This is going to be a long Post. Sorry!
My understanding of "pain control" and the reasons why it is put in place is that they
know the knee(s) will hurt for quite a time after the operation.
The reason for this pain is that damage has been done to the bones and tissues in the knees and during the healing process the body provides pain as a reminder to
NOT move the damaged materials.
However, not moving the damaged tissues can have a major side-effect in the form of "adhesions" whereby the damaged tissues heal and at the same time attach themselves to places where they are not supposed to be.
If the adhesions are allowed to form the movement of the knee will be severely restricted and subsequent movement will require the adhesions to be torn away so that the joint may be free to move.
This is an extremely painful situation and in severe cases the patient may have to return to the hospital to have the adhesions torn away under general anaesthetic.
So here's the rub,
during the healing process:
1. The formation of adhesions can only be prevented by moving the joint on a regular basis.
2. The joint must be moved to the maximum angle permitted by the swelling and inflammation.
3. Moving the joint will cause pain.
So that's why you are recommended to take pain killers before PT; the hard bit is maintaining the balance between "benefit" and "cost"!
I haven't had a TKR yet but the reason I need one is that 47 years ago I smashed my left knee to bits hitting a lamp-post on a motorbike. The knee-cap was pulped, the knuckle of the femur was broken into four pieces and the splintered end of the femur came through the side of my leg.
For "pain relief" I was given:
Day One:
o A shot of morphine when I arrived at A&E (which was fifteen miles away from where I had the accident),
o General anaesthetic when the removed the remains of my knee-cap and put me into traction.
Day Two:
o Eight 500mg of Paracetamol
o One shot of Pethidine to allow me to sleep.
Day Three:
o Eight 500mg (4 x 2 tablets) of Paracetamol.
Er .... that was it!! The Ward Sister decided that I was getting "Addicted to Paracetamol." (her words) and stopped them. I have to confess though that fluttered eye-lids (I was better looking in those days) did get me a couple of smuggled tablets from a susceptible nurse at 2am on Day Four when I couldn't get to sleep because of the pain!
I then lay in traction for four months. Discharged from hospital in a plaster spica my knee was kept unmoving for a period of nearly six months! Adhesions had formed, the movement of my knee was limited to about five degrees and trying to go beyond that limit was extremely painful.
I despaired of ever getting back to "normal" but tried my best. Then one day I took my children to a paddling pool here in Skegness. I was managing to walk with the aid of two crutches so I went paddling with them.
The two crutches shot out from under me on the slippery bottom of the paddling pool, my good leg shot out from under me for the same reason and the foot on my left foot stayed exactly where it was as my full weight went down and bent my injured knee to the maximum available angle.
The pain was excruciating but the adhesions were removed and my rehabilitation started from that date.
I sincerely hope that I can cope with the pain of a TKR sufficiently to prevent the formation of adhesions; and I will try to keep the pain-killers to a minimum so that they don't mask and potential damage.
I hope this helps.
Best regards,
Ian
United Kingdom
But now that I'm more healed I can start thinking in terms of watching my weight--and I'll be able to be more active over the next months too.
