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TKR Very challenging Left TKR

CapnRic

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I am pre-op but I think my questions need to be answered by you folks in post-op. My Dr is not the best communicator but he is highly regarded as a joint surgeon. I suppose I am not hiring him for his personality-more for his talent. However good as that is, I feel woefully unprepared for what is coming. I have had 4 arthroscopies over the years (2 on ea knee) and they finally gave out. I used to be an avid long distance cyclist in the 90's but work, etc, blah, blah got in the way and I stopped riding and put on a lot of weight. I was 350, now 305, I look forward to riding a bike again, I like the rotation of the knee.

I am so glad I tripped over this forum. I can't express how much I appreciate not feeling alone anymore in this journey.

Well, I have my surgery on Thursday and I'm a little freaked out as I get closer. I am not very good with pain. My Dr. gave me some 5mg Oxycodone but from what I hear that might not get the job done. Not sure how I am going to handle it. They are late on arranging my physical therapy, insurance Preauthorization is a real pain. I have a spouse to help me. I have a few questions about post op.

1. How many people stay in the hospital vs going home same day? If you did, how long? Was it your decision? Why did you stay over?
2. What kind of pain management were you given for time at home?
3. Do any of you use one of those small cycling/pedal devices? If so, when did you start using it? When did you start using the pedal device?
4. What kind of in home physical therapy were you given? Did someone come to your home? Did you use one of those automated knee flexing devices?
5. Is it normal to be able to walk the first day? I saw the list on Activities of Daily Living, that is helpful, how real is it?
6. Based on all the info on icing, I just ordered an ice wrap w/compression on Amazon, hopefully arrives before I come home.
7. My surgery is at 3pm, probably won't be out of post op recovery until 7-8pm so I just can't see going home that night - any thoughts or suggestions on this? My Dr changed the operating time from mid day, I have a feeling that is what he is intending. He said "you can't go home until you can walk to the bathroom and to the door of your room" (obviously with a walker). What are your thoughts on this?

Thank you all in advance, again, I am so appreciative to not be alone in this anymore.
 
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Cjackso21

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Hi, hope all goes well. I have had to stay overnight most times mainly due to dizziness and nausea but last was because I did both knees at once. I used Tramadol, everything else made me feel too wacky. I have ranged from 2 weeks - 2 months before I could get my knees bent enough to use a stationary bike, never used any other cycling device. Home PT came to my house for many surgeries for about 2 weeks then went to PT. Used a CPM (continuous passive motion) machine many times years ago but seems they have stopped using these at least for me. I was able to walk on first day almost every surgery but was usually too dizzy to continue. Your ice wrap/compression will be your best friend. I rented one and wish I had purchase it. The best position for reducing swelling is using a 0 gravity chair and the ice machine. Don’t rush going home. I would suspect they would not have you go home that late. Remember to listen to what your knee and body is telling you. Good Luck!!!
 

Jockette

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I will leave you our Recovery Guidelines, so you can read up on them before your surgery. I’ll answer your questions in my next post. Each article is short but very informative. Following these guidelines will help you have a less painful recovery.

Just keep in mind all people are different, as are the approaches to this recovery and rehab. The key is, “Find what works for you.“ Your doctors, PTs and BoneSmart are available to help, but you are the final judge as to the recovery approach you choose.

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
ice
take your pain meds by prescription schedule (not when pain starts!)​

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

6. Access to these pages on the website

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 the 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 the member’s history before providing advice, so please post any updates or questions you have right here in this thread.
 

Jockette

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1. It seems one day surgeries are very popular these days, but they will not send you home if you’re not deemed ready. My surgery was 4 years ago, so that wasn’t an option for me. I stayed one night.

2. Pain management varies for each of us and doctors are under a lot of pressure to prescribe as little as possible, for as short as possible. Some/most will renew a prescription even if they originally say they won’t.

There are other ways to control pain besides prescriptions. Check out the article in the guidelines. The ice machine you have ordered will be very helpful. Use it as much as you can, 45-60 minutes at a time, always having a cloth between your skin and the cold source.

Another way to not increase your pain is to keep your activity low for a while. In the beginning, the more you do, the more you’ll hurt. This includes the list of exercises you will most likely be given. You do not need to do a list of exercises. In the early weeks all you need are gentle bends and short walks around your house. Most important of all, don’t allow a PT to bend your knee for you, too many PTs feel they need to push a bend way past what you can comfortably do yourself, and this will not help you heal. (Been there, done that, and I will never allow that again! )

3. A cycling device can be helpful, which ever kind you like. I would wait a couple of weeks before using one.

4. Many of us have PT come to our home for a couple of weeks. For some reason I did not qualify, I stupidly went to an outpatient PT appointment 2 days after surgery and it was an extreme effort for me, but I did what I was told because I didn’t know any better. I do know better now!

And, again, you do not need to do a list of exercises with a PT, but that seems to be the focus of many of them. If any PT causes you additional pain, wait a few weeks before trying that exercise again.

Some doctors still use a CPM machine, but not that many anymore. It doesn’t make a difference to the outcome.

5. Yes, you will be able to walk the first day. I was up and walked to the bathroom (in the room) within a few hours of surgery. Your new knee will be strong, you can trust it.

6 and 7, Pretty much answered these questions above.

Best wishes, relax, let your body heal, trust that it will know what it’s doing, go with the flow, etc. You’ll do fine and we’ll always be here for you!
 

hawk2go

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Hi @CapnRic - I understand your anxiety. There's a lot to consider. I recently had my 2nd knee done and didn't have any serious problems with either, so can honestly say the pain of recovery is very real but far superior to the pain of deterioration.

1. I stayed in the hospital 2 days because, although I was up walking the day of surgery, once the post surgery nerve block wore off, I could not do the PT required to get out of the hospital.
2. They loaded me up with all kinds of pain meds, designed to hit every pain source angle. Make sure to work with your care team to find the combination that works well for you. It is a challenge but I assume you've been dealing with pain for years. The likely probability is that post-op pain will be managed for weeks maybe months.
3. I have a floor pedaler but have been hesitant to use it, yet. I plan to try it this week (in my 6th week). As a biker, you may have better experience.
4. My PT came to my home to assess me the day after I arrived, along with my occupational therapist and my nurse. PT came 2-3x a week and discharged me in my 4th week. I declared from the start, nothing aggressive and I won't push to the point of pain. Feel free to read my thread for more details.
5. I walked the day of surgery and every day after that. I have stairs to get into my home, so they wouldn't let me leave the hospital until I could safely do stairs. The 1st week out, I scrambled 2 eggs and was sweating like a top chef. Slowly I have been able to add ADLs - I made the family dinner last night with no ill effects.
6. Also order some of those longer lasting "ice" inserts, if you can unless you got the wraps that are all-in-one. When frozen, they last a lot longer than water so you don't have to switch out as often.
7. Work with your care team, everyone really is different and it depends on overall health, pain tolerance and mobility. My CNA, RN, OT and I agreed that I was not ready to leave the hospital as originally scheduled but 1 day later, boom, I was ready.

I hope this is helpful. We're here for you when you need post-op support.

eta: I have never used a CPM, just did my own gentle heels slides whenever I thought of it.
 
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Claire56

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Hi, I had surgery in the morning and stayed overnight. I may have been able to go home that evening but am glad I didn't. I was under the impression that it was my choice. I think my pain level was the worst that first night and I was able to ask for help getting it under control. I am pretty pain tolerant and only took oxycodone twice once I got home.

I was instructed to start using the exercise bike right away but to set the seat as high as possible, resistance to zero and just rock the pedals as far as I can. Once I could do full rotation, lower the seat. Repeat. My OS puts a lot of emphasis on using the exercise bike.

I was given a list of exercises but am not getting any formal PT.

Currently at almost 8 weeks, I am no longer taking any of the medications that were prescribed except for a baby asprin. Icing mostly after exercising. I am still using a cane when I go for a walk but mostly for security. Range of motion still has a ways to go but it was restricted due to bone spurs pre-surgery.

The biggest thing that I have taken away from reading this forum is be patient with yourself.
 

MARYCOOL

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Hi there and welcome! This forum really helped me get through my TKR! I am 7 months out and have my second one scheduled next month.
The anxiety you are feeling is normal, you're going to be fine!
My OS gave me percocet, which made me nauseated, so switched to vicoden.
I spent the night, did a walk and stairs, was released, came home with hubby to my daughter waiting, with everything set up! The ice machine, the cpm and a nice wedge so I could sit up in bed. The ice machine was key, it keeps circulating nice and cool! Also, a toilet seat riser is very wise, as our toilets aren't very high.
They had me start PT the day after I got home, but this time around, I will wait 4 or 5 days, just to get some healing started.
I have an exercise bike, and within the first month, I was able to do rotations.
Everyone is different, but the plusses outweigh the negative by far. Hang in there, keep us posted and be well!
 

sistersinhim

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I stayed in the hospital 2 nights due to dizziness and being alone at home most of the time.

I was on Oxycodone 5mg for the first 3 weeks. Then I tapered off of it with Tramadol. I far prefer the Tramadol/Tylenol combo to the Oxy. With the Oxy, brain fog, nausea and constipation make it undesirable for me.

I was told to stay off of my recliner bike until my 4th week. Then I could only do back and forth until a few days later. I limited myself to 5 minutes the first week of complete revolution.

I had one day of home PT and then no more formal PT at all. My daily activities were all I needed.

I walked the first day. With the IV fluids flowing, my bathroom trips were frequent! The nurse eventually brought me a potty chair and put it right next to the bed. That was much better.

I had an ice machine that I used the whole time I was sitting or laying down for the first month. I used bottles of frozen water instead of ice. They lasted much longer. Keeping a cloth between me and the baffle was constant. You can not over ice as long as your skin is protected.

Don't go home until you have no dizziness, you can walk with your walker and you have your pain under control. It's best to have someone with you those first few days if possible. If not, be extra careful and walk very slowly!

We're here for you and pray that it's a successful surgery.
 
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CapnRic

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What about cement? MY Dr plans on not using cement. What are people's experience with and without cement short term and long term post op?
 

hawk2go

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My doc used cement on both knees. I'm not sure what dictates use or not use though it may be related to the make/model of the knee. You will find there are wildly different experiences and protocols between surgeons, hospitals and countries. Ask your doctor why he uses his protocol and to clarify the risks.

eta: every time I see my doctor, for the last 7 years, I take my list of questions. During my 1 month check-up, he asked "ok, where's your list?" - hahaha, I trained him.
 
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Susie-Q

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1. My first knee, 11 years ago, I stayed in the hospital 2 nights. This time they offered out patient but that scared me so I thought I'd split the difference and stay 1 night. Well, Covid changed those plans and they said if I wanted to keep my same surgery date that I needed to go home the same day. I passed PT and OT and was sent home around 6pm even though surgery was around 10am.

2. I had a nerve catheter in my upper thigh that really helped with the zinger pain that lots of people get going over the top of the knee. I took it out after 5-6 days when the medicine bulb I had to carry around was finally empty of medicine. Otherwise I took 5mg of oxy, the first week I was taking 2-3 of those every 3-4 hours along with alternating Tylenol and Advil every 3 hours around the clock. Every one is different, some need less pain meds, some need more. I eventually tapered off the oxy completely by around week 4. For constipation, take miralax, stool softeners or I found the Smooth Move tea you can find in your grocery store to be very effective on it's own to keep things regular. Someone on Bonesmart recommended the tea, excellent! :thumb:

3. My surgeon recommended a stationary bike but PT didn't have me using one until just the last week or two (I'm 6 weeks post-op). We bought one and have it at home now, I just started using it. I can't go all the way around yet, only back and forth.

4. No in-home PT for me this time but I had it for 2-3 weeks with my first knee. No CPM this time but I had it with my first knee. My surgeon wanted me to go to PT at 7-10 days post-op. I waited until 2 weeks after. With my first knee I was at least 3 weeks post-op. Not sure why they want to rush it so much these days.......

5. Yes, you will be able to walk the first day or they won't discharge you. You will definitely need a walker or crutches for a week or two. Walking to the bathroom and to and from the bed/couch is all you should be doing for the first week or two.

6. Ice will be your best friend, use it all day whenever you are reclining in bed or on the couch. I had an ice machine for at night in bed and ice packs for daytime on the couch. I still ice whenever I'm on the couch (like right now)

7. With your surgery scheduled that late in the day I would assume you will stay the night.

Good luck and let us know when you get to the other side! :prayer:
 

Abbylayla

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My surgeon does surgery on Wednesday's and assuming no problems release on Friday. That was my schedule.
Was in horrendous pain after nerve block wore off. They put me on a Dilaudid/Tylenol IV and pain was gone in a minute.
When I got home I used Oxycodone. My pain was very controlled with it. I found Tramadol to be a step above an aspirin.
After two weeks I felt well enough to meet friends at a restaurant for dinner.
I had easy PT at home but could not handle the out patient PT because of my hips. So I quit after 3 sessions and continued my own none weight bearing PT at home. Very east exercises. My knee is just as good as those who did months of PT.
There's definitely challenges to this surgery, I mean, it's certainly not something we'd want to do if it wasn't absolutely necessary. But I remember feeling that it wasn't as bad as so many people said it would be.
I hope this helps!
 
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CapnRic

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So I wake up in recovery and there is no spinal block or local block on my leg. I can’t describe the level of pain or horror I experienced. I immediately told them and they said I metabolized it because of my anxiety. “So calm down sir”. I thought I was communicating with my eye as big as dinner plates looking at them. Yeah, right. I just woke up. How the help did I metabolize a nerve block

I have been in continuous pain. Anywhere from a level 3 to 10 or more. I can’t raise my leg without using every ounce of drive I have and then I’m causing even more excruciating pain. Walking helps with walker but even too much of that sends me into deep pain. I’m just waiting for my knee to buckle. Using cryo therapy, it helps reduce swelling. The the skin on the outside part of my knee is tight as a drum. Loose everywhere else.

I stayed in the hospital and they started me with 10mg of oxy. Didn’t touch the pain. Pain was enormous. I finally got someone to give me 15 mg and it helped but still had shooting pains from foot to thigh. The solution oils have been 25 mg is my guess. They would not do that so Then I asked for hydromorphone and they gave it through IV and it worked for 3 of the 4 hours between injections. Why can’t I have 4 of 4 hours with reduced pain. Why just 3? On discharge they give 2mg every 4 hours. I’m in too much pain to effectively do my PT. Knee feels like ground hamburger with lightning bolts. I don’t expect to be pain free but this isliterally driving me to insanity and depression. I wish I never did this. Been 5 days now. Constant pain. I’m in so much pain sometimes I’m sobbing uncontrollably. What a nightmare.
 

Jockette

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I’m so sorry you’re not getting better pain control. Doctors are under a lot of pressure these days when prescribing pain medication, which doesn’t help those of us who need more than others.

Are you icing and elevating? Ice can help the pain, and after a surgery like this you can ice as long as you want, as long as you keep a cloth between you and the ice source, to protect your skin.

Elevating can be uncomfortable at times, this early in recovery, so alternate your position as necessary. Many of us are told to keep our leg straight, but a slight bend is ok and much more comfortable.


I’m in too much pain to effectively do my PT.
Don’t worry about the exercises right now. All you need are gentle bends and short walks, which you get just walking to and from the bathroom.

Ask your doctor if you can take Tylenol along with prescribed medications, many members find adding this is helpful.
I don’t expect to be pain free but this isliterally driving me to insanity and depression. I wish I never did this. Been 5 days now. Constant pain. I’m in so much pain sometimes I’m sobbing uncontrollably. What a nightmare.
Being overly emotional is very common after this major surgery. Here’s an article from our Recovery Guidelines about it:

I hope things ease up for you soon. Continue to be in contact with your surgeon’s office about your extreme pain level.
 

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I believe you stated you are over 300 lbs. It appears that the MD's are not taking that into consideration when prescribing your meds. I was 145 lbs at surgery (lost 8 lbs since due to pain!) and 5-10 mg Oxycontin was prescribed to ME post-operatively. You definitely need more!
I'm so sorry to hear of your pain. Please call and possibly ask if they have taken your weight into account when prescribing?
I pray you get relief soon!
 

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I am so sorry you are going through this. Call your doctor and let them know what your pain level is, tell them what you are taking and ask what you can supplement with over the counter. Make sure you elevate above your heart a couple times a day, you cannot do this sitting. Ice is your best friend. I also had horrendous pain after surgery hang in there it will get better.
 

Susie-Q

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I'm sorry you are having so much pain. I hope you are able to get some help from your doctor, ASAP! Please call them and tell them what is going on. You should not be just sitting there suffering.
 

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Please do contact your surgeon about your pain levels. Once you have a pain storm like you're describing going on, it's much more difficult to bring things under control. It actually takes more medication to do get it in line than if you just took the meds on a regular schedule every 4 hours.
 

sistersinhim

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You can not ice or elevate too much! Ice is a great natural pain reliever. I iced and elevated the whole time I was sitting or laying down. I used the Lounge Doctor for a correct elevation, (Lounge Doctor). Getting some of that fluid out will help with your pain. Exercising isn't necessary, especially this early in your recovery. Just walking to the bathroom, kitchen or bedroom is enough for now. As you heal you'll be able to do more naturally.
 

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Definitely get your surgeon to listen to you and prescribe the appropriate meds needed for your pain storm. I had to temporarily increase my meds once the initial injections from surgery wore off. I too was sobbing from the pain. The jolts of stabbing pain came later and increased with exercises. Dr. just added gabapentin for the nerve pain. Not sure how well it works since I just started it. Get your surgeon to listen to you...my thoughts and prayers are with you.
 

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