Knee recoveries UK style Parts I & II (Josephine)

[Josephine]

Knee recovery UK style Part I

This is my experience:

1. surgeon told me no PT and no formal exercises for the first 3 weeks, just ankle pumps, gentle heel slides and a bit of walking around the house like to the bathroom and kitchen and stuff
2. throughout my recovery I did about 5-10 heel slides maybe 2 or 3 times a week and sat on my exercise bike for a couple of minutes once or twice! Once I was able to do a full rotation I rather lost interest and just used the bike to hang my blankie on!

3. I also dropped to one crutch indoors in week 2 and no crutches in week 3 or 4. Hardly ever used a cane.
4. 3 visits to the physio at weeks 3, 6 and 9 but that was just for assessment when they would eyeball my ROM, ask me how I was and then give me the next appointment!
5. in week 4, started doing little walks outside, starting at about 100yds and increasing bit by bit each day. After two weeks of that (week 6) I think I did a marathon as I got lost in the estate and it took me about an hour to get home. Since I loath walking with a passion, I quickly lost interest in that as well then and never did more than to the bottom of the garden and back!

6. I was doing stairs one at a time for at 3 months if memory serves me correctly. Then I managed to go up normally but it was another several weeks before I could come down normally. I never worried about it, knowing it would happen when it happened and not before.
7. I drove at 6 weeks and never looked back

What I DID do was lots of rest and elevating (hooray for the laptop!), constant icing and always took my pain meds by the clock. In the third week, when I rang my GP in tears because I was inexplicably hurting more than usual, she told me to increase the Tramadol to 150mgs if I wanted as I could take up to 600mgs per 24hrs quite safely and let me tell you, I took advantage of that advice quite often!

My ROM has always been good. Perhaps I was one of the lucky ones but my surgeon says it's a pretty normal story for his patients and he rarely has to do MUAs (which is perfectly true as I worked for him for six years and the number he did in that time you could count on the fingers of one hand!). As it was, I got to 90 two days after surgery, was at 100 by two weeks and 120 before I got to my last PT assessment at 9 weeks. Somewhere around 5 months I was at 135 degrees of flexion and 0 degrees in extension (image 1). Image 2 is my scar at 2½years - 7½".

 

[Josephine]

Knee recovery UK style Part I

I also live alone in a semi detached house, what I understand you call a duplex! I couldn't find anyone that would stay with me so I was resigned to coping alone. I bought in heaps of food (and cat food) and aids and an alarm to summon help if needed, etc. Then, in the very last few days, my brother and his wife decided to come and stay but only for about 5 days which was a great relief even so. The plan was that they would drive up the day of my discharge, arriving evening time but I would be home from hospital around midday.

Day of discharge arrives, day 6 post-op; I have a taxi bring me home. My drive gates are locked but I'm not going to try going down the steps of the single gate. While I am struggling with the combination lock (awfully difficult thing to read upside down!) the taxi driver dumps my cases at the front door and drives off!

So my first task is to get the two cases inside which I managed with amazing ease.

Second task, of course, is to feed the cats. Amazed myself again by bending down to pick up plates and again to put down the filled ones. Cats weren't amazed - they only wanted the food!

Then I went upstairs to 'change into something comfortable'! And down again. Made myself a sandwich and a drink and took them through into the sitting room (not so easy with two crutches!). Made myself comfy on the recliner and proceeded to log on only to find I'd not switched on the router ------ which is upstairs!

So up I go again to get myself online and then finally down again and by the time my brother and his wife arrived, I was good and comfy, both me and the cats were fed and watered and I was catching up with posts on BoneSmart!
Now it was someone else's turn to be amazed!

 

[Josephine]

I copied these posts from my 2nd recovery thread and made both knees one thread!
Easier for everyone!

Knee recovery UK style Part II!
Finally and at last - here I am! Thank you everyone for your good wishes and encouragement - it's meant such a lot. Jean has kept me posted.

So you all know me pretty well by now so will also know that I don't post insignificant posts!

Here's my tale ....

Arrived at the hospital at 12:30pm and had a short wait before being taken up to the pre-op admissions suite. I am very impressed with the new arrangements at Sunderland Royal Hospital (D level theatres but more on that as I go.

Was taken to a small room to be admitted and changed into my op gown. Here the admitting nurse, the registrar, the anaesthetist, the ODP (operating department practitioner) and the surgeon came to see me, each checking details and giving me their own bit of spiel! The surgeon came back a couple of times because, since I was first on the list, he wanted to get on and was getting irritated by the delays.

So eventually I was taken through to the 'block room' where it seems all the blocks and epidurals for the department are done which was quite reassuring as you then knew they did nothing else. However the lady doctor who actually did it had a little difficulty and when I heard her ask for a 'longer needle' I had to laugh and say "No kidding!".

So spinal successfully accomplished, they then injected a large amount of lidocane into the back of my knee. The consultant told me was a new procedure as evidence had shown that most of the pain experienced post-op appeared to be from there. Ah well, can't argue with that! Then they did the femoral nerve block. Both these procedures were totally pain free because, of course, they were done in the area that was numb from the spinal. All three were very effective.

I was then wheeled into the anaesthetic room where a nurse came and catheterised me (at my request) and that's when I must have been given the knock-out stuff as the next thing I knew I was in recovery!

Sorry, I just took some pain meds and am now so sleepy I can't continue with this just now.
Next instalment later!

 

[Josephine]

Part 2 - the surgery:
His nibs told me it was pretty much of a replay of #1 except he had to put in a patellar button as there was quite a bit of wear in mine. That's perfectly okay with me - I'm of the proactive mentality and would much sooner treat that now rather than later.

Was cold in recovery so had a hugger blanket which is really, nice plus foot pumps to do the anti-clot thing. Also had a hypo as didn't have any diabetic meds that day but a couple of tubes of glucose gel soon put that right! However, when the nurse asked if it was okay I had to admit I'd sooner have had a Mars bar!

So after visits from several ex-colleagues, back to the ward where I found I had a room to myself! Drainage was moderate but I did get one bag re-infused which was pleasing but sadly it ran too slow and kept getting blocked so I only had about 300 out of 500mls of it. It was very satisfying to have your own product back into your veins! It was also great not having to worry about having a pee on account of the catheter! Had foot pumps on until the next morning.

First night was good with more than adequate pain meds. Had oxycontine 10mg SR twice a day and could have oramorph 10mgs every hour. Prety good I'd say!

Now feeling drowsy again - so will be back in a while

 

[Josephine]

The lidocaine worked really well. Haven't had any where near as much pain as I did first time around. I believe it's referred to as a popliteal block but don't quote me yet as I shall have to confirm it.

There is probably a leek pie calling your name!

Most likely, Jamie, but my stomach appears to have developed a significant hearing loss!

So here's part 3 of the saga.

I have to say that today I am still feeling weak and wobbly but then I am only 5 days out so hardly surprising! It's just I don't remember feeling it this much at home before but again, I didn't get home until day 10 so also not surprising. But it's amazing how much it can rock your confidence.

So after the op day, the next day was full of busy, busy! Had dressing changed, drain out, foot pumps off and IV and oxygen removed. What a relief! Then the physios came and got me up to walk.

It quickly became apparent that the femoral block had not yet worn off but the physios told me how to cope with that and to be careful not to walk without somebody in attendance. This was fine until later in the evening when I needed to go to the loo. A rather self-important staff nurse came to see to me and after about 4 steps, decided I was perfectly okay to manage on my own and before I could stop her, she left!

So I managed the last few steps on my own, fortunately making sure the arms were down on the loo. Having turned and backed up to the loo, I went to sit down and mistakenly tried to put weight on the left leg which, of course, wasn't 'there'. As a consequence, I took a less than graceful and fearsome stumble onto the toilet where, not being properly positioned, promptly deposited my bladder-full on the floor! I was so unnerved, scared actually, I rang for the nurse and waited what seemed like an age for one to come.

It was with some trepidation I got up again and back into bed. Later the nurse who had left me came back to get my meds and when I told her about the tumble and boy! did she ever undergo a personality change! She was on the defensive, insisting that the block was 'out' and no longer effective and that the physios had told her I was okay for weight bearing. When I tried to debate the point she got even more incensed and told me she'd been doing this job for 10 years and knew what she was talking about! I told her I'd been doing it for 50 years and one things I'd learned was to listen to the patient first before applying any blanket protocols or rules. I should say the exchange was 'somewhat heated'! Of course, I ended up in tears!

It was a shame because all the other nurses were so sweet and caring and this one spoiled it!

There was also a contretemps with another physio as I prepared to depart. Having been told I could take the cuff home with me, I drained it to pack it in my case and a physio ran across the room and demanded to know what I was doing. I told her and she insisted I was doing it wrong. Puzzled I let her rant on in the hopes she would eventually explain herself but she didn't. I told her I was taking it home and first she said I couldn't, then said it wouldn't be any use to me. I explained I had a bucket at home and she waved the connecting end of the tube at me saying "You don't understand, you have to have the correct kind of bucket with this connector on it". Even though I said I had she still didn't seem to hear me and eventually stomped off muttering "Okay, obviously you know best!" I resisted the temptation to say "Yep - sure do!"

 

[Josephine]

Here's some photos of my op - some are on 'spoiler' so if you don't want to see them, don't click!

Here are the foot pumps that emulate the muscle action to reduce the risk of clots, left has a bootee, right has two calf wraps

These are photos someone kindly took for me in theatre!

Femoral jig in place

Spoiler: femoral jig

And the tibial jig

Spoiler: tibial jig

inserting cement in tibia

Spoiler: cement insertion

suturing the wound

Spoiler: suturing wound

 

[Josephine]

Been feeling a bit sorry for myself to day. Pain is controlled up to a point but grinding and persistent. I'm taking my meds are per this chart but it doesn't seem to be enough. I shall have to rethink it for the early weeks.

I also got a new connector tube for my Cryo-cuff and was able to get it working finally. Then realised the value of it compared to just ice packs. I also happened upon this article "cryo cuff vs ice packs" which was very revealing albeit it a very small study.

"Pain and swelling, which may lead to inhibition of the extensor mechanism and ultimately a delay in rehabilitation, are common complications of knee arthroscopy. Cryotherapy is the most often used means of decreasing both knee edema and discomfort. A number of methods have been used to provide cold pressure dressings, including ice and elastic bandages. Commercial devices, such as the Cryo/Cuff, also have been developed to provide similar beneficial effects.

This article describes a multicenter randomized study undertaken to determine whether the Cryo/Cuff or the ice and elastic bandage offers the greatest convenience and relief of pain. 102 patients between the ages of 18 and 65 scheduled to undergo knee arthroscopy were enrolled in the study. Postoperatively, the Cryo/Cuff patients required significantly less pain medication than those patients using the ice and elastic wrap.

The Cryo/Cuff patients also expressed a higher level of satisfaction with the effectiveness and convenience of the therapy. There were no differences between either group in the amount of pain reported, or preoperative and postoperative examinations in regard to knee range of motion and thigh circumference. These results indicate that the Cryo/Cuff is a useful adjunct in the rehabilitation of knee arthroscopy patients."

Not bad, eh?

 

[Josephine]

I am NOT a happy bunny today. Leg is as hard as a rock and I ache from the hip right down to mid-calf. Mostly the bruising, I suppose but I wish it would go away!

I've actually managed to transfer to one crutch for most manoeuvrings! I'm still being extremely careful tho but! And only 8 days out. Done a heap of elevating and icing and actually got my swelling on my foot down from looking like a lump of uncooked dough to something vaguely like a foot!

 

[Josephine]

Hi all - sorry for being AWOL. Thanks for all you good wishes.

Update is that I feel ILL and then some. Mostly, I think, due to the cellulitis. Shaky, feeble, no appetite, full of pain, disinterested in everything, especially food! Can't even cope with phone calls because my fingers shake too much to dial a number. Strangely, I'm better when I'm up and about than when I'm sitting down. Most odd.

On the plus side, I am now able to get about the house with neither stick nor crutch (as my surgeon predicted!) though don't get too concerned, I do still use furniture and stuff for support and progress carefully. Today I had my carer carry some laundry upstairs and hang it out in the spare room while I got on with my shower on my own. I have been doing it on my own all along but with the carer 'on duty' in the doorway just in case! So having managed that and feeling more like working to my own schedule instead of sitting about waiting for them to turn up, I told the agency I don't want them any more. My neighbour's been far more helpful to me than they ever have anyway, doing washing up and getting in shopping for me. Bless her heart, she's been a real gem.

 

[Josephine]

Thanks all.

hopefully those antibiotics will see it off quickly.

They appear to have done just that.

Are you sure you should be without a crutch or anything yet?

Well based upon my surgeon telling me that ALL his TKRs now leave hospital on day 2 with no assistive devices whatsoever, yes.

Had staples out today. Being rid of those and the dressing seems to have also removed a considerable amount of restraint from my leg bend. Was going to take a photo but I have discovered my camera has gone missing. Only 'other' people who have been in the house since I last used it were 3 carers. Ho-hum.

I was going to go to bed properly last night but when it came to it, I just couldn't. Could I have developed a bed-phobia?!!

 

[Josephine]

Well, the cellulitis wasn't giving up that easily! Had a flare-up a few days ago and had to have another course of antibiotics. It's still making me feel ill, sickly, anti-food and generally feeling very sorry for myself. Sorry can't be more upbeat than this.

 

[Josephine]

Well, I had a really good day from 8am onwards. Did a little bit of tidying up in the kitchen and a lot of posting on the forum. But then at about 6pm, the pain suddenly returned like an incendiary and now I can't get comfortable any way I try. Legs up, legs down, sitting up, laying back, doesn't matter how, it hurts in different places each time. Mainly it's focussed on my calf and outer thigh which is the IT band area. I know it's that because sitting on an ice pack relieves it. But the calf, which is the principle area of cellulitis, just doesn't want to give up. If I rest my foot on a cushion to relieve the pressure on the calf, the knee complains because it doesn't like the stressed extension. If I lay on my side, the entire leg complains. Can't win. Only time I am marginally comfortable is standing or walking around (thus proving it's not a DVT!). I can't take any more pain meds until 11pm (it's now 8pm) so I shall just have to grit my teeth. I'm so desperate for a nap I could cry.

 

[Josephine]

Things have taken an upturn at last. The pain seems to have become more manageable though I'm still taking 100mg Tramadol and 2 paracetamol 4 times a day. I find that if I only take 50mg, it just plain doesn't work. But then, I'm not even 3 weeks out yet so still early days. I'm also able to get about with confidence (though still with care!) with neither crutch nor cane, even going up and down stairs. I can get up from sitting relatively easily and my ROM is about 110/0 which is amazing! And just in case you were wondering, exercising thus far has consisted of 2 or 3 heel slides every other day and one attempt to go upstairs sequentially which I managed but was a bit shaky so won't try it for another few days. I'm also sleeping in bed comfortably and getting a good night's sleep to boot!

I go for a post-op assessment on Thursday with the orthopaedic nurse practitioner (not the brightest spark of cheer in the group!) but since I haven't been out of the house since the 7th, my wonderful neighbour is going with me for moral support. I don't expect the nurse will keep me for long.

Only real problem I have is knocking in the knee. This isn't the clicking kind but a regular changing of gears, a kind of triple clunk. In fact, not to put too fine a point on it, it feels like a bag of marbles in there! The thought has crossed my mind that I may need a bigger spacer but I'll wait and see what 'sir' has to say about it.

 

[Josephine]

Yes,I know some people may have a problem with strong pain killers, also things like Valium and Atavan, but statistics show they are very much in the minority. I took Tramadol for 3 months with my last knee though it's unlikely I will need to do that this time as I am already missing doses because the pain is reducing - and I'm only 3 weeks today!

I would also report that my flexion seems to have increased to about 110+ as of this morning and I have done ZERO exercises though I have actually done about 5 heels slide throughout this period just to see how things were progressing! Now I'm not advocating this for everybody as it's entirely possible I've just been incredibly lucky but it does show that, given the chance, our bodies are perfectly capable of returning things to normal without any 'help' from us!

 

[Josephine]

I expect most of you have heard the old saying "the proof of the pudding is in the eating"? Well, today was the proof of that!

Yesterday my flexion measured at around 110. This morning I woke early-ish and turned over in bed, curling up and wrapping my legs round one another as you do. I was startled into full wakefulness by the realisation that my left leg had a more normal feel about it than before. No tightness or discomfort, no restriction. I later measured it with my measuring stick and overnight it's increased to 123! I am flabbergasted, stunned, delighted and intensely satisfied! So much I feel moved to quote another little homily which, with a stretch of imagination, might compare ...

Little Bo Peep had lost her sheep and didn't know where to find them.
Leave them alone and they'll come home, bringing their tails behind them.

I hope you get the analogy!

 

[Josephine]

Had a review at the hospital today carried out by a nurse practitioner. First comment - where are your stockings?!
Then 'was I doing my exercises'. Now I know this young lady and she's not above launching into a scold rant so I said yes I was. She felt my knee for warmth and then asked me to lay on the bed and bend my leg. Her comment was that it was 'a little over 90'! That I argued with and she just shrugged her shoulders. No encouragement or positive input. What a waste of time!

 

[Josephine]

Another bit of progress on day 24 - ROM now 115/0 and the need for pain meds as reduced considerably. I am now using paracetamol 2-3 times daily and the odd 50mg Tramadol - well I did today at any rate!

 

[Josephine]

It's passed with the aid of pills! However, just to prove that recovery really IS a roller coaster ride, while I was totally fine all day yesterday, on going to bed at midnight, the pain started up and just got worse and worse throughout the night. By 5.30am I had to give up and come back downstairs. I took 50mg Tramadol and 2 paracetamol but 1½hrs later, it was a lot worse. I'd tried ice and moist heat but neither helped so ended up taking another 100mg Tramadol at 06.20hrs after which I crashed out (surprise, surprise!) and was relatively pain free. Needless to say, I slept all morning and didn't rouse till early afternoon. Hey ho!

 

[Josephine]

Re: driving after a TKR: not so long ago I phoned about 4 different insurance companies including AA, Churchill, One Direct and Admiral and asked them what their stand was in these cases. All said they had no policy but relied on the common sense of their clients not to drive if they didn't feel fit enough but that it would in no way invalidate a policy.

Had another rough day. Knee very hot and painful. Feeling very yucky, mouth like the bottom of a bird cage and a mouthful of food or drink made me very nauseous. So rang doctor who made a house call and examined leg. Is pretty sure it's neither a DVT or infection but just 'tissue kinetics'. What? Never heard that one before! But apparently it's the scientific term for the mechanism of controlled cell deletion, otherwise known by thee and me as healing! Still I was relieved to hear he was pretty confident it's neither of our most feared nightmares. But he had been prepared to phone the surgeon and pack me off to hospital as an emergency had he thought infection was a possibility.

Feeling a bit better this evening so thought I'd just drop in and explain my absence. But oh for a comfy settee or bed!

 

[Josephine]

Are you eating properly and on time?

No I wasn't eating. I had nothing to tempt me, despite a packed larder, fridge and freezer! Putting a bit of anything in my mouth just made me heave.

Second, are you resting as much as you should. i noticed that one day you posted a lot---were you sitting in a chair? or in bed with your knee up and a lap top on top of a pillow on your stomach? If the former--no wonder you had pain.

Trust me, Kelly, I am resting plenty. And I do my computing on my recliner with the leg flap up. I have a cantilever over-bed table which is extended with a 3 foot length of hardwood that reaches over my legs so I can pull the laptop close whilst I'm resting.

I seem to have been having a good day and a bad day but these last two days have been better. In bed all night, slept well, only first night had to take pain meds in the night. That night I gave up about 5am and moved downstairs to the settee. I took my duvet with me and was so focussed on not getting my feet tangled up in it, I was half way down before I realised I was actually going down sequentially and not one step at a time! I was amazed! The next two nights (Mon and Tues) I had good nights in bed with no pain meds. Today I have done laundry and needed no pain meds at all. When I took the laundry upstairs to hang out, I went up and down normally!

My last dose of anything was 10pm last night! It's now almost midnight and I've needed nothing all day. This evening was a bit uncomfortable and needed to use an ice pack but even those are used infrequently now.

And need I remind you all, tomorrow I am 4 weeks out! Assuming this keeps up, I plan to go see the chiropractor on Friday as my back and neck are getting stiff. I also have ITB and hamstring issues which I've had since early this year and they are now really giving me gip! This will be my first drive out. My neighbour's worried about me doing this and wants to come with me! If she was a driver, I might say yes but she's not so what's the point!