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TKR SusieQs Pre-op, Qs about outpatient surgery!

Susie-Q

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Hi all. I had my Pre-Op Appointment today and CT scan of the left knee. My surgery is scheduled for Aug 30th. My first knee, done 11 years ago, I stayed 2 nights in the hospital. I was hoping to spend one night this time because coming home the same day scares me a bit. My BIL had his knee replaced a couple of years ago and he came home the same day. He said if he had it to do over again, he'd stay overnight in the hospital. At my pre-op today the PA said that because they are trying to reduce the amount of hospital stays, if I want to have my surgery on the 30th, they'd prefer me to go home the same day. I am the perfect candidate for it because I'm fairly young, healthy, active and mentally with-it. I'm very curious to hear from any of you who came home the same day, how did it go? Any advice?

Some differences between last surgery (11 years ago) and this one will be:

I will have a spinal and sedation, not general anesthesia
This will be done by a robot, so better accuracy, quicker recovery?
I will come home with a Peripheral Nerve Catheter for 5 days, last time there was none
They want me to start PT in 7-10 days, last time it was 3 weeks post-op (I was a bit dismayed when he mentioned how they want me to "hit it hard" right away :nah:)
I have an ice machine this time, last time just ice packs and ziplocks of ice
Compression hose are from under the knee down to the foot for 2 weeks, last time it was thigh-high hose for 2 weeks (which I hated) (under the knee.....how is that going to work over my incision?)
They will send me home well-drugged up so there will be time to get my prescriptions filled on the way home.

I'm especially concerned at how they're trying to scare me about adhesions and arthrofibrosis. Here is the paragraph:

Arthrofibrosis: Arthrofibrosis is mainly something we worry about in our total knee replacements. Arthrofibrosis is a buildup of scar tissue causing a stiff or nonmobile joint. We determine the range of motion, or ROM, of your replaced joint at our 2 and 6 week post-op appointments and at those times we will determine if you are recovering with adequate ROM or if we need to try and increase your PT in order to acquire the proper ROM. If at 6 weeks the ROM is not adequate, we will take you back to the operating room in order to perform a manipulation under anesthesia of said joint, with the possibility of an arthroscopic synovectomy.

I was told in no uncertain terms that I was the only one responsible for how well my ROM was by the work that I put in. It sounded vaguely threatening! :unsure: I responded that if I overwork the joint it will swell up and then no ROM will be had anyway and that I wasn't going to overwork my knee!!!

Anyway, I would appreciate any feedback from those who did this surgery as an outpatient. Tips, advice, anything!
 

Jockette

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I did not have same day surgery, (4+ years ago) but many of our members recently have, hopefully you’ll hear from them. I think most of them had very good experiences. You might want to consider changing the title of this thread to reflect that.

About the PT/ROM threat. (Oh where do I begin!) They are right on one point, you are the only one responsible for how you recover. And if you want to go the gentle route, that is your decision, not theirs. They cannot force you to do anything you don’t want to, or are not comfortable with, or disagree with.

It sounds like they have a one size fits all protocol, and we are each individuals, who heal at different rates. Some of us regain our ROM rather quickly, others more slowly. Both ways are fine, we all end up at the same place, recovered!

In my opinion, 6 weeks is way to early to consider MUA, under any circumstances. And if they do mention it, it will be your decision, not theirs. They can’t do any surgical procedure without your agreement and signature on a consent form.

I think you will have to be very strong in maintaining a recovery of your choice with this medical group. We‘ll be here to support you along the way.
 

Rain Dancer

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@Susie-Q I had same day surgery July 21 and would definitely do it that way again. I am allergic to everything, which is why I need to be back in a safe environment as soon as possible. I did not have a nerve catheter and use gel packs rather than an ice machine. I ditched the compression knee highs the night of surgery. I live alone, so I paid for a health aide for 36 hours, which carried me through 2 nights. I then had an aide during the night for the next two nights. So, 4 nights total. They switched my gel packs, helped with meds, brought food, let people into my house, fed my cat and took care of his litter, and followed behind my walker as I navigated through the house. They were a huge comfort, and I am glad that I hired them.

Per the surgeon's protocol, after I was released, my sister and I were met at the door by a physical therapist and a home nurse. The nurse took vitals and administered antibiotics via IV. The PT was not helpful and probably caused more harm than good. Home nursing came two more times to draw blood and change the dressing. PT returned for 3 more days in a row. I shouldn't have permitted that because they set me back.

My surgeon, who otherwise is great, has the same philosophy as yours about ROM targets, which I know is ridiculous. My outpatient PT confirmed that the targets are crazy. A swollen knee won't bend. I will refuse an MUA. Best wishes for a smooth recovery.
 

kate97497

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@Rain Dancer I'd like to learn more about your home aid. I am interested in doing the same but not sure how to find the help I need. I absolve alone, I could go to my son's for a few days but they work and I'd rather be home.
 

Rain Dancer

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@kate97497 I suggest that you contact your local senior services center/department of aging for a list of home care agencies, which is how I found mine. You can then search for reviews of the agencies online. The rates generally vary, depending on shift and day of the week. You will want to start the process soon so that they can calendar you in. You can expect to sign a contract. Mine billed me through electronic funds transfer. Please private message me if you want to chat about this. Good luck!
 

FourCats

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Mine was scheduled as same day but due to some blood pressure issues in recovery, I was not able to pass the PT requirements so stayed the night. Since I live an hour from the hospital, I was actually glad it worked out that way. I think a lot of it depends on the assistance you have at home. I live alone but my sister took a few days off work to be with me through the first couple of days. By the time she left to go home, I was able to handle things alone such as refilling my ice machine, fixing simple foods, and basic household tasks. For me the most important lesson learned was not to set my goals to be unachievable but be realistic that my recovery is a one day at a time journey with lots of twists and turns as well as some potholes along the way.
 
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Susie-Q

Susie-Q

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In my opinion, 6 weeks is way to early to consider MUA, under any circumstances. And if they do mention it, it will be your decision, not theirs. They can’t do any surgical procedure without your agreement and signature on a consent form.

I think you will have to be very strong in maintaining a recovery of your choice with this medical group. We‘ll be here to support you along the way.
I had this same discussion with my husband today. They can't make me get an MUA or do any other procedure without my permission.

I forgot to mention I will be going home to my husband, who is taking 10 days off work (he has lots of sick leave built up) and two adult children who are living at home. They are in and out with work/activities but will pick up the slack here and there with meals/laundry/dishes. My hubby is able to work from home so once he goes back, he will still be around to help as needed. We have two cats (one very old, the other young and very active) and one 18 month old Labrador. I'm the primary person for all pet chores, including dog walks, so the rest of the house will have to pick up the slack.

I also forgot to mention I will be taking baby aspirin this time instead of Coumadin so no blood draws to check levels. I'm going to make a PT appointment for 2 weeks post-op and have found a gal through a friend who supposedly uses a gentle approach.

I also live in a rambler house now so no stairs, except for 3 down to the garage and 2 to the outdoor patio. My last house was a split level and I remember staying upstairs for at least 10 days before going downstairs.

I'm trying out the ice machine right now but only had one water bottle frozen and I also put in a blue ice pack. It's not as cold as I would like but next time I will try at least 3 frozen bottles, maybe 4.

Now to go figure out how to change my thread title!
 
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Susie-Q

Susie-Q

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I'm trying out my ice machine. Is it really cool enough to help with swelling compared to gel ice packs or regular crushed ice bags? I've got it on my bare knee with a thin dish towel in between, 4 frozen water bottles in the water and it's nice and cool but nowhere near what a frozen gel pack is. I'm afraid those gel packs will be too rigid to use post-op though.

I would say it's a gentle cooling. What do you folks think who have used the ice machines for your recovery?
 

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I had bilateral TKR, and my experience was through trial and error. During the first 4 weeks, I used 2 ice machines nonstop, and I used ice bottles and added ice cubes to get the water cold enough.That got old, expensive, and tiring. My sister was spending $15 on commercial ice every other day.
So I bought reusable ice cubes on Amazon, which were initially expensive (I bought 8 packs of 20 cubes, kept them in mesh bags, and they are easily removed and refrozen. The ice machines were then cold enough to being relief, and lasted all night. I slowly weaned off the machines and at 10 weeks, I use frozen gel packs after exercise.
 

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I am very thankful for my ice machine. We have a system down-we have 16 ounce water bottles frozen & in rotation. I use 2 at once, they last a few hours. A cheap way to keep ice always at the ready- we emptied ice tea bottles & filled with water & froze. We also have a large turkey (cold cut) tupperware type container full of water frozen that fits into the rotation as well.
 
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Susie-Q

Susie-Q

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Alright, after using it quite a bit today, I have decided that I do like the Ice machine. It's not as cold initially as an ice pack but gets colder the more you use it. You can also leave it on for a long time and it chills your knee nicely. A bit of a pain to get it set up but the hubby will be worrying about that for me post-op. I used it for quite awhile on top and then took a break and used it for awhile on the back of the knee, not going through pants this time but on my bare leg with a thin dish towel in between the skin and water pad.

My knee felt great after I took it off, a good pain reliever.
 
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Susie-Q

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I made my appointments with PT yesterday. A friend recommended someone she went to and said she advocates a gentle approach so crossing my fingers that's really true. My doctor's paperwork said to schedule the first appt 7-10 days post-op but I am waiting until 2 weeks after. That's early enough!

I'm loving my ice machine and am using it a lot right now, any time I'm on the couch for a good stretch of time. My couch electronically reclines so I can prop my leg up.
 

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My surgeon set up at PT appointment before the surgery which I hope will answer many of my questions. I will not have an ice machine since it will only be me or grandchildren perhaps daughter staying for a few days. I have gotten 2 of the flexion ice things recommended here and thinking of getting more and made several sleeves for them so I will not have to deal with towels. It seems my mine is going a mile a minute thinking about the TKR
 
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Susie-Q

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You will definitely want more of the ice packs so you can have some frozen and ready when you need to change them out. One on top of the knee and one behind is good too.

I can relate, my mind has been going a mile a minute for the past month preparing for this!
 

jaspa

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Thanks @Susie-Q I will order more from Amazon as I like that big size, the sleeves for the packs are made to size for them and another pack I have. I used flannel on inside to absorb moisture and cotton on outside just like a mini pillowcase which will tuck in at the opening, they can be thrown in washer/dryer even has my favorite Peanuts guy Linus since I am chapter coordinator for Project Linus.
ice sleeve.jpg
 

GZGirl22

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Mine was scheduled as same day but due to some blood pressure issues in recovery, I was not able to pass the PT requirements so stayed the night. Since I live an hour from the hospital, I was actually glad it worked out that way. I think a lot of it depends on the assistance you have at home. I live alone but my sister took a few days off work to be with me through the first couple of days. By the time she left to go home, I was able to handle things alone such as refilling my ice machine, fixing simple foods, and basic household tasks. For me the most important lesson learned was not to set my goals to be unachievable but be realistic that my recovery is a one day at a time journey with lots of twists and turns as well as some potholes along the way.
Had the same experience as Fourcats -- my BP tanked and I had to stay overnight. Got out next morning though. I also agree with the Bonesmart way of healing -- YOU need to listen to your leg and be in control of how it is treated. I have been lucky in that my PTs are good, but when I tell them they are pushing it I am not afraid to stand my ground. They have been good to listen. At home, if the knee is complaining after PT the previous day, I skip the exercises and rest it that day with a lot of ice along the way.
 
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Susie-Q

Susie-Q

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Ok, this is ridiculous...... the closer I get to my surgery, the more aches and pains my body has. Is this normal? My knee is getting worse and worse, I haven't taken any NSAIDs since Tuesday (doc said to stop them 5 days prior). Both my shoulders hurt, especially my right one. I've lost some ROM in my left knee a couple of months ago so I can't bend it as far as I used to, hence I'm using my arms a lot to get up and down from chairs. Using walls and the bathroom counter to push up from the toilet. Now today my lower back on the right side above my hip is hurting something awful! I'm limping around the house and can barely walk! I did walk my dog around the block today and took her half a block up to the soccer field to play fetch, which involved some walking on uneven grass. Is this just my body complaining from all the limping around I'm doing, favoring one side or the other? Withdrawl from NSAIDs? I'm spending a lot of time on the couch, icing my left knee and watching tv. I feel 30 years older than I really am...... Monday can't come soon enough.....
 

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