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Revision TKR TKR- revision

Lynne Cleveland

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Well, I've had my right knee replaced twice and a revision- four years ago. Just had my left knee replaced on 9/19. Came home in two days, overall going okay. Have it wrapped this time. Seems to have more swelling in whole leg. Doing CPM, maybe not a full 6 hours but working on it. Taking Percocet with Tylenol along with 1 Advil every 4. Have been able to make it to 5 hours. That's improvement from last time! At this point I'm trying to remember to not only work on PT exercises but get up every hour and walk around some (with walker)
But how much walking? 3-5 minutes?
 

Celle

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Hello @Lynne Cleveland - and :welome:

Please will you tell us the dates of your knee surgeries and which knees had what, so we can make a signature for you? Thank you.:flwrysmile:

Although some surgeons recommend the CPM machine, they aren't essential so don't worry if you don't spend the required amount of time in that machine. In fact, if you don't like it and choose to stop, it won't make any difference to your knee's progress.

With the walking and the CPM, you probably don't need to do additional exercises. About 5 minutes of walking around the house is sufficient, but it doesn't matter if you do a little less.

Here is your copy of the recovery reading - lots of useful information here, and most of the articles are quite short:
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. Here is a week-by-week guide for Activity progression for TKRs


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

Energy drain for TKRs
Elevation is the key

Ice to control pain and swelling
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
Sleep deprivation is pretty much inevitable - but what causes 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

We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery. While members may create as many threads as they like in a majority of BoneSmart's forums, we ask that each member have only one recovery thread. This policy makes it easier to go back and review history before providing advice.
 

Josephine

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Hi Lynne - fancy seeing you back after all this time!

I'd really like to offer you some structured advice but in order to do that, I also need to ask you some questions. Are you willing for me to do that?
 
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Lynne Cleveland

Lynne Cleveland

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Need some feedback! Even though this is my second time around (actually 4th) 2 replacements on right ( first failed, second slipped so led to revision) all have been similar but different in recovery. Pain regimen given is different this time. Sent home with Percocet, x2 every 4 hours. Alternate directions were 1 Percocet with 1 Advil every 4. I chose the alternate just taking one. Usually after a week I start getting nauseas from Percocet and have to make another change. It’s starting! I can’t seem to get past every 4 hours before needing something. 1 week and a day out from surgery.
 

Pheebs52

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Have you contacted your surgeon's office and let them know about the nausea? I would. I'm sure they'll order something else for you or prescribe something for the nausea. That's the last thing you need right now!
 
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Jaycey

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@Lynne Cleveland you will notice that I have merged your two threads together as we prefer that members in recovery only have one thread.

This is for three reasons:
1. if you keep starting new threads, you miss the posts others have left you in the old threads
2. it often ends up that information is unnecessarily repeated
3. it's best if we can keep all your recovery story in one place so it's easily accessed if we need to advise you.

Please keep all your questions and updates on this thread. If you would like a new thread title just give a shout.
 

OJ2

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I had to take nausea med for about 2 weeks. I also had to eat frequent small meals. I likened the nausea to morning sickness. Lots of crackers, popcorn, and yogurt.
I think at the beginning you get enough walking just from going into the family room, walking to the bathroom, getting a snack from the kitchen. Your knee will tell you when it is ready for more. Don't overdo it or your whole body will rebel. Been there, done that. Not doing it again.
 

Josephine

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Lynne Cleveland

Lynne Cleveland

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Jo,

Yes, any advice would be great. I called the doctor about changing it or getting something for nausea. First of all she said to stop the Advil! My husband had gotten that info wrong when he called after I got home about reducing the Percocet from 2 to 1 every four hours. She is checking on something for nausea. I take Effexor so there may be a contraindication taking the nausea med. She said I could take 1 Percocet then a Tylenol 2 hours later. Or take
1 Percocet then take 2 the next 4 hour dose if
1 doesn’t cover the pain. Good grief! Waiting to hear about the nausea med. Taking an earlier dose of 1 Percocet without the Advil was not as effective for pain control. Three hours later needed something. Have to balance it all as it is
Percocet with Tylenol.
 

Josephine

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What strength is your Percocet?
Please??

Yes, any advice would be great.
Here y'go then!

It would be very helpful if you would answer each one individually - numbered as I have done - in as much detail as you can then I'll come back as see where you are ....

1. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine. And don't forget to factor in other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness).

2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?

3. how swollen is your leg compared to these?
ai63.tinypic.com_eta39s.jpg


4. what is your ROM - that's flexion (bend) and extension (straightness)

5. are you icing your knee at all? If so, how often and for how long?

6. are you elevating your leg. If so how often and for how long?

7. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and

8. are you doing any exercises at home? If so what and how often?
This is the most crucial question so please help me by using the format I have left as an example
(which means please make a list and not an essay!)

Exercises done at home
- how many sessions you do each day
- enter exercise by name then number of repetitions of each
etc., etc.

Anything done at PT
- how many times a week
- enter exercise by name then number of repetitions of each
etc., etc.
 
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Lynne Cleveland

Lynne Cleveland

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1. 4, finished exercises, time for meds
2. Percocet- OxyContin 5/325
3. Moderate- finally! Up to yesterday it was huge
4. Flexion- 90, don’t remember extension
5. Yes, icing. Much more than I was. Doc suggested 30 minutes with 2 hours off. I’ve done that some, other times I just have iced as much as I’ve wanted usually 20 minutes and a time. Not sure about their protocol!
6. Elevation always when icing. In between different time frames. Mostly just when icing.
7. Activity level- up and walking around with walker maybe 5 minutes. Doing PT x 3 times a day. That’s it!
8. Exercise with Home PT x 3 times a week. Exercises on my own x 3 a day.
1. Ankle pumps- 10 times
2. Quad sets- hold
5, 10 times
3. Total knee heal slide 10 times, use sheet as well x 10 times
4. Straight leg raise with sheet - 10 times
5 short arc quad- with assistance (towel at bend) -10 times
6. Hip/knee abduction- 10 times
7. Chair knee flexion- 10 times
8. Standing dynamic weight shift- lateral- 10 times
9. Gait- toe up- 10 time
10. Knee lift behind walker - 10
All these x3 a day and same done with PT
 

Josephine

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Okay
2. Percocet- OxyContin 5/325
Well it would help if you'd answered the question fully - what it actually asked was "how much are you taking (in mg please) and how often?" I really do need to know that otherwise everything else doesn't make sense.
3. Moderate- finally! Up to yesterday it was huge
Good!
4. Flexion- 90, don’t remember extension
Not bad! You can estimate extension yourself quite easily

1. put your leg on a bench, seat, bed, floor or anything similar but preferably something fairly firm.
2. with not too much pressure, press the back of your knee down - use your leg muscles, not your hand!
3. slide your hand, palm down, under the back of your knee
a) if you can get your entire hand under easily, it's probably about -10 degrees
b) if you can get just your fingers under, it's about -5
c) if you can get your fingers under but it's a push, it's 0
d) if you can't get your fingers under at all, it's +5 or more


Here's a graphic to explain the degrees involved

5. Yes, icing. Much more than I was. Doc suggested 30 minutes with 2 hours off. Other times I just have iced as much as I’ve wanted usually 20 minutes
You accomplish little or nothing in 30 minutes. Ice for at least 40-60mins and more than 4 times a day.
6. Elevation always when icing.
Same as above, with icing.
7. Activity level- up and walking around with walker maybe 5 minutes
Do you mean you're UP ever 5 minutes or that you walk for 5 mins?

Exercises on my own x 3 a day - once a day is plenty and none at all at the weekends!
1. Ankle pumps- 10 times - if you're up so often then you don't need to do these. They are only for anticlot purposes when you are not mobile
2. Quad sets hold 5 secs x10 - okay but do 5, not 10
4. Straight leg raise with sheet x10 times - tip: once you can do these, you don't need to do them any more, meaning never again!
5 short arc quad- with assistance (towel at bend) x10 - same as #4. Never again!
6. Hip/knee abduction x10 - these aren't really intended for knees, more for hips. So stop them!
8. Standing dynamic weight shift lateral x10 - same with this
9. toe up x10 - these are also quite hard on the knee and likely to cause pain
10. Knee lift behind walker x10 - well okay but 5 would be plenty.

3. heel slide x10 use sheet as well - heel slides are a very easy exercise to do badly and 30 times a day is badly! Read this Heel slides and how to do them properly. This is in your recovery articles!
7. Chair knee flexion x10 - you only need one flexion exercise so stop this one!

same done with PT - I'd not do PT. You really don't need it.

Have you ever counted up how many reps you are doing per day? I make it 270. That's an insane amount of exercising to do. I bet even professional athletes don't do that much unless they are building up to a meeting!

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.

So I recommend you cut down as I have suggested and rest a LOT more!
 
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Lynne Cleveland

Lynne Cleveland

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Josephine,
Thank you very much for responding in such detail. This has been most helpful!
Medicine- it is Oxycodone/Acetaminophen 5-325 mg. Take 1 every 4 hours. I have had to add
another Tylenol in between at times.
I know every surgery is different. This time it has been more painful than last time. It seems every time the PT has come out, I hurt badly the rest of the day! Yesterday, a new exercise she was trying to get me to do, I told her I couldn’t do it, it was excruciating. I had already realized last night that was enough! You confirmed it when I read your advice this morning. I am going to take it easier this weekend. Trying to focus on doing CPM and some of the exercises and only twice a day (maybe!) I want to do what I need to do to get better. But what I have been is not working. Leading to more pain, already trying to juggle nausea with the pain meds. They can’t give me a script nausea med as it is contraindicated with another med I take on a daily basis. Thank goodness this particular therapist is taking vacation next week. They are sending out someone else. She was constantly measuring, feel like it’s just some protocol she has to meet for her patients. I will not let the new therapist push me to that point.

Yes, I have already extended my time of icing/elevation.

I meant I was trying to walk up to 5 minutes when I could , when I did get up. No way was I getting up every 5!

I see my surgeon 10/4, 2 weeks and a day post op for staple removal and teleform (sp?) like a big bandage over knee. I’ll be updating him on this particular therapist!

Thank you, thank you!
 

Josephine

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Medicine - it is Oxycodone/Acetaminophen 5-325 mg. Take 1 every 4 hours. I have had to add another Tylenol in between at times.
That dose is not enough. You would be much better taking 2 tablets every 6 hours. You could also take one more regular Tylenol (325mg) up to 4 times a day. That would be 3,900mg per 24hrs. The safe maximum is 4,000mg per 24hrs
Trying to focus on doing CPM and some of the exercises and only twice a day (maybe!)
I have a better idea - don't use it at all!
I want to do what I need to do to get better.
What you need is to do NO exercising at all! 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.
Thank goodness this particular therapist is taking vacation next week.
Why don't you fire her? If you are concerned about refusing to do therapy, you need to read this Saying no to therapy - am I allowed to?
I meant I was trying to walk up to 5 minutes when I could , when I did get up. No way was I getting up every 5!
LOL! I can imagine!
 
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Lynne Cleveland

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18 days out- limited PT exercises with home therapist. I’m having a pain straight across bottom of knee and small area to the side. Mentioned it to therapist, of course it wasn’t hurting at that time, he didn’t seem concerned. Talked about different types of pain that come and go. This has been there now 2 days, later in day. I’m icing, elevating, walking some, doing PT exercises. So bad at times that walking with walker is very painful. This is new. I’m feeling somewhat fearful as my other knee had a revision year after knee replacement. Recovery has been normal- pain,swelling coming and going, etc. Nothing unusual, until this. Saw doc for 2 week check and had staples removed this week. Of course it was not doing that then! Has anyone has something similar?
 

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@Lynne Cleveland
Just to butt in here but you are still very early after your surgery. You are having lots of pain with your current regime. What about having an almost total rest from exercising - just walking around the house would be enough - and see how you feel after a few days rest, ice and elevation. It seems what you are doing now is not working for you. My PT ( physio in UK) said if anything I did hurt or caused pain after, not to do it again. It's worth a try and might reduce your pain.
 

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Hello @Lynne Cleveland. Yes I know what you are talking about. My RTKR was Sept. 18th. You are going to feel nerves wake up. Muscles wanting to spasm and be upset at the exercises that you are doing. I had the same issue this past week. I stopped all stressful exercises. I did the ice and elevate and meds like the first few days of home from the hospital. It has worked very well. My pain is down and swelling and redness is also down. The knee is very happy right now. I slowly added a few of the exercises I knew I could handle without pain.
 
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Lynne Cleveland

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Thank you both for your encouragement! Husband just advised do one exercise and wait, see how my pain level is after a period of time before trying another.

It doesn’t start right away but hours later. I just have been able to do a straight leg raise, not very high. I wonder if this is it, knee wasn’t ready for this. It feels tight as I do this, pushing through it but not painful at the time.
 

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