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TKR Outpatient Total Knee Replacement

Hopefully, the EKG report is a minor blip and won't affect your surgery.

In 2014 when I had my TKR, patients were regularly expected to stay at least 3 days. Fast forward to 2018, and I was surprised to find knee surgeries had become same-day outpatient surgeries. Personally, I don't like it as my body needs more time after any surgery to wake up and function. But, because I am unable to take narcotic pain meds of any kind, they keep me longer as they need to use other pain control methods.

For many people, same-day surgery is great, and they are glad to go home the same day. If there are any issues, they have the option of keeping you overnight, or even a couple of days, if necessary. No one likes being in the hospital, but if we need it, it's there. IMHO, they are in too much of a hurry these days to ship patients out, and I think a large part of it is the cost. No one wants to go back to the days when patients were in the hospital for a long time for everything, but this is the other extreme and I think it's too fast in many cases. But, I also think if a patient is stable and wants to go home right after a TKR, they should be able to do so.
 
@Jockette - My surgeon has ordered me to start physical therapy at home, with a physical therapist, which he has scheduled to come to my home the day after surgery. He wants me to have my knee from 90° to 0° by my two week post operative follow-up appointment. He told me I was going to really hate him during those two weeks. I will not do anything that causes me unnecessary pain. I will be "uncomfortable" because I can not take the pain medication normally prescribed to patients after this procedure. I can not take any opiates or opiate derivatives. I can not take NSAIDs. I am only able to take 80mg dose of asprin and 50mg of Tramadol safely. My immunology specialist is part of my care team with my TKR.

I have a rare medical condition called Mast Cell Activation Syndrome (MCAS). My body produces too many mast cells and as a result every organ and system in my body is over producing histamines.. My body reacts to almost everything with anaphylactic shock I have to carry Benadryl and two epipens with me at ALL times. I have to be very selective of the foods I eat, the medications I take, anything that touches my skin or I breathe in. My immune system is always compromised. A change in weather can activate my MCAS response. It's challenging, but I am so grateful to finally have a diagnosis and know I'm not crazy.

I do agree with you that it is going to take time to recover. slow and steady progress is my expectation. My doctor does tell me recovery from surgery is a marathon not a sprint.

But I feel like the surgical team/center is expecting me to do a lot in recovery (after my same day, outpatient surgery.) I have to be able to:
Walk 150ft three times.
Walk up and down a set of three physical therapy stairs three times
Get on and off a toilet three times
Dress myself

That all sounds painful.
 
GOOD NEWS! Cardiologist cleared me for surgery. My echocardiogram and stress test came back "low risk"

They said the tech on Tuesday had a hard time getting leads to stay stuck to my skin. The Cardiologist who read Tuesday's EKG read it as normal. The EKG today was normal. Well....Normal for me.
 
@Layla
Left shoulder labrum repair and rotator cuff repair arthroscopic
November1995

Right Shoulder SLAP repair arthroscopic repair July 2009

Right shoulder Bicep long head tendon reattachment- open surgery April 2010

Right Knee arthroscopic medial meniscus tear, articular cartilage repair, plica September 1999

Right Knee reinjured in car accident.
meniscus tear, articular cartilage repair, plica and chondromalacia patellae -May 2000

status post second repair of the right ATFL/CFL, second repair of the right peroneus brevis tendon and right peroneus longus tendon transfer performed on 05/21/2020

Injuries:
Broke and displaced right fifth metatarsal July 2019
MCL (medial collateral ligament) tear, July 2019
Rupture peroneus brevis tendon, July 2019
Rupture peroneus longus tendon, July 2019
Anterior talofibular ligament (ATFL) tear, July 219
calcaneofibular ligament (CFL) tear, July 2019

Broke fourth right proximal phalange, August 2021
February 2022 I had an extremely painful lumbar (L4-L5, S1) flare up, caused from a very large bone spur inside L4 or L5 verterbrae ( I cant remember which). My nerve branch roots were getting very angry! The pain was so bad I could hardly move; movement in my lower back caused severe shooting, stabing pain. To reposition in bed, I needed to use my feet and legs to lift my back off the mattress. when I pushed my body up off the mattress (with my feet and then used my legs i e. Knees) to pivot my hips and lower back to reposition ..... that shooting stabbing pain now came from my right knee! The small pivoting motion put enough torque on my right knee joint to completely tear the meniscus and remove what little "cushioning" I had remaining in the joint. If the knee is bent there is minimal pain; however, straightening the knee is a totally different story! I feel like a knife is being stabbed into the medial portion of my knee, then comes the snap and pop and it just takes my breath away. If you are in the room you will hear it.
April 4. 2022 I see my orthopaedic. Xray shows decreased space, bone on bone. No cartilage. Miniscule tear. Osteoarthritis of knee RIGHT• My ortho Dr is speechles.. He only says, "wow." as he reviews my xrays. He looks at me and asks, "have you seen this knee!?!!" Recommends total knee arthroplasty (SURG). Surgery scheduled for April 21, 2022.


Second repair of the right ATFL/CFL, second repair of the right peroneus brevis tendon and right peroneus longus tendon transfer performed on 05/21/2020

C5/6,6/7 ACDF 02/05/2021

Anterior cervical discectomy and fusion (ACDF) is a surgery to remove a herniated or degenerative disc in the neck. An incision is made in the throat area to reach and remove the disc. A graft is inserted to fuse together the bones above and below the disc.

Anterior cervical discectomy and fusion (ACDF) is a type of neck surgery that involves removing a damaged disc to relieve spinal cord or nerve root pressure and alleviate corresponding pain, weakness, numbness, and tingling. A discectomy is a form of surgical decompression, so the procedure may also be called an anterior cervical decompression.

I hope this helps!
 
@lovetocookandsew, I hear what you are saying and agree. The pendulum on health care has definitely changed direction. My immunology specialist is from China. When he heard my TKR was outpatient he was shocked. He said, " in China they'd keep you in the hospital for five to seven days. In America they kick you to the curb."
 
BrokenAgain said:
He wants me to have my knee from 90° to 0° by my two week post operative follow-up appointment.
Click to expand...
Many of us did not have these numbers at 2 weeks post op. Our medical team may want that, but our knee will recover in its own timeframe and we can’t put a date on that. There is no window of opportunity for ROM, mine continued to improve well into my second year.
bonesmart.org

Myth busting: "window of opportunity" in TKR

This "six week window of opportunity" surgeons often speak about is little more than a myth. It presupposes that all patients have the ability to create adhesions which is far from the truth. It also ignores the simple fact that in the first 3-4 weeks after surgery, swelling reactive to the...
bonesmart.org bonesmart.org
 
Just so you know, just because your doctor fixes your knee, does not mean he owns your knee. You are the only one who can decide how you want to recover. I personally think his expectations are unrealistic, and you should just ignore them and recover at your own pace, and, more importantly, at your knee's pace. If your knee meets those random numbers, fine and good, if not, fine and good also. Every knee is different, and every recovery is different; putting them all into the same recovery box is detrimental to many.

To this day, I have never had my ROM measured, other than once or twice when my OS just eyeballed it. As your swelling recedes as you recover, your ROM will naturally improve. Doing too much PT to meet some random number is not a good idea. This does not mean we want you to be a couch potato. We want you to walk and do gentle stretches in between icing and elevating. That will all increase over time naturally as you feel better and your knee is ready. You need not argue or discuss your personal choice for your recovery with your surgeon, and I suggest before your surgery you just nod and smile when he discusses his choices for your recovery. You are allowed to say no to PT, or if you do choose to

have formal PT, you are allowed to set the boundaries you choose, and refuse any that exceed those boundaries. There is nothing your doctor can say about it as it's your knee and your choice; not his, not your family's, not your friends and so on.
https://bonesmart.org/forum/threads/saying-no-to-therapy-am-i-allowed-to.36688/

I'm going to give you our recovery guidelines now, so you can begin to read them. We usually give them after surgery, but reading them now will be helpful for you.
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 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 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.
 
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Thanks for the dates @BrokenAgain
I recorded them, in somewhat abbreviated form in an effort to include it all.
Only one week to go now. Wishing you comfort as you wait.
 
BrokenAgain said:
@InkedMarie, Good morning twinsie! I am sitting here drinking my coffee realizing that next week at this time I will be at the surgery center (05:00 am CT arrival). If you dont mind me asking, what time of day is your procedure? I am both excited and nervous about this procedure. I know I will have a great deal of pain after the surgery and uncomfortable physical therapy for a few weeks. My orthopaedic surgeon tells me I am going to hate him for about eight weeks. I am allergic to opiates with a true anaphylaxis reaction. I am limited to tramadol for pain medication. Are you also feeling anxious as we get closer to our surgeries? Knowing there is someone else to take this TKR recovery with is a blessing and encouraging. Thank you to everyone- not just InkedMarie. InkedMarie, I got your LEFT!
Click to expand...
Hello! I posted to Facebook yesterday that I had one week to go! I report to the hospital at 6am est. I’m the first case because we’re hoping I can go home later that day.

Pain. I expected a great deal, as you are, with my first one but I didn’t have it! Uncomfortable, achy...yes. Not pain where I needed pain meds. I am sensitive to opioids so I will be coming home with Dilaudid and anti nausea meds as well. I need to dig out my notebook from TKR #1 but I recall alternating with Tylenol & Aleve if needed. My ice machine was a big help as was my Lounge Doctor.

Uncomfortable physical therapy? Not needed. Gentle works. ADL works. My PT is wonderful. If he wanted to do something other than we had been doing, he asked. I’ve read horror stories about aggressive PT. I’ve learned to advocate for myself.

I’m not too anxious yet but I’m sure I will be by next Wednesday! It’s time for this knee to go and I know I’ll be better at the end.

A little advice: ice, elevate and relax. That will be your job! Do NOT over do it. When you use the bathroom, remember to kick your operative leg out before sitting. Trust me on this...I know.

Will read the rest of your thread later....need to head to work!

Marie
 
InkedMarie said:
Hello! I posted to Facebook yesterday that I had one week to go! I report to the hospital at 6am est. I’m the first case because we’re hoping I can go home later that day.
Click to expand...
@InkedMarie - Same day & same time! I too am first surgery of the day, as the plan is for me to go home later that day as well. My surgery is at an outpatient same day surgery center. However, I did find out that they will transfer me to the hospital if I need to be overnight. The hospital is maybe half a mile from the surgery center. I knew the Children's Hospital was there but was unaware there was another hospital next to it! I learned something new! We have several hospitals here. Have a great day, Twinsie!
 
Hi @InkedMarie ,@BrokenAgain , best if luck on your TKRs!! I had my LTKR yesterday at 930am (had to be at the hospital at 6am), was the second of the morning for my surgeon (so he was nicely warmed up for me!). Surgery was done by noon and I was discharged by 3pm. I got to enjoy the beautiful afternoon sunshine while elevating my legs.

All the best on both your coming journeys!!
 
Such great advice, @InkedMarie! Thanks for sharing your learnings from knee #1.

Hope your second surgery goes smoothly and that you are able to go home the same day. :fingersx:
 
@lovetocookandsew in the 90’s, I was a nurses aid on the ortho floor at a hospital. Hips & knees stayed 3-5 days. I was shocked to find out how much things had changed when scheduling my first hip in 2014.

Marie
 
BrokenAgain said:
InkedMarie said:
Hello! I posted to Facebook yesterday that I had one week to go! I report to the hospital at 6am est. I’m the first case because we’re hoping I can go home later that day.
Click to expand...
@InkedMarie - Same day & same time! I too am first surgery of the day, as the plan is for me to go home later that day as well. My surgery is at an outpatient same day surgery center. However, I did find out that they will transfer me to the hospital if I need to be overnight. The hospital is maybe half a mile from the surgery center. I knew the Children's Hospital was there but was unaware there was another hospital next to it! I learned something new! We have several hospitals here. Have a great day, Twinsie!
Click to expand...
Are you on FB? If yes, I will message you my name!

Marie
 
glidefloss said:
Hi @InkedMarie ,@BrokenAgain , best if luck on your TKRs!! I had my LTKR yesterday at 930am (had to be at the hospital at 6am), was the second of the morning for my surgeon (so he was nicely warmed up for me!). Surgery was done by noon and I was discharged by 3pm. I got to enjoy the beautiful afternoon sunshine while elevating my legs.

All the best on both your coming journeys!!
Click to expand...
Hello! How are you doing today?

Marie
 
BrokenAgain said:
But I feel like the surgical team/center is expecting me to do a lot in recovery (after my same day, outpatient surgery.) I have to be able to:
Walk 150ft three times.
Walk up and down a set of three physical therapy stairs three times
Get on and off a toilet three times
Dress myself

That all sounds painful.
Click to expand...
Is this in the few days after the surgery?
Even when you stay in the hospital they get you on your feet and have you walk. I think the first day I walked to the door of the room and back to the bed and a bit further the next day. The knee was remarkably strong and steady.
They had me do the 3 steps before I left the hospital--it wasn't easy, but I did it.
In the hospital they find it easier to keep you in a gown, but once home I got dressed every day. Admittedly it was just shorts and a t-shirt but I did it. :egypdance:
 
I was lucky to walk to the toilet, which was all of maybe 5 or 6 feet away, the first day. I did eventually walk into the hallway and up and down their PT steps. To dress myself was easy as all I wore was a light gown for a while, and at some point added panties. That was fun as I had to maneuver my pain ball and it's tubing through it, but with advice from here, managed it. If you're going to need to do all that day one, it'll likely be work, but if that's what you have to do to go home, you'll do it and rest at home later. Many people are alert and fairly mobile right away, until the pain blocks wear off, etc, so you'll most likely be in that category.
 
@kneeper ... No. Same day surgery center. That is what they want me to do immediately after recovery before I go home that same day!
 
Before they would release me home, I had to walk up and down the hall (this was after I had gotten dressed) and go up and down three steps. I also had to use the bathroom. I was glad I had to pass the test because I have several steps to get into my house and I was able to maneuver them.

I was at the hospital less than 12 hours. When I got home (it’s an hours ride), I did have quite a bit of nausea and vomiting for the first 36-48 hours but it cleared up as I rested, elevated, and iced.
 
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