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TKR Its been worse than childbirth! Did I make the right decision?

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kneegone

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It's been a little over 3 weeks since my TKR at the HSS in New York, and the last two weeks has been debilitating, depressing, bleak, with very little ROM, and slight unnoticeable improvements. I felt drugged out and nauseous, throwing up etc. My meds included Hydromorphone, Celebrex, Xarelto, Gabopentin, Pantoprazole, Colace, Senokot, Tylenol, and a compounded Pain cream. Last week, I stopped Celebrex, Pantoprazole, Xarelto, Gabopentin on my own, cause I couldn't take being nauseous anymore. I've lost 6 pounds. I informed the surgeon's nurse and she said it was fine, but now after reading some of the other forums, I'm thinking I should go back on the Celebrex because my knee is still swollen and restricting improvements in my ROM. Anyway, its hard not to be discouraged, because it seems many others are improving so much faster. I have P/T at home 3x week, but the schedule is sometimes twice in a row and skips two days. I haven't had a CPM at home, nor any electrical stimuli, just me icing as much as I can. If I had known how dependent I would be on ice, I would've looked into an icing machine, although my insurance doesn't cover it.

I think I didn't fully realize the long painful path this TKR would require. I was basically able to get around with my malformed valgus knee for several hours, before it would swell up and limit my mobility. I got accustomed to the pain, so I thought I would be able to tolerate TKR pain, but this unending pain is almost unbearable, although I am trying to cut down on my Hydromorphone intake. I put this off for many years, and I think for my other knee, you're gonna have to drag me into that operating room!

Sorry for the rant, but I don't know of anyone who can relate! Praying for normalcy soon.
 

Celle

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Hi @kneegone :welome: to BoneSmart! I'm glad you found us.
I'm sorry you are having so much trouble. Hang in there, because it will get better, I promise you!
However, you had a major operation and it does take a long time to recover - often months, rather than weeks.

You're doing the right thing when you ice your knee, because we recommend lots of Rest, Ice, Elevation and regular medication.

Here's some reading for you. Please don't be overwhelmed by the list - most of the articles are short, but they are informative.

First are the BoneSmart mantras ....
- rest, elevate, ice and take your pain meds by the clock
- if it hurts, don't do it and don't allow anyone - especially a physiotherapist - to do it to you
- if your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again
- if you won't die if it's not done, don't do it
- never stand when you can sit, never sit when you can lie down, never stay awake when you can go to sleep!
- be active as much as you need to be but not more than is necessary, meaning so much that you end up being in pain, exhausted or desperate to sit down or lay down!

Next is a FAQ (Frequently Asked Questions) thread.

And here are some very crucial articles
The importance of managing pain after a TKR and the pain chart
Myth busting: no pain, no gain
Swollen and stiff knee: what causes it?
Activity progression for TKRs

Healing: how long does it take?
Chart representation of TKR recovery
Energy drain for TKRs
Elevation is the key
Ice to control pain and swelling

Home physio (PT) and activity progress: suggestions
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds
Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

And then some wise words from members who have shared their experiences ...
Where are you in recovery?? (TKR)
Five “P’s” of knee recovery
TKR: work “smarter” and not “harder”
Recovering a knee - from one who knows!
It's never too late to get more ROM!
It's worth the wait for ROM
 

Jamie

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Welcome to the forum. I'm so sorry you are having such a miserable time these first few weeks of recovery. It happens that way sometimes, but I can assure you it will get better!

First, let's address the main problem - pain and swelling. You get those two under control and everything else will follow. Since you are in pain, please do NOT cut down on your pain medications. You should be take the maximum dosage on a set schedule. Please tell me what your prescription says....dosage and pill strength. I'm betting it's "1-2 pills every 4-6 hours as needed for pain." In that case, you should be taking 2 pills every 4 hours until things settle down. Then maybe you could drop them back, but not until you have several days with little to no pain.

The pain you're in is contributing to your swelling. So is the level of activity you're doing. Try cutting back your therapy to 2 days a week. On the days you don't have therapy, only do gentle bends and stretches throughout the day. If you have an exercise bike, you could rock back and forth on the pedals for a couple of minutes twice a day. You will get enough activity if you get up and walk around every couple of hours. Then ice and elevate as much as you can the rest of the time.

Are you doing anything around the house? Laundry? Dishes? Cooking? Errands? If so, stop all of that unless it is mandatory for your health or safety. Assign someone else in the household those chores, ask a friend or relative, or just let the task go for a while. It won't matter and your knee will thank you for it.

Now for the articles:

First are the BoneSmart mantras ....

- rest, elevate, ice and take your pain meds by the clock
- if it hurts, don't do it and don't allow anyone - especially a physiotherapist - to do it to you
- if your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again
- if you won't die if it's not done, don't do it
- never stand when you can sit, never sit when you can lie down, never stay awake when you can go to sleep!
- be active as much as you need to be but not more than is necessary, meaning so much that you end up being in pain, exhausted or desperate to sit down or lay down!

Next is a FAQ (Frequently Asked Questions) thread.

And here are some very crucial articles

The importance of managing pain after a TKR and the pain chart
Myth busting: no pain, no gain
Swollen and stiff knee: what causes it?
Activity progression for TKRs

Healing: how long does it take?
Chart representation of TKR recovery
Energy drain for TKRs
Elevation is the key
Ice to control pain and swelling

Home physio (PT) and activity progress: suggestions
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds
Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

And finally some wise words from members who have shared their experiences ...
Where are you in recovery?? (TKR)
Five “P’s” of knee recovery
TKR: work “smarter” and not “harder”
Recovering a knee - from one who knows!
It's never too late to get more ROM!
It's worth the wait for ROM
 

Pumpkln

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but this unending pain is almost unbearable, although I am trying to cut down on my Hydromorphone intake.
You are trying to cut down way to soon, you are in the very early days of healing and need your pain medications.
Here is a link to the importance of pain control during the early days of recovery.
Pain management and the pain chart

It is hard when you see everyone getting better at lightening speeds (BTW, they are exaggerating). The first month is the worst, it will get better.
Be sure to read all the articles Celle has left for you they are important and will answer most of your questions.

Others will be along soon who are early in recovery and facing problems similar to yours.
Keep us posted on how you are doing,
 

Shmi47

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Hi. I'm so sorry for your pain. I totally get where you are because after my btkr I wanted to dye because of the pain. I didn't realize that I didn't have my pain managed as well as it should have been. You need to work with your surgeon and find the best regimen that works for you. You should not be in pain- your mind and body depend on this medications to get you better. Believe me the meds are a thorn in my side too.
Do you have a support network? Any friends around to help you with anything you need. If I didn't have btkr (which all the dr's told me not to do) I wouldn't have gone back for the second one. However, all knees are different and you may not have any pain at all in your other knee.
Work the mantras for sure and heed @Jamie's advice. You will get through this. Just takes a lot of time. Hang in there.


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kneegone

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Wow, thank you all for your lightning fast replies! I really appreciate it! Jamie, I was taking 3 tablets, 2 mg each of Hydromorphone every 3 hours for the first week, but script said I should limit to 12 pills a day, so I was meeting my max pretty quickly, so I tried to stretch it out. My first script allowed me 120 pills, and that went pretty quickly. My refill, now says to take 1-3 tablets every 4-6 hours. I've been taking 2 tablets every 5-6 hours. At night, around midnight I take 2 tablets and then early morning around 6-7, I'm in alot of pain which wakes me. Right now, I try to take the pills when I feel the pain coming on. Also, it seems helpful when I supplement with Tylenol.
I was taking Gabopentin for nerve pain, but I stopped because of nausea and it seemed like I was on so many drugs.

All the articles are so very helpful and so is this forum!!!! I'm alone so sometimes its depressing cause, everything was so hard to do by myself, but its getting better and I can stand and take a shower which is great. But as you all know, the littlest task, like making breakfast, involves so much "walking", that it exhausts you to get it done. A few friends have stopped by sporadically to bring food which I'm grateful for. My kids will be coming home for Txgiving, so I'm looking forward to the company.

Again, thank you all for your kind words.
 
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kneegone

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Unbeknownst to me, I thought I could choose which knee to get. However, I soon realized that your OS decides and I was told that each surgeon uses only one brand of knee replacement. My doctor, Dr. David Mayman at Hospital for Special Surgery, NY, uses Smith&Nephew knees because he is trained on it and seems to be affiliated with them (he has some training videos with them). I was told that he used the Legion Primary knee on me. I'm wondering if this was an issue with any of you, as to which knee was used on you or were you only concerned with the choice of surgeon?
 

Racewalker45

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There is no way for me as a lay person (who just happens to be a healthcare professional), to determine the best implant for my particular situation, so I trusted my surgeon to make that choice. For my first knee surgery, he used Zimmer implants. I don't know what he used for my most recent surgery. The articles posted on this forum suggest that the skill of the surgeon is much more important than the brand of implant that he or she uses. That is why I chose my surgeon carefully. I think it has worked out for me just fine.
 

tiredwife

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Hubby has Stryker Triathlon size 5 in both knees. You want what ever your surgeon is most comfortable. If they had complaints they would stop using it, so don't worry they are all about the same.
 

Jane B.

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Kneegone, this surgery is tough. My surgeon said, "You'll hate me for a month!" I thought long and hard about that one sentence and realized this was going to be an ordeal. A month is a long time to be in pain, and a month is only the beginning.

I find myself getting bummed during the long days of THE KNEE. We have to tend the knee, think about the knee, plan meds for the knee, think about how we will walk to the bathroom with the knee, and exercise the darn knee! It's exhausting.

I would recommend that you consider purchasing an ice machine. I got mine on Amazon, but I saw some cheaper elsewhere. You'll use it for a good long time, and it encourages you to keep icing longer.

And take the pain meds, we need 'em.
 

kneeper

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For my first knee I had a Smith and Nephew of some sort and for the second a Zimmer. Same doctor. Both are fine. I only found out after the fact which one(s) I had--I asked only out of curiosity.
 
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kneegone

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Thanks Jane! You're right about THE KNEE! On one hand,I did hear that a TKR would be the most painful surgery ever, but then again I was hoping that it was an exaggeration. I'm worried that after all this pain, I will end at where I started with only about 90 degree flex. Improvement is slow and even though I make progress, the next time around, my flex has reverted to the original state, with no improvement. Anyway, I'm going to look into the ice machine! Any recommendations?
 

Jane B.

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ROM will come with time as the swelling decreases. I had decent ROM until my knee decided it hated flying the other day, and now it's stuck somewhere silly due to swelling. It will come back.

I bought a Polar Cube. What ever kind of ice machine you buy, my PT said it's better to put them on a table above your chair or bed. It's easier on the pumps.
 

Paisleydoll

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I have to laugh about THE KNEE! I keep wondering myself when I'm going to be able to plan life around other stuff besides what THE KNEE will allow me to do! It let me spend half an hour today, at the end of a very long, busy day, at the bookstore. I consider that a major success! (Even if I did grab my meds and ice pack the minute I got home!)

It will get easier, and the first month really is a stinker. I don't think I was able to get the swelling down enough to have any bend beyond 90 degrees until my fifth week, and at that point I was spending time lying on the bed with my feet up on the wall way above my head. (I was cranky, the swelling WOULD be going down! :gaah:)

It will get there, and you will too. At seven weeks, even though I really didn't want to, I had my prescription for my Oxycodone refilled. I feel like I should be able to tough it out by now, and I hate the idea of taking pills too. But, as has been said, our knees were horribly physically assaulted. It's going to hurt, and hurt for a long while. (My surgeon said I'd be off the painkillers in "a few weeks". HA! He's obviously never had a knee replaced.)

Hang in there!
 
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kneegone

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Thanks Paisleydoll, glad to hear I'm not the only one at 90 degree at almost week 4! I called the surgeon's nurse and she said minimally I should be at 90 degrees at this stage and suggested that I start outpatient p/t, cause she says they push harder!? I'm kinda scared now. My home P/T is trying to get me more in home approvals. Now, I'm not sure which is best for me. I like the in home P/T because she is kind and only encourages me to push as much as I want to. (Hopefully I get insurance approval).
 

Roy Gardiner

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It's been a little over 3 weeks since my TKR at the HSS in New York, and the last two weeks has been debilitating, depressing, bleak,
You are very, very early in recovery. Pls take your meds by the clock and just rest, ice and elevate. Don't even think about PT, you don't need it yet.
 
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Hi @kneegone
It really does gets better. I felt the same way at first. Between the swelling and pain, well it would kick those doubts in high gear.
Don't worry about your ROM. Your number one priority is to rest, elevate your leg, and ice and pain management. The rest will come.
As for pt, you are in control of that. Don't do anything that causes you to be in pain. I did not do that and I regret it.
Each day will go by and all of a sudden you start feeling better, stronger. The goal is there in front of us. Walking without pain. Being able to keep up with our grandkids. Going to a store and not having to find a place to sit because the knee hurts so much. It will be amazing!!
Don't rush it. It's coming and will be with you soon!! :)


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Jamie

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@kneegone .....don't hesitate to tell your surgeon if the prescription he's giving you isn't getting the job done. Some doctors don't really get the pain issues (amazingly). If you can't get cooperation from your surgeon you can also contact your GP. They seem to be a bit more understanding about the seriousness of pain following joint replacement surgery.

You also could ask about switching to hydrocodone which has the Tylenol in the pill. It would be a bit of a step down and maybe your surgeon would consider prescribing enough that you could take 2 tablets every 4-6 hours in these early days. At some point he may want you off narcotics and then you could ask about Tramadol. It can be taken with Tylenol and works quite well for pain after the initial month or so.
 
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