Revision TKR Multiple knee replacements

[DEL2021Feb-17]

@Celle Your list of suggestions is great however with a few exceptions I agree with all of them having been down the recovery path too many times. I did ask the Therapist at the hospital about ROM and while she did acknowledge that some swear by this practice the majority of patients ended up doing much better by allowing the Therapist to push for increased ROM. Since I seem to have continued success with allowing therapists to push for improvement I will continue.
One things is for sure pain stinks I just left a message for the Dr. to call me back since the pain is a little much YES IT HURTS!! a 5mg tab. of oxycodone every 4 hours is just not enough at this time. Later on yes but not now.

 

[Jamie]

From what I was told a larger piece was used?

The larger plastic spacer should do the job to "tighten" up your "loose" knee. By "loose" I mean the movement of your joint and not that anything was physically loose. I'm pleased to hear that your surgeons report both the femoral and tibial components are strong and solid. This is the best news ever! Your 120-degree ROM is excellent too and a factor of the swelling being minimal right now. Let's see if we can keep it that way by not overdoing things and keeping your pain minimized.

I did ask the Therapist at the hospital about ROM and while she did acknowledge that some swear by this practice the majority of patients ended up doing much better by allowing the Therapist to push for increased ROM. Since I seem to have continued success with allowing therapists to push for improvement I will continue.

I'll grant you that some people can do fine with a therapist physically manipulating their knee. The issue is how they do this. If your therapist is gently moving your knee into a bend and goes just to the point of mild discomfort for you, then you will probably be just fine. I hope this is what you're describing. What you must try to avoid is for the therapist to push beyond that so that you are experiencing real pain from the pushing. This will irritate your tender tissues and result in swelling. Please do not allow this to happen. Tell them to stop when you signal the mild discomfort. You'll know it's too much if you have significant pain and/or swelling in the 12-72 hours following that therapy session. That would be your signal that the pushing was too much.

One other point.....people sometimes think they should take pain meds right before a therapy session so they can do more while there. That is a bad idea as the meds will mask what you're feeling in terms of pain with the therapist's manipulations. You need to accurately feel any discomfort that is taking place so you can judge when to stop the pushing. A better plan is just to keep on a set schedule for your pain meds of every 4 hours and that way the medication will be consistently in your system throughout the day and night.

 

[DEL2021Feb-17]

I agree with what you wrote in the past a therapist would first massage my knee to get it loose then go for a final push. Granted this push would hurt it never hurt to the point I experienced increased swelling and pain. What caused the increase in pain and swelling was doing even more therapy once I got home. My first real day of therapy will be this Friday but it will be at home so nothing too dramatic. Really wish I was on something a little stronger knee pain stinks.

 

[DEL2021Feb-17]

@Jamie I maybe a veteran of sorts when it comes to knee surgeries but this does not mean I am immune to pain either. Granted the pain could have been worse but regardless it still hurts!! If you can suggest other ways to control my pain please do. Currently instead of taking pain med every 4 hours switched to 3, (asked DR.) Ice throughout the day. I leave the ice pack on a good 30 to 40 minutes. Yes, I do have the ice pack over the sweat pants, do not want to get frostbite, it happened once. When Icing, I elevate, when not icing I try and improve extension by resting my foot on my ottoman and let gravity aid with extension.

Going to bed I will either have a pillow under my leg if laying on back or if on my side have the pillow between my knees. It may not be perfect but it helps enough so I can get some sleep.

Never had any real luck with Tylenol in addition to pain med but figured I would try again. Still worried about infection although no signs of one. The reason for the worry, it seems knee pain seems to be going up but no temp. Knee is warm but not hot. Swelling has not really changed and no increased redness.

When I spoke to the on call DR. last night he said the pain should get better after a few days. My response (I do not think he agreed with me?) was considering how many surgeries I have had, it is going to take longer for my knee to heal than someone who has had only one surgery on the knee. Dr. Foster, (the one retiring), told me the last time I had a revision it would take longer, in fact it ended up taking a little over a year. Its amazing some of the less experienced Dr.s only know what they have been taught if what you say is different, you're wrong.

 

[Helizabug]

As I say all the time, I am not a doctor. And you have had more experience with your pain than I have, but . . .

I added ibuprofen to my pain medicine regimen when I had to stop the Oxycodone. It seemed to help, maybe because it was easing some of the inflammation and swelling. I kept taking the acetaminophen and wove in the ibuprofen three hours after each acetaminophen dose.

If you think this is a good idea, check with your doctor because ibuprofen taxes your kidneys and has blood thinning properties, I think. Also,I don’t know how it fits if you’re still taking the Oxycodone.

 

[DEL2021Feb-17]

First day of PT following revision #7. Well good news and painful news, since I have really good Flexion already 120plus no need to do exercises geared toward improving that!! Now the bad ( meaning painful ) part, the therapist told me he has never had 1 patient that has had as many surgeries as I have had all on the same knee. Instead of working on Flexion he concentrated on Extension and boy did those hurt. None of the exercises did he in any way push or bend these were all stretches. First one was heel prop stretch the easy way put heel on ottoman or chair and let gravity straighten the hard way put a large book under heel then tighten quad try and push knee down while keeping leg straight hold for 10minutes 2nd hamstring stretch similar to toe raise but no bouncing hold for the burn 3 sets 10reps each set last heel slide lay on bed belt around foot with right leg bent pull left leg so its close to even of knee of bent right knee.hold for 20sec and repeat. I have been to therapy numerous times this was the first time I have ever experienced this pain. I took a pain pill wrapped my knee in ice and took a nap. 90 minutes later feel much better but still sore. I pushed myself to hard as in way too hard.

 

[Celle]

Instead of working on Flexion he concentrated on Extension and boy did those hurt. None of the exercises did he in any way push or bend these were all stretches. First one was heel prop stretch the easy way put heel on ottoman or chair and let gravity straighten the hard way put a large book under heel then tighten quad try and push knee down while keeping leg straight hold for 10minutes 2nd hamstring stretch similar to toe raise but no bouncing hold for the burn 3 sets 10reps each set last heel slide lay on bed belt around foot with right leg bent pull left leg so its close to even of knee of bent right knee.hold for 20sec and repeat. I have been to therapy numerous times this was the first time I have ever experienced this pain.

That's all far too much exercise for a new knee. And it caused you pain. Discomfort is OK, but pain is bad. It's a warning from your knee that what happened was too much for it and will make it upset and inflamed.
It's your knee and you're not new to this, so tell your therapist "No more! I won't allow that again." Remembers, you're the boss, not him, because it's your knee and you're the only one with the right to decide what happens to it.

 

[DEL2021Feb-17]

@Celle The problem with the therapy yesterday was not with the therapist it was me!! The therapist even told me if its too much back off but being an idiot I decided to do more. There is only one person to blame and its me no one else. For some dumb reason I keep thinking the more I push the faster it will heal, now lets see I have to been thru how many surgeries and how many times to PT?? Granted this surgery was not as involved as some of the others but one thing is for sure its going to take time and not over doing it in therapy. ( like I did yesterday !! )
Another problem I have is patience. my family is from Germany and patience is not exactly one of the things I have an abundance. Its one thing if this was my first go round but its far from it. If anyone has a good grasp on recovery time frames its me. I figured if I push the faster it will heal and before you comment I know that is wrong!! There is a right way to exercise the knee and a wrong way. If it starts to hurt stop!! There is no point continuing things will only get worse. I know all of this but when you have been thru what I have sometimes you throw out logic and hope you can force the recovery time to be sooner and guess what it never works.

 

[DEL2021Feb-17]

A word of advice to anyone thinking they can make their recovery quicker by doing more during therapy " FORGET IT ". Yesterday I pushed myself maybe to impress therapist or to prove yet again I am an idiot. I did succeed on one of those I am an idiot!! When your doing your exercises unless your an athlete ( I am not ) and you know more then any therapist listen to what therapist says key word is listen and do exactly what he says. This does not mean thinking yeah this is easy I can do plenty of these, listen to what he says if you are straining to complete the exercise ( as in your so concentrated on doing your best your leg is shaking from the strain ) stop you may not feel like garbage now but just wait. Just ask me how I know?? The recovery is going to take time not to be measured in days or weeks think of it in terms of months. Your knee will heal but odds are it will not be on any therapist or Dr.'s timetable of what to expect what and when.

 

[Celle]

The problem with the therapy yesterday was not with the therapist it was me!! The therapist even told me if its too much back off but being an idiot I decided to do more. There is only one person to blame and its me no one else. For some dumb reason I keep thinking the more I push the faster it will heal,

Another problem I have is patience. my family is from Germany and patience is not exactly one of the things I have an abundance. Its one thing if this was my first go round but its far from it. If anyone has a good grasp on recovery time frames its me. I figured if I push the faster it will heal and before you comment I know that is wrong!!

Remember the movie "Kung Fu"?

"Patience, Grasshopper!"

 

[DEL2021Feb-17]

@Celle Okay you got me!! Instead of thinking of that show due to how many surgeries and cost ( before insurance ) I think of myself as a remake of the " 6 Million Dollar Man " only 2 things different first well his recovery turned out fantastic second everytime he got ready for action they always played that tune.

 

[DEL2021Feb-17]

@Jamie Yes my surgery could have been worse and yes the pain could have been worse as well but no matter what it still hurts putting it mildly!!!!!!!!!!! I am taking 5mg Oxycodone every 3 to 4 hours and 3000mg of Tylenol daily. Icing happens thru out the day along with elevation. Worked on my extension today but really took it easy nothing dramatic. While putting a pillow under your knee is not wise due to blood clots I feel getting some sleep is better then none at all. It amazes me you would think as many times as I have been thru this I would remember the pain but it seems the first thing one forgets is how much pain you went thru. This pain really stinks.

 

[sistersinhim]

 

[DEL2021Feb-17]

@sistersinhim any ideas other then what I am doing that may help? What is so stupid about all of this I knew it was going to hurt DUH!! It will get better in time just wish it would get better today, yesterday would have been better yet. The way it feels right now in some ways makes me wish I was in my 20's again. Back then ( early 80's ) did not need pain meds had other resources ( think Cheech and Chong's " Up in Smoke " ) but those days long gone. Today is just a bad day.

 

[Helizabug]

Cheech and Chong’s approach would probably just leave you stumbling . . . giggling, but stumbling.

 

[DEL2021Feb-17]

Yeah But!!!

 

[sistersinhim]

@NFenske, the only think I can suggest is lots and lots of rest, elevating and icing until this pain diminishes. You have to get over this hurdle as gently as you can. Let it heal and don't worry about ROM or gaining strength until your knee settles down.

 

[DEL2021Feb-17]

ROM is great 120 extension -9 not so good. Did a few exercises for extension but decided not to continue till this current pain quiet downs some. If anyone has a right to hate knee surgery I think I qualify!!

 

[Jamie]

I am taking 5mg Oxycodone every 3 to 4 hours and 3000mg of Tylenol daily.

A couple of things. First is your pain medication dosing. If you don't have any other medications you're taking that have acetaminophen in them (the active ingredient in Tylenol), you can take up to 4000mg in a 24 hour period, providing you don't have any known liver or kidney issues. Be sure you are taking the Tylenol in 1000mg doses, as that is what works best for post-op pain. You should coordinate whatever you take with your doctor (either your surgeon or your GP).

Second, remember that extension is the most difficult (meaning time consuming) movement to get back. Your knee has been through a lot and it may take longer than the norm for yours to return. Don't push this right now. Your therapy sessions are enough. It will take serious time to stretch muscles that have contracted. Just do the therapy exercises on the day you have it and nothing else. Stop putting your leg up when you're supposed to be resting and trying for more extension. That will give you pain and swelling. Rest means you're allowing your body the time it needs to properly heal. You're not being lazy. But keeping that constant tension on your knee isn't resting and it likely is at least part of the pain you're having.

 

[DEL2021Feb-17]

The only meds I am taking that have anything to do with pain are Tylenol 1000mg 3 x daily ( figured I would try this first if it does not help will go to 4000 if it does nothing stop. Oxycodone 5mg 3 to 4 per day. only other med is Xalerto blood thinner.
Right or wrong when I hurt like right now I am laying on sofa with leg stretched out with a pillow under. Not ideal but pain stinks ROM is fine and its not like I am doing this for hours on end I get up constantly whether to take care of my aquariums take out trash check mail I stay fairly active. I started to some extension exercises but realized if I continued things would get worse so I stopped. Some days will be better then others and some just stink today is one.