TKR TKR Pre-op questions

[winedunce]

Hi! I just scheduled TKR on my right knee for March 10, 2020. I have heard from a couple of people that they used a few devices for recovery that they felt were instrumental in their positive results. One is a CPM machine which I used 9 years ago after a microfracture surgery. I wasn't a fan as I was in that machine 10 hours a day for six weeks and got such severe back pain from lying around in it. But, I did get incredible range of motion back. I'm wondering if anyone here has used a CPM machine after TKR and if you felt it was helpful. And, how much did you use it?

I'm also planning to use either a Game Ready or Nice ice machine which I have used for three surgeries and they have been so helpful as I tend to swell a lot. And, then I talked to a friend today who is having TKR at the end of January and she said she is going to have a nerve block put into her leg because pain pills make her nauseated and the doc doesn't want her bending down on the floor to throw up into a toilet or bucket. Makes sense. I have seen a lot of videos on YouTube about how important it is to take your pain pills after this surgery so that you can get the most out of your PT. I really hate pain meds. Wondering how quickly most people can get off the pain meds. And, also wondering if others have had the nerve block and what their experience was with that. I think the nerve block is only in for a couple of days right after surgery. Is it torture when you come off the nerve block? Thanks for any advice!

 

[Pumpkin]

One is a CPM machine

CPM is no longer recommended after TKR, ROM outcomes are the same with and without. Since you had back pain previously with a CPM let you surgeon know, it may be best you stick with your ice machine or GameReady for swelling.

I have seen a lot of videos on YouTube about how important it is to take your pain pills after this surgery so that you can get the most out of your PT.

Pain meds before PT can block the pain signals you need to let the PT know they are doing too much. Best you just take them on schedule as prescribed, no need to take them before PT.

Wondering how quickly most people can get off the pain meds.

Everyone is different, some are off of prescribed pain meds in a week or two, others continue taking prescribed pain meds for 3 to 4 months.

And, also wondering if others have had the nerve block and what their experience was with that.

I had a Femoral nerve block that did not work, waking up in recovery with no pain meds on board was not fun. The nurse gave me IV meds, that worked quickly.
Talk to your OS and anesthesiologist about your history and preferences.

New BoneSmart members like you are in various stages of their journey to joint replacement. Making the decision whether or not to have surgery and preparing for surgery can be easier once you have done your research and know what lies ahead. Here are some tools that can help you decide what is best for you.

If you are at the stage where you have joint pain but don't know for sure if you are ready to have surgery, these links may help:

Score Chart: How bad is my arthritic knee?
Choosing a surgeon and a prosthesis
BMI Calculator - What to do if your surgeon says you're too heavy for joint replacement surgery
Longevity of implants and revisions: How long will my new joint last?


If you are at the stage where you are planning to have surgery but are looking for information so you can be better prepared for what is to come, take a look at these links:

Recovery Aids: A comprehensive list for hospital and home
Recliner Chairs: Things you need to know if buying one for your recovery
Pre-Op Interviews: What's involved?


Regardless of where you are in the process, the website and app My Knee Guide can help you stay organized and informed. The free service keeps all the information pertaining to your surgery and recovery in one place on your smartphone. It is intended to be a personal support tool for the entire process.

And if you want to picture what your life might be like with a replaced knee, take a look at the posts and threads from other BoneSmarties provided in this link:

Stories of amazing knee recoveries

 

[Tykey]

I had a femoral nerve block on my first TKR 10 years ago, I had virtually no pain. It was in for 3 days and when it was removed it made no difference because I assume the oral meds were by that time fully up and working.
All this changed on my second TKR, because this was no longer the practice. At the end of surgery whilst still in theatre they injected a large quantity of long lasting pain killers directly into the centre of the knee. Worked brilliantly, as with the nerve block, 3 days of comfort until the orals took over. I'd discuss this with the anaesthetist prior to the op.

I thought all CPM machines had been recycled into something useful. Really couldn't see their usefulness, being passive. They hark back to the old discredited view that there is a "window of opportunity" and the suggestion that our knees will set like concrete if we don't use them.

 

[winedunce]

Thank you so much to both of you! @Pumpkln I'm new to the group and if I have follow-up questions is it best to put them in this thread or start a new question? I wanted to ask about friends who have told me that their knee feels like a cement block (after 15-16 weeks which surprised her) I have heard this cement block comment before. I assume that sensation goes away. The other question that I have is around the clicking and noise people report after TKR. My catching and clicking is a big reason I have opted for TKR. I can't really bend my knee at a right angle without catching and clicking (tendons on bone spur but my doc also thinks it is because I'm bone on bone so it catches on the bones). I am hoping TKR resolves this so I can get back to walking up stairs and down stairs, biking (a big one) and putting on pants successfully without having to awkwardly straighten my leg out and shimmy the pants up the leg

 

[Jaycey]

@winedunce If you keep all your questions on this thread you will find it easier to refer back here. Don't worry - we review every new entry.

There are all kinds of feelings and sensations post TKR. The good news is these will fade away with time. But that time is different for every new knee.

The other question that I have is around the clicking and noise people report after TKR.

If you get this "noise" this too will ease with time. As everything firms up around the joint again this just fades as well.

 

[Jockette]

. I have seen a lot of videos on YouTube about how important it is to take your pain pills after this surgery so that you can get the most out of your PT.

Contrary to popular opinion, painful PT is not necessary in order to have a good outcome. In fact, we here at Bonesmart believe the opposite:


Regaining our ROM is more about Time than repetitions of a list of exercises.

Time to recover.
Time for pain and swelling to settle.
Time to heal.

Our range of motion is right there all
along just waiting for that to happen so it can show itself.

In the general run of things, it doesn't need to be fought for, worked hard for or worried about. It will happen. Normal activity is the key to success.

 

[Jockette]

Here is a good discussion about post op PT:

Bilateral TKR - Pre-op Pain

Maybe others have experienced this and can help. I got my booklet to prepare for surgery. It had a list of exercises to do to strengthen before surgery. Since this will be bilateral, I also added pushups (modified) to the mix. I also added exercises I found on the internet to further stretch...

bonesmart.org

 

[pamsknees]

I will be right behind you on Mar 16 with bilateral TKR- I am looking forward to it with a mix of excitement to be able to get back to biking & hiking & terror of the recovery . Getting my house ready now. My surgeon told me I’ve packs work as well as an ice machine but I think I will request an ice machine anyways as I’ve heard so many good things

 

[winedunce]

. I have seen a lot of videos on YouTube about how important it is to take your pain pills after this surgery so that you can get the most out of your PT.

Contrary to popular opinion, painful PT is not necessary in order to have a good outcome. In fact, we here at Bonesmart believe the opposite:


Regaining our ROM is more about Time than repetitions of a list of exercises.

Time to recover.
Time for pain and swelling to settle.
Time to heal.

Our range of motion is right there all
along just waiting for that to happen so it can show itself.

In the general run of things, it doesn't need to be fought for, worked hard for or worried about. It will happen. Normal activity is the key to success.

Thank you for this!! I am a big sweller. For my previous surgeries (4 of them on this right knee) I have always had a very hard time getting off crutches or doing any weight bearing stuff due to the swelling. But, I'm very disciplined about staying off it, icing and doing my ROM exercises. I have always gotten my range of motion back in spades and then build strength later. That makes me feel so much better as your approach aligns with what I have done previously. One concern I had is that I read that a lot of surgeons won't let you leave the hospital until you can walk on your walker. I'm afraid of being pushed to walk too quickly due to swelling. Thanks for your valuable input!

 

[winedunce]

I will be right behind you on Mar 16 with bilateral TKR- I am looking forward to it with a mix of excitement to be able to get back to biking & hiking & terror of the recovery . Getting my house ready now. My surgeon told me I’ve packs work as well as an ice machine but I think I will request an ice machine anyways as I’ve heard so many good things

Yes! I absolutely love my ice machines and can't say enough about how they have helped me. I have used a Game Ready which is compression and cold for the past three knee surgeries. I may switch to a Nice Machine for this one because you don't have to keep filling up the ice compartment which makes it easier on the caregiver. Good luck with your surgery!!

 

[Jockette]

You should be able to walk with a walker even with swelling.

 

[LD of Michigan]

I didn't swell much and managed well on just rotating ice packs from freezer, but initially I was moving/ standing SLOWLY from leg/ knee feeling heavy and hurting.

Don't let the hospital rush you home! Everyone ambulates at a different pace, though getting up as soon as possible helps reduce the risks of blood clots etc.

Still in all, your specific release time should be base on your ability to be safe in your home and that requires minimal standing/ walking on walker. There's no one size fits all recovery as touted by some.

I erred on caution and opted for example NOT to do the same-day/ outpatient TKR scene.

That makes me feel so much better as your approach aligns with what I have done previously. One concern I had is that I read that a lot of surgeons won't let you leave the hospital until you can walk on your walker. I'm afraid of being pushed to walk too quickly due to swelling.

 

[Rockgirl4]

I'm just commenting on the clicking/catching you were asking about above. I also had loads of catching/clicking before my TKR, as the bone spurs on both sides of my knee caused my knee to catch in certain positions, making me force my knee to "unstick" from certain positions. I had had 7 surgeries on that knee before my TKR, one of which caused massive scarring, so I have loads of experience with loose pieces of articular cartilage, torn meniscus, ruptured bursa, etc. I even had my knee get completely stuck in one position a few yrs ago where I didn't think we'd ever get it "unstuck."

The clicking noise after a TKR is NOT the same thing. My TKR knee clicks and clunks some, but the best part is NO MORE catching/sticking. I have complete stability again in that knee, and though my bend isn't what I hoped for yet at 8 months post-op, at least I can drive a car without my knee getting stuck when switching from the acccelerator to the brake pedal (I'm not kidding!!). The leg doesn't try to give out on me, and my movement from straight to bent to straight is ALWAYS smooth with no catching. My bone spur knobs from the sides of my knee are were cut away, and that leg is actually a bit stronger than my other non-TKR knee. All in all, this click is nothing at all like the osteoarthritis issues from before.

 

[InkedMarie]

I’m 17mos post op and my knee still crunches when I do stairs. I hate it but am getting used to it.

 

[winedunce]

I'm just commenting on the clicking/catching you were asking about above. I also had loads of catching/clicking before my TKR, as the bone spurs on both sides of my knee caused my knee to catch in certain positions, making me force my knee to "unstick" from certain positions. I had had 7 surgeries on that knee before my TKR, one of which caused massive scarring, so I have loads of experience with loose pieces of articular cartilage, torn meniscus, ruptured bursa, etc. I even had my knee get completely stuck in one position a few yrs ago where I didn't think we'd ever get it "unstuck."

The clicking noise after a TKR is NOT the same thing. My TKR knee clicks and clunks some, but the best part is NO MORE catching/sticking. I have complete stability again in that knee, and though my bend isn't what I hoped for yet at 8 months post-op, at least I can drive a car without my knee getting stuck when switching from the acccelerator to the brake pedal (I'm not kidding!!). The leg doesn't try to give out on me, and my movement from straight to bent to straight is ALWAYS smooth with no catching. My bone spur knobs from the sides of my knee are were cut away, and that leg is actually a bit stronger than my other non-TKR knee. All in all, this click is nothing at all like the osteoarthritis issues from before.

@Rockgirl4 Thank you SO much for this! I have a lot of anxiety around this. My knee doesn't hurt. I'm fortunate in that my bone on bone has not hurt me (on the lateral side where the bone spur is) - I just can't bend my knee which has made things so limiting. My knee does hurt on the medial side from time to time because I have a microfracture in the femoral condyle there. But, overall I am not uncomfortable day to day when I walk. I just can't do a lot of other things to live my life normally. Because I don't have persistent pain - I have started to question whether TKR is right for me. I have fantasies that the bone spur can be removed and not come back but that doesn't seem to be the case for me. And, one of my surgeons says he isn't convinced it is only the recurring bone spur that is causing the catching - it is also my bone on bone. Which I can believe because there are different catching sensations going on. I have RTKR scheduled for March 10th. My 50th birthday is May 26 and I had planned a bike trip to Mallorca which won't be happening this year. I'm feeling so deflated and nervous about it all. I really appreciate your insight on the catching and clicking. I am fine with noise as long as I can rotate my knee around to ride a bike and can lift my leg at a 90 degree angle to climb and descend stairs or put on pants. Thanks again so much!!

 

[winedunce]

I'm just commenting on the clicking/catching you were asking about above. I also had loads of catching/clicking before my TKR, as the bone spurs on both sides of my knee caused my knee to catch in certain positions, making me force my knee to "unstick" from certain positions. I had had 7 surgeries on that knee before my TKR, one of which caused massive scarring, so I have loads of experience with loose pieces of articular cartilage, torn meniscus, ruptured bursa, etc. I even had my knee get completely stuck in one position a few yrs ago where I didn't think we'd ever get it "unstuck."

The clicking noise after a TKR is NOT the same thing. My TKR knee clicks and clunks some, but the best part is NO MORE catching/sticking. I have complete stability again in that knee, and though my bend isn't what I hoped for yet at 8 months post-op, at least I can drive a car without my knee getting stuck when switching from the acccelerator to the brake pedal (I'm not kidding!!). The leg doesn't try to give out on me, and my movement from straight to bent to straight is ALWAYS smooth with no catching. My bone spur knobs from the sides of my knee are were cut away, and that leg is actually a bit stronger than my other non-TKR knee. All in all, this click is nothing at all like the osteoarthritis issues from before.

@Julia1911 Thank you SO much for this! I have a lot of anxiety around this. My knee doesn't hurt. I'm fortunate in that my bone on bone has not hurt me (on the lateral side where the bone spur is) - I just can't bend my knee which has made things so limiting. My knee does hurt on the medial side from time to time because I have a microfracture in the femoral condyle there. But, overall I am not uncomfortable day to day when I walk. I just can't do a lot of other things to live my life normally. Because I don't have persistent pain - I have started to question whether TKR is right for me. I have fantasies that the bone spur can be removed and not come back but that doesn't seem to be the case for me. And, one of my surgeons says he isn't convinced it is only the recurring bone spur that is causing the catching - it is also my bone on bone. Which I can believe because there are different catching sensations going on. I have RTKR scheduled for March 10th. My 50th birthday is May 26 and I had planned a bike trip to Mallorca which won't be happening this year. I'm feeling so deflated and nervous about it all. I really appreciate your insight on the catching and clicking. I am fine with noise as long as I can rotate my knee around to ride a bike and can lift my leg at a 90 degree angle to climb and descend stairs or put on pants. Thanks again so much!!

@Rockgirl4 Sorry I meant this response to go to you!! I so appreciate your comments on the catching!! Thank you very very much!!

 

[Celle]

For my previous surgeries (4 of them on this right knee) I have always had a very hard time getting off crutches or doing any weight bearing stuff due to the swelling.

Please will you tell us the dates of these previous knee surgeries and what they were? Then we can add them to your signature.
Having had several surgeries on this knee before may mean that you have to treat your knee rather gently, and may need to allow more time for progress at first.

 

[loneshark64]

Piling on. I am a week post TKR.

My Dr also said they don’t use CPM anymore. Thank God as I too had that 20 yrs ago and it didn’t help. Moving my knee and doing laps around the dining room table my walker helps.

I was sent home with a cryo cuff which I assume is like your ice machine. It is working very well and only needs new ice like twice a day.

I got general anesthesia and two blocks. To put in the blocks the doctor used an ultrasound to identify the right spot and then sticks in the needle. I watched on the ultrasound screen. You can see the needle go into the spot, and this did not hurt. THe anesthesiologist was going to do one block but did two after the dr told him there was extra work to do extracting old screws and the procedure would be a longer one. I just took what they suggested. My only request had been I was not doing it on an epidural, I wanted to be 100% out the whole time, which was their plan anyway. The blocks lasted until about a day and a half after the surgery. It helped with the first night and first time in my feet. After that I was ramped on a med schedule.

So far mine knocks a bit. It is an adjustment but like others said it is not like the meniscus clocking or arthritis grinding. It is just mechanical. My PT said it generally goes away as the swelling subsided and things progress, but so am already kind of used to it.

Seems like there are good and bad physical therapists. Mine seems good and the one in the hospital was very helpful. Others here have had a lot of bad experiences. If I didn’t like mine personally I would ask to switch.

 

[winedunce]

For my previous surgeries (4 of them on this right knee) I have always had a very hard time getting off crutches or doing any weight bearing stuff due to the swelling.

Please will you tell us the dates of these previous knee surgeries and what they were? Then we can add them to your signature.
Having had several surgeries on this knee before may mean that you have to treat your knee rather gently, and may need to allow more time for progress at first.

Oh thank you for any guidance you have. I was wondering if previous surgeries may impact my recovery for TKR. My first surgery was meniscus trim (40% removed) July 2009. But the surgeon didn't tell me to stay off the leg or get PT so I walked 20 minutes without crutches to a coffee shop the day after surgery - the leg swelled and never recovered. Five months later (Jan 2010) I had a different surgeon go back in. I had now developed class 4 arthritis from the meniscus trim in just five months. There were pieces of cartilage floating around and the bigger deal was that they did a microfracture of the femoral condyle. Then in July 2015 I had another lateral meniscus trim (so now I was left with less than half of my meniscus). Then November 2019 I had another lateral meniscus trim (leaving me only 20% of the meniscus) and also had a bone spur shaved down. The bone spur was back within 8 weeks and I'm having the same catching symptoms I had before my surgery 14 months ago.

 

[winedunce]

Piling on. I am a week post TKR.

My Dr also said they don’t use CPM anymore. Thank God as I too had that 20 yrs ago and it didn’t help. Moving my knee and doing laps around the dining room table my walker helps.

I was sent home with a cryo cuff which I assume is like your ice machine. It is working very well and only needs new ice like twice a day.

I got general anesthesia and two blocks. To put in the blocks the doctor used an ultrasound to identify the right spot and then sticks in the needle. I watched on the ultrasound screen. You can see the needle go into the spot, and this did not hurt. THe anesthesiologist was going to do one block but did two after the dr told him there was extra work to do extracting old screws and the procedure would be a longer one. I just took what they suggested. My only request had been I was not doing it on an epidural, I wanted to be 100% out the whole time, which was their plan anyway. The blocks lasted until about a day and a half after the surgery. It helped with the first night and first time in my feet. After that I was ramped on a med schedule.

So far mine knocks a bit. It is an adjustment but like others said it is not like the meniscus clocking or arthritis grinding. It is just mechanical. My PT said it generally goes away as the swelling subsided and things progress, but so am already kind of used to it.

Seems like there are good and bad physical therapists. Mine seems good and the one in the hospital was very helpful. Others here have had a lot of bad experiences. If I didn’t like mine personally I would ask to switch.

This is very helpful! I hope your recovery is going well. I am worried about getting a good PT. I have had excellent PTs for my last couple of surgeries but I don't know any that do PT for knee replacements or the ones I do know of seem aggressive which makes me nervous because I want to keep the swelling under control. What kind of PT do they have you doing right now?