TKR Slow But Sure Recovery

[C'mon]

I’m back after 7 years of having a L THR!
Surgery was 9/5 with an overnight stay at the Rothman Specialty Hospital.
This time I can say the knee is absolutely the worst pain I’ve ever had.
Friday I cleared therapy, with walking the length of the hallway, up four steps with the cane, down back to the room. After some quick instruction on 0-7 days of exercises off to the car ride home. So having the aide and my wife at the car it was rough but I got in. We get home and can not get out of the car, after much struggling and her trying her best we did it lol.

5 steps into the house, 15 steps to the recliner which is where I camped with the hip. After some ice and elevation the first time I tried to get up and walk to go to the bathroom I could not get up had to use the urinal, so after many many tries with the wife pulling and pulling and me straining by the time I finally got up and onto the stairlift to go to bed the pain was a clear 9 and I was an hour in with the oxy dose, so I’m gonna assume after all the therapy and getting home and the block wearing off I found out what real pain is.

I totally intend to follow all the advice of our incredible staff and moderators and take it slow and steady. Thank God the pain has become manageable, how in the world do people do both at once. This is 10x worse than Hip surgery!!!

C’mon

 

[benne68]

Welcome to the Healing Side, @C'mon.

I agree with you about the pain during the early days of recovery. Like you, I had a hip replacement before my knee replacement, and expected the recovery to be similar. It was NOT. For me, TKR recovery is much harder!

Below are BoneSmart's Knee Recovery Guidelines. Each article is short but very informative. Following these guidelines will help you have a less painful recovery.

Just keep in mind we are all different, as are the approaches to this recovery and rehab. The key is, “Find what works for you.“ Your doctors, PTs and BoneSmart are available to help, but you are the final judge as to the recovery approach you choose.

KNEE RECOVERY 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.

If you want to use something to assist with healing and scar management, BoneSmart recommends hypochlorous solution. Members in the US can purchase ACTIVE Antimicrobial Hydrogel through BoneSmart at a discount. Similar products should be available in the UK and other countries.

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

Good nutrition is very important during recovery:
Dietary Tips for Recovery
Nutrition Basics

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.

 

[Layla]

Hi C'mom!
I'm happy you joined us on the bright side! So sorry you're having a bit of a rough start with the pain and maneuvering out of the car. A tip, if you need to travel again soon. Place a large trash bag on the seat which will assist in allowing you to swivel with more ease so you're front (windshield) facing. It can also be useful in inching your way toward the middle of the bed as it removes friction. It may not be as difficult with a knee replacement to move inward from the edge of the bed, as it is with a hip replacement, but you can keep it in mind.
Wishing you lots of comfort as you begin healing. Stop back often!
@C'mon

 

[C'mon]

Hi C'mom!
I'm happy you joined us on the bright side! So sorry you're having a bit of a rough start with the pain and maneuvering out of the car. A tip, if you need to travel again soon. Place a large trash bag on the seat which will assist in allowing you to swivel with more ease so you're front (windshield) facing. It can also be useful in inching your way toward the middle of the bed as it removes friction. It may not be as difficult with a knee to move inward from the edge of the bed, as it is with a hip, but you can keep it in mind.
Wishing you lots of comfort as you begin healing. Stop back often!
@C'mon

Hi Layla!

Thanks for the trash bag tip, very helpful.
So earlier today, someone from the hospital staff called me for a wellness check, (very nice), and I asked her if side sleeping with a pillow between my legs would do any damage to the joint this early in. I don’t think she wanted to com-it with an answer other than saying whatever position you try, just make sure your leg is not bent (straight is great). lol

 

[Layla]

You're welcome!
It is thoughtful when the hospital calls to check on you. Nice if you have questions also, that's if they answer them, lol.

You may want to wait on the side sleeping for a bit, at least a few weeks and then make sure you lay on your non-op side, so there's no pressure on the knee you had surgery on.

Until then, if you find back sleeping intolerable, try to surround yourself with lots of comfy bed pillows. This really helped me tolerate sleeping on my back. Using them allowed me to rest an arm or leg on one if I felt the desire. I especially like an inexpensive Body Pillow (approx 54 inches long) I purchased at Target for around $10, but you can get them at any retailer that sells bedding. Whatever it takes I guess to catch some Z's!

If you're bored, use the SEARCH at the top right and type in key words or phrases such as - "side sleeping", "sleeping on my side" etc and all threads where it's been mentioned will pop up. Interesting to read others tips and timelines even though we always caution not to compare, but who listens to that advice?
I know I didn't.

Have a good night!
@C'mon

 

[C'mon]

These 2 pics are the exercise that replaced the heel slides from the laying down position which are brutal to do. So while your legs are over the side you can put a piece of paper under your foot and try and slide backwards till you feel slight discomfort unlike the excruciating pain with the slides, you can even help it passively with the other foot.
Looks like I got a pretty good bend out of it, and it’s as painful as the other flex exercises.

 

[Layla]

Happy Monday!
Laying down in bed, you can also use a bag under your heel for ease of movement, until it feels like too much. One of those noisy cheap WalMart, or Target type plastic bags. Will work on your bed, or on carpet like the paper you're using.
I hope today is a good one for you.
@C'mon

 

[sistersinhim]

Wow! You have very little swelling, you must be doing something right. I found the sitting slides were so much easier than when laying on my back.

just make sure your leg is not bent (straight is great). lol

I hope you know that this is not necessary and creates a lot of unnecessary pain. A slight bend is much more comfortable and doesn't cause any problems at all.

 

[mendogal]

After two successful knee replacements I want to echo @sistersinhim :

1) as you already found, seated heel slides are far better than lying down! My ortho team told me several times that in the early weeks Less Is Better! And the only exercises I did, besides my short hourly walks, were quad sets (good for circulation, range of motion, and waking up the quads) and sitting up heel slides (Tip: do them slowly while deep breathing!). I never counted reps/sets, just did them randomly throughout the day.

2) a slight bend of the knee really is necessary for most of us to be comfortable, as achieving full extension can take many long weeks. The key safety issue is to ensure there's no pillow or anything else applying direct pressure at the knee bend (promotes blood clots); as long as there's uniform support for the upper and lower leg without direct pressure under your knee the bend is fine.

Here's an article about how to safely elevate.

 

[selketine]

This time I can say the knee is absolutely the worst pain I’ve ever had.

Sounds like you've had a tough few days there at the start. There's nothing fun about that first week - that's for DARN sure. I found the seated heel slides to be about the only ones I could do - or at least wanted to do - for many weeks. As the swelling went down and my bend got a bit better and the pain was better - I did the lying down type - and eventually started liking them but that was several weeks in. I did not do that many seated ones early on - maybe a few here or there mostly just to try it. Job #1 is getting up and getting to the restroom and the bed and everything else was gravy. Your bend looks pretty good! I remember after a few days my foot got swollen and I think my leg got more swollen. If you have staples - it will feel very good to get those out.

If you read my recovery thread - you will see I fretted over many, many things and had many frustrations along the way. For me the best thing was maybe about 3-4 weeks along I could get up and go to Target and walk the aisles with my walker and buy M&Ms. Walking a bit - not much - really - REALLY - made my knee feel better and looser and shopping lifted my spirits. I'm sure I looked like a ghoul - but this time if I go to Target to walk - it will be October and everyone will think I'm part of the Halloween decorations!

I think I practiced straightening my leg while seated in the recliner - but didn't leave it in an uncomfortably "flat" position all the time. Unlike most people here, the ice machine actually bothered me and I eventually backed off of it (and found out later my doctor doesn't agree that icing is that beneficial - which I guess suited what I ended up doing - haha!). I'm SUPER sensitive to the cold and it just made me feel chills and stiffness and misery - plus it was January and I was already freezing. I'm having my 2nd knee done in 2 days so maybe this one will like the cold - who knows!

Place a large trash bag on the seat which will assist in allowing you to swivel with more ease so you're front (windshield) facing

Layla....were you holding on to this tip in your secret stash of tips? Dang - I'm doing that Wednesday to help me slide out of the cloth seats in our Rav a bit easier.

 

[C'mon]

@selketine

The day after, after clearing therapy and getting to the car and struggling to get out at home and then the walk into the house and to the recliner def took its toll, THEN after I couldn’t get out of the recliner to do my first walk and bathroom break I headed up on the stairlift and haven’t tried the recliner again yet. But shortly after reaching my wonderful bed the nerve block must have completely wore off and the pain went to solid 9 and stayed there the rest of the day and half that night, I must have dosed off so when the 4am oxy alarm went off the pain level dropped to a 7 and has been totally manageable from that point on.
I will check out your recovery thread, wishing you the best.

 

[sistersinhim]

I think your pain shot up because of all the activity you did that day. We have found that nighttime pain correlates with the amount of activity or PT a member did that day or the day before. That is why we suggest that a member do less until they find out how the knee reacts that night or next day. Less activity = more healing and less pain and swelling!

 

[selketine]

I will check out your recovery thread, wishing you the best.

Oh I wasn't encouraging you to read my recovery thread - you would need to be bored out of your mind to find it remotely interesting - haha! It is a good resource for me to look back on as it is truly amazing how much you forget.

I agree it sounds like your activity combined with the nerve block wearing off shot the pain up that first night. I honestly cannot say when my nerve block wore off - there wasn't a big change for me. I do remember the first night though - like yourself - my pain went up even after taking the oxy - so maybe that was the block wearing off. I ended up taking a 2nd one earlier than prescribed (I was on a 5 not a 10 gram - don't know the weight - type tablet). The surgeon said that was fine. After that first 24 hours my pain stayed level didn't get markedly worse.

You're coming up on having that first week behind you!

 

[Layla]

Layla....were you holding on to this tip in your secret stash of tips? Dang - I'm doing that Wednesday to help me slide out of the cloth seats in our Rav a bit easier.

I have shared it here before and read it here also. My dad is the one that originally gave me the tip for the ride home from my joint replacement 7 yrs ago. It worked like a charm! I am sure it will for you also.

 

[C'mon]

@Layla
Good morning Layla!! Doing a little better today
Could you please add Mako Robotic Assist. to my L TKR TIA.

 

[C'mon]

Made it back down to the recliner last evening figuring if I couldn't get up again my son was over and he could help lol.
Well after having a nice visit the moment of truth, not only could I get up but it was with just my wife helping!! And just now I got up myself and did my 3rd walk of the morning. There are def more things sore today from not only walking a lot yesterday but getting onto the stairlift, dangling my leg with the lasso and finally making it to the recliner then back up to bed.

 

[sistersinhim]

I will add that for you.

 

[C'mon]

Thanks sis!!!

 

[selketine]

not only could I get up but it was with just my wife helping

That's fantastic! It's nice to have the option to move back and forth from the bed to the recliner.

 

[Layla]

not only could I get up but it was with just my wife helping!! And just now I got up myself and did my 3rd walk of the morning

Great news! Small steps in the right direction for sure.
I hope you sleep well tonite and have a great Wednesday!