Bilateral TKR My Recovery

Mrs. Ciz

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Hi Folks,

I’m a 54 year old female school teacher from the US, and I had bilateral knee replacement on July 6th 2020! I’m either crazy or brave or a little of both.

Background - In my 30s and 40s I used to run regularly for exercise and weight control. 11 years ago I tore the medial meniscus in my right knee (a running overuse injury). I got it scoped and 3 years later tore the medial meniscus in the left knee! After it was repaired, arthritis set in and did a number on both knees. Fast forward 8 years - I gained a good bit of weight due to inactivity, and the medial meniscus in both knees was 100% gone. I was bone on bone and in a constant state of inflammation and pain. Cortisone shots lasted all of 6 weeks and were expensive with my high deductible insurance. I was becoming more and more crippled every year. So it was time! Seven months before surgery, I started working on weight loss and fitness. I bought a bike and rode it 4 days a week to improve strength, endurance and range of motion and to burn calories. I can’t wait to get back on my bike!!! I also had to take a joint replacement class, complete pre op testing (including CT scans of each leg for the robotic arm assisted surgery), swab my nose with antibiotic ointment and use a special antibiotic body wash for 5 days before surgery.

Surgery - Surgery went well. The worst part was that the surgeon had the catheter taken out after the operation that morning despite the fact that I had 4 large iv bags of fluids and 3 small iv bags of antibiotics flowing through my body for the next 24 hours. I had to get up to pee 6 times that first night. It was brutal! I was also very surprised that my knees didn’t hurt in the hospital due to the nerve block during surgery, but my thighs screamed with pain due to the tourniquets used during the procedure. My thighs! Who knew! Like everyone else, I walked the first day using a walker (the second day the PT switched me to arm canes), learned to do some basic exercises, and even went up and down a whole flight of stairs on day 3 before I left the hospital. The hospital PT scared me a little about not working hard enough over the next 2.5 months and “wasting” my surgery.

So when I got home, I really pushed myself. Bad idea! I ended up with a Charlie horse cramp behind my right knee on day 6 post op that would not go away. It lasted for hours and hours! I had to have the doctor on call phone in an RX muscle relaxer and use a heating bad all night to get it to go away. That was probably the worst day I’ve had. I took it easier after that. I developed a routine of icing/elevating, then sitting in a chair, then doing some exercises, then walking with my arm canes for 10-15 minutes, then back to icing/elevating. Repeat, repeat, repeat.

PT - I started out patient PT one week post op. At first I was scared, but after watching some of the 80-90 year old patients struggle with the same exercises I was supposed to be doing, I realized I COULD do them too! PT has not been hard. I’ve been working on balance, strength and endurance, and ROM. I didn’t realize balance would be an issue until I tried to put my hair up in a ponytail while standing up that first week. I almost fell down flat! Last week at 17 days post op, I was at 95-100 flexion (I’ve got some work to do here) and only needed 5 more degrees for full extension. I’m also getting ready to move to one arm cane when walking. My PT is pretty happy with my progress so far.

Pain meds - my doctor/insurance is super stingy about pain meds, which does not make me happy. I was on 2 Tramadol, 2 Tylenol every 6 hours and oxy every 4 hours only as needed for break through pain in the hospital and the rest of the first week. I needed the oxy pretty much the whole time but I had to ask for it. At my 8 day follow up, he cut it down to 1 Tramadol, 2 Tylenol every 6 hours and 1-2 hydrocodone every 8 hours, but he did not give me enough pills to actually take this dosage regularly for more than a week. I had to start rationing pain meds before I was ready. I still take the hydrocodone at night to sleep and for PT appointments. I called and got more Tramadol at the beginning of this week because during the day sometimes Tylenol just isn’t enough. Rationing stinks!!! I may run out of hydrocodone before I’m ready, and I’m dreading it.

Sleep - sometimes I sleep great for a couple of nights and then I’ll have a couple of nights where I can’t sleep much at all. I cut out daytime naps after the first 1.5 weeks in an attempt to sleep better at night. Doesn’t seem to make a difference though. I either sleep on my back with my legs elevated on a wedge of 2 or 3 pillows, or I sleep on my sides with a pillow between my legs in a nest of pillows. I’ve been trying to side sleep for the last 1.5 weeks and it’s going ok. The funny thing about sleep though - the better I sleep, the worse my legs feel in the morning due to lack of movement.

Hot Spots - my left leg feels pretty good most of the time. It gets super stiff but there’s not a lot of pain. My right leg gets really sore behind/in back of the knee. I think the tendons or ligaments back there are really aggravated by something, and I’m not sure what to do about it. I think ibuprofen would help but I can’t take it until I’m done with the blood thinner medication (Xarelto for 8 more days).

Work - As a teacher I don’t have a desk job. I walk 8000 to 10,000 steps a day, have various duties throughout the day that require 30 minutes of standing, and work on the 3rd floor of a 100 year old 3 story building with no elevators. I plan to take a full 12 weeks to recover (6 weeks of my own time this summer and 6 weeks of medical leave once school starts). I’m hoping by the time I go back at the end of September, my school will have the whole Covid face to face vs distance learning dilemma solved. I’m rooting for distance learning.

Fears -
At 54, I’m worried that I did my knee replacements too early. I’m actively working on losing more weight in order to make my new knees last! I lost 24 pounds before surgery and I’ve lost another 5 lbs post op. I need to get a good bit more off long term.
I will also breath a huge sigh of relief when the blood clot and infection windows both close. I’ve done and continue to do everything in my power to avoid both of these complications.

That’s where I am right now. Good luck and happy healing to the rest of the July Sparklers!
 
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Jockette

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Hi and Welcome!

You sound like you’re doing pretty well.

With limited pain medication, do what you can to prevent unnecessary additional pain. That can be done by cutting back some of your exercises, especially any that specifically cause pain. Painful exercises are not necessary. You will achieve a great outcome by treating your knee gently and allowing it time to heal.


I will leave you our Recovery Guidelines. Each article is short but very informative. Following these guidelines will help you have a less painful recovery.

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
ice
take your pain meds by prescription schedule (not when pain starts!)​

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. At week 4 and after you should follow this

6. Access to these pages on the website

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 the 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 the member’s history before providing advice, so please post any updates or questions you have right here in this thread.
 

Roy Gardiner

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I can’t wait to get back on my bike!!!
You will, and it'll be better than before.
The hospital PT scared me a little about not working hard enough over the next 2.5 months and “wasting” my surgery
OK. Imagine the worst language from any rebellious adolescent you've ever heard, and redirect it at this misinformed person. What he said is wrong.
I didn’t realize balance would be an issue
yes, your knees are reconstructed, you have to learn again. It takes quite a while, take care with (for instance) putting on your pants (trousers). Ask me how I know this one...
At 54, I’m worried that I did my knee replacements too early.
Nah, when they rule your life, it's time.

I plan to take a full 12 weeks to recover
:thumb: Given your work, that's a great plan.
Work - As a teacher I don’t have a desk job. I walk 8000 to 10,000 steps a day, have various duties throughout the day that require 30 minutes of standing, and work on the 3rd floor of a 100 year old 3 story building with no elevators.
I suggest you take a look at this and try to find ways to minimise the walking and especially standing. If it is too much on the first day, and you don't 100% recover by the next day, you may set yourself on a downward spiral. Sorry to be alarmist but you need to be aware, we have had members here who've set themselves really back by overdoing things. Without knowing the details of what you have to do we can't make specific suggestions, but you get the drift I'm sure.


My recovery diary http://bonesmart.org/forum/threads/recovery-diary.12548

Healing and training are different http://bonesmart.org/forum/threads/post-operative-exercise-–-the-bonesmart-view.25463.

My own ROM, Extension and Quad exercises http://bonesmart.org/forum/threads/rom-and-extension-stretches.13159
 
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Mrs. Ciz

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I suggest you take a look at this and try to find ways to minimise the walking and especially standing. If it is too much on the first day, and you don't 100% recover by the next day, you may set yourself on a downward spiral. Sorry to be alarmist but you need to be aware, we have had members here who've set themselves really back by overdoing things. Without knowing the details of what you have to do we can't make specific suggestions, but you get the drift I'm sure.
This is great advice! Luckily, my school has already started thinking about how to best help me when I come back. Our administrative assistant is a former nurse, so she took charge because she had a way better idea of what I’d be capable of upon my return than I did. She recommended temporarily moving my classroom to the first floor lunch room, so I can avoid going up and down the stairs over and over again. She also suggested a lightened duty schedule and/or doing my duties sitting in a chair when possible. And of course she said I’d need to teach from a sitting position most of the time and take breaks for ice/elevation in the clinic when I had open periods. They also realize my doctor may place some restrictions on my return to work as well. I think I’m lucky because it sounds like my school wants to take really good care of me when I return!
 

Roy Gardiner

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That sounds perfect.

I used to give lectures sitting on a bar stool (without the drink, though:sad:) which I found better because of the extra height. But then, I was in just one room - carrying the bar stool from room to room wouldn't have worked...
 

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@Mrs. Ciz , after my niece broke her leg, playing in a staff versus students football match, she found that some of her best help came from her students.

She teaches maths in senior school and she was never short of willing helpers, to run messages, move her chair, carry her bags. She thought the kids were great.
 
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Mrs. Ciz

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Two things today:

1) My lower legs are so dry! My shins are literally shedding. And my surgical scars are very dry and flakey too. They are all sealed/scabbed up now, so I’m wondering if it’s safe to start putting some sort of lotion or cream on them. If so, what lotion/cream works the best?

2) Last night behind my right knee got very angry as it sometimes does. All I did yesterday was walk every hour or two and do my two sets of home PT exercises that I do every day. I have no idea why the ligaments/tendons in back of that knee got so mad! I really HATE when this happens!!!!! It was so bad that the pain radiated down my calf and around to my shin and the top of my foot when I was trying to sleep. I took 2 hydrocodone and put the heating pad on my lower leg. It helped some, but I was still very sore this morning for my PT appointment. This week I also cut back from 2 hydrocodone to 1 hydrocodone for my PT appointments - not great timing, but I have to ration my pain meds. I told my therapist what was going on. After my 5 minutes bike warm up, he spent the next 10-15 minutes massaging and stretching out my legs. He could totally feel that my right knee and leg was much tighter than my left, and he could feel some of my calf and shin muscles knotted up. After he finished, I did all my exercises successfully without pain, and my legs felt so much better by the end of my appointment. Sometimes I wish I could go to PT more than just twice a week!
 

kneeper

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My skin was very dry too. Once things are truly scabbed it would be ok to put lotion on. I don't think I put anything on the incision area this early, but I definintely used lotion all around it. My post surgical info suggested cocoa butter with vitamin e, but you don't need anything special.
 

WhenImOld

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My skin was really dry as well. I put lotion all the way up to just before the edge of the scabs. It also helped with the general aching of my thigh, calf and shin.
 

Starsfan22

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May I suggest Vaseline for the dryness? Works for me, use it everyday on lower legs and back of hands. Cheap too!
 

Celle

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Last night behind my right knee got very angry as it sometimes does. All I did yesterday was walk every hour or two and do my two sets of home PT exercises that I do every day. I have no idea why the ligaments/tendons in back of that knee got so mad! I really HATE when this happens!!!!! It was so bad that the pain radiated down my calf and around to my shin and the top of my foot when I was trying to sleep. I took 2 hydrocodone and put the heating pad on my lower leg. It helped some, but I was still very sore this morning for my PT appointment.
All this tells me that you did too much for your knee, and it told you so, loud and clear.
It really isn't necessary to do those exercises twice a day. Once a day is more than enough. Your knee is getting exercise all day long, as you walk and as you do your other activities of daily living (ADLs).

You don't always feel pain at the time you do the exercise, but if you knee gets stiff, painful, or more swollen within the following 24 hours, you did too much. Often, that pain and stiffness sneaks up on you at night, when you're tired and trying to rest.

You're still less than a month from major surgery and all your knee tissues are still inflamed and trying to heal. We call this "the angry tissue stage". It's still much too early to be working on any strength exercises or doing q lot of walking.

Something tells me that you could be trying to push your recovery along faster, knowing that you'll have to go back to work early. That's not a good idea. By pushing, you could actually slow down your recovery.

You have excellent ROM and your recovery is going well, but do make allowances for you poor, wounded knees.
It's not exercising that gets you your ROM - it's time. Time to recover, time for swelling and pain to settle, and time to heal. Your knee has the potential to achieve good ROM right from the start, but it's prevented from doing so by swelling and pain. As it heals and the swelling goes down, your ROM (both flexion and extension) will gradually increase. Bearing that in mind, perhaps you should ask your PT therapists to spend the next few session just doing gentle massage and minimal, gentle stretching.

Have you tried icing the back of your knee? It helps a lot if you can do that, as well as icing the front.

This week I also cut back from 2 hydrocodone to 1 hydrocodone for my PT appointments - not great timing, but I have to ration my pain meds. I told my therapist what was going on. After my 5 minutes bike warm up, he spent the next 10-15 minutes massaging and stretching out my legs. He could totally feel that my right knee and leg was much tighter than my left, and he could feel some of my calf and shin muscles knotted up. After he finished, I did all my exercises successfully without pain, and my legs felt so much better by the end of my appointment.
It's not a good policy to take your pain medications so you can get through PT sessions. If you have to do that, you are being asked to do too much for your knee. Pain is a warning sign that you are trying to do more than you knee is ready to do. Taking the pain medication masks the pain and, thus, also masks the warning. Consequently, you end up doing more demanding exercises than your knee is healed enough to do. That's counter-productive, because it will keep your knee upset and irritated, instead of allowing it to calm down and heal.

Take your medications on a regular schedule, and try to work it out so that they cover you during your PT session, but don't take them just so you can get through PT.
 
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Mrs. Ciz

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Very good point about the pain meds and keeping to a schedule. I have been really off schedule as I’ve tried to reduce them because I just don’t have enough pills left. But even so, I read on here that I should be scheduling my Tylenol every 6 hours too. I kind of got out of that when I stopped taking the Tramadol every 6 hours. I do see how it’s better to have that constant flow of Tylenol in your system though. So I started tracking it again today. Had I been doing that, the last 1.5 weeks may have been easier.

I do get frustrated sometimes because my left knee feels so good. It is stiff, but there is no pain. The only pain I really get is in my right knee, mostly behind the knee. And then it radiates. It’s been doing this off and on since my surgery day. Muscle relaxers helped, but I only had 10 of those pills, and they’re gone now. I have been icing both the front and back of my knees consistently since day one - like a knee sandwich! I like my ice packs! My husband had both hips replaced 6 weeks apart in 2018. I wish we’d invested in an ice machine back then. With both of us using it, we’d have really gotten our money’s worth!

Thank you to everyone for the tips on moisturizing my dry shin skin. I put some on today after my shower, and I can already see a difference. I can’t wait until I can put it on my scars too. They are so flaky!
 

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Most of my pain was in the form of what I descibe as stiff achy-ness.

Massage can be good. Also keep in mind that when we're in pain we have an unconscious tendency to tense our muscles. I know caught myself doing that. I did use a heating pad on my thigh muscles--*away* from the knee though.

"Knee Sandwich" :thumb:
 
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Mrs. Ciz

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I knew my PT warm up was harder than usual yesterday! Boy am I sore today! I have had to take Tramadol all day, ice, elevate and take it easy.

Usually I do a 5 minute warm up on a recumbent stepper machine. I love this machine. It really loosens me up and makes my knees feel good. Yesterday my therapist moved me to a recumbent bike. It also had arm pedals, so I pedaled with legs and arms. And he moved the time up to 8 minutes. He told me the bike would be harder because it required some knee bend but no more bend than I was already capable of. He was super careful about adjusting the seat to avoid excess strain on my knees. To tell the truth, I was really excited to do it because I was biking regularly before surgery and can’t wait to get back to it! I very slowly did the 8 minutes; it was tiring but not painful. But I’m sore today. All my other stretches and exercises where ones I’ve done with no soreness before, so I’m pretty sure it was the bike. Rats!!!!
 
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Mrs. Ciz

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Pain med advice needed:

On Tuesday (8/4) I have my 1 month post op followup appointment with my OS. I’m making good progress (left = 105, right = 100) and both knees look good. I’ve cut back on my pain meds, but some days I still need it (like yesterday all day and night because the exercise bike warm up at PT on Wednesday kicked my butt).

Right now I have 3 hydrocodone 5/325 pills left and 6 50mg Tramadol pills left. These are going to have to get me through until Tuesday. I am also taking 1000 mg of Tylenol every 6 hours around the clock, but sometimes Tylenol just isn’t enough.

I’m thinking about asking the Dr to refill just the Tramadol. I know I can take 2 if I’m having a really bad pain day. But I’m worried it won’t be enough for sleep because most nights I’ve been taking 1 or 2 hydrocodone to get through the night. (The bottle says 1 to 2 pills every 8 hours but it only lasts for 4 hours).

Is one month post op too long to still be on pain meds?

What combination of pain meds at this point in your recovery worked best for you for daytime discomfort and night time sleep?
 

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You would be better off talking to your doctor about your pain med needs. What works for one person might not work for you.
 
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Mrs. Ciz

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You would be better off talking to your doctor about your pain med needs. What works for one person might not work for you.
Oh I definitely will be having the pain meds discussion with my doctor on Tuesday, but he is notoriously anti pain meds. I’d really like to get a feel for what is “normal” at 4 weeks post op, so I can make my case with him.

I just would like to know if still taking Tramadol at 4 weeks post op on bad days and to sleep at night is normal. What about hydrocodone? I have been off oxy after week 1 post op.

Has anyone else had issues getting pain relief when you needed it?
 

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@Mrs. Ciz Just had my 6 weeks post up with OS. Regarding pain meds...he was adamant that their protocol was only 4 weeks of narcotic pain meds ( Oxy, Tramadol, etc). I told him I felt that was a bit unrealistic as the need is certainly there . His recommendation was alternating Tylenol and ibuprofen. Personally, I don't think that's enough for 6 weeks out, never mind 4 weeks post op. He relented and prescribed Tramadol for me again, but I'm sure that's "it" for me which is fine because I think I have "turned the corner" and doing much better. I have chosen not to go to out-patient PT. I will continue my exercises and stretches here at home.
 
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Mrs. Ciz

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@Mrs. Ciz Just had my 6 weeks post up with OS. Regarding pain meds...he was adamant that their protocol was only 4 weeks of narcotic pain meds ( Oxy, Tramadol, etc). I told him I felt that was a bit unrealistic as the need is certainly there . His recommendation was alternating Tylenol and ibuprofen. Personally, I don't think that's enough for 6 weeks out, never mind 4 weeks post op. He relented and prescribed Tramadol for me again, but I'm sure that's "it" for me which is fine because I think I have "turned the corner" and doing much better. I have chosen not to go to out-patient PT. I will continue my exercises and stretches here at home.
Thank you! This is very helpful information and solidified what I was thinking - that I would probably ask for more Tramadol as it’s considered more of a step down pain med.

I do understand doctors’ reluctance these days. Nobody wants to get addicted.
 

Celle

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Usually I do a 5 minute warm up on a recumbent stepper machine. I love this machine. It really loosens me up and makes my knees feel good. Yesterday my therapist moved me to a recumbent bike. It also had arm pedals, so I pedaled with legs and arms. And he moved the time up to 8 minutes
At less than a month post-op, that was a ridiculous amount of warm up. Your exercise at this stage should still be so gentle that you only need to do a bare minimum of warm up. You know it was too much, because of the problems it caused you afterwards.

Concerning your medications, yes it's normal to still need to take some pain relief. If you doctor will prescribe some more Tramadol, you can get good pain relief by combining it with Tylenol.

Here are a couple of charts to suggest how to do this. The first is for 4-hourly doses and the second is for 6-hourly.


The most effective way to take Tylenol is 2 x 500 mg tablets 6-hourly, to a total of 4,000 mg (4 doses) in 24 hours. You need to take it regularly, to keep up the levels in your bloodstream. If you just take the odd dose now and then, it's far less effective.

Check all other medications you're taking, to make sure there is no Tylenol/Acetaminophen/Paracetamol in them. If there is, scale back one or two of your regular doses, so you stay within that safe 24 hour limit of 4,000 mg.
 

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