OP
OP
metalheart
member
- Joined
- Mar 2, 2012
- Messages
- 230
- Age
- 81
- Location
- East of Sacramento
- Gender
- Male
- Country
United States
HI, thanks for the follow-up question. The short answer about what I carried forward from my January 5, 2015 TKR is: be informed, strength and stretch work for muscle balance, the benefits of ice AND compression, correct dose for pain meds, and combining rest with activity. The long-winded version is below (I have time on my hands!) and just offers some examples of what I keep in mind from my first TKR. I don't think there is anything here you probably don't know already!
Be informed: I spent a lot of time finding the right physician and I trust his approach and question him frequently about topics that concern me. However, as you know, there are a variety of opinions and “do’s and don’ts” from friends and other folks about what we should or should not be doing. Those opinions can be confusing. Early in my first TKR I got a copy of Total Knee Replacement and Rehabilitation: The Knee Owners Manual. I still find that a useful reference that can help clarify issues. I also check out opinions using Google and Google Scholar to understand if there is any basis for an opinion that conflicts with what my doc says. Mostly, I think it is important for me to have a rationale for what I am doing in recovery and how it will help and I read and ask questions to do that.
Strength and stretch work for muscle balance: I developed some back and hip issues a few weeks into recovery after the first TKR. These were related to muscle imbalances that once I worked on them relieved most of the discomfort. I went into surgery with relatively strong quads and reasonable but not ideal muscle balance, especially in hip flexors, glutes, hamstrings, and calves. Now I do some very simple strength and stretching of those muscles to keep things more in balance and I hope prevent the discomfort I experienced before.
Ice and Compression: We all know about the pain relieving benefits of icing, I found that early on in my first recovery icing helped to reduce pain and some swelling, but when I added compression I noticed even more pain relief and less swelling. After 3 weeks or so, I found that heat worked better than icing for my recovery. Did I continue to ice? Yep, if there were times when pain happened from activity, then I would use the ice machine, but my issues came from my knee being stiff --- not swollen -- so heat helped that more than ice and compression. If you do some casual searches about “icing” using Google or Google Scholar, it is easy to find a range of opinions about the benefits of icing beyond the initial trauma of an injury or surgery. I just let my knee be the guide and I tried to inform myself about what health professionals say about the benefits and liabilities of icing, compression, and heat. Anyway, this time I began compression AND icing right away. Most of the swelling has gone done after 9-10 days and I will do some experimenting with heat this week to see how that helps.
Pain Meds Dose: Last TKR I took 10mg of Norco every four hours for the first 3 weeks. Despite understanding the constipation implications of opioids, it still happened and it was uncomfortable. This time I began with 5mg every four hours and that has mostly been fine for my pain levels. Sometimes at night I take a 7.5 and more rarely a 10, but 5mg works most of the time. I have not experienced any signs of constipation yet and my pain is well controlled. Getting the right dose of pain meds for me has some trial and error to it, but it is working better this time around.
Rest and Activity: I get the importance of rest after major surgery. I also benefited during my last TKR by being relatively active: physical therapy, walking, using my exercise bike. Did I over-do it at times? Yep, and I learned the limits of being active. I rested enough, but my knee felt best during and after activity and I have carried that approach forward to this TKR. An active recovery works for me. It may not for everyone for a variety of reasons, but after the first TKR I returned to the activities of daily life at a pace i was happy with. Early on I bought into the focus on ROM, but after a while I decided that whatever ROM would allow me to cycle and do the work I need to around my property is what should drive my recovery and that is the same approach I have this time. Rest enough, be active enough to aid recovery, and don’t over-do either, that is a simple but important lesson for me.
There are a few more, but this is long-winded enough and covers the things I think about every day. I hope that helps.
Be informed: I spent a lot of time finding the right physician and I trust his approach and question him frequently about topics that concern me. However, as you know, there are a variety of opinions and “do’s and don’ts” from friends and other folks about what we should or should not be doing. Those opinions can be confusing. Early in my first TKR I got a copy of Total Knee Replacement and Rehabilitation: The Knee Owners Manual. I still find that a useful reference that can help clarify issues. I also check out opinions using Google and Google Scholar to understand if there is any basis for an opinion that conflicts with what my doc says. Mostly, I think it is important for me to have a rationale for what I am doing in recovery and how it will help and I read and ask questions to do that.
Strength and stretch work for muscle balance: I developed some back and hip issues a few weeks into recovery after the first TKR. These were related to muscle imbalances that once I worked on them relieved most of the discomfort. I went into surgery with relatively strong quads and reasonable but not ideal muscle balance, especially in hip flexors, glutes, hamstrings, and calves. Now I do some very simple strength and stretching of those muscles to keep things more in balance and I hope prevent the discomfort I experienced before.
Ice and Compression: We all know about the pain relieving benefits of icing, I found that early on in my first recovery icing helped to reduce pain and some swelling, but when I added compression I noticed even more pain relief and less swelling. After 3 weeks or so, I found that heat worked better than icing for my recovery. Did I continue to ice? Yep, if there were times when pain happened from activity, then I would use the ice machine, but my issues came from my knee being stiff --- not swollen -- so heat helped that more than ice and compression. If you do some casual searches about “icing” using Google or Google Scholar, it is easy to find a range of opinions about the benefits of icing beyond the initial trauma of an injury or surgery. I just let my knee be the guide and I tried to inform myself about what health professionals say about the benefits and liabilities of icing, compression, and heat. Anyway, this time I began compression AND icing right away. Most of the swelling has gone done after 9-10 days and I will do some experimenting with heat this week to see how that helps.
Pain Meds Dose: Last TKR I took 10mg of Norco every four hours for the first 3 weeks. Despite understanding the constipation implications of opioids, it still happened and it was uncomfortable. This time I began with 5mg every four hours and that has mostly been fine for my pain levels. Sometimes at night I take a 7.5 and more rarely a 10, but 5mg works most of the time. I have not experienced any signs of constipation yet and my pain is well controlled. Getting the right dose of pain meds for me has some trial and error to it, but it is working better this time around.
Rest and Activity: I get the importance of rest after major surgery. I also benefited during my last TKR by being relatively active: physical therapy, walking, using my exercise bike. Did I over-do it at times? Yep, and I learned the limits of being active. I rested enough, but my knee felt best during and after activity and I have carried that approach forward to this TKR. An active recovery works for me. It may not for everyone for a variety of reasons, but after the first TKR I returned to the activities of daily life at a pace i was happy with. Early on I bought into the focus on ROM, but after a while I decided that whatever ROM would allow me to cycle and do the work I need to around my property is what should drive my recovery and that is the same approach I have this time. Rest enough, be active enough to aid recovery, and don’t over-do either, that is a simple but important lesson for me.
There are a few more, but this is long-winded enough and covers the things I think about every day. I hope that helps.
But Ouch! 
