TKR LTKR 5 Nov; plan to make WISE rehab!

[Paradise06]

@skigirl - very astute comment as no two knees are the same. One just needs to keep an open mind and deal with stuff as it happens. I agree totally with you that knowing much more is fundamental to managing the issues that present themselves, ie swelling, pain etc. I know that I am very happy that I chose to come home directly from hospital (1 night pre-op, 6 nights post-op; this is France and medical coverage is fantastic!). However, my first knee was much more difficult that second knee, and I hadn't discovered this site, so would I have been able to manage at home? I don't think so. I think I would have been in tears a lot due to pain and not meeting my own expectations.
Anyway, a couple of questions:
1. Sleepless nights - I've been home a week today, and haven't slept well. Never did either for a month with first knee-one week in hospital, three weeks in rehab facility. Once i returned home after first knee, I did begin to sleep better. So, was that due to a month elapsing or other factors? I seem to wake up at 1:30am, then 3:30am, then 6am each night. I take appropriate meds during the night, just to stay ahead of pain, but really pain is minimal. I'm not tired during the day, and I'm really not doing much activity...mostly rest, elevation, ice, simple exercises, CPM, now taking two or three 10 minutes walks in the flat garden. I asked my PT yesterday, and she responded that pre-op I was a very active person, so post-op my body doesn't need as much sleep. Any thoughts?
2. Headaches - I've been waking each morning with a nasty headache and don't know why. Anyone else experiencing this?
3. Leg Support - I was required to bring a leg device to the hospital which was put on my leg post-op prior to any walking in the hospital. It is a device with 6 adjustable velcro closures, and stiff metal rods on back side of device. Its called an "atelle" in french which translates to a splint in English. It goes up and below the knee perhaps 12" in each direction and the knee cap is exposed. It keeps the knee quite straight. When I'm resting on the bed during the day its off, but I put it on before any walking. I also wear it at night sleeping. Yesterday I went to the PT, and forgot to put it on...got chastised by the PT! I was using two English canes, as i had to negotiate a ramp, a couple of steps, and PT office plus blood lab within same general area. I won't forget it again. I haven't seen comments on BS about leg supports....

BTW, I am managing the backseat of the car very well, for going to PT. Its a 15 minute drive each way, hubby drives, and PT session is a half hour three times/week. It feels really good to get outside in the fresh air and see people and the sites. No weather issues to deal with, as this is the south of France...we expect sunshine everyday! I'm glad its worked out this way, although I had originally wanted in-home PT, but that didn't work out. Plus, I adore the PT that I'm going to; she's experienced, competent, works on extension and quads, plus ROM, all just to a point of "that's enough!" from me, then a nice massage of the entire leg. Anyone who's reading this, and not feeling happy with their PT, either pushing too hard or not enough, should evaluate what's best for them. It took me a few trial and errors to find this PT, plus all the awareness that I acquired on this site helped me to know what is best for the knee.

Any and all comments most welcome, and good recovery wishes to all in the process.

 

[Josephine]

The Tramadol pills are 200mg each and the prescription says one AM and one PM, thus 400mg total in 24 hours.

Ask you doctor if you can have 100mg tablets instead. Can't do any harm - she can only say no!

I also cannot understand why they are requiring you to wear a splint when walking. Seems ridiculous to me - never heard of such a thing!

 

[skigirl]

LOL---that splint!!! I had a tkr just so I would not have to wear such a thing. I would not wear it---well maybe to the pt's office--because you want your muscles to wake up and start working---and a splint encourages muscle weakness.

I really slept well in my own bed right from the beginning, but many people have difficulty sleeping for the first month. So, it is a length of time thing!

Some opiods cause headaches---I think Tramadol can cause headaches.

 

[Paradise06]

@Josephine - thank you, I will ask OS for the Tramadol in 100mg dosage. BTW, you said the following regarding my inquiry earlier in the tread about the medication Lameline, which was the only medication offered post-op for pain greater than 5 on scale 1-10 while I was in hospital:

Never heard of it but my research says that Lamaline contains acetaminophen, caffeine and opium powder! Not something I'd want to mess with!

I agree with you, it isn't something I want to take. I did learn that it is produced in France (national pride perhaps?!) and is only marketed in France and Madagascar; thus no worldwide marketing. Not for me! I like more tried and tested!

BTW, I am American, not French and can see the pros and cons of both country health care systems. I do recall the WHO Report 2000 ranking health care systems: France was #1, UK #18, Canada #30, and US # 37; obviously there were different criteria, it was controversial, and they did not make the report in 2010.

I could use your advice regarding my Hemoglobin report one week post op:
Platelets: 734 (734,000/mm3)
Range of Reference: 150 to 400
My prior report one month before surgery: 335

I am having a daily injection of Lovenox. Do you have any comments or suggestions as to how to lower this?

 

[Paradise06]

@Josephine @skigirl The splint thing has me mystified. So glad I asked the question. There are three prominent knee surgeons locally and they all follow the same protocol regarding the usage of the splint. I'm going to take your advice Skigirl, and only wear it to the PT appointments, since she scolded me for not having it on. It provides stability, but is that necessary? Obviously not if no one else is doing it. Plus it absolutely inhibits walking properly, ie heel to toe, bend knee, straighten back leg. I had enough trouble re-learning how to walk properly after RTKR, which followed two progressive years of deteriorating gait.

 

[referee54]

I also cannot understand why they are requiring you to wear a splint when walking.

Me, too!

i have read of a few of our forum members who have had to wear them, but the vast majority of us never had to use one and were up walking without one either the same day as surgery or the next morning.

 

[Paradise06]

I'm just amazed about the splint; because everyone in the hospital and the rehab with my first knee was wearing a splint. I just did some internet research and came up with the following:

• Knee Immobilizer: The knee immobilizer (splint) is to be worn two weeks to maintain extension while sleeping. Knee splint is not to be worn during the day.

This came from an orthopedic association, pertaining to post-op procedures. It was the ONLY reference I found suggesting the use of a splint following TKR. There was plenty of evidence supporting the lack of usefulness long term of using the splint.

So, thank you all! I trust you and your knowledge and I won't wear it except to go to PT sessions, thus avoiding a
problem since the PT supports the use of the splint. It really does totally prevent proper walking.

 

[skigirl]

I love it---a splint which inhibits proper walking!!! I had to wear an immobilizer after ACL surgery--mostly because the surgery was in the winter and the doc was afraid I would fall. I never wore it inside the house. I hated the stupid thing and since I have fairly slim legs, it slipped down and bounced around my ankle most of the time!!!

There are lots of things here and in other countries that become the "protocol"--use off TED hose is an example. There are studies which show the TED hose have no value in the prevention of clots---yet some docs proscibe them for 3 weeks, 6 weeks and 3 months!!! How you could wear them that long baffles me!! The problems there too are that the top folds over the top of them--which hangs down so that you can see it and stops circulation at the spot where it hangs down.

I also see walker use promoted for up to 3 weeks while my doc thought they were useless unless you had balance issues. I used crutches outside the house for a week or so--but he told me they were not necessary.

 

[Paradise06]

@skigirl - I couldn't agree with you more about the splint. I've had the same problem of it falling around my ankles. Its a nuisance and certainly a hindrance to walking properly. However, in some cases wherein people have been walking poorly for a long time prior to surgery, its important to learn to walk once again in a correct manner. The splint hinders proper gain....so what would be the other side of the argument, meaning the pros of using the splint?

I stopped using a walker after a week. It serves its purpose initially but it also hinders walking correctly. I think its best to concentrate on balance, proper gait motion, walking on safe level area, and looking ahead, not down, which I have a tendency to do.

I've got the TEDs on when walking but question their value also. However, I did have my first blood test of platelets last week, and the number is very high, almost double the high side of the reference range. I emailed my OS yesterday but no response. So, I'm pursuing Plan B and contacting my primary care doctor and see what he has to advise.

Any thoughts or advice??

 

[Josephine]

To maintain extension? Oweee! As if this recovery isn't bad enough without having an iron maiden on your leg to boot! No way I would use one. Extension returns naturally as the swelling goes down. You don't need a splint. the very idea! I shall be asking my chap about this when I get my other knee done after Christmas!

About your blood results - that's outside my pay grade, I'm afraid. Sorry.

 

[skigirl]

Many people here take blood thinners of some kind after tkr surgery to avoid blood clots. There is coumadan---and I used a drug called Lovenox which was injections I did twice a day for 10 days. Others simply take an aspirin daily. Like everything else, it is all over the place!

 

[Paradise06]

Hi to all....I haven't added to my thread in a few days; just too busy doing heel sides and leg lifts! Actually, I have tuned in each day and been catching up on other people's journeys. All this info is so very helpful.
I read from beginning to end @Celle and found it fascinating. I too am experiencing an easier time with LTKR, second knee operation. You are ahead of me by about 7 weeks, so good barometer...yes, I know, not two knees are the same.
@Josephine @skigirl regarding the splint. I wore it to my PT session on Friday because she had scolded me for not having it on, and I didn't want to waste 5 minutes of my session being scolded. Interest thing happened; I arrived with it on, told her that people in the US and UK don't use the thing, I find it cumbersome and it certainly interferes with proper gait. She had a woman patient just before me, who was a few weeks ahead of me with TKR and she wasn't wearing a splint. She told the PT that her OS didn't use the thing. I think the PT had a moment of reflection, saw how good I was walking w/o it and just one cane, and she ended the session saying, I didn't need to wear it. Yippeee!
Regarding blood thinners, I'm on Lovenox and a visiting nurse comes to my home everyday to give me the injection (and change bandage every few days). Did I understand you @skigirl that you gave yourself the injection twice a day? and only for 10 days? You're right when you said "like everything else, its all over the place!"
I read with keen interest some comments Josephine made in response to a comment I made about MUAs on another person's thread. You stated facts and it is such an eye-opener. I did a c & p to keep the data in a journal that I'm keeping. I know you are planning knee #2 TKR after Christmas. It will be such an interesting read to follow your progress; I'm really looking forward to it! Bet you are too, pardon the pun.

 

[skigirl]

Yes, I also used Lovenox and gave myself an injection twice a day for 10 days. It is almost funny when I read of all the different ways docs treat tkr's. Some folks just take a daily aspirin---others are stuck on coumadan for weeks on end and then have to have blood levels checked really often since it is such an unstable drug. I refused to take it, which is how I ended up with Lovenox.

The most important thing with the knee is to know that you cannot rush the first month--you have to rest and do exercises sparingly. Ice and elevation are the most important as you get rid of the swelling and pain. By the end of the month, I was off opiods and had very little swelling in the knee. Then, I could begin to strengthen the muscles and found walking although my pace was slower, to be very enjoyable.

 

[referee54]

I love it---a splint which inhibits proper walking!!

The irony of it all!

There are lots of things here and in other countries that become the "protocol"--use off TED hose is an example

I had to wear those dreaded stockings for three weeks! Awful!!

Regarding blood thinners, I'm on Lovenox and a visiting nurse comes to my home everyday to give me the injection

I had to get Lovenox injections due to some DVT's---then I went on an aspirin protocol for several weeks. Thankfully, my wife is in the healthcare field, so she gave me the injections!

 

[Paradise06]

Thank you @skigirl and @referee54 for the input about the blood thinner. I apparently have to have it for 30 consecutive days. It isn't really inconvenient since the lovely visiting nurse comes to my home.

About the TEDS - I'm supposed to be wearing them, but honestly, since I'm spending a whole lot of time being a good girl, meaning in bed with elevation, ice, rest, meds, (tomorrow marks 3 weeks post-op), what's the point of wearing the stockings?? They are so difficult to put on, even my strong husband struggles to put one on operated leg...aren't they meant for compression when being active and up on your feet, ie walking? Yes, I do walk but it is short trips around the house, to the potty, kitchen etc. I will follow skigirl advice and get more active gladly, after one more week of inactivity and then step up the exercises and strength building. All this good advice has resulted in this knee operation going a whole lot better than the first knee, wherein I had big inflammation problems for many many months, partly caused by doing all the wrong things in the early stages. Wisdom is a beautiful thing!

So, do I wear the TEDs or not at this stage? and if so, on operated leg only or both legs??

 

[referee54]

They are so difficult to put on, even my strong husband struggles to put one on operated leg.

I am not sure how my wife did it, be she could help me put those dreadful things on in a heartbeat!

 

[Josephine]

I'm on Lovenox and a visiting nurse comes to my home everyday to give me the injection

Uh? Giving yourself the injection is such a weeny thing! And I had to do it for 6 weeks! I knw,I know - I'm a nurse so it would be okay for me - but what about the 1,000 of adult and children who have to give themselves insulin shots every day. Sometimes several times a day? No big deal really.

I read with keen interest some comments Josephine made in response to a comment I made about MUAs on another person's thread. You stated facts and it is such an eye-opener. I did a c & p to keep the data in a journal that I'm keeping. I know you are planning knee #2 TKR after Christmas. It will be such an interesting read to follow your progress; I'm really looking forward to it! Bet you are too, pardon the pun.

Journals are always a good idea. I've been known to convert some into charts with colour references to explain my problem to the doctors! Once or twice they've even asked to keep them so they can use them for other patients! My visual migraine one has been co-opted by 2 GPs and an eye surgeon in the past! Very effective tools.

About the TEDS - I'm supposed to be wearing them, but honestly, since I'm spending a whole lot of time being a good girl, meaning in bed with elevation, ice, rest, meds, (tomorrow marks 3 weeks post-op), what's the point of wearing the stockings?? They are so difficult to put on, even my strong husband struggles to put one on operated leg...aren't they meant for compression when being active and up on your feet, ie walking? Yes, I do walk but it is short trips around the house, to the potty, kitchen etc.

Even though you are being a 'good girl' with rest and all that, it doesn't mean you're not walking around the house as you said. That should be more than enough to fend off the dreaded clots! I wore my TEDS for precisely 4 days! And they aren't intended for compression. The elastic construction in them is supposed to copy the elasticity of the vein walls as they pump the blood back up the vessels. That's all.

I will follow skigirl advice and get more active gladly, after one more week of inactivity and then step up the exercises and strength building.

Please don't 'tep up the exercises' too much! And remember that your muscles aren't weak they are injured which is a big difference. Do read this Activity progression for TKRs