TKR Sailor's Recovery Thread

[SFBaySailor]

Lauramacky,
I had in-home PT for the first 6 weeks post-op. They gave us a booklet in the hospital that describes all the home exercises, and my PT followed these. The one you mentioned is in there. I will also say that if I missed one or two days of doing these, my knee did seem to feel a bit stiffer. The exercises give me a good stretch, and I still do them, just not daily anymore. But most of these are ROM exercises, not muscle building. And the ones that are for muscle building are only so effective, since they are home exercises. The exercises at out-patient PT that are giving me trouble are the muscle building ones.

I am in the South Bay, so Walnut Creek is a 50 mile drive. You know how East Bay traffic is, so that's not really an option for me. But thanks for the suggestion
I'm going to try to work with my PT, maybe cut down to 1 day/week, or take a week off altogether and see how I feel.

BTW, I can't really explain why I have had such good progress on ROM. But my guess is because I had good ROM going into the surgery. My knee never swelled that much because I was on heavy NSAIDs. In fact, only the lateral part of the knee needed replacing. I would have had a PTKR if it was not for problems with the knee cap. And actually, I probably would have delayed the TKR even longer if it was not for all the joint fluid leaking out of the knee. The pain from that was incredible, as it put pressure on my knee.

 

[SFBaySailor]

I'm a great believer in "good things take time"! This applies to recovery after a knee replacement, too.

As I mentioned in another post, and I'll say again:
As they say in Jamaica, our knees are on "island Time", mon.

 

[Roy Gardiner]

Roger, you have answered your own questions.

- Healing happens, it cannot be sped up, but it can be slowed down or reversed by overdoing things
- Mobility in the knee will be helped by gentle stretching exercises
- Training exercises that hurt muscles will make you fitter, but won't help the knee. They could harm it if the knee itself is having force put through it.

 

[Josephine]

Even my dentist suggests it in the event of tooth pain

And did it work?

He also prescribed me some strong antibiotics to take prior to having any dental work performed

Interesting - because the AAOS have just issued this statement:
Dental antibiotics: Evidence insufficient to recommend prophylactic antibiotics for dental procedures.

But my guess is because I had good ROM going into the surgery

Probably but my guess is that you had a surgeon who also knew how to handle human tissue!
Gentle surgeons get great outcomes!

 

[SFBaySailor]

Even my dentist suggests it in the event of tooth pain​

And did it work?
A prescription dose of Ibuprofen (800 mg) worked marginally when I had an abscess. What worked better was the Vicodin he also prescribed.

He also prescribed me some strong antibiotics to take prior to having any dental work performed​

Interesting - because the AAOS have just issued this statement:
Dental antibiotics: Evidence insufficient to recommend prophylactic antibiotics for dental procedures.
Very interesting article. Both my OS and dentist supported the use of antibiotics. My OS also said no dental work for 6 months after surgery. I have read somewhere that after 2 years the antibiotic is not necessary, because risk of infection is lower. As I said earlier, I have periodontal disease, so I was very concerned about this. Even in the hospital, when I was immobilized in bed, I had them set me up with a spittoon and tray of water so I could brush and floss my teeth.

 

[Lauramacky]

I also was told no dental work for six months and I'm taking an antibiotic one hour prior to dental work.

 

[Josephine]

I expect the directive from the AAOS (American Association of Orthopaedic Surgeons) will take a while to filter down through the ranks. But it makes sense since there are now good signs that periprosthetic infection does not come from systemic infections like dental work and urinary tract infections. We never knew actually did anyway. It was just a wild guess back in the 50s and 60s and has become firmly entrenched in 'knowledge' ever since.

 

[SFBaySailor]

Josephine,
That would be very good if the evidence holds true.
To be honest, during recovery I have been more cautious to avoid deep cuts, insect bites and stings (I am allergic to wasp stings), and sinus infections (I am prone to this when I get a cold).
What about risk of heart disease or arterial disease from dental problems? That may be out of your field of orthopedics, but I wonder if you have heard anything about it? Not too long ago, I visited my dentist and they started recording my blood pressure!

Roger

 

[SFBaySailor]

Well, last night I had some minor muscle pain. Not nearly as bad as Friday night (after PT), though. I took 1 Tylenol PM and 1 Vicodin, and was out like a light! Had good sleep. Today, the knee felt a bit stiff in the morning, but not much swelling. I did my home PT regimen, then iced and the knee felt better after that. I still had some muscle pain, though, but 2 regular Tylenols seems to work. After that I did some light yard work, and the knee feels good
So it seems that the Tylenols work, and I can ditch the Ibuprofen. I'll keep trying the Tylenols.

 

[maryo52]

Would you come work in MY garden??!! Because since TKR I seemed to have made island time, mon, permanent!

I get regular emails from Medscape with the latest research in my areas of interest. I have been in the medical field for 23 years. What I notice is that things change. "They" say this one year, and the next year "they" say something different. It's all very interesting. Ultimately we have to make our own decisions.

I have taken pre-med for dental work since my TKR, which my dentist recently questioned. I don't disagree with discontinuing this practice. However, after a difficult recovery from TKR, an infection would put me over the edge. So my choice is to go along with my ortho's position to take this cautionary step of unknown benefit.

 

[Josephine]

What about risk of heart disease or arterial disease from dental problems?

That's a completely different situation - there the bacterial infection does settle in the heart valves. That's been proven and well established. You should read this article where the supposed link between systemic infection and PPI is disproved - well read it for yourself Infection: peri-prosthetic infection - also known as late onset infection. I am also intrigued that you feel the need to avoid deep cuts, insect bites and stings and sinus infections. I never have and I doubt many of the other 2-3 million hip and knee replacement patients (every year world wide) ever bother much either other than the usual hygiene and wound care.

 

[SFBaySailor]

Good article on late onset infection. My dentist concurred with the use of antibiotics, but he didn't agree with having to wait 6 months for dental work. He ended up going along with it, since that is what my OS suggested. The antibiotics I was prescribed are to be taken 1 hour prior to dental work. I believe my OS also mentioned taking them before a colonoscopy, which I have done every 5 years.

The insect sting sensitivity may be a phobia, since I am very allergic to wasp stings. But I did read somewhere here on BS that someone got an infection near their incision from an insect bite.

 

[Josephine]

Perhaps but it didn't pose a danger to the joint replacement. And like I said, that directive from the AAOS has only just been published so I expect it will take sometime to filter down through the ranks!

 

[SFBaySailor]

Would you come work in MY garden??!! Because since TKR I seemed to have made island time, mon, permanent!

I get regular emails from Medscape with the latest research in my areas of interest. I have been in the medical field for 23 years. What I notice is that things change. "They" say this one year, and the next year "they" say something different. It's all very interesting. Ultimately we have to make our own decisions.

I have taken pre-med for dental work since my TKR, which my dentist recently questioned. I don't disagree with discontinuing this practice. However, after a difficult recovery from TKR, an infection would put me over the edge. So my choice is to go along with my ortho's position to take this cautionary step of unknown benefit.

Maryo,
Well, for 2 months I had enlisted my neighbor to mow my lawn, trim the edges & blow the patio off. The grass grows fast, so he had to do this 4 times! Lately he's been neglecting the edging and blowing off the patio. I guess I'll need to invite them over for a BBQ. So I decided to give it a shot, and it went OK. As long as I am moving, I'm fine. But standing in one position for a long time is very difficult, and my knee will swell. So, my knee is still on island time of sorts!

I see you are in ME. I am a New England native from CT. I moved to CA 33 years ago. But I still go back there every couple of years to see family & friends. I love the 4 seasons, which we really don't get in CA.

I agree that the advice does seem to change from year to year. So, I'll just follow my OS advice and take the antibiotics. As it says in the article Josephine recommended, I'd rather not be the 1 in 1000 who gets infected.

Hope you feel better.

Roger

 

[SFBaySailor]

I had another PT session today. I expressed my concern about the severe muscle pain I was experiencing Fri & Sat after last Friday's session. They were more than willing to work with me on it and were very accommodating. We agreed to cut back on about 25% of the exercises, specifically the ones that were the most difficult and which likely overdid it for me. They also urged me to call them if there is any muscle pain. We'll see how I feel tonight & tomorrow, and take it from there. I worked from home today, and will do so on all my PT days, to try to keep the activity level down.

I do want to continue with the PT. I have 3 more weeks left, and I do believe it has helped me, most of all in regaining the strength in the quads and other muscles. I am not walking with a limp anymore, plus I can do stairs much better, all positive indicators that muscle strength is improving. I think it is just a matter of finding the correct balance between exercise, work, other activities, and rest. Going back to work last week upset that balance.

 

[SFBaySailor]

Well, I'm happy to say that the reduced PT exercise regimen on Monday really helped. I've had very little muscle pain last night and today. I've been taking the Tylenols, and they seem to be working. I went into work today, and after getting home I noticed that the knee did not swell much at all! Good sign. So at least I have a strategy that seems to work.

Tonight, my wife and I are going out for our first "night on the town" since I had the TKR. We are going to a B52's concert at the Mountain Winery, which is a very intimate 2000 seat outdoor amphitheater, in a winery, which is nestled on a hilltop in the beautiful Santa Cruz Mountains. The B52's are an 80's/90's band. I'm more partial to classic rock from the 60's & 70's, but my wife is a big fan of them, so we are looking forward to it! It will be good to stretch the legs and test out my walking. The venue is not that large, plus they do have electric golf carts to shuttle you around, if needed. When she first bought the tickets a few months ago, I wasn't sure if I would be able to go, but it looks like it's a go for tonight! I'm very excited to get out among the living! This will be a major milestone in my recovery

 

[Lauramacky]

How cool!! I heard they were playing. I love the B52's! i remember dancing to them in the 80's, lol, although my favorite era is the 70's too. Glad you're out and enjoying life again! It's so good to hear! And I'm glad you did what you needed to regarding the PT. We will be seeing Chicago in August I think at Wente Winery. My husband's company is one of the sponsors. Enjoy the concert and let us know how it went.

 

[SFBaySailor]

The concert last night was great! We both had an excellent time. In addition to the B52's, the Go Go's also played, which is an all girl band from the 80's. Very high energy show. Lots of dancing going on, although I'll admit that I was seated most of the time. My knee seemed to handle it pretty well. We availed ourselves of the golf cart service to & from the parking lot. My wife has a skin condition on her hands and soles of her feet which makes it very painful for her to walk when it flares up. The Dr's have been trying to pinpoint the problem for years now. At first they thought it was psoriasis, but no luck with the standard treatments. Now they think it may be eczema induced by an allergy to Nickel. So, we both appreciated the courtesy shuttles!
I managed the short stairs pretty well, some moderate inclines, and also standing in line at the concessions. So, all in all, it went very well, and it was so nice to get out!
Today, I'm working from home. Only a little bit sore. No PT until Friday. Plenty of ice & elevation today

Roger

 

[Lauramacky]

Glad you had fun! You seem to be doing really well with your knee, certainly farther along than I was at your stage. Congratulations!

 

[SFBaySailor]

Thanks Laura.
As I said, a bit sore today, and I'll need a med tonight. But to me it was well worth it.

Roger