TKR Reader's Left TKR Spacer Exchange

[MerlinWizard]

Praying you find resolution TODAY. Please let us know how it goes

@Gingerbread I don't know what I would do without you. I just sent a message to the PA at my surgeon's office telling him that the Tramadol isn't really helping and that I am considering going back on the Hydrocodone for a few weeks. I asked what he thinks about it and I'm waiting to hear back. I wish I knew why the back of my knee hurts so much, and what it would take for it to stop.

What I found interesting during my journey is that I really responded well (weeks after surgery) to the Tramadol. Early on, nothing would touch the pain or take the edge off. Which is why I stopped taking the narcotics after only 5-7 days.

On occasion I will take a Tramadol before bed but that is down to only once a month if that now. Before surgery, I had never had Oxy before but I had had Tramadol before it became a scheduled narcotic.

I never found Tramadol to be addictive and back in the day I was on a regimen for tennis elbow (which has now since been fixed).

When I came out of surgery they offered me Oxy or Tramadol. Silly me, I chose Tramadol. Big mistake. Although I wouldn't find out until later that it really wouldn't have mattered if I chose Oxy anyway because those 5 MG pills don't do anything. I was also limited to 6 painkillers a day in any combination of Oxy and Tramadol. I could have 2 Oxy at a time but that cut into my 6 allotment for the day.

The hospitalist the day after my surgery (Thursday) came in during her rounds and took one look at me and said "You are in a lot of pain aren't you". I asked how she could tell. I don't remember what she said but she did say she was going to "fix it". The nurse gave me a dose of hydromorphone (dilaudid) and the next thing I remember it was Friday.

I didn't moan and complain or anything like that. I didn't even ask for more pain killers. I just sucked it up. Apparently my face didn't wear it well. My wife knew I wasn't right, she was so concerned.

I didn't see that hospitalist again until Saturday and she was upset that I was still there and she said that after all the hoops she jumped through she was more than concerned. I explained it was because of Covid test results we were waiting on in order for me to go to rehab as my wife decided she couldn't care for me at home. PT then came in and did their thing and they said they thought I could go home. When it came time to go to rehab we found out my wife couldn't visit me. I said screw that I am going home.

So I had 1 extra night in the hospital that I could have avoided because of the pain and my wife's concern.

I wasn't able to take anything but Tylenol because of the blood thinner they had me on for 20 days post surgery. Now I use ibuprofen at night (800 MG) a few times a week and it's all good.

I know that the surgeon does a lot of things to minimize pain during surgery for post operative mobilization since they get you up just hours after surgery.

This wasn't the worst pain I had ever been in. Did it hurt - heck yeah! But was it something I couldn't handle, no. While the pain was excruciating, it wasn't unlike the pain I had had before I had the surgery to begin with. It just didn't go away after a day or so like it did before surgery.

When it comes to pain relief and the standards here in the U.S. for prescribing narcotics, I think they went to far to prescribing too much to not prescribing enough. Somewhere in the middle there is a compromise.

 

[Reader525]

@MerlinWizard What an experience you had, I applaud your toughness. You said you could handle the pain, and I suppose I could just suck it up and deal with it but, I can't walk without pain and it's inhibiting my moving around.
I'm so envious of your response to Tramadol! I wish it worked for me.
My surgeon provided me with Rxs for pain meds and I took them and was nauseated but I think it was post anesthesia nausea and not the Hydrocodone. I experienced nausea after my last surgery as well. I can't wait to get to the point where you are, only needing Ibuprofen.

 

[MerlinWizard]

I don't know if I would call it "toughness", I've never been a fan of medication period. So I guess in my case, pain is relative. We all have it to varying degrees and we all let it affect our lives or we don't.

My wife is disabled and I have been caring for her for the last 14 years now. While it really isn't hard to do, everything in life we chose to do is modified to some degree. The only times it's hard is when she's had surgery - and she has had a lot of them. Also, I look at the pain she goes through and I think to myself that if she can go through what she does without reliance on pain killers than whatever I pain I may have isn't even worth mentioning.

She had the option to have all sorts of pain killers. We had enough to get anyone addicted coming from all of her doctors. They ended up at the police station drop off.

My wife recently had her knee looked at and she saw the x-ray, she isn't anywhere near replacement at this point. In time sure, but not right now. So they shot her up with cortisone and she is doing just fine.

The one thing she keeps telling me is her admiration for the pain she knows I was in. She had no idea it was as bad as it was. All that time I thought the complete opposite with the pain she was going through!

Neither of us have ever let pain of any kind prevent us from living life to it's fullest. We are both also pretty stubborn and competitive so I am sure that played into it a little bit as well.

When it gets right down to it, you either let the pain manage your life or you manage your life. We chose the latter. Right or wrong, it works for us.

 

[beesknee]

@Jockette My husband can take care of the dogs, I just wanted to try and I feel as if after almost 8 weeks it might be getting tiresome for him, but it's probably just me worrying about being a burden. He hasn't complained.
I am off the opioids, because I didn't want to keep taking them and I was feeling nauseated and attributed that to the meds, but it might have been just the general recovery from surgery, I am pretty sensitive to anesthesia. I take 500 mg Tylenol and 600 mg Ibuprofen three times a day, every 6 hours. It doesn't really eliminate the pain, just takes it down a little. I have a friend who had both knees replaced 8 weeks apart and suggested Tramadol and Tylenol. She said it isn't as strong as opioids and is in another class and is better tolerated. Have you heard anything about it being an effective painkiller? I feel so weary of the pain I am considering it.

I had a shoulder injury a while ago and the doc prescribed tram like candy. I took them and felt great. They also have anti-depressent properties.. I thought they were as safe as Acetaminophen.

When I felt better I stopped taking the few I had left. I had really bad flu like symptoms for almost 3 weeks. I really thought I had the flu. Shoulder bothered me a bit a week in so I took one and bam, no flu like symptoms for 24 hours.Body was craving for one.

The good thing ( and the the bad ) tramadol has a very long half life. They tend to do the job for 6 - 8 hours and take about 24 hours to total be out of your system. Oxy, which I had for my knee worked great, but after about 3 hours I needed more so went many hours without pain medication. I requested no Tramadol even though it works much better for me.

Now I am down to old fashioned toughness and Acetaminophen and Naproxen which don't really seem to do anything that I can notice. I did not have any withdrawal symptoms from the Oxy but I never took more than 200 mg (4) in a day. Normally 2 or 3.

 

[Reader525]

@beesknee Wow, that's amazing because this is the 3rd day of the Tramadol and I'm stopping. I couldn't sleep last night, kept waking up, that's THE LAST thing I need. I also noticed my leg kind of kicking a little here and there when on them, strange! If it stays in your body for 24 hours I'm just going to take Tylenol and Ibuprofen and maybe tomorrow I'll try half a hydrocodone if I need to. Do you think Naproxen is better suited to the pain of knee replacement?
How terrible to have that kind of withdrawal, and if it happened now, you probably would be testing for Covid!
I just wish I could be like others and just muscle through this, disregard it and be tough. It makes me judge myself that I can't.

 

[beesknee]

Yeah they are great when you need to get stuff done. Mood lift and extra energy for 6 to 8 hours is great, but if you take too close to bedtime they are a problem.

Ibuprofen works great for me. If I have one of those headaches that just won't go away, a few Ibuprofens and the headache is gone. Only problem is headache is traded for stomach ache, so I have to stay away. Naproxen seems easier on my stomach and seems to maybe help but I will only take one at a time with food. Acetaminophen has no effect on my stomach but does not really help much that I can tell.

 

[Jockette]

The doctor seemed to think it was the bursa reacting to overdoing my exercises, i.e., doing leg raises with weights and all the rest every day.

@Jockette I know it's only 4 days since I wrote about my bursa, I'm just having a hard time finding the patience I obviously need.

Do you think anything is wrong? My PA had X-rays done and he said everything is 100% perfect. But why am I so sore?

Most likely there is nothing wrong with your replacement. Recovering from basic surgery induced trauma, and overdoing things, can take a while, depending on what we did and how our body reacted to it. I had an overdo weekend as late as 4 months post op, and it took me a whole month to start to improve again

I take 500 mg Tylenol and 600 mg Ibuprofen three times a day, every 6 hours. It doesn't really eliminate the pain, just takes it down a little.

The most effective way to take Tylenol is 2 x 500 mg tablets every 6 hours, to a total of 4,000 mg (4 doses) in 24 hours. You need to take it regularly, to keep up the levels in your bloodstream. If you just take the odd dose now and then, it's far less effective.

Check all other medications you're taking, to make sure there is no Tylenol/Acetaminophen/Paracetamol in them. If there is, scale back one or two of your regular doses, so you stay within that safe 24 hour limit of 4,000 mg.

I did this, and I also took 800 mg of ibuprofen, which I find very helpful. I took each medication 6 hours apart, but I staggered the medications, so that I was taking one or the other every 3 hours. It certainly didn’t relieve my pain, but it did tone it down quite a bit.

 

[Irongirl56]

@Reader525, I have had terrible calf pain from day 1 post op. I actually thought I had a DVT it was so tender (but it wasnt). My ortho had no answer other than to heal, my PT says to heal.
It took weeks to not hurt when I walked and even today on my 3 mile walk, it started to bother me right at the top of the calf at about 45 min into my walk so I slowed my pace a bit and will ice it.

I am 11 weeks out from a medial partial. Pretty sure my bursa back there are still inflamed and get the bakers cyst kick in as well. But it is getting better with time.
Since I was limping while walking and doing triathlons for so long prior to surgery I am sure all those muscles are finally getting a chance to realign and heal.

My PT also provides painful massageon it which helps as well as ongoing icing as needed.
so slowing down and letting things heal will improve.
as for Vit E, I use that on my scar and it seems to work well. I dont really care much about scars but it keeps the skin soft and pliable for healing.

 

[Reader525]

@Irongirl56 You are so encouraging, thank you. I am always told the back of my knee hurts because I am pushing my leg back when I walk. But I'm not, I used to, but no longer. I feel like they don't know and are kind of shifting the blame to me. I had baker's cysts before the TKR, it never occurred to me that they might come back. Did you take pain meds?

 

[Reader525]

@Jockette I didn't realize I could take 4,000 mg Tylenol every 24 hours. Here I am taking 500 mg 3 x a day. I just took 800 mg Ibuprofen and will take 1000 mg Tylenol in 3 hours.

 

[Jockette]

I did take the 4 doses of Tylenol, but I only took 3 doses of the ibuprofen.

I didn’t set an alarm for the middle of the night dose of Tylenol, I took it whenever I happened to wake up. I wrote down the time (in an old fashioned little notebook ) then that set my schedule for the day. I had to write it down because I woke up at different times different nights, so the times varied day by day. Then, during the day, I did set alarms accordingly, on my phone.

 

[Reader525]

@Jockette I love that you had a little notebook. Lol. I just left my physical therapist and he checked my knee and felt some swelling in the back, said it was probably a Baker’s cyst which I had before. My knee is hot too. The movement is still excellent what with bending and straightening. He told me to do nothing until I go back to see him next Tuesday. No exercises at all. He wrapped me in an ace bandage and suggested a compression sleeve. He reassured me and told me not to worry but I am. Did I just overdo? Is that why I hurt?

 

[Reader525]

@Gingerbread I never heard back from the doctor. I have 3 Hydrocodone so I definitely could take one without his input, but I'm going to try 800 mg Ibuprofen and 1000 mg Tylenol as @Jockette does. I don't like the druggy feeling if I don't have to go back to it and the OTC meds help, that would be great. My PT thinks I should do nothing but rest and heal through Labor Day. He also said to wear a compression sleeve which I just ordered on Amazon.

 

[Reader525]

@Jockette Thank you! Thank you! Thank you! After taking 800 mg Ibuprofen at 3 pm, and 1000 mg at 6, the pain is remarkably less. It worked better than the Tramadol, and I'm so grateful you told me. I'm going to rest this weekend and just do my ADL.

 

[Gingerbread]

@Gingerbread I never heard back from the doctor. I have 3 Hydrocodone so I definitely could take one without his input, but I'm going to try 800 mg Ibuprofen and 1000 mg Tylenol as @Jockette does. I don't like the druggy feeling if I don't have to go back to it and the OTC meds help, that would be great. My PT thinks I should do nothing but rest and heal through Labor Day. He also said to wear a compression sleeve which I just ordered on Amazon.

I'm glad to hear the Ibuprofen and Acetaminophen combination is working for you!
Agree with your PT about taking it easy. I would continue to elevate and ice frequently. Compression is a good idea as well. Just be careful to watch for swelling distal to the area (from the calf down). If you notice it, the compression most likely is too tight. Adjust accordingly

 

[kneeper]

Interestingly with knee #1 I was taking NSAIDs, with knee #2 acetaminophen. Both worked on post op pain after I was off the narcotics. The swelling just takes time.

 

[Irongirl56]

ou are so encouraging, thank you. I am always told the back of my knee hurts because I am pushing my leg back when I walk. But I'm not, I used to, but no longer. I feel like they don't know and are kind of shifting the blame to me. I had baker's cysts before the TKR, it never occurred to me that they might come back. Did you take pain meds?

Yes, I read that the cysts can come back especially if you are still inflamed and swollen. For pain management I took OxyContin for the first 3 days then could not handle the nausea after my scopalomine patch wore off. I was also on Celebrex but that made me feel yucky too so by day 5 I was off of everything but Tylenol or Advil.
I took 1000mg Tylenol in the morning then 200mg Advil (like it way better than Motrin) at nite. I eventually stopped the daytime Tylenol as I had minimal pain during the day and just took it or Advil at nite before bed. I also iced right before bed as well, that seemed to help.
I also took CALM, a liquid magnesium product to help with the twitches and restless leg feeling. I still do that several times a week and take Advil at least every other nite. Trying to decrease intake as the effect all these meds have on kidneys and liver. But do still need most nites if too active during the day!

 

[MerlinWizard]

On thing I should mention, my surgeon really subscribed to Tylenol therapy. They had me on IV Tylenol for half the time I was in the hospital and I was advised to keep it up for pain relief.

I do think there is something to the Tylenol aiding in pain relief. While I know I didn't take 1000 MG when I got home, I was able to mix it in every 4-6 hours if I wanted to.

Again, Ibuprofen I wasn't allowed to have because of the blood thinner I was on. Looking back, had I been able to do the Tylenol/Ibuprofen regimen I really believe that's all I would have needed for pain relief and then narcotics for break through pain although those 5 mg Oxy are pretty much worthless.

I do have good luck with Tramadol but I don't think it's a good post surgery medication for pain relief. It works much better once the healing starts.

Hydrocodone prescriptions usuall have acetaminophen in them, so you have to consider that Tylenol in with your regular dosing. I didn't have any options for pain meds other than the 5 mg Oxy and 50 mg Tramadol. The Surgeon still has no problem refilling Tramadol - although I have plenty left, but after the initial Oxy, which I still have some left, they wouldn't give any more of that out. I was curios so I asked question =).

 

[Reader525]

@MerlinWizard I think I read about Tylenol causing kidney/liver damage so I was worried about taking such high doses, but after reading here that most everyone has had success with it, I am forging ahead. I had good luck with the Oxy and the Hydrocodone, but the spaced out effects were very uncomfortable for me, I didn't really enjoy that, plus my appetite was affected. What really is troubling to me is the reaction of my knee right now. I didn't realize how sensitive it is to PT exercises and how reactive it is. I wasn't using weights and I wasn't being excessive in my mind, but obviously my knee felt differently.

 

[Jockette]

If you are really concerned about the Tylenol you can take less. The US has 3000 mg per 24 hours on the label, but that is because they think we might not think to check other medications that also have it, like some prescription pain medications and OTC ones like some cold medications.

The schedule I took worked well for me, but we are all different, so, as always, listen to your body.