TKR My recovery begins...again!<

[Celle]

Big concern! Please respond if you have some ideas: I am having terrible pain in the front of my leg directly below my incision. It is a bit to the left of the incision.

It's still only a very short while since you had this very major surgery. You have normal post-op pain and it sounds to me as if you are under-medicated and, possibly, overdoing the exercises.
I'm going to ask @Josephine to advise you. Please try to answer the questions she will ask you as fully as possible, so that she can advise you appropriately.

The PT yesterday said that shouldn't be occurring and checked my knee for extra swelling and fever. Nothing noted. He surmised that it is from having bad gait habits for so many years. He also feels as if it's surgery pain.

Well, he's right about the post op pain. The rest of his advice sounds wrong.

 

[Josephine]

Well, let me first start with some basic questions:

Can you tell me the exact site of your pain using this chart?

Then, I'd like to ask you some questions if you don't mind, and it would be very helpful if you would answer each one individually - numbered as I have done - in as much detail as you can then I'll come back as see where you are ....

1. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst pain you can imagine)

2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?

3. how swollen is your leg compared to these?

4. What is your ROM - that's flexion (bend) and extension (straightness)

5. are you icing your knee at all?

6. are you elevating your leg, how often and for how long?

7. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and

8. what kind of PT exercises and exercises at home are you doing? How much and how often?
This is the most crucial question so please help me by using the format I have left as an example
(which means please make a list and not an essay!)

Exercises done at home: (how many sessions each day)
enter exercise then enter number of reps and sets
etc., etc.

At PT (how many times a week)
enter exercise then enter number of reps and sets
etc., etc.

 

[LoveGiants]

Hi Katrina, I had surgery the same day as you. We're just two weeks (and a day ) out, so still so early in recovery. For me, the first nine to ten days were very painful, I'd say mostly between 6 & 8 on the pain scale. I could barely put any weight on it at all. My knee still really hurts at times, particularly the inside and/or bottom of the knee, but thankfully it's mostly between 2 & 4 now.

I'm taking one Percocet every three to three and a half hours during the day and two at bedtime and two more between 2–3am. The ice machine is going at all times, except for meals and showers.

My OS isn't a fan of PT, and after my one PT appointment, I agree with him. I'm going to work on the exercises (heel slides and extension and stretches) at home as I'm able.

I hope you're doing better today.

I love the doggie in your avatar. I'm a big dog lover—wonderful fur babies.

 

[katgonmom]

Josephine,

Thank you for getting my answers! I hope this helps you help me.

My main pain is in E LF4.

1. I am seated now, so I would say my pain is 4. When I got up a few minutes ago and stood on my leg, it was an 8.
2. I have been taking Hydrocodone/Acetaminophen 7.5-325 T. I have been taking two at 10 pm before bed, two around 3am if I wake up in pain at night, 1 at 7 am, 1 at 10, 1 at 1 pm, 1 at 4 pm, 1 at 7 pm. I went to my regular physician today and, after hearing me talk (whine) about my severe grogginess, she prescribed Tramadol for the day, and I'll continue the Hydrocodone at night. The Tramadol is 50 mg and says to take one tablet twice a day.
3. My leg is moderately swollen.
4. flexion (bend) and extension (straightness) My PT has not given me numbers, but, because I've already been down this road before, I have an idea. My flexion is about 115, and extension is almost 0. The PT is "amazed" as he says.
5. Yes, I ice three to five times daily if I'm home. Twice, if I have a busy day of appointments like today.
6. If I'm home, I elevate two-three times per day. If not home, zero-one.
7. My activity level is low to moderate. I am doing a little more each day. I have made a very simple meal for my husband , son, and myself a couple of times. My son puts the dishes away, and I load the dishwasher. I have gone outside in the yard and watered my plants a little.
8. Exercises at home:
1. AROM hip abd uni supine/10 reps/3 sets twice a day
2. Quad sets/10 reps/3 sets twice a day
3. Walking around house: about 250 steps
9. PT exercises:
1. Quad set/relax while sitting and extending leg/ 10 reps/3sets
2. Quad set/relax while sitting and extending leg, then letting leg go to a bend/10 reps/3sets
3. AROM hip fox (SLR) supine knee bent/10 reps/3sets
4. AROM hip adb uni side lying / 10 reps/3sets
5. AROM hip add side lying /10 reps/3sets
6. AROM knee flx uni standing/ 10 reps/3sets
7. Modified squats while holding back of chair/10 reps/3sets
8. Toe raises while holding back of chair/10 reps/3sets
9. PT has me practice walking


Also, I have looked for your Tramadol/Tylenol regimen as I've seen it within this site. I haven't been able to find it tonight. Could you please point me in the right direction?

Thanks again!







Katrina
Two ACL surgeries on left knee (March 2001 & May 2006)
RTKR ---15 December 2015
LTKR--- 12 July 2016

 

[katgonmom]

@LoveGiants

We are TKR Twinkies! It sounds like you are progressing well. I remember reading a bit of your surgery story. You are quite young for this "fun". I thought I was young for it, but you've "beat" me. Haha!

I am probably being too impatient...one of my wonderful virtues. I don't remember the pain being this intense the last time. It was more of a dull throbbing.

Yes, that fur baby is Max, our GREAT Pyrenees. He's enormous. During the first week of June, we got a mini-dachshund, Heidi. Believe it or not, Max is terrified of her! Heidi has been such a boost throughout the post-surgery. Lots of company along with our two cats.

Thanks for reaching out!


Katrina
Two ACL surgeries on left knee (March 2001 & May 2006)
RTKR ---15 December 2015
LTKR--- 12 July 2016

 

[newlybionic]

You are doing quite a lot of exercising for only 2 weeks out. At this point your main focus should be ice and elevation. That should help with your pain. My prescription for tramadol was 100 mg every 6 hours with 1,000 mg of Tylenol but I didn't start that until about 4 weeks or more and only when I could walk without severe pain. I also had Hydrocodone 5mg two tabs every 4 hours which I took around the clock for the first several weeks. I tried rehabbing my knee by doing a lot of exercises the first time around and all I had was a lot of pain. With my revision I took it much easier and didn't start PT until after three weeks and then only did some gentle stretching and massage. IMO if you take some time off from all these exercises your pain could very well subside.

BTW your dog is beautiful!

 

[LoveGiants]

@katgonmom - Oh I believe it! My parents have four dachshunds and they run the show. I love great Pyrenees, they're beautiful dogs. I would see a couple on the bike trail walking three of them! That's a whole lotta fur.

I'm trying not to be frustrated with my ROM, I'm at around 45* and it's stiff as can be. ugh. It is hard to read some people progressing very well. I know we're not supposed to compare, but sometimes I worry.

I do have some real pain but am glad to go through this so I can get back on my feet.

How is the Tramadol working during the day? I might ask my OS for a prescription for the day.

 

[Celle]

I'm sure that Josephine will comment more fully on your activity, but you are doing far too much for just a couple of weeks after major surgery.

What is all this about, "if home" you rest, elevate and ice your leg? Right now, you should be at home almost all the time.
You shouldn't be doing any house work at all, including getting meals and watering plants. You have two able-bodied men to do this. It's your job to rest, ice, and elevate. Did you read this article, that Pumpkln left you in Post #2?
Activity progression for TKRs

If you feel guilty about lying around and letting someone else wait on you, read this:
Nurturing mother: how to let go and accept help

I'm pretty sure that much of your pain problem is two-fold. 1. Too much activity and exercises. 2. You're under medicated and cutting back your pain medications too early. As well as relieving your pain, the grogginess you felt on the Hydrocodone was doing a good job, as it was forcing you to rest more, which was what your body needed.

You've had major surgery. Your body and your knee need time and gentle treatment to get over the trauma and to heal. Please allow yourself that time.

 

[katgonmom]

@Celle I know you are right. I need to remember that my main job is to heal right now. The "at home" reference is to the several times I've have doc appts in the past couple of weeks. We have to travel to get there, so it throws off the day and doesn't leave room for staying home and healing. Next week, for example, I have a dermatologist appt on Tuesday and an OB/GYN appt on Thursday. Both are in the morning, so I'll come straight home afterwards, but it's and hour and thirty minutes car time that I could be at home. Unfortunately, both are dealing with an issue and not simply a checkup which could be put off.

Yes, both my husband and just-turned-18 year old son should be doing more. It's my problem that, when they're not, it's just easier to pick up the slack. I will be more aware of that and communicate to them that it's their turn...for a good while.

Yes, I've read everything, but I have found I'm fairly stubborn. I'm rereading everything again right now to settle myself down.

Thank you, Celle, for being the voice of reason.


Katrina
Two ACL surgeries on left knee (March 2001 &amp; May 2006)
RTKR ---15 December 2015
LTKR--- 12 July 2016

 

[katgonmom]

@LoveGiants I only took one dose of the Tramadol yesterday, but it seemed to work alright. Since I'm home today, I may just stick to my Hydrocodone today. I do recall that, when I had my ACL years ago, I really liked the Tramadol. Hopefully, I feel the same about it this time around.

I know it's tough, but do not compare yourself with others regarding your progress, in particular ROM. You will get there, in your own time.


Katrina
Two ACL surgeries on left knee (March 2001 &amp; May 2006)
RTKR ---15 December 2015
LTKR--- 12 July 2016

 

[Josephine]

So your pain is here?

I'll speak on this later

1. I am seated now, so I would say my pain is 4. When I got up a few minutes ago and stood on my leg, it was an 8.

I see

2. I have been taking Hydrocodone/Acetaminophen 7.5-325 T. I have been taking two at 10 pm before bed, two around 3am if I wake up in pain at night, 1 at 7 am, 1 at 10, 1 at 1 pm, 1 at 4 pm, 1 at 7 pm. I went to my regular physician today and, after hearing me talk (whine) about my severe grogginess, she prescribed Tramadol for the day, and I'll continue the Hydrocodone at night. The Tramadol is 50mg and says to take one tablet twice a day.

She prescribed it for the day? That's a lot of good! If you find it works, will she let you switch to it?

I used this routine for both my knees -

You are two weeks out and this much.

3. My leg is moderately swollen.

I would imagine!

My flexion is about 115, and extension is almost 0.

Well that tells me something which I will share later!

5. Yes, I ice three to five times daily if I'm home. Twice, if I have a busy day of appointments like today.
6. If I'm home, I elevate two-three times per day. If not home, zero-one.

That's not enough, not at all! You accomplish little or nothing with that routine. Ice and elevate for at least 40-60mins and more than 4 times a day.

7. My activity level is low to moderate. I am doing a little more each day. I have made a very simple meal for my husband , son, and myself a couple of times. My son puts the dishes away, and I load the dishwasher. I have gone outside in the yard and watered my plants a little.

And what about the 'busy day of appointments'? I suggest you read this again Activity progression for TKRs

Exercises at home:
1. AROM hip and uni supine/10 reps/3 sets -
2. Quad sets/10 reps/3 sets -
3. Walking around house: about 250 steps
PT exercises:
1. Quad set/relax while sitting and extending leg/ 10 reps/3sets
2. Quad set/relax while sitting and extending leg, then letting leg go to a bend/10 reps/3sets
3. AROM hip fox (SLR) supine knee bent/10 reps/3sets
4. AROM hip adb uni side lying / 10 reps/3sets
5. AROM hip add side lying /10 reps/3sets
6. AROM knee flx uni standing/ 10 reps/3sets
7. Modified squats while holding back of chair/10 reps/3sets
8. Toe raises while holding back of chair/10 reps/3sets
9. PT has me practice walking

I really don't think you need to do any of these. You ROM is excellent and the pain you experiencing is, in my opinion, directly related to too much activity. I suggest you stop going and stop doing exercises at home before your pain gets any worse.

So you are under-medicated, too active, doing too much PT and not resting, elevating and icing enough.

BoneSmart philosophy for post op therapy

 

[katgonmom]

@Josephine

For now I plan on sticking to the Hydrocodone. After reading other Bonesmart replies and then yours, I realize that I am needing to be home icing, elevating, and napping. That's all I've done today with a bit of work from my recliner on school plans. My leg still hurts in that same spot under my kneecap on the outside of my shin, but it doesn't hurt with the intensity.

I see that your Tramadol regimen uses 100 mg many more times than twice per day. I wonder if she (my PA) put me on 50mg because I do take 25 mg per day of Zoloft for depression.

My OS would not consider Tramadol because of the Zoloft, but, yesterday, when I saw my PA, she said that she had me on such a low dose that I would be ok on Tramadol. BUT...will 50 mg combined with Tylenol be enough when I begin taking it???

For now, I'll continue to take the Hydrocodone at least for a week or so. Do you not think 1 Hydrocodone every three hours during the day is enough?

Also, you said something about addressing my flexion and extension. I don't know that you did that. I could have missed it, though.

Thank you so much for taking the time and energy to help me work through this.


Katrina
Two ACL surgeries on left knee (March 2001 & May 2006)
RTKR ---15 December 2015
LTKR--- 12 July 2016

 

[katgonmom]

@Josephine I am also having issues with sciatica. I was prescribed Gabapentin 300 mg three x per day for that. I think it adds to the drowsiness, so my PA prescribed 100 mg capsules to be taken twice during the day with the 300 mg taken at night.

The physical therapist is supposed to address the sciatica next Wednesday when I go in. I've had sciatica since March. I did try three sessions of chiropractic work,, but it did not help.

Just some additional info, in case you need that.


Katrina
Two ACL surgeries on left knee (March 2001 & May 2006)
RTKR ---15 December 2015
LTKR--- 12 July 2016

 

[katgonmom]

@Josephine Sorry... One last question. On your Tramadol and Tylenol routine, is the Tylenol in mg? I've been told not to take more than 4000 mg of Tylenol per day.


Katrina
Two ACL surgeries on left knee (March 2001 & May 2006)
RTKR ---15 December 2015
LTKR--- 12 July 2016

 

[newlybionic]

Tylenol is in mg. the chart Josephine gave you is one thousand mg four times a day for a total of four thousand a day. You will have to subtract from that total the amount that are in the Hydrocodone/acetaminophen tablets which is 325mg per tablet. So for example if you take 3 of those that's equivalent to 975 mg of acetaminophen so you would have to only take 3 thousand mg doses of Tylenol a day.

 

[kneeper]

I'm not sure what mg of hydrocodone you have. My prescription was for 1-2 every 4 hours. I took 2 for each dose for several weeks.

 

[Josephine]

will 50 mg combined with Tylenol be enough when I begin taking it???

On your Tramadol and Tylenol routine, is the Tylenol in mg? I've been told not to take more than 4000 mg of Tylenol per day.

The chart excludes the use of any other narcotic. But yes, you are quite right to be careful of it if you have already have depression. And all the doses on the chart are in mgs.

Do you not think 1 Hydrocodone every three hours during the day is enough?

Actually no I don't. But it's either managing your pain or it isn't.

Also, you said something about addressing my flexion and extension.

I addressed it in the comments about your exercises.

I think it adds to the drowsiness, so my PA prescribed 100 mg capsules to be taken twice during the day with the 300 mg taken at night.

That's okay - I always think the drowsiness is good because it makes you rest more!