TKR Meecies musings (questions, comments, maybe some venting here and there too)

[Layla]

Hopefully that's not the case. It might be best to focus on where you are right now, rather than jump ahead.
It would be unfortunate if you're denied surgery. If that happens, you can research ways to manage the situation as far as pain and mobility. Some type of gentle exercises or PT to remain comfortably mobile. Use assistive devices where helpful, find ways to manage pain, through meds, injections, topical and alternative treatments. If it's for medical reasons work with your physician to see what you're able to do to improve your condition. Seek additional opinions and hope another offers new insight if you were denied for a health reason. If cost is the issue check hospital financial programs, Medicaid if eligible, nonprofit hospitals that offer charity care.
@meecies

 

[Layla]

Those of you who used a recliner after TKR (or any surgery)

Do you already have one, plan to purchase or rent one...have the space for one?
Obviously they take up space when you're in the reclining position.

Lift recliners are great. Manual recliners require arm / leg strength, and strength varies from person to person for many reasons, one being the amount of muscle loss in those that were unable to remain active and strong pre-op.

It is not advised to spend a lot of time in bed post op. You need to be up and moving often enough for good circulation, to help with stiffness and to avoid DVT's. You should be up every hour or two and usually a trip to the bathroom or to the kitchen for a drink or snack will suffice in the early days.

When up / sitting, you need a firm supportive arm chair. As far as upholstered furniture goes, FIRM, as opposed to squishy cushions so you're not sinking into the furniture, or straining to stand up. Chair arms help with getting up safely. Avoid low sofas and chairs. It is difficult to truly get "toes above nose" while sitting in a chair, but even some elevation is helpful in reducing swelling. Inexpensive furniture lifts can be purchased at many home improvement stores and Amazon for furniture that is too low.

 

[Jamie]

for anyone who did NOT use a recliner-

where did you spend your time when you were not in bed?
and how did you keep your leg elevated?

I spent my time either on the bed napping or on the couch with my leg elevated with pillows. That was before I knew about Lounge Doctor, which is what I purchased after both my knees were done. If you layer pillows like we show in our elevation article, that is inexpensive and works just fine. Sometimes I even just hoisted my leg up on the back of the sofa for elevation. I did try to spend increasingly longer times sitting in my dining room chair with arms. Straight chairs with arms are better than an upholstered chair because you can sit up straighter and you have the arms to help you raise and lower yourself. I iced with large gel packs as much as possible wherever I was.

 

[meecies]

There is no way I can afford surgery. It's impossible. When I see the surgeon or rather, his care coordinator, she will know and understand that immediately, but I'll see him anyway to see what he has to say about how the joints may deteriorate and roughly how much longer I might have before I am no longer able to get around or just exactly what he thinks will happen next. he will be angry because he only wants to do surgery and he has made it clear that he feels I'm wasting his valuable time trying to find a way to get by without it. The OS last year did not say it will just keep getting worse. I don't know how it could, I mean, the cartilage is gone.

Ah, but you hear all sorts of things and most of it seems to be based more on what the teller believes or wants to believe- than anything even remotely resembling the truth. Too many people don't want to say "we don't know" too many people have something to gain or can't open their minds to other ways of thinking about something and cling to their misguided notions and try to apply them to everyone else.Too many people think they know what another person's life and experience is or "should be" and can't accept that everyone has different experiences and different resources and different knowledge about the world they inhabit. Too many people believe that others should not consult google for information, but then they rush off to google to try to prove someone else wrong (this one really kills me!!) Too many people believe they have some special insight into something and can't wrap their head around the fact that they do not know it all and never will, nor can they accept that at times they will be wrong. Too many people are only looking out for what matters to them. Too many people want to control the narrative at all costs, and don't even realize how much of their bias and true intentions are revealed in doing so.

 

[benne68]

the OS last year did not say it will just keep getting worse. I don't know how it could, I mean, the cartilage is gone.

It absolutely CAN get worse. Bone rubbing on bone can cause multiple other problems, ranging from increased pain and disability, to collapse of the joint. Take a look at this article for more information:

What are the risks of delaying my knee replacement surgery?

Patients delay knee replacement surgery for a number of reasons, mostly out of fear and misinformation. The risks related to delaying knee replacement surgery often involve the deterioration of the joint, increased pain, and lack of mobility. Learn more.

bonesmart.org

 

[IndigoKnee]

I’m sorry to hear that it might be that you will be denied surgery and hope that is not the case. I’m sure the surgeon will not get angry as you fear. He will surely want to find a way round for you.

Obviously not ideal to manage without. I did have many years prior to my knee replacement with no cartilage and rubbing bone on bone. I did manage to get around with a heavy duty knee supportive wrap and using sticks. However, lets hope that you are able to arrange surgery. Let us know what happens.
Best wishes

 

[meecies]

It is not advised to spend a lot of time in bed post op.

Chair arms help with getting up safely. Avoid low sofas and chairs. It is difficult to truly get "toes above nose" while sitting in a chair, but even some elevation is helpful in reducing swelling.

These two statements seem to contradict each other. if you need to be toes above nose, how else is that possible without being in a bed? Or a recliner that lays flat, with pillows to elevate? How often and for how long would you need to have your feet elevated?

Moving around is a given, but I've heard you can barely stand to spend more than 5-10 mins at best on your feet at first, so that means that at least 50 mins of every hour will be spent either sitting (probably not advised if you need your feet up) or laying in bed.

 

[Jamie]

When you’re in recovery, there is a balance you must find between the amount of time you spend lying down with your feet elevated to the max and time spent sitting up where the elevation is not as great. We discourage people from actually doing their lying down in bed because that tends to put one in the mental state that they are “sick.” Instead, it’s encouraged to sit in a recliner or lie on a couch where you can recline, but you’re not in bed. You need to get up each day, get dressed and spend your day in whatever recovery areas you have set up in your home. Especially in the early days, it’s not advisable to spend your day sitting in a chair, even if you do elevate your feet. Does this make more sense now?

 

[Layla]

No one is going to lay around toes above nose 24/7. You don't want to spend too much time in bed for several reasons. Number one being increased risk of blood clots. Lying around slows circulation especially in our legs. This can increase the risk of blood clots which can be life threatening should they travel to your lungs. You're not doing your muscles any favor either as our muscles weaken when we're not using them. You will feel more stiff if you spend too much time laying around, which will reduce your ROM. Then there are the mental health reasons as well as possible digestive issues since digestion slows with immobility.

There is normally a mix of napping, either in bed or on a recliner, or sofa, sitting upright on a chair, recliner or sofa, walks to the bathroom or the kitchen to get a drink or snack, showers, and walks around your home. Mobility is important to promote circulation. Toes above nose helps reduce swelling which reduces pain and pressure. You need a balance of both.

 

[meecies]

Especially in the early days, it’s not advisable to spend your day sitting in a chair, even if you do elevate your feet.

Ok so not in bed, but not in a chair. If those are your only options, then what?
Every where I have looked it says repeatedly that you will not be able to tolerate much time on your feet, so what do I do, become a bat and hang upside down? Obviously I would be getting up to walk at least once per hour- especially since I have acquired nephrogenic diabetes insipidus and drink and pee a lot..but that leaves many hours of the day.

 

[Jamie]

If you don’t have a sofa or recliner as an option, then obviously you will have to use your bed to recline and elevate during the day. You will still need a balance between the reclining location and the sitting location so that in the early days of recovery you’re not sitting or standing a majority of the time.

 

[meecies]

You need a balance of both

Doesn't really answer the question of what the balance is, I assume that as time goes by it will be less painful to spend time standing/walking (hopefully that happens very quickly) At what point do the vast majority of ppl manage to spend more than 10 mins out of every hour on their feet? At what point can you spend 15 mins standing/walking? I was told I could not walk the 1/4 mile to the drs office at 4 weeks post op. which is literally a ten minute walk.

My choices are sit on bed, lay on bed, sit on hard kitchen chair, no arms-why would I need arms on the chair? there aren't any on a bed, so how do ppl get out of bed? I'm not trying to be difficult, this just doesn't match up with the videos of folks who are recovering from TKR (there's a LOT of them) and it doesn't match up with what I've read on this forum either. The vast majority of ppl say they were too tired and dopey/drugged to do much more than sleep off and on for the first 2 weeks for sure and a huge percentage of those said the same about the next 2 weeks or more. At least 2 ppl I know slept in a recliner day and night for a month (and were on oxy for that entire time)

I am not one to lay around much. I sleep 6 hrs at night. Hopefully the doctor's nurse will have some handout on how much to elevate, how much to ice, how much to sit, etc, for avoiding blood clots, sitting on a hard chair for long periods seems pretty risky. Seems like having your feet up even if you need to be laying down in bed, is a much better option. Obviously you're doing ankle pumps and heel slides and whatever else they want you to do.
I do these all the time now (just for muscle memory and to be in the habit)

There are ppl who have no living room furniture. Would you like a photo of my place?
I still think I'd be safer on the floor, but apparently getting up off of it would be hilariously difficult. But if you fall.... you're going to have no choice but to figure it out. Seems like it would be a good idea to figure this out in advance. I know at least 4 people who fell after their TKR (not ppl on the internet, ppl in real life that I either bowl with, or play cards with, or do yoga with etc) One broke her foot and shattered her pelvis-ended up with lots of hardware. Another one had a fractured femur, and the other 2 were pretty badly bruised but otherwise ok. Falling after a TRK seems to be fairly common.

I was in a full straight leg long cast (covering my entire foot to the very top of my thigh) for well over 6 mos. I was able to get up off the floor. I could not put any weight on my right leg, the cast was not a walking cast (I only had a walking cast for the last 2 mos) I did fall flat on my back once in the snow (was a bit drunk) and needed help but only because I was drunk and laughing too hard to figure out the steps to take to get up. This is the only frame of reference I have. I must try splinting my leg to see what I'd need to do to get up. Admittedly I am 50 yrs older now LOL but I think with a chair nearby this should be do-able. I'll try it tomorrow, that should be good for a laugh at least.

Your leg must work just fine right after surgery if you are able to get up and walk to the bathroom and climb stairs, you must be able to bend the operated leg at least a little which is more than you can do with a full straight leg cast. In the videos of people in the first days and weeks after surgery they are walking around and no one is moaning or groaning or grunting in pain (I always make funny noises when I'm in pain so it seems odd to me that these folks are silent) so I'm guessing it can't be all that painful. They also walk pretty fast. People who have a TKR disappear for a full 6 weeks. Every. single. one. I must know of at least 50 people who had this surgery but I've never been able to see any of them in those first 6 weeks. That's kind of scary you know?

Met a guy at PT who was at 6 weeks and wasn't using a cane, but he limped on the operated leg and on the bike, he just did a half a revolution and then went backwards. I sat right beside him on the other bike and he never got the pedals to go around once. All of this is very confusing to me. He didn't appear to be in a pain. His knee was not especially swollen, maybe a tiny bit bigger than the other leg (he was in shorts) IDK what to think. He said he didn't want any company for those first 6 weeks, but he does have a wife.

 

[meecies]

I spent my time either in bed napping or on the couch with my leg elevated with pillows..(elsewhere you said We discourage people from actually doing their lying down in bed because that tends to put one in the mental state that they are “sick.”

so you must have been feeling sick, I guess.

lucky you had a sofa though.

 

[meecies]

I did have many years prior to my knee replacement with no cartilage and rubbing bone on bone. I did manage to get around with a heavy duty knee supportive wrap and using sticks.

I don't need any kind of supportive wrap and do not use canes or sticks, walk upstairs without using a handrail, no problems at all and can walk 2 miles in about 45 mins.
My knee sometimes swells a little if I'm walking for a couple of hours but not so much you can see it, so I ice it and its back to being fine pretty quickly,

how many years were you using a brace etc?

why was the surgery delayed so long?

 

[IndigoKnee]

Lots of questions here. I had a TKR two years ago and certainly my leg did not work 'just fine' immediately after surgery as you suggest. I do not have a recliner and although I got up and dressed every day after having my breakfast at the table I did go and lay on (not in) my bed and elevated my leg using a stack of pillows. I then got up and walked around a little later, sat at the table again for coffee and later for lunch. I was spending 5-10 minutes on my feet a few days after surgery, walking round every hour. After a few days I walked round out of doors but using crutches and very carefully. My operation was in January so initially if it was wet or icy underfoot I didn’t go outside but kept walking indoors and doing my exercises. Bear in mind that what is a 10 minute walk pre-op will take much longer for a while afterwards so that’s probably why you were told you couldn’t walk to the Drs office.

 

[IndigoKnee]

I wasn’t using a 'brace' just a soft support . I waited many years for surgery. That’s what the NHS is like.

 

[LorAll]

After my THR I had to go back to the hospital because my knee was so swollen, I could not bend my leg. When I was in emergency they thought I had a knee replacement.
Everything was ok, I was told to ice and elevate. I definitely was on my legs too long. So I say everything in moderation, but laying in bed would not be good.

 

[meecies]

I had a TKR two years ago and certainly my leg did not work 'just fine' immediately after surgery as you suggest.

What was different about it? I gather you need to move more slowly (this makes me nervous as the bathroom is as far away from my bedroom as is possible in my small place- imagining not making it there on time! eep)

I mean, there are a lot of videos of pts just one to 3 days after TKR showing them standing and walking with no support (some of them) and some with just a cane-and they are not younger patients. If you check who is making these videos they are almost always done by a surgical practice...and the patient is always asked how they feel. it gives the illusion that TKR is not big deal and you'll be walking just wonderfully right away
which is probably not true and they don't mention the nerve blocks you may have been given that wear off in a couple of days, or other meds that you may be on.

I was spending 5-10 minutes on my feet a few days after surgery, walking round every hour

Was it easier to walk or to stand still?
I want to be able to stand at the sink and the stove to make simple things like steamed veggies and to wash up a few dishes.

I did go and lay on (not in) my bed and elevated my leg using a stack of pillows.

How many times did you need to elevate and ice? I've gotten the impression from friends that they had an ice machine on all day long, and that they spent almost all their time with the leg elevated if they were not sitting to eat or use the bathroom or doing their little walks

Ah, I never lay "in" my bed, not even to sleep. I sleep on top of a bedspread and if I feel like it, toss a throw blanket over me. Have always needed to have my feet uncovered and hate getting tangled up in bed clothes etc
Still having a hard time picturing what those first few days and weeks will be like but I guess time will tell.

 

[meecies]

After my THR I had to go back to the hospital because my knee was so swollen, I could not bend my leg. When I was in emergency they thought I had a knee replacement.

Wow! That's scary! How long did it take for the swelling to go down? It must be hard to ice after hip surgery- I'm guessing the incision (if anterior) is still off to one side, so keeping an ice pack on it must be a chore.

 

[meecies]

For those of you who live alone- what was THE most helpful thing that others did for you during the first weeks or months after TKR? And or before the surgery? Not necessarily all the time, but which if any of these were esp helpful to you?

These are just some suggestions, please add your own! I know it will vary based on what is important to you and also based off your own circumstances.
Did you want/need someone:
To shop for you?
To take out the trash?
To cook and clean up?
To run errands to get meds or other things?
To call you and see if you're ok?
To help keep track of medication times and remind you or wake you up to take them?
Help getting in and out of the shower?
Visiting to break up the day and to keep from being bored?
If you had no family or friends nearby to help, did you hire someone and if so, how did you find someone suitable?

Pre-op?
Help arranging furniture and/or getting the supplies you needed for surgery, especially if you are not able to drive or get these delivered?