TKR Reached the other side

[Rbohno]

Titianlady, thank you very much for your words of encouragement

They mean a lot to me!!!

Rich

 

[Titianlady]

Rbohno

 

[Morgaine]

As others have said, everyone heals at a different rate. My father-in-law had bi-lateral TKR, and was up walking around, and driving 5 days after surgery. I couldn't even stand up for 10 days. Just take your time and thngs will get better. On your therapist, call his company, ask for someone different if you aren't happy with him or his attitude.

 

[amab]

Younger knee replacement patients , as expressed by some others above sounds almost like a direct quote from the discussion I had just this week with my ORS Assistant! I had an appointment for a Euflexxa injection for my right knee. We were discussing my TKR, rehab, and current range of motion. He just remarked that if I'd been much older I would have been happy with 90 degrees. But due to my extensive activity level and muscle tone prior to surgery he remarked that it made sense why the initial stages of recovery were such a challenge.

So hang in there, stick with your PT, exercises, icing, elevating etc. it will get better!! For me, around the 6-8 week mark it was like night and day in the way I felt. I had my longest walk to date this past Tuesday...4 miles. Am awaiting the assembly of my new bike by our local bike shop. I am looking forward to riding the bike....still keeping my fibers crossed I have sufficient flexion.

Best to you in your recovery!

 

[Rbohno]

Yesterday marked two week anniversary for surgery. Here is where I am at:
* ROM - started use of CPM machine last Monday at 50, today it is on 64 and -3
* Pain control .... about out of the 12 hour time release OxyContin ( don't see huge benefit from this) I take a dose at 10:00 pm at night and still am wakened by pain levels of around 7 Was prescribed 10/325 Oxycodone to take every 4 hours and when asked for refill was given 5/325 Oxycodone which works as long as I don't push my knee very hard. Have once or twice a day where pain can't be controlled by 5/325 other than that pain isn't too bad

My main frustration and hurdle through this entire process has been all the differences in opinion as to how the therapy and knee should be worked and at what level I am progressing.

Advice coming from:
* pre-op meeting at hospital given by hospital staff for hip and knee replacement surgery info
* Pre- op visit with surgeons assistant
* Pre- op paperwork stating what to expect and what to do for successful recovery
* Physical Therapist - those at hospital and those that come to the house
* Home healthcare nurse
* Friends and coworkers of my wife that know someone that has had knee replacement
* Obviously this website which is awesome but my wife won't read it, says she knows what I need to be doing by listening to the above mentioned references

My wife travels a lot with her job and has 30+ sick days banked that can be used for medical care of immediate family. She had 3 trips scheduled in June ( 1st week, 3rd week and 4th week) She had cancelled her trip for next week due to my surgery but I pleaded with her to go on all the trips in June so I could rehab in peace to which she agreed because this surgery has created more stress on our marriage than I have experienced in almost 14 years.

 

[bottomshollow]

Unfortunately, the only way your wife will ever truly understand TKR recovery is to experience it for herself. I can personally vouch for the BoneSmart way of recovery. I followed to the letter and had a very uneventful recovery, and absolutely love my new knees!

 

[Rbohno]

Got staples remover yesterday - had 27 total and was uneventful except for the last 4. Skin had grown over/around (those last 4)staples and they were very uncomfortable to have removed.

My poor wife, the saga continues- she didn't think the paper for my Celebrex prescription was anything so she threw it away on day of discharge. I have been asking her about it because even with all the meds I was on at discharge from the hospital I would have sworn there was an RX in the packet for an anti-inflammatory. Maria kept arguing -No, there wasn't......... Well when nurse was was examining me yesterday she made the statement "You still have some swelling, how much Celebrex are you taking? To which I responded "none", she replied that I should have been taking it and it will help a lot in my recovery. Maria was speechless when I relayed this info and started crying, I told her it was okay I will get the rx and start taking it and we will get on track.

So many pieces to this puzzle ..... You can't force any of them into place.

 

[puffin]

My main frustration and hurdle through this entire process has been all the differences in opinion as to how the therapy and knee should be worked and at what level I am progressing.

Advice coming from:
* Friends and coworkers of my wife that know someone that has had knee replacement

Isn't always the way that advice seems to come from everyone's cousin's, neighbour's brother-in-law who had a TKR and was practically competing in the Olympics a mere matter of minutes after surgery

Come to think of it I had the same when I had Appendix surgery in the 1980s - co-workers wanted to know why I needed several weeks to recover while Pat Cash played tennis at Wimbeldon a month after - although Mr. Cash got (then) pioneering key-hole surgery in a private hospital while I went in to a crowded East London emergency room on a Sunday where exhausted junior doctors were everywhere (one fell asleep taking my medical history 72 hours into a 96 hour shift) and ended up with a 6 inch scar and post-op infection

 

[eastside85]

Hi Rich - another Charlottean here! Sounds to me like we were at same hospital and have same OS ... not sure of course, but everything sounds very familiar!

Hope things get better, they always do. Patience and good medications are all you need right now. And a good therapist, I fired my first one, the second one was my saving grace, so don't give up, keep up the good work, there is a light at the end of the tunnel!!

 

[Rbohno]

Having a tough day today, have an intense pain in my lower shin and knee cap today has a a deep continuous pain. I must have let the PT work me too hard today.

 

[Rbohno]

Question for fellow members: what is more important for rehab- ROM or rigorous PT?

My quandary - last week thru Wed my CPM was at 63 , I was advancing about 2-3 degrees per day. Well my PT showed up Wed and worked me so hard I could barely get to the restroom that evening. Next day Thursday very stiff and had to reduce CPM to 53 and was still painfull, home care nurse came in and saw that and said "You need to rest your knee - give it a break".

PT came back yesterday(Friday) and worked me out a little easier after I told her how sore I was but she added an exercise with a rubber band around my ankle. Well yesterday evening and last night it was terribly painful even with meds and ice. So today I have CPM on and knee is stiff again so I am having to start with a 53 setting.

How hard should I push my knee this weekend to get back to and maybe surpass my prior CPM setting of 63???

 

[My way]

I can see you are having a very rough time. Josephine will be sure to set you on the proper course. Just hang in there. When I had my pre op class the PT said you will have to push through the pain while still in hospital! My regular PT says do not let physio hurt. guess which way I'm goin' to go post op.

 

[Josephine]

Well, you mustn't have read the articles skigirl left for you in post #15, as all of that is covered in them. But I will go through them again in more detail.

what is more important for rehab- ROM or rigorous PT?

If by "ROM" you are referring to the CPM then you're on the wrong track. The CPM doesn't get you your ROM, the clue is in the name 'continuous passive motion'. It actually does nothing for the muscles, strength or activity. More on that later ...

Well my worked me so hard I could barely get to the restroom that evening. Next day Thursday very stiff, PT worked me out a little easier after I told her how sore I was but she added an exercise with a rubber band around my ankle. Well yesterday evening and last night it was terribly painful even with meds and ice.

That PT is going to be your greatest enemy! You must stop her being so aggressive, there is no need for it. In fact, it is very counter-productive and, as you are finding, actually impede your progress. Why they do it I have no idea but we have shown again and again that a gentler way is much more productive. So you have two choices. 1) tell her to be gentle and don't take no for an answer. Remember that you employ her and she cannot do anything without your express consent. Further, she must not do anything when you have told her no. That is withholding your consent and in law, if she goes against that, it is technically an assault. So you are in charge, okay?

home care nurse came in and saw that and said "You need to rest your knee - give it a break".

and that nurse is absolutely correct. You need to read this Swollen and stiff knee: what causes it? and you will understand why this kind of treatment impedes your recovery big time.

So today I have CPM on and knee is stiff again so I am having to start with a 53 setting. How hard should I push my knee this weekend to get back to and maybe surpass my prior CPM setting of 63???

Well, I've already explained about the CPM (in the UK our surgeons don't believe in them and they have just as good (if not better!) results than in the US) and why stiffness is your enemy. So the answer to your question is "NOT AT ALL"! Never push past discomfort, never go into pain - not ever, never. Get the message?


So now I have some questions to ask you:
1. what medications have you been prescribed, how much are you taking (in mg please) and how often?
2. how often are you icing your knee and for how long?
3. how high are you elevating your leg, how often and for how long?
4. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and
5. what kind of PT are you doing? How much and how often?


Now you need all this ...
First are the BoneSmart mantras ....
- rest, elevate, ice and take your pain meds by the clock
- if it hurts, don't do it and don't allow anyone - especially a physiotherapist - to do it to you
- if your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again
- if you won't die if it's not done, don't do it
- never stand when you can sit, never sit when you can lie down, never stay awake when you can go to sleep!

And here are the recovery articles, very crucial information that you need to read
The importance of managing pain after a TKR and the pain chart
Myth busting: no pain, no gain
Activity progression for TKRs
Healing: how long does it take?
Chart representation of TKR recovery
Energy drain for TKRs
Elevation is the key
Ice to control pain and swelling

Home physio (PT) and activity progress: suggestions
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds
Post op blues is a reality - be prepared for it

And wise words from members who have shared their experiences ...
Where are you in recovery?? (TKR)
Five “P’s” of knee recovery
TKR: work “smarter” and not “harder”
Recovering a knee - from one who knows!
It's never too late to get more ROM!
It's worth the wait for ROM

 

[Rbohno]

1. what medications have you been prescribed, how much are you taking (in mg please) and how often?
Percocet 5-325 (dose age 1 or 2 every 4 to 5 hours)
2. how often are you icing your knee and for how long?
I have Kodiak ice machine so 3or 4 times daily and about 1 hour at a time
3. how high are you elevating your leg, how often and for how long?
I am elevating 7" during every icing period
4. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and
My activity level is minimal, no cooking or house work. I make myself coffee and a sandwich but that ismabout the extent of it. I have a deck that is approximately 60' long with a patio table at the far end that I try and sit at daily
5. what kind of PT are you doing? How much and how often?
PT comes to my house 3 times a week
Exercises
* heel slides
* leg lifts
* put towel under ankle and press knee into bed
* pit towel under knee and raise leg and hold ten times
* stand at kitchen counter and move leg ten times to side, then ten times to the rear
* heel pumps( stand on tip toes and raise yourself)

 

[Josephine]

Percocet 5-325 (dose 1 or 2 every 4 to 5 hours)

You should read the article on pain management. At only 2½ weeks our, you need to be taking much more than only one tablet at a time. You could also add one extra regular Tylenol (325mg) each time you take your meds.

I have Kodiak ice machine so 3or 4 times daily and about 1 hour at a time
I am elevating 7" during every icing period

Not enough. Use ice all the time you are resting and elevate "toes above nose" at the same time. More is better. Don't ration yourself and make good use of your fantastic machine!

My activity level is minimal

Good, very good!

PT comes to my house 3 times a week
Exercises
1 heel slides
2 leg lifts
3 put towel under ankle and press knee into bend
4 put towel under knee and raise leg and hold ten times
5 stand at kitchen counter and move leg ten times to side, then ten times to the rear
6 heel pumps (stand on tip toes and raise yourself)

Okay while the PT is there but I would suggest you don't do #4 or #6 until week 5 at the earliest. And don't forget to give yourself a day off each week - even God had a day of rest!

 

[Rbohno]

You should read the article on pain management. At only 2½ weeks our, you need to be taking much more than only one tablet at a time. You could also add one extra regular Tylenol (325mg) each time you take your meds.

I had to argue with home healthcare nurse to get these. She thinks I should be on Celebrex only but I told her I couldn't afford $382 for Celebrex and also I needed something for pain. She said okay but only take one tablet every 6 hours, I have to take two every 4 hours for pain relief

 

[Josephine]

She thinks I should be on Celebrex only

Well, NSAIDs aren't that terrific for pain management anyway and you don't need anti-inflammatories for this kind of swelling.

She said okay but only take one tablet every 6 hours, I have to take two every 4 hours for pain relief

No idea why she said that. It's utter rubbish! You need pain meds more often than that carry on as you are.

But what does this have to do with taking an extra Tylenol?

 

[Josephine]

About quoting a post - know you'd love to know how to do this properly so here's the "how to" that explains it How to quote a post

 

[kneeper]

Hope you took a bit of a knee-cation and are feeling better.

 

[Rbohno]

Thank You Kneeper,

Had surgery 5 weeks ago today. Home physical therapist made last visit and final evaluation on Friday. He measured my ROM and with pushing it we could only get to 80. He said that is not good that he would have liked to see me over 100 so he was going to recommend to surgeon I go to physical therapy in town. I am all for anything that will help me improve my ROM.

Activity - I am getting around 80% of the time without my cane
Went for a ride to town to get out of the house- 45 minutes each way to hamburger joint, knee didn't like that too much was sore afterwards but next day wasn't too bad so I thought lets go out for a ride again ( yesterday for Fathers Day) by the time I walked around the house a couple of times and then took a shower I was too sore to go anywhere.

Sleeping - just starting to get a few hours at a time but knee is always very sore when I awake in the morning. I am sleeping with it elevated can't get comfortable without it elevated.

Pain and Meds - woke yesterday morning with only minor discomfort so I didn't take pain meds then within an after after waking and walking around my knee starting hurting quite a bit so I had to take my pain meds. I am taking 2 Percocet (500-325) every 6 hours and that seems to be keeping the pain managed except when pushing the knee.