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TKR SZone's Recovery Thread

SZone

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Hi. I had a right TKR on September 1. I think I am past the most intense pain. I’m spending all of my time when not making short trips to the bathroom or just down the hall and back icing and elevating. At a surgeons visit last Thursday, my flexion was at 80 and my extension was 0. I’ve increased flexion a little more since that visit but I’m at a point where progress forward is slowing due to extreme stiffness. The dr was impressed with my flexion at 7 days and also felt my incision healing is exceptional and my swelling was minimal. I’ve been ramping down my painkillers and have only been taking half of a 10/325 norco in the night when I can’t sleep and using extra strength Tylenol during the day as needed.

All of this sounds positive but of course I’m struggling with all the usual things, worrying that I’m not getting my ROM quickly enough, inability to sleep at night more than an hour at a time, wondering when I should be trying to walk without a walker, and regaining a normal gait. Because I had an old, previous surgery on this knee in the 70s, they had to close my incision with staples. I’ll be getting them removed next Thursday and will be glad to get rid of them.
 

Pumpkin

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@SZone
:welome: to BoneSmart,

Sounds like you are doing well with all the normal ups and downs of a TKR.

worrying that I’m not getting my ROM quickly enough
Your ROM at 80 degrees is fantastic, what is blocking your ROM is swelling, like a full water hose is hard to bend, so is your knee. Let the water out (swelling) the hose is easy to bend as will be your knee.
There is no window of opportunity, my surgeon said 90 degrees at 3 months was fine. You are almost there. Keep spending your time resting, icing, elevating, and medicating on schedule as prescribed.

inability to sleep at night more than an hour at a time,
This is a normal response to a TKR, there is an article in the guidelines about sleep deprivation, be sure to read it. (the guidelines are posted below).
wondering when I should be trying to walk without a walker, and regaining a normal gait.
You should wait to walk without your walker when your gait is normal in your walker. Walking with a limp or gait deviation only reinforces walking with a limp or gait deviation.
I’ll be getting them removed next Thursday and will be glad to get rid of them.
We all were glad to be rid of the staples. :SUNsmile:
I’ve been ramping down my painkillers and have only been taking half of a 10/325 norco in the night when I can’t sleep and using extra strength Tylenol during the day as needed.
You may be ramping down too soon, be sure your pain levels are well controlled. Pain can contribute to swelling, reducing your ROM.

Here is your copy of the Knee 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
ice
take your pain meds by prescription schedule (not when pain starts!)​

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

5. At week 4 and after you should follow this

6. Access these pages on the website


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 the 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 the member’s history before providing advice, so please post any updates or questions you have right here in this thread.

 

Pumpkin

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You will notice I have moved your post to the recovery forum where you will receive more answers to your concerns and questions. Please post about your recovery in this thread, you will create a recovery diary for yourself, and it is easer for staff to go over your posts when responding to questions.
If you would like a different title, post it here and a moderator will change it for you.
Thanks,
Chris
 

Rain Dancer

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Your ROM is coming along nicely. I moved from a walker to a cane 5 days after surgery because I had no balance or dizziness issues, and my knee never buckled or hyperextended. I also was able to put my full weight on my leg from day 1. I am still using the cane at 7 1/2 weeks out to manage my gait and not limp.
 
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SZone

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I tripped and fell today with my walker. I was walking to the stairs with my walker and was pivoting the walker around so I could leave it at the top of stairs for when I came back up. One of the wheels caught on the carpet causing the walker to tip just enough for me to lose my balance. I knew I was going down and just did my best to protect my knee on the way down. I did pretty well but did tweak it pretty well. I just lay there for quite awhile waiting for the pain to settle down. Then I had to figure out how to get back on my feet. Luckily I was close to the stairs and was able to scoot to them, sit on the top step and stand up. I’m icing now, and it seems ok but is a little sore. One thing I learned while I was down there on the floor is that my extension is not at zero like I thought. I’ll need to start working on that.

I have a question regarding sleeping positions. In my mind, I remember someone at the surgical center telling me to sleep on my back. However, I can’t find that anywhere in my reading material. Normally, I sleep on my left side, which would have my bad knee on top. When I try this position, it just does not seem comfortable But sleeping on my back is just miserable. Do any of you sleep on your sides and if so, do you have any tips? I‘ve been averaging ~4 hours of sleep per night since surgery Which is getting very old.
 

Pumpkin

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Sorry to hear that you fell, the implant is fine, it is your soft tissue that is so upset. Glad you are OK.
Keep icing, resting, and elevating.
Finding a comfortable sleeping position on your side will take awhile, it took me awhile to find the pillow that was just right between my knees.
 

Scanne

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Oh no SZone that's is terrible that you tripped and fell, my knee ached for you hearing that!
I have learnt to get down and up from the floor by straightening my new knee leg out behind me and using my good knee, leg and hands to lower or raise myself. I like laying down on the floor to help relieve my aching back and hip. I have been able to sleep on both my right and left sides for short periods for the last couple of nights. For the left side I put a pillow (a soft bamboo pillow) in front of my good leg and lay my new knee/leg on the pillow, it takes a few adjustment to get comfortable enough to be able to doze off. Hope you can find a way to give the back sleeping position a rest.
 
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SZone

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Scanne, thanks for the tips on how to get up and down. I’m going to have to practice. I will also try out your pillow tips tonight as well. I’m crossing my fingers that I’ll be able to get comfortable enough sleep through at least part of the night. My iwatch has me at between 4-5 hours of sleep every night since my surgery and that’s getting really old.

I am so thankful that I found this site. Thank you to everyone for all of the advice and tips. It’s nice to not feel alone through this.
 

Scanne

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You are certainly not alone on this journey, it seems everyone on this forum has each others back, it lifts you from the depths of despair. I also take my meds about 1/2 hour before bed and go straight into the side position, then later on when it get uncomfortable and awaken I swap to my back. Do you use a leg relaxer when on your back? I do and it helps take some pressure off.
 

Susie-Q

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Wow, your falling story is scary! Especially so close to the top of the stairs! :flabber: I'm glad you are ok. I can't imagine ending up on the floor, I'm not sure I'd be able to get up again without help.

I am normally a stomach or side sleeper and have to sleep on my back and I hate it! We have a memory foam topper on our bed so it is rather soft, not easy to shift around but I feel like I'm nestled in and as comfy as I'm going to be on my back. I sleep on top of the comforter with my operated leg propped up on a length-wise body pillow plus a memory foam pillow with a channel in it. Light fleece blanket on top of me (I'm always hot when I go to bed) but I always get cold in the middle of the night so I have an extra blanket nearby. I'm wearing the wrap around my knee for my ice machine with the two tubes coming out the end, so any shifting around by my leg is uncomfortable. Somehow I'm able to get sleep in between pain medications every 4 hours, although I'm not sure how..... Sorry if I'm rambling..... I'm anxious to be able to some day sleep on my side with the body pillow in between my knees but not yet.

@Scanne , what's a leg relaxer?
 

Jockette

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That stretching at the back of the knee is so uncomfortable. I’m forcing myself to sit with my leg outstretched with a towel under my ankle several times a day but it’s difficult to do it for long due to that pressure/pain. I had been at 0/-2 extension but now it’s back to 2 because I’ve been avoiding this stretch. Now I know I have to keep at it.
There is no need to force yourself to do something painful in this recovery. This is not a “no pain, no gain” process. Bonesmart believes “no pain equals more gain.”

You did not lose extension because you avoided this stretch. You mentioned a fall, which most likely caused more swelling, which reduced your extension number. What you need is time to heal, not painful activities to ”fix“ this.

You are very early in a recovery that takes an average of a year, for complete recovery.

Regaining our ROM (both flex and extension) is more about Time than repetitions of a list of (painful) exercises.

Time to recover.
Time for pain and swelling to settle.
Time to heal.

Our range of motion is right there all
along just waiting for that to happen so it can show itself.

In the general run of things, it doesn't need to be fought for, worked hard for or worried about. It will happen. Normal activity is the key to success.
 

Jockette

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Also, 2 is practically 0 in the grand scheme of things, so please don't worry about it. It’s going to be fine, in time, and you have lots of time.


 
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SZone

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Today when my PT arrived he saw me walking with my walker and told me that I am ready to graduate to a cane. I feel a little unsteady with the cane so I think I will continue to use the walker at night for bathroom trips. PT with the therapist is always a completly different experience than when I do it on my own and I am always a bit of a noodle when he leaves. Today he gave me a specific list of exercises to do 4 times per day which seems like a lot. He also told me he recommended another full week of at home PT before moving to external. I am fine with that as I’m not excited about going out for PT at all. Thursday is staple removal day and I cannot wait.

Last night I attempted side sleeping again and lasted about 5 minutes. My incision is on top of an old incision I have from surgery in the late 70s. It doesn’t go straight down my knee like the pictures I’ve seen here. It curves inward and goes around the outside on my knee and then curves back to middle at the bottom of my knee. The result is that sleeping on my side puts pressure on my staples, so I’m hopeful that it will be more comfortable after they are removed. On a positive note, I did sleep better than I have since surgery. I hope that tonight will be good as well.
 

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Susie-Q

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@SZone 4 sets of exercises seems like a LOT. Also, how does he know you are ready to graduate to a cane? If you feel steadier with the walker, keep using it! I'm only a couple of days ahead of you and I'm still using my walker. There are times I don't when I'm in my house and feeling strong but there are other times I do feel more confident when using it. I would make up your own mind on that.

I mentioned to my PT that I felt I was almost ready to ditch my walker and she said don't rush it. Especially when out in the big wide world, that walker can give you stability when you don't have the comfort of your familiar house with its walls, counters, etc....
 
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SZone

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I’m in agreement with you on the cane. I’ve been using it during the day around the house, but in the night while making bathroom trips, etc. I switched back to the walker. I just don’t feel secure enough to use the cane in the dark when I’m half asleep. While using the cane around the house I am trying to be very conscious on walking with as normal a gate as possible and thinking of it as just one more area of my rehab/PT.

I also agree that 4 times a day for the PT is just too much. My pain had been really well controlled, but I’ve been in a lot of pain since our PT session. It has made the area under my knee cap to swell. I ended up having to take half a norco in the night to be able to sleep Because of the pain. I haven’t done any of my exercises yet this morning and think I will do an abbreviated version today. I know that I won’t be able to stand doing everything he had me do yesterday 4 times everyday. It’s just too intense. His advice was to take more pain meds but I only have a couple left and my insurance has denied a refill.
 

Susie-Q

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My PT has me doing my exercises twice a day. I can handle that. More than that would seem daunting to me and I wouldn't want to do it.

I agree on the walker at night. I'm usually so stiff when I get up to go pee that I lean on the walker quite a bit.

Yeah, I don't understand the desire for you to exercise to the point that you need MORE pain pills. That seems counterproductive? I was taking 1 every 4 hrs prior to PT and was feeling well enough that I could have cut down. Now that I'm doing more exercises, I really need that 1 every 4 hours but certainly not more. I got less pills at this last refill on Monday. Not sure if I will get more or not when they run out. I'm hoping I will continue to improve and that the exercises won't require me to take more but actually less..... (that sounds like common sense :chinstroke:)
 

Jockette

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Yeah, I don't understand the desire for you to exercise to the point that you need MORE pain pills. That seems counterproductive?
I agree, it is counterproductive. Any activity that causes you to need pain control is, at the least, limiting your healing, and at times it causes a set back.

Regaining our ROM is more about Time than repetitions of a list of exercises.

Time to recover.
Time for pain and swelling to settle.
Time to heal.

Our range of motion is right there all
along just waiting for that to happen so it can show itself.

In the general run of things, it doesn't need to be fought for, worked hard for or worried about. It will happen. Normal activity is the key to success.
 
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SZone

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I agree completely. There is no way that I’m doing that series of exercises 4 times per day. I’m still in pain from yesterday’s session. I only have 1 1/2 Norcos left and my insurance denied the refill. I’m not going to get myself in so much pain that I have to use them just to get through a normal day. I’m taking xtra strength Tylenol several times a day and will save the hardcore meds for PT days. Now that I am finished with the blood thinner prescription I will see if I can take Advil, which I think works better than Tylenol.
 
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SZone

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Day 15

I can hardly believe I’m at the beginning of my third week. Time has felt like it was standing still and yet here we are. Today’s a big day as I will get my staples out today. In my new limited world this feels like such a big deal! I’m supposed to remove my bandage and gently clean the area around the incision before I go in. I am definitely getting stronger and my walking has improved. I found myself all the way into the bathroom yesterday before I realized I had left both the walker and cane in the other room. Oops! I guess that’s a good sign but I will need to be careful. On a very positive note, I FINALLY slept last night for the first time since my surgery. I had been getting ~4 hours or less every night. It’s such a good feeling to not be exhausted.

I haven’t posted about this, but almost from day 1 I have been dealing with some type of intestinal issue. I have been having pretty severe and constant painful cramping night and day. This is what prompted me to get myself off of the norco as soon as possible as I thought it was probably related. Once the constipation resolved, I have had non stop diarrhea, pretty much every half hour all day long. It has been so uncomfortable and is wearing down as I am also dehydrated asa result . I was finally able to see the dr yesterday and had some lab tests done and a stool sample will be dropped off this morning. The labs came back quickly, all normal except my platelet count was really high. I let my surgeon know ASAP and she thinks it’s probably due to dehydration so I really upped my fluid intake. I checked my pre surgery labs and it was well within the normal range 1 week prior to surgery. Now to wait for the stool sample results. I think I probably have an infection somewhere.
 

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