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TKR with Rheumatoid history

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dms1808

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So I made it home last evening after just two days in the hospital. I was amazed at how good things felt both knee and head after all I went through. My procedure was done with a regional nerve block three fold. Implanted catheter for the front of the knee, block in the rear, and epidural for the procedure. This meant I was much more coherent shortly after procedure and I was in control of my faculties. I was up on my knee within 14 hours, (Cemented). Doctor commented on how bad the knee looked when they went in which has played into my biggest issue right now. Swelling. Its pretty big and restricts my ROM, First day we tried the CPM I was able to get 0° and 90° the next day lucky to get 80°. We want to get three hours a day to keep buildup at bay given my rheumatoid.

My question to all out there is what has been experiences with TKR and Rheumatoid. I have had to be off my RA drugs for two weeks and flares have come on, and I have two weeks before I can get back on meds. Once I get back on meds will my swelling change dramatically?
 
Hi Welcome glad it over for this most part..............The selling will do that but n time it will go down and you will see such a difference ice ice Im sure you have heard all of that...........are you allowed to take anti inflammatories didnt know if that was the drug you were talking about that works good with swelling........hang in there ........it really gets better........sorry your arthritis is giving you so much trouble why cant you take it.Sorry i dont know alot about R Arthritis.......but i do wish you the best.
 
Welcome . You wil have to wait for our wonderful Jo to answer the medical question, I guess. Unless we have some other rheumatoid patients on here. Glad everything went smoothly though. Do spend a lot of time icing and elevating. When I had my hip replaced , both legs down to my toes swelled incredibly. Laying in bed over a weekend got rid of the majority of swelling. I have a muscle inflammatory disease, which was undiagnosed at the time, but probably contributed to the swelling madness.
Good luck , rest and elevate and ice and take meds and stool softeners
judy
 
Welcome! I would bet some of our folks here on BoneSmart have experience RA. I am glad you are doing so well...keep up the good work
 
Welcome dms!
I'm glad your surgery is over and you are doing well. I agree the swelling is a problem and often is a cause of pain. Lucky thing is that the swelling doesn't last forever. Use LOTS of ice and elevation when possible. The CMP machine will also help with the swelling because it keeps the knee moving. Just don't overdo it at this point. I don't know what your schedule is, nor do I know which medication you were on for your RA.
The main problem with TKR's and RA is that most RA folks have softer bones so I'm sure that's why your surgeon used a cemented prosthesis .The harder the bones are, the better the prosthesis will bond. It sounds to me that your OS has a lot of experience with implants and he's well aware of your RA problems.
Jo will be on later and give you more info I'm sure. For now, you really need to ice and elevate. If you have to lay on your back and put your foot and leg up on the back of the sofa for elevation then do so. Try to get your knee above your heart, then add ice packs or whatever you're using. Much luck to you and please let us hear from you often! We do care!
Blessings to you!
Nancyo
 
An interesting find last month was the fact that my Vitamin D level was very low. Apparently the RA medicine effects the absorbtion of Vit D and we struggle to keep it up. But no fear I found out about it prior to my operation and hopefully I'll have stronger bones from the finding.

RA drugs fight the immune system and my defense against infection is lower because of it. Stopping the drugs for a while hopefully gives me enough defense while I recover.

I was given Celebrex in the hospital but no mention at home. I'm waiting for the Dr to call and see if I can take it again since they already have me on Lovenox. Strange to understand motion helps inflammation but the more I move it the better it gets.

Hopefully all my stars will align here shortly. Ice on 20 off 10 is my mantra for now.
 
Hi, DMS....welcome to BoneSmart. Glad you found the forum and we'll be here for any support that you need during recovery. Our forum nurse, Josephine, is the best person to talk about the relationship with RA and joint replacements. She has a TON of experience in this area.

I'm glad you are icing and hope you are doing it not only during the day but also at night. If you have access to an exercise bike, that many times is a good form of exercise for a new knee. The reason activity is helping, I think, is because as your muscles move, they force that fluid (swelling) to move around and dissipate in your body. So while it's good to rest and elevate, it is also good to balance that with some activity.

You are so new into recovery....don't feel like you are in a race to get better. Your body has a lot of healing to do and it just takes a while!
 
Hello again dms,
I'm glad that you posted again so soon and I"m very glad to hear that your contacting your OS about the Celebrex. A great medication. It sounds to me that you are doing your very best to follow "Doctors Orders" and I do understand your wanting to be back on something for the RA as soon as possible. Those flares are no fun at all.
May I ask if you also have RA in the hips?
I know your going to be surprised at how much pain relief you get from having a TKR and your weight bearing will be much less painful, When the surgical pain is gone, that should be it for the knee pain. Most of the time, this surgery will stop the bony destruction associated with the disease. Your ROM will increase with your PT. I know how very painful RA can be and what a big step it is to have this surgery. Your knowing about your Vit D before hand was also a very good thing to find out. Improvements in this area will certainly help.
Please keep us up to date about what's happening with your recovery. You are doing so very well, and as Jamie says.. Don't be in a hurry! Your body has been through a lot with this surgery and it will take time. Let us hear what's going on!
Blessings~~
Nancyo
 
Hello, dms. You know that swelling is a big issue with TKRs and can be both troublesome and persistent. So what the others said is good advice - elevate, ice, control the pain and rest lots between the PT. Oh - and don't overdo the exercises!

As for you RA meds, it rather depends what they are. Steroids are anti-inflamatories of course, so they can help some. But that's about the extent of my knowledge there, I'm afraid. In the OR, the only pharmaceuticals we delved into were pain killers!
 
Hello!
I have rheumatoid arthitis and had my left hip replaced 3 months ago. I am recovering really well and looking back I think that the worst part was being off my RA drugs for 10 days before the surgery and 3 weeks after it. I had major flares on almost every joint affected and I was really depressed and frustrated for not being able to use my new hip because of pain on my knee, ankle etc. Walking even short distances inside the house was impossible cause I was unable to use my crutches since I would be in pain in my shoulder and both wrists.
However, when I was finally allowed to take my medication (Enbrel-have you heard of it?) everything changed within 1 day!! It was unbelievable and since then I've been feeling really good and almost pain free. I'll have fluid removed from my left knee next week but apart from that everything is going great!
 
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