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[TKR] szrmom recovery thread

Discussion in 'Knee Replacement Recovery Area' started by szrmom, Aug 10, 2019.

  1. szrmom

    szrmom new member
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    Hi,

    I had a left knee TKR on 7/15/19. It was outpatient surgery, so I went home the same day. (You have to agree to have someone with you 24/7 for the first week) My surgeon has a little bit of a different protocol than a lot I heard about, and you must agree to his protocol. I had to drink a surgical recovery drink twice a day for 5 days leading up to surgery and swab my nose with Bactoban twice a day for 5 days prior to surgery. You also have to get a dental clearance. You have to agree to not leave your house for 4 weeks, with the intent being you are to rest, ice and elevate. A home health nurse came to the house the day following surgery, and luckily, based on the amount of blood in the drain, she texted the dr. and he allowed the drain to be pulled. (Most people have the drain for 3-4 days so I lucked out here) Once the drain comes out, pt could come. Another difference, and what I was a little nervous about, was that he doesn’t prescribe narcotics. I was prescribed Celebrex for swelling, Tramadol, and Tylenol. He also uses a long acting lidocaine in the soft tissue before closing, so I didn’t have much pain at all till day 3, and that was really the only day it was uncomfortable, but the meds worked. By day 4, it was all very manageable with the meds he prescribed.

    My surgeon employs a pt at his office, who ended up creating her own company, so they can be hired through home health agencies. He has 4 pt’s that only see his patients, so he has complete control of the protocol. It is all about keeping inflammation down. All pt is hands off. They give you a few isometric exercises to do, and slowly add rom exercises. You also walk a little bit each hour. It starts with 5 min. and maxes at 10 min. You must use the walker for the first 2 weeks, and then the pt will decide when you can move to a cane. There is also no sitting in a chair till 2 weeks post op, and then it is limited to meals only. The pt pulls the staples at 2 weeks, and you go in for your first post op appt. at around 4 weeks. He does NOT prescribe outpatient pt because he believes they overwork the joint and cause more harm than good.

    One issue I had dealt with was burning nerve pain in the lower inside area of the knee this is now numb. It made the exercises difficult and painful. My pt had them call in a prescription for Gabapentin and it helped almost eliminate the burning pain.

    The number of people who told me that this surgeons protocol sounds crazy and I should look at another surgeon was a lot, but, I am now 4 weeks post op, off all pain meds, and have extension of 0 and Flexion of 124. I see my surgeon for my first post op this Wed. and am looking forward to be released to drive and return to work. Following seeing him, I will meet with his pt, and she will evaluate and give me new exercises to do for the next month. I follow up with her at 8 weeks, and then see him at 3 months. I got to admit that staying home for 4 weeks has been difficult, but I can’t argue with my results.

    My pt has been with him for 4 years now and she says his patients by far recover better than most other patients she has treated before joining his team. She attributes it to his surgical technique. She says his patients have far less swelling, bruising, and pain than other surgeons, as well as his pt protocol.

    I was very nervous heading into this process, but it has gone far better than I expected. I also have a saint for a husband. I will eventually need the right knee replaced as well, but I won’t go into it with the same trepidation as I did with this one.

    PS. I am also ready to be rid of the battery operated calf compression sleeves you have to wear for 16 hours a day for 4 weeks. My favorite sound is when the batteries die and have to be recharged for 3 hours.

    Well, I’m off to walk again. Good luck to everyone with their recoveries!
     
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  2. Jockette

    Jockette FORUM ADVISOR Forum Advisor

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    Welcome to Bonesmart! Your recovery is going very well.

    I will leave you our Recovery Guidelines. Each article is short but very informative. Following these guidelines will help you have a less painful recovery.

    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
    5. At week 4 and after you should follow this
    6. Access to 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.
     
  3. Celle

    Celle FORUM ADVISOR Forum Advisor

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    Welcome to recovery @szrmom .
    I like your surgeon's protocol, although he does seem a bit controlling.

    My surgeon doesn't allow any formal PT at all for the first month after a knee replacement. He says your knee needs that time, to start on its journey of healing. For that month, we rest, ice and elevate our leg, and walk around the house. The walking is our exercise and we increase it a little each week.

    After that month, we just go to PT once every 2 weeks, where we are shown a few new exercises to do at home each day.

    His patients all do well and achieve good ROM, as I did, and he hasn't had to do a manipulation to help with ROM for the past 4 years. I think that speaks for itself.
     
  4. InkedMarie

    InkedMarie graduate

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    Good for you....I couldn’t follow the protocol lol. I’d fail.
     
  5. szrmom

    szrmom new member
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    It actually wasn’t as bad as I thought it was going to be. The pt came 3 days a week for 4 weeks, and we had lots of meals brought round. I had friends come and bring lunch. They explained why they wanted me at home, and it was about not wanting it bent in a car, or the amount of walking that would be required when out of the house. The three big things my surgeon wants to prevent are inflammation, infection, and blood clots. I can’t complain because my progress has been better than I expected. Hoping to be cleared to drive Wed., and return to work, at least part time.
     
  6. Jaycey

    Jaycey SUPER MODERATOR Moderator

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    Sounds like your surgeon's protocol worked well for you. Watch out for energy drain when you return to work. It's real and you just can't fight it. Can you do a phased return?
     
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  7. Roy Gardiner

    Roy Gardiner FORUM ADVISOR Forum Advisor

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    How many of these people had TKRs, or were doctors or physiotherapists?
     
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  8. Jockette

    Jockette FORUM ADVISOR Forum Advisor

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    I wholeheartedly agree with this. I had surgery mid day Monday, discharged Tuesday evening and had be at out patient PT at 1 pm on Wednesday.

    Getting in the car to come home from the hospital was awful. I dreaded having to do that again the next afternoon to go to PT. I just couldn’t bend enough to get in the car on Wednesday and finally my husband just did it for me. :yikes: After all, we had to be on time. (My husband is a very caring man and took excellent care of me, he was not rough when he did this but it still hurt a lot!)

    And, like you mentioned, the walk into the PT building was too far for 48 hours after surgery. And sitting in the car with my leg on the floor, after being assisted in, was painful.

    My PTs and my surgeon believed in pushing my knee to a painful place every time they measured. :bawl:

    I have come a long way in experience since then! Next time no one will force bend my knee or even touch it. There will be no formal PT. It’s not rocket science, all one has to do is give the knee mobility.

    As you have found, different surgeons have different opinions on this recovery. I’ve read of many here on Bonesmart. So, there isn’t only one right way to do this recovery. Next time I will choose the bits and pieces that work for me.

    What kind of things did the PT do with you when they came?
     
  9. lovetocookandsew

    lovetocookandsew FORUM ADVISOR Forum Advisor

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    I actually agree mostly with your surgeon's protocol, if not his controlling nature. I see where he's coming from and do agree with most of his ideas on healing and recovering. My revision surgeon was (and is) pretty amazing also. I had about 12 days of pain relief due to not being able to take any narcotic pain meds at all, so he used a combo of different non-narcotic pain relief tailored for my body. After the pain ball was removed on about day 12, I was miraculously mostly pain free, so never needed anything more than to ice and elevate. I also had absolutely no bruising after the revision, unlike the original TKR where my leg was one giant bruise.

    I had no formal PT at all; I just increased my ADLs over time and spent a lot of time icing and elevating. As a result, my recovery was night and day from my TKR recovery. I fully believe a lot of the bad recovery issues we have are directly related to not only the surgeon's techniques, but also the kind of PT that most surgeons and therapists inflict upon us. Your doctor has the right idea, IMHO, although I do think he may be a little too controlling in his methods. But his results may compensate for his control, and in the end we all want good results.

    I am hoping as time goes on, the recovery protocols for this surgery see a drastic change to no PT of the type done today; instead either no formal PT at all, or at least only basic PT where they help you walk around and get your gait back to normal since many of us have a terrible gait due to limping and pain from bad knees. There've been so many other changes in the last few years with this surgery; IMHO changes in recovery methods are long overdue!
     
  10. szrmom

    szrmom new member
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    Everything was hands off.

    The first few days it was only ankle pumps, gentle pressing and holding my knee into the couch, pressing my heel into the couch, and squeezing my butt and holding. started with 10 reps and am now up to 20 reps. After 2 weeks I got to eliminate the butt squeezes.

    After week 1 she added sitting on the couch and extending my leg straight, bringing it down and sliding heel back till I feel a stretch. If it hurt to raise leg I was allowed to use a strap because nothing we did was about strength. Only stretch and ROM. We also added heel slides using a strap and hold for 10 sec. also, only sliding to stretch, not pain. She also added a leg raise keeping feet pointed towards ceiling and moving to side and back x 10.

    After more time she added putting a roll under my knee and having me straighten my leg. X 10. And we added having my leg pointing to the ceiling, supporting back of leg with hands and letting my leg dangle down and hold for 30 sec. if there was pain, once again I stopped. It should only feel like a deep stretch. Then she added holding onto a counter and marching with a high knee with both legs so I have to bear weight on just the left leg.

    The last exercise added was facing the counter and I lifted the leg up bent behind me. Basically kicking my heel up.

    I was not to do anything that caused pain, and if the swelling increased following exercises, I was to back off. I iced after every session. I did them 2-3 times a day.

    And I was to walk every hour or so for a max of 10 min. That was non negotiable.

    Another thing in my protocol paperwork that sounds extreme was we are not to use a recliner. He wants us on our back with our leg elevated on a wedge or pillows, keeping the leg as straight as comfortable. (Not bent)

    My recovery has gone so well that I no longer question his methods, although my pt says the reason his patients recover so well lies with his surgical technique. He is in and out in under 1 hour, and he creates the least amount of trauma to the knee. She says his patients have significantly less bruising and swelling than other doctors she has worked with in the past.
     
  11. hoopsgran

    hoopsgran junior member

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    I just jumped here to read your recovery thread after you responded to my post. Wow, I am amazed at your surgeon’s protocol but it sounds like it really works. Glad you are doing so well.
     
  12. tabbykit

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    He sounds positively enlightened compared to most surgeons I read about! Great that you are making such good progress!
     
  13. kneeper

    kneeper FORUM ADVISOR Forum Advisor

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    This is listening to the knee. :thumb:

    I found I iced and elevated better on my bed for this reason. I only used the recliner after a few weeks (with an extra pillow) for a change of scene. Also I find it difficult to really rest in a recliner--I do better when I can actually lie down.
     
  14. szrmom

    szrmom new member
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    Hit 4 weeks yesterday, and am feeling great. Looking forward to my first post op appt. with my os on Wednesday. I’ve not needed any pain meds for the last week, and only feel mild tightness without any pain when I walk. Curious to see if they will still have me using the cane. PT thought I will be able to drop it at home, and only use it outside. My os requires his patients spend the first 4 weeks resting at home, so needless to say, I can’t wait to leave my house! I feel very blessed that this knee recovery has been better than I ever expected. I will have less trepidation in having the right knee done, but I am well aware that just because I had one good experience doesn’t mean the next one will be just as easy. Any thoughts on questions I should ask my os on this visit?
     
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  15. InkedMarie

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    I read your OP to my husband last night. He agreed that I couldn’t follow two protocols: no recliner as I am uncomfortable laying flat and not leaving the house unless I could walk outside and sit on my patio, like I did less than a week post op.

    Hope your post op goes well tomorrow!
     
  16. MissNoodle

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    Well, the whole experience sounds completely foreign to me! Back to work after 4 weeks? That is fabulous! Maybe I should rephrase. Well enough to go back to work at 4 weeks. :heehee: I am currently day 8 post op on my second TKR. So far this recovery is going much better than my first, which was in 2015. I had same doc, same knee. I'm curious about where your surgeon practices, and where you're from. Obviously you don't have to tell me either fact. (I seem to recall from 4 years ago that everyone's profile used to mention age and place of surgery. It made it easy to follow people of like ages and experiences. This is really a question for the administrators, I guess.) It sounds like you are in the UK. The idea of a home nurse or home PT visiting seems both quaint and progressive at the same time, and I sure wish this were available here in the states. Regardless, it took a lot of courage to take that protocol on. I'm so happy to hear how well you're doing.
     
  17. Jockette

    Jockette FORUM ADVISOR Forum Advisor

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    I think with all the opinions and protocols out there, we pick and choose the ones that work best for each of us, as individuals.

    It’s nice to read other surgeons’ ideas so we can formulate the best recovery for ourselves.

    No one plan works for everyone.
     
  18. szrmom

    szrmom new member
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    @MissNoodle, I live in Texas. The Dr. office took care of all pre-approvals with insurance from the procedure itself to the home health service and the medical equipment company that provided the battery operated calf compression sleeves and the ice wrap. The home health service than subcontracts my dr. PT, who has her own company for this purpose, to handle all in home pt.
     
  19. MissNoodle

    MissNoodle junior member

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    @szrmom Wow, great insurance you have there! I noticed a big difference in coverage from 2015 to today. In 2015, the hospital provided lots of little things, such as the ice machine, which they no longer do. Health care in the U.S. is such a cluster that I am always taken aback when something seems to be going great for someone! I lived 20 years in Canada as an adult, but was born and raised in the US (where we now live) so I've had ample time to compare the two systems. I cheer your recovery on, and hope you continue to do fabulously!
     
  20. szrmom

    szrmom new member
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    My doctor doesn’t like the ice machines. He orders an inflatable Velcro wrap that has an insert you put in the freezer. He doesn’t want us icing ice more than 20 minutes at a time, which is about as long as the insert stays frozen. I actually have a polar cooler machine with a knee wrap from a prior knee surgery years ago, but never pulled it out.
     

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