TKR Jancat's recovery thread -7.5 years after the 1st knee!

[jancat]

Hello again, Dear Bonesmarties!
Well I did it again! I was supposed to have my right knee replaced last year but it didn't seem too bad so I delayed until this year. I had my right knee replaced November 18, again at Hospital for Special Surgery in NYC and again with Dr. Steven Haas.
I am amazed at the advances in 7.5 years! Just a few differences from my left TKA in March 2018:
I did not have to give blood pre-op in case it was needed for surgery. It was so great to be able to drink clear fluids until 3 hours before the surgery! No PCA catheter. No Foley catheter. No knee drain post-op. The mepilex dressing. No CPM machine. Xarelto instead of Coumadin.
However, this time I was not able to tolerate Dilaudud as a pain med (although had no problems with it last time), so am still trying to figure out a good regimen using Oxycodone 5 mg doses.
It is so lovely to be back here! I am catching up on all the great advice and wil contribute when I feel I have something worthwhile to add!

 

[Celle]

Hello @jancat - and back.

it sounds as if your doing well - apart from the pain relief regime. I hope you can soon get that sorted out.

Here are the Recovery Guidelines and some helpful articles:


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. At week 4 and after you should follow this

Activity progression for TKRs​

6. Access to these pages on the website

Oral And Intravenous Pain Medications​

Wound Care In Hospital​

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.

 

[sistersinhim]

It sounds like there have been some positive changes since your last tkr! I imagine each year new things are coming out to help with this surgery. I'm holding off asap with my left knee. Who know, maybe by then it'd be non-invasive. Now, wouldn't that be great!

 

[jancat]

I am noticing that this time around, every time I talk to someone I am always asked my ROM and extension, even when just refilling a pain med. I do not recall this from my other TKR 7.5 years ago. I can't find the source of this now, but I somehow recall a goal of 90 degrees by the time OP PT begins at 3 weeks. I am am 16 days post-op and am at 75 degrees. My leg is still swollen and bruised from the tourniquets during surgery. Obviously my knee site is still swollen. Right now I am not concerned because I am making slow-but-sure progress. Should I be concerned?

 

[Jaycey]

Should I be concerned?

Not at all! And please do not let PT push that knee. There are no "goals" for ROM. Reread the articles Celle left for you. Keep icing and elevating to get that swelling under control. ROM will come with time a patience.

 

[Celle]

I can't find the source of this now, but I somehow recall a goal of 90 degrees by the time OP PT begins at 3 weeks.

Most surgeons are happy with a flexion of about 90 degrees by 6 weeks. Try not to get caught up in other people's obsession about ROM numbers.

There's no need to rush to get ROM (Range of Motion) because it can continue to improve for a year, or even much longer, after a knee replacement. There isn't any deadline you have to meet:
Myth busting: the "window of opportunity" in TKR

 

[jancat]

Has anyone used the hypochlorous solution? I read the information provided in the link but am wondering if anyone has used it. Did it help your wound heal faster? Is there a benefit to using it?
Also, has anyone tried the scar lotion advertised here on the website?

 

[sistersinhim]

Also, has anyone tried the scar lotion advertised here on the website?

Yes, I have used it for a few years now. When I have a cut, sore, bug bite, scrape or anything like that, I put it on it and it heals quickly. I am now on my third bottle. I will always have this in my home and highly recommend it.

 

[lovetocookandsew]

Hello, and welcome back, @jancat , although I'm sorry it has to be under the circumstance of another TKR. I agree with the advice given above. Spend a lot of time icing and elevating, along with gradually increasing your daily activities. Don't let anyone push, pull or force your knee to move in any way in order to achieve a ROM number of their choosing.

The only numbers that matter are the ones you achieve by bending and straightening your leg with no help at all. But, don't stress over the numbers, they are only a guideline and really the only thing that matters is that you are recovering on your knee's timeline, that you're moving around some each day and that you are letting your knee heal without forcing it to heal on someone else's timeline.

Over time, as you look back, you will see improvement; sometimes only a tiny bit, sometimes a lot. And sometimes you'll feel like you've gone backwards. But this is all part of the recovery journey, so take it one step at a time (pun intended) and let your knee tell you what works and doesn't work at any given time.

I agree with you about all the changes over the last years; I had four years between my TKR and my revision and was astounded at the changes in those years. Some I liked, some I didn't, but overall I liked the advances. My favorite change was no more staples, only glue and stitches and that was a huge relief.

I used the Active Skin Repair Hydrogel and think it helped. One bottle lasted me a long time, so it's worth the cost.

Good luck! Please keep us posted as you recover.