TKR Pecanpie's recovery thread<

[Josephine]

Here y'go then!

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 forget to factor in 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 swollen is your leg compared to these?

4. what is your ROM - that's flexion (bend) and extension (straightness)

5. are you icing your knee at all? If so, how often and for how long?

6. are you elevating your leg. If so how often and for how long?

7. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and

8. are you doing any exercises at home? If so what and how often?
This is the most crucial question so please help me by using the format I have left as an example
(which means please make a list and not an essay!)

Exercises done at home
- how many sessions you do each day
- enter exercise by name then number of repetitions of each
etc., etc.

Anything done at PT
- how many times a week
- enter exercise by name then number of repetitions of each
etc., etc.

 

[Pecanpie]

1. Pain 5-6 ...all a bit tight and achy this morning

2. 2x500mg paracetamol x 4 times per day
1 x 30mg dihydrocodeine x 4 times per day

3. Huge

4. Not had this measured formally yet. Physio seemed happy that it was circa 90 when I left hospital but my first follow up appointment isn't until 25th july

5.icing my knee probably 6-7 times a day until the gel bag melts each time

6. elevating for 2-3 hours in morning , up and sitting or walking for 2-3 hours then alternating
I've ordered a foam wedge pillow to make this work better

7. Currently husband off for a week to look after me. Trips to and fro bathroom, walk outside and sit outside for 20 mins, short walk round lawn wearing Fitbit, it shows circa 700-1000 steps per day

8. Calf raises 30 x 5 times a day
Heel slides 10 x3
Heel raises over rolled up towel under knee 2 or 3 x10
Circling ankles as often as I can all day
Pressing knee flat with toe pulled towards me 10 x3
Quad tensing (trying to lift leg from horizontal) 5 x3
Standing stepping on the spot lifting leg and bending 5 x3

Not had my follow up physio appointment yet

Thanks

 

[Pecanpie]

My foam leg raiser just arrived. ..I cant believe how great it feels lifting my leg with perfect support. ...it doesn't press my calf and it's very soft

 

[Pecanpie]

Ok....good phone discussion with THE GP.....
He is giving me another 60 dihydrocodeine on the basis that I will attempt to go 6 hours through the day but can take every 4 hours at night which is really where I need them at closer intervals so maybe 4 maybe 5 per day

I do want to reduce as soon as I can anyway, so we are aligned on that!

I've to take omeprazole then go back on diclofenac at the weekend (after a few days head start on omeprazole) so that should help in reducing the dihydrocodeine and protect my stomach.

If I need more after next week I've to call and we can discuss.

Seems sensible to me. Also told me that whilst hes written me a sick line for 8 weeks, he expects to extend it to 12 and is more about persuading me that I need to be off work for longer

 

[lisabl]

@Pecanpie I'm in the uk and was in a similar position to you at 2 weeks. Very surprised when I went to my Dr's surgery and spoke to reception about repeat prescription of codeine and without question got 3 more weeks supply!!!! I started to reduce on my own at 3 weeks and still have 28x30mg tabs left which are my 'just in case I really need it' but so far they have not been required at all in last 2 weeks.

You might be surprised tomorrow.

 

[Celle]

Seems sensible to me....also told me that whilst hes written me a sick line for 8 weeks, he expects to extend it to 12... and is more about persuading me that I need to be off work for longer

I like your GP.

We usually recommend taking about 12 weeks off work and then doing a Phased return to work
if possible.

 

[Pecanpie]

@Celle before I started on this journey.... I thought I might be working from home around week 4...back in office at week 6 and fully back to my old self at week 8.....


I have reassessed this situation

 

[Josephine]

1. Pain 5-6

That's not too bad at only 1½ weeks out

2. 2x500mg paracetamol x 4 times per day
1 x 30mg dihydrocodeine x 4 times per day

Okay

3. Huge

You will see in here Swelling/pain comparisons that huge swelling, being a form of pain, adds 9-10 points to your pain score - quite a thought, eh?

4. Not had this measured formally yet.

I can help you do this.

Flexion:
Get someone to take a photo in one of these poses, taking care to include the foot and hip

Extension:
A good way to check extension yourself is like this:

1. put your leg on a bench, seat, bed, floor or anything similar but preferably something fairly firm.
2. with not too much pressure, press the back of your knee down - use your leg muscles, not your hand!
3. slide your hand, palm down, under the back of your knee

a) if you can get your entire hand under easily, it's probably about +10 degrees
b) if you can get just your fingers under, it's about +5
c) if you can get your fingers under but it's a push, it's 0
d) if you can't get your fingers under at all, it's -5 or more​

Here's a graphic to explain the degrees involved

5.icing my knee probably 6-7 times a day until the gel bag melts each time

As long as it exceeds 40 minutes at a time.

6. elevating for 2-3 hours in morning , up and sitting or walking for 2-3 hours then alternating

Good

7. Currently husband off for a week to look after me. Trips to and fro bathroom, walk outside and sit outside for 20 mins, short walk round lawn wearing Fitbit, it shows circa 700-1000 steps per day

Fitbit steps to miles
That would be almost half a mile which is far too much.
I suggest you cut it down to 400-500 steps a day


Circling ankles as often as I can all day - these are only intended for the first few days when you are not very mobile. Since you clearly are now mobile, you no longer need to do them
Calf raises 30 x 5 times a day - 150 a day? that's far too many. You should do one session a day and then 10 reps only
Heel slides 10 x3 - again this is far too many. Read this (which was in your list of reading in the third post of this thread) Heel slides and how to do them properly
Heel raises over rolled up towel under knee 2 or 3 x10 - these are half leg raises and no longer required
Pressing knee flat with toe pulled towards me 10 x3 - do these once a day, 4-5 at a time
Quad tensing (trying to lift leg from horizontal) 5 x3 - also known as a straight leg raise. But I suggest you do them once a day and then only 3 at a time
Standing stepping on the spot lifting leg and bending 5 x3 - these are bad for you, will cause lots of inflammation and pain. Don't do them

Not had my follow up physio appointment yet

When you do get the appointment, do make sure they only check your ROM and don't give you any exercises, nor any extra exercises to do at home.

good phone discussion with THE GP.....
He is giving me another 60 dihydrocodeine on the basis that I will attempt to go 6 hours through the day but can take every 4 hours at night which is really where I need them at closer intervals so maybe 4 maybe 5 per day

Did you ask him about the Tramadol? But he seems to have become Mr Nice!

I've to take omeprazole then go back on diclofenac at the weekend (after a few days head start on omeprazole) so that should help in reducing the dihydrocodeine and protect my stomach.

He should have done that from the start! Watch for break through. If you get it, tell your doctor and he should tell you to take two tablets at a time instead of one. (Personally, I've been taking 2 tablet twice a day for 30 odd years - and I don't take NSAIDs!)

Also told me that whilst hes written me a sick line for 8 weeks, he expects to extend it to 12 and is more about persuading me that I need to be off work for longer

Another Mr Nice award!

In summary:
a. note the pain score adjustment in line with swelling
b. take the photos for me to measure your flexion and do the check for extension
c. cut your steps on the Fitbit
d. adjust your exercises as recommended

If you are concerned about refusing to do therapy, you need to read this Saying no to therapy (physio) - am I allowed to?

 

[kneeper]

I found it helpful to walk fairly frequently but not much at a time.

Do you have more than one gel pack? I had a couple so I could always have one freezing while I was using the last one. For the first few weeks (and my PT told me this too) your main focus is getting the swelling down.

 

[Pecanpie]

@Josephine thanks very much for all the personal advice and commentary above

Few updates

The omeprazole. .. GP has given me 20mg so I guess this is effectively 2x the 10mg they have occasionally prescribed in the past

The exercises.... will totally cut down on these, but it's being programmed to 'a do as you are told' by health professionals upbringing!

Feels wrong to deviate especially as so many people tell you that the best outcome is for those who work hard! (I do completely see that doing things that hurt are crazy just now, theres enough hurt in this knee to keep it going for a while )

I'm trying to have less active days (although ADL will be increasing as I up my independence ready for my husband going back to work on Monday!)

I'll sort out a sideways photo and send it over, but I'm not particularly worried about the number ...I can feel it improving each day as I sit on the edge of the bed... looks like a 90 degreeish bend to me

My original flexion on my bad knee pre OP was 115...and that was only by pulling it with my hand (which I now know was wrong...so the knee was not in good shape)

Original extension on the bad side was 0... good leg -5... I think its probably about +2 just now

Keeping my icing going... @kneeper I got 2 icepacks home from hospital with me and basically swap them all day

Glad to cut most of the calf raises out! Had very sore legs last night on top of everything else!

Again thanks..... really helps to feel that you're not alone in this and not going nuts!!!

 

[luvcats]

The exercises.... will totally cut down on these, but it's being programmed to 'a do as you are told' by health professionals upbringing!

We are having a very subtle battle in my house about these things. My husband is a total rule follower. Me, not so much. He worries and argues a little any time I deviate from assigned parameters and keeps cautioning me about listening to 'random boards on the internet'. Which is funny because I have a number of other health issues that I only managed to solve because I stopped listening to doctors and did my own research on the internet and met people going through the same things to share stories and solutions with.

 

[Josephine]

GP has given me 20mg so I guess this is effectively 2x the 10mg they have occasionally prescribed in the past

I've been on 40mg twice daily for years!

will totally cut down on these, but it's being programmed to 'a do as you are told' by health professionals upbringing! Feels wrong to deviate especially as so many people tell you that the best outcome is for those who work hard!

Well I believe that we should all fight against this draconian approach. There are many on this forum who did their recovery whilst doing NO exercising whatsoever! I was one of them and never did even so much as a single heel slide for either knee. And my outcomes were stellar!
I am quite convinced that all this 'work hard' ethic is totally unnecessary and may even be harmful. There are many, many knee surgeons in the UK and quite a few in the US who require no formal exercises at all, just ADLs and walking. (No exercising: what does that really mean?) Besides which, there is no compunction for us to believe the myths told us by physios and even surgeons. Did oyu read these that were left for you in the third post of this thread?
Myth busting: no pain, no gain
Myth busting: the "window of opportunity" in TKR

There are more
TKR: Ceasing aggressive physical therapy after surgery
TKR: Evidence shows that less really is more when it comes to exercising!
TKR: In-Patient Rehab Not Always Needed After TKR
TKR: Pushing to gain ROM - don't do it - have patience!
TKR: work “smarter” and not “harder”

I'll sort out a sideways photo and send it over, but I'm not particularly worried about the number

But I'd like to know in order to complete my advice to you.

 

[newpartial]

@Pecanpie I cannot remember what I was on in the hospital but was a very strong painkiller - while in they moved me to Tramadol.

I am 5 weeks in and still taking max dose paracetamol and naproxin - as for the Tramadol just at night now. I was sent home with a few day's worth.. The first GP only gave me a short prescription as was waiting on the hospital notes and discharge information to come through from the hospital.

Now they have all the information I just need to mail the pharmacy in the doctors who then put it through as a repeat and get a doc to sign it. I do not have to make a appointment or anything.

Do not think the restriction is a UK wide one probably just you are unlucky with your GP?

 

[Pecanpie]

Day 13
Today is a new milestone. The staples are coming out at lunchtime so this is going to involve somehow folding myself into the back of car and walking into the surgery.
Everyone tells me this wont hurt - fingers are crossed!!!
If only it wasn't pouring with rain!!
Not looking forward to stepping out onto slippy surfaces. Will just take my time.

Btw I do keep reading and re-reading the articles above
Trying to relate each bit to how I'm getting on. Feels like unlearning everything that all 'wise' people have told me to date. Now that I have my very own knee to relate it all to it all makes enormous sense

Exercises that hurt seem stupid
Ice is my friend
As is elevation
And keeping track if my medication has become like a full time job to make sure I'm on top of it.

Today's feeling is sort of pain, but more like the concrete knee that I've seen others describe. .. reassuring in itself to know that is 'normal '

34 of those pesky wee staples are gone. Mostly just a wee nip.. Couple bit more
But I'm chuffed they're out and I got both my own socks and trainers on.
This is a red letter day indeed

 

[snowdrop]

@Pecanpie , it’s those teeny tiny small victories that can make your day!! Congrats on putting on your own shoes! We are all enjoying the euphoria that toddlers have

 

[kneeper]

It definitely does feel good when those staples come out, doesn't it? Re-reading the articles is great. I did a lot of that with my first knee--I even printed some of them out and put them in my recovery binder my OS' office gave me.
Keep listening to the knee.

 

[winemama]

Congrats on the shoe and sock milestone. I remember when I was super excited when I could put cream on my feet myself.

 

[luvcats]

Is life better without staples? Tell us everything! lol

And keeping track if my medication has become like a full time job to make sure I'm on top of it.

Right? I got out a little notebook. At first I wrote out what was due when. Now I am taking less but I note down everything I take so I can't forget, plus I have one of those weekly pill containers and have all the dailies sorted for the week. It's a little insane.

Congratulations on putting on your shoes and socks all by your self. Trainers are hard!

 

[Pecanpie]

Day 16

Yesterday was full of lessons!
The wound is looking great after staples coming out on Thursday, although still keeping it covered with a dressing just until it gets little bit more healed. I was a bit nervous of doing much bending on Friday (I know its more in my head, but just wanted to be gentle after staples out)

My lower leg swelling was definitely reduced and used my new goniometer app to measure 91 flexion whilst sitting
(This also confirmed that this figure changes all the time, largely depending on how swollen my knee is)

But... as I've read with others .. I got a bit cocky with this new feeling and sat up for about 3 hours yesterday evening without having the leg elevated

Cue swollen, tight knee and thigh in time for bed and a step backwards in the search for a decent nights sleep.

Waking up this morning , cant wait to get ice on it to undo this.
I know the legs healing, I know elevation and ice really helps the swelling and I know that gravity hurts!!
But nothing like first hand experience to reinforce this. Intend the day ahead to make use of all this knowledge and focus on getting the swelling back under control.

Slow slow steps to recovery, but it is only day 16!

 

[Pecanpie]

2½ weeks in and I can see definite improvements!
The spectacular bruising that's been working it's way out is clearing nicely, down to the deepest purple at my ankle and the swelling is definitely reducing along with the bruising

Getting around the house using one stick which means I can carry things in my right hand! Yay for being able to get my own coffee and lunch now that my husband is back at work.

I seem to have the meds under control, spread nicely through the day.

Nights are improving but still only 2 hours asleep at a time. I think I get sore in one position and cant turn, so my body wakes me up. Its adding up to circa 5 hours a night... supplemented with a daytime nap.

I can also lift my foot about a foot of the ground when sitting with my foot in front of me! This is huge progress, end of the first week it was just clearing about 5mm off the floor!! Still using the leg lifter aid to get on and off the bed, but it's a much more seamless process now.

All in all, feels like daily improvement, but still taking things easy and slowly. Lots of elevation, lots of ice.

Long way to go, but small steps each day. It's really helpful and encouraging to read everyone else's journey! All those odd aches and pains seem normal and bit less worrying when you read that lots of folks been through exactly the same.