TKR Hawkie's 2nd Knee

[hawk2go]

I had the surgery on Sept 7th and have been moving along. I was up walking the afternoon of the surgery and was out of the hospital 2 days later. Two frustrations - compression hose and pain management. My doc's go to post-op cocktail is Celebrex and Oxy. I'm allergic to Celebrex, so started on meloxicam (Mobic). I left the hospital with meloxicam, tylenol, gabapentin, flexiril and oxycodone. I removed the last 3 from my regimen about 12 days ago, with the doctors advice since they didn't seemed to help just made me loopy. I have never not been in pain though the pain is reduced as I have improved extension, flexion and mobility over time. Sleep is really hard since I have the most pain when I lie down. I'm a side sleeper and have tried various types of pillows and also tried sleeping on my back. Compression hose just hurt.

I'm really happy with my recovery progress except for the pain management. My grandnuggets call me a cyborg lol. Kids! <3

 

[Jockette]

Compression hose just hurt.

Call your doctor and ask for another size, they really shouldn’t be that uncomfortable.

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.

Just keep in mind all people are different, as are the approaches to this recovery and rehab. The key is, “Find what works for you.“ Your doctors, PTs and BoneSmart are available to help, but you are the final judge as to the recovery approach you choose.

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​

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. At week 4 and after you should follow this

Activity progression for TKRs​

6. Access to these pages on the website

​

Oral And Intravenous Pain Medications​

Wound Closure​

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.

 

[eaglemom]

How long were you told to wear the hose? Its over 2 weeks since your surgery and that usually is the time frame. I would call your physician and just say that the hose are too tight. Ask them for a recommendation.

Sleeping is a tough one. I think what's best is multiple naps throughout the day. Staying in bed all night is difficult, as most of us know. It does get better with time.

 

[FCBayern]

@hawk2go are you icing? It works wonders for the pain. You need to ice at least 45-60 minutes at a time for best effect. As long as you keep something between your skin and the ice to protect it, you can't ice too much. I used an ice machine that circulated ice water through a pad which I wore 24/7 for the first few weeks. I also found that I slept much better in my recliner than in my bed for a few weeks.

 

[hawk2go]

@hawk2go are you icing?

I am icing during the day! I have an ice machine that is way better than the ice wraps that I used with the first knee. Unfortunately, I didn't go super high end, so the water exchange hose is heavy and awkward to sleep with. Today was a tough day and I took one of the oxy tabs that I hoarded. I feel better now and am a bit loopy.

How long were you told to wear the hose?

The doc wanted me in the compression hose for 6 weeks 24/7 - I negotiated to remove them at night. The PA on the team said to definitely wear them if I notice a lot of swelling, but that has not been a problem, so far.

I think what's best is multiple naps throughout the day.

That's what I've been doing naturally after routine activity so that may just be the way to go, at least for a few weeks more. I guess I have a hopeful vision of a restful night. Neither of my recliners is comfortable right now. I've tried a few different types of pillows between the knees that reduce the discomfort enough to fall off for a few hours at a time. It seems I just have to adjust my goals.

 

[Cjackso21]

Hello, I have found that the large ice packs, that have velcro wraps, are great to use right before going to sleep. If you fall asleep with them on, they just become compression wraps. I usually take them off but it helps to take the edge off to help me fall asleep. I have also found that many pillows help. At first I had one behind me to keep me not quite on my side and allows a little more comfort when using a pillow between my knees. I also stretch my knees with gentle movements. A belt around the ankle and pull then push without pain, just to move the joint before going to sleep. Hope this helps a little. Good luck!

 

[Virginia123]

I Had my 2nd tkr done at the mayo clinic. when I had my first one at mayo in 2017 they had me use compression socks which I HATED. After much frustration after a week I gave them up. My second surgery there, I asked about them and they said they have discontinued Having patients use them. they said with ankle pumps and other exercises and elevation I will be fine. My swelling has not been an issue other than normal amount in my knee and calf which has come down nicely.

 

[Susie-Q]

6 weeks of compression hose seems like a long time! I wore mine for 2 weeks and didn't have to at night. It does sound like yours are too tight if they are that uncomfortable.. Mine were just a nuisance to take on and off, had to have hubby help me. I didn't have any issues with swelling in my ankles or feet.

Good luck with your second recovery! I remember reading about your first. At least this time you know what to expect!

 

[hawk2go]

I've been in touch with my home care team and my surgical team about the pain and the hose. The home care team believes I can give the hose up now, the surgical team does not. I haven't worn them for the last few days and have not had any swelling except for the normal stuff when I work the knee out.

I've been going back and forth with them all about the pain especially since my BP has been reading high the last week or so. The home care nurse says that's expected given that my pain is not well controlled (pain raises blood pressure). I saw my PCP on Friday about the BP and he added a diuretic (which we removed several years back because my BP was controlled with just the 1 med). I hope to talk to someone from the surgical team today about both the pain and the hose. I figure, worst case, the diuretic will help with excess swelling.

The pain is worse right when I wake up (I think it wakes me up) and at the very end of the day. It's an intense stabbing on the medial side where the joint meets and less intense dull pain on the lateral side where the joint meets. It's worse when I bend while lying down. When I bend too far while sitting or standing, I feel a significant pull around the front of the knee, from side to side.

On the bright side, I'm super comfortable walking with a cane and have eliminated the walker. I'm able to do all my care stuff on my own, even getting in/out of the shower. I've cooked several meals and am more self sufficient serving myself most meals. I've been practicing walking around the room or from room to room without any device, as long as I feel stable and am able to walking without limping. I do all of the activity without much pain at all but wonder if the cumulative effect is causing my pain. I'm still wonky putting full weight on my surgical knee and need to hold on to something.

 

[Susie-Q]

I'm sorry you are still having issues with pain. Good luck talking to the surgical team. Hopefully they can help and get you a better pain management plan.

 

[Sisterpat]

Since you are not even a month post-op, you might be overdoing it with your activity. Try to tone it down for a few days and see if that doesn’t help the pain issue a bit. This is a long recovery.

 

[FCBayern]

I agree with Sisterpat, your level of activity is likely causing the end of day and night pain. Take another look at this article:

Resting after Joint Replacement surgery

Even with so many advances in surgical methods that allow surgeons to replace traditional open surgery with less invasive approaches like robotic, laparoscopic, or arthroscopic surgery, any procedure is considered to be a major stress on the body and mind. Your body spends a lot of energy...

bonesmart.org

 

[hawk2go]

Thanks for the advice all. I'll scale the activity back and be more mindful of what I've done each day. I think I go by how I feel at the time, which doesn't seem to be the right metric.

I also reread the activity progression article, so thanks for reposting.

 

[hawk2go]

My home care nurse released me today, as did my home care PT. My flexion jumped from 84 on Thursday to 98 today, my extension is -2 (probably will work those last couple degrees out by heel to toe walking). When I canceled my PT session scheduled for Monday (2 days ago), I was nervous about regressing. It seems the rest, ice, elevation and light ADL worked wonders for the knee. Go figure.

I see my ortho for a surgical follow up on Monday. I'll schedule outpatient PT in a couple weeks but will continue to do my home stretches/exercises until I resume PT. Reminding myself to take it easy.

 

[Susie-Q]

If your extension is -2 then you are beyond flat and a tiny bit hyperextended. My right knee is -5 so a bit hyperextended too. My baby knee (left) is somewhere around 2 so I've got a tiny bit yet to go. My PT says they will usually want the two knees to be similar eventually.

You are doing awesome! Your extension is better than mine and you are a week ahead of me! (I know we're not supposed to compare, just wanted to say you are doing great!)

 

[hawk2go]

Well, the PT said "a couple degrees", so I assumed -2 since last week I was -3. He said that it was great. Who knows ...

One note for future me is that, from the beginning with this right knee, the care team encouraged me not to rest with the knee bent for too long - different advice from the left knee. I was doing the heel slides and quad sets whenever I thought about it this time. IIRC, it took a few months for the left knee to be completely straight. Every person and every knee is different (ok to compare for guidance but don't obsess, she warns herself too ).

I walked outside today, then did my rehab on the porch, sat with friends while I finished a cup of tea. It was lovely. Walking outside is tricky since I feel even slight inclines and declines on the sidewalk (city dweller here). I'll plan to do that daily.

BTW, I opened a new pair of compression hose and realized I have 2 different sizes. I wonder if the times when the hose actually hurt (vs. being uncomfortable) was when I had on a size too small. At any rate, I now check before I put them on and they're more tolerable, which could also be due to decreased swelling. Onward and upward - recovery pain is better than pain of deterioration.

 

[dogwalker2]

I sympathise on this. Because I have little pain in the day I do way too much, it is the same trap I fell into with my first tkr! Then I wake up at 02.30 with pain and no relief scheduled till 06.30. Seems I am a slow learner!! Note to self, try and take it easier ☺

 

[hawk2go]

@dogwalker2 - I know the daytime pain seems untouched by meds - tylenol and meloxicam - but the pain is also very low level, so I end up doing what feels fine to do. Then nighttime comes with the predictable pain flares and The Knee doesn't settle well. Lying down is the least comfortable of all positions but I haven't tried the recliners recently. Maybe this weekend.

I know with the left knee, I got really good relief when I was able to saran wrap the knee at night. It resolved scar sensitivity (the right knee still doesn't like when the sheet touches the scar), that middle of the night pain flare that makes me sit up and also the morning stiffness. I'll have to go back to that thread to see when I started using that remedy. It may be time ...

 

[Rubietuesday]

I am 10 weeks post op on Monday and still having trouble sleeping, my scar is very sensitive, I am going to try cling film wrap tonight & hope it helps.

 

[wander03]

I have tried to sleep in my bed several nights in the last three weeks or so. I have an organic latex mattress, so it doesn’t compress when I lay on it as other mattresses do. However, I did no more than doze for a very short time before waking up with my leg aching. I have tried laying on both sides and on my back. I tried different sizes of pillows between my legs. I ordered a foam thing that was supposed to help after knee surgery and tried it for two or three nights, then returned it. Nothing has worked. I am still sleeping in my Smith Bros. leather recliner. I don’t know if it’s being a high end recliner makes a difference, but I sleep very well in it. I do not know how I would have been able to sleep without it.
I am very fortunate in that I have had no problem with my scar. I may have had some pain after the surgery, but I don’t remember it. My OS did a beautiful job. There was a flat bandage that covered the incision, which a nurse removed after two weeks. The incision was noticeable but not obtrusively so. At six weeks, the OS said the incision was fully healed. It is relatively faint. I now massage pure vitamin E into the scar.
It appears that I am fortunate that my recovery has been very smooth compared to yours and some others. Of course, my surgery was seven weeks before yours. Until the aggressive physical therapy created problems last week, I had been making steady progress with very little if any pain, as long as I didn’t try to sleep in the bed. The strength in my legs has not developed as quickly as I would like so I am still using a walker and my stamina still leaves a lot to be desired, but I could not walk without limping for about three years before the TKR, so I guess that is understandable.