TKR The Mysterious Pilgrimage of NewKnee

[BluesmanVT]

I was having another sleepless night in the aftermath of my TKR and in the wee hours of the morning I grabbed my computer and began scouring the Web for information on knee replacements. I was fortunate to stumble on the Bone Smart site and was really impressed by the community and the valuable information available here. Sincere thanks to those of you who manage the forums and keep the site going. I'm very lucky to be here.

I'm 8 days out of surgery -- TKR Right Knee -- performed on January 22, 2019 at Dartmouth Hitchcock Hospital in New Hampshire. I had a spinal along with a nerve block for anesthesia. Spent about 30 hours in the hospital (one overnight) before discharge. Pre-surgery issues included extreme bowleggedness in right leg and a prior ACL reconstruction in 1980. I had the reconstruction at National Orthopedic Hospital in Arlington, Va. At that time, I spent 6 nights in the hospital and was in a full leg cast for six weeks. Treatment philosophy has change

During the first week, I've struggled with pain mgmt., high level of inflammation and lack of sleep. Of course, they're all related. I opted for immediate outpatient PT with an experienced PT who teaches at Univ. of Vermont (where my daughter is in school). So far he's been pretty moderate on the "aggressiveness" scale. Treatment has included icing, massage, and learning to walk. I'm now familiar with the overall view of PT in this community and it's definitely pushing me towards a softer and less urgent approach.

This morning, Day 8, I removed the bandage. It was quite a shock to see what the wound looks like. Apparently the wound has dissolving stitches with a coating of medical glue which is supposed to peel off over time. I already have 3 other scars on my knee from my ACL surgery, so, in the end, I think it will kind of resemble a Chinese calligraphy character.

Thanks to everyone for creating such a welcoming community. I'm enjoying (and learning) from following the stories of those who have gone before me.

Best wishes to everyone.

 

[Pumpkin]

@BluesmanVT
Welcome to BoneSmart, glad you joined us!

Sounds like you are doing well, glad you have found a PT you trust and who has a gentler approach.

Here is your copy of the 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
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.

 

[maryo52]

Your mention of the National Orthopedic Hospital brings back memories. I grew up in Arlington, and at age 13 suffered a tib-fib fracture in Southern Maryland. My follow up was at the orthopedic hospital. That was 1965. In any case, I leaned heavily on this forum in 2010/11 going through a rough TKR recovery. This time has been a breeze by comparison. The articles here are practical and so helpful.

At least in the Northeast we're not being clobbered by the polar vortex! Stay warm, taker it easy.

 

[Jockette]

Welcome to Bonesmart, we’re glad you joined us!

 

[sistersinhim]

Welcome to Bonesmart! It sounds like you're off to a good start with your recovery and have already familiarized yourself with our way of recovery. Keep us updated on your journey!

 

[kneeper]

Glad you found us. As you've learned, you're experiencing the typical pattern of the first couple of weeks. But it sounds like you're doing ok. Hang in there and listen to the knee.

 

[Josephine]

Pre-surgery issues included extreme bowleggedness

Almost everybody has that!

 

[SnowHare]

@BluesmanVT " I already have 3 other scars on my knee from my ACL surgery, so, in the end, I think it will kind of resemble a Chinese calligraphy character." Oh, I can so relate. I had 2 scars from a car accident and a 3rd one, diagonally on the side, from a cartilege repair 45 years ago.

I wonder what our calligraphy scars might translate as? I'm going for messed up knee gets better.

 

[BluesmanVT]

Climbed stairs today with a crutch. First time I've been upstairs in my house since surgery 11 days ago. Very excited to be able to shower.

My biggest struggle at this point is sleep. I can't seem to get more than a couple of hours in short spurts. Can't get comfortable with my leg and, additionally, having great discomfort in my stomach, which I assume is the result of the ongoing pain meds.

Any knee vets out there have some good tips for sleeping post surgery?

Thanks

 

[Jockette]

We all struggled with sleep. Catch naps when and where you can. Don’t think that avoiding naps will make you tired enough to sleep at night, it doesn’t seem to work that way.

 

[kneeper]

I napped every day and just accepted that I would sleep in installments overnight. It did get better as the weeks passed.

 

[BluesmanVT]

Thanks for comments about napping. Napping is definitely helpful. This is Day 13 Post-op for me. Climbed stairs to upstairs bathroom for second time (14 stairs with one railing) using crutch. This morning I used a 4 footed cane, instead of walker. Felt tentative. Doing PT exercises without pushing beyond limits. Using herbs Turmeric and Bromelain to help with inflammation, since NSAIDS are not being tolerated by my stomach. My stomach and sleeplessness are more of a problem right now than the knee itself. Didn't expect that.

 

[Lindylee]

Hi Bluesman, I'm a day ahead of you, but didn't have the other knee issues that you've had in the last. Like you, I've been so impressed with this forum and the advice given, especially in sleep (or lack of) and napping. Once you know you're not the only one, it's easier to accept isn't it? Wishing you a very good recovery as you go forward.

 

[maryo52]

I suggest you talk to your surgeon or PCP about the stomach pain. You may be right about the cause, especially if you're never had GI issues. There may be better options for you. Resolving the GI pain may in turn help with the sleep.

 

[bumneej]

You might try digestive enzymes for the stomach issues. I have IBS and the NSAIDS and narcotics are not my friends. I take as little as possible. I have started taking 1 ranitidine in the morning and then take 2 chewable Papaya Digestive Enzymes twice a day or when ever my stomach is acting up or I have acid reflex. It really helps. Even my husband who is a pharmacist and believes prescription drugs are the best will take the enzymes because they work. I like to try the natural way before resorting to prescription drugs. Good luck. Bad enough we have to struggle with this recovery but to have these other issues is even more frustrating.

 

[maryo52]

It's important, however, to try to sort out the cause of stomach pain. I've been in the medical field since 1990 and have seen a lot of instances where people assumed an obvious cause to something but it turned out to be something else. Abdominal pain is not something that should be treated lightly.

 

[SusieShoes]

I’m going to gang up on you about sorting out your stomach pain. I once had a lower abdominal pain I assumed was one thing and minor, and a few months later turned out to be something completely different and serious. Good thing my PCP caught it when I (finally) saw her. Your doctor might also point you to relief faster than if you work through it on your own.

 

[Celle]

I also agree that the cause of your stomach pains needs to be established.
For a start, stop taking the NSAIDs. You should never take them if you get an stomach issues when taking them.
Don't try to mask the pain by taking Ranitidine or digestive enzymes.

NSAIDs can cause stomach ulcers and gastric bleeding. They aren't essential for recovery from a knee replacement.

 

[BluesmanVT]

Thanks to everyone for your comments, cautions and suggestions about my stomach pain. I've been a vegetarian for 40 years and have almost never had chronic digestive issues or stomach pain until the day I came home from the hospital 16 days ago.

I contacted the Ortho department at Dartmouth where I had my surgery and they offered me a prescription for Prilosec (a PPI). Not interested. I'm now off of all narcotics and managing pain with only advil, turmeric, a baby aspirin (mainly for anti-clotting), ice, and breathing/attention exercises. I went off of Tylenol 24 hours ago and noticed my stomach symptoms lessened (but didn't go away completely). So I'm going to see what happens in the next 48 hours.

I understand the concerns of others emcouraging me to seek medical assistance because this may be something more serious. If it persists, I will definitely do that. The fact that it started exactly 2 days after the surgery suggests that it is medication related. I have no blood in my urine or bowel movements. So I plan to take a wait and see approach and reevaluate my options in 48 hours.

My knee itself it progressing nicely. I'm walking with a cane, and each day my leg feels a bit stronger. Inflammation has decreased, but very gradually. I'm going to my 4th PT appt. today.

The best medicine I have is my wife, who has been an incredible support in the past two weeks.
And I appreciate all the encouragement and support from this forum.
Thank you.

 

[sistersinhim]

Can you drink protein drinks? They would help to coat your stomach as you take the Advil, which is an NSAID, and bad for the tummy.