TKR Seven Month Update and Questions

[Equinista]

Hello Everyone and Merry Christmas to you all!

I am 4 weeks post TKR on Christmas Day. I was well prepared for the operation. I was quite fit and lost weight beforehand. I had made a deal with myself that the recovery was going to be my job for the forseeable future.

The operation:

This was done under spinal block with sedation. I recall trying to pull down the green curtain to have a look and also taking great interest in the ultrasound to find a nerve for a femoral block post op. I was in a high dependency unit overnight and this was really hell as the pain was off the scale and despite best efforts of the doctors and nurses, the pain was not under control and without a catheter, there were some accidents as the spinal wore off. It really was an experience not to be repeated and I was just unlucky. The final morphine shot about 7am (op was at 2.30pm day before) seemed to reduce pain down to a 6 or 7 thank goodness. I was taken back to the ward room (only two of us sharing) and somewhat bemused and exhausted finally drank something.

Hospital Stay

I am English living in Ireland these last 18 years and the medical/surgical protocols are similar to UK. This involves a 4 to 5 day stay and physio two or three times a day CPM machines and physio assisted exercise, walking, stairs and graduated to elbow crutches as soon as able. My pain relief was well managed but I was very sore and in pain but was delighted at how sturdy the new knee felt and how solid. It was daunting putting weight on it the first time but I was pleasantly surprised. I was able to use the bathroom and wash and dress by day 2 without assistance and shower with assistance. The staff were incredible, they helped me shower, blow dried my hair and when I had a meltdown on day three as had run out of my favourite go to when not well drink Lucozade, one nurse bought me some in her lunch break and my co-patient's husband brought in a six pack!! The meltdown was not about the drink but I think an emotional reaction to the operation. Upon discharge my ROM was at 65 and my extension was spot on. The swelling was horrific from thigh to below knee twice the size. This reduced slightly with icing and meds. Even though I had been taking small doses of tramadol for years for the arthritis, the hospital discharged me on ibuprofen, solpadol, aspirin and Losec.

I should explain I live alone in a very rural area and my only family is my daughter who now lives in the UK. I have a couple of marvellous friends with busy lives who did what they could but I had no visitors and it is tough alone. However, I am nothing if not resilient and was prepared to be discharged alone confident I could cope. However, a friend had pulled some strings and arranged for me to be discharged into a very nice nursing home/rehab for two weeks.

Nursing Home:

The nursing home was very good with a chef who kept trying to make you eat with special dishes which was lovely but I had no appetite since the operation. However, the nurses were on a mission with my ice packs and medication but again the pain became overwhelming and I was in great discomfort. The staff contacted my own doctor who revised my medication to tramadol and celebrex. This helped with pain levels. After 5 days in the home I was feeling depressed and really wanted my own home so I went home and had my daughter with me for three days. My mindset and overall well being improved a million percent being home.

Home

I have a downstairs guest room and en suite which I moved into and got to grips with life on crutches and self exercise/icing and rehab. It has been ups and downs but generally speaking seems to be going the right way. My flexion is not the greatest but walking is fine and now I can use one crutch in the house and two outdoors. I try and go for a walk for fresh air each day up to 20 minutes and ice and exercise with resting and doing essential jobs and tending my two cats. It feels lonely as my two horses are not here at home while I am recovering but I do have my two cats who of course don't care about my knee they just want feeding! have weekly visits from the public health nurse to change dressings and monitor how I am doing and she is pleased with progress. A friend has called once a week to take me to the shops where I have managed to walk around a small supermarket and buy supplies. Otherwise, I am alone.

I think what I was delighted with is that I thought I would be far more disabled than I am and incapable of doing much at all but I am coping with basic house chores, laundry and even changed my bed slowly but surely. It may seem like I am having a great recovery but there is pain of course, erratic sleep combined with fact I just cannot nap during the day, plus a restless mind that wont slow down. My appetite is still poor and I have lost 4 kg (about 8 pounds) since surgery. I am trying now to have a smoothie with protein each day and eat a small meal but food just is not on my radar but I know I need to eat to heal. The nurse said my doctor could prescribe protein drinks which I think might be an option after Christmas. I feel very fatigued and tired and pain is so variable with different bits painful at different times. I think this recovery is as much a mental one as physical and I am hoping I can keep up what is a relatively positive attitude.

I have cut out my night time meds which seems OK for me and when I do sleep it is relatively pain free though I find myself upon waking like a contortionist at times!

So week 4 tomorrow and Hoping through the ups and downs will arrive out the other side in a good place. My dream is to ride again after the arthritis put paid to it a few years back. This community has been so helpful and the articles are reassuring and stop you getting into a panic about where you should be along the way. I accept its a long road and it will literally be a few steps forward and quite a few back.

I have a couple of questions for you all:

Has anybody gone back to horse riding after TKR?

I feel out of any kind of routine and do get quite bored as I cannot seem to concentrate on anything from books, TV internet. I imagine this is normal when you are used to being active with a purpose or maybe the meds though I am used to them. How do you fill your days?

MY medication is : 50mg tramadol - 3 times a day, Celebrex - 2 times a day, 2 aspirin - once a day for 6 weeks, Losec 1 a day for 6 weeks. As said have cut out night time dose of celebrex and tramadol.

Thank you all for listening xx

 

[Jaycey]

@Equinista Welcome to BoneSmart! Sounds like you are well on your way with this recovery. Are you icing and elevating that op leg. There are some tips on this in the articles below.

Has anybody gone back to horse riding after TKR?

Yes, it should not be a problem. You need to be fully healed and do be careful about falls. You wouldn't want to ruin all the good work that surgeon did. Somewhere in the Social Room there is a thread started by one of our members for those of us who own equines.

Here are your recovery guidelines:
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

6. Access these pages on the website

Oral And Intravenous Pain Medications​

Wound Closure​

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.

 

[Equinista]

Approaching 5 weeks post op now and had three days where I felt back to square one with increased pain, fatigue, nausea and even less appetite. This set back coincided with a somewhat erratic sleep pattern changing to one of 12 hours sleep over the three days I felt dreadful. The sleep in its own way seems to have given great pain relief ( I think the electric blanket helped!) and I woke again today after about 11 hours relatively undisturbed sleep with my knee feeling very much under control pain wise again.

I know there is not one size fits all recovery but I am just a little concerned that this amount of sleep is not normal - can anyone advise? General fatigue during the day. I am doing house chores within reason (light stuff, load of laundry, washing up) and enjoying a 20 minute walk in the fresh air each day plus of course elevation, icing, exercises.

 

[Celle]

I know there is not one size fits all recovery but I am just a little concerned that this amount of sleep is not normal - can anyone advise? General fatigue during the day. I am doing house chores within reason (light stuff, load of laundry, washing up) and enjoying a 20 minute walk in the fresh air each day plus of course elevation, icing, exercises.

I don't think you need to worry at all about sleeping for such a long time. You're recovering from major surgery that caused a lot of trauma. Most of your body's resources are still being directed towards healing your knee and there isn't a lot left for anything else. Your body obviously needed that sleep.

Check these articles.
One is about fatigue - Energy drain for TKRs
And one is about activity progression - Activity progression for TKRs

 

[Helizabug]

I had my surgery the same day as you!

I create some structure in my days with exercises, mostly gentle, and walks. I have been thinking of taking some online courses, but I’m probably heading back to work in a week or two. Coursera is an amazing resource, and if they still have Dan Arielly’s course on behavioral economics or Yuval Noah Harari’s course on human history, those are great options with interesting lectures and interesting activities to support the learning.

Podcasts are fun too!

Good luck finding things to do until you can ride again. You’ll get there!

 

[Equinista]

Thank You Helizabug! 27th November was quite a day for us. I think my issue is that my mind is just racing and wont slow down so my concentration is not good. I love Coursera and have done several of their courses and listen to podcasts when I go to bed. I just need something to focus on now I am not feeling so unwell. I have a HUGE list of things I said I would do so will start picking that list off and when my attention span seems reasonable I would like to enhance the very bad Spanish I speak! I think I am being very impatient and not taking kindly to all this enforced inactivity.

 

[Helizabug]

I can relate, for sure.

 

[Naturelover]

Hi Equinista, I started riding again after a 10 year absence about 3 years after my left PKR. It took a few months to get my seat and my legs back, but my knee did not bother me while riding. I was able to start jumping cross rails. I do believe that walking around the barn wearing riding boots with low heels did irritate both of my knees. (If only I could afford to have a valet get my horse and saddle him up for me) I could have continued riding.
I had been postponing surgery on my right leg with both steroid and gel injections but unfortunately my right knee became too painful and unpredictable so I reluctantly went forward with my right TKR. I am 6 weeks post Op and I do expect to get back in the saddle in a year or so.
I am easily sleeping 8-10 hours most nights. I think I sleep in mostly due to boredom and I feel that all that sleep is probably helpful with healing....
I agree, this forced inactivity is the worst!
When you get a chance, please tell me about your horses and equine activities....

 

[Equinista]

Hi Naturelover so happy to hear your riding experience thus far. I do think us riders have different musculature, I know my calf muscles are very stretched and my quads were strong going into the op. Whether this is an advantage or not I don't know. I have a small yard (barn) here in Ireland and I breed Irish Sport Horses although this has been off the agenda for a couple of years now. The two horses I have at home are Alfie (Book of Kells) a retired 25 going on 4 yo who is enjoying 3 months bed and breakfast with a friend while I get over this knee op and Allegra (Garden Party) a youngster who has gone away to another trusted friend to be started under saddle. My other two are with my daughter who is living in the UK these last couple of years ( I say mine, one I gave her on her graduation as a vet and I suppose the other one belongs to her by default). They are very competitive and do high level showing (similar to hunters/hunter jumpers) and also dressage. This is William (Subaltern Will) and Radley (Radley Brogue). Except for Alfie, all have been bred and produced here. I need to rethink things once I know what I can and cannot do once the knee is recovered (mucking out, lifting feed sacks, hay bales etc) so its a bit up in the air. I am also an affiliated horse judge so that keeps me busy especially in the summer months.

I do think it is frustrating when you are used to having so much to do to do nothing but I am trying to embrace it. I have withdrawal from not even seeing a horse this last month or so!! Wish you well with your recovery, what do you enjoy horse wise? We may end up back in the saddle at the same time! Interesting what you said about preserving your right knee. On x-ray the doctors said my right knee is a few years behind the left knee arthritis wise and at present does not give me any trouble so I am hoping to preserve this as much as possible. Its a dilemma; do you just get the thing replaced and grit your teeth or wait for the deterioration. ITs a hard one but if I could avoid having the right one done.

THanks for your encouraging post on riding

 

[Suz]

Hi @Equinista! Your life and love for horses is fascinating! I know this is a difficult time for you, being away from your beloved horses. But it is so worth the recovery time you must invest.

When I look back on my first knee replacement, the pain & inactivity frustation I knew then is today a blur. In fact, I only remember it when I look over my recovery journey documented here at Bonesmart.

What I do remember clearly is how it feels to be able to walk and move about without that horric pain I suffered in my right knee pre-op. Pain that caused me many, sometimes embarrassing falls, because it just gave out. I spent so much time in constant fear of what would be involved having my knee replaced. That may have been the worst and why I endured the pain far longer than I should have.

I'm propped up again with my 'new' left knee 4wks into her recovery. It's not fun, it's 'extremely' frustrating most of the time because of the constant on-going attempt at finding 'any' comfort.

But I'm growing a brand new knee here and (serious) growing-pains are part of it! I planned this replacement during the time of year that winter weather keeps me indoors so that when milder weather returns, I'll be 4 months into my recovery. Moving about a little better! And resting on the porch outdoors in addition to being indoors recovering.

I came from that frustrated recovery place in 2016 with a strong, pain-free right knee! Today it never hurts. Ever! It never gives out leaving me on the ground. I waited far too long to get my first replacement, out of fear. This time around, I was more in control because of my experience with the Bonesmart concepts. Things as simple as replacing negative recovery thoughts with positives. It makes such a difference in how this slow journey plays out. I come to Bonesmart now to encourage others and in turn, it helps me so much!

We have a farm and I love observing & caring for our beehives, gardens & animals. For the past few years I have been limited due to my growing left knee pain. That limitation will hopefully end because of the replacement surgery I am now recovering from. The time required surviving this slow recovery is difficult, but worth every minute to me because of the hopeful outcome. And a much better experience at doing the things we love!

Thank You for sharing your recovery with us. My daily motto: 'This too shall pass'!

-Suzie

 

[Helizabug]

For my part, I had been very active, and I could put up with a lot because I’m stubborn, but the pain was getting to be too demoralizing, so I decided to get my knee replaced in hopes of returning to my active life. It’s my first, and maybe only, replacement, and the recovery has been a lot like training for the marathon I ran in my 40s. This time, though, I will be more whole as I go along. I will be growing and healing instead of breaking down. I think it’s a good choice.

 

[Equinista]

Hi @Suz

Thank you for your warm and encouraging post! The article you linked was very apt under the circumstances! I re read my original post and my initial thoughts were to treat the recovery as my job for the next three months or however long it takes. The timing in mid winter is good too. I am just back from my walk along the country lane where I live and it is lovely to be able to stop and observe what is going on with nature and I am grateful my knee also enjoys the walking too.

Probably did a bad thing today in that I drove my (manual) car to the nearest shop 5 miles away as had no butter, juice or bread!!! This was not without drama but actually went better than I thought and feels like a huge achievement. I have now made a deal with myself not to drive again unless it is a dire emergency. It was a bit sore but I managed surprisingly well. Psychologically, it now feels like I am not a prisoner so that is positive. I live alone very remotely and no friends available to take me to the shops or pop by at this busy time of year. But I am upbeat and positive, and spring time to look forward too.

Yes finding comfortable positions is a trial and its slightly better now, but so annoying wriggling and adjusting just to sit still for a little while, especially when rest is so important!.

Strangely, while walking today, I realised that I was pain free of the arthritis pain and how sturdy and strong the new knee felt. Like you I have also had the falls, been carried when the knee just gave up, having to stand for ages on getting out of a car in order to mobilise the joint, crumpling to the floor dismounting a horse - it goes on and I now realise how disabling it was and how easy it is to adapt to living with the pain not realising how crippling it is and how restricted you are.

Anyway better times ahead. Your farm sounds idyllic by the way lovely home produced honey Yum.

 

[Suz]

Probably did a bad thing today in that I drove my (manual) car to the nearest shop 5 miles away as had no butter, juice or bread!!! This was not without drama but actually went better than I thought and feels like a huge achievement. I have now made a deal with myself not to drive again unless it is a dire emergency. It was a bit sore but I managed surprisingly well. Psychologically, it now feels like I am not a prisoner so that is positive.

Funny how when alone, we are faced with decisions others might frown upon during such a significant recovery. Had I been without butter, juice or bread, I would have done exactly what you did! Successfully! The discomfort of your adventure will pass, but knowing you are capable of taking care of needs when no other option is available, is huge, in my opinion. Good for you!

 

[Equinista]

Progress at 6 weeks.

I have to say that I am feeling quite pleased with progress. I am walking without crutches around the house and my physio said to wean off one crutch outdoors gradually to use one crutch. I am definitely a little less tired and managing a lovely 20 -30 minute walk most days plus of course exercises. Pain levels have reduced and pain only kicks in during exercises. Physio pleased with shape and suppleness of knee area and my flexion is a couple of degrees off 90 but extension is normal. She gave me some slightly harder exercises to do on account of my quads being strong that makes it a little more taxing and uses inner thigh more. I have to say she is so good and a little tip I learned from her is when she is doing assisted bends, she was gently massaging my knee at the same time. It really helped in holding the bend when there was discomfort.

Appetite is still poor, I cannot face a proper meal but am concentrating on smoothies, soups, jelly and although I hate milk, I am drinking skimmed chocolate milk. Anything to get protein in. Picking at cheese and crackers. I find after a morning smoothie of peanut butter. yoghurt, orange juice, banana and a sprinkle of cinnamon I am full for the day. I have lost around 4 kgs since surgery but seem to be maintaining weight rather than losing more.

Sleep is a disaster, I am still getting very tired and exhausted from time to time, but cannot have any sort of consistent sleep. I wish I could nap but cannot do that either!!! I had a spell of blissful 12 hour sleeps but now I am waking every hour or so and finally sleeping for maybe 4 hours come 8am so all over the place. Its not pain or discomfort keeping me awake. I do have some sleeping pills (think I used one of them) and was thinking about trying to kick my body into some kind of rythmn - I detest still being in bed come lunchtime and of course it makes the days short.

I am only taking one tramadol and one celebrex in the morning and then if I need it, take the same again at night but mostly I do not need the medication.

Generally speaking quite pleased, seems remarkable the surgery was only 6 weeks ago. I have my review with my surgeon next week so hopefully will get signed off to drive etc. ( Although I am managing very well driving to the local shop)

Hope everyone else is doing OK

Denise x

 

[Equinista]

The one thing I forgot (I don’t know how) is that I have been suffering agonizing phlebitis from below the knee tracking up and ver the upper thigh. My doctor is not concerned but the Skin is very discolored, the vein is hard and lumpy, sore and tender. It’s been well over a week. Using heat compresses and anti inflammatory gel but ouch so painful. Has anyone else suffered this?

 

[Macknit]

Hi @Equinista, Welcome!!

I've been reading through your recovery thread and saw this most recent question...Is this pain you're talking about on the inside of your leg? I'm at a bit over the 4 month mark and I had a very painful vein up until this week (technically 18 weeks) and I just noticed the other day that all that hurt and tenderness is just gone. So weird!??

My skin was not discolored, but it was a lumpy, sore, and very tender vein that I had. I even had to move the seam of different pants away from the vein...My OS said there is a specific nerve that runs right where the vein is and that was definitely aggravated during surgery. His suggestion was to wait until about 6 months and then see a vein specialist if it still was so bothersome.

So my guess is even if it is a different vein and nerve it most likely has happened to others too.

Good luck with this and like all of our recovery, it looks like it is just a time thing again!

 

[Equinista]

Hi@Macknit

Yours does sound like phlebitis too. Mine runs in the superficial vein from below my knee on the outside of the leg up and across my upper thigh. Its a prominent vein anyway but the whole of it is hard, lumpy , swollen and tender. The skin is a kind of dark suntan colour over the vein. It throbs and hurts and am following treatment plan but it just feels like a double whammy with the residual knee pain as well!!! Hardly surprising the body is protesting really after the brutal surgery so gritting my teeth and getting on with it - but ouch!! Hot compresses good and been using anti inflammatory gel topically. I take celebrex as part of my pain management too but no improvements yet. It is a weird feeling having an ice pack on my knee and a heat pad on my thigh!!!!!!!!!

All part of the healing process I guess. I will visit doctor again as no improvement though apparently it can take a long time to go. I am just worried about it progressing to a DVT. I know the risk is low but you cannot help being concerned!!!

 

[Equinista]

I am at 7.5 weeks post LTKR now and have had my review with my surgeon. He is happy with progress and has cleared me to fly and drive (even though I drove the hour to the hospital). My next review all going well is in three months. I am feeling well and not suffering pain unless doing wretched heel slides and other ROM exercises. I have taken the Bonesmart approach and really using the clutch in my car is as good a ROM exercise as you would find! I am not getting too hung up on the ROM The Physio put it at 90 after 6 weeks and I think there is a little more and will find out at this week's physio session.

I have reduced crutch use and dont use in house anymore, I use one crutch when I have to go food shopping and still use two for my daily walks on uneven country roads, though mostly hold them to do as much without crutches and only use when I need too.

My sleep is hopeless just cannot drop off at night. Appetite is still poor but am not losing weight due to some adjustments having smoothies, soups etc and the odd plate of pasta plus fruit. So for now, I am satisfied with that although I do have 2 more stone to lose (28 pounds) ideally. I had lost 70 pounds over the two years leading to surgery.

I feel quite blessed to be doing so well at 7 weeks but will not take it for granted as there is still a long way to go and I can feel new adjustments and sensations each day.

The awful thrombophlebitis which tracks about 10 inches along my vein on outside surgical leg is still giving me some serious pain. It is getting on for 4 weeks now but it is improving. The doctors are not concerned.

Day to day quite active and able to look after myself OK but difficult to balance between doing too much, doing too little and doing enough.

 

[LD of Michigan]

Awesome! Look at you driving a stick! I drove those for years and years. Yeah that's some ROM for you. And yes I get the lack of sleep part -- It's nearly 3:00 AM here. LOL! Feel free to chat any time. Someone will be up. Be well despite the adjustments this TKR stuff imposes... ...

I have taken the Bonesmart approach and really using the clutch in my car is as good a ROM exercise as you would find!

 

[Helizabug]

I am so impressed with your progress. Not fair to have the extra pain of the phlebitis.

Though I’m up in the middle of the night, right now, my sleep has been pretty good, overall. I find it helps to listen a book. That way, even if I don’t sleep, I feel good about the down time.