PKR PoorlyKnees’ road to recovery

[PoorlyKnees]

March 1st: Day of the Procedure
Today I had my left medial PKR procedure.
We all have the same basic fears; hopefully I can share information that people with concerns will find useful

What Anaesthetic Did I Have?
All performed under spinal injection anaesthetic. This was the first time I’d had a spinal injection; I was nervous. It worked really well, I felt almost nothing as they administered it and my legs went numb over a 10 minute period. The team were very good and sprayed cold liquid on my legs to prove I couldn’t feel anything

What About Sedation?
They gave me a light sedative, which I thought would just relax me; I was fast asleep before I knew it.

What About After-Effects?
They brought me round as the surgeon was completing the procedure. I was aware I could hear hammering and stapling (I know that sounds gross, but I felt no pain at all).

The best bit is that I did not have any after-effects; I just felt like I’d had a lovely afternoon nap. My legs slowly regained sensation over the next few hours during which time the other pain management had kicked in. It’s now been 8 hours since the procedure and I have felt absolutely no pain.

Rehabilitation and Physiotherapy
The real work begins in the morning.

 

[Jockette]

It sounds like you are off to a good start.

Rehabilitation and Physiotherapy
The real work begins in the morning.

The real work is having patience with this long recovery, and listening to your body’s signals and not overdoing the PT. Partials take just as long as totals, to recover, even though most of us who have partials are/were under the impression that it’s a quicker recovery. Many of us partials found that isn’t true.

Regaining our ROM does not require forceful bending or painful exercises.
Regaining our ROM is more about Time than repetitions of a list of exercises.

Time to recover.
Time for pain and swelling to settle.
Time to heal.

Our range of motion is right there all along just waiting for that to happen so it can show itself.

In the general run of things, it doesn't need to be fought for, worked hard for or worried about. It will happen. Normal activity is the key to success.


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.​

​

If you want to use something to help heal the incision, ​

BoneSmart recommends hypochlorous solution. Members in the US can purchase ACTIVE Antimicrobial Hydrogel through BoneSmart at a discount. Similar products should be available in the UK and other countries.​

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.

 

[PoorlyKnees]

March 2nd: Day 1 of Recovery
The care I’ve received in hospital has been wonderful. The nurses have kept me topped up with painkillers and taken the time to explain the role and importance of each one.

What’s the Pain Like?
I have a dull ache in my “new” knee but, to be honest, this is no worse than what I was experiencing before the procedure. I know the painkillers are helping, but I’m more than happy with the comfort levels.

What’s Your Mobility Like?
I can flex my ankle and tighten my quads without any stabbing pain. I can feel the swelling around the joint preventing it from fully straightening; I think the large dressing is affecting this too.

Check Out and Go Home
After a night of close monitoring I was sent home. I’m confident that I have enough medication to manage the pain. The heavy dressing has to stay on for 4 days, but that’s a small price to pay. It’s nice to be home.

 

[Tino2You]

Hi @PoorlyKnees. One piece of advice I received, shrugged it off and then learned the hard way is, take your pain meds when they are scheduled at least for a couple of weeks Take your time and don't try to do much too soon.

Tino

 

[benne68]

I’m confident that I have enough medication to manage the pain.

Don't stop with pain meds; you need to ice and elevate as much as possible -- especially during the early weeks post-op to manage the pain and promote healing.

Be sure to read about the correct way to ice and elevate in the links that Jockette provided for you above.

Good luck and keep us posted on your progress.

 

[JusticeRider]

@PoorlyKnees congratulations on getting your surgery over with and getting home! Time to start healing!

I agree with @Tino2You and @benne68 though re pain medication, icing and elevating. It can be a nasty surprise when that nerve block and all those wonderful drugs they pump you full of at the hospital wear off on day 2 or 3

Make sure you’re ahead of the pain before it hits. You’ll do great!

 

[PoorlyKnees]

March 3rd: First Full Day at Home.

Pain Management
Thanks for all the support (JusticeRider, benne68, Tino2You).

My surgeon was very insistent that the most effective way to manage the pain was to ensure that I took the medication at the prescribed times to prevent any pain from getting a foothold. To that end I set up alarms to make sure I don’t miss any. This has been invaluable; the pain has been under control throughout the day.

Mobility
I’ve continued to flex my ankle throughout the day, even daring to flex my quads a bit. I’ve taken regular walks around the garden, followed by ice packs has proved to be quite effective.

I’m looking forward to removing the big bandage.

 

[trinket]

In addition to taking the pain meds on schedule, I would add to ice and elevate as much as possible. I had no pain the first three days because the nerve block was still at work. I let the ice and elevating go because I thought I didn't need it. I swelled up like a tick and am still swollen after three months. Had I gotten on it earlier I may not have swelled so much.

Good luck. You'll love your new knee.

 

[Tino2You]

@PoorlyKnees I am glad to have been a little help. Along that same line, when I got my knee done in January, i was given an ice therapy machine (Mine is a Berg). It really is a god send. As I type this I have mine on “chillin” my knee. Between that and the Dr Lounge (mentioned to me by @beachy) it works much better than trying to arrange three pillows to elevate your leg. Both are available at Amazon. (I am not being paid by any one to recommend anything). Now if I can find a way to sleep through the night I will be golden!

 

[PoorlyKnees]

March 4th: Finding a Routine
I’ve figured out that finding a routine is probably the best way to work through the recovery. My medication is all planned out at regular intervals to ensure appropriate pain management. I take regular trips around my house and garden to keep active and have 2 ice packs that I use after exercising and when there is any pain. On the whole this is proving to be quite effective.

Icing and Elevation
I’ve changed the way that I am elevating my leg in accordance with the BoneSmart guidelines. I’ve also ordered an ice therapy machine as I see icing as a long term solution. The harsh truth is that my other knee also needs a medial partial replacement so the ice therapy machine is more of an investment than a cost.

Removing the Compression Dressing
I’m due to remove the bandage tomorrow and I’m very excited to see what lies beneath. I’m equally as excited to finally have a shower (whilst covering the dressings).

Overall, I’m very happy with how things are progressing.

 

[PoorlyKnees]

March 5th: Doing the Right Thing.
I just stuck to my routine today. Medication at set times, a brief bit of exercise after the meds have had a chance to kick in, the ice and elevation. Im happy with that.

How’s it Looking?
Today I got to remove the compression dressing. I was quite nervous as I didn’t know what to expect; I was pleasantly surprised. Whilst there are a lot of individual wound dressings stretching from my thigh to my shin, there is very little bruising. The area around my knee is a bit swollen and a bit numb but overall it’s no worse than when I’ve had keyhole arthroscopies in the past.

Getting Back to Normal
Removing the compression bandage meant I could have a shower! Historically, I’ve always wrapped my leg is Clingfilm to keep the wound dressing dry. I bought a Bloccs Knee protector and it works really well.

 

[Layla]

Glad to read you're happy with your progress. First shower post op is the best!
I hope you have a good week!
@PoorlyKnees

 

[Tino2You]

sounds like you are well on your way. Congrats.

 

[PoorlyKnees]

March 6th: Pain Relief vs Rest, Ice and Elevation
I had a quick catch up with my medical team today, primarily to book an appointment to have the wound checked but I used the opportunity to ask a few questions. I wanted to know how I could acquire additional painkillers (Codeine), if necessary. Their response was clear, elevation and ice supported by over the counter painkillers (Paracetamol/Ibuprofen) was the correct approach. I’m good with this as I don’t like the Codeine-related side effects. Rest, ice, elevation and time is the key to success.

I’m making an effort to get some exercise during the day. I’m lucky enough to live in a quiet area where I can walk around the block to encourage my circulation, if nothing else.

What Does my Knee Feel Like?
The area around my knee is still puffy. There’s very little bruising; it’s not red nor hot so I’m not concerned. It’s still a bit numb on the outside of the knee joint and around the patella which I assume is as a result of intra joint pain management administered during the procedure.

Ideally, I’d like to end up with a “normal” looking knee; I’ll be happier when I feel the swelling has subsided and the feeling returned.

Ice Packs and Compression
I have 2 ice packs that I use. My team have recommended that I use the ice packs for “10 minutes out of every hour”. This is OK, but I’m taking delivery of an Ice/ compression machine as I see the need to manage my knee as a long term challenge. I’ll be able to use it on my right knee when I get that fixed.

 

[Jaycey]

My team have recommended that I use the ice packs for “10 minutes out of every hour”.

I am afraid 10 minutes won't do much at all. That instruction is more for injury versus recovery from surgery. Ice for 45-60 minutes several times per day.

Your routine for medication is spot on! The trick is to stay ahead of the pain at this stage.

 

[Tino2You]

@PoorlyKnees one thing you will need (or at least I did) was something to put on before the wrap/pad. The hospital have me a couple of cotton sleeves. At first that was all I used, after a couple of weeks, I had to put 2 of them on at the same time, a week later, I needed something like a wash cloth plus the sleeves or a hand towel only. That was just when I first put the ice/water in the machine. I would (still am) leave the ice/water in the machine and after exercise I could just out the wrap on by itself.

 

[Layla]

I agree with Jaycey on icing, but the choice is yours.
Icing for up to twenty minutes only is what most of us have heard or been advised to do following an injury. Following joint replacement, ice is a critical part of pain management and should be used not only on the joint, but any surrounding areas of discomfort for as often and as long as you're comfortable doing so, always placing fabric between your skin and the ice source. Icing helps bring relief from the soft tissue trauma and internal swelling. Icing is a great natural pain reliever and best of all, it's free. While some care providers do put a maximum time on icing, others suggest you ice as often as you see fit.

Icing after therapy, exercises, or prolonged activity that challenge ROM and endurance should help ease any discomfort, or preventively keep pain at bay. You may find relief through icing for weeks to months post op.

I am reading your updates with interest, I think the formatting grabbed my attention with the headings and concise
updates beneath. Thanks for sharing your journey with us. A great rest of the week to you!
@PoorlyKnees

 

[PoorlyKnees]

My team have recommended that I use the ice packs for “10 minutes out of every hour”.

I am afraid 10 minutes won't do much at all. That instruction is more for injury versus recovery from surgery. Ice for 45-60 minutes several times per day.

Your routine for medication is spot on! The trick is to stay ahead of the pain at this stage.

I agree “10 minutes out of every hour” doesn’t really work. I was aggregating it up and using pads from the freezer for 30 minutes in the morning, afternoon and evening. That is about how long they would be useful for. Things will change with my new machine.

 

[PoorlyKnees]

@PoorlyKnees one thing you will need (or at least I did) was something to put on before the wrap/pad. The hospital have me a couple of cotton sleeves. At first that was all I used, after a couple of weeks, I had to put 2 of them on at the same time, a week later, I needed something like a wash cloth plus the sleeves or a hand towel only. That was just when I first put the ice/water in the machine. I would (still am) leave the ice/water in the machine and after exercise I could just out the wrap on by itself.

I’m using a microfibre cloth between the pads and my skin

 

[PoorlyKnees]

March 7th: End of Week 1
Thank you all for the feedback and support. I’m feeling pretty chipper. My knee may still be swollen and numb, but I’m mobile, relatively independent and pain free.

AirCast Cryo/Cuff
I took delivery of my new ice pack and compressor. It works really well; way better than the standard ice pack and (dare I say it) better than the ice pack/compressor used in the hospital.

It’s had an immediate (positive) impact by reducing the level of swelling around my knee. It cost a bit but I’m having my other knee done later this year so it will get a lot of use on both knees.

Exercise and Physio
I went for my morning walk today and managed way more than I was expecting. I’m very conscious of listening to my body and stop as soon as I think I’m losing form to prevent any onset of pain.

I’ve been tentatively attempting the exercises shared by my physio, but they are tricky with a numb knee. I plan to step them up tomorrow.

My programme is basically Walk, Physio, Ice, Rest then 3 cycles of Physio, Ice, Rest throughout the day.

Further Updates
I see things settling down now, so I’m going to reduce the frequency of my updates to every other day.

My next major milestone is my first appointment with the physio in just over a week. I should get the dressings removed then and finally get a look at the surgeon’s handy work.

Keep working hard on your respective recoveries and be positive.