she's worried about my ability to take care of myself in the times in between. Some other perspectives might help her relax.

 

[Lindylee]

I moved from a walker to 2 canes/sticks 2 days after my surgery and PT wanted me to come home with just 1 cane, but I insisted on having 2 until I felt confident with 1. I mostly use 1 indoors and 2 outside or during the night if I feel a bit groggy or if I have pain and feel I'm not walking correctly. I can't advise you when might be the right time for you, as we're all different. If you've been shown, or know, the correct way to use canes you could try whilst your wife's still at home so she can see how you're coping, but keep the walker on standby.

 

[sistersinhim]

Still she's worried about my ability to take care of myself in the times in between.

Many of us went through this recovery alone and did OK. It just takes some planning ahead. Tell your wife to not worry, it's easy if prepared for.

Can anybody chime in on how long to use a walker after surgery?

You need to use the walker as long as you feel unsteady. The most important thing is to not fall. Let your knee and body be your guide.