TKR Things went wrong

[Widget1]

@Tough cookie - I'm so sorry to hear of your experience, and it must seem like a nightmare that has come to life!

I shuddered when I read that your OS wanted you to have PT after dx of a blood clot.

I had a history of DVT 25 years ago, so my OS proceeded with caution. The TEDS stockings were put on me when I was being discharged from the hospital, and the hospital had been checking my INR/PT twice a day while I was an inpatient. I was discharged with a supply of coumadin and the injection syringes (those were a mistake and not ordered by my OS), and had to take the coumadin and wear the TEDS for 7 weeks post-op. There were a couple of times when my INR/PT was far too high, and in addition to stopping the coumadin, my therapy immediately stopped and I was cautioned to be very careful. When the nurse came to my house and the INR/PT was again within range my PT could resume.

Please continue to speak with your primary about the level of activity that is safe for you while you have the blood clot. I agree with the others that a little walking should be ok, and particularly to ice, elevate and rest as much as you can.

There are horror stories everywhere, but I wonder why there are so many from Florida? A stranger stopped me when I was putting bags into my car last winter and asked what was wrong with my knee (was wearing an unloader brace). She said she had a TKR the year before and that it had become infected and the OS wouldn't do anything or even see her, so she found a great OS at Coastal Ortho and he had eventually done another TKR on her. She warned me not to go to the first OS she had (and he had a "good" reputation for replacements). After I broke my foot had to go to a hospital for nuclear med tests and the tech there told me that if I had to have a joint replaced to not go to that hospital. She said the surgeons never stopped by to see any of their patients after the patients went to recovery.

 

[Poz222]

I think it is sheer numbers... We have such an older population that there are sooooo many OS and thousands of tkr and all other type if orthapedic surgery that there will be more with issues cause there are just more done every year... Just a statistical theory...

 

[KarriB]

I was very fortunate, after my infection surgery done by a revision OS, my first OS came by the hospital/rehab to visit. He sat down and stayed for 10-15 minutes. He felt badly about my infection as I was only his 2nd patient to develop an infection. My rehab was part of the hospital, so my docs stopped by often to check on me. A friend who developed an infection couldn't get her OS to see her or admit her knee was infected. She ended up going to an ER to see an infectious disease dr, finally another surgeon from her group saw her and ended up putting an antibiotic spacer in. They had to dig the infection out of her bone.
But it does get better, my friend went to the shore for vacation a few months after her revision. I went back to teaching part time at the 12 week mark and full time at 18 weeks. I swam 20 laps a day this summer and ride my bike 4-5 miles a day through the school year. Have faith, you will persevere.

 

[copsham]

Hello @Tough cookie
You are going through such a lot and like many here you describe yourself as strong and in control etc. Like many of us the transition to needing help can make us feel so vulnerable and very out of control. Oh the weeping ... I felt so unlike my usual tough self, tears over almost anything ... it did go though after quite a while. The whole process is quite an emotional one, like a roller coaster, but i think we grow from it.

I had an infection in the stitches had eight days of antibiotics and finally at day 7 the infection cleared. I was reassured by Josephine the Nurse Director here that infection in the incision does not automatically go down to the joint which I was relieved to hear. I did have inflammation of the incision though that related to a reaction to the internal stitches.

Just two weeks post op! It does get better so hang on there and keep posting!

( I am a hippy not a knee person though)

 

[Josephine]

no compression stockings were put on me, no machine that intermittently compresses the leg,

Compression device is nice but only applicable for 48hrs post-op. The jury is still out on whether TED stocking are truly effective. You certainly never got a clot because you had neither of these things. It was just bad luck. Not much comfort I know but there it is.

no ice, because the doctor forbids any ice

What a cruel man! I hope you've been using ice now?

diagnosed as a blood clot, told it could be life threatening, two days later went by, ambulance to local ER, as per surgeon's nurse instruction, pain was off the chart. Told I have a pinched nerve from the spinal.

The pain attributed to your 'pinched nerve' is probably referred pain from the thrombosis.

Next the stitches were infected

How is that going? Is the infection settling down some?

Finally insisted I had to see the surgeon and his first response was, this was not my fault!

Yeah, that says it all!

pinched nerve is getting better. His concern is I'm not rehabbing the knee enough. How the hell can I? I pushed through and the therapist is using heat on my sciatica while I do the exercises.

You can NOT do exercises when you have a thrombosis. The order is rest with reasonable activity - short walks around the house every hour and plenty of foot rotations and ankle pumps are the order of the day!

Surgeon insisted I go to physical therapy and therapist said he would not work with me until surgeon talked to him because the blood clot could be life threatening. PA called and told them she thought it would be okay and then the PA said she'd leave it up to me.

She 'thought' it would be okay? How reassuring is that? And then she leave it up to you? Well, you're unlikely to be at risk by now but you are still in pain because of the inflammation from the DVT. And you cannot do ANY exercises with that pain. Only what I've said above.

Don't worry though, your knee can still rehab okay even without exercises. Do read my recovery threads to see how little exercising I did!
First knee. Knee recovery - UK style
Second knee. Josephine's 2nd knee story - short version where I did even less!

 

[Kssii]

So sorry about what has happened to you--it is so discouraging when those we trust to care for us become cavalier--you have every right to be weepy!! The thing is, let yourself off the hook--you don't have to be brave, you don't have to do PT, or anything else for that matter. Try to be as comfortable as possible and let the worries of life go until you get past this blood clot thing. As others have said, ice elevate, rest. Can't emphasise the importance of rest enough. Even if you can't sleep--I used to "listen" to the TV a lot as I couldn't keep my eyes open but also couldn't actually asleep. Also I found putting a small pillow under the small of my back and putting a hot pad below that across the top of my hips helped a lot with the sciatic pain.

 

[cairistiona60]

I cannot believe your OS does not approve of icing. That boggles my mind. Ice is your best friend. Hope you feel better soon.

 

[Tough cookie]

Aug. 13 TKR and today was finally better. The posts on this site have helped more than you can know. I've stopped the silly nonsense of cutting pain pills in half, afraid I'd become addicted, walked through my home several times a day and the pinched nerve in my back is bearable while taking a dear hearts advise to put heat on the back with a pillow behind me. I've taken the constipation advise, the elevate and rest advise and letting myself off the hook advise. All have worked wonders both mentally and physically. I was told I cannot have another Doppler to see if the clot is gone for 6 weeks because it takes at least that long to be absorbed by the body. The pain is there but I'm managing it better. I see my surgeon again Wednesday and his nurse added he has never personally seen anyone like this before, lucky me! Before hanging up she reminded me NOT to ice under any circumstances. Maybe I "turned a corner" towards recovery. And I understand it's okay to weep when you are in pain and afraid and no one to turn to for answers. If I continue to make a little progress each day or at least every few days I feel I can get over this, but I've accepted it will take more time than I ever imagined.


Sent from my iPad using BoneSmart Forum

 

[KarriB]

You cannot become addicted in this amount of time. Take what you need to relieve the pain. I took oxycodone off and on for 3 months, I did not become addicted or dependent. A time came when I forgot to take a pill, I began to cut down and take it when I knew I would need it (walking distances or riding in a car). Good to hear you've got a better handle on things.

 

[Poz222]

I so do NOT understand the no ice thing??? I can't find ANYONE who's surgeon told them not to ice? How else are you going to bring the swelling under control??

 

[bdink21]

@Tough cookie so sorry you've had to go through so much in the past couple of weeks but glad you're finally feeling better. This forum is such an awesome support, it's so great to know there are others who are going through the same struggles that you are and truly know how you feel. Good luck at your appointment on Wednesday. I am so curious though, WHY does your OS forbid ice lol? I just find that interesting. Anyways it really DOES get better, slowly but surely. Hang in there....

 

[Slainte]

Oh, sweetheart, hugs for you. I would guess that the no ice rule is because they don't want anything slowing the blood flow down. Glad you are getting some pain relief from the meds and heating pad. Right now you need to give yourself permission to totally coddle yourself. Rest whenever you can and let your body and spirit heal.

 

[Pumpkin]

Some OS's have had an experience where a patient had frost bite from not properly protecting their skin from the ice. There is some controversy over using ice after surgery or injury, your surgeon may be in the no ice camp.
You might want to try a cool compress instead of ice.
Hope things improve for you now that you have your pain under control.

 

[cairistiona60]

Has the no icing order got something to do with the blood clot? I am trying to make some sense of it and failing.

 

[Tough cookie]

Au13 TKR no the ice is this surgeons standard. He has a patent on this lateral knee process and the hospital he was(before abruptly switching to another with less than 24 hour notice) even included the no ice in their extensive package. It also tells you on all the discharge papers, no ice even if PT insists! I will ask him Wednesday and perhaps he will answer or perhaps not, he seems to be a narcissist. I slept over four hours last night, feel like I can face the day ahead.


Sent from my iPad using BoneSmart Forum

 

[Celle]

Don't bother asking about the No Ice policy. It's just one of your surgeon's "things" and there are a multitude of different theories out there.
Ice won't do any harm, as long as you use it properly, so if it were me i'd be sneaky and not mention it if you have been icing. Tell them you've been icing and they'll use it as an excuse to blame you for anything that isn't quite right.

 

[Tough cookie]

Tough cookie TKR Aug. 13- Thank you BoneSmarties! Much of my reading has taken place in the wee hours but that too has helped the night time blues. 26 days out and finally I slept a full night. Although I still have a blood clot and a pinched nerve causing sciatica pain, things are better. I require less meds now and am making slight progress on the PT front, slow but sure, but once the clot is gone I'll do better. The OS did finally see me twice after the doc in the ER said this is about pain management and the surgeon needs to step up. My tenacious, tough cookie, exterior has been more than tested in this process and pain changes us, making me thankful for little things, like short walks rather than a "spinning class" or being able to sit long enough to eat a meal rather than entertaining guests every week. The Warfarin has been extremely hard to regulate for my primary care doctor and still no answer as to my need for a Hematologist. I will go with this course of action until another Doppler on the 23rd then seek a specialist on my own since I understand the blood thinners will probably be needed for 6 months. My advise is for anyone having replacement is be prepared to be your own advocate!

 

[jeffreyclay]

Much of what you are experiencing is typical and experienced by many TKRs. I found Miralax helped greatly with constipation (my rehab nurse suggested this after colace and senacot did nothing). Are you taking your pain meds on schedule and what are you taking? At this point you don't want to wait until you're in pain to take something. It's important to keep ahead of the pain because catching up is terrible. Set an alarm to take your meds on schedule, even through the night. Sleep is awful! But many here have found using their ice machine through the night helped.
For the first four months I only rested, elevated, iced and went to PT, made my first meal (throwing chicken in a crock pot) at week 4. Be kind to yourself, stay off your knee as much as possible, leave chores for others and focus on yourself for the next couple of months. This is a long recovery.

Another vote for Miralax, nurses gave me a glass of water, twice a day with Miralax added to it. Tasteless so it goes down easily.

 

[Widget1]

Dear fellow Floridian @Tough cookie -

I hope that you're experiencing better days/nights now than in the first month after your TKR. It would be indeed tough for your primary to monitor your INR/PT. My levels varied greatly, especially after the home health nurse had me give myself an injection along with taking Warfarin (I was shaking, because I've never been able to look at needles, much less stick one in me. With my epi-pen I could just jab into my thigh without looking at the needle). She had not checked to see that the injections were not ordered for me, and my OS ordered Warfarin only for 7 weeks. Of course that spiked my levels, and PT was halted immediately. Even so, I started feeling like I was doing something wrong, because she told me a couple of times when my INR/PT levels were too high that I'd done that by not drinking a gallon of water each day.

My primary told me this week that the OS needs to step up, as well.

Hugs to you, and hope your spirits are up and your pain is down....

 

[Tough cookie]

Aug. 13 TKR Tough Cookie- my dear supporters at Bone Smart, I have turned the corner. No more blood clot, a pinched nerve that is better, not good, but manageable. A new knee that is at 92 % ROM and 7 hours sleep a night. I'm thankful for the small things, which after this experience were life changing and not so small. My surgeon is still a jerk, but after all the problems sees me himself the last three visits. He did say an aspirin was enough once the clot was gone, but I have my voice back and made an appointment with a hematologist that said absolutely not, 3 more months of blood thinners are required and I am now under his care. He mentioned the "no ice" theory is probably due to blood flow and circulation going to the new joint. Anyway, it is still a while before I can resume my active life and the sad part of this, as my hematologist said, was avoidable. My best wishes for success and a compassionate surgeon for those that are just now going through this procedure and my sincere sympathy and prayers for those that have a lack of support and medical attention required in a knee replacement. Bone Smart made me realize my experience was NOT normal, my care was lacking and it was okay to cry a lot. The advise was very pertinent and I followed most of the suggestions except icing, I guess because the surgeon was in my head by then, but thanks to everyone that answered in the wee hours that I was spending sleepless for three weeks! Lots of work ahead, but I can cope now, and get full use of this knee back and one day forget it s foreign to my body and not shudder when I look back at this time in my life. Thanks.