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TKR No surprises!!

Pk4tmjsd

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Ten days post-operative (March 28, 2017) right knee TKR. Spinal; nerve block; another shot of something in the joint; and sedation. Two hours portal to portal surgery time. Uneventful recovery room time before transfer to med-surg unit. First night should just be re-named, "hell night." That is, until Daphne Dilaudid and her PCA jazz band began playing. Discharged home on March 30, 2017. In-home PT commenced March 31, 2017 (last Friday) and continued three times this week. Walker has been retired. Crutches are almost retired. Managing discomfort with Oxy, Acetominophen, Ice, Elevation, Rest. Swelling is responsive to elevation and ice and rest, also.

Looking forward to a positive weekend doing exercises and continued elevation and rest. CPM range is -10 to 120 degrees; "on my own" ROM -5 to 94 degrees this morning with therapist. Focusing on good nutrition (protein and good fluids), also. Feeling very blessed and relieved. Mostly 'patient' patient - lol; got sick of looking at dirty curtains earlier this week and washed thirteen windows' worth. LOL Needless to say, there was some resultant swelling and a scolding from the PT and my wife (she was away from home - working). Otherwise, been patient and attentive to what my body is telling me it wants/can accomplish without adverse consequences.

Looking forward to a busy, informative, and productive week next week. See Surgeon for first post-operative visit, Thursday, April 13, 2017. First outpatient PT already scheduled or Monday, April 17, 2017. Apologies for the delayed entry to the Recovery Forum. be well ~ Pat
 

LindaO

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Congratulations on the new knee! Sounds like you have been progressing fast! Hang in there but don't overdo it!
 

Celle

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Welcome to recovery, Pat.

It sounds as if you're doing very well, but beware that tendency to overdo things. Washing all those curtains was definitely overdoing!
Don't let your therapist bend your knee for you. It can unwittingly cause harm and there's
no benefit to it, because you get the best results by letting your own muscles do the work. Using the CPM is OK, but don't set it too high. Discomfort is OK. Pain is not.

Here is your post-op reading. Do take particular note of the one about activity progression.
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
elevate
ice
take your pain meds by prescription schedule (not when pain starts!)
don't overwork.
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. Here is a week-by-week guide for Activity progression for TKRs


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 a 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 history before providing advice.
 

Pumpkln

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Welcome to the otherside!
Washing curtains, be careful to avoid overdoing, you knee will let you know.
 

KarriB

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Yikes! I could barely get a shower for the first two weeks let alone wash curtains! Be careful as your knee is likely to swell which will limit your ROM.
 
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Pk4tmjsd

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Greetings to All:

Apologies for not having posted in a very long time. Right knee TKA March 28, 2017; Left knee TKA June 6, 2017.

I had posted intermittently regarding the right knee, but nothing regarding the left. So, here goes, then some information - essentially, now, I am recovering bilateral TKA, i guess.

After having been able to have post-operative visits with the surgeon for each knee, he describes them as being " 'shot' with ACL and PCL in each ineffective and dried up." Like everyone else, probably, I got as much as I could out of the old lads (i.e. waited too long) before heading to surgery. The overall plan is for both knees to have been replaced and healing to have progressed so that I am on snow - skiing - for season 2017-2018. Overall, we are progressing according to plan.

I was out of the hospital within 30 hours for the second TKA. Presumably, hospital and patient familiarity helped on each end. They knew how I was after the first TKA and I knew what they expected of me before discharge could be granted. Was able to drive nine days - locally - post op with left knee - had driven eleven days post op on the right knee. (no narcotics for many hours prior)

No grand surprises in the operating room and I managed well - typical discomfort (pain) and managed with rest, elevation, and ice. I will say - the BIGGEST hitch this time around was the very excessive bruising to left leg - knee extending to ankle and base of foot that was also VERY sensitive to touch. I peeked on line for a general 'remedy' and a BoneSmart link popped up. The photos there depicted my own leg and recommended witch hazel. Well, it worked!!! I applied liberal amounts of witch hazel to a facecloth and placed it upon my lower leg and held it in place with TED stocking. Moved the 'compress' around the leg periodically and, voila, bruising started to resolve - looked better and felt a lot better. Unfortunately, home nursing (went home with adductor canal nerve block analgesic so they were supposed to be checking on me) was clueless regarding the bruising to lower leg and i took care of it myself. When home nursing care called for another visit - after they blew me off once - I simply let them know there was no medical reason for them to visit - I was fine. Home physical therapy for two weeks then outpatient - will begin 8th week post op (left) and 18th week (right) next week.

I have to comment - Physical Therapy? I have been most fortunate and truly blessed. A great group of assembled professionals with wonderful personalities, committed to their patient, and an appropriate balance of progressively and 'challenging' activities and exercises.

Flexion for right knee - not presently actively in PT due to left knee, so, not regularly measured (but, i am there and we work it along with the left) - a nice 125 degrees is a good estimate; extension likely around 5 degrees on a good day and 8 on a bad day (not yet stretched out)

Left knee is the fun one - Extension Lag - is how the PT put it in his report to the surgeon last week. We're working to eliminate swelling; i have been urged to keep with elevation and ice; i have been urged to watch level of activity (the Irish lad may occasionally be doin' a wee bit too much......) We're hovering around twelve degrees; Flexion? Passive i.e. on my own, last week, I slid the heel to 123 degrees. Active flexion - with PT assistance, has certainly been more - I have felt that extra 'nudge', if you will - lol. Looking forward to the measurement - limit is 130 degrees and, if able, certainly hope that we can. More importantly, though, I endeavor to get much closer to 0 degrees extension - straighten that leg - both of them, for that matter.

Scars have healed nicely - applying Vitamin E oil upon advice of lay people and I guess it has helped. - not that the lads will be in any modeling magazines.

I guess my daily challenges is knowing 'which' knees are going to show up for the daily ' party.' I now have a situation where the healing right knee TKA is the 'big brother' when it used to be the 'little brother.' After the left knee TKA, the right knee was promoted to big brother, without consultation, while the left knee looked for support. LOL Sometimes, the two "brothers" decide they will be more collaborative or less; just like raising kids!! Sometimes, the right knee just decides, "nope, not today."

I have returned to work - with self-imposed restrictions - however, find myself fatigued pretty regularly. Not used to being so tired when seemingly not being very active, however, from all that I have read - one TKA is considered to be major surgery nevermind two TKAs ten weeks apart.

I have tried to completely wean myself away from the heavy duty meds - only to pay the price. Generally, the heavier meds are now taken at the end of one day to help relieve some discomfort and before bed with an over the counter sleep med to assist with overnight rest. Of course, as I have read here and elsewhere, I often feel as if I could sleep/nap during the day; nope, can't sleep at night. Ugh. No heavy meds during the overnight or during the work day.

I don't regret the decisions to proceed with each knee replacement; it is certainly a roller coaster ride, though. Sharing in hopes it may assist others.......as all of us keep on healing............. Have a good day.
 

KarriB

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I imagine your LTKR is slow going because of your return to work. Working = less time for elevating, icing and resting a new knee.
 
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Pk4tmjsd

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Hi Karri:

Yes, the reality of paying the bills, etc. Given the past couple of weeks, I am anticipating a change to work from home one or more days/week. Finding that balance.........
 

KarriB

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Working from home would certainly help because you could elevate while working, then there's the added activity of getting ready, traveling etc.
 

liam2015

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you've been doing great. too bad you had to go back to work so soon after 2nd knee replacement, but good that you are looking for balance. working from home will help. best wishes to you for a comfortable recovery.:SUNsmile:
 

Josephine

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Have you read the recovery articles left for you in post #3? If not, do so - top priority.
 
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Pk4tmjsd

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Hi Josephine:

Thank you. Yes, I read that post upon arrival and re-visit it, frequently. Interestingly, I was reading Recovery articles when I logged in today comparing and reflecting upon my own journey. Frankly, I've been amazed with the Energy Drain and the very real impact upon my stamina even this far out from surgeries - (8.5 and 18.5 weeks post-op). Still needing power naps!! Thankfully, I continue to watch the nutrition/diet and 'think' before I go ahead and do something.

I have been blessed and fortunate to have another positive week despite potential hiccup (s). Extension lag will hopefully come - hot baths, quadricep flexes, and purposeful, but gentle, leg extension while walking. This week, PT commented/observed a leg length disparity on the order of 3/8 to 1/2 inch. He seems to notice a "drop" on the right when I walk. I do not present with any hip or back discomfort. I don't think I have had leg lenght disparity during the first 60 years of life, but, did we measure? Of course, "that" has been on my mind ever since - "am i lopsided?, nope, not on that step., oops, maybe on that one?" - and so on. LOL

From what I am reading, it appears I may be a wee bit early in the recovery (ies) to be overly concerned with leg lengths? Let healing continue and monitor lengths and go from there? I thought I would ask on the Forum and read of members' experiences? Thank you, all, for reading, and replying, if appropriate. ~ Pat
 

KarriB

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Chances are you're feeling a disparity due to the difference in rehabbing two knees a few months apart. I'm sure one knee doesn't have the same extention as the other. You are still very early in what can be a year long recovery. I have one TKR and one natural knee, my TKR has far better extention than my natural knee and can feel it when just standing. My TKR knee actually pops back into negative extention and my natural knee (which will be replaced) does not. So you may be feeling something similar, which will even out once your knees have similar extention.

I'm not surprised you're still feeling the energy drain, especially because of the June TKR. When I began swimming again 7 months post op I totally felt energy drain and muscle soreness because swimming was so different from working, biking or ADLs.
 
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Pk4tmjsd

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Hi KarriB:

Thank you. I think your hunches are correct....Surgeon has told me 12-18 months recovery, so that is in the back of my mind, certainly. One leg does extend better than the other. I refer to the legs/knees as "lads" when I chat with people who ask how things are going. For some, I will add the big brother/little brother characterization. My right knee was first and upon left TKA, the right was promoted to "big brother" without discussion. Prior to the left knee surgery, the right knee was feeling pretty good (overall, it still is), however when elevated to big brother status......... LOL Left knee likes being the "little brother" for now. As for me, the captain of the ship, I am trying to navigate the channel without hitting the coral reef!! As i wrote earlier, I did not really have an understanding for the energy drain until........... Thankful that I've been paying attention to nutrition and rest, as best I can. Thank you for your insight - much appreciated.
 

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Pk4tmjsd

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Hi:

thank you - I like these - In-home and off-site PTrecommended same and utilizes same. Spent three hours today in a zero-turn mower with plenty of leg room. When appropriate, quad sets and extended leg with heel on forward frame thus suspended left leg/knee - i.e. extensions time. Undulations of fields and lawns yield bouncing for the knee/leg. All very tolerable and with appropriate breaks/i.e. flexion opportunities. then a hot bath to loosen up both legs some more. We did not swim today, but it was a nice, purposeful, but relaxing day for the knees today - PT in the morning. Thank you for your suggestions. ~ Pat
 

sooz58

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Read through your posts, I have been a bit frustrated with the energy drain, and am a bit concerned about getting right done next month! It must be normal! Thanks for sharing!
 
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Pk4tmjsd

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You're welcome, Sue. Honestly?, despite the "not myself, still" feeling, I am glad I opted to have the knees done ten weeks apart. I was already in the 'healing' and pt mode when time arrived for surgery # 2 - all in all, i had prepared myself, on all the fronts. It has been a memorably journey and thus far, yielding good results.

Positive energy and thoughts as you prepare the left knee to be big sister/brother to right knee...... LOL that's how I refer to my lads.....little birth order conflict going on.....right knee enjoyed being the younger sibling coming out of surgery; when it was time for the left knee surgery, right knee bucked at the changing responsiblity. Best wishes ~ Pat
 

sooz58

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@Pk4tmjsd Thank you, I only have an additional 3 weeks between both of mine. I tried the other day to walk down my steps with my operated knee being the good knee since I am 4 weeks away. I can tell you lefty was not at all impressed with doing the leading, I sure hope she bucks up to the task in the next few weeks!
 

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