Revision TKR Here I go again - round three

midwest girl

Mar 11, 2014
United States United States
Well I’m home and recovering. Surgery on the 14th didn’t go as originally planned. He said the tibial component was so loose that he could just lift it off the bone. He saw some other things with the femoral component and decided to do a total revision instead of the planned partial.

Recovery in the hospital was a challenge as they couldn’t get my pain under control. I think in part because I was on an every 6 hr med schedule, but when I would page them for meds it took 40-60 min for them to get to the room. So I was at every 7 hr. Saturday night my pain hit a 9 and I couldn’t wait anymore and I paged again saying it was a 9 and I needed something now. That got someone in there promptly. I did tell the hospitality that every 6 hr was too long. I was getting these peaks and valleys of pain and never getting below a 5. So they added toroidal to the mix Of only using Tylenol and tramadol. One night they added oxy and I was so nauseated and throwing up after that that they dropped that from the routine.

At home, I’ve tried to stick to the 6 hr schedule but switched to 4hr last night. And it’s been working well. But when the follow-up nurse called today and we discussed my meds schedule, she wasn’t a fan. I was using the bone smart schedule of tramadol and Tylenol on a 4 hr rotation. I gave her the exact schedule and she exasperatedly signed and said oh Peggy - she preferred I stick to every 6 hr as prescribed. And she wasn’t a fan of the ibuprofen script that was given to me just because I’m taking aspirin twice a day as a blood thinner. So I’m going to try and go back to the 6 hr schedule and give it another shot.

The knee joint itself isn’t hurting. It’s the shin to ankle pain, and thigh pain (due to reaming the bones to put in long-stemmed implants). The only pain I’m getting around the knee is burning and I think that’s from the tape used to hold the prevena in place. No TEDs were given, just the one leg wrapped in an Ace bandage, which the dr. PA said I could remove it now and then. I tend to keep it off more than on - but I’m getting ready to try and put it back on myself, because the nurse doesn’t like that it’s off.

I had one PT session at the hospital. My extension was 2 and flexion was 93 and I was able to do all the exercises and steps with no problem. The 90-mile drive home from the hospital Sunday night did cause swelling and pain. My first formal PT yesterday at the clinic was a little harder. The PT had to start most exercises for me - like the leg raises etc. I’m having a lot of hip pain at the joint and I’m just assuming that's coming from moving me sideways and up to get in/out of the hospital bed. So home exercises are tough because I can’t get things started on my own yet. She measured my ROM at PT yesterday. Extension at 3 and flexion At 90, so lost a few degrees I’m sure to swelling.

Overall everything is going ok. Not looking forward to going back to 6 hr, which I’ll probably have to do anyway. I was given a small number of tramadol (25 pills) with no refill so a 4 hr schedule I’d be running out before my follow-up visit on Aug 3. So I’m off to wrap my leg and figure out a new meds schedule.
And she wasn’t a fan of the ibuprofen script that was given to me just because I’m taking aspirin twice a day as a blood thinner.
Ibuprofen also thins the blood because it's an NSAID. I agree with your nurse.
No TEDs were given, just the one leg wrapped in an Ace bandage, which the dr. PA said I could remove it now and then. I tend to keep it off more than on - but I’m getting ready to try and put it back on myself, because the nurse doesn’t like that it’s off.
Quite a few of us were not given TEDS or were wrapped. I wasn't. As long as you're up and down every few hours you should have no problem with clots.
She measured my ROM at PT yesterday. Extension at 3 and flexion At 90, so lost a few degrees I’m sure to swelling.
Oh yes, just about everybody has increased swelling when getting back to home. You are up and down more, taking care of yourself, which leads to more swelling. Be sure to ice and elevate as much as you can.
I was given a small number of tramadol (25 pills) with no refill
Call your doctor and ask for more. That is a ridiculously low amount of pain meds for someone after having a joint replacement! If your OS won't approve more meds, then try your PCP. Many have found that they will prescribe pain relief when their surgeons won't.
@sistersinhim i understand about the ibuprofen and the aspirin affects. I’m just surprised they prescribed the Ibuprofen to begin with knowing his protocol for blood thinners is the use of baby aspirin twice a day. It’s 800 mg tablets to take one every 8 hrs as needed for mild pain or fever. I’m wondering if the small number of pills was to cover until my post-op follow-up on Aug 3rd when I can ask for more at that point. Yes, I do get up and down every 2-4 hours for bathroom or to just walk around the house. Just got done doing the exercises I could do - like standing leg lift and seated heal slide. Knee feels pretty tight and the quads are sore. And I’m sure some of the tightness is from the layers of tape used to hold the prevena to my leg. Tape only stretches so far.
Today has been a hard day. Swelling, tightness around the knee and thigh and just constant pain from toes to high thigh. It’s just different intensity that comes in waves ranging from a 3 to a 6, with the majority of the time at 5. Lots of crying jags today. PT went fine. She said this is all normal. It takes 2 weeks for things to die down and getting anesthesia out of the body. She said the first two weeks are the hardest. And I’m not even a week out from surgery. I’m very hyper aware of the one spot that caused all the pain pre-surgery and I’m noticing pain in that area when I walk. Again, she said this is all normal. There will be pain at different spots all the time as the tissue heals. Trying to be compliant with the nurse‘s request to go back to 6 hr meds interval, but it’s been tough. today I’m on a 5 hr cycle. I ice and elevate every time I’m sitting, and I get up every couple of hours to walk around the house. I can’t wait to get this prevena wound vac off my leg. I think some of the pain is coming from that and the tape. Hoping tomorrow is a better day.
With you in this much pain, it isn't necessary to do all the exercises. The best thing you can do for your healing tissues is to rest and let them heal. Doing too much too soon will just keep them inflamed, swollen, and painful. Rest and time is your best friend right now.
Again, she said this is all normal. There will be pain at different spots all the time as the tissue heals.
This is so true!

As has been said, don’t worry about the exercises, all you need right now are some very gentle bends, and short walks, which will happen when doing any daily activities. Too many exercises, too early, keeps our pain level up, which is counterproductive. :console2:

Regaining our ROM does not require forceful bending or painful exercises. That is counterproductive.

Regaining our ROM is more about Time than repetitions of a list of exercises.

Time to recover.
Time for pain and swelling to settle.
Time to heal.

Our range of motion is right there all along just waiting for that to happen so it can show itself.

In the general run of things, it doesn't need to be fought for, worked hard for or worried about. It will happen. Normal activity is the key to success.
My PT sessions have been very gentle. No forcing or pushing anything and no multiple reps. To me it feels more like stretching those muscles that feel so tight. To me it feels like it helps. And honestly at this point I think I would have had that level of pain if I didn’t go to PT at all. It was like that at the hospital - pain was constant. It’s 2:45 am and I took my pain meds and I can honestly say this is the first time I’m not squirming in pain after getting up for bathroom, meds, new ice bottles. Maybe today will be a good, less emotional day than it was yesterday when I was a hot mess
The first few weeks are a lonely nightmare. Nobody understands the pain unless they are actually experiencing the same. Your thought that tomorrow may be better has already proved to be the case, so keep that attitude!
I too couldn’t wait for dressings and stitches to come off, convinced that it would help, it didn’t. It was what was underneath.
Your level of activity and exercises seems to be just about right, staying mobile and avoiding DVT within your pain level. I made the mistake of trying to get back to normal in the shortest time possible, I am wiser now.
This afternoon I left a voicemail at my surgeons office indicating I needed a refill on tramadol. Based on what they give me I’m changing my pain meds schedule back to the 4 hr schedule of tramadol and Tylenol that is suggested on this site. Besides knee pain I have constant. Very low back pain on the left side, just off the spine midline. It’s full and achy 24/7. I’m sure due to surgery, elevating, recovery, sleeping in the recliner related. I can tell it’s just out of alignment. So with the constant pain of that and of the knee I need to adjust the schedule. I’ve had way too many crying jags per day due to pain. I tried going back to the 6 hr schedule that the hospital followup nurse wanted, but it’s tough. I switch to 5-51/2 hr and even that can be too much. So if I’m given enough tramadol it’s going to be 4 hr. I’m no whimp to pain, but I can’t take much more of this. And I don’t know how to help my back outside of adjustments I’ve used ice. I’ve used heat, I’ve the theragun, salonpas patches, bio-freeze.

On a positive note. Today was my birthday and i received lovely greetings from several friends. So that helped with the tear filled, pain filled day.
Happy Birthday!!!!! Oh I hope you got to have, I don't know, a cupcake or ice cream or *something* to brighten a difficult day!
Happy Birthday and good luck with the Tramadol refill.
So sorry about the back pain. I have lumbar arthritis/ spinal stenosis and my back was bad post surgery. It is still not great but manageable now I can get to the floor/ lie on my tummy/ four point kneel to do back pilates.
In the early days it was really tough. My pilates teacher got me to put a folded yoga mat on the bed to make it firmer for exercise. That really helped as otherwise doing say heel slides on a soft bed just made my back worse.
Aww, I am sorry you had a tearfull and pain filled birthday. :console2:
Hopefully this calorie free cupcake makes you feel better. :wink: IMG_9825.jpeg
A belated Happy Birthday! I hope today is a better day.
The nurse called back and said she’ll send a refill through to my pharmacy. And to just call each time it needs refilled. A good way to start my day. And yet funny and sad that getting drugs is what made my morning so far.

Thank you for the birthday wishes!
Prevena wound vac came off today. So happy. Got a look at the incision and was surprised to see there were stitches instead of staples. I bet those have a bite when they come off. Is the meshed peeled off at the time of stitch removal?
This past Friday was a rough day. Started the morning with the decision to wash my hair. Which had to be done in the kitchen sink. By the time I washed that, got to the bathroom to dry it, and then to the bedroom to change clothes, and then back to the living room to get ready to leave for PT I was a mess. Lighted headed when I would stand up, shaky, clammy skin, and heavy panting. I definitely didn’t feel right. My thought was that my blood pressure is too low. I didn’t take any of my regular blood pressure meds while in the hospital and my BP was low. And I know pain meds will lower BP also. When I got home I resumed taking my usual meds, including blood pressure. Called my PCP and he said to stop taking the BP meds and make sure I’m drinking a lot of water. I see him on Tuesday for a post-hospitalization visit so I’m sure we’ll discuss this. Since I stop the BP meds it has helped tremendously

At physical therapy they checked my blood pressure several times, and all in the normal range. PT was very gentle and easy because I was just feeling off. I didn’t want to cancel the session because it does make my knee feel better when we do some extension and flexion And it would be a long break from Wednesday to Monday. So after the exercises it was time for the 20 min of icing and E-stim, which I usually like. Not this time. First minute into it I was getting this zings across to the shin. Painfully enough that I had the tech come in and place the electrode in another spot. And then I was getting zings across the knee. So I had her come back and lower the current. It just wasn’t a relaxing time.

Ever since then I have this pain in my shin or to the side of the shin (where the electrode was and singing across) that when I stand/walk I can’t put full weight on my leg without having pain or the feeling that it’s weak and going to buckle. It’s the weirdest sensation. May be coincidental. Also makes me wonder if the peroneal nerve wasn’t irritate by the stimulation or even damaged a bit during surgery, which I’ve read is common with TKA. so that’s a bit concerning to me the new pain with walking. And I’m always hyper aware of any pain in the medial spot by the tibia that started the need for a revision. And I’ve had some intermittent pain there. Which I’m guessing Is probably normal.

Overall, everything is going ok. It’s a tough journey. And this one feels harder than the original TKAs. And it’s been hard doing it alone. Granted, I do have friends that give me rides or are available if I need anything. It’s the little stuff. Getting the ice, making lunch etc…. My pain is finally managed because I went back to the 4 hr schedule. But wowzers if I go beyond that. Since the wound vac came off today it’s been constant burning under the new bandage. I’m guessing that will ease up with time. Lots of tears were shed this past week - my first full week. And today is my first tear free day. So for me that’s a good day. Still have no energy and no stamina. At all. yesterday took a walk out to the mailbox in the 90+ degree heat, trying to work on stamina. But with the leg pain, and no energy, that little walk wore me out. Every day I’m sure will get a tad bit better.
I remember those light-headed days. They were quite scary. Be sure you move extra slowly when feeling that way. You certainly don't want to fall or pass out. Your body is still trying to recover from the trauma of the surgery and needs lots of TLC. Take your time and get lots of rest. Don't worry about the last of energy and stamina. It will return. Here's how your body is reacting to your new knee's healing. Energy drain for TKRs
Evenings always the worst for discomfort. Mornings and afternoons relatively comfortable and you think this is going to be a great day until about 7pm and then you start squirming. Haha. Pain/achiness/discomfort is a funny thing. I think my body is starting to hate the recliner also. At least my back is.

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