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[BILATERAL TKR] Hot knees - 2 month update

Discussion in 'Knee Replacement Recovery Area' started by Alloyssius, Mar 30, 2019.

  1. Alloyssius

    Alloyssius junior member
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    Recovery I though was gong well, 10 days after and at 114/-3 in the right knee while left is 10/-2
    ROM seems very good but muscle spasms, cramps etc are horrific. Any ideas would be helpful and appreciated.
    Richard


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  2. Jockette

    Jockette FORUM ADVISOR Forum Advisor

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    Welcome to Recovery!

    I am going to tag @Josephine
    our forum administrator and nurse director to address your concerns.

    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.

    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
    5. At week 4 and after you should follow this
    6. Access to these pages on the website

    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.
     
  3. Alloyssius

    Alloyssius junior member
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    Thanks, can you delete the duplicate post? Didn’t see the original had posted.
    Thanks


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    Last edited by a moderator: Mar 30, 2019
  4. Jockette

    Jockette FORUM ADVISOR Forum Advisor

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    @Alloyssius
    This is your Recovery Thread, please keep all your questions and updates here.

    Sure, I will have a moderator delete that duplicate thread for you. You’ll get the hang of this forum.
     
  5. Alloyssius

    Alloyssius junior member
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    Taking flexeril, Tylenol, OxyContin and eating pounds of bananas. Purchased TheraWorx and yet to see if it’s working.
    Thanks for any advice


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  6. Jajakio

    Jajakio graduate

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    I had no cramps after surgery but before surgery they got bad at times. I think it may have been a reaction to steriods for me. Potassium and magnesium helped mine but it depends a good deal what's causing the cramps. Stretches, heat (on mid thigh or midleg where cramps are)or changing position frequently sometimes helped me too. After surgery, once the bandages were off I would sit on my shower bench and let warm or hot water run over the whole leg too.
     
  7. Lilli215

    Lilli215 senior

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    Are you taking on enough fluids, dehydration can also cause cramps
     
  8. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    I'd really like to offer you some structured advice but in order to do that, I also need to ask you some questions. Are you willing for me to do that?
     
  9. Alloyssius

    Alloyssius junior member
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    Absolutely, I’m using heat now on quad but trying to keep swelling down. Surgery 3/20
    Ask away


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  10. Alloyssius

    Alloyssius junior member
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    Thanks and am drinking at least 64 oz of bottled water a day in addition to occasional LaCroix and a coffee in the morning. Good suggestion and maybe I’ll ramp that up a bit


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  11. skigirl

    skigirl FORUM ADVISOR Forum Advisor

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    I did not have cramps after my surgery, but have them now when I overdo and, I think, drink less water. Skiing all day makes the cramps appear and I think some of it is the altitude and not enough water.
     
  12. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    Here y'go then!

    It would be very helpful if you would answer each one individually - numbered as I have done - in as much detail as you can then I'll come back as see where you are ....

    1. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine. And don't forget to factor in other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness).

    2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?

    3. how swollen is your leg compared to these?
    ai63.tinypic.com_eta39s.jpg

    4. what is your ROM - that's flexion (bend) and extension (straightness)

    5. are you icing your knee at all? If so, how often and for how long?

    6. are you elevating your leg. If so how often and for how long?

    7. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and

    8. are you doing any exercises at home? If so what and how often?
    This is the most crucial question so please help me by using the format I have left as an example
    (which means please make a list and not an essay!)

    Exercises done at home
    - how many sessions you do each day
    - enter exercise by name then number of repetitions of each
    etc., etc.

    Anything done at PT
    - how many times a week
    - enter exercise by name then number of repetitions of each
    etc., etc.
     
  13. Alloyssius

    Alloyssius junior member
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    Thanks I amping up my water. Dock prescribed a muscle relaxant and will see how that goes. He said and I agree a bilateral TKR for a 6’5” 250 guy is tough rehab.
    So for now increased water intake and am lessening rehab for right leg. It’s at 0 and 113 after 11 days. Maybe pushing too hard

    Taking muscle relaxant and lots of ice and elevation. Using heat where tourniquet was applied near groin

    Thanks for your help


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  14. Alloyssius

    Alloyssius junior member
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    1. Pain when icing and elevation 4. When movement, rehab 7-10. 10’being he cramping ham

    2. Just prescribed and have taken first dose 5mg Diazepam 4 x day
    OxyContin fast acting no more than 1 every 4 hours but using mostly at night
    2 x 50mg tramadol in morning
    1000mg Tylenol 4 x day

    3. Swelling Moderate

    4. Left knee 110/0 Right knee 114/-2

    5. Icing 30’minutes on and 30 off
    6. Elevating during icing but not every icing as cramping occurs

    7. I’ve a wonderful caregiver (wife) and only focus is rehab and getting healed

    8. Exercises usually 3 x per day but taking it easy now with right knee (1-2x per day)

    Leg left 1 set 10x
    Ankle pump 1 set 10x
    Heel slides in bed 1 set 10x
    Heel slides from chair with paper towel under foot 1 set 10x 5’second hold
    Quad scrunch 1 set 10x 5 Second hold
    Butt scrunch same as above
    Left lift from chair 1 set 10x 5 second hold

    Let me know if this makes sense

    And thanks very much


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  15. Knitmama

    Knitmama new member

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    Rehab for both knees is no joke. I did surgeries one week apart. At seven and six weeks, cramping has gone away and movement is much better. When I did have issues with my legs, hip or back I found that changing positions frequently helped. Changing chairs, elevating or taking elevation away, even doing heel pumps was enough movement at times to make a difference. There is a wealth of information in the forums. Hope it helps and your recovery is successful!
     
  16. Alloyssius

    Alloyssius junior member
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    Knitmama
    Your advice makes sense as I’ve had some relief from changing positions. Heel pumps.
    It’s hard to get sleep changing positions every 15 minutes.
    I Notice I can get a comfortable position even on my side with a pillow properly situated between knees. Almost blissful (when compared to not doing) and I drift off only to be awakened with excruciating cramp in my hamstring.

    So much so that last night my heel was curling upwards toward my rear far beyond the range achieved during PT. Pain was unreal.

    Sometimes I now catch the beginnings and if I move slowly but steadily can avoid the worst.

    Probably doesn’t help that I’m 6’5” 250


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  17. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    Moderate swelling, being a form of pain, will add 4 points to your pain score.Making it 8 or 12!
    Diazepam is not a painkiller! It's just a sedative and an extremely addictive on at that!
    Tylenol is good but you could do with taking MORE Tramadol. I suggest you take a 50mg with each dose of
    Tylenol. You must ge4t that pain under control.
    That's very good for 2 weeks out! I am astonished!
    You accomplish little or nothing in 30 minutes. Ice for at least 40-60mins and more than 4 times a day.
    You lucky man, you!

    Exercises usually 3 x per day but taking it easy now with right knee (1-2x per day) - I suggest once a day and none at all at the weekend!
    Leg left 1 set 10x - what are these, please?
    Ankle pump 1 set 10x - you don't need to do these now. They are really for the first few days
    Heel slides in bed 1 set 10x - you don't need to do these either - your ROM is excellent
    Heel slides from chair with paper towel under foot 1 set 10x 5’second hold - or these
    Quad scrunch 1 set 10x 5 Second hold - or these
    Butt scrunch same as above - or these
    Left lift from chair 1 set 10x 5 second hold - or these

    In summary
    1. adjust your pain meds
    2. adjust your icing/elevating times
    3. Note the recommendations for your exercises - i.e., stop them!

    If you are concerned about refusing to do therapy, you need to read this Saying no to therapy - am I allowed to?
     
  18. Alloyssius

    Alloyssius junior member
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    Thanks and no concerns at all about saying no!
    Played a lot of basketball in college and Europe.
    Second biggest lie coaches tell you is: “Play through the pain’”. He biggest lie! .........
    I don’t know the biggest lie but playing through the pain is definitely the second biggest!

    Will consider the recommendations and agree diazepam or Valium is not a pain relief. Already limiting

    Also will cut back on some of the exercises, may have been overdoing.

    I cut out ALL salt to minimize swelling and was drinking only water, changed to Gatorade with potassium and sodium. Hopefully that helps as well.

    And still eating bananas for days!!

    Thanks again for your time and help

    Richard


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  19. Alloyssius

    Alloyssius junior member
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    Last therapy for home completed, stairs and getting into car as next week therapy is outpatient.

    Last ROM

    Left knee 0 and 115

    Right stiffened a little -1 and 120

    Like you I’m pleasantly surprised with range of motion.

    They used a DJO Empowr 3D Dual Pivot Knee and a new type of dressing just approved by FDA

    IMG_9656.jpg 57497008534__ABDDA296-4CA8-434D-A2BE-B1C294696A43.jpg


    The brochure is for the older one this one wraps around he knee and had a negative pressure pulling the wound together and supposedly increasing healing. Other than carrying around he pumps for the dressing it really seems to have worked


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  20. Roy Gardiner

    Roy Gardiner FORUM ADVISOR Forum Advisor

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    It's not really possible to underdo exercise, it's very easy to overdo it. See the guidelines, don't do stuff that hurts. You hurt yourself it training, sure, but not in recovery, which is what this is.

    You cannot do training until healing is complete because it worsens damage to the ligaments and tendons that were affected by surgery. You can easily tell if this is happening because your knee will get stiff, will hurt, will swell up in the 24 hours afterwards. When this happens, stop.

    Here is a longer explanation of the training/healing differences (although as an athlete I'm sure you know this; it just brings it home) https://bonesmart.org/forum/threads/post-operative-exercise-–-the-bonesmart-view.25463/
     

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