PKR RPKR done November 28th<

[Wags]

Well I’m out the other side! Nearly had a meltdown and told hubby I wanted to go home, had tears in the theatre waiting for spinal block, last time I had one having c section I didn’t have a good experience but this has been good so far. Was attached to a heater just before I went down to theatre, was toasty and warm

Had the spinal, back on the ward about 8pm I think. Had a sandwich and drinking water. Low blood pressure seems to be the order of the day, no pain as yet. All bandaged up so nothing to see as yet.

Have some kind of pad that is being blown up in the bed to make each leg move regularly.

Morphine is making me really itchy, also have oxygen which is making my nose itch....other than that so far so good....even managed to pass urine....bit drowsy and slip in and out of sleep....onwards and upwards I guess

I

 

[Jockette]

I’m glad the surgery is over.

My blood pressure went way down the day after surgery. I thought they would keep me another night, but my surgeon was not concerned, he said anesthesia and pain medicine can do that, so after hearing that, I wasn’t concerned either. He discharged me anyway.

Rest well!

 

[Pumpkin]

@Wags
You'll notice that I have moved your newest post and started your recovery thread. For several reasons, we prefer that you have your own recovery thread:

• That way, we have all your information in one place. This makes it easier to go back and review your history before providing advice.
• With your own recovery thread, you will see the posts and advice others have left for you.
• Having only one thread will act as a diary of your progress that you can look back on.

So please post any updates, questions or concerns about your recovery here. If you prefer a different thread title, just post what you want and we'll get it changed for you.
If you need an urgent response to a question, just tag a member of staff.
How to tag another member; how to answer when someone tags you

Here are the instructions on finding your thread, How can I find my threads and posts? . Many members bookmark their thread, so they can find it when they log on.

 

[Pumpkin]

Welcome to the other side!
Sounds like you are doing well. Let the nurses know morphine is causing you to itch, they may be able to change you to another pain medication.

Here is your copy of the recovery guidelines, the articles are short and will not take long to read.

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
elevate
ice
take your pain meds by prescription schedule (not when 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 - 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

the BoneSmart view on exercise
BoneSmart philosophy for sensible post op therapy​

5. At week 4 and after you should follow this

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.

 

[susieo461]

I had morphine years ago and itched and started feeling I had a rash (it was middle of night and I never turned the light on) but since then I have been told I have an allergy to morphine.


Sent from my iPad using Tapatalk

 

[bill 3/20]

My narcotic pain meds maked me itchy, but I persisted due to pain, and the itching subsided. I am glad I stayed on pain meds. It made a difference in function and recovery. I also used an ice machine and lots of ice and elevation. Managing pain and swelling lets you work on recovery.

 

[Wags]

So I came home yesterday around lunchtime. Had a very teary day, was given codeine and paracetamol to come home with and was worried it would be enough to deal with pain,seeings as I’d had stronger meds in hospital, but, so far so good. I’m feeling quite frustrated because getting about is harder than I thought. I had Zimmer frame in hospital to go to the toilet and could get there on my own, took my own crutches in to the hospital and walked with them once and was then given two sticks. Felt fine using them in Hospital, but don’t feel quite so confident at home.

Knee feel a little like it is going backwards as I’m walking sometimes . Been icing and elevating and leg is not too bad but is swollen and tight and difficult to move. I can lift it myself to get it on and off the bed but once on the floor the bend is almost non existent and finding it really difficult to move it backwards.when lying in bed the leg seems fairly flat, slept quite well last night, woke at 1am needing the toilet, used the zimmer but want as easy as in hospital as there isn’t as much room. Went back to sleep until 6am whereupon I needed another trip to the toilet, this time used the stick and it was better. Not using a riser as didn’t have one in hospital, will see how that goes.

Just recently taken my codeine so feeling a little whoozy, and think I shall have to come back to this later

 

[Jockette]

You are doing fine. Don’t worry about any bend, it comes later. That’s great you can get your leg on the bed yourself, it took me about 2 weeks or more to accomplish that.

Tears are very normal and it will last a while. Major surgery takes a major toll on the body and so do the pain medications. Don’t worry about it.

I think of you often!

 

[Roy Gardiner]

Knee feel a little like it is going backwards as I’m walking sometimes

If you mean that your knee seems to be moving further back than you're used to, it's because the surgeon removed bone spurs that were stopping movement. It feels weird but is in fact normal, it's what was pre-surgery was abnormal but you were used to it. Happened to me, very strange isn't it!

 

[Josephine]

was given codeine and paracetamol

I think that't unwise. Generally, in my experience, codeine is inadequate for a knee.

I'd really like to offer you some structured advice but in order to do that, I also need to ask you some questions. Are you willing for me to do that?

 

[Wags]

@Josephine

Yes please ask away

 

[Josephine]

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.

 

[Wags]

@Josephine

in answer to your questions

1. About 7, it’s uncomfortable and some burning pain

2. Codeine phosphate 30mg - one or two tablets up to four times a day, was suggested I take one tablet with two paracetamol and then if I needed any mor I could take another codeine

Paracetamol caplets 500mg - take two tablets four times a day

3. I would say it is moderate swelling

4. I’m not sure how to measure this but my knee is fairly straight but the bend is not very good, mainly because of the swelling and pain

5. Icing knee 4 times a day for 20 mins

6. Elevating when icing and resting and keeping leg up as much as possible.

7. Activity level, only discharged from Hospital on 30/11 so just getting myself up washed and dressed, walking to toilet during day, walking around the downstairs 3 to 4 times per day for 5 mins at a time. Going up stairs to bed at night, coming down in morning

8. Exercises at home. 4 sessions

Sitting on hard back chair (dining chair) moving operated leg back and under chair....except I cannot get it under chair so moving as far back as I can at present, hold and repeat approx 10 times

Sitting on hard back chair with another chair in front, placing operated leg heel on chair in front for straightening hold as long as comfortable.

2 - 5 sessions per day

Lay on floor with rolled up towel underneath calf, lift heel and push knee towards floor, repeat 5 times

Lay on floor, engage quads and lift leg 5 to 6 inches from floor repeat 5 to 10 times

not Having PT yet

Hope thats answered your questions correctly

Thank you

 

[Josephine]

1. About 7, it’s uncomfortable and some burning pain

That's very high, even for 4 days out.

2. Codeine phosphate 30mg - one or two tablets up to four times a day, was suggested I take one tablet with two paracetamol and then if I needed any more I could take another codeine. Paracetamol 500mg - take two tablets four times a day

Codeine is absolutely no good for a knee. You need something more effective like Tramadol. I suggest you ring your GP and tell him that the codeine is not working and wonder if you can have something else 'like Tramadol'. This was what used for both my knees and it worked very well. I used this schedule

3. I would say it is moderate swelling

An did you factor this in to your pain score?

4. I’m not sure how to measure this but my knee is fairly straight but the bend is not very good, mainly because of the swelling and pain

I expect you will have a physio review shortly and they will tell you what your measurements are. But you are perfectly correct about swelling and pain obstructing the ROM.

5. Icing knee 4 times a day for 20mins

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

6. Elevating when icing and resting and keeping leg up as much as possible.

How do you 'keep your leg up'? Is it like one of these?

7. Activity level, only discharged from Hospital on 30/11 so just getting myself up washed and dressed, walking to toilet during day, walking around downstairs 3 to 4 times per day for 5mins at a time. Going up stairs to bed at night, coming down in morning

Yes that's perfect! That's all you need right now.


Exercises at home. 4 sessions - I take it this means 4 session as day? One would be plenty
Sitting on hard back chair (dining chair) moving operated leg back - hold and repeat approx 10 times - these are heel slides and doing 10 4 times a day is a very bad way to do them. Read this Heel slides and how to do them properly. This article was among those left you by Pumpkln in post 7. You did read them, didn't you?
Sitting on hard back chair with another chair in front, placing operated leg heel on chair in front for straightening hold as long as comfortable - you should never ever do this exercise. It will increase the pain and block your ROM even more

2 - 5 sessions per day
Lay on floor with rolled up towel underneath calf, lift heel and push knee towards floor, repeat 5 times - this is another extension exercise which you should not do for the same reasons as above
Lay on floor, lift leg 5 to 6 inches 5 to 10 times - once you can do this, you don't need to do it any more!

not Having PT yet - good, then I suggest you decline to go if you are offered any. It's an option, not a requirement and you are perfectly at liberty to decline

My advice to you here is that you don't do any exercises at all. Just your normal/average activities of daily living such as oyu have described here. Do also go back and check out all the articles Pumkln left you, specially the one about activity progression. It has some very important information - well they all do, as a matter of fact!

If you are concerned about refusing to do exercises, you need to read this Saying no to therapy - am I allowed to? There any many of us on the forum who never did any exercises at all and yet we got really good outcomes. @sistersinhim is one. I also recommend you read my recovery thread to see how little exercising I did for either knee! Knee recoveries UK style Parts I & II (Josephine)

 

[Jockette]

I can’t imagine getting down on the floor and up again so soon after surgery! I haven’t done it yet and I’m almost 9 months post op!!!

 

[Josephine]

Me neither. I can't do it even now!

 

[Wags]

@Josephine

Hi

Codeine is absolutely no good for a knee. You need something more effective like Tramadol. I suggest you ring your GP and tell him that the codeine is not working and wonder if you can have something else 'like Tramadol'. This was what used for both my knees and it worked very well. I used this schedule

I’m allergic to Tramadol but I’m sure there is something else I can take along these lines, will check with GP, thank you.

Thank you for your advice, I will respond to your points as soon as I can but I do have a question about icing, I have bags of peas and was told to wrap them in pillow cases and use one under and one over my knee, when I have the one on top of my knee it hurts my wound after about 15 mins, it’s almost a burning feeling. I still have my plaster type dressing on that covers the actual wound and as I say the peas are wrapped in a pillow case, with the folds of fabric between the knee and peas giving extra layers, but the pain worries me, is this normal, am I doing something wrong for it to feel like this, should I have this pain? I am worried that because it hurts I’m doing something bad to it

 

[Wags]

@Jockette

I can’t imagine getting down on the floor and up again so soon after surgery! I haven’t done it yet and I’m almost 9 months post op!!!

Have to admit I haven’t tackled this one as cannot imagine trying to get up off the floor either !

 

[Jockette]

Oh good! I wouldn’t bother with getting on the floor for anything!

The bag of peas might hurt just from the weight of it. My knee, at almost 9 months post op is still very sensitive to any weight on it, like a little couch pillow even. Maybe you could position the bag so most of it is off center of the kneecap and against the sides of the knee.

The ice pack the hospital sent home with me was long, with 2 sections, and gel packs made for it, so when I used it, the center seam was on top, and it formed a tent, which helped keep the pressure and weight off the top of my knee.

 

[Josephine]

Shame about the Tramadol.

when I have the one on top of my knee it hurts my wound after about 15 mins, it’s almost a burning feeling. Is this normal, am I doing something wrong for it to feel like this, should I have this pain?

A pillowcase is too thin. You should use a thick-ish tea towel. Ice should NOT cause pain. It should just be a soothing cold. So if the ice burns that's not good and a sign you should use something thicker.

And I've never like frozen peas, they thaw too quickly. Get some nice big gel packs off Amazon.