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Pre- Op Questions???

Discussion in 'Knee Replacement Pre-Op Area' started by Cynof4, Apr 16, 2019.

  1. Cynof4

    Cynof4 member
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    Friends,
    I have a few questions I hope some of you can help me with... I am a 53 year old female with stage 4 osteoarthritis in my right knee. I sustained a tibial plateau fracture in July of 2018 and had a right medial meniscus removal in January 2019. I am also a tightly controlled familial type 2 diabetic. I have TKR scheduled for June 12th. I am confident in my orthopedic surgeon and looking forward to a full recovery over the summer. Many of my family members work in the medical field and I have received a multitude of advice on what to expect and how to prepare for this surgery. However, none of them have ever had a joint replacement surgery before, so I'm looking for some reassurance and information from y'all.
    My questions:
    • Is there anything you wish you would have asked before surgery?
    • Did any of you do "prehab" up until surgery? Did it help?
    • Do any of you have experience with femoral nerve blocks? Or any other type of nerve blocks? Did it work for you?
    • What was your experience with post op pain management?
    • Has anyone on the forum had a Consensus implant and/ or worked with their Tracpatch app?
    • What items are essential for home care- ice machine, elevated toilet, shower chair, etc.?
    • Anything else you can tell me to ease my anxiety???
    Thanks!
    Cynthia
     
  2. Mutti3

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    @Cynof4
    To answer your questions. Today is my 18 month knee replacement anniversary.
    1. I didn’t have any questions.
    2. I did upper and lower body exercises to gain strength and endurance.
    3. No femoral block, my husband had one, no problem.
    4. I took my pain medication faithfully. Also had a prescription for an anti nausea drug.
    5. my OS does over 400 knee replacement a year, I trusted him with what was best for me.
    6. use ice machine, toilet seat riser, walker and cane. ( for me only, was finished with with all the equipment by week 4)
    7. Keep a sense of humor! You will do well and get your function back! Be confident!

    And support from Bonesmart.
     
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  3. Cynof4

    Cynof4 member
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    Thanks for the feedback Mutti3. Do you have an opinion on crutches vs. walker vs. cane?
     
  4. Mutti3

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    Used walker for 2 weeks, the cane for 2 weeks.
     
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  5. donnag1108

    donnag1108 senior

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    As far as questions really the only thing I would have asked about was the everlasting insomnia post op and about the depression. I was not really prepared for either, especially the latter, but I got through it. I had a wonderful supportive medical team and feel truly blessed that was the case. I used my walker a couple weeks and cane only a week or so. I think we all have worries going into this, and it is not easy but I can tell you I for one am absolutely thrilled with my results. The left one will need to go at sometime but we will not talk about that right now. Good luck with everything and I am sure you will do great! There are so many here who have been through this and will be a wonderful source of help and hope for you.
     
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  6. Jockette

    Jockette FORUM ADVISOR Forum Advisor

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    I would suggest reading some of the threads on the Recovery Forum to learn what you might expect post op.

    I didn’t even know what questions to ask, so I was woefully uninformed and had unrealistic expectations as a result. I still don’t know what I’d ask, but I wish I’d found Bonesmart before my surgery rather than 4 weeks after, after some unnecessary painful PT episodes.

    I didn’t even know about prehab, so I didn’t do it. Some can be helpful but it doesn’t guarantee a better recovery.

    My femoral block lasted about 24 hours and kept me comfortable and I didn’t have any problems with it.

    My post op pain management after I was home was so-so. I could only assume it was working as I still had pain and the pain didn’t get noticeably better/worse as time got close the next dose.

    I stopped taking prescription drugs on day 11 due to blurry vision and managed. My doctor told me to take Tylenol and ibuprofen alternately.

    Essentials for me were:

    Raised toilet seat, I even ended up buying a portable one for going to someone else’s house.

    Walker/cane.

    Elevating foam wedge.

    Small pillow in the car to elevate as much as one can in the front seat. Even a few inches made a difference early on.

    And the biggest thing I wish I’d known was that PT is not essential like we are led to believe. Gentle movements at home work just fine. If I do another knee replacement I will not go to PT.

    The other thing I wish I’d known is that recovery takes an average of a year. No one told me that. I notice you mentioned you were looking forward to a full recovery over the summer. I hope you didn’t mean that literally. You could have what we call an amazing recovery, but they are few and far between, so don’t be upset if it takes months longer than you expect. No matter how good your surgeon is, he has no control over your personal body’s rate of healing.

    Last but not least, Best Wishes!
     
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  7. Cynof4

    Cynof4 member
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    Donnag1108,
    I do have concerns about the insomnia. I'm a light sleeper as it is and any annoyance will keep me awake for hours. After my arthroscopy in January I couldn't get comfortable and sleep longer than a few hours at a time for 3-5 days. Did you find anything that helped better than others?

    Thank you for the encouragement! I've got a great support team in place, but as I said none of them have experienced this from the patient perspective ;-) It's a little different on the other side of the mask- LOL

    My left will need TKR somewhere down the road as well, but for now I'm strengthening my quads and preparing for the right TKR in June.
     
  8. Cynof4

    Cynof4 member
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    Jockette,
    I am currently stalking the post op/ recovery threads as suggested! Looks like people have a variety of experiences and recovery stories.

    Thanks for the specific info on your femoral nerve block (FNB). I'm considering it but the thought of a needle in my groin seems painful. The medical side of my house is all in favor of it though, so I'm trying to come to grips with it...

    I'm researching pillows and wedges for at home. I hadn't even thought about the car though. What a great idea!

    As for PT, I have a great relationship with my current physical therapist. He's responsive to my feedback and has never pushed me to the point of pain. I'm sorry you had such a bad experience. I wouldn't want to return to someone who intentionally hurt me either!

    I have a lot on my plate this summer... one of my sons is getting married, a late summer anniversary trip to Key West (surgeon approved- as long as there are no complications) and continuing education to keep up with my work as a dyslexia therapist! I know full recovery will be a marathon and not a sprint, but I'm determined to keep focused on the finish line.

    Thanks for the well wishes and encouragement. Both are appreciated and needed!!!
     
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  9. rosieNZ

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    Dear fellow stalker!
    Knowledge is king so read widely but remember people are different.
    All equipment aids which raise you up are sensible. I only needed them for 2 weeks but because you cant tell yoyr complete post op needs they are worth it. Plus those 2 weeks need all the help you can give it! Raised toilet seat, leg lifter, bed blocks, powered recliner, wee step to climb up in our high vehicle, cushion on chair yo raise a little. Lounge Doctor for elevating legs, ice packs and wraps, Aircast machine, Game Ready *hired 2 weeks)

    Sleeping: Meds made me sleep a lot the first week and a little less week 2. If awake at night I got up and went to my recliner and snuggled down there (maybe with some tea). Sometimes its delicious to be awake and not have to do anything! A luxury bonus.

    Meds. Regular for 2 weeks (celecoxib, panadol, tramadol). Panadol and Celecoxib for week 3. Now at week 5 pretty much not required(occasional ache if I do too much).

    I used crutches for week 1. Dropped to walking stick week 2 and when on public transport in week 3. Nil since. I had a loan walker but didnt use it.

    Depression and tiredness a little bit in week 2 and 3. Still tired in week 5/6 but not exhausted. I realised I wasnt eating enough and when I fixed that I felt better. Week 1 and 2 are challenging plus the surgery is a big op for your body so its not suprising.

    I had an epidural anaesthetic. No sedation so was awake (could have requested sedation). Was ok just a bit boring and I was ready to go when the wound was finally closed.

    For me rest, ice and elevation worked like magic.
    I did some upper quad strengthening pre op but was too disabled plus working for anything more.
    Best wishes. Rosie
     
  10. Jockette

    Jockette FORUM ADVISOR Forum Advisor

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    I did not get mine in my groin :yikes:, it went in my thigh not far above my knee. I was still awake when he did it and I hardly knew he did.
     
  11. Celle

    Celle FORUM ADVISOR Forum Advisor

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    I Had a femoral nerve block and it didn't hurt, because the anaesthetist gave me a small injection of local anaesthetic first. He didn't insert the block into the nerve itself, but placed it beside the nerve, using ultrasound imaging to locate the nerve near the top of my thigh (not in my groin).
    The nerve block worked very well for me and I didn't have any problems with it.

    Pre-op conditioning can be helpful, as long as it doesn't increase your knee pain. It does help to go into surgery with muscles and tendons in good condition, but that's not always possible.
    It's a good idea to concentrate on upper body strength. You'll be glad of strong arms in the first few weeks.

    Here's some pre-op reading that may help you:
    If you are at the stage where you have joint pain but don't know for sure if you are ready to have surgery, these links may help:
    Score Chart: How bad is my arthritic knee?
    Choosing a surgeon and a prosthesis
    BMI Calculator - What to do if your surgeon says you're too heavy for joint replacement surgery
    Longevity of implants and revisions: How long will my new joint last?

    If you are at the stage where you are planning to have surgery but are looking for information so you can be better prepared for what is to come, take a look at these links:
    Recovery Aids: A comprehensive list for hospital and home
    Recliner Chairs: Things you need to know if buying one for your recovery
    Pre-Op Interviews: What's involved?

    Regardless of where you are in the process, the website and app My Knee Guide can help you stay organized and informed. The free service keeps all the information pertaining to your surgery and recovery in one place on your smartphone. It is intended to be a personal support tool for the entire process.

    And if you want to picture what your life might be like with a replaced knee, take a look at the posts and threads from other BoneSmarties provided in this link:
    Stories of amazing knee recoveries
     
  12. Celle

    Celle FORUM ADVISOR Forum Advisor

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    Thank you for your surgery dates. Were all the incidents and surgeries on your right knee?
     
  13. ebungalow

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    I, too, had femoral blocks for both TKRs and very much appreciated them. They lasted for three days each time and helped a lot with pain for those days.

    Regarding sleep, in my experience you’ll just need a TON of patience.

    I’ve just been able to sleep in bed again within the past couple of weeks (but I think I’m slow and have historically had sleep issues). Before that, I was camped out in the recliner at night for months.

    Bed still isn’t super comfortable - last night I evidently twisted both legs around despite all of the pillows and both knees are more sore today.

    I’ll bet you do just great despite the anxiety! It’s a very good feeling to have the surgery over with.

    It sounds like you’ll be well-prepared and such. Just be kind to yourself and practice your patience :)
     
  14. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    I've had two TKRs as you can see in my signature. I had both for both! You can read about them here Anaesthetics - spinals, femoral blocks, GAs and everything else. Both times the anaesthetic was excellent.
    Like a previous poster, I took my pain meds religiously as prescribed and had no problems.

    This was the chart I wrote out for myself!

    aa Tramadol routine 1.JPG

    Later on, as things settled down, I moved to this one

    aa Tramadol routine 3.JPG

    anything out of this article Recovery Aids: A comprehensive list for hospital and home. But basically I was provided with toilet frames for both toilets, a leg lifter and a handyhelper. Also a CryoCuff ice machine. Basic job but perfect for my needs!
    I got myself a pair of elbow crutches (never used a walker, physio wouldn't let me!)

    my crutches.JPG

    Don't expect to sleep well for the first few weeks. That's natural.

    I'd also recommend that you do NO exercises or PT at all. Many of us on here never did any of that at all and yet we all came through with excellent outcomes.

    Read this also: It's not the exercising that gets you your ROM, it's time. Time to recover, time for swelling and pain to settle and time to heal. One thing that seems to be missing from all the PT's protocols is that all your ROM is there right from the start, just waiting for all 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. Exercise as in strength training is counter-productive and in the early weeks does more harm than good. Normal activity is the key to success.

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

    I'll leave you the Knee Recovery: The Guidelines which contain essential information. Note the one's made bold
    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 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.
     
  15. Bebob

    Bebob junior member

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    I had some prehab, mostly for my left hip (replacement on right) as I developed a trochanteric bursitis due to weird gait from the bad right knee.
    I got a raised toilet seat and shower chair. I was able to step over the tub fairly quickly, so did not need the chair to get in and out of shower, but I wanted it just in case.
    I used a walker for about 3 weeks (although was walking without it in house prior to that). I did not have much luck with crutches. The PT recommended I switch to a cane, but I found it too awkward, like it wasn't really taking any weight off my leg, so I just went with nothing. I have heard some people (more so in UK) are not allowed to use walker for long. For me, I felt much more secure, and it was easy to step off and on my porch and up and down curbs safely. In fact when I asked about crutches after surgery, my doctor gave an emphatic no!
    I used gel ice packs. Living alone, I felt an ice machine would be too much bother to refill and move back and forth.
    I had a spinal, with sedation. They did a nerve block to knee at end of surgery, but before I was awake. I don't think it worked well, I had a lot of pain coming out of surgery. This surprised me, as I had a nerve block after arthroscopy which worked great. This may have been from the tourniquet.
    One issue I had after surgery was cramping in my quads, which the pain meds weren't handling well. The doctor prescribed a short course of muscle relaxers, which helped the cramps, and my overall range of motion as well.
    My doctors practice has a caseworker who called every week for the first 4-5 weeks, and she was good about passing on questions to the doctor and PA.
    I am one who has been going to PT, and I have found it beneficial. I am able to tell him if an exercise is too hard or painful, and he listens.
    I was able to figure out how to lie on my side from my first night home, and did not have too much trouble sleeping. I was surprised by my lack of appetite, so it helps to have lots of high protein snacks which you don't need to prepare.
     
  16. Vansan

    Vansan junior member

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    @Bebob
    Hi
    I am interested to know how did you on your side
    I can not sleep on my back ever I am a stomach and side sleeper. My TKR is in 10 days


    Sent from my iPhone using Tapatalk
     
  17. Cynof4

    Cynof4 member
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    rosieNZ,

    Thanks for sharing your experiences!

    I have decided to focus on quad strengthening prior to surgery. My PT is very supportive and I'm actually enjoying having the 3 hours per week to ask him with questions about post op expectations and recovery.

    I'm having general anesthesia as I've had horrendous experiences with spinals/ epidurals and sedation. They just don't work for me and in previous attempts have always had to be converted to general anyway. My surgical anxiety is extremely intense.

    I'm busy researching post op recovery aides and prepping my home and support team. It seems like 8 weeks is forever away, but I'm sure it will get here quickly!

    Thanks for the encouragement!
     
  18. Cynof4

    Cynof4 member
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    Celle,
    Yes, all my knee procedures have been on the right knee thus far.

    My surgery is scheduled and I am definitely all in. I am a very active person by nature- hiking, hunting, fishing, gardening, etc. and can no longer do these activities due to pain and instability. It's time.

    I actually found bonesmart through my knee guide. Both have been very helpful in providing information and connecting to other joint replacement patients. I'm glad I found the forums!

    Thanks for sharing information and pointing me toward resources!
     
  19. Cynof4

    Cynof4 member
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    ebungalow,

    I'm strongly leaning towards the femoral nerve block as part of multi modal post op pain management. It's helpful to know that others have had positive experiences with it. 3 days seems wonderful!

    I was a deep sleeper until I had kids. No so much now- even though they are all young adults- just a different set of worries :heehee:. Fortunately, I won't have the worry of having to return to work until school resumes in late August, so I can let my body be the guide on when and how I can sleep. I'll just have to work through it!

    I am looking forward to being on the recovery side. Waiting is the worst and patience is not my strong suit :gaah:

    Thanks for your kind words!
     
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  20. Cynof4

    Cynof4 member
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    Josephine,

    You are so organized! I love the tables and pics! My primary care givers will be my mother (a very spry 81) and my husband. As there will be two of them taking shifts the first two weeks, having a schedule would probably be very beneficial. I have seen this used in clinical settings in hospital rooms but hadn't thought about this for home. Very helpful idea.

    I, personally, would rather use crutches, but my PT seems to think a walker is the only option I will be offered at first. I really don't understand the logic in that as I am used to moving around on crutches and can move much more quickly and efficiently even when using them to support just one leg. But, we will see what happens.

    As for post operative PT and ROM, I have been explicitly clear (as has my endocrinologist) that as a diabetic swelling will be more intense and healing will take longer. I will not allow anyone to manipulate my knee in any way just to reach a number on a chart. My concern is purely functional. Can my knee do the things I need it to do reliably without pain?

    Ah, the sleep. I have an adjustable bed and a rocker/recliner. Hopefully I'll find something comfortable to at least nap in for awhile!

    I am clicking through the links absorbing the information as I have the time. Thank you for making it so easy to pin point what I need to be researching now. The bonesmart site is super easy to use!

    Thank you for sharing all of your time and experience!
     

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