| Pre-LTKR Plan | Actual Results |
Pain Management | |
- ,I plan to take Meloxicam as my primary anti-inflammatory (vs Advil and Aleve for Knee #1). I didn’t take Meloxicam after my RTKR.
- I’ll have both Tramadol and Oxycodone prescriptions filled and (try to) be less hesitant to take them (starting with Tramadol) as warranted. I didn’t take either after my RTKR and had a really “interesting” time on night #2 … something that I’d rather not go through again. I plan to use Tylenol in conjunction with Meloxicam as my primary pain meds.
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- Took Meloxicam 1 time but it didn’t seem to help ease the pain and since the recommended dosage was 1 per day, I quit taking it after the first time in lieu of Advil and Aleve (all three are NSAIDs). After seeing the PA at Dr Thomas’ office 2 weeks post-op, I was admonished to start taking baby aspirin for at least 2 weeks (for clot prevention), at which time I quit Aleve and switched to Advil and Tylenol.
- On the 2nd night post-Op, I took a Tramadol to ease the pain, managed to sleep for several hours and then took another Tramadol early in the morning. Those were the only 2 doses of Tramadol taken. To me, Tramadol was amazingly good - but since I wanted to get back to driving as soon as possible, I stopped at those 2 tablets of Tramadol.
- From Day 3 onwards it was the combination of Aleve (dropped after 2 weeks - see above bullet), Advil and Tylenol.
- For most of the first three weeks I was oftentimes behind the pain curve, not a good place to be!! But I did get back to driving much earlier than I would have had I continued taking Tramadol.
Recap:
If I had a third knee to replace, I’d have to come up with a better pain management plan - at least to get me through the first couple of weeks with a lot less pain than I went through with my LTKR. Pain in the knee and thighs were somewhat expected but the peripheral aches in the hip/pelvis/lower back/ankle - due to the realignment of the left leg - were much more intense and initially unrelenting than expected. |
| Constipation avoidance/Recovery Diet (first weeks post-op): | |
- To deal with possible constipation (caused by antibiotics messing my gut bacteria or my probable use of prescription pain meds), a week before surgery I will start taking probiotic capsules, eating yogurt and some prunes, drinking kombucha, and adding spinach, broccolini, brussel sprouts, and Polish sauerkraut to our meals.
- I’ll have Smooth Move tea, more prunes and Miralax in reserve. For Knee #2, the equation won’t be “pain versus strain” … hopefully it’ll be “no pain and no strain”.
- For the first week or two, I plan to take a protein drink (Premier Protein, 30g protein, 1g sugar), a protein bar (Kirkland, 21g protein, 1g sugar, 15g fiber), and a cup of yogurt (Chobani less sugar - 12g protein, 9g sugar) in addition to oats for breakfast — ensuring I’ll get plenty of protein and fiber regardless of what else I eat the rest of the day. The drink + bar + yogurt = 63g protein with only 11g sugar.
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- For the most part, the plan seems to have worked well. In addition to Miralax, SmoothMove tea, and ample fiber, I occasionally took a tablet or two of Colace.
- The protein drinks and protein bars were a very quick way to get a lot of protein in to jumpstart and continue the healing process, especially post-workout.
- Real food - meat, veggies, fruits, grains - helped maintain my gut bacteria and fuel for the healing process.
- Very little carbs and sweets.
Recap:
My constipation avoidance/recovery plan worked as well as hoped for. Constipation was never an issue. My incision healed very quickly and I suspect, a lot of internal healing progressed nicely, if I interpret the leg’s rapid gain in strength and stability after the first week.
If I had a third knee to replace, I’d stick to this plan. |
| Inflammation reduction | |
- I now have a very light inflatable elevation wedge (very cheap at Amazon) which I will use on my recliner ottoman, couch, and bed. For Knee #1, I used pillows but the elevation angles weren’t reliably sufficient. The wedge is so light, it’ll be so easy to move it from one place to another.
- I will use the Breg Polar Cube machine to ice the leg … this time around, while icing, I will have my legs elevated on the elevation wedge.
- After icing, I plan to use leg compression sleeves (cheap version from Amazon) with my legs on the elevation wedge.
- After compression, I plan to massage the leg from foot to ankle to calf to thighs … kneading as hard as tolerable.
- When I’m able to maneuver the leg up against a wall (hopefully within 2-3 days), massaging downwards will be a lot easier and the hard pulling downwards will, together with gravity, help get excess fluids from my lower leg, knee and thigh into the lymphatic system as efficiently as possible. I’ll probably be able to use a yoga strap to move my leg around while it’s still in its log stage.
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- The inflatable wedge I had pre-op sprung a leak and I ended up getting a foam wedge from Amazon (not quite as steep as the Lounge Doctor one.)
- I stopped using the Polar Cube after the 2nd or 3rd day post-op as icing didn’t help ease pain or swelling.
- I would use an ice gel wrap around or a colpac wrap around the knee after gym. Once a day for the most part - around 20-30 minutes or till when the gel pack warmed up.
- Elevated legs as high as possible - most often on the seatback of a settee couch, giving me at least a 45 degree elevation.
- Did a lot of my version of lymphatic massaging - that managed lower leg and thigh swelling very well - to the point where at times both legs would be the same size. After almost 3 weeks in, I started massaging around the knee as well. Lots of elevation every day.
Recap:
(Steep) elevation combined with “lymphatic massage” kept swelling in the lower leg and thigh areas to a minimum. As early as the second day post-op, after an elevation/massage session, the left leg (apart from the knee itself) was the same size as my right leg. The attached picture is from a couple of days ago (mid-way the third week post-op.)
By contrast, it took almost 6-7 weeks before my right leg’s size normalized.
I stopped icing after the 2nd or 3rd day post-op as icing seemed to slow down excess fluid drain - even if I iced with the legs elevated. Since icing did not provide me any pain relief and since it seemed to be a detriment to excess fluid drainage (using the need to pee as proxy gauge for drainage efficacy), I completely stopped icing other than for post-workout cool down (20-30 minutes max.) |
| Flexion and Extension exercises and outside PT | |
- Unlike with Knee #1, I plan to focus the first days post-op on inflammation reduction before doing any heel slides or extension exercises. I’m hoping that by “aggressively” working on inflammation reduction, I’ll be able to then move into flexion/extension exercises with a lot less discomfort (than Knee #1 did) towards the end of the first week… especially if the new knee is a lot less swollen by then.
- I already scheduled my first PT session … it will be 2 weeks post-OP ... unlike my first RTKR PT session which I had on day 2 post-op. While I found it useful and enlightening, I really didn't do much by way of PT ... and since I am now better aware of what to expect post-op, it seems to make sense to wait a little longer before formal PT. If my left leg is somehow ready for “work” before my first PT session, I’ll start doing the exercises at home (most of which I know and have listed in my RTKR log.)
- As soon as I can start doing calf raises, I will do so. I didn’t do these regularly enough the first couple of months after my RTKR but have found that doing them improved my balance quite a bit once I started doing them daily. That said, there’s the chance that calf raises might entail pain early on … in which case, I’ll postpone its use.
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- The first week I didn’t do any heel slides or quad squeezes or any other prescribed exercises. My main focus was to “aggressively” address swelling - and I stuck to that plan. By the end of the first week I could already put my shoes on and lace them - without much difficulty.
- Early into the second week, I started doing seated heel slides and leg raises. I also started doing sets of calf raises, several sets of 10-20 reps throughout the day. Later in the second week, I started stretching my leg across a second kitchen chair, allowing gravity to weigh the leg into an extended position.
- Also late in the second week I started doing leg work at the gym - leg extensions, hamstring curls, legpress, abductor and adductor work. I also started my pre-op stretching routines albeit modified to accommodate my current inability to kneel or to contort either leg as much as I could pre-op.
- By the third week I started doing “assisted seating squats” where I’d ease onto a kitchen chair using my arms to ease myself down and ease myself up. Later in the week I was able to do it easily without needing my arms to execute a sit down and a stand up. I also started doing “laps” up and down at the gym - 29 steps up going from the first floor to the second.
Recap:
By the middle of the third week, my left leg started getting stronger and more stable … at which time the aches in my pelvis, hip, and lower back started easing up considerably.
I can fully extend my left leg. My ROM - which hadn’t been measured in the last 2 weeks of PT - appears to be a couple of degrees worse than my right knee (which was last measured at 138 back on Week 8 post-RTKR). Neither I nor my physio feel it necessary to do anything specific to increase ROM - I know it will continue to improve as long as I continue with my exercise program.
If I had a third knee to replace, I’d follow my LTKR plan. |
| Mental wellbeing management | |
- I’m mentally preparing myself for a more difficult adjustment with the LTKR. My right leg was bowed while the left is knock kneed, and looking at the x-rays, I’m anticipating that my left femur will need to undergo a much more pronounced adjustment once the left knee is done and the leg straightened … which in turn, could cause more left leg discomfort and could throw my body and my new-ish right knee out of whack as well - at least for a few weeks. I hope I’m wrong, but I’m preparing for the worst while hoping for the best.
- Like post-RTKR, I plan to spend a lot of time reading forum postings (ala bonesmart) and viewing replacement related clips on YouTube. I find the feeling of being part of a large community of fellow TKRees comforting.
- Set numerous daily low bar, easy to accomplish tasks … to give me lots of opportunities to celebrate little “victories” throughout the day.
- After week 1, I’m hoping to be able to have not only outside PT but to also get to the gym (as I did post-RTKR). Getting out of the house and being amongst others, especially in a gym environment, can be very motivating. It helps too that at the gym I go to there are 2 others who have had their TKRs done within 10 days of my RTKR and another one who will have his TKR on the same day I’m getting my LTKR.
- Sit outside when it’s nice and sunny. I plan to read, nap, elevate, ice, etc etc there as much as possible. There’s nothing like being outdoors on a warmish day, in the shade, in Colorado! As an added bonus, we have a very distant view of the mountains from our deck, always a spirit lifter. I had my RTKR in December, so this wasn’t really an option.
- Continue maintaining a right knee log and start a left knee log side-by-side. Regular snapshots of the left knee will be included in the log … that’s something I wish I did with the right knee.
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- Despite preparing myself for a more painful experience, I occasionally struggled with the peripheral aches and pains, especially with my lower back which prevented me from being comfortable seated, laying or standing!
- The pelvis and hip pain when I'd do my hobble/walk every hour, made for an unpleasant experience several times a day. That made it tough keeping a positive outlook.
- Comparing my right knee log side by side with my left knee log provided "glimmers" of hope that the next day would be better. These "glimmers" were very valuable and instrumental in my maintaining a measure of equilibrium.
- I declared a lot of little victories those first few days, in an attempt to make things seem much better than they actually were. I continue to do so to this day as I find this a very valuable technique in staying semi positive.
- Daily visits to the gym continue to be great motivational boosts. Comparing notes with fellow TKRers there is invaluable. For one, we all "speak the same language" and are all similarly motivated to speed our recoveries along as best as we can. We all agree that we'd rather ache because we worked hard than ache because we didn't do anything active towards our recovery.
- I managed to weed whack and mow our yard a little into the third week post-LTKR and that provided a nice boost.
- I've set several realistic, some aspirational, and some pie-in-the-sky dreams of when I have two good, solid, strong legs. These will serve as "north stars" to guide continued hard rehab work.
Recap:
I thought I was mentally prepared for new aches and pains but it didn't seem that way the first couple of weeks post-LTKR. That said, overall I think I managed to stay fairly positive most of the time. (The Mrs didn't think I whined too much - so I must not have vocalized my complaints too much!)
Overall, I think the plan was a good one. |
United States![[Bonesmart.org] GlideFloss TKR Report - from Dec 06 '21 on](https://data.bonesmart.org/attachments/75/75650-da83de4d20050f33842d1d02d6cbad52.jpg?hash=2oPeTSAFDz)
