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TKR Geoffa recovery

Geoffa

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Here is my story.
Firstly priveldge and gratitude.
Priveldge because I live in Canberra which has had minimal COVID19 impacts and has an outstanding medical infrastructure. Also are close to all medical support and have s supportive and caring family.
Gracious for all those who have cared for me.
30th Jun was op date spent night in hospital before because I was first cab off the rank. Total of five nights in hospital two in ICU. Had some serious post op low blood pressure issues which needed care.
Also had a lot of fluid accumulate in calf muscles, as recovery progressed the pain from this was excruciating.
RTKR plus an Osgood Slatters bump removal from top of shin.
Had LTKR 2011.
Same OS used this time with ROSA assist.

Pain management was PCR with nerve block above knee, this lasted 4 days, and was very effective.
Oral 12 hour Lyrica and Targin, 6 hour, paracetamol and endone as required.
Since hospital at 4 weeks have used 70 endone am now not using Targin and on 6 hour cycle of ibuprofen.
Will stay with Lyrica for about another three weeks.

Pain management this TKR is much better than 2011.
Icing I use a powered AIRCAST cut the top off five fruit juice containers filled with water and frozen. Just drop one in a day!
I ice probably four times a day, always after exercise. Icing makes a huge difference.

I tòok the decision to have surgery in May because pain had become intolerable and recovery in winter is much easier, also because of COVID19 sod all else to do.

I am 70 and generally in good health, have occasional Afib which is monitored by a loop recorder and manage with Sotalol and a pacemaker. Yesterday I had a read out of monitored activity and there was no signs of any abnormality during the operation.

I suffered a serious ACL injury left knee in 1969 playing basketball and this has been the cause of both knee issues. Played basketball until I was 45 and did a lot of running.

My post op exercise are as per recommendactions of both hospital PT and our family PT. Nothing special just standard stuff you can Google search. The emphasis now is flexibility and ROM. Strength can come later. I had about 110 deg before op and at 4 weeks had 132 with the PT. I refuse to do anything with a pain above 6 and I am a sook!!
I exercise all the time. Now I do a 1000 step walk one day and the full suite of exercise the next. I focus on technique rather than quantity. Prefer to walk by myself as I am rather slow. Have got better lateral stability than I would have thought and stairs do not trouble me.

Have had no troubles getting to sleep just get the wake up in pain syndrome. Always. As time goes by I have been waking later, pain call this morning was about 4 and I popped 1/2 an endone and got back to sleep.
I imagine I will be managing this for months. With my first TKR I got the awful restless leg syndrome.

Fatigue is real with each day getting slightly better I expect to manage this for months.

Had a nice glass of wine with dinner last night and hope to be able to drive when the Targin is fully out of my system. My OS is quite adamant on the importance of delaying driving as long as possible, which is good.

The most important aspect of support has been my wife; without her my recovery would be diminished. My 5 year old granddaughter visits on the weekend and channels her magic powers to help recovery.
 

newlybionic

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:welome: back to Bonesmart! Glad to hear that you are doing well. Be careful not to push your new knee too hard as it is recovering. Your range of motion is excellent for a month out from surgery.
 

Jockette

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As I said in the other post, welcome back to Bonesmart! It sounds like you are doing well and in a good frame of mind. It’s always nice to be a part of a group like Bonesmart for camaraderie and support!

I will 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: 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. At week 4 and after you should 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.
 

leejaa

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Welcome. We are glad you are here to share your recovery with all. Have a peaceful evening.
 
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Geoffa

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At 28 days am weaning off Targin, it certainly works, as my knee told me on the weekend. I had a horrible weekend, pain seemed everywhere, bone, joint, muscle and ankle. Rested both days, iced regularly, did some light exercises and rested some more!
The fatigue was palpable!
Thankfully there was rugby on TV!
Feeling a lot better today!
Got some sun on the wound only got about 30mm on the knee crown to completely close.
All the best.
 
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Geoffa

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At 5 weeks:
Incremental improvements;
No major setbacks;
No longer on slow release opioids;
Getting by on one endone mid to late evening;
Walking pain reduced slightly;
Had a drive, issue was never knee always opioids;
Fatigue dropping;
Even had a couple of hours where I actually had no pain in my body at all, what a glorious feeling;
Wound still got about 25 mm to fully heal;
ROM about 135, interesting my left knee has improved ever so slightly, not that I thought I had a problem;
Getting more non recovery stuff done in a day;
Looking forward to fathers day and some of the best pain killer, a nice glass of Champagne.
Best wishes
 

Starsfan22

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Something to look forward to! What kind of PT did you do?
 
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Geoffa

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Something to look forward to! What kind of PT did you do?
PT the $64k question!!
The formal answer:
PT provided in hospital, provided very informative program of exercises. My wife kindly laminated the two sheets. Mostly focussed on ROM and ability to usd aids and get up stairs.
Followed up with family PT, long term relationship because he looked after my grandsons recovery from a horror road crash. Focus was on ROM and fidelity of exercises, continued to use program used by hospital. Not at all at this stage of recovery interested in any strength work. Only had three visits. Always take 1/2 an endone before visit. Never pushed to pain beyond 6.
Always fatigued after so I need my wife to drive me.

The informal stuff.
All exercise is supported by ice, elevation and rest. I use a powered AIRCAST as only have to throw a block of ice in once a day. Probably ice at least four time a day. Ease of use means you use it!!!
Exercise before surgery is critical, of course depends on how damaged your knee is.
In some respects I do knee exercises 24/7 anytime anywhere. Anything that stretches and only uses gravity to load.
Technique is more important than quantity I never cared if I fatigued before I completed reps. Now as I have increased amount of walking I cannot do the whole exercise program when I do more than 600 steps.
I use the elastic band and a rubber tube to help exercise. I like the 'dead ant' exercise using the tube this helps lower back, leg extension and hamstrings.

Hope this helps.
Geoff
 

Starsfan22

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It did thanks, will have to look up dead an't exercise. Dr. told me today 30 minutes of exercise per day
 
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Geoffa

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It did thanks, will have to look up dead an't exercise. Dr. told me today 30 minutes of exercise per day
A real oddity of RCAF mess life, the game “Dead Ants” was popular in the 1950s and 60s. An “Ant Master” was appointed at the beginning of the evening and each time he called out “dead ants” everyone in the mess was expected to fall on their backs and simulate ant expiry. The last one down had to buy a round of drinks. Anyone besides the ant master who used the phrase “dead ants” was also subject to the buy-a-drink-for-everyone rule. One could refer to the game as “deceased insects” and thus avoid the penalty
 
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Geoffa

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Not a rhetorical question.
Not sure where to ask!
Question. During the recovery process what should be the emphasis ROM or being taught again how to walk!
Are they completely different or symbiotic?
What are best practice timings or reasonable expectations on when to start relearning?
Is this even issue for a reasonable number of TKR patients?
Thoughts and counterpoints!
 

Jaycey

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@Geoffa you will notice that I have merged your two threads together as we prefer that members in recovery only have one thread.

This is for three reasons:
1. if you keep starting new threads, you miss the posts others have left you in the old threads
2. it often ends up that information is unnecessarily repeated
3. it's best if we can keep all your recovery story in one place so it's easily accessed if we need to advise you.

Please keep all your questions and updates on this thread. If you would like a new thread title just give a shout.

ROM and gait retraining are 2 separate issues. If you are having issues with your gait you might try heel/toe walking. Plant the heel and roll completely forward to the toe. Do this slowly and focus on your stride.

ROM on the other hand starts to build as you get more and more into activities of daily living. No need for excess exercise. Gentle stretches are all that is needed. Here's an article from our Library BoneSmart philosophy for sensible post op therapy.
 

Jockette

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I found that for me, time took care of these things by itself. I did very few exercises, I just let my daily activities help things along. Sometimes I would think “heel to toe” but over time I didn’t need to do that and as I healed my gait took care of itself.
 

Roy Gardiner

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Question. During the recovery process what should be the emphasis ROM or being taught again how to walk!
Are they completely different or symbiotic?
IMO they are different and there's no emphasis one over the other, stretches for ROM and walking practice were independent for me.
 
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Geoffa

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At 6 weeks.
Continuing incremental improvements.
Opioids down to occasional break thru pain always evening.
ROM changed little at about 135, extension gone back a tad.
Went out COVID19 safe clubbing on Tues evening.
Walking nearly back to normal.
Sleeping still troubled, more restless than angry. OS recommended melatonin, will see how that goes.
Pain in calf remains and manageable.
Driving and stairs fine.
Still need regular ice rest elevation.
Sort of manage my life around the ubiquitous tight band around the knee syndrome, when it arrives I rest!!
Take care.
Geoff
 

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