TKR Post-op questions for you experts...

[pawprint1125]

Hi folks,

First off, this forum has been a Godsend for me. Like most people, I knew very little about TKR until my knee issues evolved into replacement. I'm getting the surgery on October 26th. I'm sure I will have additional questions but I have this one I am trying to figure out. Maybe you can help...

I live in a nice big old house. 2 story, and around a dozen wood stairs to get to my bedroom, bathrooms, etc.

I'm not sure what to expect when I come home. Will I be able to manage getting me upstairs to my bedroom and the start of my recovery? Outside our house is a walkway from the driveway with a couple of exterior stone steps, and it comes into the house to a living room with a large "L" shape couch that I could conceivably sleep on. There is a half bath on the first floor (a step down to enter).

Since it is an old house, the some of the doorways are kind of small - I'll have to see if a walker can be used easily to go into our kitchen and get into the first floor bathroom. And this bathroom is small, as are the one closest to my bedroom. There's a larger one down the hall on the second floor.

So my question is: where would you ensconce yourself when coming home, at least for the first few days?

 

[hawk2go]

Welcome @pawprint1125! I'll share my experience but YMMV (your mileage may vary).

I have an old 2-story house with steps to my front door. I was in the hospital until I could safely climb stairs.

Here's my layout:
street to front door - 2 steps up, then a rest step, then 4 more steps up, porch to door, wrought iron rail all the way up
1st level - the living room where I could lounge or eat, and kitchen where I could cook, dining room, but no powder room on that level
2nd level - about 14 steps with a banister between levels; the bedrooms, an office (with mini fridge and microwave) and full bath

Here was my experience:

• came home 2 days after surgery - using my cane, I made my way up the stairs to the porch then switched to the walker (I put the walker wheels on the inside because the doorways and hallways are narrow); used the cane to get upstairs to second level (no rest stop); I waited for my walker to come up behind me then made the switch and went straight to the bedroom
• day 1 - 3 at home - I set up in the back bedroom because I knew sleep would be a challenge; had the commode in the room with some Just a Drop treatment in case I could not make it down the hall to the bathroom; I had easy access to shelf stable snacks in a small cooler and yogurts, meat/cheese snack packs, fruit and water/drinks in the fridge; my meals were delivered upstairs (bless my beautiful spouse) and I ate on a snack tray; my nurse, my OT and my PT all saw me upstairs on Day 2; I went downstairs a couple times but was on heavy drugs, so was careful - used the cane on stairs with a spotter and then switched to the walker
• day 4-14 at home - I moved the commode downstairs because I consistently made it down the hall when upstairs; I started going downstairs for meals at least 2x a day; I sat on the porch a few times; my nurse saw me upstairs to remove my bandage week 1 and my staples week 2; I did PT downstairs; OT released me after 2 visits; I walked (paced?) back and forth upstairs and downstairs several times a day; I did my PT exercises once or twice a day
• day 15+ at home - I had my meals downstairs unless I had no energy; the commode moved to the basement because I didn't need it; PT sessions were downstairs or on the porch; I started walking outside; I started cooking meals

 

[Pumpkin]

@pawprint1125
to Bonesmart!

Will I be able to manage getting me upstairs to my bedroom and the start of my recovery? Outside our house is a walkway from the driveway with a couple of exterior stone steps,

They will not let you come home until PT knows you can handle the amount stairs at your house.

Since it is an old house, the some of the doorways are kind of small - I'll have to see if a walker can be used easily to go into our kitchen and get into the first floor bathroom.

You may want to ask for crutch training for getting through narrow doorways. You can turn your walker side to go through those doors.

You'll notice that I have moved your newest thread to the Post Op forum. Where you will receive more responses, Post OP members frequently look at the p Pre Op threads to answer questions and concerns.
If you prefer a different thread title, just post what you want and we'll 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.
How can I find my threads and posts?

 

[pawprint1125]

These replies have really helped me prepare myself for the surgery, which was literally supposed to take place as we speak. What I WASN'T prepared for, is my surgery getting cancelled around 14 hours before it was scheduled.

My insurance company (Aetna), after dragging and dragging their feet, DENIED my surgery, saying that I needed to have PT first. My doctor (who has performed 5000 TKR) has never run into this before. Aetna is refusing to "fast track" an appeal - I'll have to go the standard route, which takes 30 days at least.

Naturally, I've been hearing for years about people's issues with their insurance company but have been lucky enough to have avoided such insanity. I don't have to tell you - after preparing (mentally and physically) for TKR surgery, after lining up all my ducks, this is one of the biggest kicks in the teeth I've ever had.

Any suggestions going forward - with insurance, or otherwise?

Thanks, as always.

Stuart

 

[Sara61]

Stuart, so sorry your surgery was cancelled last minute, unfortunately coming from Europe I cannot answer your queries but have brought it to the attention of my colleagues so someone will soon reply and give you some advice.

 

[pawprint1125]

Thank you, Sara...

 

[Jamie]

Stuart, I'm assuming your surgeon is taking care of the appeal, correct? If not, call their office and enlist their help. They usually know what language to use to help things along. We don't see this denial thing happening as much these days, but I'm sure there are times where some administrator tries to be a Big Shot and make this type of decision.

If you must deal personally with Aetna, make sure you are always calm and sweet on the phone. But you can ask to speak with a supervisor and manager to find out how to make the request for review move along faster. Ask what documentation they need to approve the need for surgery without all the more conservative treatments first (this is information your surgeon can usually document for you). Request a copy of their denial in writing. Document every step of the way and follow up with update phone calls to check progress. Be sure to get everyone's name you talk to and make a note of what is said.

Then, if I were you and you have the option, I'd consider another insurance carrier for 2022 and change during Open Season which starts November 1, 2021.

 

[pawprint1125]

Thank you, all, for your help...

Apparently, it's the PT thing which is in their rules. My regular physician told me that I would either have to run a course of PT, or show them that PT was making my condition worse.

I started PT right away, and was sure I would need to immediately show the latter. Luckily, I found the right physical therapist who understood immediately what I needed - both in terms of PT and in her documentation. The plan is to give me a few weeks of PT to better prepare me for an easier recovery and since it's only 3-4 weeks, I'll go that way.

My surgeon's office said that an appeal would be fruitless, anyway. So I'll handle it this way. A complication is (get this) MY surgeon is going on leave for his OWN TKR soon, so I'll probably need to make other arrangements, perhaps with his partner, perhaps not.

Jamie, you are SO right about finding a new insurance company after this. I'm 65, and could have gone on Medicare and Supplemental last year, but since my wife's office has had such "good" healthcare, we decided to stick with it. I've learned the hard way!

 

[kneeper]

It sounds like you found a good PT. The PT exercises can work as "prehab."

 

[WFD]

I would really like to hear your surgeon’s thoughts on recovery from a TKR after he has gone through it himself .

Many of us not so secretly wish our surgeons and PTs had gone through it.

 

[Susie-Q]

So sorry your insurance cancelled your surgery at the last minute!! My husband has good insurance at his work and I knew I'd need to get this second knee done before he retires soon. My knee got so bad this summer that I knew it was finally time. I was getting desperate as surgery got closer and was scared something (Covid) would delay it. Good luck to you and your navigation of all this red tape. If nothing, like @kneeper said, this prehab will be good prep for you. your surgery goes through as planned this time.

 

[Catalien45]

I agree with these previous posts. And, one positive in all this, the PT you are doing ahead. My Dr. had a list of exercises I was to do ahead of surgery; it was stressed this would aid me in my recovery. My PT ( we set up my post therapy with her as soon as we could, starting 5 days after my surgery) agreed that it would aid me in recovery. My one regret is that I didn’t set up just one short session with her to be sure I was doing them correctly. A couple, I wasn’t . But, they still paid off, I did them faithfully 2xday as instructed til my surgery. When I got home, many of those same exercises, I was to do; they were familiar to me, and, having done them for roughly a month, had strengthened my leg somewhat, and, I suppose, given me some muscle memory. Some, I still do. It sounds like you have a good therapist, hopefully you can stay with that one...mine is great, & we’ve both worked with her for some time, so I’m fortunate there. And, the pre-therapy will be a real plus. I wish you the best on all this..... hoping to see you soon on the “post TKR”..... lots of good folk & good advice.