TKR Rodney's TKR recovery

[AussieRodney]

G'day, folks.

My TKR was on the right knee on Feb4, so I am now just over 4 weeks in.

I am stoked with my progress.

 

[sistersinhim]

Welcome to Bonesmart! Your incision looks great for just a little over a month out. You are swollen. Are you icing and elevating enough? You can ice as long as you like as long as you have a cloth between your skin and the ice pack. I iced and elevated the whole time I was sitting or laying down for at least a month and after activities after that.

Each person is different as is their recovery. Most find that the Bonesmart approach works best for them, but others find that a more aggressive therapy helps them more. It's your recovery and your choice on how you recover. As you read more on other members' recovery threads, you’ll get a better perspective of what to expect. The following are our basic guidelines and should help get you started.

Knee Recovery: The Guidelines

1. Don’t worry: Your body will heal all by itself. Relax and let it. Don't try and hurry it, don’t worry about any symptoms now; they are almost certainly only temporary.
2. Control discomfort:

rest​

elevate​

ice​

take your pain meds by prescription schedule (not when the 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 to hurt you.
b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again for a few weeks.
4. PT or exercise can be useful BUT take note of these

the BoneSmart view on exercise​

BoneSmart philosophy for sensible post op therapy​

5. Here is a week-by-week guide for Activity progression for TKRs


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.

 

[AussieRodney]

Thanks.

Tomorrow will be 5 weeks, so I'm a bit late to the party.

At 4 weeks, I had an ROM of about 130, which I sent off to the surgeon with some other pictures.

All of my initial efforts went into putting everything up onto my website for the month - I'll post that when the system allows me to.

I have been combining icing and elevation into one process, at least once a day, usually coinciding with my afternoon nap. I'm also walking using a walker, for as far as I can get before my knee shouts at me. The apartment block has a U-shaped level path - one lap of that is about 100 yards. Usually, there is a short stint on a huge exercise bike that was given to me, very slowly, with the accent on "slowly". And as so many others have said, keeping on track with pain med every 4 hours, by the clock!

The lovely smooth scar is the best part, even if it still hurts.

 

[AussieRodney]

Here's that link: https://www.fiddaman.info/website/2021/02/february-2021/

 

[sistersinhim]

Welcome to Bonesmart, @AussieRodney. It sounds like you are having a remarkable recovery. Your bend is way beyond what's normal. Most OSs expect 90 degrees at 6 weeks. You are way ahead of that!

 

[AussieRodney]

Thanks.
Yes, I tend to heal extremely well, although that picture was taken on a day when everything was coming together equally well.

 

[Celle]

Hi @AussieRodney ,
Your recovery blog is detailed and interesting, but I wonder if you would mind also writing about your recovery here in this thread, for the sake of people who don't read your blog?

It doesn't have to be as detailed, but we do appreciate stories of people who have done well. It helps to reassure people who are concerned about how their recovery will go, and it balances the stories of people who have problems.

 

[AussieRodney]

In response to my Kiwi friend's request, here is my story from the start.

I'm actually very lucky when it comes to putting together stories like this. Whenever I take a picture, I use a piece of free software to change the title of the picture, based on the time digital stamp on it, and using the format of YYMMDDNNNN. For example, a picture with the of IMG7016.JPG, taken on Feb 4 2021, becomes 2102047016.jpg. I can return to that file at any time and know when it was taken, and even better, they sort into chronological order.

Day zero, Thursday Feb 4 - out of surgery. I recall feeling pretty cheerful, but that was probably the drugs.

My Assistant Coach was April, my wife's daughter. More about her vital part in the process as we go on. My wife Julie has difficulty walking, so a lot of the early "coaching" came from April.

Day 1, Friday Feb 5 - This was taken at home, the following day. It looks like I had a very makeshift "elevation", with both legs slung over the end of the couch.

At some point, I was off the couch and stumbling around. The one aspect that only became obvious much later was that April and I had been given a heap of instructions. April has her own life - work, child, study, etc, and couldn't be with us the whole time, so sometimes important information was not conveyed to us until her next visit. No harm done, just a little frustrating. For example, I didn't realize the importance of icing and elevation for several days. Meanwhile, my fuzzy brain was dealing with "how to wear and/or carry the nerve blocker pump".

Day 3, Sunday Feb 7 - With me jumping between "zombie" and "getting it right", my fuzzy brain came up with a breakthrough, totally unaware of the rig that was included in our "going home" package.

 

[Celle]

Thank you, Rodney. Much appreciated.

 

[AussieRodney]

Day 4, Monday Feb 8 - OK, let's take a look at this thing!

I am amazed (still am, weeks later) at the amount of bruising and swelling, and how widespread it is.

Time to change the bandage ....

.... and work around the huge blood blisters.

I even added a makeshift "drip catcher" to absorb the blood dribbling out of them.

My theory is that the entire leg was so swollen and jammed up against the skin, the excess blood had to go somewhere, so it broke through the surface and formed blisters on the outside.

It's freezing outside, so would stick my leg out through the doorway and try to keep the rest of my body warm! Not very effective, but fun while it lasted.

 

[Celle]

My theory is that the entire leg was so swollen and jammed up against the skin, the excess blood had to go somewhere, so it broke through the surface and formed blisters on the outside.

Your theory is quite correct. That's exactly what happened. It can happen after a bone fracture as well and those blood blisters are actually called fracture blisters. They sometimes contain lymph, rather than pure blood.

If they burst, keep them covered with sterile gauze, to try and prevent the introduction of any infection.

 

[AussieRodney]

Day 5, Tuesday Feb 9 - This picture shows the tightness of the skin across the whole leg.

Day 6, Tuesday Feb 10 - Today I finally took a picture of just one of the fills of the urinal that we bought at Value Village.

I am amazed at the huge urine output every night. I think on this particular day, I generated 2.5 liters of pee. For me, that is simply unheard of. My theory is that it is part of the elevation drainage system. The leg is "full to overflowing" with fluid (as we have already seen) and the urine output is the body's mechanism for eliminating it. I'd love to hear comments on that theory, please.

And the mandatory comparison picture.

And on the subject of elevation. This is about the time that I started to take it seriously. I have taken over the couch and brought my pillows with me. And Buddy doing his usual cat thing.

Where are we now? Day 6? Yep, it's taken that long for the urgency of some of the post-op instructions to filter through.

In the next picture, no, I have not fallen. Actually, it's known in Care Giving terms as an "Assisted Fall", where if if the client is starting to fall, you go down with him/her as slowly as possible. I had lowered myself down to floor level to inspect something on the cabinet. It's included here because of how well it shows the extent of the bruising on the back of my leg.

 

[Celle]

I am amazed at the huge urine output every night. I think on this particular day, I generated 2.5 liters of pee. For me, that is simply unheard of. My theory is that it is part of the elevation drainage system. The leg is "full to overflowing" with fluid (as we have already seen) and the urine output is the body's mechanism for eliminating it. I'd love to hear comments on that theory, please.

You've got it right once again.

 

[AussieRodney]

Day 9, Tuesday Feb 13 - This next piece is copied directly from my website:

Some of the changes made in the living to create my temporary bedroom.

1. Rolled up Towel
2. Pillow
3. Cold Pack
4. Gait Belt (now not used)
5. Pillows for Elevation
6. Water Bottle to squirt the cats when they fight
7. Pain and other meds
8. Mini Drone for fun
9. (Next picture) Cane
10. Webcam (was already there)
11. Blankets and Jackets
12. Meds Supply
13. Urinal

This is what it was like outside.

So what does stupid do? He sits outside in it, to cool his leg a bit, rugged up everywhere else.

Still solid.

I recall feeling just a little bit apprehensive about how well the incision would hold when the staples came out.

 

[AussieRodney]

2 weeks post-op!

Day 14, Tuesday Feb 18 - Time for the staples to come out.

Swabbed

He even allowed me to remove the last one.

 

[AussieRodney]

2-3 weeks post-op

Within a few days, the strips started fraying. When they dragged on my sweats (track pants), it was time for them to come off.

Shortly after that, Julie and I took a good look at where I was sleeping and grabbed the unused pillows from our bed. These pictures (taken more recently) show the end result. The elevation pillow is packed in solidly, the right knee is uncovered overnight, while the left one is tucked under the Seahawks blanket. Two separate jackets for warmth when needed, the walking frame parked out of the way but within easy reach (next to the urinal) and the "grab area" is organized, right down to the extended phone charger cable.

 

[AussieRodney]

4 weeks post-op

This was my first attempt at measuring my ROM. Using 2 Field Hockey sticks, which by definition are pretty straight, lie down and align one with the thigh and the other with the shin. Carefully get up without disturbing them and take a guestimate of the angle. Looks like a good 120 to me!

I swear and declare that this is indeed my right leg. It was feeling good one day, so I thought I'd bring it back as far as it was happy to go, and here's the result.

 

[Kneeophyte]

TKR in early Feb & your knee was 'happy' in that position? Wow!

 

[Jamie]

Great photos, Rodney! Thank you so much. Your last one measures around 140 degrees. That's fantastic.

 

[AussieRodney]

Great photos, Rodney! Thank you so much. Your last one measures around 140 degrees. That's fantastic.

Thanks. I'm slowly getting used to the idea that I have been blessed with a body that for the most part, does the job extremely well.