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TKR Recovery: what to do and what not to do

Josephine

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Here is a 10 bullet point list for clarity

1. pain management: take your pain pills, full dose prescribed as often as prescribed and do it by the clock. Don't ever wait until the pain begins because that then means you are playing catch-up which is not good. Take a look at this article Ice to control pain and swelling
Note: pain pills will make you drowsy. It's a necessary trade off in being pain free. Don't fret about it!

2. icing: have you got anything with which to ice your knee? If not, a big bag of frozen peas will do but you must have ice. Use it for hours at a time. Do use a tea towel underneath to start with so you don't get freezer burn!
Ice to control pain and swelling

3. elevate your leg: just look at this article Elevation is the key to controlling pain and swelling

4. sleeping: you can sleep on your side if you must but it's better not to as in my experience it's actually more painful. You can sleep with your leg slightly bent though but do make sure you move it around every so often.

5. activity: there are two parts to this
a) activity is necessary both for clot prevention and for regaining the correct range of movement (ROM) in your knee but too much structured exercising can be counter-productive.
b) progressing suitably in getting about the house is best done in easy stages which are described in this article Activity progression for TKRs. It really doesn't matter whether you use a walker, two crutches, one crutch, two sticks or one stick - use what you need to feel secure and confident at that time. As time goes on you will regain confidence and will naturally progress to different methods of support.

6. Getting the knee flat (extension) can be tough at the start but but don't obsess about it. This is more likely to be an issue with you not taking adequate pain killers so check item 1 and make sure you are. Best is to use two or three not-too-soft pillows or big cushions along the entire length of your leg.

7. sleep: is going to be a fond memory for quite a while. No-one really manages to sleep well for many weeks but everyone gets fractious about it! Try not to let it get to you but just cat nap during the day as you feel inclined. If(when!) you have sleepless periods during the night, make sure you are not in pain, do something to while away the hours - that's why we have a Games Room in here! Just don't worry about it. Sleep deprivation is pretty much inevitable - but what causes it?

8. loss of appetite and constipation: also common problems which are, of course, related. It's also a consequence of the 24+ hours of fasting, the anaesthetic drugs and the impact of the surgery. Read this Constipation and stool softeners

9. finally, you are going to be very easily fatigued for weeks. This is normal Energy drain for TKRs

10. And finally, finally, here are the rest of the articles you need for this time in your life - happy reading!

Knee Recovery: The Guidelines
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
5. At week 4 and after you should follow this

The Recovery articles:
The importance of managing pain after a TKR and the pain chart
Swollen and stiff knee: what causes it?
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

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


Finally, do remember that it's not the exercising that gets you your ROM, it's time. Time to recover, time for swelling and pain to settle and time to heal. One thing that seems to be missing from all the PT's protocols is that all your ROM is there right from the start, just waiting for all 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. Exercise as in strength training is counter-productive and in the early weeks does more harm than good. Normal activity is the key to success.
 
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