TKR Rick's Recovery Thread<

[D2ens5]

yes I would be happy to answer any questions

 

[D2ens5]

Hello everyone, Today is 1 week post op. The last two days have definitely been the worse. Sunday evening I was instructed to remove the bandage and leave it uncovered and shower if I wanted to. I did make an attempt to shower but it was extremely difficult. Could not get the operated leg in the shower so I got water everywhere. I did manage to clean up, but boy the rest of the night I was in extreme pain and really could not sleep.

Spent most of yesterday icing, elevating and walking in the first floor of the house. Today has been better and I am still doing the gentle exercises as recommended by this forum: heel pumps, static quads and very gentle heel slides. I'm not getting much with the heel slides.

I have still have significant swelling and bruising but it has improved. The worst part is when I first stand up I get a burning type pain on the inside of the leg from my knee to mid thigh. It does improve as I move around. I was wondering if this is normal. I'm supposed to start OP PT this Thursday. Will see how it feels then. Any other advise or suggestions is appreciated

 

[Josephine]

Well, to start with, if you are doing all that walking around you don't need to do heel pumps (by which I suppose you mean foot pumps). They are only necessary when you're not ambulant.

I'm supposed to start OP PT this Thursday. Any other advise or suggestions is appreciated

Yes, decline to attend them. You don't need them!


Here y'go then!

It would be very helpful if you would answer each one individually - numbered as I have done - in as much detail as you can then I'll come back as see where you are ....

1. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine. And don't forget to factor in other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness).

2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?

3. how swollen is your leg compared to these?

4. what is your ROM - that's flexion (bend) and extension (straightness)

5. are you icing your knee at all? If so, how often and for how long?

6. are you elevating your leg. If so how often and for how long?

7. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and

8. are you doing any exercises at home? If so what and how often?
This is the most crucial question so please help me by using the format I have left as an example
(which means please make a list and not an essay!)

Exercises done at home
- how many sessions you do each day
- enter exercise by name then number of repetitions of each
etc., etc.

Anything done at PT
- how many times a week
- enter exercise by name then number of repetitions of each
etc., etc.

 

[D2ens5]

1. pain level when resting about 4, when standing around a 7

2. oxycodone 5mg 1 tablet every 4 hours. 2 tablets at bedtime
acetaminophen 325 mg tabs 2 tabs every 6 hours

3. Moderate

4. In hospital flexion 62, extension 5

5. icing all day 20-30 minutes on 20-30minutes off,

6. Elevating all day when not up walking, in recliner chair

7. Activity level, walk around inside of house around 10 ties per day. Approximately 8-10 minutes
Walk to kitchen to fix a snack or lunch, bathroom breaks, tried to shower but was very hard to get in shower

8. Exercises done at home
ankle pumps x10 4 times per day
heel slides x5 each 3 times per day can't get much movement and painful
seated quad set in recliner x5 3 times per day,
glut squeezes in recliner x10 each 5 times per day

Out patient PT is supposed to start October 18 2-3 times per week for 4 to 6 weeks

 

[Josephine]

1. pain level when resting about 4, when standing around a 7

Not bad considering you're barely one week out!

2. oxycodone 5mg 1 tablet every 4 hours. 2 tablets at bedtime. Acetaminophen 325 mg tabs 2 tabs every 6 hours

Very good!

3. Moderate swelling

Okay

4. In hospital flexion 62, extension 5

Ah! That'll be the swelling is hindering it.

5. icing all day 20-30 minutes on 20-30minutes off,

You accomplish little or nothing in 20 minutes. Ice for at least 40-60mins and more than 4 times a day.

6. Elevating all day when not up walking, in recliner chair

Elevate when you ice!

7. Activity level, walk around inside of house around 10 ties per day. Approximately 8-10 minutes
Walk to kitchen to fix a snack or lunch, bathroom breaks, tried to shower but was very hard to get in shower

All good


Exercises done at home
ankle pumps x10 4 times per day - you don't need to do these, you are active enough already.
heel slides x5 each 3 times per day can't get much movement and painful - yes, so stop doing them! They are largely unnecessary anyway.
seated quad set in recliner x5 3 times per day - don't do these either
glut squeezes in recliner x10 each 5 times per day - nor these

Out patient PT is supposed to start October 18 2-3 times per week for 4 to 6 weeks

Decline it! You don't need it. 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.

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

 

[sistersinhim]

Josephine is right, you don't need PT. Many of us never took formal PT or did exercises. I am one of them. I had 11 knee surgeries, 2 of them kneecap removals and 1 tkr. Even after those I never took PT. But, I didn't just sit around and do nothing. I took care of myself, my house and yard as my knee allowed me to do. As I healed, I did more. But, my knee was always in control! This was enough therapy for me and would be for any tkr patient. All the awful pain of PT is so unnecessary.

All you have to do is use it in your daily living! Your knee knows how to rehab itself and doesn't need anyone telling it how. Just use it and it will come back like new! You have to be patient, though, it doesn't happen quickly! ADL,(activities of daily living), going to the bathroom, brushing your teeth and bathing, fixing a light meal, getting something to drink and or a snack, those kinds of things will be all the exercise your knee needs. If you just use it daily in your living, you can have a less painful recovery. We know what works, we've been there!

 

[D2ens5]

Thank you for the advice.

I did cancel my PT for tomorrow but rescheduled for next Tuesday, told them I only want to do gentle exercise and no pain. They seemed ok with it.

Rough night last night after such a good day yesterday. Had a lot of pain around knee. It was a different kind of pain than I have had. It seemed deeper and more like twinges.

Plus when I got up this morning my incision at the shin was bleeding through the gauze. Called docs and they said it is normal and just keep it clean and dry and pour hydrogen peroxide over it 3 times a day. Today is just rest, ice and elevation.

 

[sistersinhim]

I will tag @Josephine for you.

 

[D2ens5]

just an update on my recovery 10 days since RTKR. During the day it has been less painful and the swelling seems to be coming down with the exception of the ankle on the operated leg. Bruising is still very evident throughout the leg especially on the inside of the thigh and back of knee. Well as I mentioned I do pretty well during the day moving about walking with walker 10 times about 5-8 minutes each walk . Still have some burning type pain on the inside of the leg but seems to be getting better. I an continuing to take the pain meds as prescribed and keeping ahead of the pain. I did push back my PT till next Tuesday to see if more of the swelling subsides. My biggest problem right now is trying to sleep at night in my bed. I have not been successful with that part of the recovery. I just tried again and here I am back on he recliner! I just cant seem to get comfortable in the bed. Pain is always much worse for me at night than during the day so that effects trying to sleep in the bed. So if any of you have had he same problem as I please let me know how you dealt with it. Amy advise would be greatly appreciated.

 

[Kiwigirl62]

I had no recliner so had to sleep in bed. ..not that successful. Only short bursts of sleep. I have read that many forum members used recliners for up to 3 weeks or more, so seems to be the norm. ..i am sure they will reply. Sleep deprivation is one of our companions unfortunately

 

[79newknees]

I have been taking Normison (Temazepam) at night, and it is very effective...to begin with I took two, but have cut it down to one now, ....next week I think I will be fine without! No doubt sleeping pills are not usually prescribed, perhaps to guard against falls? I took them for the first ten days in hospital, and it seemed fine,with the medicos!

 

[SusieShoes]

Sleep. Nearly all TKR end up despairing about not sleeping. It’s truly a rare member who can say they get enough during early recovery. It’s a combo of medications, disrupted body processes from the surgery, pain, and just plain stress (few things in life are as stressful as having a joint relaced). Have you read the article about sleep deprivation in your new member reading? Here it is again: https://bonesmart.org/forum/threads...tty-much-inevitable-but-what-causes-it.13344/

What worked for me? First: Obey the knee. If the knee was comfy, maybe I could sleep. I slept on my back with my legs elevated because it made my knees happy. I hate sleeping on my back. My knees were only happy if I was on my back, so... I slept. Not the best, but it was sleep. Second: Take your pain meds. Don’t think you can sleep through the pain. Early in recovery you’re better off with the meds, even if you have to wake up to take them. Third: A ritual. Train your brain to think “sleep” by doing things that set it up for sleeping. Some people read, listen to music, or watch a restful TV program. Some people drink a nice hot cocoa or maybe a nice stiff brandy. A nightly massage is lovely if your partner is willing (promise to return the favor down the road). Relaxing rituals can ready the brain to shut down and sleep already.

 

[D2ens5]

Thanks all made it through the night, and read the link that Sussieshoes
attached in her message. Very helpful article and it is nice to know that many of the TKR veterans have experienced the same things I am going through now.

 

[Softtail]

The allusive sleep fairy, I remember she skipped my house for the first 3 weeks. Kept ending up on couch wedged in with knee elevated ,often with my gel pack cooler wrap around it that helped me grab maybe 2 hours at a time. Somewhere between week 3 n 6 I was able to spend more time in bed , and now at week 6 am back to pretty much normal. I found my “bed” time increased as I was able to put my leg in different positions beforefalling asleep. By that I mean as it became more comfortable to bend my leg more and to put more pressure on the knee when it faced down towards mattress , ( cause I am a side to stomach sleeper), I could sleep longer.

Don’t worry about it too much ,it will come. Get in the best configuration your knee let’s you and take whatever sleep you can get, and know it will get better.

 

[D2ens5]

Thanks will do,

 

[mopa]

I am exactly 3 weeks post op and cannot take NSAIDS because I take coumadin for a mechanical heart valve. So I can relate to you about the swelling and bruising. My swelling has come down but is still there along with bruising. I was home the day of surgery and began PT the next day. Follow the advice on this forum and go very slow on the exercise because it will aggravate the knee and cause more swelling. It is a very delicate balance of exercise and rest because you do not have the luxury of taking anti inflammatory medication. I have had a some disagreements on how fast I should progress on ROM with my surgeon but am trying to not take a step forward and 3 steps back.

The sleeping problem was there for me too and for the first few nights I slept in a recliner. I tried to sleep in my regular bed with wife but it was too uncomfortable. I began sleeping on guest bed for our grandkids that is a double bed. I wear pajamas with socks and sleep on top of the covers with a loose blanket so I can move freely. I also take my phone with earbuds and listen to music while I sleep. I sleep amazingly well like this in between getting up to urinate and take pain meds. I sleep on my back but before the surgery always on my left side. I have started using a pillow some on my knee to help getting comfortable. Hang in there and don't get discouraged.

 

[D2ens5]

Thanks Mopa for your thoughts, I am on Xarelto for Afib, and the bruising and swelling has been slow to calm down. Its good to know someone is out there with similar circumstances. I will just be patient with the sleep, Im sure it will come as time progresses. I will try the music with my phone. Thx

 

[ThumperJB]

I feel so fortunate that I purchased an adjustable bed last year. Like most of you I like to sleep on my side with a pillow between my legs but the angry knee doesnt like that. I have found I can get 2-3 hours of sleep at a time if I put my bed into zero gravity position. If I won the lottery I think I would get eàch of us an adjustablè bed to go along with our ice machines.

 

[D2ens5]

Hello all, just a brief update on my recovery' Its been two weeks since RTKR and I had my first out patient PT yesterday. . Physical Therapist measured by flexion at 65 and extension at 3. I was concerned the the flexion was not very good but he said everyone is different and it ill get there. Did a lot of exercises, and some were extremely difficult to do, particularly any of the ones to do with flexion. The inside of my thigh is just so tight that it is difficult to bend. I will be going 3X per week for several weeks and doing the exercises he gave me to do at home. I have been icing and elevating since returning home from PT. My pain is not to bad and I am pretty mobile as far as walking around the house with a walker. In general it seems to be coming along and the only concern I have is getting it to bend more. I know everyone progresses and heals at there their own pace. Hopefully the flexion will come as I progress.

 

[Celle]

Please don't worry about getting your knee to bend. It's still very early days and your knee will still be swollen. It's that swelling that prevents the bending. As for extension, 3 is almost straight and your knee will straighten gradually as you heal
.
There's no need to rush to get ROM (Range of Motion) because it can continue to improve for a year, or even much longer, after a knee replacement. There isn't any deadline you have to meet:
Myth busting: the "window of opportunity" in TKR

Don't rush into doing too much exercise - PT 3 times a week is not necessary.
It's not exercising that gets you your ROM - it's time. Time to recover, time for swelling and pain to settle, and time to heal. Your ROM is there right from the start, just waiting for all that to happen, so it can show itself.