TKR TKR #2 --Left Knee -- (August 5 2015)

[metalheart]

Thanks wings, I am doing well. My surgery was a week ago tomorrow. The home PT person came yesterday and she is the same PT that worked with me in January for my 1st TKR. Her approach is gentle stretching and strength building and she never pressed me to do anything painful. We went through all the usual paper work and did the basic exercises I have been doing: foot pumps, quad sets, heel slides, short arc leg lifts, passive leg extensions, and a flexion stretch. After doing the basics, she measured by flexion at 93 degrees and extension is 0. I am happy with that and it is just bit more flexion I had at the same point in recovery as my first (right TKR). I decided to press for a bit more on my own in the afternoon set of exercises and over-did it a bit with resulting increase in pain and swelling last night and today. So, today is an easy day, just 2 sets of stretches/exercises and mostly icing and elevating.

I am taking 5mg norco every four hours. My usual pain level is a 2-3 although when I over-did it yesterday it rose to a 5-6 and I went to bed with 10mg norco, but I am back to the 5mg dose today. My appetite is reasonable: light breakfast (bran cereal, fruit, soy milk), protein (usually chicken) for lunch, snacks of prunes or apples/peaches, light dinner (last night it was chicken piccata and farrow). I drink a glass of prune juice in the morning and drink 4 or so 15 ounce bottle of water. So far, constipation has not been an issue and I am working to make sure it stays that way with high fiber foods, prune juice, and a daily dose of miralax,

I am sleeping well-enough, usually 2-3 hour stretches at night, then bathroom visit and back to bed. I am mobile using a walker. I can dress myself, shower (I have an Aquacel bandage on my incision), get in and out of bed, and otherwise function without assistance. I have been able to apply lessons-learned from the first TKR to this one and that has helped my overall functionality.

The lower back pain in experienced in the hospital returned this past weekend, but it ialmost completely resolved now. I am sure it is related to the spinal injection. This has been the only bump in the road so far, other than my over-doing it yesterday and causing myself problems: lesson learned.

I had a relatively easy and successful recovery from the first TKR and it looks as if things are off to the same start. I am not complacent and realize that I need to attend to the basics of addressing swelling, working on flexion and extension, resting, and ensuring good nutrition. Being active in recovery is also part of what worked for me during my first TKR and I plan on doing the same this time.

 

[wings]

Glad to see a your report, except for the bit of overdoing it.

How frequently do you use your icing machine?

Chicken piccata is one of my favorite foods. A local restaurant has it as a lunch special every Tuesday. I just returned from grocery store and the temp. was 104 degrees. I think our dinner tonight will be something cold like a salad.

 

[wberry]

Well if you are sleeping, your doing very well indeed.

 

[metalheart]

Glad to see a your report, except for the bit of overdoing it.

How frequently do you use your icing machine?

Chicken piccata is one of my favorite foods. A local restaurant has it as a lunch special every Tuesday. I just returned from grocery store and the temp. was 104 degrees. I think our dinner tonight will be something cold like a salad.

It is way too early for me to be pushing for more ROM, but when the PT measured the first time I felt there was more but did not push it. In the afternoon, I pushed it and it was not a good thing. Not a big set back, but an annoyance right now.

I use the ice machine for about an hour at a time. Then I get up, walk around, do some heel slides, sit outside (the weather here is unusually pleasant 85 or so) and then do another hour of icing. I total about four or so hours a day. I do sleep with my leg elevated and that seems to help some with swelling.

At 104 degrees I think I would be eating something cool too! That is real Texas weather. I hope you find a way to start cool!

 

[metalheart]

The home health nurse came today (7 days post surgery) and removed the 24 staples in the incision. She then applied steri-strips that are supposed to stay on a couple of weeks. The staple removal was uneventful, no drainage, pain, or other issues.

The PT came earlier in the day and we did some gentle work on flexion, extension, and balance. After my over doing it episode Monday, I have just taken it easy with just icing and elevation, so there was a bit of a setback on ROM to 90. Just for interest, she measured my right knee (surgery in January) and flexion is 130. It has continued to improve since I stopped PT, but then I have been cycling and doing gym work so I am happy about the 130.

I am resting the knee the rest of the day then back to the 3x day for exercises tomorrow.

 

[bdink21]

@metalheart Great report. Sounds like you are doing well. Also good to hear the your other knee continues to progress.

 

[PolarBear60]

Steri-strips may not stay on that long. Don't worry if they don't.

 

[metalheart]

I am 10 days out today and progress is steady. My pain level is usually a 3-4 and well controlled by ice and 5mg Norco every 4 hours. I do experience some twinges and sharp pains that are 5-7, but these are episodic and similar to what occurred with my first TKR. Nothing to worry about, just a sign things are recovering. Swelling is almost gone in my calf, but it is still noticeable in the thigh.

My leg feels strong. I can get in and out of bed and elevate my leg without using the non-surgical leg for support. I am mobile using a walker and I can walk from one end of the house to the other without using it (but I carry it with me). The home PT asked that I not switch to a cane yet so that my gait improves so I do not limp. Her rationale is that muscle memory could influence my gait to include a limp. So, I hold the walker in both hands while I move around the house now, although after I have been icing or sleeping for awhile, the stability of the walker comes in handy. After the Monday PT session I hope to switch to a cane for stability.

Home PT is two times a week focusing on flexibility, balance and strength work, although the strength work is focused on quads. The other days of the week I do stretching and flexibility exercises 3x a day 10-20 reps each: heel slides, leg lifts (up and side), knee straightening hang using a foam roller (10 minutes), sitting long arc knee extension, and glute squeezes. Every 1-2 hours I also do 20 reps of ankle pumps and quad sets. Otherwise I ice and elevate for 40-60 minute stretches. Between ice-elevation sessions I take short walks from one end of the house to the other and sometimes I hop on my bike (mounted on a trainder) and rock back and forth for s short time. No doubt the amount of icing and elevation has helped decrease swelling. The stretching and flexibility work totals about an hour or so a day and it is completely tolerable.

Sleep is ok, but 2-3 hour stretches are still the norm. I have episodes of low back pain when I sit for more than about 15 minutes and sometimes when I am elevating. This seems a hold-over from the back issues I had in the hospital and just after returning home. I ordered a TENS unit to try to help with the back-pain. Otherwise, progress is steady and my focus is on functionality (steps toward returning to normal activities) and muscle balance and strength so that hip, back, and other issues do not develop later in recovery (which did happen during the last TKR).

That’s my 10day out story.

 

[Slainte]

You are doing a lot, but it seems to be working for you. I had a tough time with sleep being interrupted but finally got that resolved just last week. Good job on the icing and elevation. Hope the TENS unit does the trick for your back.

 

[metalheart]

I'm glad your sleep issues are resolved, I'm still working on that, but it just seems to be part of the process of recovering in these early weeks. I'm not really doing that much, it just seems like it when it is in print! The stretches and other activities are only what my doc's office suggest in their handout and I followed the same plan more or less with my first TKR. I get plenty of rest so I don't think that is an issue. But, I believe more in an active recovery, the challenge is finding that line between doing too much and doing enough. My goal is to return to doing the important things in life for me in the least possible time.

It does not take much reading here to see there are many pathways to recovery and what works for one person will not necessarily work for another. We have more or less the same knees, but they come into and go out of surgery with different histories that affect the recovery process. So, generalizing from one case can result in the wrong path. Anyway, there is value in sharing out experiences and discovering different ways to understand recovery. I'm enjoying reading your thread, Sainte mhaith!

 

[Josephine]

the challenge is finding that line between doing too much and doing enough

I totally agree but the trick is to err on the lesser side rather than the more.

My goal is to return to doing the important things in life for me in the least possible time.

Well good luck to you with that goal but in my experience it's a largely unattainable one. As I said before, it's always better to err on the lesser side because if you don't you risk causing more problems than you solve. You simply cannot dictate the speed of your recovery and as others have said, the knee is the boss!

 

[metalheart]

My experience with my first TKR is there was a downside to less is more: on those days when I did nothing but rest, my knee became more stiff, less mobile, and more painful. On days when I was active enough, my knee felt flexible and less painful. That is my experience. Overdoing activity also has a downside, but for me, so does the less is more approach.

About my goal, I think it is attainable based on my first TKR. Cycling is an important part of my life. After 7-8 weeks after my first TKR I was cycling outside for short distances (20 miles or so). By 12 weeks I was cycling 30-40 miles with few compromises other than loss of conditioning and muscle atrophy. I cycled up to the day of this most recent surgery. I would not have tried cycling before the 7-8 weeks post TKR and it was soon enough for me. I expect something similar for my most recent TKR. A goal is a good thing to have for me.

 

[PolarBear60]

That sounds reasonable, metalheart. I was amazed I could do a complete pedal revolution on my stationary recumbent bike at 2 weeks. I'm not a big cycling fan, but I have not trouble on my stationary bike. I haven't fired up the hybrid bike yet, but I'm pretty sure I could do it.

 

[metalheart]

Hi Polar Bear, good news about your revolution on the stationary bike. I am sure you can do the hybrid if you want to use that as part of your recovery or just for fun! For me, cycling is both fun, good for my cardiac health, and my mental health. I am moving more slowly than last time on the bike: I am just rocking back and forth and not pushing the limits at all. Last time I pressed to make a full revolution quickly, but this time I know it will come when it is ready.

Where did you get the bear in your profile pic? It looks like an Alaskan ivory (walrus tusk)?

 

[PolarBear60]

I wish I could find cycling fun. I concur about it's value for cardiac health. Maybe I just need to push past the first days of discomfort in the saddle and maybe it will get better. I was much happier as a runner -- many years ago before knees deteriorated.

As for my profile picture, it's what I call a broken link removed: https://www.lomonosov-russia.com/figurines/animals/bears/big-polar-bear.html. It's a Russian porcelain creation. Actually, the one pictured is from the USSR days, but I have both old and new. There's also a Sitting Lomonosov and a broken link removed: https://www.lomonosov-russia.com/figurines/animals/bears/baby-polar-bear.html. They're all part of my polar bear figurine collection.

 

[metalheart]

Yep, the running thing will do in your knees, same thing happened to me. Getting used to the saddle is a chore, but once you get things broken in, the saddle goes away and it is just you and the wind!

Those porcelain bears are amazing! I have a few polar bear figurines from various places in Alaska and they always evoke a smile when I look at them.

 

[PolarBear60]

That's the part I've never gotten beyond -- getting used to the saddle. If I were willing to try, what's the trick?

 

[metalheart]

The saddle thing is often an issue, but can be resolved. Short answer, right cycling shorts, chamois cream, proper fitting saddle. So the Mods don't ding us for being off topic, I will send you a PM with a longer answer.

 

[PolarBear60]

Good idea, or maybe post in the cycling club area of the Social Room so anyone else could benefit from the information.

 

[Timetolive]

"I have been able to apply lessons-learned from the first TKR to this one and that has helped my overall functionality."

Would you care to share what your "lessons learned" are? I am finding your thread very informative!