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TKR Left Knee Replacement

Eire1

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I had a total left knee replacement on the 28th of September 2021 in a South Eastern hospital in Ireland.
I am female (59) , 5ft tall and obese. I was diagnosed with Psoriatic Arthritis and osteoarthritis many years ago which led to me ending up as bone on bone requiring a full knee replacement.
Week 1-4 progress was as expected, extremely painful but meeting all goals regarding extension and flexion, only one PT session in week 3 where I was told to use 2 crutches outside, one crutch/walking stick inside for a few days and then walk inside without support. I had no difficulty doing this up to week 5.
Week 5 while walking inside at a normal pace I heard a small pop in my knee, 7 paces later my leg collapsed under me- no pain just suddenly wasn’t there. A few hours later pain started and the knee has continued to give way every 2 days or so.
As my OS was unavailable I saw another surgeon who after viewing X-rays said he believed it was due to weak quads and to focus on exercising them more. The pain levels kept increasing, not able to sleep at night no matter what position or bed or recliner I used. Pain is focused behind the knee on the outside edge and radiates downwards to curl around the outer ankle bone, sensation is burning “electrical “ feeling. If I try to sleep on my back the back of the knee burns, going on either side with pillows burns at the outer edge of the knee.
My next hospital appointment which was just before my week 7, I was given blood tests, X-rays and an ultrasound, all of which were clear. I was told I could remove my TED knee high stockings and I was given a prescription for OxyContin 5mg slow release, 1 every 12 hours to help with pain. I had been prescribed OxyContin up to week 3 and had moved onto Ixprim 2 four times a day which I had been lowering the dosage on.
When I removed the TED knee high stockings my legs were white for over 12 hours, my right leg had a temp of 34.6 degrees and my left leg could not be measured as the temp was too low to be registered on the thermometer- this was 12 hours after removing the stockings. The stockings never fit correctly being too long and ending up folded under my foot. The Oxycontin 5mg allowed me to sleep for approximately 4 hours but that was the only benefit to it, no real pain relief other than that.
I saw my OS yesterday , 22cnd of November 2021,I am just in week 8 now. She was very happy with my flexion and extension and said she thought the knee collapsing was down to the muscle fearing pain so just giving way- she believes it will stop in time and that I was to stop exercising for flexion and extension and to really go back to taking things easy. She continued the prescription for the OxyContin for 2 weeks and I am scheduled to see her again in 3 months.
I just feel that since the implant is fine that they are ignoring the other symptoms and I will just have to suffer for the next 3 months before they even start to look at it. With regards to PT, I have had 3 appointments in 4 weeks, they really seem to be stumped and are now recommending visualisation to work on the quads( I don’t believe in this at all!) I have bought a Beurer EM49 which is a TENS, EMS and Massage machine, using it every day at a comfortable level to help with pain and quad exercise.
I am just so frustrated at this stage as prior to week 5 I was proceeding perfectly and this set back has really thrown me for a loop- I am also panicking as I only went ahead with the knee replacement due to my husband being currently stable with his heart problems BUT it wouldn’t take much for him to end up back in hospital again- I thought at this stage I would be in a position to help out more.
Any help , guidance and opinions would be gratefully appreciated.
 

Carol Anna

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So sorry to hear about your set back. I am not knowledgeable enough to offer much advice and I am sure someone more experienced will come along to help but just wanted to offer my support and understanding. I hope you get this resolved soon.
 
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Eire1

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Thank you for your good wishes, it helps
 

Jaycey

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@Eire1 Welcome to BoneSmart! I agree with your OS. Back off on all the exercise and activity and focus on ice and elevation. You need to give that knee a rest. See if this all settles with this gentle approach. If not, I would try and see the surgeon again for further diagnostics.

Here are your recovery guidelines:

Knee Recovery: The Guidelines
We are all different, as are the approaches to this recovery and rehab. The key is, “Find what works for YOU.“ Your doctor(s), physiotherapist(s) and BoneSmart are here to help. But you have the final decision as to what approach you use.

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
ice
take your pain meds by prescription schedule (not when pain starts!)​

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

5. At week 4 and after you should follow this Activity progression for TKRs

6. Access these pages on the website

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.
 
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Eire1

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Thank you for the links, I will read them all.
 
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Eire1

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I have read all the links , most of the suggestions were things I was already aware of and doing but I didn’t know anything about how the Paracetamol (Acetaminophen) made the OxyContin more available to the body. I normally wouldn’t use it even for a headache as I find it doesn’t work for me BUT I am using it at the moment along with the OxyContin 5mg slow release. The only information I previously had about this just said some Drs prescribe Acetaminophen as standard treatment following a TKR, there was no information regarding its beneficial action in combination with the OxyContin.
I suppose the most confusing aspect of my setback for me is that up to week 5 everything was fine and then suddenly without any notice or contributing factor my muscle decides it’s now afraid to move and starts collapsing the knee- I would have thought it would have been a lot more afraid at the beginning !
 
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Eire1

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Well here I am at 1:37 AM Irish time, my OxyContin 5mg already worn off and my sleeping over for the night. I decided today to use just one crutch in the house so long as I don’t feel like I’m going to fall- I have spent over 5 years using crutches to get around and have to admit I hated going back to them after my setback. I am going to be smart about it though and if I feel unsafe I will go back to using 2. It has been nice today having a free hand available to carry things instead of asking my husband to help me. You feel like it’s progress again!
I also cancelled my forthcoming PT session, there didn’t seem to be a point after the OS told me to rest and try to let the muscle heal. I have found your BoneSmart position on PT and taking it slow very interesting and am adjusting how I approach my healing. I was definitely one of the “no pain no gain” types, always pushing myself but there is no way to power through this so it’s time I just “go with the flow“
 

Jaycey

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Unfortunately sleep problems are a part of this recovery. Nap during the day if you can! The good news is that it is all temporary.

Glad the slow and steady approach is working for you!
 

Jockette

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patriciad

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Just wanted to offer my wishes for a speedy recovery from your setback. I had a setback at 3 weeks. It’s all on my thread and I did have a couple of instances where I felt my knee start to buckle and I thought I could fall. In my case it was aggressive physiotherapy that caused internal tissue to become inflamed. I was checked out and prosthetic was sound - when swelling went down after 2 full weeks of back to basic rest, ice and elevations I had not regressed re Rom and extension. I had no more PT and have made good progress but that setback was very scary and made me feel depressed. Hopefully your setback will be temporary too. I did a few leg lifts daily to help the quads and have not had any problems since. Good luck and try not to worry.
 
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Eire1

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Thank you Patriciad , I have read your posts and I found a lot of inspiration from what you went through. You have my sympathy for the loss of your dog- I have 4 rescues , one of which has ongoing issues with pancreatitis so we take it one day at a time. They dont like the crutches and seem to know I'm injured so they are extremely careful of me- good mornings are a delicate lick on the ankle of my good leg! At least they distract me during the day.
Yesterday I seemed to have overdone it while using the single crutch, was moving around more and ended up having a very painful night. Hopefully tonight will be better.
 
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Eire1

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Ok, it’s 2AM Irish time and sleeping is pretty much over for the night. The knee has been increasing in pain levels, I am not overdoing anything, in fact being like a complete and utter slug all day- resting, elevating etc etc. With my husbands encouragement I have decided to go to my GP next week whenever I can get an appointment, it’s been over 3 weeks of seriously cutting back in exercising and using R.I.C.E. without any noticeable improvement and since it will be more than 3 months before I can see my OS again I know I need to explore other options regarding pain relief and sleep. I am currently back on OxyContin 5mg slow release twice a day with 1,000 Acetaminophen 4 times daily- I do have a back up of Oxynorm 5mg that I can take for breakthrough pain but the quantity is limited and I am not keen to use it frequently.
I think my increasing pain levels are more to do with neuropathy having previously experienced it many years ago- not a nice thing, that tingling burning electrical sensation. I ended up having to do nerve blocks twice because it wasn’t taken care of in time following abdominal surgery. When having issues following carpal tunnel surgeries Gabapentin was used with success to settle down the nerve pain.
Christmas is just around the corner, it’s my favourite time of the year- I would normally bake and decorate my Irish style Christmas cake, gingerbread house, Christmas pudding etc etc etc. Everything would be homemade, the house decorated inside and out, neighbours children over for baking and homemade sweet treat days, all the old family Christmas traditions. Here in Ireland the dinner would be the same as your Thanksgiving meal with roast turkey, baked ham, potatoes and stuffing- the only thing different would be no sweet potato dishes. This year I have decided to be smart and to take it very easy and buy everything in, no visits from neighbours due to COVID, husband will roast the turkey and the slow cooker will take care of the ham! The planning and ordering of all this in advance is keeping me focused on slowly moving forward with my recovery while still anticipating enjoying the holidays- Christmas here starts the 1st of December to the 6th of January, Little Christmas or Women’s Christmas- it is the day the women are suppose to eat, drink and be merry while the men take care of everything, very old Irish tradition.
 

Rubyroo

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Good for you on making adjustments to your menu & deciding to make some of it easier for you & your hubby cooking wise. When it’s all said & done- the most important thing is being with the folks you love & care about. I’m getting ready to jump on board for knee knee #2 December 10th- so soon I will be experiencing again many of the things you are going through. I am hoping you will get some relief from pain and sleeplessness soon. Hang in there :ice:
 
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Eire1

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Thank you, the very best wishes on your forthcoming surgery!
 

Jockette

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Thank you for sharing the traditions you love in Ireland. It’s always nice to hear about the different ones in different countries. Even though you are not feeling as well as you’d like, I hope you will still be able to enjoy things, though maybe on a smaller scale this year. You’ll be doing great next year!

I hope your GP will be able to give you some medications to settle things down for you.
 

Jaycey

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@Eire1 So sorry you are dealing with this pain. Yes do try and get into see your GP. It sometimes takes awhile to get the right "cocktail" for pain management.

Good that you are scaling back on the preparations for Christmas. Remember that all this is temporary. Next year you will be back to doing all the activities you love.

Hang in there!
 
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Eire1

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Since I seem to be complaining a lot I thought I might start a list of the items/ actions that I have found useful over the past 8-9 weeks.
1. Clothing- very loose very soft trousers/ shorts. You will live in them for at least a month immediately after surgery and the last thing you will want is anything itchy or scratchy rubbing off your wound. The wider the leg the better so you can ice the wound, apply lotion etc.
2. Soft fleece blanket- if you are like me you won’t want to have any weight on the leg, I spent the first 6 weeks sleeping (as much as I was able to sleep) on top of the bed with the fleece blanket lightly draped over. Of course it depends on time of year and if you feel the need for the little bit of heat the blanket can bring.
3. Leg Lifter- My PT called it the dog lead, it is like a flexible loop with a handle that you use to lift your operated leg up with. I actually got mine in the hospital because the hospital bed at the lowest setting was still too high for me to get into and out of as was the PT bed. It saved me calling a nurse to assist me all the time and I used it a lot once I came home. It was also a helping hand when doing the exercises at home in the beginning.
4.Raised Toilet Seat- This was a must for me at the beginning, the toilet was too low for me after surgery causing me to painfully bend the knee, the raised seat made it so I could keep my leg straighter until my flexion was at 90 degrees and I could use the toilet comfortably.
5. Folding table- when you get home first you will have the one chair you can sit in comfortably and I can guarantee you it won’t be a dining chair. The folding table is invaluable for meal times, being on a computer, even just to hold your meds etc. etc. Definitely worth getting if you don’t have one already.
Just going to continue my list…
6. Cushion- when you feel able to use a dining chair put the cushion behind you- it will push you a little forward so that you don’t sit with the back of your knee at the edge of the seat. I found when I wanted to sit at the table my leg would get very painful just behind the knee and the edge of the seat of the chair would press in, the cushion pushes you out just enough that you have space for the back of the knee. You can also use a cushion on the seat itself if you find the chair is painful at the back of your thigh.
7. Walker- All of us start out using the walker just to get around and after a couple of weeks discard it for crutches or a walking stick. Provided you have the space I would recommend keeping it close to where your favourite chair is, it gives you something sturdy to grab in case of a wobble when rising from a seated position in the first few weeks , it can be used during exercises as a safe hand hold and if you have dogs it can be used as a protective shield for your operated leg- they are far less likely to try to jump on your operated leg with the walker in front of it!:dogsniff:
8. Rice- yes it’s not a spelling mistake I said rice not R.I.C.E. ! If money is tight and you aren’t in a position to buy/hire an ice machine you can make your own cold pack with rice and 2 medium/large zip lock bags- just fill 1 bag with uncooked rice, seal with as much air removed as possible , place bag with sealed edge down in other bag , sealed and put in your freezer for at least 2 hours. The rice moulds to you same as any standard ice pack but make sure you use a towel/cloth between your skin and the bag. Refreeze after use. Do not eat the rice once you have finished icing your knee as I’m sure the constant defrosting and freezing isn’t the best for it.
 
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patriciad

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I love your suggestions and tips and agree with all. I slept on top of the bed with very light blanket for first month at least.
So sorry to hear that no improvements despite RICE for past 3 weeks and am keen to hear what your GP can offer. I have a couple of other suggestions that helped me with the nerve pains and sleeping.
I know this is going to sound crazy but wrap your leg from above the knee to end of scar with Cling film when you go to bed. It doesn’t have to be multiple wraps - once around will do and make sure it’s not too tight above the knee. I did this with both knees and it gave amazing relief. It was suggested on here when I was suffering with my first knee and helped tremendously with the shocks and tingling of the nerve pain. There is a video somewhere here and I’ll try to share the link.
Sleeping - my surgeon recommended Melatonin and it definitely helped but once I was further along and only taking 1000 mg of Tylenol (Paracetamol) a night I changed over to the Tylenol with a sleep aid and that made a big difference. It’s only 500 mg so I would take one of those and 500 mg regular to get me where I needed to be for pain. Personally I didn’t find the stronger opiate type of pain meds particularly effective and I didn’t like the side effects.
Tramadol and Tylenol together worked best for me on a schedule one of the moderators suggested - it’s on my feed I think. At 5 weeks I rarely had to take Tramadol- we are all so different are we not?
I so enjoyed your description of an Irish Christmas- my grandparents were from Cork and Clare and I grew up in England. I’ve been in the States for 30 years but still create a traditional Christmas Turkey dinner here with all the lovely accompaniments. I used to have to make my own Xmas pudding and cake but the world has shrunk and I can buy them all here now at a speciality store.
You will enjoy a scaled down year this year but be back to better than normal by next! Have patience it’s a lengthy recovery.
 

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