TKR Larry’s LTKR Recovery

[SusieShoes]

While I think the pure BoneSmart way will benefit almost every joint replacement, it’s also the case that some knees — primarily because of the people involved — recover very well indeed with an exercise regimen of carefully managed strength work. If it’s working for you then keep doing it.

We just need to step in with a warning because members and lurkers who come to this forum often are struggling with knees that are swollen and painful and are looking for ideas on how to have a better recovery. For them machines are not a good idea.

Sounds like you’re doing great, Larry! Keeping Righty strong in prep for surgery will pay off in recovery. No one ever says they wish they hadn’t exercised.

 

[Larryhg3]

Hi all,
Just came back from my first vacation since my LTKR. Coming up on 6 months post op (8/14). We spent ten days at the lake which was my first time in the water swimming since the surgery. I went really really easy basically just floating and bending/straightening my leg in the water. You guessed it, feels like I tweaked my IT band and hip flexor muscle. No pain in the knee itself just my left hip. Live and learn. At this point in my recovery I am slowly resuming my summer activities and paying attention to how Lefty feels about it. Any good hip stretches you all can recommend would be greatly appreciated.

 

[Celle]

This article may help:
ITB (ilio-tibial band) issues and treatments

 

[Larryhg3]

Hi All,
I had Righty done this morning. Apparently my pulse oxygen level did not bounce back as well they would have liked so I spent some quality time with the Recovery Room staff. It also earned me 4 hour checks by respiratory to monitor it. Translation no sleep for Larry tonight.
PT has already been in to evaluate me, they measured extension and flexion. No touching just measuring. I have now freaked 2 nurses and a Physical Therapist out because I completely engaged my quad and dis a straight leg raise. My quad is alive. The 2 nurses said “just understand that while we understand why you “ needed” to do that there is a price for that paid in pain”. On the pain management side they changed that protocol which is confusing to me. Last time for the first 2 weeks I was 10 mg of oxycodone every 4 hours with the option of adding another 5 mg if I felt I needed it. This time I am on 4 mg dilaudid every 3 hours with 2 Tylenol and Gabapentin (not clear on dosage every 6 hours. I will be staying on top of pain management for certain. The no bend terrorists have already attacked me and removed the ice from under my knee.
Apparently they have adjusted the protocal for release since 7 months ago and they want me home tomorrow instead of Friday like last time.
Out of energy for now will try to not be a pain but will try to keep you all up to date. Thank you all for the patience guidance and support.

 

[Jockette]

Great report! As long as there are no complications I think the sooner you get home the sooner you can recover the way you want to!

Best wishes!

 

[Celle]

Welcome to recovery again, @Larryhg3

Things seem to be going well so far.

Here is your post-op reading again - as a refresher:
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. Here is a week-by-week guide for Activity progression for TKRs


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

Please don't be overwhelmed by the list. The articles are not long and they and contain information that will answer many questions and help you make your recovery much easier on your knee and on you.

We are here to help in any way we can: answering questions and concerns; supporting and encouraging you from start to finish.

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.

 

[Larryhg3]

Thank you Celle. I am certainly changing my approach this time around. I am going to spend much longer lying with legs elevated. I am absolutely not going back to work even from home until week 8. I am giving myself that time to worry about my knee. The company has been there 75 yrs they can afford to lose me for 8 weeks.

Found out today that they switched me to dilaudid because they finally noticed that I react to codeine badly. Basically codeine makes me extremely jittery (like drinking a pot of coffee and a red bull together). I wonder why I was never able to sleep while taking oxycodone ? This has been listed in my chart as an allergy for 20 years.

Plan for today is PT at 8:30 and 11:30 then homeward bound for me. I just have to,prove to them I can navigate the 8 stairs to get into my house. I actually got a couple of 3 hour naps in over night block wore off for sure so @ 3 hours it lets me know that it is awake.

 

[SusieShoes]

Hi Larry! Happy to see you’ve returned for Righty’s adventure. I hope you get to go home today and settle into another great recovery.

 

[sistersinhim]

Home is a wonderful place to be! Be sure you have the correct meds before you leave.

 

[Larryhg3]

Came home today after two rounds of PT. Very easy stretching exercises nothing strenuous at all. Basically they want to make sure you have some simple stretches, can get into and out of the car, climb stairs and have help for the first few days. While doing the seated heal slide during the second session I felt a pop that hurt for a minute or so. The PT said “That was probably a tendon popping back, regardless it hurt no more for you back to bed.”

My nurse today was a horse’s butt. He started first thing saying that I should begin right now cycling down my pain meds. This is Day 2 mind you. I asked if he had ever had joint replacement he said no but his opinion is that pain meds are dangerous and should be used minimally. I was allowed 2-4 mg every 3 hours I tried the 2 yesterday it was not sufficient. Every time I asked for my pain meds he would come to the room ask what dose I wanted , shake his head when I said 4mg and proceed to take 30 minutes to bring my meds. At one point he was in my room 5 minutes prior to when I was due, I asked for my meds he looked at the board and said you aren’t due for 5 minutes call me then and left.
At my discharge he said you have been given opioid pain medication by week 2 you should be managing with Tylenol. “State law doesn’t allow your doctor to prescribe past that”. I got home and called my doctor and asked what their policy was on pain meds. The PA said “Larry you just had total knee replacement yesterday you shouldn’t be worrying about this right now. Our policy is in your welcome packet. We will manage your pain with gradual decreases for up to 3 months after your surgery. Now go lay down and rest”

Sitting in bed with my legs up on my lounge doctor. I hope the home PT who is coming tomorrow says I can use it.
Sorry for the ramble. So far so good.

 

[Celle]

At my discharge he said you have been given opioid pain medication by week 2 you should be managing with Tylenol. “State law doesn’t allow your doctor to prescribe past that”. I got home and called my doctor and asked what their policy was on pain meds.

That nurse is an idiot. I think you should report him and his attitude.

Sitting in bed with my legs up on my lounge doctor. I hope the home PT who is coming tomorrow says I can use it.

@Larryhg3 - It is your home, your bed, your lounge doctor, your life, your recovery, and your knee.
You don't need the permission of your PT for any of those.
He/she is there to offer advice, but you have the right to choose whether or not to accept that advice.
CONSENT: what it means and how it can be used
Saying no to therapy - am I allowed to?

You are in charge of your recovery, so set your limits on what you will, and will not, do during PT.

As long as you are elevating correctly, you can do it as much as you like:
Elevation: the do's and dont's

You can ice your knee at the same time as you're elevating - Ice to control pain and swelling
As long as you have something between your skin and the icing medium, to prevent frost bite, you can ice as long as you like. You do need to ice for at least 45-50 minutes for it to be effective.

 

[Jockette]

hope the home PT who is coming tomorrow says I can use it.

If you are comfortable on the lounge Dr, use it. It doesn’t matter what the PT says. It’s your knee, your decision.

 

[sistersinhim]

Sitting in bed with my legs up on my lounge doctor. I hope the home PT who is coming tomorrow says I can use it.

Elevating and icing is the best thing for you knee. Never mind what that PT says. We know what works because we have had the surgery unlike you PT!

 

[Larryhg3]

Funny thing about PT first thing out of her mouth “you have a lounge doctor I love that pillow for elevation”. We reviewed the gentle stretches, heel slides in bed, pushing my knee to the bed, abducters lying in bed ( like snow angels) short arc quads, long arc quads and seated heel slides. Cautioned me no more then 2 sets of 10 daily for now “plenty of time for more as things settle down”
Wants my leg elevated 2 hours for every hour I am up and about. Wants me icing 45 min to 1 hour at a time as often as is reasonable.

She also weighed in on where I plan on going for outpatient therapy saying “ in my opinion they are far too aggressive for replacement surgery”.

One thing that is new this time is I get a very painful popping feeling when doing seated heel slides sometimes. It is on the inside towards the top back. The PT at the hospital and the lady yesterday say that it sounds like a tendon popping trying to position itself. Both say if it happens stop that exercise for the time being.

I guess the point is not all Physical Therapists are bad and I won’t be disregarding their professional input without considering their side.

 

[Jockette]

abducters lying in bed ( like snow angels) short arc quads, long arc quads and seated heel slides. Cautioned me no more then 2 sets of 10 daily for now “plenty of time for more as things settle down”

At just a few days out of surgery this sounds aggressive to me, I wonder what she considers aggressive!

 

[sistersinhim]

“ in my opinion they are far too aggressive for replacement surgery”.

That PT is right! She sounds more on the same page as Bonesmart. Less exercise is more healing!

 

[Larryhg3]

Day 6 post op for Righty. Pain management has been a struggle. The meds that they sent me home with were simply not keeping up with it. Called the OS yesterday and asked to have it switched back to what I took for the first knee. The good news is that 18 hours after switching the pain meds my pain is back under control. The bad news is that his office gave me 2 days worth of them. I will have to call for a new script tomorrow and will have to ask that they ensure I have enough to make it through the weekend (can’t call on weekends no exceptions). During Lefty in Feb I never had this added stress, pain management was never a factor.
My days have fallen into a routine. In home PT comes in daily and works me through very gentle stretches. She has an extremely BoneSmart philosophy. At this stage she wants me doing no more than 5-10 reps of each exercise and never more than 2 times per day. I continue to walk around the house with the walker focusing on gait and form when walking. Icing,rest and elevation are my focus. Yesterday and Sunday she wouldn’t even let me do my stretches because my pain wasn’t managed and I wasn’t getting any sleep. I move around to get coffee, lunch and go to the bathroom. She won’t even measure ROM says those numbers are irrelevant at this stage.
The good news is that Lefty has stepped up like a champ so far. I get the occasional twinge but overall doing good.
Righty has had new challenges but I plan on following the plan. Going to have the BoneSmart conversation with outpatient PT during the intake process. If they can’t accomodate it I will find a PT who will. I chose one of the two best surgeons in my area for my OS ( other surgeons use my doctor). I chose one of the best PT clinics (again where PT and doctors go) for my rehab. I trust them both with my care. I know that my philosophy around professionals differs from those of many here, but my philosophy around the healing process doesn’t. As always I thank you for all of the support.

 

[SusieShoes]

I like what I’m hearing about your PT. What she said about not measuring ROM because it’s irrelevant right now is spot on. Exercise is good for the knee (not moving it at all would be a mistake), with the key being to make the exercise appropriate to where your knee is at. A good therapist is worth his or her weight in gold because they can assist in finding that happy balance. It’s different for everyone. You had success with an exercise regime for your first knee. You’ll learn what works for this one.

The pain control issue can be a problem for some TKR patients. A two-day supply is ridiculous for this surgery. I’m glad you have an OS with whom you can communicate and get added pain control (and the right pain control for you).

Glad to hear you’re doing well!

 

[Larryhg3]

Week 2 check up with PA at surgeon’s office. Follow up xrays look excellent staples removed as were the sutures where they insert the robot. Those would have dissolved but my doctor likes them removed to avoid unnecessary irritation. She eyed my ROM at @ 90 degrees and had me put my leg flat on the table...she couldn’t put her finger under it, raised an eyebrow and said wow. Said to make sure I am icing and elevating 2 hours up for every hour down. Warned me that technically the staples should not be out for 5 more days so “don’t make any cowboy moves”. My bruising is easing up slowly. Asked about the deep thigh pain, she said it is not the tourniquet rather a very severe deep muscle bruise. Said it can take 4-6 weeks to go away.
Also talked about out patient PT. The doctor’s stance is now based on function over numbers. Basically they don’t care about a ROM measurement number. I told her I will work hard at my PT provided it does not cause pain or swelling. She looked me in the eye and said sounds like we are on the same page. I told her that I will not allow anyone to push on my knee and she said “ nobody should ever touch you to achieve ROM”.
I left feeling really good about where I am and my path forward. I understand that many here don’t trust the professional community when it pertains to PT and post op but I trust the path mine have set for me. Next conversation is with the outpatient PT later this week. As always I am grateful to all who have shared their journeys here it gave me the courage to take control of mine.

 

[Jockette]

I SO wish I’d had a surgeon like yours. Shame on mine for hurting me almost every checkup, and causing me to mistrust orthopedic surgeons in general, and for my PTs who did the same.

I will have a very difficult time emotionally when my partial totally fails (and it’s never really healed well yet, at 19 months) and needs to be converted to a TKR. I get knots in my stomach just thinking about it.