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May 15 Left TKR

Discussion in 'Knee Replacement Pre-Op Area' started by TMWDeM, Apr 12, 2017.

  1. TMWDeM

    TMWDeM
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    Hello to all in this wonderful forum.
    After decades of knee surgeries (3 on left including a Hauser Procedure for Dislocating Patellar Syndrome + 1 to removed hardware, 1 arthroscopies to resect a blown out cyst, 7 on right including a Hauser Procedure-now an obsolete procedure- for Dislocating Patellar Syndrome, +6 more I hardly remember) I am finally at TKR.

    Fibromyalgia (FMS), chronic pain syndrome (CPS), Osteoarthritis (OA)/sero-neg Rheumatoid( RA ) make things a bit complicated. I do have issues with degenerating wrists. Right wrist has had 4 bone fusion, scaphoid excision + CMC (thumb) suspension arthroplasty, carpal tunnel release, trigger thumb release. Left wrist had Kienbock's Disease of Lunate where the lunate bone was actually saved (rare) by bone grafting from ulnar source, +carpal tunnel release, and a CMC (thumb) suspension arthroplasty. Some finger bones are also getting and may have to be considered for future . Right shoulder has also had 2 surgeries torn labrum and A/C impingement.

    Left knee TKR is set for May 15. Target for right knee TKR is July 15. MRI's have determined 100% loss in medial/central compartments of both, lateral compartments are 85% lost. I have had to stop prednisone therapy which is part of my many forms of my FMS/CPS/RA/OA pain management regimen, to prepare for surgery. Of course, the basics include ice, heat, whirlpool, and several meds Celebrex, and opioids

    I'm absorbing every article and resource offered by the experienced sources here, both professional and layman alike. Everyone has something wonderful to contribute in all of the threads I have read so far!

    OS and Primary physician are in communication to collaborate on pain management issues and I have been with both for over 10 years. Though this is first actual surgery with this OS- all other surgeries were by other OS or speciality OS.

    Thanks in advance for any ideas to make this easier to get to the other side of the road!
    Several patients here mentioned the Game Ready Cryo-Compression system. Discussed with OS who gave RX for me to order one. It arrives tomorrow. Yay! Will use right away to learn it before surgery and try to get the swelling/pain down now.

    Pain walking/steps/standing is really bad now, using cane sparingly to spare my wrists as much as I can.

    Power recliners for main and upstairs just arrived today- nice and high seats much easier to get out of.

    I have had an adjustable bed by RX for years for the other issues, so that is already in place.

    Cleaning, clearing, and trying to 'see ahead' how to make the house easier to navigate. Two steps in from front or garage. 2 steps to landing then 14 to upstairs.

    Putting a futon on a wooden riser base on main floor den for laying down by daytime. Installing grab bars in bathrooms.

    Pre-op is set, and signed up for free pre-surgery class on TKR offered by hospital.
    Whew. It is overwhelming. It's feels like trying to pack to go to the moon?

    I keep thinking about the many folks who I've heard say "I wish I would have done it (TKR) sooner", and hoping it is true.

    My friend knows a lady who had bilateral knee done last November, and she was able to play pickle-ball in February!

    I saw a woman at the clinic who was only 6 weeks post-op (by my OS) who I never would have guessed had even had a surgery.

    All good signs!
     
  2. SusieShoes

    SusieShoes FORUM ADVISOR Forum Advisor

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    Wow, you've certainly been through the wringer. Sure love your great attitude! I'm having BTKR on May 10 and am doing what you're doing: setting up things in advance. Kind of helps to keep that feeling of being in control, doesn't it? :heehee:
     
  3. KarriB

    KarriB FORUM ADVISOR Forum Advisor

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    Welcome to BoneSmart! Many TKRs use recliners throughout their recovery, so it sounds like you'll be good to go. You may need a toilet riser and possibly an elevation wedge or pillows to help with elevation. My favorite tool was the leg lifter. Take a look at other suggestions and ask away!

    Some of this information may help you to prepare:

    If you are at the stage where you are planning to have surgery but are looking for information so you can be better prepared for what is to come, take a look at these links:

    Recovery Aids: A comprehensive list for hospital and home
    Recliner Chairs: Things you need to know if buying one for your recovery
    Pre-Op Interviews: What's involved?


    Regardless of where you are in the process, the website and app My Knee Guide can help you stay organized and informed. The free service keeps all the information pertaining to your surgery and recovery in one place on your smartphone. It is intended to be a personal support tool for the entire process.

    And if you want to picture what your life might be like with a replaced knee, take a look at the posts and threads from other BoneSmarties provided in this link:

    Stories of amazing knee recoveries
     
  4. jboles

    jboles

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    I'm also having left TKR on May 15, right TKR in August. Just found out yesterday that I have a sensitivity to cobalt, so that brings up a discussion that I'm going to have to have with my OS. Sounds like you have really had some problems. I hope these replacements fix at least some of the problems for you, and me too! It sure is a lot to prepare and get ready. I keep looking around my house, wondering if I've thought of everything. I also have stairs to the bedroom, but my OS said it won't be an issue. I guess we shall see.
     
  5. TMWDeM

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    Thanks for your reply, Susieshoes!
    So you are 5 days ahead of me, certainly will have you in my thoughts and prayers.
    I keep trying to remember my lovely father-in-law, now gone, who had bi-lateral TKR's at the age of 84 about 1986--so the early technology at that.

    I still chuckle at some of the 'family disclosures' he gave out on his pain meds! :old: He said he had wished he had the opportunity to do them decades earlier they were so much of an improvement. He drove till he was 92 from the rural MN country into the metro TC! If he can do it, so can I! I am also fortunate to have a wonderful daughter-in-law (DIL)who is a RPT (Reg Physical Therapist)- she and my son live too far away to help daily- but when they visit for Easter she is going to do a walk-through of the house and tell me specifically what to change/add.

    I'm starting by making a list of all the things that I have had to give up, not do, or cannot do -but hopefully, with time -can do them all with two new knees. I will try to keep my eyes on the goals, and try to get through the rough times by looking at my list

    1-Get on the floor to play with my 3 beautiful grandkids!
    2- Bike the Cannon River Valley Bike Trail again- had to stop 3 years ago
    3-Hike the amazing 230 acre park trail that has a 3 mile loop trailhead off my backyard. It has hiking, mountain biking, X-country ski trails, and I have not been able to hike the trail in over ten years. It's right here, it's free and I simply can't do it.
    4-Get active enough to lose significant weight- I know there is a skinny person inside hiding. I have pictures of her!
    5) Walk down my 16 degree grass hill on side of house to the community meadow with my pooch.

    Those are all pretty big things that are realistic goals I think so I will leave the list there for now and add more as they come to me.

    Have a bright day, SusieShoes!
     
  6. TMWDeM

    TMWDeM
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    Thanks so much for your reply, KarriB! I appreciate all the information.

    Hmm- I have Wedges are in the basement- good idea. I will bring them up, clean them and get new covers ready to go. Have tons of pillows as before I had the adjustable bed I used 8 to sleep.

    I vaguely recall the old knee surgeries being taught by PT to use my "good' leg to lift the surgical leg and the cane lifter trick. Since I don't want to tax my right knee which is mechanically worse than the left that much to press my luck, I will look at the leg lifters- are these real things that you can buy on amazon or are they invented using other things? :umm:I will look at the links you sent, thanks!

    You had your TKR in '13- and then a 'washout'? That sounds scary. May I ask, Is your mobility good now? Do you still have pain and limitation?

    Have a bright day, KarriB.
     
  7. TMWDeM

    TMWDeM
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    Hi JBoles, Thanks for your post! We same day TKR's! I'm feeling same way- what am I missing? What more can I set up? Can I send someone in my place to go through the surgery?? :snork:

    My OS and his PA-C (I adore his Certified Pysician's Assistant! She is amazing, and I have bonded with her over the ten years with that clinic) both of them have said they will have me doing steps before I leave hospital. Both of them and my primary have said that I will be shocked at how much better the actual knee pain is afterward- the surgical pain is temporary- the junk knee pain is history.

    Having had bone surgery before - I know that the pain of that is pretty intense for me- and controlling it a challenge.

    Can I ask others how many days to ask hubby to take off work to be home with me after hospital release?

    I also have a 14 year-old Jack Russell Terrier (or "Terror" as the case may be-aka JRT) to get out to potty .

    If he takes the following week after surgery off, should I be able to manage alone starting the next week -week 3? Especially with the dog?

    Thanks for the post, JBoles!
    Have a Bright Day!
     
  8. KarriB

    KarriB FORUM ADVISOR Forum Advisor

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    If you scroll through the recovery aids you'll find quite a few pics and ideas. You won't need all of them. But I found pillows or a wedge helpful in elevating (you don't want to elevate with a straight leg), a leg lifter https://www.amazon.com/Kinsman-Ente...TF8&qid=1492098500&sr=1-8&keywords=leg+lifter, ice machine and gel packs for the back of my knee and grab bars.

    Below are the recovery guidelines. You can read through these before surgery, but they are extremely helpful.

    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
    elevate
    ice
    take your pain meds by prescription schedule (not when pain starts!)
    don't overwork.
    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. Here is a week-by-week guide for Activity progression for TKRs


    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.
     
  9. KarriB

    KarriB FORUM ADVISOR Forum Advisor

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    Lots of TKRs are home alone from the start, but if your husband can take off work I suggest the first week you're home. It can be difficult toting the ice machine you're going to use as well as carrying meals to your nesting place. If you are going to be using a walker it's helpful to attach a flat bottom basket from the Dollar Store to the front of the walker in order to carry things around the house.

    In regards to the ice machine, we found it easier to freeze water bottles to use with water instead of actual ice cubes. Just have enough to keep some in the icing machine and some refreezing in your fridge.
     
  10. TMWDeM

    TMWDeM
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    KarriB! Wow. GREAT tip on the frozen water bottles for the Game Ready! Thank you so very much. I was wondering if my fridge freezer ice maker would be able to keep with the need. Will start saving empty bottles now. I think you just save the life of my Kenmore! Yikes, I need to make room in my up freezer! Bottom is full of 12" PT-Grade Gel Freezer Paks as I will need those for my Fibro.

    The machine arrived 5 minutes ago by fedex. I wonder if I should ask my OS/PA-C for a PT order to teach me how to use it or is it pretty easy to figure out? I read one doctor's website where he has patients use it post-op 5x /day , 30 minutes on , 30 minutes off minimum with Passive Motion in between... I know I will be getting a PM machine for home.

    May I ask the group how they used the machine- how often, settings, best results, do's and don'ts, did it make a big difference in mobility, etc.

    Also, good timing- going to Dollar store today for Kiddies Easter basket things!

    Ok- hubby is set for taking off surgery day, the release day, and then 22-29th (Memorial Day)

    Also just learned that my daughter is coming into town on 22nd for work- she stays with us instead of hotel- only see her in evenings, but I'll take it.
    Extra motivation to keep my spirits up in that first week home! :flwrysmile: She always bring the 'sunshine' and is my biggest cheerleader on getting the surgeries. She said she cannot remember ever seeing me being able to walk without pain....she's 30-something.
     
  11. KarriB

    KarriB FORUM ADVISOR Forum Advisor

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    We've only had one person that I know of who's used a Game Ready, but lots have used a cyro cuff or other type of ice machine. Josephine, our forum nurse, says you need to ice for at least 40-60 minutes at a time. I'm not sure about the Game Ready because I think it uses compression (?).
     
  12. Arttie

    Arttie

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    Compression and cold water circulation. I'm going to ask my OS about it on Monday. I understand that it is NOT covered by Medicare. Not exactly cheap either.
     
  13. TMWDeM

    TMWDeM
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    Thanks, KarriB. Yes the Game Ready uses pneumatic compression settings of None/Low/Medium/High.

    I did send a query to my care team re: a request for PT to train me on the use and also for the care team to provide a written "Rx" of a pre-op use regimen and then a after surgery, the post-op home regimen they want to follow. I hope they will use one in the hospital also.

    Thanks for the link to the Kinsman lifter- it led me to another style that I ordered that will allow me to use forearms v. Wrist/hands the Kinsman 4 loop model:

    But why is the leg suddenly so heavy or unresponsive that a lifter is needed?? That's a bit frightening to me. I don't recall that kind of dead weight feeling with other knee surgeries (although it has been 15-20 years) - I can recall the soreness and stiffness, and using my "good leg' to help lever up into bed.
     
  14. Arttie

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  15. TMWDeM

    TMWDeM
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    Hi Arttie, that is correct pneumatic compression and cold water circulation . I bought mine outright and hoping for the best with insurance coverage under Durable Medical Equipment with the Rx's from OS and the fact the buying outright was cheaper by far for the duration of time needed for my two surgeries. Rental through the Game Ready website was $60/day, +$10/day for whichever sleeve (Knee in my case). My Rx was for 3 months post-op usage so around $6300 to rent.

    To buy outright ( do negotiate with a sales vendor - I got them to come down a bit) was under $3K. My understanding for the company is that some insurance companies do cover it with proper coding and written substantiations from the Care Team.

    I guess I was willing to gamble that on it being of substantial benefit for my pain control issues and hoping it gets me off a walker or cane sooner because of my wrists.

    There is some White Papers on their site. I cannot speak to the validity of them, or if they are weighted for sales purposes.

    I am hoping that my insurance carrier will cover and reimburse.
     
  16. KarriB

    KarriB FORUM ADVISOR Forum Advisor

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    If your good leg is truly good use it, mine was/is not so good. Some use a belt or scarf, but a friend gave me the leg lifter and it came in handy at home when I elevated or got in/out of bed, as well as getting in/out of cars. I know a few people used the crook of their cane, but I liked the security of the lifter. No one lifted my leg except me, I was afraid it would be dropped. I was just a little worried. :wink:

    This surgery is unlike other knee surgeries which is why the recovery can be long. Many have a heavy feeling at first and it can take a few days to a week for the quads to wake up which makes lifting the leg difficult or impossible for some at first. Once the quads are working you won't need a lifter as much, but I used mine often. I had an infection which required a second surgery and an imbolizer brace. At that point I would lift my leg by grabbing the Velcro bands on my brace. Even though I could lift my leg it was just quicker.
     
  17. TMWDeM

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    KarriB, thanks for that. Are the quads cut during surgery, or just 'moved around'? Like yours, my right knee is mechanically worse than the left, it is just screams more quietly than the left. I am ordering the lifter and taking the advice from those that have been through this.

    I also asked my OS what he plans to do with my patellar tendon which was relocated in the first Hauser procedure and he said that he will have to evaluate that problem during surgery. The Hauser was relegated to history as an unsuccessful method of controlling subluxation of patella because there were so many, many adverse complications and long term degradations of the patella and of the joint. It really could be at the crux of 40 years of knee pain, surgeries, altered gait and wear. There is only enough patella left to attach the prosthetic patella underside. And the way the patella tracked on the bone underneath left a spike on one side of the patella that is running in the bone. All due to the old Hauser procedures.

    Another one of the Hauser's claim to failure is that the quads are weakened often permanently. Scary that the procedure was done so pervasively in the 1970's and 1980's.
     
  18. TMWDeM

    TMWDeM
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    Arttie, thanks for posting that thread from MBrown- it is excellent reading. Is Mr. Brown still active on this forum? It would be interesting to hearing how it is for him today.
     
  19. TMWDeM

    TMWDeM
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    I just tried to add all my surgeries to a signature block --got alllll the way through and got a "you are not authorized to use this field" type error message! Wish I would have done a copy to clipboard! Yikes! I was in the signature section- all looked fine until I hit save.
    ?:gaah:
     
  20. Arttie

    Arttie

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    I'm curious too. Lets try this, @mbrown we were interested in the GameReady system and while discussing it started to wonder how you are doing now 4 months out from your TKR.
     

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