TKR The right knee this time

[NimbleKnee]

I had a left TKR in 2020 just as the pandemic started going. This time (on March 29, 2024), I had the right knee done. Preparation was a built of a whirlwind since I found out the Monday before that someone had cancelled, and did I want the opening on Friday? Yes!
So far, so good. I’m reminding myself there will be easy days and rough days. The rough so far has been foot cramps, a sudden drop in blood pressure that almost resulted in my passing out, the pain block catheter pulling out early, and some issues with the ice machine, and of course the general discomfort and poor sleep. The good has been a great home Physical Therapist who taught me an alternative to heel slides (hanging leg on edge of bed and gently bending inwards), very supportive family and friends, and so far somewhat less swelling than last time. Maybe it is in knowing what to expect, but this time around I feel overall less miserable. The left knee was a great success, so maybe it helps knowing that even taking it slowly, the eventual outcome can be positive. I’m sure there will be setbacks and rough patches ahead, but for now I’m just glad the surgery went well, and I’m now in the recovery stage. It’s been interesting to read articles again that I read 4 years ago, now with the gift of hindsight.
I hope all are doing well on their journey.

 

[Roy Gardiner]

Welcome back; and your own personal copy of the guidelines:

Knee Recovery: The Guidelines

We are all different, as are the approaches to recovery. The key is, “Find what works for YOU.“ Your doctor(s), physiotherapist(s) and BoneSmart will offer advice and are there to help. The advice may vary, but YOU are the final judge as to the recovery approach you choose.

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​

6. Access these pages on the website

Oral And Intravenous Pain Medications​

Wound Care In Hospital​

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.

 

[benne68]

Welcome back to the Healing side, @NimbleKnee! You have a great attitude about this recovery.

Maybe it is in knowing what to expect, but this time around I feel overall less miserable.

I've had the same feeling about my second TKR (December 2023). Knowing that much of what I'm experiencing is normal really has reduced the "fear factor" for this recovery. I found that being able to go back and read my thread from my first surgery was helpful, too.

Wishing you a smooth recovery.

 

[DizzyBlond]

Your post is such an encouragement to me, @NimbleKnee! I’m on the pre-op side of things, but reading posts such as yours helps me to better approach my TKR with a balanced perspective - it’ll be challenging, but it’s doable!

I’ll be following your recovery, and wishing you a good, tolerable week!

 

[SnowHare]

Maybe it is in knowing what to expect, but this time around I feel overall less miserable.

I think knowing a bit about what you are up against makes a huge difference. This time around - my surgery was April 1st - I was not nearly as anxious to start with. Also, there has been a change in how they do things from 5 years ago, and I am a lot more comfortable and sure of myself and my recovery. The whole not knowing things makes things only more difficult.

 

[DizzyBlond]

@SnowHare
That makes such sense. As much as I'd rather not think about the pain, the swelling, the lack of mobility, and the sleepless nights, I'll continue to read, educated myself, and "prepare for battle!"

 

[lovetocookandsew]

@NimbleKnee Welcome back and congratulations on another brand new baby knee! Now that you have a matched set, after recovery you'll be ready to take back your life. Your attitude is great and I hope your recovery continues as it has begun. Please keep us updated.

 

[NimbleKnee]

Thanks all. Each day brings its ups and downs. Last night the pain med (oxycodone) was making me feel queasy and headachy, so today I only took one, because the pain wasn’t so bad and I’m feeling much better. And though I was crowing about less swelling just yesterday, today I overdid it on using the walker and my knee swelled up. Ah well, that’s what ice and elevation are there for, right? I was hoping to sit in the garden for a few moments today, but instead I got to look out at the rain. Haha!
It is amazing how fast medicine is changing. This time around my surgery was computer-assisted, so I have a tiny wound under my main incision where the camera went in.
We shall see what tomorrow brings.

 

[Layla]

Hello and Welcome to recovery! Congrats on your new knee.
Hopefully todays weather is brighter and you're able to sit in the garden.

And though I was crowing about less swelling just yesterday, today I overdid it on using the walker and my knee swelled up

The ups and downs of recovery. I hope today is a good day!

 

[NimbleKnee]

Well, this morning I woke up feeling like I had been on a 3 day bender, while all I had really done was just a few minutes of gentle knee micro-bending with the in home PT. I’ve emailed the doctor asking to be switched to some milder pain medication. I took 1 oxycodone last night and regretted it shortly afterwards, too many side effects!
On a sweet note, my dog has learned to walk at a snail’s pace behind my walker as I go. Last time I did not have a pet, so I was a bit worried, but he has been great. Prior to surgery I was the primary source of food and walks, so now my husband has taken those tasks over and they have really bonded more!
I am really fortunate in that my husband is taking good care of me, meal prep, ice changing, etc. I truly cannot imagine how people who don’t have strong support manage. I’m very grateful.

Thank you for the well wishes and the funny cartoon. It’s so true, in our minds we think it will be a linear progression, but reality has its own way of playing out.

 

[benne68]

On a sweet note, my dog has learned to walk at a snail’s pace behind my walker

I love this! Isn't it amazing how sensitive our pups are to what we are feeling?

My two little guys -- who always jumped up on family room couch to cuddle with me -- took to lying on the floor instead (right next to the couch) during my first recovery. Somehow they just know!

 

[NimbleKnee]

Oh yes, I was surprised how well he adapted. Now he will lie under the bed when I’m icing. I don’t know if he likes or fears the sound of the ice machine?

 

[Shea]

Dogs are much better people than we are. I want mine back, she died a few years ago of old age, but I have to say it’s been a relief not to need to take care of her during the last couple of months. All my dogs were used to walking daily and refused to give that up for long, recovery or not. I love to hear about dogs being so loving.

 

[NimbleKnee]

Well a week out from surgery and here’s the report.
The Good: reduced pain and swelling, better ability to move around, got on right pain med, getting lots of support
The Bad: can only sleep in 1-2 hr stretches though I’m tired all the time
The Ugly: Don’t read if TMI, laxative they gave me to counteract opioid pain med works too well! Yikes! Even my urge to urinate seems more frequent than prior to surgery. I used to sleep through the night without getting up to go to the bathroom, but not at the moment. I don’t remember that from the first knee, but I could just be forgetting!

Overall, things are going well. The weather was nice and sunny today so my husband too me for a short ride in the car just to clear out the cobwebs from my brain. Lovely! Of course I applied ice and took a nap afterwards.

 

[benne68]

Glad to hear you were able to get out for a car ride and enjoy the day, @NimbleKnee!

I had the same issue with my laxative working a little too well post-op. (I immediately reduced the dosage to avoid repeat performance.)

Regarding the increased frequency of urination -- it's know it's annoying, but it's a good sign because it means your body is getting rid of all the excess fluids that are causing swelling. Interestingly, I didn't experience it with my first TKR either! But I did with the more recent one in December and can assure you it will stop soon.

Your great attitude -- and your previous TKR experience -- will make the journey easier.

 

[NimbleKnee]

Thanks, @benne68! Glad to know that frequent urination is actually a good sign!

 

[mendogal]

Insomnia is a real bummer for many of us in the initial weeks after knee surgery. Definitely sleep whenever (and wherever it's safe and comfy!)

Icing, elevating, napping.... All help, but you might also consider some nonprescription remedies....

If you're lactose tolerant, a glass of warm milk! If you're not diabetic, a teeny bit of honey makes it even more comforting... plus milk is high in magnesium! Helps us relax!

If you aren't a milk drinker, or want an easier way to, an evening magnesium supplement has been very helpful for some members.

OTC diphenhydramine, an antihistamine also used as a sleep aid (Benadryl) because it makes you drowsy; it's also included in some cold, flu, etc "nighttime" combination meds.

Low dose melatonin, sustained release - not for long term use but I have used for a week at a time without ill effect. It should be taken an hour to hour and a half before going to bed, and during that time stay in a dimly lit area to allow this hormone to activate.

Valerian root - an herbal remedy, it can be taken in capsule form but that dose might be high compared to my preference, herbal "sleep" blends that include a smaller dose of valerian and make me pleasantly drowsy. Plus the other tea flavorings make it nice tasting! Celestial Seasonings and Traditional Medicinals sell teabags by the box. Their sleep blends without valerian have never ever made me sleepy.

Be aware: even benign herbals and supplements can interact with your routine or post op prescription meds, either making their effects weaker or stronger. If you're on meds you may want to check with your doctor or pharmacist, or even check online for interactions.

 

[Layla]

Good Morning NimbleKnee,
Lack of sleep is sadly an issue for many early on.
Pillows certainly are my "go to" still, to help me get comfortable in bed, making it easier to drift off.
Hopefully your bed is made up with your most comfortable bedding / blankets along with a few extra bed pillows of different degrees of firmness and you are able to block out the light if it's daytime. Minimizing noise, not always easy, and listening to calming relaxation music, a fan, or white noise may help lull you to sleep. I find making sure the room temperature is not too hot or too cold definitely helps. I also try to disconnect from devices at least an hour before the targeted nap or bed time, so it's easier to wind down and I limit caffeine throughout the day, and have used some natural sleep aids such as Valerian, Chamomile or, Magnesium, my personal favorite, which can assist in muscle relaxation and nerves and promote healthy sleep (falling asleep and staying asleep)

An article on Magnesium from our Library -
https://bonesmart.org/forum/threads/magnesium-is-a-star.20301/

Most large grocers carry a variety of teas such as Celestial Seasonings which you may find soothing to sip on - Sleepytime Herb Tea, Yogi Teas, Bedtime, Bigelow Cozy Chamomile, all of which may help you relax...at least worth a try.

Glad things are going well overall and you made it out of the house for a car ride on a beautiful sunny day.
I hope you have a nice day and week. Happy Sunday!
@NimbleKnee

 

[NimbleKnee]

Thanks for the tips on sleeping. I fall asleep easily but then am awakened either by pain or an urgent need to urinate. I think both will ease over time. The new medication is helping.

I do have a question (please refer me to search the articles if needed). I have almost no swelling on the inner side of my knee, but a huge ball of swelling on the outer side. I’m wondering about this, could it be the position I’m using to sleep or elevate? Could it be a remnant from my pre-op condition? The more severe arthritis was on the outer part of the knee and it would indeed swell when irritated. My in home PT will come by on Tuesday and I will ask him as well. Thanks in advance for any ideas about this.

 

[NimbleKnee]

Slow but steady progress. My fasting blood glucose is finally back to normal. I am a non-insulin dependent diabetic and I was advised my levels might rise. They did, but now seem to be lower and stable. I think that means less inflammation? When I previously got steroid injections in my knee, the level would go up for a day or two afterward.

Slept 4 hours straight last night, which felt amazing. Took slow walks around so now I’m tired and feeling some pain, nothing terrible.
I sat in on a class on Zoom I had signed up for before I knew I was going to have surgery. I only fell asleep in the last half hour.

Not bad.