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[TKR] Fractured patella/quad repair 3 years post TKR

Discussion in 'Knee Replacement Recovery Area' started by Poohstew, Jul 13, 2016.

  1. Poohstew

    Poohstew junior member
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    Hi all!!

    Admitted yesterday, July 12, for RTKR.
    Prepped and went into surgery schedule for 82 minutes at 7:30 am. Ended up being 75 minutes. Spinal anesthesia with IV sedation. They had some difficult placing my spinal, took a few tries as I have degenerative disk disease, but was not painful. Scooted over onto the surgical bed and I was out.

    At some point during surgery, I woke up. I could hear the doctors talking. I asked the nurse if I should be awake. She said "Are you ok? Do you want to be awake?" I told her I didn't care, and that I was fine. I am in the medical field, so ok for me...it was interesting. They let me know they would put me out if I wished.

    They had a drape up, of course, so I couldn't see anything, but I could hear the surgeons discussing implant size and such, though their specific words are kind of a blur. At one point I could hear the drill then later the hammer. It was so cool, and I am glad for the experience. I drifted back in and out, and awoke fully as they were taking me to recovery. I have to say, I felt great. I had no drowsiness, no nausea at any point, and zero pain. I was in recovery for about a half hour. During this time they got my TED hose on, my pressure cuffs on, placed an ice pack.and took vitals. Worst part was my itchy nose. They gave meds for that, which eventually made me very drowsy and the itching stopped. I have since had a few more doses of that as the itching has returned.

    Once I was back to the room, my family was waiting, and said I looked great! I felt great! PT came within the hour for heel pumps, glut squeezes, and got me up with the walker and into the chair. Various checks by the nurse, and got up to use the bathroom. No issues there, though I am still having to push a bit to get the flow going, which is normal. Visited with family, and eventually had a dinner of jello, raspberry ice, chicken broth, and my diet coke I had been asking for.

    They have a nasal cannula placed with a sensor to monitor co2 levels. This has been the biggest annoyance so far, constant beeping as the placement moves. Respiratory therapy has been in off and on checking that I am doing my breathing. Stupid nasal cannula has to be left in for 24 hours. Gah!! Oxygen was set at 2 liters, reduced to 1 liter in the evening, and discontinued late night.

    Had a great night...slept off and on pretty well. Norco 5/325 was started at midnight every 4 hours for pain. Aspirin therapy was begun. Norco will be increased to 10/325 before therapy session today. I got up and got washed and dressed. I have individual PT in the room this morning at 9 am (basically heel pumps, glut squeezes, and getting into the chair.) I have OT coming at 11 am (how to manage at home) then group therapy from 1 to 3 pm.

    I posted my incision pic on the photo page. It goes across my knee at an angle, like half of the letter X. Hadn't seen one like that before! I counted the staples. Worst pain right now is from the tourniquet that was placed during surgery above my knee.

    Will update as I go through the next few days! Everything went VERY smoothly! Much better than expected!!

    Kim
    RTKR July 12
     
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  2. Roy Gardiner

    Roy Gardiner FORUM ADVISOR Forum Advisor

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    I don't want to be too much of a wet blanket, but please be prepared for things to get more uncomfortable over the next few weeks as your body reacts to the surgery and healing progresses. It might not happen, but it's as well not to be surprised if it does -- it can be most disheartening if one is not expecting it.



    Now, the Bonesmart recovery philosophy in a nutshell:

    - rest, elevate, ice,take your pain meds by prescription schedule (not when pain starts!), don't overwork.
    - If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you
    - If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it.
    - Take note of the BoneSmart view on exercise and how exercise may affect pain and swelling.
    - If you won't die if it's not done, don't do it; if you must do it, short and sweet, not hours on your feet.
    - Don't stand if you can sit; don't sit if you can lie down, don't stay awake when you can go to sleep

    Then, the FAQ (frequently asked questions) and Library index

    And here are some very crucial articles
    The importance of managing pain after a TKR and the pain chart
    Swollen and stiff knee: what causes it?
    Energy drain for TKRs

    Myth busting: no pain, no gain
    Activity progression for TKRs
    Heel slides and how to do them

    Extension: how to estimate it and ways to improve it

    Elevation is the key
    Ice to control pain and swelling

    Healing: how long does it take?
    Chart representation of TKR recovery
    Myth busting: the "window of opportunity" in TKR

    Myth busting: on getting addicted to pain meds

    Post op blues is a reality - be prepared for it
    Sleep deprivation is pretty much inevitable - but what causes it?
     
  3. Tabbycat

    Tabbycat post-grad

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    Hi Kim, welcome to recovery. I'm glad your experience of surgery was good, I insisted on a GA for mine, waking up would have been a nightmare, but we are all different. Don't forget you have just had major surgery, Roy is right, it's better to be prepared for what might happen, so follow the BoneSmart mantras as much as you can and I hope you continue to have a smooth recovery.
    Tabby xxx
     
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  4. smarttoys

    smarttoys senior

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    Congratulations on the new knee. I chose to stay awake for my surgery and I'm glad I did. They had a big screen tv set up above my head so that I could watch the whole thing.
     
  5. Tabbycat

    Tabbycat post-grad

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    Yikes!
     
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  6. skigirl

    skigirl SUPER MODERATOR Moderator

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    I also had no pain after the surgery---until day two!!! Then, the nurses gave me 10 mg of oxycontin, which I took for 10 days. They called it "the big guns"!! Hope all goes well. You do not need extra meds for PT_-you need gentle, non painful PT.
     
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  7. kneeper

    kneeper FORUM ADVISOR Forum Advisor

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    I'm glad you're off to such a good start. I wouldn't have wanted to be awake for the surgery, but then again maybe if I had woken up for the 2nd one and was on the good drugs I would have found it interesting too. :heehee:

    I wish you continued smooth sailing to home.
     
  8. Poohstew

    Poohstew junior member
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    This morning I was at 0 degrees extension and 84 degrees flexion. This evening I was at 5 degrees and 75. After this session is when my pain sky rocketed to a hard 9. Was switched from the Norco to MS-contin. Better but can't lift my leg at all and my muscles hurt. Things are hurting and I am having huge jerking sensation from my muscles and nerves refiring. A lot of lower back pain and hip pain today. The nurse said I will need to tell them not to work me too hard during therapy. Lesson definitely learned. Knee is SO swollen hot and red. They added ambien to my meds tonight.
    Kim
     
  9. uva55

    uva55 post-grad

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    You just had surgery, you don't need to worry about ROM right now, the only important thing now is pain management, icing and elevating!!!
     
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  10. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    It's nothing to do with 'nerves refiring'! Whoever told you that doesn't know what they are talking about! You have Tourniquet pain which will stop you using your quads and lifting your leg. I know because I had this myself. So don't even try. You'll not be able to do a thing until it goes away.
    Better yet, don't have any therapy!
    a) it's far too early day 2 for pity's sake!
    b) you need to do nothing until the tourniquet pain wears off
    What session is this? If it's PT, tell them no more!
     
  11. LFitz

    LFitz senior

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    Kim I'm with Tabby "yikes" on being awake during surgery. I'm as big a chicken as there is and was very happy to be knocked out :snork:. Hoping the pain meds help you stay ahead of the pain in this early stage of your recovery. Sending well wishes your way.
     
  12. skigirl

    skigirl SUPER MODERATOR Moderator

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    It is ironic to me that a PT would think that he/she should really work a brand new knee!!! As you now know, aggressive PT causes pain and swelling---exactly the things you are trying to avoid.

    For the first two weeks, I lay mostly in bed with my leg propped up on three pillows, with pain meds on board. I felt that my knee needed to heal and that the swelling had to go down. By three weeks when I started PT, the swelling was mostly gone. My PT is very gentle---stretches, massage, leg lifts and clam shells for the first two weeks. I did not begin anything really weight bearing until after week 5.

    You do not have to suffer and feel badly. Tell the PT to back off and get someone who is trained in the new techniques of more gentle PT for tkr rehab.
     
  13. Poohstew

    Poohstew junior member
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    It isnpart of their program for new knees...PT for 2 hours twice a day while in the hoapital, and wanting you to continue the exercises 2-3x per day after that. They ideally like knee patints to be at 0 extension and 90 flexion before they leave the hoapital.

    Needless to say, i did not push it. Some of the exercises feel good... heel pumps, quad sets, glut squeezes. I naturally have 0 degrees extension with no pain. My flexion is the pits, but I believe it is due to the swelling and inflammation. Overall, the joint feels good. I do have quite a lot of tourniquet pain that i am still dealing with. Discomfort and itching. Beuising still a bit tender, but improving.

    I am doing the exercises above plus a few gentle heel slides while sitting, walking our cul de sac comfortably, and icing and elevating as often as I can. Have begun to stretch the hydrocodone a bit or lower my dosing a bit during the day, but not a lot.

    Suggestions? I am flat out not doing the majority of the exercises i was given...they cause too much pain and honestly my leg is to swollen to perform them. I see PT ag my home clinic tomorrow.

    Is it normal to have such swelling a week out? Incision looks good. Does it aound like i am doing ok as far as the Bonesmart way?
    Thanks, all!!

    Right TKR
    July 12, 2016
     
  14. newlybionic

    newlybionic FORUM ADVISOR Forum Advisor

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    Swelling is one of the main things that happens in the beginning. If you are feeling pain your knee will swell more. In the first few weeks I did nothing more than ice and elevate almost constantly with occasional bathroom breaks and trips to the kitchen to grab a drink. A few ankle pumps to keep the blood circulating and a heel slide now and then when I though about it. I found that doing this I actually saw better results faster than I did the first time around doing all the exercises I was given to do.
     
  15. Celle

    Celle FORUM ADVISOR Forum Advisor

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    That's plain ridiculous, and totally unnecessary!
    Your knee isn't lazy or unfit. It's wounded - and severely wounded, too - by major surgery. All the exercising you need to do right now is ankle pumps, to help prevent DVTs, and walk around the house a bit. You could also do a few Heel slides and how to do them - but not a lot of them.

    Imposing all that exercise on a new TKR is going to do nothing but increase swelling, inflammation and pain.
    I'm glad you're not doing all those exercises - very sensible of you!

    My surgeon didn't expect 90 degrees until about 6 weeks after surgery, so I think the hospital expectation is far too optimistic.

    For what it's worth, my surgeon does not allow any formal PT for at least a month after a TKR, and only occasional PT after that. His patients all do well and he hasn't had to do a MUA (manipulation under anaesthetic) to help with ROM for over three years.
    I had no formal PT at all after my last TKR, and only minimal PT for the previous one. Both my knees are strong and reliable, with good ROM.
     
  16. skigirl

    skigirl SUPER MODERATOR Moderator

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    Really? four hours a day of exercising for a knee that is one or two days old???? what in the world are they thinking?? That knee needs rest and healing!
     
  17. uva55

    uva55 post-grad

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    I did very little PT for the first three weeks, heel slides and worked on my extention, started outpatient PT at three weeks but not aggressive, last week my ROM was 101 and extension 2, so you don't have to overwork your knee to see results, the more you work it the more it swells, and I feel it's way to early to cut back on your meds, that's just my personal opinion... There are many experts on this site that will advise you!!!
     
  18. kneeper

    kneeper FORUM ADVISOR Forum Advisor

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    So long as you're not doing very many of them in a row and no more than twice a day; and it doesn't increase your pain, I don't see a problem. Listen to the knee though. Long PT sessions are generally counterproductive as they increase swelling.
     
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  19. Poohstew

    Poohstew junior member
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    1 week since surgery: Rough start to the day. Tried just sleeping through, rather than setting an alarm for pain meds. Woke up at 8 am...2 hours past my morphine dose, and skipped a hydrocodone dose altogether, which was great, until I tried to MOVE! Once I got all that straightened out, I felt much better (especially after a kitchen sink hair wash and a sponge bath, yay!)

    First physical therapy session was today. Thankfully, they believe in the less aggressive approach. Still, looks like I am on track and doing well so far, with 0 degrees extension and 84 degrees flexion. The biggest issue I have to work on right now is significant swelling! The swelling hurts...all the way from my toes to my hip. I need to increase the angle of elevation, and apparently need to keep it up much more often. I'm icing most all the time. Therapy wont accomplish much until the swelling begins to subside, which was thankfully their biggest concern.

    I am beginning to see some improvement in the activation of my quad muscle, so am able to lift my leg under my own power a bit more each day. Still have a weird pins and needles feeling up and down the leg, and some areas of complete numbness on the underside of my foot. That feels weird!

    Oh! Was able to sleep somewhat on my side with a pillow for support! That is a victory!! I am NOT a back sleeper!

    Baaically, therapy was focused on discussing ways to reduce swelling, which exercises they did NOT want me attempting, some gentle stretches to help with pain, and some that should help gwntly wake up that quad muscle.
    Onward!

    Right TKR
    July 12, 2016
     
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  20. Celle

    Celle FORUM ADVISOR Forum Advisor

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    I'm glad your therapist sounds sensible. Yes, the most important thing is to reduce that swelling, because once that has decreased your knee will be able to bend more easily.
    So, lots of this: rest, elevate, ice , and only a little, gentle exercise.
     

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