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TKR Pecanpie's recovery thread<

Pecanpie

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Morning folks
I came across bonesmart in my endless internet searching for some feeling that I'm going through 'normal' recovery! Sitting up awake at 4.30am with ice pack wrapped round my knee wondering how much tighter can it get! (my poor husband trying to sleep)

My TKR was on 28th June 2019 and I got home from hospital on day 5. It feels like I'm making big progress every day, but struggling with the swelling and tightness. I've been given what looks like all the same exercises as lots of others (reassuring) and trying really hard with the heel slides (definitely the toughest).

Does it get better when the staples come out? (Next Thursday)

Usually I'm a lurker in forums like this but seems like a great community of support so thought I would step in
 

Rockgirl4

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Welcome to Bonesmart, and I'm glad you found us. One of the moderators will be along soon to give you the recovery materials and more advice, but I will definitely say you are totally normal. For everyone here who had minimal pain & swelling, there are just as many of us that had moderate to severe swelling. Some get their bend back fast, others need longer. There's just no "normal" or "typical" with a TKR recovery. I was one of the ones with massive swelling and pain/tightness that was untouchable with pain meds---even the good stuff (2 Oxycodone-5's every 4 hrs). I also took longer than many to start getting my range of motion back because of so much swelling. I didn't do really any PT (per Dr's orders) the first 2-3 wks because he wanted the swelling controlled first, so definitely don't overdo it in these early days.

As for the tightness you mentioned---I never had what a lot here call tightness. Mine was more of an all-over bone-deep pain (for good reason!!!) radiating from my hip to my ankle. Many people here discuss the tightness and tight band feeling that can take many weeks/months to go away though, so you are in great company. :) I will say hang in there, as each week brings change and improvement. I'm 6.5 wks out and amazed at how things can change in just a few days. Keep resting, icing and elevating if you can and stay ahead of the pain. Best of luck to you.
 

Celle

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Hello @Pecanpie - Welcome to recovery.

You don't have to work hard at your exercises. Just treat your knee gently and remember that it needs to heal before you stress it with lots of exercise. Just a little will do. Spend lots of time resting, while elevating and icing your knee, to try and reduce swelling.

Here is the recovery reading we give to everyone - lots of useful articles.
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. At week 4 and after you should follow this
6. Access to 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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Pecanpie

Pecanpie

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The articles above are great! So good to have your own questions and thoughts confirmed by others all at different stages.
My initial interest is in the opioid addiction/dependence discussion.
I got home last Tues evening and called my GP on Wednesday morning. My husband handed in my discharge letter which detailed the medication that the hospital considered appropriate.

After bit of argument with the receptionist about how long I would have to wait to get my prescription .....I received my new prescription on Friday (which was good as I would gave run out of painkillers today otherwise...)

However! My GP has already reduced my dose of dihydrocodeine and has put a note on the box to say..reduce further when possible.

Everyone has told me that in the first few weeks, its important to keep on top of the pain, moving from 6 x 30mg per day to 4x 30mg per day is already making a difference and I have painful gaps now.

Did anyone else have this trouble with their GP (who hadn't seen me, had no idea how I had responded in hospital, but was just instantly cutting me back)
Thanks x
 

Rockgirl4

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I didn't have trouble getting my narcotic pain meds refilled, but it's a HUGE problem with many. I'm in the United States and have lost count of the people I've read about here and on another platform who were only given 1-2 wks of narcotic pain meds with NO refills. :headbang: Many in America are seeking out Pain Management Drs or asking their general practitioner for refills when the surgeons refuse.

Luckily, my state has slightly less strict opioid laws, and my surgeon understands one heals better with controlled pain. He does refills up to 90 days post-op, as long as one s making progress and needing less over time.

I hope you can find a way to get more if you need it. A lot of people on Bonesmart seem to need less (maybe 2-3 wks), but I was NOT one of them. There are just as many of us needing them still at 6-7 wks post-op and longer. Thankfully, I'm down to taking only 1 at bedtime and that's not every night. Can you ask your GP for more or is it non-negotiable? I'd be fighting for it if I needed it.
 

snowdrop

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What a wonderful forum you have found and I’m glad you did! Bonesmart made all the difference for me in my recovery of my first tkr in 2016, and now, in my second recovery of the other knee. Such a great support system here!

I know what you mean about the hesitance in the medical community to prescribe opioids for pain management! My surgeon was fairly generous with his initial prescription coming out of the hospital. When I was almost out, I called his office for another script, only to find out he was on holiday! Another call to my GP found that he was on holiday too! Long story short, I spent a couple of days on the phone trying to convince another GP in his practice to fill me a short-term script. Luckily, I was successful.

Even though I am on day 17 post op, I find I am still needing hydromorphone to get me through the night. The amount I take has reduced a lot from those early days, but I definitely rely on them to help me sleep. After all, a good rest is absolutely necessary in the healing process!

Try taking tylenol during the day. It seems to help keep the break through pain bearable. I hope your GP will be understanding when you need another script. It’s not like you’re increasing the dose either...you’re just using it as needed to get through your day, so your intake will automatically decrease over time.
 
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Pecanpie

Pecanpie

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Great to hear from others in the same boat

On the pain meds question...I have no idea if the issue is supposed to be the amount if time we are on it to make us dependent?

Seems hard to imagine I'm forming a habit in 9 days? But I have no experience of this at all. Suffered from the arthritic knee for circa 15 years before finally getting a referral and during that time my GP would only prescribe diclofenac and paracetamol (regularly wanting me to stop taking diclofenac!), so I'm used to being in constant chronic pain.

This is definitely more acute.

Even from day 1 though, I could see that the operation pain was different from the endless pain I've had in the joint for soooooo long

I had my post operation meltdown on Saturday afternoon. Couldn't stop sobbing for over an hour after standing up on my new knee.The nursing staff thought I was miserable and disappointed. I was trying to explain to them how HAPPY I was!

Reading up on Tylenol.? Being in the UK I gather this is the same as paracetamol? I'm allowed 2 every 4 hours of them up to max 8 per day. Thinking I may try to shift the overlaps between diclofenac, paracetamol and dihydrocodeine to give me more of the dihydrocodeine to get through the night and start the day off better. This was just so much easier when I could take a dihydrocodeine every 4 hours!
 

snowdrop

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I think you are right when comparing paracetamol with tylenol. And I know exactly what you mean about post op pain vs pre op pain! My first knee had been arthritic for 12 or more years, and by the time I had my tkr, I was only able to walk a short distance before having to stop and sit down. After the surgery, I was so very ecstatic to find that horrible arthritic pain gone from the get go! Even though post surgery pain was bad, I knew immediately that it was a healing pain, and that made me so, so happy!

I ended up shifting my hydromorphone towards the night too. Taking my tylenol dose about an hour beforehand helped too. It seemed to make the hydromorphone stretch a little longer at night. I still wake and take a tylenol during the night, followed by hydromorphone an hour or two later. Sleep is disrupted for sure, but pain is much better managed which makes for a superior two or three hour stretch of sleep!
 

Jockette

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Hi and Welcome to Bonesmart!

I am going to tag @Josephine,
our forum administrator and nurse director, to come and advise you about your medication.
 
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Pecanpie

Pecanpie

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It seems like many of you, a really good day is followed by a dreadful night and conversely a better day ahead!
Had a bit longer snooze this morning after reading so much positive commentary about not beating yourself up about needing to lie down and heal!

Made a huge difference to the afternoon...managed to enjoy a visit from my friend who I had almost postponed
Walked round the garden ....sat in the summerhouse chatting and drinking coffee
A little joyful moment of normality
Currently icing as the leg has been down for smidge too long, but was lovely for someone else to be amazed at how well I appear to be doing (I have to admit, the simple dressing looks great and already my fabulous colourful bruising is calming down a lot!)
Also watching the women's football world cup final watching all that harsh treatment of good healthy knees !
 

winemama

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I was 4 weeks till I was off the Oxy, in the beginning it was 2 every 4 hours, by the end it was once a day. I’m in the USA, and my Dr agreed, that Dr’s are being restrictive with opioids, but common sense must prevail. Follow BS, and you’ll do great.
 

Jockette

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Also watching the women's football world cup final watching all that harsh treatment of good healthy knees !
I am much more sensitive to seeing athletes on TV get hurt since having my replacement. I often think, there’s a TKR in the future!
 

Indygo

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I was only given only two weeks worth of the Oxy as well, but stretched it out to three by cutting back slowly. It was hard the first couple of days without it, mostly because it was harder to sleep, but ultimately I'm glad. The first three or four weeks were hard in a lot of ways, and I was glad to be done with the side effects of the heavy painkillers and to not have to worry about weaning myself off of them later!
 
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Pecanpie

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More drug related questions. I've been on diclofenac for past 8 months with no stomach issues, so wasnt prescribed anything 'protective ' with it.

This week, taking the diclofenac that my GP now seems to prefer to the dihydrocodeine I've had terrible heartburn for past 3 days. I'm a bit concerned that the Fragmin (dalteparin sodium) that the hospital is having me inject myself with (23 nights of injections to go) would make me more susceptible to heartburn from the diclofenac....or is this just my head running away with me

I will try to call surgery tomorrow, but its virtually impossible to speak to a doctor on the day, and I'm really struggling to physically get up there. (I will have to get there on Thursday for staples removed)

Appreciate if anyone else has encountered this?

Contemplating halting the diclofenac in the meantime....
 

Celle

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I'm a bit concerned that the Fragmin (dalteparin sodium) that the hospital is having me inject myself with (23 nights of injections to go...) would make me more susceptible to heartburn from the diclofenac....or is this just my head running away with me
It's usually recommended that you don't take NSAIDs, such as Diclofenac, while you are taking anticoagulants. Both the anticoagulant and the NSAID will increase your tendency to bleed.

Discuss it with your GP and remind him/her you're still administering an anticoagulant injection. Stress that you're now getting heartburn, which is a new symptom.
I think you should stop the Diclofenac. You're at risk of bleeding from your stomach.
 
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Pecanpie

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Been reading lots of others journeys today and it really helps to allow yourself to feel like what you mostly want to do is rest!!

Most of my prolonged sessions 'up' are to sit or stand with visitors....tricky to say please. .30 mins max

One thing I have found today (and yesterday)
My feet are cold.... I wiggle and wiggle and then get up and stretch, but they still feel bit like chilblain feet for ages

Anyone else?
 

kneeper

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I agree with Celle. Since you're still on an anticoagulant I wouldn't take the diclofenac-and talk to your doctor about it. The paracemetol should be fine.

I'm surprised you are managing to stand for 30 minutes at a time. I could not do it that soon.
I pretty much got up and walked to the bathroom or a little in the house.

I don't know about cold feet specifically. I would get cold overall after my tkr. I did a lot of covering up with a fleece throw (often while also icing.)
 
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Pecanpie

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I've not taken diclofenac today and no heartburn!!

I need to follow up with GP this week as he only gave me another week supply of dihydrocodeine (based on 1 every 6 hours)

I've managed ok with that today, alternating with paracetamol (although I do have to beg the question...why am I being made to 'manage ' by a GP that has no idea what I'm going through )
I know its 'the system ' in the uk that hospital sends you home with limited medication and GP follows up...but it doesn't seem right in any way for the actual patient

Just thinking about my cold toes. ..guess anti coagulant is blood thinning. .likely to make me colder than my usual cosy self!

Visit to GP on Thursday, may be able to discuss some of this then
 

Josephine

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I have no idea if the issue is supposed to be the amount if time we are on it to make us dependent?
Didn't you read this article that in the group of articles left for you in the third post of this thread? Myth busting: on getting addicted to pain meds
I've not taken diclofenac today and no heartburn!!
You beat me to it! Diclofenac is far and away the worst NSAID in respect of stomach issues. You should read these
Medications: acetaminophen (Tylenol, paracetamol) and NSAIDs, differences and dangers
NSAIDs Diclofenac. ibuprofen increase risk of heart problems: new study
I need to follow up with GP this week as he only gave me another week supply of dihydrocodeine
You GP is being unnecessarily harsh with you. You're only one week out and most people need strong meds for at least 6-8 weeks. Perhaps you could ask him if he would prescribe you some Tramadol instead of the dihydrocodeine. It's worth a try. Plus, don't you have other GPs in your surgery you could go to instead of that one?

Here are two routines I used for Tramadol/paracetamol when I had my knees done

aa Tramadol routine 2.JPG



I'd really like to offer you some structured advice but in order to do that, I also need to ask you some questions. Are you willing for me to do that?
 
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Pecanpie

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Thankyou so much @Josephine please ask away , I'll do my best to answer

Your table of medication above is great, I will see about making an appointment with a different GP
 

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