HerbM: Here We Go Again, Bilateral TKRs for late October/early November

[Rather]

Thanks @HerbM. I'll give him a call and at least get a second opinion. I'm a believer in tech innovations for most situations, so I am intrigued by the PSI approach as well as your strong recommendation.

 

[HerbM]

@Rather ,

I interview only 3 surgeons, which is actually a lot. It's difficult to interview them personally beyond a few.

Dodgin got me primarily because of the Anterior OUTPATIENT THR, but also the PSI was something I had wanted but given up on finding and new it was not a MAJOR difference.

Personally, I think it better, especially in the recovery phase where less cutting more comfort and a quicker recovery.

He also was much more open to my questions and helpful in giving me answers (which I actually consider a secondary advantage because a surgeon with ZERO people skills might be the best procedure guy in the world.)

He also told me he would go with my first surgeon (if I didn't choose Dodgin himself). This was a straight out, no quibble statement without me having to ask and put him on the spot.

If you want PSI and don't have a PSI surgeon yes, then likely he is the best you will find around here -- or at least in the same class.

 

[Celle]

Surgical techniques for knee replacement are not like clothes. They are not one-size-fits-all.

Ultimately, the success of the operation depends on the surgeon's experience and technical skill.

Sometimes, it is better to choose a surgeon who will modify his/her approach to, and the method of, the operation, to fit the needs of the individual patient.

 

[Roy Gardiner]

The other downstairs bathroom has assistance rails without the raised seat; also that is a small bathroom where my long arms can reach to the sink which provides a stable and reliable hand hold to pull myself up.

I'd say to get a riser for that one as well; even with hand-holds it'll hurt. Even if you can get yourself to standing with arm strength alone the knee bending will be painful.

 

[HerbM]

I'd say to get a riser for that one as well; even with hand-holds it'll hurt. Even if you can get yourself to standing with arm strength alone the knee bending will be painful.

Thaks Roy Gardiner

That's generally good advice, but the two bathrooms are equally accessible downstairs, and the raised toilet seat makes it slightly more difficult to stand at the toilet without wetting the seat, etc., my plan is to use the bathroom off the bedroom primarily to sit, and the on by the kitchen primarily to stand (at least at first.)

I am also planning to get a couple of plastic urinal devices so that every time it's urgent there's no requirement to hurry all the way to the bathroom -- I think with two TKRs that would likely make for some accidents, and my new chair is a bit slow to come upright, especially with blankets, pillows, computer, over-bed table etc.

How many days Post-Op were before you could fairly comfortably use the facilities seated?

 

[Roy Gardiner]

How many days Post-Op were before you could fairly comfortably use the facilities seated?

You know I'm not sure, probably a month or so. But I am not typical, my recovery was very fast; Josephine has said that she's not known anyone to come off prescription drugs any faster than me, in over 50 years as a nurse. Not because I'm a hero, either, far far from it, I just didn't need them any more.

 

[HerbM]

How many days Post-Op were before you could fairly comfortably use the facilities seated?​

You know I'm not sure, probably a month or so. But I am not typical, my recovery was very fast; Josephine has said that she's not known anyone to come off prescription drugs any faster than me, in over 50 years as a nurse. Not because I'm a hero, either, far far from it, I just didn't need them any more.

Wow!

A month (or so?) seems like a long time to be able to comfortable use the bathroom facilities, and if that is atypically fast it is very sobering. I was expecting a long time might be a week or maybe two.

Do you remember if it was your quads or the knee itself or some other combination of elements?

For the hip, the meds were unnecessary immediately (I took/take a few but that is more to be CERTAIN & mostly to sleep really, really well, and because the surgeon plus you folks here encouraged it.)

Knees are clearly harder (than hips), and two knees harder yet, but it's that type of report that makes me want to rethink bilateral TKR. (And your case was exceptionally GOOD.)

Again: WOW!




PS: I am looking to buy or build (an inexpensive) frame for pulling/pushing up from a chair and the bed. Building would probably involve PVC Pipe.

Ideally (I believe) it would be light but allow me to PULL up (into it) and/or have bars for my hand that allow me to do "dips", i.e., parallel bars.

Probably would need two, one for bed and one for easy chair.

Anyone have any suggestions, ideas, or leads?

 

[Crow22]

@HerbM Before surgery my doctor's office gave me an extensive booklet. In there were/are exercises to do pre and post surgery. Pre op exercises are ankle pumps, leg lifts lying on your back, side, and stomach, heel slides, butt clenches! Stretching quads, and whole leg. Pretty simple stuff, doing each 20xs. holding the stretching for 30 sec or so. I think all in all it limbered me up and gave me quad strength that I am rebuilding now, but I believe my quad strength would have been weaker had I done nothing.
Also, as far as being able to use the facilities without too much discomfort, I'm only a month out, and it is much easier to use my bathroom, I can even get off the toilet un aided. (no riser). That being said, I haven't tried venturing out to use any other bathroom.
Hope this helps.

 

[ljrfrm]

At 4 weeks post-surgery, I still need to use my toilet riser thingy. My husband carries it to the downstairs bathroom each morning, and takes it to the upstairs bathroom for overnight use. I have a sink in front of me downstairs and thought that would be enough - but for some reason, it's harder to pull of from that than using the toilet riser frame. I have strong legs too but I just need the help to stand up. I have it on the lowest setting (at first it was much much higher) which is right above the toiler - so the height isn't the issue anymore. But, I just still need the bars on each side to push up. I may try getting up from the sink again soon - I think I might be almost ready to do it that way.

 

[HerbM]

@HerbM Before surgery my doctor's office gave me an extensive booklet. In there were/are exercises to do pre and post surgery. Pre op exercises are ankle pumps, leg lifts lying on your back, side, and stomach, heel slides, butt clenches! Stretching quads, and whole leg. Pretty simple stuff, doing each 20xs. holding the stretching for 30 sec or so. I think all in all it limbered me up and gave me quad strength that I am rebuilding now, but I believe my quad strength would have been weaker had I done nothing.

THANKS!

That's great -- I found another source which pretty much agrees with your list above and the GOOD NEWS is that these my current rehab for the THR pretty much covers all of it.

I am going to add DIPS (arm strength for getting up) even though I am strong in that now, a bit more will only help.

My rehab work and my Meridian Stretching Massage therapist should take care of the flexibility (as much as it possible for me) - also going to do some yoga, water and/or conventional, for flexibility and mobility.

Also, I am doing leg extensions (for quads) with light weight now (10 lbs for continuous reps and 20lbs for 20x sets).

Should work that back up to my usual moderately heavy weight (maybe 10x x 3 sets at 60lbs or more -- I doubt that there is time to get me much beyond 70 or 80 lbs.) But heck, don't know if I can even do 40 yet, 7+ weeks remaining though (51 days).

It might be time to try the X-country ski glider machine again -- last week it wouldn't work for me, the reach was too far for my still immobile right leg AND my left knee. Today's session will include these ideas at least at a test level.

Good info. Thanks.

 

[ljrfrm]

I worked with a trainer to prepare for the surgery, and I really think that helped me so much. I really feel strong - which has really helped my recovery. I think you are right - that the majority of exercises you are already doing for your hip will help you prepare for the knee surgeries. I did a lot of leg presses, extensions, calf raises, etc. And also a lot of upper body (dips, etc.) that all helped.

 

[Roy Gardiner]

How many days Post-Op were before you could fairly comfortably use the facilities seated?​

Wow!

A month (or so?) seems like a long time to be able to comfortable use the bathroom facilities, and if that is atypically fast it is very sobering. I was expecting a long time might be a week or maybe two.

My recovery thread goes into some detail and should give an idea. Yes I think you have the wrong unit, weeks should read as months.

I am a keen cyclist; I did nothing in Dec 2011, Jan 2012, then Feb 45 miles, March 137, April 503 including a holiday in Majorca. Recovery looked at that way is 'exponential' improvement, really.

Do you remember if it was your quads or the knee itself or some other combination of elements?

95% ligaments/tendons around the knee, 5% quads, lower leg and back of upper, nothing.

Knees are clearly harder (than hips),

Well I can't tell you about hips personally, but yes everything I have read says yes, much much harder.

and two knees harder yet, but it's that type of report that makes me want to rethink bilateral TKR. (And your case was exceptionally GOOD.)

Don't rethink because of me, please! I think the case for either bilateral or 2 within a couple of weeks at most is overwhelming. Just one recovery!

Guessing from your background, I'd say that you are probably very fit and have great upper body strength. I was fit (in the worst 0.1% of racing cyclists, but you've got to be fit to race at all) with poor strength (I weigh 82kg (about 180lb) and can do one pull up only). You will be able to handle it easily, IMO. The one thing - guessing again, risky business - that might get you is trying too hard. It's difficult to convince oneself that watching telly all day is 'active recovery'; I'm the laziest person in the world, the only time it's worked in my favour.

 

[HerbM]

I hope @Roy Gardiner that we are not confused about weeks vs. months but talking two different results.

My question was ONLY how long did it take you before getting on and off the toilet (or out of a chair) was not a major isssue, and not so much how long was the 'recovery' itself. (I need to finish reading your thread.) Thanks.

I worked with a trainer to prepare for the surgery, and I really think that helped me so much. I really feel strong - which has really helped my recovery. I think you are right - that the majority of exercises you are already doing for your hip will help you prepare for the knee surgeries. I did a lot of leg presses, extensions, calf raises, etc. And also a lot of upper body (dips, etc.) that all helped.

Normally, I probably would work (closely) with a trainer but I have the luxury of the insurance company providing two for me, one manual therapy & gym and the other in the pool so I am going to take advantage of the therapy for my "hip" (which I could do all by myself quite easily from this point) to prep my knees -- the exercises are pretty much the same anyway.

Then I contracted with the Meridian Stretching massage therapy for about one session per week, and there is a nice Health Director (Collette) at the Y who is helping me quite a bit (almost enough to qualify as a person trainer.)

There are a couple of other massage therapist I MIGHT involve so I have something like 4 1/2 trainers for the 7 weeks.

Today I did get on the dip machine, worked up to (only) 60 lbs for 5 reps x 2 sets (with other sets at lower weights preceding this.)

Took the leg extension up to 65 lbs x 2 sets (after some lower weight sets).

I DID get that Slider/Glider X-Country ski machine to work smoothly and without pain and ran it at about 110 BPM (my heart) for 6 minutes. Not long enough or high enough for real aerobic work, but hey it's a start (12 days post surgery.)

Went to the outdoor pool and did my full water walking and stretching routing (almost an hour).

Stretching was very successful -- put my forehead on my non-procedure knee without strain (I've been a TIGHT guy all my life so this is not a small thing), and ALMOST put my head on my procedure leg. At this rate I will get that in 1-2 weeks.

I can now cross my legs pretty comfortably so it's a real luxury to on shoes and socks without a struggle or aid. This is all new in recent months (or years).

Another good day; I am so happy that my surgeon talked me into the hip surgery FIRST.

 

[ljrfrm]

Sounds like you have made great progress from your hip surgery! Great job.

 

[Roy Gardiner]

My question was ONLY how long did it take you before getting on and off the toilet (or out of a chair) was not a major isssue, and not so much how long was the 'recovery' itself. (I need to finish reading your thread.) Thanks.

As I said, about a month I guess but I'm not sure. It certainly was not a major issue, the riser just made life easier and I dispensed with it when no longer needed. No bother.

 

[kneeper]

The riser and for me frame made the getting up and down easier. It will depend on your ROM, soreness of your quads etc. even for people who have one knee at a time.

 

[HerbM]

Ok, I have the raised seat with handrails in one bathroom and just handrails in the other.

I am considering ordering this: Re-useable Portable Standard Male Advantage Urinal System with Down Drain Bag Making It Spill Proof https://www.amazon.com/gp/product/B003C3P174/?tag=ate362da-20
and some cheap bottles to leave in strategic places (like garage for when coming home and having trouble getting IN, setting stuff down, dealing with doggies, and getting to bathroom.)

This wasn't a real problem with the Hip but I will likely be moving slower with BOTH KNEES.

[EDITS follow: I did some thinking and returned to just edit my original ideas on how to get up from my bed or chair more easily.]

I also WAS going to buy an 'under bed anchored' bed rail, stand assist $37: Drive Medical Adjustable Height Home Bed Assist https://www.amazon.com/gp/product/B005JIJRZ2/?tag=ate362da-20

​

Even though the above might be sufficient in the bedroom when combined with leaving the walker there by the bed when sleeping/resting, my current plan is to build the following "high bar pull-up stand".

The plan includes two of these stands:

• One for the bedroom 3' to 6' wide (plus pipe joint size of maybe 2")
  
  
• One for my recliner roughly 3' wide (plus pipe joint size of maybe 2")

The 33" outside dimension base of my over-bed table will track INSIDE the legs of the smaller stand.

My design is roughly based on the following diagram, but without the two short hand grip pieces at the top, and with somewhat different dimensions

• 6' tall
• 36" across for recliner (perhaps wider for bed)
  
• 18" forward legs
• 30" rear legs to keep it more stable back towards the chair or under the bed
  with have less sticking out in the forward direction

​

Another consideration is to put two or three 4x4s across the top of the rear legs, and put my recliner ON the 4x4s to bring it up a bit, about 4". (4x4s are planed smaller than 4" but the 1/2" pipe will make up for that.)

Considering a 1/2", "black iron" (pipe) to construct these pull up frames (Lowes has the pieces at an affordable price, probably about $50 per frame.)

I have rejected hanging anything from the ceiling (e.g. a hawser/rope), but I likely will WRAP cord or line around the bars for a better grip and feel, and tie rope loops at strategic places to get me started up to the high bar. (When young, I was a commercial diver and did a lot of rigging with ropes and knots.)

Also I might tie a line under the chest at the foot of the bed to pull me upright and give me leverage.

Any better ideas for SIMPLE projects or buying something?

Also ordered a cheap digital "goniometer" Electronic Digital Goniometer Orthopedics Occupational Physical Therapy (gon = angle, as in octagon) https://www.amazon.com/gp/product/B00ES2BQZY/?tag=ate362da-20

​

Might as well be able to keep up with my own flexion and extension. The digital goniometer makes that feasible since it will hold a reading when you press a button. It was less than $15 IIRC.

 

[Celle]

@HerbM
Most people use a walker or crutches. I think you'll be able to get into and out of bed just fine using those before you are discharged from hospital. You probably won't need all that fancy stuff.

 

[HerbM]

@HerbM
Most people use a walker or crutches. I think you'll be able to get into and out of bed just using those before you are discharged from hospital. You probably won't need all that fancy stuff.

Thanks -- You could well be correct.

However, I am a little bit concerned that my wife will have to spend a lot (too much?) time and energy helping me in and out of bed, and if it's going to be a month or two as in @Roy Gardiner 's case (and he was said to have done very well making that a LOW estimate.)

I am hoping my quads, tendons, and ligaments will recover a bit faster but it COULD be a LOT slower. For CUT muscle, 6 weeks might make a good estimate so Roy's "a month or so" fits right in line with that.

There are some other advantages (difficult to explain) due to power and computer cord management alongside the over-bed table I now use & love. Having it track inside the pipe legs will make all that work better and it will make the table more stable to push away and retrieve.

Also, with the table there, the walker will need to be elsewhere (pushed aside) and hauled into position once the table has been pushed back.

Maybe I'll build the one for the recliner and skip the bedroom version.

 

[Jamie]

I agree with Celle.....you will be able to get yourself up before you leave the hospital. With knee replacements no muscles should be cut. They are "teased" apart to gain access, but not actually cut in the manner I think you are anticipating. Roy's comment about a "month" was in answer to how long before you could comfortably use a regular toilet. You're going to be fine with risers and the frame with handles. You will be able to "lift" yourself up out of any chair that is a reasonable height that has arms. Then you will hold on to your walker. I think you are letting yourself come up with problems that are not going to be there. Please read some of BTKR recovery threads. We've never had anyone have the kind of problems you are talking about.