TKR New year, new knee!<

[lilbit]

Hi there everyone,
I too have been a lurker here for months, and wish to thank you for helping me to come to my senses when working with this knee. At first I set myself back by treating this injury as a gym workout! The knee soon put a stop to that when it swelled to tree trunk proportions.

I am in my tenth week, and am now in the process of packing up my elderly mother's house, as she has been diagnosed with dementia, and is in a retirement residence. The closing date looms, and the buyer is pressured by their closing date as well.

Thank to your advice here, I do periodically elevate and ice (frozen peas have become my new best friends). A few friends have come to take away boxes to the charities - packrats keep everything!

I continue to take Tylenol 1, and am also using Aleve twice a day. There still seems to be some internal swelling. At 4 weeks I had about 80 degrees flexion and 15 degrees extension. With gentle stretching and bending, that has increased to 90 degrees flexion and 5 degrees extension, but I have been stuck there for a few weeks.

With this workload, and having to be vertical for as many periods of time as I can manage during the day, I am not optimistic about improvement anytime soon. This. however, is not a choice, and my sister lives 3 hours away. She comes as often as she can, but it's still a huge responsibility.

Every couple of hours I sit in that chair and do slides and extensions, then ice, but not as long as I would like to. At night I elevate all night long as well, which I hope is the right thing to do.

Congratulations to all of you who have managed to do so well with ROM, and to those of you who share my boat, I extend my understanding and sympathies.

I am supposed to return to work the third week of April, but can extend that if necessary.

My surgery was January 4th, 2016 - New Year, New Knee!!

 

[Josephine]

Hi @lilbit and welcome to BoneSmart! You can see I have moved your post into a thread of its own so we can talk to you here without derailing the other member's thread.

First is the reading - everybody gets a free copy of the recovery reading!

Here are the BoneSmart mantras ....
- rest, elevate, ice and take your pain meds by the clock
- if it hurts, don't do it and don't allow anyone - especially a physiotherapist - to do it to you
- if your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again
- if you won't die if it's not done, don't do it
- never stand when you can sit, never sit when you can lie down, never stay awake when you can go to sleep!
- be active as much as you need to be but not more than is necessary, meaning so much that you end up being in pain, exhausted or desperate to sit down or lay down!

Next is a FAQ (Frequently Asked Questions) thread.

And here are some very crucial articles
The importance of managing pain after a TKR and the pain chart
Myth busting: no pain, no gain
Swollen and stiff knee: what causes it?
Activity progression for TKRs

Healing: how long does it take?
Chart representation of TKR recovery
Energy drain for TKRs
Elevation is the key
Ice to control pain and swelling

Home physio (PT) and activity progress: suggestions
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds
Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

And then some wise words from members who have shared their experiences ...
Where are you in recovery?? (TKR)
Five “P’s” of knee recovery
TKR: work “smarter” and not “harder”
Recovering a knee - from one who knows!
It's never too late to get more ROM!
It's worth the wait for ROM

 

[Josephine]

I continue to take Tylenol 1, and am also using Aleve twice a day. There still seems to be some internal swelling. At 4 weeks I had about 80 degrees flexion and 15 degrees extension. With gentle stretching and bending, that has increased to 90 degrees flexion and 5 degrees extension, but I have been stuck there for a few weeks. Every couple of hours I sit in that chair and do slides and extensions, then ice, but not as long as I would like to.

With these comments, I would surely like to off some constructive advice, so 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 you can imagine. And don't compare this with the bone-on-bone pain you had before surgery! ) Also don't forget to include other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness

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

3. how often are you icing your knee and for how long?

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

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

6. how swollen is your leg?

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

Exercises done at home: 3 sessions a day
Heel slides x10 (reps)
Straight leg raises x10
Steps x10

At PT
Squats x5 (reps) x2 (sets)
Wall slides x5 x2
Clamshells X5 x2

 

[lilbit]

Hi there Josephine, thanks for moving my post - being new here, I appreciate the help with forum etiquette.
To tell you the truth, I have lurked for a while, so have read all the valuable information you have posted, which is what changed my approach drastically. I live in Canada, where the mantra is "no pain, no gain". The U.K. approach makes so much more sense. I just nod and smile when my PT talks about that "magic window" we all know does not exist. He is quite gentle after I told him that my knee swelled up after that first session (at 4 weeks), and I could not sleep that night. Now he is more careful.
1. Pain levels - Most of the time, pain is quite reasonable (2 or 3) but it becomes stiffer as the day progresses, and those boxes are packed up. It can get to a 5 or 6 later in the day.
2. I was only given prescription pain meds for three weeks. When the surgeon would not renew the Tylenol 3 prescription again, a friend brought me some Tylenol 1, which is over the counter in Canada. it has 300 mg of Tylenol, 15 mg of caffeine, and 8 mg of codeine. I usually take 2 and a half every 4 hours, but if the pain and stiffness are worse, I take 3. At night I take a night time Tylenol that has 500 mg of Tylenol, and a muscle relaxant, and I take one of the Tylenol 1 with that.
This was my first ever surgery, and I didn't know that morphine did not work for me. I just kept passing out with the pain until they tried codeine 36 hours later. At first they increased the morphine, but it just knocked me out, and I would then awaken to excruciating pain as soon as I "came to". The codeine seems to work for me, so the surgeon prescribed T3s for me to take at home.
3. & 4. I used to ice more often, until the pressure increased to get this house packed up. I explained the situation above, so won't bore you with repeating it here. I am still elevating and icing three or four times a day for 20 to 30 minutes at a time, both front and back. I use frozen peas. While on the laptop, I put my leg up on a chair across from me.
5. My ROM has gone from 15/75 (first PT measure at 4 weeks) to 5/90 in the last two weeks, and it's a more comfortable 90 now, not so much discomfort.
(When I first came home, I had little information and thought I had to do as much as possible, so I was trying for that "no pain, no gain" heroic effort, and my leg swelled into a tree trunk from my hip to my baby toe for a week and a half)!
After I read the information posted at Bonesmart, I knew enough to rest, ice, and elevate, which I did for several days. I could not bend much at all in those early weeks.)
6. By this time, my swelling is somewhere between moderate and slight. There is more swelling as the day goes on. I try to elevate for longer periods in the evenings.
7. My activity level has increased in the last few weeks because of the impending closing date of my elderly mother's house. She has been diagnosed with dementia and is now in a retirement residence. I call her every evening. I am now vertical for1 hour to 1 hour and a half periods from 8 am. until 7 pm. I sit for 20 to 30 minutes after every hour and a half vertical time. During those breaks I elevate and ice. it helps, but the knee is still cranky at the end of the day.
8. Four times a day I gently bend to the point of discomfort and hold for 30 seconds X 3. I also place my heel on an opposing chair and add a bit of weight to the knee for extension.
Twice a week I go to PT where I try to make the pedals go around (LOL!), and he gently pushes for another degree or two. He also uses a tens machine, and sometimes does acupuncture.

Thank you again for your time Josephine - I read all your posts with interest, and I learned somewhere that you are presenting a less aggressive PT method to the hospital administrators there. I wish you could bang some heads over here. They get us on the CPM and doing stairs second day here!!

I hope there is more recognition of a gentler PT approach in future. I also hope there is more research into kinder treatments - they are the same as they were 30 years ago! I am following gene editing and stem cells research with enthusiasm. Sawing bones and hammering a hunk of hardware into a person's body is rather barbaric in 2016!
I work in a prison and will be setting off the metal detectors when I return to work!

 

[lilbit]

p.s. I forgot to include the Aleve 2X per day, 12 hours apart. Thank you!! Ice is best!!

 

[sleepilu]

Welcome.
You've certainly got a lot on your plate but it sounds like you're taking as sensible approach as possible with your intermittent resting. Life gets in the way doesn't it!
I'm in the UK and they do still get you on the stairs on day 2 here. But ice machines are a novelty. Only saw one. And my PT on leaving consisted of an A4 sheet of suggested exercises! Thank god for bonesmart!



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[lilbit]

Hi there sleepily! Thank you for taking the time for your message. I appreciate your input from the U.K.!!!
Actually, one reason I hurt myself at the beginning is because we go home with just a piece of paper with exercises too, and no advice about resting damaged tissues. I went gung ho and forced my knee through the pain - of course, the knee won! It swelled up like a tree trunk for a couple of weeks.
My PT is paid for by work for the first 6 visits. After that I'm on my own.
The CPM is a continuous motion machine - we are on that, starting the next day for five hours off and on. We have to be able to get 90 degrees on that machine before we leave. Of course that provokes swelling too! Some hospitals use it, but some no longer do. Long term results do not demonstrate a significant difference in results, so it depends on the policy of the hospital where you have your surgery here.
The ice machine is a wonderful solution to the pain and swelling. A friend of mine had one after an ACL surgery, and it was a big help.
The knee is pretty sore and stiff today, but I have to accept the fact that this will happen, considering present circumstances!
I do feel sympathies for my elderly mother, who is still mentally present enough to feel that she no longer has any control over her life, but she needs 24/7 assistance now.
We've come a long way in extending life, but not so far in improving quality!! I wish I could wave that proverbial magic wand for her.

 

[OldHippie]

Welcome @lilbit.
Looks like we share a surgery date
I too lurked for a bit before climbing on board,finally signing up to get advice about restarting my naproxen.
Here I have learned to properly elevate my leg,stay on top of the pain,and most valuable(to me anyway),slow and steady wins this race.
Sorry about your mother,recently my brother in law lost his father to dementia,very painful indeed.
I hope you can find time to rest a bit more after the house business settles.
Best wishes.


Dave

 

[Josephine]

1. Pain levels - Most of the time, pain is quite reasonable (2 or 3) but it becomes stiffer as the day progresses. It can get to a 5 or 6 later in the day.

2. I was only given prescription pain meds for three weeks. When the surgeon would not renew the Tylenol 3 prescription again, a friend brought me some Tylenol 1, which is over the counter in Canada. It has 300mg of Tylenol, 15 mg of caffeine, and 8 mg of codeine. I usually take 2½ every 4 hours, but if the pain and stiffness are worse, I take 3. At night I take a night time Tylenol that has 500 mg of Tylenol, and a muscle relaxant, and I take one of the Tylenol 1 with that.
Also Aleve 2X per day

:rolleyes: Gee, how do you keep track of it all?! The key question is, is it helping?
Did you not think to ask your GP (primary care) if he would help you out? Some will.
The most effective dose of acetaminophen is 1,000mg. The safe daily maximum is 4,000mg per 24hrs.
Aleve - also known as Naproxen - is an NSAID and a fairly poor quality pain med. Medications: acetaminophen (Tylenol, paracetamol) and NSAIDs, differences and dangers

3. & 4. I used to ice more often, until the pressure increased to get this house packed up. I explained the situation above, so won't bore you with repeating it here. I am still elevating and icing three or four times a day for 20 to 30 minutes at a time, both front and back. I use frozen peas.

You accomplish little or nothing in 20 minutes. Ice for at least 40-60mins and more than 4 times a day when possible. Plus, you'd be better getting yourself some of those gel packs as they stay cold longer than peas. Get 4 then you can use two while two are freezing again!

5. My ROM has gone from 75/15 (first PT measure at 4 weeks) to 90/5 in the last two weeks, and it's a more comfortable 90 now, not so much discomfort.

You're only 10 weeks - plenty of time to get improvements yet.

6. By this time, my swelling is somewhere between moderate and slight. There is more swelling as the day goes on. I try to elevate for longer periods in the evenings.

There y'go! It's the swelling that's holding you back! Once you can get that down with more elevating and icing, your ROM will improve.

7. My activity level has increased in the last few weeks. I am now vertical for1-1½ hour periods from 8am until 7pm. I sit for 20 to 30 minutes after every 1½hrs vertical time. During those breaks I elevate and ice. it helps, but the knee is still cranky at the end of the day.

Yes, it will be but - as they say - this too shall pass!

4x a day
bend to the point of discomfort hold for 30 seconds x3
place my heel on a chair and add a bit of weight to the knee for extension

That's not bad but do read this to refine your routine even more Heel slides and how to do them

PT twice a week where I try to make the pedals go around (LOL!), and he gently pushes for another degree or two. He also uses a tens machine, and sometimes does acupuncture.

Not too bad then!

They get us on the CPM and doing stairs second day here!!

They do in the UK in certain places. Not all surgeons are advocates of the softly softly approach!

 

[sleepilu]

Wow those CPM sound like medieval instruments of torture!


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[charmed-life]

I actually find the CPM machine to be helpful in getting my knee to move easier. It does not need to hurt at all and often I fall asleep. My doctor does not usually suggest them, my case was unusual he said.


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[lilbit]

Josephine, thank you from my heart for your kindness and for your support for this website, which has helped so many of us who were feeling isolated and uninformed. You've been generous with your time and your expertise.

About the meds - my GP was on vacation until the end of February. She is located at a walk in clinic, though, so she is not inclined to prescribe narcotic medications. She is a good diagnostician, but lately I have given some thought to finding a doctor who is not so rigid about prescribing. The surgeon renewed once, but his secretary was most discouraging. It is beyond comprehension that there is no pain management protocol for such a major procedure. How merciful your treatment is depends on the beliefs of your particular surgeon about how to deal with pain.
The Aleve is for my arthritis, which is throughout my body, including my spine. That was the reason that I had to have a general anesthetic.

Please understand, I am thankful that this surgeon was available to take me as a patient. After he received my X-rays, he scheduled me for the knee replacement within two months. During the consultation, he mentioned osteophytes(?), and said that he could see this knee had been a problem for a long time. But my elderly mother had experienced a series of health crises, so that was the priority.
This surgeon operated in a city an hour from the city where I live, but he has decades of experience. He has no bedside manner, but skills are more important when it comes to this surgery.
The centre where I live is larger. It would have taken a year to schedule surgery here, and I was so thankful that he used a triage approach.

Thank you for the suggestions about the heel slides - I can see the difference, and how that would help.
I will take your advice about the gel packs - you're right - those frozen peas get pretty mushy!

Thank you again for being so generous with your time and expertise. You helped me when I was feeling very low and discouraged. (I actually made a note on my calendar on January 29th that said "suicidal". That night I read about post op depression on Bonesmart - no coincidence). We are blessed to have you here.

I would be so interested to hear the results of your presentation to the policy makers!!!!

 

[Josephine]

So would I! I am finding it very hard to be patient but it's going to take several years.

If it's any comfort to you, we all have had osteophytes - they are an inevitable part of osteoarthritis.
This was my first knee with the spurs marked with a white outline (left) and a yellow pointer (right)

 

[lilbit]

Hello Josephine,
I do hope that this exciting news gets through to you!!!
Some very clever researchers in Australia (of all places) have figured out how to use a "biopen" to target joints and "draw" stem cells to repair cartilage! They do believe that this will help to reduce the number of our barbaric knee and hip replacement surgeries. Oh my - will sign up to be the guinea pig!
Just google "biopen" to find the articles. Here are a couple of links. I am so excited !!!

http://www.3ders.org/articles/20160...aw-human-stem-cells-for-cartilage-repair.html

http://www.medgadget.com/2016/04/biopen-used-to-deposit-stem-cells-repair-tissue-within-joints.html
All the very best - oh I do hope this news gets to you this way.
take good care,
Lynn

 

[lilbit]

By the way, I do hope all of our Aussie Bonesmart friends understand that I am strictly "tongue in cheek" as I say "of all places", when attributing this wonderful discovery and marvellous feat of medical engineering. It was meant in good fun, but if any are offended, I offer my humble apologies. We all owe the Australian researchers our heartfelt gratitude for this ground breaking discovery!!!! congratulations!!!

 

[Celle]

Yes @lilbit
I realised you were tongue in cheek. From our little nation across the Tasman (NZ) we heard that they even have cars in Australia now!

The article look interesting. Of course, the technique will be experimental for some time yet. I hope it works.

I know that hip and knee replacement surgery does sound "barbaric" but it's actually very technical and highly developed and highly skilled. These joint replacements are some of the most successful surgeries ever done.

 

[Josephine]

Honey, if I got excited every time they came out with one of these new ideas, I'd be in a constant orgasmic state!

 

[Celle]

Unfortunately, at 3 months, I had no choice but to sort and pack up my mother's house. Her advanced dementia made it necessary to move her to a facility where she could have 24 hour care.
I tried to make sure I included time to elevate and ice, but there was not always time for that - moving is a messy business, as you so well know.
Now the knee is so tight, and my ROM has decreased. It was at 98 when I started, but now it has regressed to less than 90 again.
In 3 days I have to return to work - there is no way to extend that time off - there is a new computer program being implemented for our leave times, so there is a black out on any leave requests.
I have a wonderful, supportive supervisor, and I know I will be able to include times to elevate and ice during the day (probably more than I could while packing up the house).
My fear is that if the ROM does not improve again, that the surgeon will want to do a manipulation. I honestly believe this tightness is swelling, from all I have read here at Bonesmart, and I am hoping that a regular rest period worked into my days will allow the ROM to come back.

Hi. @lilbit
I've copied your post from Campervan's thread, so I can talk about it here.

First, I'm very sorry to hear that you had to move your mother into a 24-hour care facility. That's hard. My mother was getting close to that, and I was dreading having to take action. However, we were both spared that, as she died peacefully in her sleep.

Ideally, looking after your knee would have come first, but Life isn't always ideal. You did your best and did what you had to do.

The increased swelling and stiffness in your knee are a natural reaction to the increased activity. With plenty of rest, ice and elevation your ROM should come back to what it was before.

The loss of bend is due to increased swelling and you know the bend is already there. I don't think that an MUA would do a scrap of good, as you don't have adhesions. If your surgeon mentions a MUA, tell him you want to wait a while. It's your knee and he can't do a MUA without your permission. There's no need to rush anyway, no deadline that must be met.

Of course it would be better if you could take extra time off work, but it appears that you can't. So, your plan to take rest periods to ice and elevate while at work seems very sensible. On work days, try to do nothing but work - no housework, no cooking (if possible) no PT. Just come home, grab a quick bite to eat and then rest, rest, rest. It's a good idea to plan to spend the weekends resting, icing and elevating too. Thank goodness you have an understanding and helpful supervisor!

Do come back and tell us how you get on.
Best wishes.

 

[lilbit]

Good morning (here in Canada it's a.m.) Celle!
Thank you for taking the time for this reply. You are one of the experienced advisers here, and I appreciate your input.
It's a mixed blessing that your mother passed away peacefully in her sleep. That is the ideal way that all of us would wish to make the transition to the next adventure, but you must miss her. I am sorry to hear of your loss.
That can make us feel like a bit of an orphan for a while.

Even the good long term care facilities have their problems, so we're working our way through those hiccups, which are also time consuming, but I live nearby which helps. I will visit as often as I can so that she does not feel abandoned. That is her greatest fear right now.
I am also responsible for her appointments, which after her fall a few weeks ago, have been more frequent.

Even the possibility to have a decent night's sleep is a help after the last couple of months. Last night I crashed after dinner and woke at 9:00 this morning.

My house could be condemned after the long term neglect as life imposed its own schedule.
But just to be able to not have a deadline over my head, and to be able to do my "bendy" exercises (heel slides etc.) is a relief.

Thank you again for your reassurance and for your guidance. This surgery can knock one sideways.

gratefully, Lilbit

 

[Celle]

I'm glad I was able to help. That's what we're here for. When I had my last two knee replacements, people on BoneSmart were such a help to me, so I just stayed around, to pay back the help I had received. It's a pleasure to do that and i'm still leaning heaps.

It's a mixed blessing that your mother passed away peacefully in her sleep.

Yes, it was a mixed blessing. I experienced equal parts of grief and relief when my mother died. She was happy in the nursing home where she was, but they lacked the facilities to care for her increasing confusion and I knew she wouldn't want to move. Through all that, the most upsetting thing for me was that she often didn't recognise me, but thought I was just a kind stranger. She remembered the past and still thought of me as a little girl.

It's been 15 years since Mum died, but I do still miss her. There are times when I wish i could ask her a question about family history, or one of her favourite recipes. I wish she could have been around to see my children as grown-ups, and my grandchildren. However, she was a good mother and she did have a full and happy life, and I guess that's what we all wish for.