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TKR Left TKR November 13, 2019

Seatides

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Hi! I just found this site a few days ago and have learned so much from you already. I understand that I should start my own thread in the appropriate area and I'll do that. It's been 10 days now and so far, so good. Thanks for being here!
 

Crossfit

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Glad to hear you’re doing well. I had BTKR 11/14 and I’m doing pretty well so far too. This site is great isn‘t it?
 

Celle

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Hello @Seatides - and :welome:

Here is the recovery reading we give to everyone with a new nee - lots of useful and helpful articles here:
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
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

6. Access to 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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kneeper

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Hi :wave:Glad you found us.
 
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Seatides

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Thank you, everyone. I'm working my way through all the very helpful reading and have a question about pain management, please.

I feel that I've been receiving conflicting messages about pain medication (specifically, opioids). Before surgery all I heard was "Don't be in pain -- take your medication so you can do your post-op therapy." "Stay ahead of the pain -- don't wait until it hurts to take meds." "Take meds an hour before PT so you're able to do the therapy." I did this for the first few days I was home last week when I suddenly looked at my pills (Percocet) and realized that my prescription was for only about four days' worth of medication (I had 28 tablets and the label said "take 2 tablets every 6 hours as needed"). I didn't use the maximum, but when I noticed I didn't have many left, the in-home physical therapist was concerned that I wouldn't have enough medication to manage outpatient therapy after in-home was done.

So I called my surgeon's office and that's where I sensed some resistance to my request for more; the office staff talked about "tapering off." Meanwhile no one ever told me to do that, or how to do that; and if I did do that, no one ever told me what other pain medication I should use instead (when I called, the staff suggested extra-strength Tylenol). The surgeon actually called me later to discuss my request and said, "PT shouldn't hurt that much" (which I did read later on this site and discussed with my PT; stopping the painful techniques improved that situation a lot).

So the surgeon did prescribe me another 30 tablets; but now I'm trying to come up with the most effective way to use the Percocet and Tylenol (including timing and number of tablets) that keeps the pain at a mild to moderate level day and night. And frankly, I usually need the Percocet to relieve the nighttime ache I feel so that I can sleep (and I just hate sleeping on my back!).

I'll see the surgeon tomorrow for staple removal and can ask him more about this then. It just feels like, on the one hand, I'm being told to manage the pain to keep it at an even level so that I can do the therapy; but on the other hand, I'm also hearing that I should cut back on the opioid medication. This is fine with me, except that I'm no pain management expert! How do I do that? Is trial and error the only way to find what opioid/Tylenol combination works best for me? Also, am I being rushed to get off the opioids? There's so much opioid phobia these days that I suspect that even people who need them are discouraged from using them.

Thank you in advance for any insights and experience you can share. I appreciate it.
 

Celle

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It's too early to cut back on your pain medication.
When you phoned, you ere probably given a stock answer and not one specific to your surgery date.

Talk to your surgeon tomorrow about pain management.
 

Sara61

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Maybe @Jamie can give you an idea of what to ask your doctor- she was super helpful in my case, unfortunately we are all given prescription pain meds but rarely told in what sequence to take them.
I'm nearly 7 weeks post op and only now am I slowly reducing - there is no point being in pain it's just counterproductive.
PT shouldn't hurt at all, if it does then either stop it or tell the therapist to back off the old quote "no pain no gain" is a total myth for knee replacement surgery patients.
Wishing you a happy recovery x
 

Roy Gardiner

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"Take meds an hour before PT so you're able to do the therapy."
:bignono:
The surgeon actually called me later to discuss my request and said, "PT shouldn't hurt that much" (which I did read later on this site and discussed with my PT; stopping the painful techniques improved that situation a lot).
:yes!:

Excellent, sounds like a good doctor you have there. PT indeed shouldn't hurt, pain=damage!
 

Jamie

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I've probably missed providing this information to you prior to your appointment, but you still can talk this over with your surgeon at some point.

It would not be surprising to hear that the surgeon wants you off opioid pain medication after a couple of weeks. But stepping down to Tylenol sometimes doesn't work for everyone. Ask if he would prescribe Tramadol for you. It is not a controlled substance like Percocet and doctors are more likely to approve it for you. It can be combined with the Extra Strength Tylenol and that combination works quite well for most people. If your surgeon won't prescribe it for you, you might try your GP. They are sometimes a bit more understanding about having proper pain management in these early weeks of recovery.
 
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Seatides

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Thank you all for being so helpful! I saw the surgeon and the staples are out now. He told me to try to just use the Percocet at bedtime (it's so hard to sleep comfortably, which I'm reading here is common). I just don't find that the Tylenol helps enough. It's not that I'm in severe pain; it's more of a constant aching pain, along with tightness/stiffness, plus an inability to stand (versus walk) without a lot of discomfort. So I frequently ice and elevate, but don't always look forward to PT and moving!

And I keep tweaking: one Percocet at x time, then 2 tabs (1300 mg) Tylenol at y time; then sometimes the reverse. I found 2 tabs Percocet worked best for me, but I find myself avoiding taking 2 because of this pressure I feel to taper off it. Then I also realized that because Percocet has acetaminophen too, you have to avoid exceeding the maximum daily dosage of acetaminophen. I'm trying to find what works best for me so I can stick with it consistently.

i never anticipated that the pain management aspect of this would be causing me the most stress (at the moment, at least). I like the idea of asking my primary care physician about tramadol.

Also, related to discomfort, can you use any ointment or cream on the skin around the incision? It feels so tight and dry, like it's pulling and preventing straightening of the leg. Or is the tightness really from internal swelling?

I really appreciate this site. I look forward to being able to share my experiences with others. Thank you!
 

Jockette

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I read this that one of our other advisors wrote about tightness:

“Many members think PT is needed to alleviate tightness. Tightness is a normal occurrence after this kind of major surgery. Your surgeon did major carpentry work and disturbed every millimeter of soft tissue in this area. You aren't tight because your muscle is underused and needs to be stretched and rehabbed. You're tight because your tissue is healing...and full healing takes a full year or more.”
 
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Seatides

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Thank you, @Jockette! I appreciate that information. I tend to think that it must be me -- that I'm doing something "wrong" -- if something with my leg is bothering me.

For example: if I place a pillow beneath my knee so I can sleep, am I dooming myself to never being able to straighten my leg? Is it bad for your knee to sleep on your side (assuming I can find a comfortable position)?
 

Celle

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And I keep tweaking: one Percocet at x time, then 2 tabs (1300 mg) Tylenol at y time; then sometimes the reverse. I found 2 tabs Percocet worked best for me, but I find myself avoiding taking 2 because of this pressure I feel to taper off it. Then I also realized that because Percocet has acetaminophen too, you have to avoid exceeding the maximum daily dosage of acetaminophen. I'm trying to find what works best for me so I can stick with it consistently.
Percocet contains 325 mg of Tylenol/Acetaminophen in each tablet.
It appears that you're still using Tylenol Arthritis, which contains 650 mg in each tablet.

In the US, the recommended safe dose of Acetaminophen is 3,000 mg in 24 hours.

However, as long as you also take into account the Acetaminophen in other medications, such as Percocet, it is safe to take up to 4,000 mg in 24 hours.

But, you should never take more than 1,000 mg in any one dose and you have been taking up to 1300 mg. That's a bit too much for your liver in one shot, so cut it back.

Taking one Percocet (325 mg) , plus one Tylenol Arthritis (650 mg) would give you 975 mg in one dose,which appears to be safe. But Tylenol arthritis tabs are slow-release and their effect lasts 8 hours, instead of the four hours regular Tylenol lasts. That makes dosage calculations even more complicated.

I suggest you buy some Extra Strength Tylenol, which contains 500 mg of Acetaminophen and lasts for four to six hours. That will make calculations easier.

You need to get on a regular schedule of pain medication and not take your medications when you feel the need. I suggest you follow Jamie's advice, below.

Ask if he would prescribe Tramadol for you. It is not a controlled substance like Percocet and doctors are more likely to approve it for you. It can be combined with the Extra Strength Tylenol and that combination works quite well for most people.
Here are a couple of charts that suggest ways of setting up a Tylenol-Tramadol regime. The first chart is for four-hourly doses and the second is for 6-hourly. (Paracetamol is the UK name for Tylenol.)




The most effective way to take Tylenol is 2 x 500 mg tablets 6-hourly, to a total of 4,000 mg (4 doses) in 24 hours. You need to take it regularly, to keep up the levels in your bloodstream. If you just take the odd dose now and then, it's far less effective.

Check all other medications you're taking, to make sure there is no Tylenol/Acetaminophen/Paracetamol in them. If there is, scale back one or two of your regular doses, so you stay within that safe 24 hour limit of 4,000 mg.
 

Celle

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Also, related to discomfort, can you use any ointment or cream on the skin around the incision? It feels so tight and dry, like it's pulling and preventing straightening of the leg. Or is the tightness really from internal swelling?
yes, you can apply any sort of moisturiser to the skin around your incision. Just keep it well away from the incision itself. Much if the tight feeling is probably swelling, though.

if I place a pillow beneath my knee so I can sleep, am I dooming myself to never being able to straighten my leg? Is it bad for your knee to sleep on your side (assuming I can find a comfortable position)?
Putting one pillow beneath your knee is not a good idea, because it can restrict blood flow and may make you more prone to getting a DVT (deep vein thrombosis). Doing that won't condemn you to having a bent knee for ever, because you don't have to keep your knee straight all the time.

It's better to elevate your leg on three pillows, placed length-ways, as in this picture:
Images 2.PNG

You can see that the knee is bent slightly, but there is no pressure at the back of the knee.

No, it's not bad for you knee to sleep on your side, but you may not find it comfortable at first and you'll probably need help to get there.

You can lie on your un-operated side, with a pillow between your knees, supporting both your knee and your ankle.

Lying with your knee completely straight can be quite painful and it's not going to make any difference to your knee's eventual extension if you bend it a little while you sleep.
 
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Seatides

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@Celle, thank you for all this very helpful information! I appreciate it very much.
 

sistersinhim

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I lot of us have used the Lounge Doctor or something similar. I had two of them, one for my recliner and one for my bed. Since I was alone, I didn't have to worry about dragging one back and forth while using my walker!

As long as I was swelling, I used the leg elevator. It, along with icing, really helped to keep the swelling and discomfort down.
 
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Seatides

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@sistersinhim, I'm studying these leg elevators now at amazon.com. Thanks for the interesting suggestion!
 
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Seatides

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Thanks to all the great information and advice here (and no doubt also, to the passage of time), things have improved over the past few days. I'm feeling more comfortable in general and am sleeping better (although I've also noticed how I feel like I've regressed some days, and then much better other days, which you've all explained is normal).

May I ask another medication question, please? Before the left TKR 18 days ago, I took meloxicam for my OA. My right knee is also bone-on-bone and, as my new left knee becomes more comfortable, I'm noticing the old right-knee pain more. (Or maybe this is because I'm taking less Percocet and relying more on acetaminophen?)

I will ask my doctor this question, but will I be able to take meloxicam or something similar again for the OA soon? I've been anemic since the surgery, though, so maybe NSAIDs have to be avoided because of the GI bleeding risk? I'm still taking an aspirin a day as a blood thinner, though (and I'll ask the doctor how much longer I need to take it).

Thank you in advance for sharing your knowledge and experience!
 

sistersinhim

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My OS told me that NSAIDS slow down bone healing, so I stayed off of them for about 6 months. As my new knee took on more of my weight, my old knee started feeling better. Hopefully, yours will, too.

You should ask your doctor about the Meloxicam.
 

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