TKR Joy's Recovery thread<

[Joy77]

Day 7 -

It's hard to believe it was last Friday I had surgery. I have no regrets at all but I am a bit impatient and wish I'd move beyond this "needing to be on meds to feel good" stage. lol

@Josephine I want to ask your professional opinion on a few things if you don't mind. One is my medication regime and the other is the use of tourniquets during surgery.

My medication regime is 2 Percocet (5mg - 325mg) every 5 hours. My medical staff would like me to make to to 6 hours before next dose but I'm too miserable if I do that. With every 5 hours I'm comfortable enough to shower, move around the house and focus on ADLs. In addition, I maintain the icing and elevating of 20 on /40 off to the best I can. Sometimes I find I'm icing more than 20 min at a time but it's generally close to that schedule. I have a nurse who checks in with me via phone. Yesterday, she wanted to try something new since she felt I was taking the Percocet too often. She asked that I maintain the 2 Percocet but wait the 6 hours before taking more but if I have breakthrough pain to take 2 mg of Dilaudid at 5 hours to carry me over until 6 hours. Depending how I feel at 6 hours (after I've taken the 2 mg of Dilaudid) either take 1 Percocet (moderate pain) or 2 Percocet (severe pain).

Well I tried that. At 5 hours the pain was getting bad so I took 2 mg of Dilaudid. That didn't seem to bring me any relief. To me it seems it should have helped but the pain was getting worse and then I just felt overall miserable. It was the first time I didn't feel good at all. I waited until I got to 6 hours when took a Percocet. I feel like it threw off my routine and it wasn't until I got back to 2 Percocet every 5 hours that I felt good again. I told the nurse it didn't seem to work at all so she told me to go ahead and do what I was doing - 2 Percocet every 5 hours. Maybe I didn't give it enough of a chance and I should have tried it again.

At the rate I'm taking the Percocet I'm going to run out before I see my surgeon next Friday. I'm guessing I can ask the nurse to get me more Percocet but I'm wondering if I'm taking too much Percocet. I do worry about addiction but at the same time isn't this was Percocet is for? And I'm only at day 7. I'm questioning if 2 Percocet (5 mg - 325mg) every 5 hours is too much and at what point should I be cutting back from this?

Regarding the use of tourniquets in surgery. I've been reading that it's the use of the tourniquet in surgery that causes so much of the thigh pain post op. I've also read studies where they do surgeries both with/without a tourniquet and those that did not use a tourniquet have a significant reduction of thigh pain post op thus requiring less opioids for pain reduction.

The use of a tourniquet can cause some degree of neuromuscular injury, postoperative weakness, stiffness, dysphasia and pain in the area directly under the tourniquet placement. Tourniquet time longer than 40 - 60 minutes places the patient at higher risk for complications and with shorter tourniquet times of 20-30 minutes there is much less adverse effects.

I also read the using a tourniquet brings about a much cleaner field for the surgeon. So as with everything there are pros and cons. I wonder how much current surgeons factor in tourniquet time and if even not using one is an option. Since I need my other knee done I plan on talking about this with my surgeon but thought I'd ask you Josephine if you have any first hand knowledge of pros/cons of using a tourniquet during surgery.

It seems if I could get my thigh pain under control I could do so much more and feel so much better. I am now realizing my thigh pain is most likely a result of the tourniquet.

It's time for my shower, fresh clothes, a little makeup and the arrival of PT in a few hours.

I hope everyone's today is better than yesterday!

 

[Josephine]

In addition, I maintain the icing and elevating of 20 on /40 off to the best I can.

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

She asked that I maintain the 2 Percocet but wait the 6 hours before taking more but if I have breakthrough pain to take 2 mg of Dilaudid at 5 hours to carry me over until 6 hours. Well I tried that. At 5 hours the pain was getting bad so I took 2 mg of Dilaudid. That didn't seem to bring me any relief. Maybe I didn't give it enough of a chance and I should have tried it again.

I think that if you found a system that works, stick with it and don't allow that nurse to mess with it. It's NOT her knee!

I'm wondering if I'm taking too much Percocet. I do worry about addiction but at the same time isn't this was Percocet is for?

In is indeed! You're actually taking it about right for only 7 days out. Stop worrying about it and don't think about weaning off until at least 6-8 weeks out.

I am now realizing my thigh pain is most likely a result of the tourniquet.

Unlikely. Tourniquet pain is actually quite uncommon and even when it does occur, it's usually very short lived, say about 3-5 days. All the other issues you mentioned are even more uncommon so don't worry about them. And you will get pain in your thigh from the surgery, not the tourniquet.

 

[DLR]

Hi @Joy77 i also have a lot of thigh pain. I think it is simply muscles and nerves reacting to being pulled and abused during surgery. Also for me I was knock kneed and I think my back and glutes and all the muscles running down the thigh are in revolt at being used differently after all these years.

 

[Joy77]

@DLR I thought that too... my thigh muscles being pulled in all directions but both my PT and the nurse that phones me told me it's most likely the tourniquet. So I started reading about it (nothing else to do - lol) and I found out a lot of info on tourniquet use during surgery. I knew one was used but wasn't aware how much pain the tourniquet creates post op. It does benefit the surgeon (stops blood from going all over) but leaves the patient in a lot of extra pain. That's when I thought I'd run it by Josephine to get her opinion on it. I'm curious how much of my thigh pain is due to the tourniquet and how much to muscle tweeking - or probably some of both. But Josephine doesn't think it's from the tourniquet and if it was the pain should be subsiding about now. So that's good. I trust Josephine's opinion.

My back has also been hurting and I'm attributing that to laying down so much. Also to not being able to sleep on my side. I know this is just one of the things we have to endure.

The Dr. upped my meds today. The nurse that called wanted to change my meds. Yesterday she added dilaudid, I didn't like it, today she wanted to try morphine, I said No. So the Dr. called and he suggested I just up my Percoset to 10mg (percocet) - 325mg (tylenol). I was as 5-325. I said Yes. So I just started the higher dose and it's working so much better. The percocet is higher without raising the tylenol. I didn't understand why the nurse wanted to change my meds when all I was doing was taking it an hour early. If it were dangerous I'd understand. But the Dr. agreed with me and didn't want me to add another narcotic. He just upped what I was doing.

@Josephine Thanks for your input to my questions above. I feel supported. I will increase the icing too. I generally did leave my leg iced longer than the 20 min as it felt so good. Now I know it's okay to do that.

Time for bed.. I'm beat.

 

[Celle]

The nurse that called wanted to change my meds. Yesterday she added dilaudid, I didn't like it, today she wanted to try morphine, I said No. So the Dr. called and he suggested I just up my Percoset to 10mg (percocet) - 325mg (tylenol). I was as 5-325. I said Yes. So I just started the higher dose and it's working so much better. The percocet is higher without raising the tylenol. I didn't understand why the nurse wanted to change my meds when all I was doing was taking it an hour early. If it were dangerous I'd understand. But the Dr. agreed with me and didn't want me to add another narcotic. He just upped what I was doing.

So, listen to your doctor in future and not the nurse. It's much too early to be cutting back your medications, and once you're on a regime that works, stick to it.

 

[kneeper]

I'm glad to see your doctor adjusted the percocet. I know I sure wasn't going 6 hours between doses at your time out of surgery--more like 4 hours. I gradually got to 5 hours & then 6 but it took a few weeks.

 

[Joy77]

Day 8 -

Thanks @Celle and @kneeper regarding my pain meds. It seems I can get to 4 hours and I'm the most comfortable but I work at trying to take it to 5 hours before I need more Percocet. But when I take it to 5 hours I'm very uncomfortable. It's my own head game I'm playing thinking if I can last 5 hours I must be improving.

I think today I'm going to stick with Percocet (10-325mg) every 4 hours, I won't try to push it any longer than that and see how I feel. I'll set my timer so that I keep it on schedule. Right now, I feel like I'm chasing my pain which is what I was told not to do. At 4 hours I hope I will be ahead of my pain. @kneeper It makes me feel better knowing that you were at every 4 hours.

Overall, it's my darn thigh that hurts so much. My knee and calf are doing well.

This experience is making me realize I'd make a very bad drug addict. lol I think today I'm going to sit in the backyard a bit more, watch my dogs play, enjoy the fresh air and my flowers.

You are all so helpful! I appreciate everyone on this forum and enjoy reading all of your experiences. Every day is a learning experience.

Blessings to you all.

 

[DLR]

@Joy77 i had a talk with my PT about my thigh pain, She can feel the remains of a bakers cyst and a tight muscle knot. She worked on massaging the knot, then told me to make sure I not only ice the front of the knee but also the back. I realized my ice machine pad doesn’t go all the way around so I have to choose to place it on the back. I remember preop reading on BoneSmart this reminder..but post op forgot...perhaps it would help you too?

 

[Joy77]

@DLR Thank you for that insight. My icing machine doesn't go all the way around either but I'll make a point to work on icing the back. I'll see if that helps. I will be sure to check with my surgeon at our next appointment to see if I have a Baker's Cyst. I vaguely remember it being talked about from a previous Dr. Thanks Again!

 

[MtnSearcher]

@Joy77 My doctor used a tourniquet, and I had no thigh pain. A friend who had surgery three weeks after me had excruciating thigh pain that his doctor solved with a muscle relaxer.
Everyone experiences pain differently and has a different tolerance for pain. I was taking 10-325 Percocet every 6-8 hours, and was still in pain, but not unbearable. After two weeks, I was switched to norco, then two weeks later to tramadol. I'm now taking 800 mg ibuprofen.
Your pain will get better. The ice machine is a lifesaver, and the more I have moved my leg, the less pain I've experienced. Hang in there, and if you have to remind your nurse and PT it's not their knee.

 

[Joy77]

@MtnSearcher Thank you for your kind words. It looks like your surgery was a month before mine and you are doing well. That's exciting for me to see.

I have to say when I woke up this morning I didn't notice my thigh pain as much. Maybe the increase in Percocet (10-325 every 4 hours) is the ticket that's helping me or maybe I'm healing or probably it's some of both. Since I'm only at 9 days I'm not going to focus on reducing my meds yet and am just going to enjoy the bit of comfort it brings me.

I agree that the ice machine is a life-saver. I'm glad the hospital gives all their knee recipients their own machine to take home. I'm guessing it's covered through insurance. It certainly is making recovery easier.

I have discovered that unless you've had knee replacement you couldn't possibly understand the pain we go through. My husband even said, "I'm sorry you're in so much pain but because of my back pain I know what you are going through". I replied, "I know you think you know but let me assure you, you don't know this pain. But I do appreciate the empathy". lol there's no way he knows this pain.

It would be nice if there was a requirement that at least one person on each of our medical teams had to have had a knee replacement. But instead, most of my team members are young, strapping, muscle built men and women who would probably faint if they got stung by a bee let alone endure this recovery. lol

Anyway, thank you for your input, it's very appreciated.

 

[Spex10]

I had a tourniquet for my second TKR. My thigh was sore and bruised but the pain was OK. Just like a bruise healing. Didn't require more than paracetamol which I was taking anyway.
I had much less bruising lower down my leg and behind my knee than I had following the first TKR op which didn't involve a tourniquet. Tourniquet /no tourniquet - depends on the surgeon I suppose.

 

[Ark_PB]

Joy77 your surgery was the say after mine.
It has been nice to see someone put into words exactly what ive been feeling. The thigh pain has been the hard part of all of this.
I was doing pain meds every four hours for the first 6 days. I started stretching that out to 5 and 6 hours and skipping my night dose.
Down to 3-4 times a day.
The hard part so far has been the CPM machine. The first 1/2 hour or so is the hardest then knee stretches out and seems ok.
Have enjoyed your writings , keep up the good work

 

[Joy77]

Hi @Ark_PB! It's nice that you and I had surgery basically the same day. Although, you seem to be much further along on the pain meds. I can't get out of needing something every 4 hours. Can I ask what you are taking for pain? That's great you don't need pain meds at night!

My surgeon and her group doesn't do the CPM machine. So I've had none of that. They don't seem to push too much exercise in the beginning. I do have PT that comes 3 times a week but I don't feel pressured to do anything uncomfortable. Yes, the exercises create some pain but they are bearable. If the PT feels it's too much for me he'll back off. BUT, starting this Friday I go to the office for PT, no more home care. I'm going to end up with a different PT. I know she's female but that's all I know about her. It'll be interesting to see how much it changes.

How is your swelling? Mine seems to consistently swell even when I baby my knee.

You are doing great!

 

[SusieShoes]

Pain control is so individual, but that’s also the best thing about it. Your body will tell you when you no longer need the Percocet. One day you’ll realize you skipped a pill. At least, that’s how it went with me. I took oxy every 4 hours, on the nose. Keeping my pain low helped me want to move around, take short walks, and stay relaxed. Then I started missing my pill times. It’d be an hour or two before I’d realize I hadn’t taken the pain pill. That was when I knew I could start weaning off.

Being comfortable is important. The body heals best with less stress. Pain is stressful. So pain control is one of the best things you can do for healing.

I hope your therapist at the facility is of the same mindset as your home therapist. You know what to look out for, right? No forcing the knee in any way, just gentle exercise. One thing I liked about PT was it got me out of the house and among other people! Getting out and about feels nicely normal.

 

[sistersinhim]

The amount of pain meds you need depends on how much damage you had to your knee before the surgery and how much repair work was done. I took pain meds for about 2 months, and then was able to cut down to nights only for a few weeks. Everyone's recovery in an individual thing and no 'one size fits all'!

 

[Joy77]

Day 14 -

Wow, it's been 2 weeks! While I'm far from out of the woods I am certainly so much better.

My sleep have never been much of a problem except on occasion. I take a pain pill (Percocet 10-325) at 10 or 11pm-ish then head to bed. I can't get that comfortable but good enough to get some sleep. I wake up once at about 3am and evaluate in my head, over about 30 minutes, if I really need another pain pill, and I do. So I take another pain pill and I'm good until 6am when I have to get up because of the dogs. They get let out of their crates, dash for the backyard then come back in to be fed. I go to the recliner, have a cup of coffee and watch the news while the dogs play with each other. After coffee I do some of my exercises. Not much pain because my 3am pain dose is still working. The rest of the day is ADLs, going for short walks outside, taking naps, and mostly icing and elevating my knee. It's still swelling quite a bit but I'm sure that's to be expected at only 14 days out. I don't push myself. I enjoy relaxing.

With this Percocet I've really lost my appetite. I was reading about it and that's one of it's side effects. For me that's a good side effect because I could lose another 15 lbs and be happy. I do make sure I'm getting my protein in as it's so good for muscle repair. But I don't find myself wanting to eat much at all.

Today I had my first outpatient PT. I was nervous but it went very well. I took 1/2 pill (extra) of my Percocet before going in to ward of any pain. My PT girl never touched me. She directed me what she wanted me to do and allowed me to do what I could. My initial ROM was 73º and 0º. She asked that I do about 5 exercises. There was some pain but nothing intolerable so I pushed through them. She told me she didn't want me to hurt bad - to only hurt in moderation. By the end of the PT appointment I was 93º and 0º . I was very pleased and surprised. I did so much better than I thought I would. She said her goal is for me to get to 120º and 0º but not for me to be in intolerable pain to get there. She said if I swell too much than I did too much in PT. She expects minimal swelling but really wants to keep the swelling to a minimum. I really felt good with her and let my guard down a bit. But I will be prepared to say "no" at any time. The main issue I have is to strengthen my quad. That's probably the same for all of us. lol. I can't lift my leg on it's own without help. I'll work on that this week. She said when I'm able to lift my leg up and down a good amount of times I can move to a cane. My physical therapy will be 2 times a week, move to 1 time a week, then after that when I feel I need to come in.

I do notice the right side of my knee has more pain. I know the surgeon told me I had multiple bone spurs that she had to remove. I'm seeing her next week and I'm going to ask her if that's where she removed them from. I'm not sure what questions I have for my surgeon. I know she's checking on my progress but I always like to have questions for these appointments.

I hope everyone is finding your successes today - no matter how small they may seem to you.

 

[sistersinhim]

I took 1/2 pill (extra) of my Percocet before going in to ward of any pain.

You should never take a pain med before PT. It will mask the pain that you should be feeling and will then do too much. Doing too much slows your healing down. We stress that you should feel no pain at all, just a little discomfort at the time or that night or the next day. Anything more than a little extra pain is telling you that is is too early for your knee to be doing that right now. You can hold off for a week or two and then try it again. You don't want to keep your knee inflamed by doing too much.

 

[Jockette]

The main issue I have is to strengthen my quad. That's probably the same for all of us. lol. I can't lift my leg on it's own without help. I'll work on that this week.

At 2 weeks post op it is too early to “work on” strengthening your quad. It is naturally traumatized by the surgery. It will strengthen as you heal and that takes time.

I couldn’t lift my leg, either, for a while after surgery. I did not work on it. Several weeks later I realized I was getting my leg up on my foam elevating wedge by myself, a couple of times a day, and a light bulb went on that I was actually doing a leg lift. I pushed my wedge aside to test it and my leg went all the way up!! I accomplished that simply by doing my activities of daily living (getting my leg on my wedge as needed) not by doing X amount of leg lifts.

Try not to let your guard down at PT, those higher numbers are very tempting. (Been there, done that) PTs usually encourage you to try for a little more. But the pleasure is short lived as you are the one with the resulting pain later that night or the next day, not the nice encouraging PT.

 

[Joy77]

@sistersinhim I got your comment about how I shouldn't be adding a bit more pain med before PT. I'll remember that.

@Jockette thanks for the heads up about how there's no need for me to work on quad strength. And as I said I will always be prepared to say "no" when needed.

I still feel like today was a success for me. I felt really good about my PT experience. She never touched me and only requested that I do what I was comfortable doing. She specifically said she didn't want too much pain. Just me walking causes pain and I can't stop walking so I know some pain is going to happen. I didn't feel pressured at all. We talked about our long term goals and we both have the same goals but a timeline wasn't set. I put the timeline on myself to focus on my quads this week. It was me, not her. I'll slow down my expectations for my quad. She reiterated it's how "I" feel and she'll be there to help me.

It's now several hours later and I've been relaxing, elevating and icing. So far so good. Nothing unusual noted.
I'm happy