TKR t2paythepiper's LTKR Recovery Thread

[t2paythepiper]

Home at last!

Short version, going well now but having issues with swelling since I got home and can't reverse or stop it.

Long version: Arrived at the hospital 4/10 at 5:30am for a 7:30am surgery. Other than being nervous and still second-guessing myself (yeah, that never went away), all went well. Surgery was uneventful and my surgeon said it went very well. Had a spinal, nerve block and Propofol. That was my first nerve block - interesting procedure.

Because of the bleeding complications I had with my 2016 RTHR, I opted for inpatient with an overnight. Although my counts dropped, they weren't' as bad as 2016.

Nerve block wore off very quickly (they said I came out of surgery wiggling my feet) so pain managment was an immediate concern along with a peroneal nerve that took its sweet time to fire. Then my bp decided to crash. With BPs in the 70s/40w, my pain meds were limited and then the pain levels spiraled up. Fun, fun, not. By Friday, things were stabilized and today (Saturday) I was discharged.

Getting home was fine and I thought settling in would go really smoothly but I have been suprised by how bad the swelling is. In hospital, I had a CPM which I liked and it made a nice trough for holding ice. At home, I am finding my leg is slipping off the pillows and my ice machine doesn't seem to be as cold as what I had in the hospital.

I am using a pillow under my calf, another set of pillows under my ankle and am then in a recliner. May try the bed later tonight.

Will post more tomorrow but wanted to check in. Hopefully the swelling will be better.

 

[mendogal]

Welcome to the healing side of things, though I imagine it doesn't quite feel that way!

Are you using frozen 16 oz water bottles in the machine instead of ice? (If the ice machine at the hospital was anything like the one at my outpatient PT I swear you could freeze a side of beef in no time with it!!!!)

You are in the very early stages of an average of a yearlong recovery. I will leave you our Recovery Articles that have helped tens of thousands of other knee replacements. We are here to help you through this journey the best we can. The very best thing for your knee right now is to rest, ice, and elevate. Exercises can come later. There is no rush to achieve ROM because it will come naturally as your swelling decreases. Your OS was able to bend your knee while checking for movements during your surgery, so it will be fine. It just takes time.

Each person is different as is their recovery. Most find that the Bonesmart approach works best for them, but others find that a more aggressive therapy helps them more. It's your recovery and your choice on how you recover. As you read more on other members' recovery threads, you’ll get a better perspective of what to expect. The following are our basic guidelines and should help get you started.

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

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.

 

[mendogal]

I want to especially point this one out to you...
Here's an article about how to safely elevate.

 

[benne68]

Welcome to Recovery, @t2paythepiper.

Sorry to read about your BP problems post-op. I had something similar happen to me with my first TKR, so they kept me overnight.

Take things slowly -- resting, icing and elevating should be your primary occupation for now to give your body time to heal from the trauma of surgery.

Please do read through the articles mendogal shared above. You will find this recovery is different from your hip recovery, so -- even though you've been through a joint replacement before -- you'll find lots of helpful information in those articles.

 

[SnowHare]

I really recommend the Lounge Dr pillow. Just had my 2nd knee replacement. The pillow does make life post knee surgery quite tolerable.

So sorry that your initial few days did not go well.

 

[Jamie]

Be sure when you are icing and elevating that you have your "toes above the nose." You need that much elevation to get the lymph system t do its best work. Gravity really helps. Sometimes sitting in a recliner (even with extra pillows) doesn't get that height for you. A Lounge Doctor does help if the pillows aren't getting it done for you.

Also, don't hesitate to take your pain meds on a set schedule throughout the day and night. The swelling is caused from inflammation and pain can increase that, especially in these early days.

It will get better!!

 

[t2paythepiper]

Thank you everyone for the replies.
@mendogal Yes, proper elevation has been a challenge. I keep tweaking what I am doing and it gets better each time. I didn't realize the calf was off-limits and @Jaime, thank you for mentioning the lymph nodes with respect to drainage. For some reason, that one comment connected some dots for me. I think I have a good elevation now and correct height however it still slips away.

@Jamie and @SnowHare - I showed the lounge doctor to my surgeons and to PT and neither wanted me to get one. WIll ask again this week

Pain seems to be better and inflammation is a "little" better. I had forgotten about my meds induced narcolepsy. LOL. I can't even get one text out with nodding off!

 

[Jockette]

I showed the lounge doctor to my surgeons and to PT and neither wanted me to get one. WIll ask again this week

Did they say why they didn’t want you to get a lounge doctor?

 

[t2paythepiper]

@Jockett They said it was supporting the knee. . I wasn't in a position to question it (Pain plus meds).
I only had the Amazon picture on my phone so I'm hoping that when I have more time with PT next week they either can look at it more critically or have possibly seen one I know it's okay. The folks in the hospital preferred that straight slant one that I've seen a few people have

 

[mendogal]

Re the Lounge Doctor...
It's job is to support the knee (well, the entire leg)
I suspect they misinterpreted what they saw and thought it was pressing on the underside of the knee - which is a strict no-no! - the beauty of the Lounge Doctor is that the back of the knee is floating freely while both thigh and lower leg are fully supported at an appropriate angle.

 

[SnowHare]

t2paythepiper​

When I had my first knee replacement. I gave the Lounge Dr website information to my case manager. She and the clinic physiotherapist reviewed it, and they were very impressed, so much so, that they wanted to be able to bring in the pill to well at cost to the patients. Unfortunately at that time, Lounge Dr was only available on their own website.

What is especially nice, is that the pillow is sized to your height.

 

[t2paythepiper]

I agree that the pictures could have been misleading. I plan to ask again Wednesday at my first PT.

The setup I have now (finally) I believe follows the rules but it slips often. It is also not for ideal for icing.

 

[t2paythepiper]

Today, April 17, marks one week post-op and my first PT appointment!

Walked out of PT with a smile on my face! My extension is 0° or maybe even -2°). My Flexion is good, we got to 95°active (right is as close to 180°) as they measure. The big news was I was able to do full pedal rotations on the recumbent bike . She wants me to work more on flexion (not to point of pain) and use a cane vs. walker with a normal gait (no wedding march).

Of course now it hurts a lot. I go back again Friday and have appointments twice a week.

We had a good discussion on how far to push something (pull/uncomfortable/stretch vs hurts/pain).

She also removed and replaced my steri-strips. That woke up some nerve endings I would have preferred stayed asleep. The skin is feeling hypersensitive. :-( I hope it feels better tomorrow.

I have now had four days at home and the pain has been very manageable. I am sleeping a lot for short stints and not necessaritly when I want to LOL (lots of nodding off while typing, writing, watching TV)).

FYI: The dicharge delay was a hiccup with my insurance. I should have been discharged Friday morning to home health and PT but someone dropped the ball on the preapproval. Rather than spend 2 or 3 more days in hospital while they straightened that out (or not), I agreed to be discharged to outpatient PT.

Very happy with PT so far. Hope I feel that way Friday!

Signing off now. Will try to list the exercises later..This has taken a ridiculous amount of time to type.

 

[t2paythepiper]

Yay - incision nerve endings are dormant again
Low BP when I first got up this morning (and stupidly went outside with the dog). Maybe because the batteries to my calf compression pumps had died overnight so they weren't running for quite awhile?

Rereading all the PT/rest/elevation information again now that we have had a PT session. Good info as always but especially helpful for me as a reminder of what to do when NOT doing the exercises (i.e. rest, elevate and ice!!)

 

[mendogal]

You're off to a good start!

 

[benne68]

I am sleeping a lot for short stints and not necessaritly when I want to LOL (lots of nodding off while typing, writing, watching TV)).

That's your body is telling you it is working hard to recover from the surgery. Give in to it.

BoneSmartie motto: "sleep wherever you can, whenever you can" -- especially during the early weeks of recovery.

 

[t2paythepiper]

Wednesday was 2 weeks post op. I have been meaning to post and wanted to add more but the fatigue is real I have had a 4th PT today and they seem to be going well.

Beginning inbetween asterisks is mostly what I texted to some friends.
*********

4/24/24: Today is 2 weeks post op and 3rd outpatient PT.

110° flexion (from 95° last week), new exercises, steri strips removed (yuck), took away cane for inside ambulation, and when I asked a few questions about exercises she replied that I was overthinking things. Moi???

I told her it was my superpower
***********

Today was PT#4. I really like the new exercises. They are more about stretching and ADLs. One of the PTs does some massage which feels great! He then manipulates my leg which is something I didn't think I would tolerate but with the massage and the relaxing and then pretending I'm at the beach I don't even really notice what he's doing.

Stability is amazing. So different from the hip replacement.

Frustrated with the swelling although I am pretty sure it is improving.

Pain really amps up as day goes on. They want me to alternate between leg elevated with extension and sitting with it bent at 90°or more. I know it is helping with flexion.

I actually feel better as I move and do things during the day, it is the evening and night were my leg talks to me.

The thing that has me most creeped out and anxious is the impending stitch removal. When the steri-strips were removed, I saw the incision had been closed with glue and one long suture with only a few entrance/exits. It will not be removed until May 7th which is one month post-op. I'm just getting very anxious at the idea of this long, subcutaneous suture being pulled out after living there for a month. It didn't help to have an acquaintance tell me today how painful it was. Is there anything I can ask for? Even lidocaine? I feel like a wuss after everything we go through with these surgeries to be anxious about this but I always have been. Every surgery I've had I feel like it's an extra bit of pain we don't need.

Thanks for any advice especially on this last little irrational bit

 

[Jockette]

Pain really amps up as day goes on. They want me to alternate between leg elevated with extension and sitting with it bent at 90°or more. I know it is helping with flexion.

It is extremely early to be sitting with your leg at 90 if you aren’t in a situation that requires it. I found that quite painful for months, and didn’t do it unless I was out somewhere and couldn’t put my leg up. When I was home and sitting, my leg was up, not always “toes above the nose” but at least up on an ottoman. Your flexion will return on it’s own, as you heal and your swelling goes down.

Regaining our ROM is more about Time than anything else.

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.

Pain that ramps up as the day goes on, and especially more pain at night, is usually a sign we are doing too much during the day. It could also be because you have your leg at 90 too much yet. Be gentle with your leg and baby it, it’s “been through the mill” with this surgery.

I have never heard of a long stitch like you mention, to be in for a month. Mine were small stitches which they took out at 2 weeks. I did not have glue.

 

[mendogal]

Sitting up with a 90 degree bend?

Despite having superb ROM immediately (thanks to lax joints) .... at nearly four weeks post op I could only tolerate sitting in a chair with my foot on the floor (no idea if it was 90 degrees or not) for ten minutes, then ice and elevate 45 minutes. I know because I was drawing every day, and set the timer for ten minutes so as not to be agonized upon standing.

Many of us have difficulty sitting up for long for months. At six months I still needed two walking breaks when watching a movie!

I agree that it's contributing to your evening and night woes and setting you back, rather than helping you achieve better results.

 

[t2paythepiper]

I have never heard of a long stitch like you mention, to be in for a month.

Is it allowed to post a picture of the incision here? As I said I had never seen anything like this and was surprised. Thank you for the other feedback I think I need to pay more attention to what I'm doing each day. The surprising mobility has probably made me do more than I should.