Metal Allergy Is Metal Allergy (solely) a reason to have a knee revision?

[DLR]

@Kathy0427 so glad to hear your update. You are doing great, wow 100 degree flexion. You seem to be having more active pt than I do. My pt visited Saturday a couple hours after I arrived home from hospital. She reviewed the bed exercises and asked me to do them 4 times a day and she is coming back a week Thursday. I am also struggling with the sleep thing and the Pain pills constipation. I am on Tylenol3 for pain

 

[momweb]

@Kathy0427 my surgery was a couple days before yours. I'm also on Oxycodone 5mg with the instructions 1-2 for pain every 4 hours. During the day, I find I can make it with just the 5mg every 4 hours. If I wait longer than the 4 hours, the pain is overwhelming and I find myself trying to catch up to relieve the pain. So, I've learned this week to take the 5mg every 4 hours no matter what. Night is a different story. I take the 10 mg beginning at 10pm and every 4 hours throughout the night. It lasts only 3 hours and I find myself counting the minutes to the time when I can take another 10mg. I'm not afraid of addiction since the pain is so real. I have to call the OS for a refill on Wednesday, so we'll see what happens then.

As for PT I'm very lucky. My home PT is great! She pushes me which I need but not to the point of no return. If it appears that I can't do anymore we stop. As a result after working out today I then went for a walk with my husband. She believes that it does more harm than good to make you work to the point of increased pain. For that I am thankful. Hopefully your PT will understand your needs and I wish you well.

I'm anxious to follow and see how you are doing.
Sue

 

[Mutti3]

@Kathy0427
It is truly like childbirth. I found some FB text to family and friends during the initial week discussing my pain, that now I can’t recall. I can walk with no pain, and don’t even think of my knee.

 

[Josephine]

So, I've learned this week to take the 5mg every 4 hours no matter what. Night is a different story. I take the 10 mg beginning at 10pm and every 4 hours throughout the night.

@momweb you are a very wise lady! However, does your oxycodone have acetaminophen in it? If it does, I assume it's 325mg in which case you could add another one or even two regular Tylenol to a few doses, just so long as you don't exceed the 4,000mg per 24hrs.



@Kathy0427 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?

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.

 

[momweb]

Thank you @Josephine. The OS ordered 325mg Tylenol three times a day for 9 doses along with the Oxycodone. Now that the 9 doses are done, I stopped the Tylenol. However, last night I did add 650 mg at bedtime. It didn't make the pain meds last any longer like I had hoped. I'm trying to last the 4 hours. It doesn't always work.

 

[Josephine]

The OS ordered 325mg Tylenol three times a day for 9 doses along with the Oxycodone. Now that the 9 doses are done, I stopped the Tylenol. However, last night I did add 650 mg at bedtime. It didn't make the pain meds last any longer like I had hoped.

He may have prescribed that but since Tylenol is a non-prescription medication, why stop? I suggest you get some regular Tylenol and take additional ones up to a maximum of 4,000mg per 24hrs.

What people often forget - or don't even know - is that these drugs are only effective in the system for about 4-5 hours so you need to keep taking them as long as the pain persists else you will get the impression they are doing nothing when the real truth is that you're not giving them a chance to work.

 

[Kathy0427]

@Josephine
1. Pain level varies...Would say 5-7

2. Oxycodone: taking 3x5 mg. Per day. Told to take any variety Tylenol; as long as I stay under 4000 mg in total daily. I take the limit per day.
celecoxib 200 mg daily - I take one capsule in morning. I also take Lisinipril/ hydrochlorthiazide 20/5 mg

3. I’d say I am between “ huge” and “ moderate”.

4. ROM : 100; extension: -10

5. Icing knee 3-4times per day , 20 minutes to an hour each icing.

6. Elevate knee always when not in CPM machine; would say 10-12 hours per day.
use CPM 6 hours per day.

7. Walking around kitchen to living area 4 times daily; about 20 minutes total. Husband doing all cooking and housekeeping

8. Home PT coming 3 times per week.
I do two sessions PT exercises per day..
Toe raises (15x2)30 per day,
Gluteal stretches,
Heel slides: (5x2 or 10) per day,
Mini squats (10x2) or 20 per day
Marching (15x2) or 30 per day
Adductor kick to side standing (15x2)
Foot lifts : (15x 2) or30 per day
kicks to side (15x2) or 30 per day
Barely can lift my leg an inch to do even one unassisted leg lift
Pressing knee into bed (15x2) or 30 per day



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[kneeper]

When I tearfully explained my pain; my therapist today - who was fairly benign to that point - said, “ don’t you think some of your emotionality might be due to the oxycodone you are taking, 10 mg is a fairly large dose...” I knew where that was headed.

Possibly....but more likely the intense pressure the previous PT was putting on you, not to mention major surgery not very long ago...

And, no, I am not yet ready to taper. At that point I just thought “Kathy, she doesn’t know you. Just make the most of your time with her.” I did , relaxed, and achieved 100 degree flexion. and I am convinced I could not have done that without some strong pain reliever in my system at this point in my recovery.

 

[Josephine]

1. Pain level varies...Would say 5-7

Well, you're one week out so this is a difficult time for you.

2. Oxycodone: taking 3x5 mg. Per day.
Told to take any variety Tylenol; as long as I stay under 4000 mg in total daily. I take the limit per day.
Celecoxib 200 mg daily - I take one capsule in morning.

Why are you only take one dose of oxycodone per day? You need to take it as prescribed which is usually about every 4hrs.
Don't forget to subtract the amount of acetaminophen in the oxy every day.
Celecoxib (Celebrex) is an NSAID as I am sure you know. There are some things about it that you might not know and ought to:

- NSAIDs are very poor pain meds
- they might reduce swelling but rarely to type of swelling you have at the moment which is trauma induced
- NSAIDs have side effects
Medications: acetaminophen (Tylenol, paracetamol) and NSAIDs, differences and dangers
NSAIDs Diclofenac. ibuprofen increase risk of heart problems: new study​

3. I’d say I am between “ huge” and “ moderate”.

Not good but to be extpected

4. ROM : 100; extension: -10

Hey that's pretty darned good for one week out!

5. Icing knee 3-4times per day , 20 minutes to an hour each icing.

You accomplish little or nothing in 20 minutes. Ice for at least 40-60mins and more than 4 times a day.

6. Elevate knee always when not in CPM machine; would say 10-12 hours per day. Use CPM 6 hours per day.

But are you elevating it properly? Look here Elevation: the do's and dont's

7. Walking around kitchen to living area 4 times daily; about 20 minutes total. Husband doing all cooking and housekeeping

Don't make a rule of this - just walk when you need to go to the bathroom or get yourself a snack. That's quite sufficient.


Home PT coming 3 times per week.

I do two sessions PT exercises per day - I suggest you do one per day and none are all at the weekends
Toe raises (15x2)30 per day - I expect you mean ankle pumps. You are doing too much - do 5-10 every so often during the day
Gluteal stretches - too early to do these
Heel slides: (5x2 or 10) per day - this is too much. You need to read this Heel slides and how to do them properly.
Mini squats (10x2) or 20 per day - certainly don't do these! It's far too early!
Foot lifts : (15x 2) or30 per day - don't do these either
kicks to side (15x2) or 30 per day - or these
Barely can lift my leg an inch to do even one unassisted leg lift - then don't even try!
Pressing knee into bed (15x2) or 30 per day - don't do these, they will not be productive at this early stage
Adductor kick to side standing (15x2) - these are more suited to a hip. Don't do them
Marching (15x2) or 30 per day - same here

These exercises are the reason you have so much pain and swelling. Many surgeons now say no PT/exercises for the first three weeks. This is sensible because the knee is in an acute state of inflammation and the very last thing it needs is all this work!

As a matter of fact, there are lots of us on this forum who never did any exercises/PT as all and yet had excellent outcomes. I know doctors and PTs have this thing that you MUST work hard and MUST endure pain in order to get a good outcome but we all are living proof that this is untrue.

I recommend you read my recovery thread to see how little exercising I did for either knee! Knee recoveries UK style Parts I & II (Josephine)

 

[Kathy0427]

hi, @DLR .
Just read your last few posts and I wanted to tell you I am in about the same place as you in terms of pain. My last two days have been slightly better, but I can honestly say - that as I recuperated from THR in 2017- I seemed to feel better (in terms of pain) by much larger increments each day, than I am currently with this RTKR. I think I am a day before you..I am at day 11 post surgery today.

Nights are the worst for me, as the inside of the knee just aches like a toothache - even with the prescribed Tramadol and Tylenol and icing and elevation - and I just keep thinking “please STOP THROBBING”. Several times -since I am sleeping on a recliner downstairs- I just get up and walk around in circles in my kitchen at 4 am! I tire myself out and usually - with a fresh dose of Tylenol and Tramadol - finally fall asleep for 3 hours.

Blessed sleep! I feel like I will never sleep a normal seven hours again!

My husband has been so supportive as the pain medicines and lack of sleep has made me very emotional ; he has put up with a lot of tears so far.

But I have gotten so much encouragement, support and faith in my ultimate recovery from all the wonderful recovery threads, that I believe my expectations for quick recovery are now more realistic. That, in turn, has made me less fearful as I work through the pain in these early days.

I would encourage you by saying throughout many threads comes that picture that everyone’s recovery is individual. It seems like patience is our most important companion as we work through things.

The postings have given me courage, as I am sure they have you, to own the pace of my own recovery and take ownership of my tender “baby” knee and all that I LET happen to it (in terms of PT).

One thing I really liked that I read yesterday was the advice to keep our eyes on the prize and visualize a better future and keep reassuring ourselves that things will get better. The good old power of positive thought!

So much of this does seem to be dependent on our frame of mind! I just was NOT prepared for both the intensity and the “no escape” nature of this early pain, as my hip replacement was SO much easier!

Anyway, as I said earlier, my pain has seemed to blessedly lessen- albeit very slowly- and now nights are only the worst in terms of constant medium level pain. Have faith! I do believe we are both “ on course” and we must be patient with the pace of our recoveries, even if they do not seem to be on our pre envisioned schedules. ( speaking to myself there- not you .

Keep in touch . I know we are in the right place for REALISTIC support.

 

[Celle]

Hi @Kathy0427
You'll notice that I have merged your newest thread with your original recovery thread.
For several reasons, we prefer that you only have one recovery thread:

• That way, we have all your information in one place. This makes it easier to go back and review your history before providing advice.
• If you keep starting new threads, you miss the posts and advice others have left for you in the old threads, and some information may be unnecessarily repeated
• Having only one thread will act as a diary of your progress that you can look back on.

So please post any updates, questions or concerns about your recovery here.
Don't worry that we won't see your question because, between us, the staff read all new posts every day.
If you need an urgent response to a question, just tag a member of staff.
How to tag another member; how to answer when someone tags you

If you prefer a different thread title, just post what you want and we'll get it changed for you.

Here are the instructions on finding your thread, How can I find my threads and posts? . Many members bookmark their thread, so they can find it when they log on.

 

[Kathy0427]

Hi @Celle, I am sorry about the wayward posting. I have only my iPad and iPhone available to me. On the iPad- which I am using now, I am permitted to “Reply” while within a thread. On the iPhone, I cannot see any “ Reply” option while in someone’s recovery thread and the only capability I appear to have is to create a new thread . The instructions provided for use appear to be for use within the Internet , and many of these instructions simply do not appear to be available when not accessing the internet version via your PC.
In order to adhere to the posting instructions, therefore , I will not use BoneSmart on my iPhone and use it strictly on my iPad . Hopefully, I will post replies in the right thread going forward. I appreciate your instructions.


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[Kathy0427]

Am going to say that today the lack of sleep and pain at night is really getting me down. It seems like any decrease in pain is short lived. I ha ve my own private reasons for trying to limit my narcotic pain relief usage; ( I am taking 50mg Tramadol morning and night and Tylenol around clock up to max dose) and I know under BoneSmart I am not abiding by the rule to take narcotic pain relief by the clock- but I am also very surprised and depressed by the constant pain I feel under my regimen. When my hip was replaced I don’t recall at all this constant pain and lack of sleep.
Anyway, please trust that I have valid reasons for being afraid to take narcotic pain relief around the clock and what I am trying to understand is are there some alternative therapies available to lessen my pain. I have a CPM machine I am currently using around 3 hours per day ; can I use it more often? Should I be using it less often? In multiple , quicker periods? Is a TENS machine worth purchasing?
Lastly, I am getting almost no relief from icing and elevating (and I do follow the BoneSmart guidelines for each activity). Does anyone have success with warmth causing pain relief? Thanks for any advice. I know it’s early but I feel so worn down by pain and not sleeping ; I am depressed and definitely in the “ why did I do this to myself” phase.


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[DLR]

@Kathy0427 it is quite different than the hip. I found that with my hip the narcotic pain pills gave relief but not with my knee. I also found nights harder, not being able to be in bed. With the hip that wasn’t an issue, pain came getting in and out but not just laying there. That’s what was driving me nuts and you too the night time knee pain. The OS here don’t use CPM anymore. What if you would give yourself a day off the CPM and exercise, everything but ice, elevate, walking as needed for bathroom and kitchen just to see if you could bring the swelling and pain level down and break that cycle. It’s what I finally did Saturday because I was so sore and sleep deprived. I vegged watched some Netflix movies, napped...it seemed to help as Sundayand today are more manageable. Just a thought...thinking of you and rooting for you, we will make it to the good times

 

[Kathy0427]

@DLR thanks for the quick reply.
I know there appears to be a wide variation of beliefs about these CPM machines. My brother had a knee replacement last year with the same OS group in Pittsburgh that I am using, and he is the one who told me to use the CPM a lot and at fairly high degree rotation for ROM. I am using it at 110 degrees right now for about 3 hours per day split into 2-3 sessions. I am not sure if this is too high or I might be using it for too long at one “ go”.
PT is coming in an hour, I am going to see what she has to say.
In general, this surgical practice in Pittsburgh that I am using have a reputation of good results and fairly quick recuperation. I am learning the hard way that their aggressive expectations may not be suitable for this lady’s baby knee. I am also frustrated - and feel I would be more receptive to their methods if I just felt a tiny bit better. I was so spoiled by my hip replacement being relatively painless.
Anyway, I am so glad to hear things have calmed down for you by Sunday in terms of pain. Having at least a few hours of pain free sleep sure helps!
What has been expected of you in terms of PT to date?
Any pressure on you yet to use a cane instead of a walker? I still feel too unsure of my new knee to attempt the cane yet.
Once the therapist goes, I feel so beat today I surely am going to follow your suggestion and veg a bit.
It’s really nice to have someone to talk to who is going through this at the same time!
Take care! Kathy


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[DLR]

@Kathy0427 my PT has been here twice, she checks my exercise and ROM and gives me new ones then leaves 15 min visit.
My exercises are 3 to 4 times a day
10 ankle pumps
10 press knee down to straight hold to count of 5
10 heel slides hold to count of 5
10 leg raise (leg on bolster) hold to count of 5
5 min let ankle rest on bolster
This week she added
10 straight leg (when able hold to count of 5)
10 push leg back under chair with good leg
10 seated leg raise
My ROM extension is almost to 0, flexion is 90 with heel slides

I am using one crutch around the house. She said I could use a cane but at this point I feel more secure with the crutch.
Right now I have come to a point where I am happy to do my exercises to the point of discomfort and as long as any pain resolves within about an hour it’s good, if it continues longer than that or if I am in intense pain doing a certain movement I gear back. Just trying to walk the balance of effort and comfort for healing.
I agree so nice to walk through this together, hope you get a good rest later
Diane

 

[Jockette]

Am going to say that today the lack of sleep and pain at night is really getting me down.

Have you cut back your exercises like Josephine said? It really will help lessen the pain if you stop doing what causes the pain.

Also keep in mind, it’s not exercising that gets our range of motion back, it’s Time:

Time to recover.
Time for pain and swelling to settle,
and 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. Exercise as in strength training is counter-productive and in the early weeks does more harm than good. Normal activity is the key to success.

 

[Larryhg3]

I have to say that you are doing too much way too soon. While I respect your reasons for avoiding narcotic pain medications (whatever they may be) at this stage they are absolutely necessary. I was told to not consider cutting back on pain management for two weeks minimum, and I too have reasons for avoiding them. Ultimately I took them for @ 6 weeks before cutting them almost completely out.
All that being said pain is cumulative, meaning that everything you do during the day seems like it peaks when you try to go to bed. The best thing you can do at this stage is absolutely nothing. Stay in bed with leg elevated no exercises no CPM nothing. Give everything a chance to calm down. This is a very long process, there is plenty of time to worry about ROM ( which is what the CPM is for) but until you give that knee time to heal it will continue to complain. This community is here for you, we have all been where you are right now. Good luck

 

[Kathy0427]

Hi, @Larryhg3 and @Jockette
Thank you for the caring responses.

I have determined today I am going to cut back quite a bit on both the CPM and the aggressive exercises. The book of exercises I was sent home with includes thirty reps of twenty different exercises; can you believe it? I was actually doing all of those prior to surgery and my quads ached even BEFORE surgery! Some days it took me nearly two hours to complete them all.

Oh, and I love the pic of your dogs, @Larryhg3

After my therapist visited today, I have cut quite a way back on the super aggressive exercises. The one coming to the house - thank goodness- is much less aggressive than the god-awful PT team at the hospital. This PT never pushes past the point of pain. She believes my ROM is good (100-110), despite a fair amount of stiffness, and feels it will improve further with more quality rest (yes, a PT actually said that!)

I told her I had cut back substantially on the prescribed exercises by Sunday due to ongoing pain at night and she said that “whatever I did, just try doing that for the next week “ as my ROM had improved between Friday and today. Although I do like her, I swear all PTs are rewarded for ROM increases in their patients.

All in all, I am starting to gain a feel for how far I can push my daily walks around the house and exercises without making things worse. It does take time to gain that knowledge, as I know from my hip replacement it takes me awhile to figure out that magic combination of exercise, rest, meds, icing and elevation to help keep my progress steady.

And we all know - that even as I think I gain that knowledge - in the end, I might not be able to affect the outcome at all if the surgeons work was not ideal.

Talks with all on BoneSmart have encouraged me in calling my own shots on exercises and what I should and shouldn’t do. That’s helped a LOT!

I am taking Tramadol (50mg) twice daily with Tylenol Arthritis Strength three times daily- that is every 8 hours - so pain relief med is almost by the clock. I will be at two weeks out on Monday , so I am so hoping this pain subsides soon with slightly less narcotic pain relief than normal.

My reason for not wanting to take narcotic meds is private and I just don’t feel free to discuss here so, I guess I wanted to find maybe an alternative method to alleviate some of the pain. Thus, my questions about use of CPM machine or TENS machines as a means of pain relief. I was just told the CPM would be delivered to the house and that I could use it up to 6 hours per day. No other directions were provided.

My pain seems to decrease quite substantially with the generic Celebrex I have been prescribed. Actually seems to help my pain during day better than either the oxycodone I was prescribed (it did nothing ) or the Tramadol I am still taking. I have been told by my OS PA that I can take a second Celebrex at night (200 mg) but that seems a lot.

I am supposed to not take NSAIDS in general - OS made an exception for Celebrex- because I had DVT two years ago and am on Eliquis (blood thinner) for life. Does anyone out there take a second Celebrex at night?

Elevation does just not seem to alleviate my knee pain and icing, also, it seems sometimes actually make the pain more throbbing, if that’s possible. But, I will keep trying in the hope I eventually get relief from this activity. I do follow all the instructions for pillow stacking and the “good” positions.

And, lastly, @Jockette, I agree with your wise words cautioning about strength training.

I read your entire thread and I must say, my heart is with you. I am not sure how I would have dealt with all you have gone through . Your bravery is remarkable and you are always there to provide us currently the benefit of the lessons you have learned in your journey. I look forward to continue reading your updates and wish you all the best. I know I will certainly value any opinions you provide me as you have been through so much. I certainly don’t blame you at all for any fear about pursuing more surgery or even any additional procedure after what you have been through. If anyone deserves a happy ending to her saga, it is you.

Thanks to all of you for your suggestions!
Kathy

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[Jockette]

Thank you for your kind words.

I still struggle quite a bit at times, more mentally than physically. So many have had their knee replacements after me and are doing so well while I am “left behind” in recovery.

It breaks my heart to read PT experiences like yours, especially your hospital PT experience. There truly is no need to do all those exercises. Especially since not all surgeons prescribe PT. So how important can it be? Yes, we need to move the knee, but not at the rate most of us are told to do.

No PT for me if there’s a next time. I will recover just fine without it, and most likely better.