TKR Peripheral Nerve Catheter

[Susan1234]

I had my left TKR on Monday, home on Tuesday.

I want to tell everyone, make sure your hospital does peripheral nerve catheters!

Having heard so many horror stories about the extreme pain of knee replacements, I've been totally amazed at how little pain I've had. I haven't taken or had any need for anything stronger than Tylenol since surgery. Not a single dose of narcotic pain medication with their nausea and other unpleasant side effects.

Alas, I have to take the catheter out tomorrow, and then we'll see; I'm expecting a lot of pain. But 5 days without pain after major surgery is pretty good. Of course, I'm uncomfortable, trying to find a position I can sleep in is extremely difficult. But I'm managing fine on my own, I had someone stay with me for one night when I got home; didn't feel any need for them to stay longer.

 

[Jockette]

Welcome to the Recovery side! I’m glad you’re doing well at home on your own.

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.

Knee Recovery: 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. 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 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.

 

[Josephine]

@Susan1234 would that it was that simple! Not sure about the US but here in the UK, it's the surgeons and anaesthetic doctors who get to choose those kind of protocols! Sounds really neat though!

 

[Susan1234]

So what are you supposed to do for this full year while waiting to heal? It's been 3 months and I'm still basically just stuck in my apartment or taking slow boring walks around the halls of my apartment building. I don't want to ski or climb mountains. I just want to be able to walk a few blocks. Without a cane causing unbearable pain in my hand and without being run over because I'm so slow I can't make it across the street before the light changes. I know this is the preop section so what should I be doing if anything to at least strengthen the unoperated leg? Unfortunately, the doctors don't bother to tell you that having one knee replaced is going to make the other much worse very quickly.

 

[Celle]

Susan, I have moved your post, above, from the Pre-Op area.

This is your recovery thread,
Please post any questions here and we'll try to help you.

Did you ever come back here after posting about the peripheral nerve catheter?
Jockette posted a lot of useful articles that would have helped you during your recovery.

It sounds as if you need to mobilise a bit more. You're not meant to stay in your apartment for teh full year of recovery.

This article gives examples of what you should expect to be doing at various stages of your recovery:
Activity progression for TKRs

Are you still going to PT? If so, what does your therapist think about your mobility?

I'm going to ask @Josephine , our Nurse Director, to advise you. She has many years of experience in orthopaedics.
She'll probably ask you a lot of questions. Do try to answer them as fully as possible, so she has all the information she needs, to advise you appropriately.

 

[maryo52]

I hear that you have a recovering TKR and a knee that is hurting. I have found that I can maximize my lower extremity function and minimize pain with straight leg raises. I use a light ankle weight. I don't do tons of them. Right now I do 10 a day. I've done them for years and years. You will get some good guidance from Josephine. Did your physical therapist not work with you to improve your mobility?

 

[Josephine]

So what are you supposed to do for this full year while waiting to heal? It's been 3 months

When we say healing takes a year, we don't mean it will be a year like this ! Healing comes in stages:

first stage: 1-3 months
second stage: 4-6 months
third stage: 6-12 months​

 

[sistersinhim]

the doctors don't bother to tell you that having one knee replaced is going to make the other much worse very quickly.

My old knee went through this twice. First after the trk, then after the broken foot and ankle. What I found out though, was that as my new knee healed and did more work, the old knee got better. It was the same after I became weight-baring after my breaks. My old knee again started getting better. The same will probably be for you. As your new knee takes on some more of the work, the old knee gets a break and starts to feel better.

 

[Susan1234]

I have read all the articles, though some seem to me to like people are living in a different world than me, maybe Downton Abby with servants to fix their meals, wash the dishes and do the laundry! I certainly haven't needed (or wanted) anyone to do any of that stuff for me and I have been doing my exercises, and going to PT. I know the Bonesmart philosophy is don't do exercises, don't go to PT; if you do it's your own fault if you're not healing. Whereas the doctors are always going to blame your slow progress on not doing enough exercise. I have my 3 month appointment with my surgeon next week and I'm terrified he's going to tell me exactly that; I'm mobilizing as much as I can, but the cane causes excruciating pain in my thumb, and I'm afraid to walk on the uneven ground outside without it. I do go round and round the halls of my apartment building without it , not very exciting. My ROM is fine, but so what, the last 3 months have been the longest months of my life and I'm certainly not any better off than I was before surgery.

 

[sistersinhim]

I know the Bonesmart philosophy is don't do exercises, don't go to PT; if you do it's your own fault if you're not healing.

No, that's not our philosophy. It's to not do exercises that hurt. There's a big difference. I didn't go to PT or do exercises, but I didn't sit around doing nothing either. I'm divorced, had 13 rescued cats, an acre lot, house and myself to take care of. Was I not doing exercises doing those things? I was doing exactly what my knee was created to do. Crazy, painful exercises in early recovery set recovery back because it keeps the knee inflamed. Bonesmart has had thousands and thousands of recovering patients and have learned from them what is the better recovery for the majority. For a few, excessive exercise does work. But, not for the majority. If you try the excessive way and get worse, then we suggest you cut back and do your daily work activities, not just lay around having servants wait on your hand and foot.

the last 3 months have been the longest months of my life and I'm certainly not any better off than I was before surgery.

It takes months to see improvement above what you had before this surgery. I was about 5 months before I was able to ride my bike and hike short distances without pain. As time went on, I could do my fun things for longer. But, always had ice ready in case I overdid. I even took my ice machine on a camping trip 6 months out and used it after a little while of hiking!

Please be patient. This recovery takes time.

 

[Bebob]

Susan, you may benefit from an adapted cane. I would suggest asking your surgeon or PT. An Occupational Therapist or orthotist could probably make a device to modify your cane handle, that would take the pressure off of your thumb. The other option to consider would be a forearm crutch, that lets you put the weight on your forearm, rather than your hand. This might be especially handy if you have your other knee done and continue to need a cane.

 

[skigirl]

I agree that we do not recommend no PT. I attended PT for 3 full months after each of my surgeries, I am a ski instructor and wanted to get back to skiing after the surgery. But, we do not recommend painful PT or having a PT force your knee to bend.

But, all of this does not solve your problem---hopefully now the weather is better, you are able to go outside more. I never used a cane, but think the suggestion for an adaptive cane is a good one. A lot of shopping malls allow you to walk there, which would at least get you out around other people.

I will give you some of the suggestions I have made for the first month or so when you are housebound after surgery.
Here is some of what I did; I learned to knit on you tube, bought stuff on line and had it delivered. made hats for all the granddaughters! Watched Downton Abbey from day one. Looked at videos of Jane Austen.

I looked up some videos of old tv shows that I hear people talking about that I never have time to watch. Then, I got books from Amazon on my iPad and read a lot of mysteries.

I just looked up some kayaking videos on you tube because my daughter had one in front of her house---they were helpful. I watched a lot of ski videos on you tube. and started watching a show called Britain's got Talent on you tube--so many of the try outs are hysterically funny.

I had friends who took me out to lunch once a week--even though I had to put my foot on a chair. I walked my dogs---1/2 mile at a time.

I did a little bit of jewelry. I watched some Soccer games---ugh, it all sounds so silly when I write it down. Most of all, try to keep yourself going with something. You really do need to sit and elevate for the first two weeks. I made myself do that and almost all of the swelling was gone when I started PT at week three.

Here are some things that will make things worse. A PT who pushes your need to get extra rom!! This is a biggie, the swelling can last for weeks. For me, it was being on my feet in my studio---one night I was in agony--my knee needed more rest. So, at week 3---two hours down for every one hour up.

You are doing something good for your body, you are healing. So many people try to rush this stage and some frantically exercise so that they can be first to recover---we ususally find them later with tendonitis---you simply cannot rush these first three weeks.

take a topic and research it---Kayaking in Australia,in New Zealand. Beaches in Hawaii, how to change the oil in your car---you get the picture. Your computer is your friend right now.

I even got some audio books so that I did not have to hold the ipad!! Have you listened to the HElP? or Lord of the Rings? or Pride and Prejudice.

I am a reader, if you are not watch videos. Amazon prime was a good friend for those weeks when I had to order stuff on line since it was delivered in one or two days. I studied some art--oh yeah there are classes on Craftsy---cake decorating, knitting, sewing, quilting, painting---I took 4 on acrylic technique--oil painting, drawing. Now is the time to indulge your brain and find something new to learn.

 

[Celle]

I have read all the articles, though some seem to me to like people are living in a different world than me, maybe Downton Abby with servants to fix their meals, wash the dishes and do the laundry! I certainly haven't needed (or wanted) anyone to do any of that stuff for me

No, we don't have servants. We have family. Husbands, teenagers, younger children, sisters. That's what family is for - helping each other when we need help. And there is nothing wrong with asking for help when we need it.

Some of us even came home to live alone - but we didn't spend our time doing too much. A little prior preparation before surgery meant we had already cooked extra portions of meals and frozen them, so we just had to re-heat and we had a nutritious meal. We even called for takeaway meals sometimes.

Have a look at this thread for some suggestions of how to cope alone, without overdoing things:
Home Alone After Surgery

 

[Susan1234]

Well, I don't have any family to help me, but that hasn't been an issue. I've been able to do everything I needed to do in my apartment from the beginning. My surgeon asked me how I was going to get my groceries and get to PT, apparently he'd never heard of taxis or grocery delivery services. At least I can walk the 2 blocks each way to the grocery store now, though it hurts. But it's been 5 months since my surgery and I'm nowhere near being able to function comfortably. Standing hurts even more than it did before surgery, so I have to think very carefully about how long I'll have to wait for a bus or a taxi before going anywhere. (I don't drive). I still walk so slowly that I'm terrified of not being able to get across the street before the light changes. My balance is horrible, partly because I have a 25% valgus in my unoperated leg. PT says balance improvement depends on strengthening my quads and core, and I'm trying. But not sure it will really improve until I have the other leg done. But of course I'm worried that may not help at all and I'll go through all that pain again for nothing. But I don't have much of a life now, so I guess I'll do it, if my surgeon is willing. Just dreading it so much and not at all convinced I'll be any better off.

 

[Benay]

Well, I don't have any family to help me, but that hasn't been an issue. I've been able to do everything I needed to do in my apartment from the beginning. My surgeon asked me how I was going to get my groceries and get to PT, apparently he'd never heard of taxis or grocery delivery services. At least I can walk the 2 blocks each way to the grocery store now, though it hurts. But it's been 5 months since my surgery and I'm nowhere near being able to function comfortably. Standing hurts even more than it did before surgery, so I have to think very carefully about how long I'll have to wait for a bus or a taxi before going anywhere. (I don't drive). I still walk so slowly that I'm terrified of not being able to get across the street before the light changes. My balance is horrible, partly because I have a 25% valgus in my unoperated leg. PT says balance improvement depends on strengthening my quads and core, and I'm trying. But not sure it will really improve until I have the other leg done. But of course I'm worried that may not help at all and I'll go through all that pain again for nothing. But I don't have much of a life now, so I guess I'll do it, if my surgeon is willing. Just dreading it so much and not at all convinced I'll be any better off.

I'm sorry you're having such a difficult time. I'm sure the experienced forum members will have lots of suggestions and help for you

 

[eaglemom]

You said your cane hurt your thumb - is the cane handle a curved one with padding or a straight handle. Maybe getting a different cane would help. Now, don't be discouraged, but what about using your walker? I know the stigma with a walker - and I very quickly decided me walking safely was more important than my vanity.

Others will come along, but make certain to try an socialize somewhat. You said you walk around your building - simply saying hello to others can help your day and theirs. Be patient - and yes I know its difficult - I'm right there with you.

 

[lisabl]

@Susan1234 I can sympathise with the valgus leg, and the pain. Last year I had a partial knee replacement, and the other half of the joint rapidly deteriorated during the yeat causing a valgus leg like yours. I know how frustrating it can be in pain, as I had no pain prior to last years op (it just gave way), and lots of pain since. I am having a revion op next week to a full Knee replacement and can't wait. Although I know it could be up to another year on recovery, it's got to be better than constant pain, and walking so slowly with two sticks. What has helped the valgus knee has been a weight baring knee brace. Maybe see if this is available for your 'good' bad knee.

I hope your second knee improves soon.