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TKR Right TKR Jan 13, 2020 my recovery so far

AliceO

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Hi Smarties!
I am in my sixth week of recovery and this is my first post OP post. I have been reading stories and help articles here all along (no need to post the helpful links in this thread, I have read them all!), and am so grateful to this site for answering the zillion questions one has before and after.

After the surgery I was mostly looking to see how others were faring at the same point in recovery I was in, and it was abundantly clear that no two recoveries are alike. However I also stopped reading after a while, since the preponderance of posts (understandably) were by people having very scary problems--and recovery was hard enough without getting needlessly scared.

So now at six weeks I am sharing my own unique recovery because while I had a couple of scary things happen, I am at last doing really well, and it may help others who need reassurance that it does get better.

Here is my journey until now.

My right knee has been my bane since 1973, when I was 17 and the ACL spontaneously ruptured, tearing my lateral meniscus in the process. I was on and off crutches for the next three years, as I tried to avoid surgery with conservative management/physical therapy. Back then they didnt really do ACL reconstruction, and when I had a lateral menistectomy in 1976 the surgeon didnt say a word about my ACL. But the knee served me well until 1990, when the medial meniscus tore and had to be removed. Finally in 1998, I got an ACL reconstruction, which was very successful. But unbeknownst to me I had an additional problem that was going to take me down--i am hypermobile, and all the years of compensation got me so cockeyed that other ligaments began to spontaneously rupture under the strain of poor biomechanics. It did not help that I had been prescribed ciprofloxacin in 2006.

In 2010 I woke up one morning and couldn't walk because of severe peripheral neuropathy in my right foot. After that, I was In and out of a wheelchair for years, unable to travel. But then by a fluke I started horseback riding and found it was helping my nervous system enough that I could walk again. After a few years of leasing horses to keep me fit, I got a horse of my own and began an amazing journey of freedom and independence, despite my musculoskeletal issues. It all came crashing to a halt, though, when my right knee got so bad that it was painful to ride. I was bone on bone, had been for years, in fact, and the right knee was becoming more and more valgus, throwing my alignment off so badly that i was injuring my beloved horse.

My aim in getting a TKR was to straighten the leg and in so doing take pressure off the peroneal nerve, and allowing me to rebalance my body and learn how to move with healthy kinematics, hopefully then stabilizing my pelvis and taking the terrible strain off my other joints. It actually was my horse's chiropractor who urged me to go ahead with the TKR and who referred me to his own surgeon.

So day one of the TKR surgery i awoke in mind bending pain. The nerve blocks they'd injected to my knee hadn't worked. They'd tried putting me on morphine but my breathing became too slow, so they instead put me on something else that definitely wasn't working. I begged for a morphine drip but the surgeon refused, and tried dilaudid, which i needed every 2 hours or it did nothing. I demanded to speak to the hospital pharmacist, but he said his hands were tied, he couldn't dispense opioids more frequently or he'd be in trouble with the DEA. I finally persuaded the surgeon to approve morphine, but it wasn't administered. It was the night nurse who, taking one look at me, ran for the morphine. The next morning I was pain free but the surgeon was ticked because now I couldn't be discharged. I was in the hospital a total of four days. My ROM immediately following surgery was 0-110.

They discharged me with about 15 different powerful prescriptions. My husband was in charge of my care. I was too out of it for the next two weeks to have any idea what was going on. I'm very sensitive to all drugs and i guess it was a blessing that i remember just about nothing of those first two weeks. One thing they neglected to impress on my husband was that most of these medications needed to be taken with food. He had alarms going off every 3 hours around the clock to remind him to give me my meds, but they were being taken on an empty stomach. Don't do this!!! He had them all organized in pill dispensers. The dilaudid wasn't working at every 3 hours and i was miserable. We got them to change the prescription to oxycodone, which worked fine, at last.

I had found a breg ice machine on craigslist a few days before the surgery and was using it around the clock. This particular model has sleeves that go around the calves as well as around the knee and you can choose an air compression feature that pumps the calves to prevent DVT. It's a very well made machine and if you can find one i highly recommend it. I found the compression as soothing as the ice water circulating. I kept it on all night and most of the day.

During the first two weeks my surgeon does not want patients going to PT. He wants them up and walking every hour or two to discourage blood clots, and I was given just 3 exercises to do: foot pumps, heel slides, and leg extensions (quad sets).

On the way home from my two week check up, where my staples were removed, i became severely nauseated. I thought maybe I was carsick from sleeping across the back seats, but hours after returning home I felt no better. It was severely painful to be hungry, but when I ate it hurt worse. I called the surgeons office but his team wasnt in. The surgeon on call said to take one less baby aspirin, and to take pepcid in addition to the omeprazole I was already on. The stomach pain became alarming. It felt like I might vomit blood. In the middle of the night that night I was awakened by extreme pain shooting across my chest. My husband took my pulse, blood pressure, temperature, and blood oxygen (we have the tools for these at home) and determined it wasn't my heart. Google suggested it was my gallbladder.

Did you know that gallbladder malfunction is a common complication of any surgery? I didn't.

In the morning we went in to urgent care and after they saw my blood test results they called the emergency room and sent us over. A major blood clot was indicated. Apparently DVT can present like a heart attack. I didn't know that either.

At the hospital they wheeled me right in for an EKG, then did a dye contrast CT scan. No heart attack, no blood clot. Whew! The ER doc suggested it could be acute gastritis, but since my liver numbers were normal he wasnt going to do a gallbladder ultrasound. Over the next two weeks I had two more very frightening attacks. My regular GP ordered the gallbladder ultrasound and it looked fine. The diagnosis? Gas. Anesthesia and lack of activity and meds all created a horrible perfect storm of gas. Now I know what horses feel when they have a gas colic. Like you don't care if you live or die.

Weeks three through five I was at PT twice a week. I was very mindful of the bonesmart philosophy that "less is more" when it comes to PT. However my surgeon and my excellent PT impressed on me that attaining ROM of 0-120 by week 6 was imperative for a good recovery. Most of my early PT was focused on relearning how to walk correctly--something I hadn't been able to do since I was 17. It was soon clear that my gait could not improve without good ROM. But I was careful not to flex or extend to the point of real pain. I have an exercise bike at home and every morning used it to warm up the knee with 3/4 circles until I could pedal all the way around. Then I'd lower the seat another notch and repeat the process. By the middle of week 5, I was -1 to 120, and by my 6 week visit to the surgeon I was all the way to zero extension.

I've had 6 prior knee surgeries and regaining ROM was always easy for me--probably because i am hypermobile. Since establishing a healthy gait was my first priority, I wasn't willing to not work on my ROM and take chances with it. I found that if I consciously relaxed into the stretch it goes much better.

So that takes me to this week, my sixth post OP. My stomach finally is settling. Here is what has helped: I stopped taking aspirin and celebrex and oxycodone as quickly as I could. I used Tylenol for pain. I ate yogurt with prebiotics sprinkled on it before taking any meds. I took a probiotic once a day. I took pepcid twice a day for a couple of weeks and Maalox if I felt an attack coming on. I also am taking NAC to help clear the liver of the anesthesia, and l-glutamine to heal the stomach lining. I am not eating citrus or tomatoes, and i switched to just a shot of cold brewed coffee with lots of water and milk and cream added in the morning. Now that I am cleared to be more active, I expect that will help with the gut issues as well.

So on Tuesday this week I saw my surgeon again. He took xrays of both knees and pronounced the implant "perfect". He cleared me to drive, to swim, to work with my horse. He says I can ride a little bit but thinks I'll be a lot more comfortable if I wait a bit longer before riding. Which is okay as my horse and I need a bit of time to rebuild mutual trust and our bond after I abandoned her for six weeks. I'll begin with ground work and my husband's help tacking up.

In retrospect, here are a few things I'd like to say to those embarking on the knee replacement journey, as per my own experience.

First of all, don't expect to see daylight for the first six weeks. I suffered cognitive impairment from the drugs, exacerbated by lack of sleep. Also not being able to walk normally, not being able to drive these things are isolating, and for me, the lack of autonomy was very hard to take. I gave myself permission to web surf mindlessly, watch stupid stuff on tv, and take lots of long naps. I started reading a big biography, but it was weeks before I could focus enough to read for longer than a few minutes. My body has been in kind of a stunned, frozen, confused state. Now that I am cleared to begin strength training and can take longer walks, I expect that the body will reintegrate and reorganize.

I'm off all meds. I quit the Tylenol and just take one Aleve twice a day. Plus vitamin and herbal supplements.

The leg is strong, straight and feels incrementally better every day.

If anyone has any questions, feel free!
 

Celle

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welcome to recovery, @AliceO .
It sounds as if you've had a bit of a hard time. I hope things will improve gradually from now on.

I know you said you'd read all the articles before, but I am going to give you your own copy of the recovery guidelines, for reference, so you don't ha d to go hunting on someone else's thread:
Knee Recovery: The Guidelines
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
ice
take your pain meds by prescription schedule (not when pain starts!)​

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. Try to follow this

6. Access to 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 the 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 the member’s history before providing advice, so please post any updates or questions you have right here in this thread.
 

Qdogpa

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Did you know that gallbladder malfunction is a common complication of any surgery? I didn't.
Sure found this out the hard way..5 years ago to the day as my recent PKR, I had shoulder surgery..within days I developed DVT , which in turn caused pulmonary embolism...3 days later , gallbladder went bad, and needed to be removed.BUT, because of blood clots , I had to wait til they went away, so they did a Choly, where gallbladder was tied off, and a billiary bag was attached thru abdomen with a tube to removed bile... 2 months later, finally had the gallbladder removed....this getting old stuff is miserable ...
 

Celle

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Did you know that gallbladder malfunction is a common complication of any surgery? I didn't.
While I'm sorry it happened to you, AliceO and Qdogpa, gallbladder malfunction isn't a common complication of surgery. While it may be a potential complication, it isn't even mentioned in the list of possible complications for most surgeries.

I have never seen it happen to anyone I encountered in my years of nursing.
I wouldn't want members here to start worrying about it.
 

Qdogpa

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No, it is uncommon...but so was DVT and PE from shoulder surgery...without any prior symptoms
 

Summer2020

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@AliceO hello! It was interesting to read your story. I had my RTKR surgery the exact same day you did 1/13/20. I too have had problems with my knees since I was a teenager. I had a very bad dislocation of my left knee when I was 18 and I think I always protected that one while in the meantime wearing out my right knee. So right knee first and I’m sure I’ll need the left one done in the next few years.

I experienced a lot of pain while in the hospital too. The first night they allowed me intravenous dilaudid which worked so much better than the oral oxycodone for me. But 2 doses were all they would allow me of the Dilaudid and then it was oral oxy after that. The OS allowed me oxycodone for about 2 weeks then a step down to hydrocodone. Now at 7 weeks I’m still having quite a bit of pain but am trying to stick to Tylenol. I do take the hydrocodone right before my PT which I’ve been doing 3 days a week. My extension is at -4 and that’s with a 10lb weight and my PT puddling down on my knee. So I don’t feel that’s my true extension. When I walk it’s still bent some (like it was before my surgery). My flexion is 120 which my OS and therapist seem to be happy with. I haven’t driven yet, and I’m not going back to work til after I see mysurgeon again on 3/30/20. I just wish I could have less pain, swelling and stiffness. If you’ve been oked to ride a horse you must be doing way better than I am. Hope all goes well for you from here on out.
 

Julia1911

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Wow, sorry you have been thru so much for so long.

Worst I have gotten so far was a UTI end week 3 beginning week 4, and what I thought was a "recurrence" of hemorroids I found out today was actually a few small tears from all the stool softeners making me go so much/so often (and me having to use wet wipes constantly to feel clean).

Also having lots of skipped heartbeats since the first week, that I had mostly gotten over 18 mos ago. Don't know if drugs or not being able to sleep more than 2-3 hours at a time still.
 

Qdogpa

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Sleeplessness has been the norm for me..never more then 3 miserable hours, followed by 4 twice as uncomfortable hours...finished 5 weeks post op this past Tuesday ....long for a good night sleep
 

valgriff2

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Got the UTI too. Hate antibiotics....they tear my stomach up.......but 1more day.

Still taking pain meds. Still icing.....19 days since surgery.
 

Celle

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People, please let's remember that this is AliceO's recovery thread, not really a place for reporting your own post-op complications.
 
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AliceO

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Walked a little over a mile yesterday on level ground! Played with my horse and hubby put her saddle on for me. I didnt get on--just getting her used to it again. I did clean the stalls, picked out her hooves, and fixed up her supplement. Then collapsed into my recliner too tired to make dinner. It was a lot for one day, but this morning the knee feels better than ever! I'm so pleased with how much better it feels each morning. Today I'll get in the pool at the gym for the first time. I just want to be in motion all the time now! It feels so good to be regaining strength. My friend I walked with has known me for 30 years and she couldn't stop exclaiming over how straight my leg is and how normal my gait.
 

Jaycey

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Equine maintenance can be exhausting - especially after major surgery. Ease into any activity. It's good you are doing just bits of what is needed. Build up the activity slowly. Your gym work is going to take most of your energy.
 
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AliceO

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Thanks Jacey. Just came in from the barn. Started to limp from sharp pain the the patella so let hubby finish the chores. Now have the leg elevated and icing with the breg cooler. May or may not head to the gym depending on how it feels in an hour. Hate to have to choose between the gym and the horse!
 

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