Revision TKR Lovetocookandsew’s long road to recovery

[KarriB]

They would have liked me to use a walker, but I used a cane. I was allowed to bear weight, but not bend. Originally the dr said no bending for 2 weeks, but then the seeping began again and I wasn't allowed to bend until the seeping stopped, my leg was in an imbolizer for a month. I saw my OS twice a week for a month and every appt I asked him if my knee would bend. Right after the TKR my attention was all on bending, then it was on not bending, so I worried. He always answered that the knee would bend when we told it to bend. And it did. The knee was stiff, but thankfully my OS prescribed non-aggressive bending which he modeled by pushing my foot a few inches with his foot. Those were heel slides for the first few weeks! I started walking with a slight bend and then each week tried to bend it a bit more while walking. After a month I was able to go the whole way around on the bike.

 

[lovetocookandsew]

Thanks. I'm just reading through your thread. Are you having your left knee done at some point still? Luckily my left knee is fine, although I am getting some twinges of pain in it at times. I think it's from walking funny now and limping a bunch again due to the pain in my right knee. I'm hoping to only be in the hospital a day or two, but won't push myself too hard as I know all the problems I have with oral pain meds that send me back to the ER multiple times. I seem to do much better when I stay in for 4 or 5 days on IV pain meds, then go home on orals for a few days. But when I need them for weeks, as in the TKR surgery and an upper spine surgery I had a number of years ago, I really have a lot of problems. I am always torn between being home in my own bed with my own food and my own recorded television programs, and being in the hospital where they can control my pain with fewer adverse reactions by my body. It's a huge dread I have, and I never know quite what to do.

 

[lovetocookandsew]

I'm not sure if it's a guy thing or a surgeon thing, but they sure don't say much at a time...lol. I asked my OS for details about IV antibiotic therapy (length of time, how long in the hospital, exactly how they do it long term, etc) and he replied, "You'll be on IV antibiotics for 6 weeks". I guess it's true that men say one word for every 10 words a woman says (or some similar ratio).

 

[Pumpkin]

length of time, how long in the hospital, exactly how they do it long term, etc

He only told you that you would be on IV antibiotics for 6 weeks, not how long you will be in the hospital. Some are able to go home with a ball of antibiotics an IV or Groshong catheter, or outpatient infusion therapy.

 

[lovetocookandsew]

@Pumpkln I know, right? lol. Thank-you for the info. I wanted to know if I'd be there a while, or a few days, how they do it at home if they go that route, etc. After reading here I suspect it's done at home through a PICC line, but didn't ask him about that specifically as I wanted him to explain what he does. But I'll corner him at my pre-op or sometime and get details, although I'd rather know sooner so as to be more prepared. I'm kind of anal about knowledge that way. I do better when I have all the details and can physically plan and mentally prepare.

 

[Josephine]

Or do you recommend PT here? I followed your gentle exercise advice after the TKR, but now I see you've changed that to no exercise, so am wondering what you think.

I now don't recommend PT at all. This changed from 'gentle' to none after my second knee when I made a conscious decision not to do anything and see what happened. I actually did nothing for my first one and got a good outcome. But this time I was more decisive about it and got an even better outcome. I don't think there was anything else particularly different about the surgery. I've spoken a couple of times at a surgeon's conference in the UK and the feedback I got from surgeons was that they are also thinking exercising invariably does more harm than good.

My OS did tell me the recovery will be harder than the scar tissue clean-up I had, but not as difficult as the original TKR

Well, he's hedging his bets then, isn't he? Doesn't want to say yes and too scared to say no!

I wanted to know if I'd be there a while, or a few days, how they do it at home if they go that route, etc

There is no hard and fast rule about it. Every surgeon has his/her own procedure for this and the variations can be quite extensive.

 

[KarriB]

@lovetocookandsew your OS may not have said much because in my experience the infectious disease dr writes the script for the antibiotic, picc line, oral antibiotics (I was on both) , home health nurses to come in draw blood for labs and change the dressing on the picc line weekly. My OS did not handle any of that. He did have OT/pt come into the house until I cancelled it because I wasn't allowed to bend anyway and didn't want to waste my insurance.
While in the hospital someone came by and gave me a list of home health companies to choose from.
You could check on infectious disease groups that take your insurance and work out of the hospital you'll be in to see who you'd like in case there is an infection.

 

[lovetocookandsew]

@KarriB Thank-you for all the info. I actually have really great insurance through Kaiser (my choice because I love it and have for 40 years), so they'll set it all up from there. I'll choose an ID, or my OS will, I'm not sure, but if I happen not to like him/her, I can always change to one I do like. I love the home health nurses and PT they send to my home-I have one PT in particular I love so I always request her. She's in agreement with the no pain philosophy, and is a great help overall. I won't have a limit on visits-whatever the doctor orders is what they'll do.

After my TKR, the original plan was home PT and home nurses for a couple of weeks, I believe. But I had so many issues it ended up at almost two months for both. It's going to be stressful...I get the clean-out and spacer exchange, then go home when I'm able, then wait a couple weeks or so to see if the cultures are positive. If they are, then it's IV antibiotics for 6 weeks. My doctor seems to think I have a good probability of a low grade infection, so it's quite possible I do. So, what I wanted to know from my OS was how it'll work since I'll still be recovering from the surgery. Would I have to go back into the hospital, if so, for how long, or do they just do it from my home, etc. I told him I'd pin him down for all the details if it is positive, or if after the surgery he is pretty sure it looks infected, I'll pin him down on one of his rounds. I do prefer to know all the possibilities and the related details well in advance though as I am a really organized person and love to have my ducks all in a row.

His preference if it is positive is a 2 stage revision but I really want to avoid that, so he has agreed to antibiotics for the 6 weeks and see if that works first. If not, we both know what has to happen then....

 

[lovetocookandsew]

@Josephine Thank-you for the info. Maybe he was hedging his bets, but I think it's more that he really couldn't say how painful and difficult it would be as everyone is different. He knows me well and knows my body always rebels to some extent the first days and weeks, so I think he wanted to answer my question but didn't really know the answer, so gave me the best answer he could. I like your no exercise philosophy and plan to follow it if I do end up with a dreaded revision. I don't know what this recovery will entail-but I will soon.

 

[KarriB]

An ID doc showed up in my room the day after my surgery. He was on call Thanksgiving Day, then I picked one from that group. I think they're as important as the OS when you're dealing with an infection. @PegGar16 is now going through the 2 stage revision and may be taking antibiotics over the long haul. The IDs really study the different infections and the best treatment. I loved that mine told me she consulted with her mentor with my infection. That tells me she is willing to listen, learn and take advice.
One nurse came out the day after I was sent home to deliver the pump for the IV antibiotics and teach us how to use it. My BFF has had multiple picc lines and currently has a port so she came to learn also. It was awkward for me to give myself the antibiotics because the picc was in my right arm, but I managed after a while. You have to learn to flush the line etc.

 

[lovetocookandsew]

How much did the PICC line hurt going in? It sounds quite scary and painful to me. I hate needles and the aspiration I had about killed me. I am to the point of being paranoid of big needles after that. Blood draws don't bother me, but the normal IV's do so they always numb me a little first. My veins like to hide so it's a bit more work to do, plus they infiltrate on average once a day with me so have to be done over and over....sigh. And was it painful to have it in all that time? I've been following @PegGar16 and saw that she's in hospital about to have a 2 stage revision. I feel for her, believe me and wish her an easy time after.

 

[KarriB]

So I'm petrified of needles and always ask for a butterfly when I'm getting labs done! For two days the nurses would tell me they were putting the picc line in and my BP would go sky high! But Sunday morning two picc line techs came to my room with a portable sonogram machine. They talked to me about my fears, my veins (I have really good veins and after they set all their tools up the woman on my left engaged me in a conversation about my job while the woman on my right inserted the line. Next thing I knew, it was in, I felt nothing! It didn't hurt once it was in either. When I had to have it pulled because of my white count, I just happened to have an appt with my ID, the nurse took it out and I felt nothing! There was nothing about it that hurt.
The biggest pain is you can't get it wet. So I used press n seal to wrap around my arm once the OS said I could shower. I wrapped two pieces around my arm separately to keep it dry.

 

[lovetocookandsew]

I'm glad to hear someone else is petrified of needles, and that the PICC line didn't hurt. I am scared to death of this whole thing, more so because I know more about what's coming. I get to the pre-op area with every surgery and the anesthesiologist sees me shaking like a leaf, my normally low blood pressure is sky high, so they always medicate me through the IV at that point. It usually knocks me out or close to it. Can you take a bath with it in? I don't really like showers, I'm a long soak in a tub kind of person.

 

[KarriB]

You probably could take a bath with it, but not sure you could take a bath with your knee. I wasn't allowed a shower for a month. If you go the antibiotic spacer route you aren't allowed to bear much weight on it. My OS told me if I had to have the two stage revision, I would only be allowed toe weight for the six weeks. I have 13 stairs to the main floor of my house, everyone in my family has stairs to their house or bathroom, so we were trying to figure out what I would do and where I would live for six weeks. We thought about driving through the yard and having a ramp into the front door. But in the end I didn't have to think about it.

 

[lovetocookandsew]

Oh, yea, I forgot my knee would still be recovering. Good news is this time he is going to use glue instead of staples! Last time they did 47 staples and almost every one of them had scabbed over to some extent. I was in tears the entire time as they were removed. My sweet nurse was wonderful as she took them out, but it was horrible. I guess I'm just a big baby and a bit of a pain at times.......

 

[KarriB]

I really had no time to worry or be scared of the surgery. I went to the Drs office and they sent me straight to the hospital. I was in pre-op a half hour later. It was probably better that way. There was time for my family to get to the hospital, meet the OS and ask questions then away I went. First question I asked when I woke up was, "do I still have a knee?" Then the post op nurses and I started talking about Black Friday shopping. I was the only one in post op so all the nurses were with me. : )

 

[lovetocookandsew]

Neither way is easy, but I think it would be nicer in some ways not to have to dread it for a long time.

 

[lovetocookandsew]

Well, it looks like I have a surgery date for my clean-out and spacer exchange. It's scheduled for May 17th right now, but that could change to a closer date as I am also on the cancellation list.

 

[Celle]

May 17th seems like a long way away. They're not treating it as urgent, then?

 

[lovetocookandsew]

As I've been thinking about that date, I've been thinking about asking my OS if we should wait that long, or if we should go ahead and do the aspiration. I thought it was a long time myself.