TKR Here we go

[stedmakr]

I'm on the docket for a left leg TKR in a couple of hours. The protocol is one night in the hospital followed by home care. I had a right leg TKR 2 and a half years ago and it took a little over 6 weeks to return to work. As I get closer to the operation I'm recalling the problems I had with pain management and the early on difficulty with constipation.

We'll - here we go

 

[robhunt3]

You're previous RTKR makes you well prepared @stedmakr, and I would say it makes a huge positive difference knowing what to expect. Wishing you all the best for your left TKR!

 

[Hood1980]

Good luck [emoji256] today @stedmakr! See you on the other side! [emoji4]


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[Babushelen]

Sending prayers your way @stedmakr and best wishes for a speedy recovery. Keep us posted.

 

[MSgirl]

Knowing what to expect will be a tremendous help to you. Best of luck! Keep us posted.

 

[sistersinhim]

Good luck, @stedmak. I will leave you our recovery articles to help you through this. Can you please put your surgery dates in your signatures? This information helps us if we need to advise you. Here's a thread that on how to create a signature. Give a shout if you need help!

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. Here is a week-by-week guide for Activity progression for TKRs


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 a 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 history before providing advice.

 

[Teal23]

Wishing you a safe surgery and quick recovery!


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[Carpediem]

So how goes Day #2 @stedmakr? I also was given a shiny new LTKR yesterday in an Ambulatory Surgical Center where I was discharged in 21 hours! Phew the surgery is behind us now. We earned this rest after struggling with our decrepit knees for so long. Good outcomes will come to the patient ones. Small victories before big victories.
You got this!!

 

[stedmakr]

Well it's done. The operation went smoothly. I spent one night in the hospital returned home a couple of hours ago. Yesterday afternoon after the operation I was very pleased that I had good range of motion and only a little pain. Over time the pain increased and I didn't sleep well last night and was in pain. The doctor said my initial minimum pain period was a residual effect of the block in my lower back for the operation.

I'm not sure I fully understand the pain management equation. Multiple pills including tramadol, celebrix and tylinol. I am also taking Dulaudid as necessary (its necessary now) but its making me nauseous and I'm worried about constipation.

Tomorrow a physical therapist visits and we start that regime.

I'm really happy that I had the operation and am looking forward to a steady recovery and getting my life back!

 

[sistersinhim]

Remember to not let that PT push or pull your leg or knee in anyway. If it hurts, don't do it. If you do, it'll just delay your recovery. Right now, just worry about healing and keeping your swelling down. RICE!

 

[Carpediem]

Hi, just a thought re: effects of opiates/narcotics on the lower GI tract aka constipation. There are some excellent over the counter choices for effective relief eg Colace and Dulcolax. Also there are anti nausea prescription meds to counteract the nausea symptom, recommend you discuss with your PCP or OS. Sidebar...swelling increases a few days after surgery so do all the RICE you can to help reduce swelling and you'll have more success with managing your activities of daily living and doing the exercises whether on your own or with your PT. Harken the Bonesmart mantras (guidelines) and "don't overwork". Your goal is simple right now...be patient and kind to that new knee!

 

[stedmakr]

Today is the third day after surgery. I'm in a much better place than I was after TKR on my first knee a couple of years ago. My biggest challenge is constipation. To the extent that I can, I am trading Dulauden and Tramatol for prunes. My knee is swollen to the point that I can't stretch it (flexation) without help from someone else. One way to describe it is to say that my left leg is just there. If I lay down there normally isn't a lot of pain. When I need to get up and bend my knee there is significant pain.

A couple of thoughts on these first few days.
1) My wife has been fantastic. I literally can not do anything that requires me to bend. A good caregiver (in this case my wife) is the most important element during this stage of recovery.
2) I am spending a lot of time on my back in bed. It is important to have the recovery room all figured out and everything close to the bed.
3) I am a manager and didn't want to give up email and phone conversations from work. I've realized I can't stay tied into work (may in the future). I'm not thinking very well at all, at least not on the level that is necessary for work.

Thanks for the email above - I very much appreciate the insight and the links.

Left leg TKR on 13 February

 

[sistersinhim]

You will have the brain fog for about a month or more. At least I did! I teach an adult class Sunday School and on my 5th week out I tried my best to prepare for my lesson, but failed terribly. I got my backup to teach another week for me! The brain fog is really real. I think the body is concentrating so much on getting our knees healed, that all the energy, including brain energy is going there!

 

[Carpediem]

@stedmakr the mantra of RICE needs a 5th element N = nap...resistance is futile

 

[stedmakr]

I'm at the 8 day point and guess that I am doing alright. ROM greater then 90, but extension still needs work and I can't sit straight and lift my leg in a swing forward fashion. The PT says it will come in time. I have three questions:

1. How many hours a day do I elevate? I do so when I can and it doesn't hurt but is the expectation that elevation occur all the time and during sleep.

2. I've been increasing steps per day. I walk with crutches 5 to 7 minutes at at time. I use a fitbit and was up to 3600 steps per day. When I took off the bandage yesterday I noticed that my foot had three separate large areas that were black from blood that had pooled. I walk with crutches and didn't feel like I was pushing at all. Was I over doing it?

3. I am wearing a compression stock on my injured leg. Should I be wearing one on both legs?

Thanks,

Keith

 

[liam2015]

i hear you about the constipation. in my case, the only thing that helped was discontinuing all meds at 3 weeks post op, including meds for constipation and meds for the ensuing diarrhea. (this happened to me before after abdominal cancer surgery 11 years ago). couldn't find the right balance. i was miserable for the first 3 weeks and then another 2 weeks. i'm not recommending you do the same ~ if you need the pain meds and if the others help you, then do what is best for you. i found that eating a few pieces of black liquorice (little teddy bear forms, not the long sticks) every day helped with the constipation after i quit the narcotics.

your flexion of 90 after 8 days post op is excellent; wish i had that so soon. 3600 steps sounds like a lot. i don't know about the pooling of blood you noticed; i hope it's nothing serious but maybe someone else here with medical experience can advise you on that. as far as elevation with ice ~ i think you're supposed to do that for at least 40 minutes to an hour each time you are resting and if you feel comfortable enough to do so when you sleep. what kind of elevation device or pillows do you use? i found that the "lounge doctor" (a foam elevation device) was invaluable to me but there are other suitable home made devices. i used it up until a couple of weeks ago ~ kept me still and my legs comfy. i did not wear compression stockings.

continue to have a good recovery.

 

[SusieShoes]

How many hours a day do I elevate?

Elevate to your heart's desire. For early recovery, the more the better (though of course you need to get up and move around sometimes). Do you have to sleep with legs elevated? No. However... I did. Why? Because my knees wouldn't let me sleep any other way! On my back, legs elevated on my foam wedge. Only way I could sleep. Any other position and my knees would yelp or ache. Sleep being the important commodity that it is, sleep however you are able!

When I took off the bandage yesterday I noticed that my foot had three separate large areas that were black from blood that had pooled. I walk with crutches and didn't feel like I was pushing at all. Was I over doing it?

I had that too! Both legs (because both knees). I think I said my lower legs looked like a bison danced on them. Yep. Bruised black and blue. You will see a few other colors over the next week or so. The bruising goes away.

I am wearing a compression stock on my injured leg. Should I be wearing one on both legs?

Someone else will have to answer this one. I never wore them.

You're doing great so far! Extension often gets to straight slower than you get your flexion back. It can take months, so be patient with it. It will get there! Walking is a good extension exercise and you will be doing much more of that as your recovery progresses. You're already doing a lot --and if your knee gets swollen and painful, you can cut back a bit. There's plenty of time.

 

[Carpediem]

My surgery was the same day as yours. I wear TED stockings on both legs as requested by my OS. Elevating and icing as much as we can, the more the merrier these early weeks. I elevate on a soft pillow in bed when I'm sleeping, the sleeping part is a misnomer tho, not getting much of that yet. I use the lounge doctor occasionally during the day, it get's the leg a bit higher. The bruising is from blood pooling and will disappear in time. Your ROM is really good and extension will come in time. Moving your leg normally as in assisted walking is great to do. So much of this is about being patient. Glad that 1 week is behind us.

 

[Beckadeez]

Patience is definitely the key. Someone at my OS appt asked me if the recovery is rough. I told him the truth. And like SusieShoes, I didn’t wear compression stockings either. I woke up after surgery without one on my operated leg. Try to be patient and pace yourself. I don’t do any PT at home and am doing great, according to my OS.

 

[stedmakr]

I may have a problem. On Sunday I was sitting down and my operative knee may have been out of alignment with my foot and I felt something move adjacent to the knee followed by intense pain (10) on the outside side of my knee towards the bottom of the knee. The pain isn't related to the implant but probably a tendon or ligament. If its a ligament it would be the lateral collateral ligament. The pain subsided after a few seconds but the area stayed sore and swelled. When I move the pain returns if I make a misstep or slightly twist my knee. I elevated and put ice on it and this morning the swelling has subsided but I can't do my exercises without experiencing the same sharp pain.

The PT came today and he thought it was a tendon. He advised ice, elevation and rest.

Anyone have any experience with this type of pain/injury?

Thanks.
Keith