Revision TKR Mamie's Recovery Thread

[Jamie]

As long as your leg is swollen or in pain, you should not be doing any exercises in therapy other than gentle bends and stretches to keep the joint moving. You need to be doing that during the day as well every couple of hours. It is not good to spend all your time lying down. But Jockette is right....that old story that your leg will freeze up and scar tissue will render you motionless is not true. Just be sure you are doing some bends and stretches every hour or so and walk about 5 minutes every couple of hours. The important thing is to get your swelling down and keep pain at bay.

The medication that they may want you to taper off is Dilaudid. Ask them if you can try to taper it and instead use the Tramadol along with Extra Strength Tylenol for pain for a while. Most people will do well with 50mg Tramadol taken every 4-6 hours (not to exceed 300mg in 24 hours) and the Tylenol taken every 6 hours (not to exceed 4000mg in 24 hours). If you have any kidney problems, you need to ensure your doctor knows about that because it can impact how much Tylenol is safe for you to take.

If this assistant refuses to work with you on pain medications, ask to speak with the surgeon. The surgeon is your doctor, not the assistant. You can always try your GP, but it would be best to try and work with the surgeon to find some way to keep you comfortable as you're healing. You should never be in extreme pain. That hurts your recovery.

It may seem like you're worse for a while, but your knee and leg have been through a lot. I suspect your recovery may be a bit slower than normal and your surgeon should allow for that with what he expects from you. And, he should convey that to his assistant so she's not trying to treat you as if your situation is just a routine recovery.

Stay strong and stand up for yourself. I know that sometimes is difficult and it might not make the people you're trying to work with very happy. But it is your right to advocate for yourself. You are an equal partner in your healthcare and you have a voice. Don't be afraid to use it. Insist that each person you talk to give you logical explanations for why they want you to do something, weigh it with what you know about your own body, and then make your decision about what you're willing to do. The fact that your knee might need a little more time to regain ROM and get swelling down doesn't mean you cannot have success.

 

[Mamie]

Hello Dizzy!

I am so sorry you are in such pain after 6 weeks. Has your in-house PT been hard or did they push too hard?

My PT comes again tomorrow and I don’t look forward to it. She gave me difficult and painful exercises to do which I have not done.

One thing that helped me that :I Indirectly learned here may help you. I keep a journal and writr down everything I do each day. Maybe when you read what you have done in the day. Then you can see what your extras and back and back off. maybe it will help you. It sounds like you work hard. Do you now go to PT away from home?

You likely push hard enough on your own. Please don’t stress. I know your pain and I am just getting started. I learned in here from so many kind souls to vent and rid your. frustrations. This was a huge surgery. I hope you have help. Are you taking baby aspirin to help from clots forming. I think sometimes it helps me to feel better. Take care and if you do not mind, I will say a little prayer for you to find peace and pain relief. Frustration needs a place to go, so please share what else you need to rid of,

Please take care of you first.

 

[Mamie]

Hi pamsknees. Thank you for kind wishes for recovery. I’m happy you have had success. Here they are telling me (PT) that if I don’t do as they say my knee will freeze up and that I only have another window of five days to make the ROM needed at my stage. They also said that home PT can only be for 3 weeks and a more professional setting can help me better get to where I need to be. Makes a convincing argument, but I was hurt before and afraid.
Good luck.

 

[Dizzy]

@Mamie No, my in-house PT was wonderful and understanding. I am very comfortable with her. We have one more session and then on my own. My motto " one day at a time" ..hopefully without too much discomfort. THX for the prayer and I will reciprocate in kind.

 

[sistersinhim]

They also said that home PT can only be for 3 weeks and a more professional setting can help me better get to where I need to be. Makes a convincing argument, but I was hurt before and afraid.

Not true. Your knee and your knee only knows where it is supposed to be. This recovery is not a cookie-cutter recovery. Each person and knee is different!

 

[Jamie]

@Mamie .... don't worry if you are cut off from Home Health after 3 weeks. You can actually argue that with your surgeon if you care to. There is no Medicare requirement that it only is permitted for a certain amount of time. That's somebody's arbitrary requirement. But if it does stop and you don't feel ready to make a long drive to a therapy clinic, you can continue to rehab on your own and be just fine. We can guide you with some exercises to do. That plus walking and your normal daily activities will be just fine to help you get your ROM. You wisely recognize that if you started out before surgery at 60 degrees, you're not going to be at 100 or more in a few weeks after surgery. Stay strong!!

 

[InkedMarie]

Mamie,
YOU dictate what PT, if any, that you will do. If I was you, I would call around to various physical therapist offices and see if you can find a PT that does more gentle therapy.
Marie

 

[Mamie]

InkedMarie, I have found a physical therapist I have known for years and who openly states if a therapist inflicts actual, pain, quit, and run like hell. Discomfort is one thing but not outright torturous pain. IF I go, it would be at his clinic. But, I am inclined to just stay here. First off, its too hard to get up, dressed and out of our home, climb up in an SUV and drive 1 to 1-1/2 hours each way plus therapy time. I am totally wasted to go through that. I have allowed my leg to rest for the last two days and iced it like crazy. Today it feels a tiny bit better but improved no matter how small. The pain has driven up my blood pressure to stroke numbers or heart numbers. That scars me so I will not allow the so-called therapist to bring more harm. Today, one called for my appointment tomorrow. I told her my surgeon's office sent me straight leg raises and she said stop, do not do any of those exercises he has sent. Of course, my husband and I tried one and said no. I still cannot but barely lift my leg but it has only been one week. Each day it gets better. My surgeon expects me to get to 90 degrees by Monday. I will not get there as my leg and foot are still swollen and way too hot. Thank you all for your support. You are all in my prayers.

Jamie, and Sisterinhim, I spoke to my go-to doctor today and he feels Home Health for 3 weeks is not enough and will override the surgeon, but only if he has to for my sake. In the state of Washington, a new mandate has happened today due to Covid and the PT offices are changing what is available so maybe he-the surgeon-will have no choice but to allow me the help I need. Please know this surgeon is a great human and surgeon but swayed by his assistant, who has a bad freputation in the hospital with the nurses on how the aftercare goes with pain control. That is sad as I saw a glimpse of what appeared as a caring soul in her, and with a sense of humor. I believe he will also take care of my pain meds if the surgeon decides I should not be having any more pain.

 

[Mamie]

Jamie, your message had many helpful suggestions. I do spend a lot of time in bed but only to try to get the swelling out of my leg and foot. However, I am up every two hours and walk for about 20 minutes and go through all of my easy-going but joint moving exercises.

The medication is all of them, Tramadol included. the surgeon wants to stop. My health is a real concern. This surgery was too hard for me. I am already in kidney failure as I believe I listed at the beginning, stage 3-sometimes 4. My blood pressure is ranging from 177 to 205 over 78 to 108. HR 90 and up. I am not well. Add a little depression from the pressure to do better and you get this soul fighting back!

I will recover and hopefully with a good outcome for my knee but it has to be much easier than is ordered. I believe I have said already that 7 days after surgery they sent me straight leg lifts with 10-second holds. They and 6 other exercises arrived this morning in an e-mail. Even a physical therapist laughed and said she was amazed asking me to please not try to do it.

I can't thank you enough for helping me.

Mamie

 

[Mamie]

Does anyone know how long after surgery you can walk without a walker or brace? I would sure feel better knowing expected. I know they vary by patients but there must be some rule of thumb so you can watch for hope and Inspiration. Thank you!

 

[Jockette]

Like you said, we are all different, so don’t compare yourself to anyone else. It’s wonderful for stability. Plan on using it for at least several weeks. Don’t transition to a cane until you feel ready. I used my cane for months, longer than many others. I just felt better using it.

 

[WhenImOld]

Does anyone know how long after surgery you can walk without a walker or brace? I would sure feel better knowing expected. I know they vary by patients but there must be some rule of thumb so you can watch for hope and Inspiration. Thank you!

Everyone is different, and honestly it varies day by day. I'm almost 6 weeks out. Some days I wake up, try and stand up and question exactly how badly I need to actually use the restroom. Some days I can go a mile and a half without even a cane.
It's frustrating, knowing that I'm not in control of how my leg behaves and what I can do. But we'll both get there!

 

[Celle]

Does anyone know how long after surgery you can walk without a walker or brace?

As the others said, there is no set time. Everyone is different. Some people give up the walking aids early and some late. A lot depends on having enough muscle strength to support the new knee.
We've even advised people who have problems with their gait to keep using their walker until they can walk without a limp - and that can take several months.

Walkers, canes, and braces are just tools, to help support you and your knee. There are no prizes for giving them up early and the danger of giving them up too soon is that you risk having a fall.

 

[Dizzy]

I used a walker until I felt comfortable and secure using a cane. I always have big fear of falling! I used a cane in the house until I felt secure not to. Still use a cane when going out. It is a personal decision based on your own personal comfort.

 

[Jamie]

You need to ask your surgeon how long he anticipates you having to wear the brace he gave you. As I recall from your post about it, it had something to do with extreme swelling and foot pain. Has that improved? I would think you'll be able to discontinue the brace as soon as it does, assuming you can put weight on your leg without problems. I think if you bring this up with the surgeon or your therapist, you'll find out what the plan is and know what you're working toward.

The use of a walker, crutches or a cane is another matter. It's important to stay with whichever of those tools helps keep you safe and stable as you regain strength and a normal gait. A walker especially can be very beneficial as it allows you to focus on your gait completely and not have to worry about stability. The number one thing you want to avoid is a fall. None of these are forever, so try not to worry about this time where you need the assistance to get back to normal.

 

[Mamie]

I’m not in a hurry but this morning I laid here trying not to wake my husband who was so tired. It’s no easy job being a caregiver as they tire out too. As I looked at my legs with the compression wraps, and the ice wraps I was wishing I did not have to go potty. I had a bad night with pain and extremely high blood pressures so we were up until 4 am and it was 8:30 not wanting to get up. That’s why I asked.

I also wonder if others are in a brace too. I do not remember being in a brace before. It’s so much work several times a day taking it on and off.
Have a great day.

 

[Jamie]

The brace is not routine with a joint replacement. This is why I suggest you talking with your surgeon. There was some other issue that I suppose was connected to your post up swelling and foot pain that made a brace necessary. It should be a very temporary thing because you need to be able to move your leg freely when walking. That will be one of your first goals....to do whatever the surgeon feels you need to accomplish so the brace is history. Then you can focus on your recovery.

The fact that you had extremely high pain last night is not good. If you were taking the maximum amount of your pain medication and still had the problems, you need to contact your surgeon and let him know. That level of pain will ensure you continue to have inflammation and swelling that also contributes to pain. It's a bad spiral and you have to get the pain under control to break the cycle. Please don't let this continue.

You mention high blood pressure. What was it? When you talk with the surgeon's office, be sure to tell them of this problem as well as the pain.

 

[sistersinhim]

I used a walker outside of the house for at least 6 weeks and then the cane another 6 months or so. I even used my walker at 5-weeks, my first checkup after my tkr. My OS never said a word about it. I've always believed in taking extra precautions. I have fallen many times and two of those times led to surgeries. You don't want that, so use those devices as long as you need to, to keep safe. It's so much better to be safe than sorry!

 

[kneeper]

But, I am inclined to just stay here. First off, its too hard to get up, dressed and out of our home, climb up in an SUV and drive 1 to 1-1/2 hours each way plus therapy time.

Sitting with your leg down in an SUV for an hour and a half is likely to make your knee blow up before you even get to PT. I know I found time with my leg down was a recipe for swelling in those first weeks.

I told her my surgeon's office sent me straight leg raises and she said stop, do not do any of those exercises he has sent. Of course, my husband and I tried one and said no. I still cannot but barely lift my leg but it has only been one week.

Exactly so. Being able to do a straight leg raise (even an inch or so) comes at different times for different people. Each of my knees was different. So no worries there.

 

[Revision lefty]

Hi Mamie I had my revision on Tuesday and came home yesterday Thursday. I’m on a good pain regimen, resting, icing and taking short walks around the house. My Pt came today, he asked if he could push my leg back, I said absolutely not. And he was ok with it. Slow and steady wins the race this time. I’m praying things get better for you, Rest, ice and elevate. God Bless be well!