TKR Nanners adventure to the other side

[Roy Gardiner]

Celle is bang on the money. As much exercise as you like, as long as it doesn't hurt! Or make your knee swell. And no taking extra medication, either!

What do you mean "and no taking extra medication either"? Do I understand you to be saying that PT should not hurt you in the sense of causing no additional pain or need for extra meds?

EXACTAMUNDO​

​

 

[1ELISEA]

Oh thank you so much for your response. Yours is one of the "afters" that I have been following. You had a lot more pain afterwards and had a lot of difficulties. Were you by any chance on pain killers already before your knee surgery? I have heard, and I am one too, who takes opioids already, and I have heard we have much more pain than others, and wondering if that was you too. Hope your recovery is going well. Hugs!

It is was funny because I thought my dr would be gung-ho to get going on PT. But he was just about opposite and could have written the BoneSmart mantra of ice, elevate and rest. He has a set schedule he likes to generally follow with his patients and PT doesn't begin prior to 3 weeks. Before that you are resting and working on the swelling. Go figure!

Yes, very astute, you are correct, I did take a low dose prescription pain medication prior to surgery as I could not take NSAIDs and other similar over the counter medications. I did know going in that controlling the pain would be more difficult post op but I was allowed to make the decision and I chose, and would do so again, to take the pain meds prior to surgery.

Some of the other difficulties were because I have severe allergies and metal sensitivities and therefore tried to prepare for an ideal outcome. Such as choosing a non-nickel implant; not all OS use this implant so I needed to find one who did and was also very experienced with it. And then having waited so long because of my allergy concerns, by the time I was ready for surgery, my knee was in a very sorry state and surgery was more involved.

 

[referee54]

My PT was begin as an in-home PT and then an out-patient PT at the hospital satellite center. The PT's knew what they were doing and understood the difference between what I would term "athletic" injuries and joint replacement recoveries.

I never felt rushed nor did the PT's ever really seemed concerned about progress (or lack thereof). I would ask when things would clear up, and the PT's simply said that I would eventually reach my destination. When I read what some PT's have put people on the forum through, I cringe---but I felt, and still feel, very blessed to have the PT's the guidance, and the patience that the PT's showed me.

 

[Dulcimer Diva]

My previous ortho (who 'scoped 2 yrs ago me to trim away my initial R. lat. meniscus before my bone-on-bone lat. compartment chewed up what remained of it) has an in-house PT facility in the offices of his ortho group. There was a variety of patients there--from back-and-neck-school "students" to athletes rehabbing overuse injuries (which group, inexplicably, they put ME in) to patients rehabbing after major open procedures such as full ACL reconstructions, internal fx fixations, and joint replacements. He is primarily a sports physician, being team doc to a number of second-tier pro teams in this area, and most of his patients were athletes. He doubled the duration of my outpatient PT because he was unhappy with my progress of regaining flexion--even though he had no idea of my ROM pre-surgery. (I'd had a Baker's cyst that, with self-treatment & rest, had resorbed a couple of weeks before the very unexpected meniscal tear). I was discharged after hitting 125 degrees--not great but not awful either. He kept dismissing my descriptions of a popping and ripping painful sensation upon pivoting, saying I was not reinjuring myself when in fact I was. My visiting PT says he is unusual in that even though he does very few joint replacements, he does them very well. Nonetheless, I was determined to find someone better.

I chose my current surgeon because his wife--a fellow attorney and castmate in the Bar Assn. show--saw me using braces, gels, patches and icing during and after rehearsals and performances. When I told her at the closing night cast party, ice packs on my knee and champagne in my hand, that I had to get my knees replaced ASAP before doing one more run of the show, she mentioned her husband was the top joint replacement guy in town. I didn't take her word for it, but asked other doctors and looked him up online; she was right. He does 3-6 TKRS and THRS (slightly more knees than hips) per WEEK, does not allow residents & fellows to perform any part of the surgery, and holds patents for various surgical devices and cements. So when he advised against BTKR, and advised doing my R before my L, I listened. My husband (a cardiologist) before my TKR warned me that most of his own internal medicine patients who've had TKR (mainly my age and size) have trouble leaving their homes 6 mo. post-op. (We have a European river cruise scheduled for Sep., and he was afraid I'd be spending the whole trip onboard rather than able to take the walking tours). He was amazed to find out that my second night home (2 wks post-op) I was easily able to take a taxi to my song circle and back---and now insists I do one outdoor walk a day if weather permits. When I asked my PT why the wide differences in outcomes, he replied that in his opinion it was the competency of the surgeon and the number of procedures (s)he performs per year. So for my LTKR I'm sticking with my current surgeon. Why mess with success?

And he advocates doing as much PT as soon as one can tolerate it without pain (other than the inevitable agony of sitting up and walking with assistance in-hospital the first few post-op days). I had formal PT and OT in rehab every day for the 10 days I was there; and though he usually prescribes 2 weeks x 3 sessions of home visiting PT before going to outpatient, he okayed 4 weeks because I left rehab already at 95 degrees and my visiting PT has been very good at improving my flexion. I achieved 126 as of yesterday--better than what I'd achieved after 6 weeks of outpatient PT after my lateral meniscectomy by my previous surgeon--actively (my bending my knee myself)--rather than the PT passively pushing my knee for me. As to outpatient, both he and my visiting PT want me at maximal achievable flexion because outpatient PTs can't work one-on-one with patients for an entire 30-min. session, and so I need to be able to continue monitoring and maintaining my progress in that regard.

 

[Nanners]

I was reading some post tkr posts and noticed in a few that they gained inch or so in the leg repaired. Does that happen to everyone? Or just a few.

I am hoping only have to do the left knee now, and hopefully the right is not needed for years to come. But if you get longer in the new knee, will that make you have to do the other?

Thanks for your thoughts!

 

[referee54]

I am not sure if I gained an inch or inches, but i was taller after my BTKR, as my legs were no longer bow-legged; my pants bore this out as the cuffs had changed in height.

 

[pmonroe]

I was reading some post tkr posts and noticed in a few that they gained inch or so in the leg repaired. Does that happen to everyone? Or just a few.

I am hoping only have to do the left knee now, and hopefully the right is not needed for years to come. But if you get longer in the new knee, will that make you have to do the other?

Thanks for your thoughts!

I'm not sure if it always happens, but it seems to have happened to me. I already had a height difference, due to uneven hips. Now it seems to be even more pronounced, which is why I think I'm still having trouble with a limp. The PT said I might need a lift in my other shoe.

 

[kneesrus]

Very interesting Tim. I have never taken change in height after BTKR surgery as a possibility. I will have to start taking some before and after height measurements with my population.
Thanks
David

 

[1ELISEA]

I noticed when I was using the walker a few days after surgery how tall I was standing. I hadn't realized until that moment how much height I had lost with my bad knee. It was astonishing. Have yet to take a post height measurement but will when I have the opportunity.

 

[RestAssured]

Well, I had lost an inch and a half. I think I said the other night 1 and 1/4 but I had gone down to 5''8 and now I am back to 5 9 1/2.

 

[LucyBelle]

Standing on my left leg, I marked my height on the kitchen wall before surgery and again after surgery. There was a 1 3/8 inch difference! I have to wear a lift in my shoe to make up for some of the difference until surgery on the right knee in October.

 

[Roy Gardiner]

I am 1cm taller as, like Tim, my legs are now straight. It's great!

 

[reetpteet]

It does seem to be fairly common problem, & one that I wasn't prepared for! I had LTKR 7 weeks ago & my 'new' leg is longer, although my surgeon tells me the bones are the same length in both! I sense that it is about 1 cm, not much but enough to make walking & particularly standing feel quite wonky. My right knee has no cartilage (was there once 1 cm of it?) & although extension feels the same on both legs my physio says I have better extension on my TKR leg. Until I get my R TKR (not on the cards at the minute, although it is worn out) I think I will need a lift in my shoe. Will limit shoe choice but will be more comfortable. Bonesmarties who have bilats don't seem to have this issue thankfully - they have enough on their plate.

 

[RestAssured]

I was reading some post tkr posts and noticed in a few that they gained inch or so in the leg repaired. Does that happen to everyone? Or just a few.

I am hoping only have to do the left knee now, and hopefully the right is not needed for years to come. But if you get longer in the new knee, will that make you have to do the other?

Thanks for your thoughts!

Well, as I said I had gained back the inch and 1/2 I lost. I was walking on my tiptoes with my right leg until I had ir replaced 2 and 1/2 months later. You could get a lift for your other shoe if you find that you are taller after the first TKR. I was Bone on Bone for both knees, and the pain dictated my choice also.

Good luck in whatever you decide to do. Just having the new knee will give you back a lot of freedom you might have been limiting!

 

[Pumpkin]

My TKR leg was shorter before surgery, and it is still shorter. The difference is from my tibia fracture that was improperly set. I was hoping the TKR would even it up a bit.

 

[Nanners]

Tried looking in the library and didn't have any luck. But was reading Michael's recovery and he discussed taking showers. We can shower soon after a TKR? Any requirements about not getting them wet or anything special about showering afterwards I should know? Thanks!

Gail*Nanners*

 

[referee54]

It depends, I believe, on the OS's post-op protocol. Some people showered quite early---I had to wait for about four weeks---and boy, did that shower sure feel good.

 

[sunshine in nc]

I was allowed to shower as soon as I felt I could manage getting in the shower (shower was inside tub). I did have to wear a waterproof bandage. My at home PT person would change the bandage for me. Then after the staples were removed was allowed to shower after 24 hours.

 

[Coachie]

I was allowed to shower as soon as I wanted after both tkrs and my revision. I think it was day 2 post-op when I took my first shower at the hospital as it was a walk in one. The PT at the hospital showed me how to get in and out of a shower/tub combination. Once I got home, I showered whenever I wanted. In fact, with my right tkr, I even went in the lake on post-op day 12 as my staples were removed on day 10 and the PA at my ortho's office told me it was safe to go in as my incision was almost completely closed up at that time.
I didn't have to cover my incision or anything either and had staples with my tkrs and glue with my revision.
In fact, I didn't keep my incisions covered hardly at all after most of the bleeding stopped (around day 2.) I only covered my staples at night when I went to sleep so they wouldn't catch on the sheet/blanket.
Every orthopedist is different, though...

 

[ChrisO]

I showered day 3 but had a wound voc over staples. They took wound vac off on day 4, and I showered again. Then had staples out on day 5 and showered with steri strips.
I was home on day 8. I was not allowed to take a soak bath till there were no scabs. Bath was a moot point because I couldn't get down and back up out of the tub. Swimming at a public pool was forbidden for 4 weeks. ChrisO