TKR Has anyone had a nerve ablation post tkr?

[Vida]

Hi everyone. Well I am pleased to report that things have gone quite smoothly. I was home after 24 hours: such a relief as there is no rest in hospital or nutrition! I am lucky to have a great, experienced nurse/husband who has kept the icing machine on and made sure that pain and poop are under control. No problems getting around after the hospital physio showed me how to go up and down stairs using two hands: no need for stick or crutches. But I am living on the ground floor for the time being so it’s not an issue.

Because I am taking the pain killers as scheduled - something I learned from this site with my hip replacement - my pain has been minimal. As I came home with a 90 degree bend and an almost flat leg, I have not been pushing exercise. Icing and elevation is my main focus and just walking around the house from bed to recliner! At a week post surgery I have almost graduated to using a stick, unless I need to pee at night, in which case I don’t risk injury and use the walker. I have started doing heel slides to increase my ROM and can do about a 110 bend without awful pain. Knee can still lie flat, so I am not adding any strengthening exercises at all. I do have a basic bike and already can comfortably do 5 mins of super slow, full rotation cycling. Could do more but my body says that’s all I need. My sense is that I am doing pretty well at such an early stage. I don’t have my first physio appointment until the 21st. And I don’t plan to let anyone hurt me!

Every now and then we get physical reminders of why we need to take it slow, not get too cocky or worry about pain meds. Right now tramadol is my best friend. I sometimes sleep through a dose, then adjust the schedule going forward, which seems to work. And I recommend Lactulose for the bowel thing. I have had lots of surgeries and it really works. Being stuffed up is the most miserable experience. A friend who had his surgery on the same day as I did, only just sorted that out a week later. It becomes a miserable obsession!

 

[Jockette]

@Vida Hi and Welcome to Recovery. You are having an amazing recovery so far, and are handling it very sensibly. Keep doing that and you’ll do fine.

I moved your post from your pre op thread, and started a Recovery Thread for you, since you are now post op. So please keep all your updates and any questions here in this thread going forward. If you would like a different title just tell us what you want and a moderator will change it for you.

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.

Just keep in mind all people are different, as are the approaches to this recovery and rehab. The key is, “Find what works for you.“ Your doctors, PTs and BoneSmart are available to help, but you are the final judge as to the recovery approach you choose.

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

​

the BoneSmart view on exercise​

BoneSmart philosophy for sensible post op therapy​

5. At week 4 and after you should follow this

Activity progression for TKRs​

6. Access to these pages on the website

​

Oral And Intravenous Pain Medications​

Wound Closure​

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.

 

[Vida]

Hi everyone. Sending special love to those who have had their tkr in the last week after me. I feel your pain but trust me, after having a complex hip replacement, I know it will get better. it will probably feel worse the odd day but it will gradually get better.

i am seeking help designing a pain control schedule. At 10 days in I am in the process of switching from Percocet, which works great for me but they only give you a few, to Tramadol 37.5/325 (Tylenol), which seems to be the standard dose prescribed here in Canada.

I took a look at the suggested tramadol/tylenol schedule posted on this site but it seems that in other parts of the world, the drug must be prescribed without Tylenol. If I took my dosage in accordance with the suggested chart, I would be way over the 4000 daily Tylenol maximum.

Can anyone share their four or six hourly Tramadol schedule? Did you add in anything else for inflammation?

Cheers and many thanks.

 

[Mrty2019]

The first few days I relied on oxycontin. However, I quickly moved to 50 mg of Tramadol and 500 mg of Tylenol every 6 hours. I knew if I had terrible pain, I could add a second tramadol or Tylenol, but I never needed it. I found that 8 am/8pm and 2am/2pm schedule worked best.

A week or so ago, I switched to the Tylenol/tramadol dose only around 8 pm and then again if I woke in pain at 2 am or so.

Let me know how you do.

 

[Vida]

Thanks so much.

 

[Carol Anna]

I threw the kitchen sink at it in the beginning I took paracetamol (Tylenol) every 4-5 hours with ibuprofen for inflamation inbetween again every 4-5 hours this did mean that I used up my maximum doses by bedtime when a hour after my last dose of paracetamol I took a codein 30 mg. When I woke at 2 a.m. and could not get back to sleep due to pain I took another codein 30 mg. I dropped the ibuprofen off first at about week 6 and then the codein week 7 and I am now in week 8 down to paracetamol 3 times a day and nothing in the middle of the night. I do on occassion still supplement with ibuprofen if I have had a busy day or sometimes if the pain re-appears (usually mid afternoon) even if I have done very little (these knees are very contrary) You will find what works for you but just wanted to give you my approach to the pain and to let you know that I have found pain relief is a necessary part of my recovery. Good luck with the rest of your recovery

 

[Sigma1]

I threw the kitchen sink at it in the beginning I took paracetamol (Tylenol) every 4-5 hours with ibuprofen for inflamation inbetween again every 4-5 hours this did mean that I used up my maximum doses by bedtime when a hour after my last dose of paracetamol I took a codein 30 mg.

I was specifically told to not use ibuprofen or naproxen. Those are NSAIDs -- anti-inflammatory, and I think the thought is that inflammation is part of the healing process. So I would encourage you to look into that. I have come to think about inflammation a whole different way. Ibuprofen and naproxen have been my go-to pain killers for years. I am rethinking that.

I had been told to take aspirin for blood thinning, but that may have some pain-control aspects too.

I was fortunate in that my pain was not super-strong except during certain maneuvers -- primary getting out of bed. I developed a technique that helped that. It was not that long before I cut my narcotic tablets in half, and even did 1/4. Pain was never at the incision, but below the incision.

 

[Carol Anna]

The hospital told me to use ibuprofen and even gave me it in hospital inbetween paracetamol and morphine. It worked for me as I have not suffered much pain and have not had my sleep disturbed by pain. I am down to between 4 and 6 paracetamols a day now and don't worry about taking them if I am in pain. We don't get any medals for suffering but we are all different and can only do what is right for each of us.

I was given blood thinners but do not take aspirin due to previous stomach problems.

There may be someone on here who can offer advice vis a vie inflamation and healing. I can only find much conflicting information on the internet.

 

[Vida]

Hi all. I was doing really well at two and half weeks: walking comfortably with a stick, able to gently ride the stationary bike and do very basic exercises with ease, almost reaching the required ROM without even trying. I was at the point of gradually reducing my pain medications, knowing it was unlikely I could get any repeat prescriptions.

Then, and I really should have known better, I had my first physio appointment. Because of Covid there was only one entrance to the hospital and that meant really a long walk to the rehab department. There were no wheelchairs. When I got there the physio was very nice and seemed amazed by my early progress. I should have left while I was ahead. She asked me to add in some reciprocal stair climbing and to do some stretches while leaning into the stairs. I attempted a few, albeit rather gingerly. After the appointment my husband searched out a wheelchair for the return journey … a weird metal job that was incredibly uncomfortable. I had to sit in it for 20 minutes while he went and brought the car around. until then I had not sat in anything other than a recliner and when I stood up, I could not believe the amount of pain. I could barely get my leg into the car.

For the past week I feel as though I am back to square one. I have injured my quad muscle and have a burning pain on the outside of the knee. It has left me unable to do much at all: I can barely walk and exercise is completely out. All I can do is ice and move from bed to chair, Of course I am also running out of medication as both my surgeon and GP are away until the new year. I know it was my own fault. The exercises added by the physio were way too advanced for week three even though I had been progressing really well.

Has anyone experienced this sort of set back with a strained quad? Could I have damaged anything internally or is it just my new knee screaming at me for not following your sage advice? It’s been a frustrating and disappointing experience. Thanks for allowing me to whine!

 

[Jaycey]

Please say no to these over zealous PT staff! That poor new knee is not in training - you are healing. Far too early for anything other than gentle stretches.

I doubt you damaged anything. But muscles, tendons and soft tissues have been through major trauma. You have probably just aggravated the area. Rest, ice and elevate. Take pain medication if you need it to get this under control.

And next time follow your gut feeling. Sounds like you know what you limits are. Don't be afraid to voice them.

@Vida You will notice that I merged your newest post with your original recovery thread. For several reasons, we prefer that you only have one recovery thread:

• That way, we have all your information in one place. This makes it easier to go back and review your history before providing advice.
• If you keep starting new threads, you miss the posts and advice others have left for you in the old threads, and some information may be unnecessarily repeated
• Having only one thread will act as a diary of your progress that you can look back on.

Please post any updates, questions or concerns about your recovery here. If you prefer a different thread title, just post what you want and we will get it changed for you.

If you need an urgent response to a question, just tag a member of staff.

Many members bookmark their thread in their computer browser, so they can find it when they log on.

 

[MoragsMum]

So sorry to hear this. I'm 8 weeks after. The last time I went to a physio session, (and that was after I requested less aggressive therapy) my knee swelled alarmingly and was generally painful) and remained like that for 48 hours. I then told them that I'm leaving, and have continued with gentle exercises three times a day at home, and feel much more optimistic. This site is an absolute lifesaver. Meanwhile I have heard of a gentle physio and may give her a try. Do take it easy and feel better ASAP!

 

[Sara61]

@Vida if you read my thread from last night you will see you are not alone, yesterday was my first physio session at 3 weeks post surgery, stupidly I went against my doctor advice and my own better judgement because I had compared notes from my previous replacement and it appeared I was dragging behind, however what I didn't take into consideration was that there was more work done on this knee and I was also just taking Paracetamol, like you I was doing just fine, at PT I still didn't use my head, what was I or the PT thinking doing 20 minutes on a electric stationery bike, plus legs lifts and other such exercises I was fine until about 9pm then all hell let loose. Moral for anyone reading this post is aggressive PT is not acceptable, I for one will follow my own advice for once.
I think both of us have just overdone it, our knees are healing not training.
Here's to a better day for both of us xxx

 

[DEL2022Jan-22]

Vida,

At 2 weeks, I had my first PT and my ROM was about where you were at. Although my PT assigned alot of exercises, they were conservative with squats (no more than 90 degrees) focusing on strengthening my quads through knee extensions and straight leg raisers. I was very sore and took the next day off.

At weeks 3, they pushed me with trying single leg step-ups and almost died (teary eyed too). I was really sore and took the next couple of days easy with lots of icing and elevation. After 2 days, I tried at home and found I could do them using the walker for assistance and balance! Fast forward to week 6/7 and my muscle memory and leg strength have returned. The PT actually "kicked me out" because there is nothing more they can prescribe other than keep with the program. Sounds like you might be on the same track.

Sara61's post is right on. At the same time, the PTs know some patients will ignore the post-op work that is needed. So, to some extent and in their defense, the PTs have to push us a bit. And, we (the patients) have to advocate for ourselves by pushing back and ask alot of questions. My PT helped me see my limitations and how to get past them.

Sounds like you are doing great to me.

 

[Jockette]

The only post op work that “is needed” is to keep the knee mobile. We have members who don’t go to formal PT and don’t do formal exercises and they recover very well, but without the unnecessary additional pain of the trial and error to find what exercises their particular knee can handle.

Healing must come first, before strengthening. An un-healed knee has been surgically damaged, and you can’t strengthen damaged tissue, it must heal first. That’s why some PT can cause painful setbacks, too often we are given more than our healing knee is ready for.

 

[Vida]

Thank you all so much. I think we are in a pretty vulnerable place in the first few weeks and we either fall victim of our own hubris and want to show what we can do, (I put myself in this category) or are intimidated by the professionals who l know have our best interests at heart but have not been through such a challenging medical procedure. My surgeon’s office assistant called this morning and said she had found a sympathetic on call OS who would prescribe some more tramadol in my surgeon and gp’ absence. This is going to help a lot. I will behave and start again, only this time trusting my own good judgment.

 

[eaglemom]

And also remember ice and elevation to your recovery. As basic as it sounds these two simple things help with pain and swelling, which you are dealing with. Remember to ice for at least 45 minutes and don't hesitate to move the ice around on the knee, even to the back of the knee if need be.

 

[patriciad]

@Vida - so sorry you are experiencing this setback. If you read through my feed you will see I suffered exactly the same setback. It’s frustrating when you are doing so well but really rest, ice and elevate the knee it might take a few weeks (I hear your groan) but eventually the muscle and internal soft tissue will heal and you will get back to where you were walking in to that appointment. I never had another PT session after that 1st disaster and have done well by simple in home exercises and normal daily activities. Walking was only consistent exercise I did, gradually increasing distance and I made sure to stretch and bend my knee every morning before getting out of bed. Good luck and sending wishes for a speedy recovery.

 

[Vida]

So am at week 5 and it has been quite the journey so far. I was unable to exercise at all for 10 days following my physio incident and have been miserable trying to ration the handful of Tramadol prescribed by an on call surgeon as mine was away. In the last week I have gradually regained my basic extension and flexion. So am back to where I was at week two…,, only with a great deal more pain. Things are looking up though. My surgeon is now back in town and called me yesterday. He confirmed that the injury is most likely related to doing prescribed exercises way too soon and has given me enough painkillers to help me move forward. He told me to take them as needed, And is ok with me doing my own rehab. I know this too shall pass but I wish I had skipped that first physio appointment. It’s a real cautionary tale!

 

[Jockette]

I’m really sorry your PT caused you such a setback. Mine caused me several, too.

One week post op he pushed my knee too far and I gripped the edges of the table to brace against the pain. Later that afternoon at home I woke up from a nap with extreme pain in my left shoulder. An X-ray several days later and my PA told me I had acute tendinitis in the shoulder, all from gripping the table. That pain was worse than the leg pain, which was bad enough.

At 4 weeks post op they put me in a pool for 50 minutes, doing countless bending exercises. Another set back. That’s when I started cancelling appointments and only went to 2 in my second month. Thankfully I got an honorable discharge from PT just before the 8 week anniversary. If I ever do this again, I’ll be doing my own rehab at home.

 

[patriciad]

After going through one knee replacement you would hope I knew enough not to let the Physiotherapist put me through a very hard and challenging routine at just 3 weeks out. But no I was so thrilled to be doing so well at that point that I cooperated with him resulting in the same setback that you are experiencing @Vida. Good news is that no permanent damage has been done and you don’t need to go back but can progress at home at your own pace. I have done so successfully. Good luck and let’s hope smooth recovery from here on in.
Seems we only ever learn the hard way but I should definitely have known better!