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TKR Vinca’s hinged knee recovery

Vinca

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Well, I survived! Still feeling rough tonight. Stayed in the hospital last night and suffered a lot. There was only one nurse for 34 patients and it took her an hour to bring me pain meds or a blanket or anything. I was in tears several times.
Came home today and it still hurts a lot, even with ice and elevation. To add insult to injury, my left foot has quit responding and wants to drag. I can’t flex it back at all, but I could do it this morning. It just suddenly quit working.
Did PT this morning (my foot messed up before this) and they said I did well, so that’s one good thing. I hope it settles down some tomorrow and quits hurting so badly. I’m on Percocet and Celebrex, seems like that should be enough...
Haven’t had hardly any sleep, so I can’t write very well- sorry for my negative outlook! Surely it will improve.
 

_Lisa_

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Hi Vinca!

I’m sorry you are having such a rough time. Don’t apologize for being negative—the first few days are really challenging. The lack of sleep makes everything even harder. Things will get better! There are many knowledgeable people on this forum, so I’m sure you will get excellent advice and support. You might want to call your surgeon tomorrow if your meds don’t keep the pain at manageable levels. I’m no expert—but that’s what I would do. Take care! I hope you can get some rest very soon!

Lisa
 

Jockette

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I agree, if your medication is not helping, call and ask for a change. I also agree that it’s hard to cope when we haven’t had enough sleep, even without being fresh out of major surgery.

I‘m sorry you had such a rough beginning. :console2:

I will leave you our Recovery Guidelines. 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.
 

Jamie

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Welcome to recovery.....even if it is a bit rocky right now. Hopefully a few days resting at home will see things start to improve for you.

Be sure you're taking something for your pain on a regular schedule. Celebrex isn't really a pain medication, but it can help with inflammation and swelling. Be sure if you are in pain that you take the Percocet on a set schedule as prescribed on the bottle. If you wait until you feel pain, it actually takes more of the medication to do the job. You'll be a lot more comfortable on a set schedule.
 
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Vinca

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Thanks for the encouraging words.
I’m taking the Percocet as prescribed, every four hours, but it only works for about two hours. Then I just wait and suffer (and use ice packs) until I’m allowed to take more. I’m wondering if it just doesn’t work well for me. Or maybe everyone goes through this.
I always thought I had a high pain threshold- maybe not.
 
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Vinca

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Day 3: I might be feeling a little better. At least I’m not yelping in pain every time I move my leg.
They say not to stretch your pain meds out, to stay on top of the pain and don’t let it get bad. But in my case, it’s almost always bad. I get a couple of hours of feeling sort of ok when I take a pill, then it’s back to agony and waiting till it’s time for another.
The problem with asking for a change is that I will have to go pick up the RX at the doctor’s office an hour and a half away and then wait at the pharmacy until they can fill it. I’m just not up for sitting that long right now.
So I’m hoping the pain decreases to a point that the Percocet works better. We’ll see, I guess! (Sorry for the constant complaining.)
 

beesknee

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Day 3: I might be feeling a little better. At least I’m not yelping in pain every time I move my leg.
They say not to stretch your pain meds out, to stay on top of the pain and don’t let it get bad. But in my case, it’s almost always bad. I get a couple of hours of feeling sort of ok when I take a pill, then it’s back to agony and waiting till it’s time for another.
The problem with asking for a change is that I will have to go pick up the RX at the doctor’s office an hour and a half away and then wait at the pharmacy until they can fill it. I’m just not up for sitting that long right now.
So I’m hoping the pain decreases to a point that the Percocet works better. We’ll see, I guess! (Sorry for the constant complaining.)

I am on my last 3 oxy. I have had 4 refills of 30 5mg, all electronically. I like to take 2 oxy just before rehab and one after. Early on I was taking 5/6 a day. I am going to see if I can get one more refill but am thinking it will be denied or I will get a call from them and have to beg. Fortunately, so far there have been no questions on refills.

I think one more refill would get me past the worst of this. To bad the addicts ruined pain killers for those that need it. I don't see the attraction. Sure, maybe the first time you take it you feel real good mentally. But after that it just helps kill some of the sharp pain.
 
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Jamie

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@Vinca .... What is the dosage on the Percocet bottle? (1-2 pills every 4-6 hours is the normal recommended dosage) What are you taking every 4 hours?

Also, what is the strength of the Percocet (the label should say something like 5mg/325mg APAP)? It's possible that a higher dose would work better for you.

I suggest you call your surgeon's office and let him know your problem with the prescribed pain medication. There are lots of options to help with pain in these early days. Trying to just tough it out isn't good for you or your knee. It's also possible to contact your GP for a prescription if that doctor is closer to you.

I understand your problem with having to go in person to pick up the prescription. Although beesknee is fortunate to be able to get his prescriptions without a personal appearance at both the surgeon's office and the pharmacy, that is not the norm in most places. When the FDA tightened rules on controlled medications, most surgeons and pharmacists require you or your designated representative to physically pick up the prescription and deliver it to the pharmacy.

Once I know exactly what you're taking, I may have some options for you to discuss with your doctors.
 
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Vinca

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@Jamie, it’s 5/325, one every four hours. I’ve been wondering if I’m some sort of outlier for whom narcotics don’t work very well. I had tylox when I broke my fibula- that’s the only other time I’ve needed them. I think the tylox worked well.
I looked at the doctor’s paperwork. It does indeed state that we have to come pick up the prescription. The first Rx is for 10 days and they won’t allow another one until the tenth day. Wonder what happens if the 10th day is a Sunday? And we can only ask for a refill on mondays and Wednesdays when the doc is in the office. sheesh.
2nd Rx is for 7 days- after that it changes to something non narcotic.
They are really really afraid we’re going to abuse drugs... I’d just be happy to have a 2-3 pain level.
 

Jamie

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Well, for one thing, you can dispute those guidelines with your surgeon. They are not mandated by the FDA and if you're in pain, you're in pain! Don't hesitate to be a bit assertive with him.

You are on just about the mildest dose of Percocet possible. Many surgeons will prescribe 1 or2 pills of the 5/325 every 4 hours for at least the first week.

But here are a couple of things to try:

- Be sure you are icing your knee front and back as much as possible. Put a towel between the ice source and your skin so that you protect it from freezer burn. Ice is a wonderful pain reliever. You can even ice during the night while you sleep. Be sure to elevate your leg when icing....that helps too.

- Each Percocet pill has 325mg of acetaminophen in them. If you take 1 every 4 hours, that's a total of 1950mg of acetaminophen in 24 hours. The limit is 4000mg for 24 hours. You could take a 500mg Extra Strength Tylenol at the 2-hour mark if the pain returns as long as you don't take any more than 4 of these supplemental Tylenol doses in any 24 hour period. That would put you just under 4,000mg. One caveat, though.....you must also count in the amount of acetaminophen in any other medications (over the counter or prescription like allergy or cold and flu meds) you may be taking in your total AND you need to not have any kidney issues that would keep you from taking acetaminophen.

- Another alternative would be to get a pill splitter and cut the Percocet tablets in half so you could take 1/2 the dose every 2 hours instead of the full dose every 4 hours. You could still use the 4 Extra Strength Tylenol for any breakthrough pain (as described above) as long as you don't go over the 4,000mg a day.

- If you're still having pain issues and your surgeon won't fill your Percocet prescription, you can talk with your GP about a prescription.

- If none of that works and your surgeon is adamant about stopping the Percocet, ask if you could use Tramadol to counter your pain. It can be used on a schedule with Extra Strength Tylenol and can work quite well to keep pain at bay. Tramadol is a narcotic, but it is not on the list of controlled substances like Percocet is. Most surgeons will agree to let you use it for a while as a "step down" from the controlled narcotic drugs. You could also ask your GP about Tramadol if the surgeon is uncooperative.

Let me know if you have any questions about the options I've provided. We need to get your pain under control.
 
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Vinca

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@Jockette, thank you so much! I’ll try the extra Tylenol today. I’m also going to call the OS office and see if they’ll give me any options. I’m not an aggressive person (and I’m very conflict-averse) and I’m afraid they’ll label me “drug-seeking” and cut me off completely. Plus, I’ll probably cry. But something has to change!
I’m icing and elevating most of the time, but getting up and moving around the house for 5-10 min every hour. Today is the last day I’ll have my grandson, so activity is going to increase a bit. Just for the record, I don’t have any kidney problems and am a normal BMI. No health problems at all and I’m not on any regular medication. Well, I was healthy until my knee fell apart. Lol
I might have my son get me a pill cutter. But, honestly, I’ve been wondering if I should skip a dose of Percocet, just to see if my pain gets worse. But there might be some placebo effect from taking it, so I’m not sure.
In other news, my operated foot has decided to develop foot drop. Yay. I could flex my feet right after the operation, but the next morning my left foot went numb on top and I can’t flex it back. Can point it a bit. So it drags when I’m hobbling around with the walker. I thought maybe the swelling has pinched a nerve? Will ask PT. Even though I had decided to avoid PT, I need advice on this.
Sorry for the length of this. Guess I had a lot on my mind!
 

Sisterpat

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My Sister had a little bit of foot drop after her TKR. What helped her was to take a belt and put it around her foot and GENTLY move the foot back and forth to exercise the muscles. Foot drop is a possibility after TKR and she was warned of this. This is NOT the same as people who advocate using a strap in PT to force the knee to flex! That is totally counterproductive and should never be done. This is just a way to move your foot back and forth to strengthen the muscles. It is actually a nerve problem which causes foot drop and hopefully, that will resolve in time. But strengthening the muscles will give you a bit of an assist.
 

Jockette

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I hope the Tylenol helps you, but it was actually Jamie who explained about it, but I do agree with everything she said.

SisterPat has some very good advice for your foot drop. And your thought that swelling is the reason is probably right. Be very cautious if you choose to involve a PT, as some of them tend to go overboard with “strengthening” especially this early in recovery.
 
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Vinca

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@Jamie, I’m sorry I got your name wrong! Thanks @Jockette for pointing it out. Not sleeping is making me slow and sorta stupid.
Thanks for the foot advice @Sisterpat! I’ve actually been using a bathrobe sash to pull my foot back a little- it feels good, but I didn’t know if I was hurting anything. Did your sister’s foot drop resolve without surgery!
I thought I would give the PT one shot. I’ll fire him if he hurts me. Heck, I’ll probably fire him anyway and go back after I’ve healed a lot more.
 
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Vinca

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Did her foot drop resolve without surgery, question mark. Not exclamation point. Gah.
 
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Vinca

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Waiting for OS to call back and talk pain meds. Tried a Tylenol at the two hour mark (1.5 hrs ago) and I think it helped.
I also talked to the PT to set up home care. Told him how I felt about how tissues need to heal before aggressive PT and that I am being active, not just lying on the couch. And he said (y’all are gonna love this) that if I had been in a car accident and traumatized my knee, the correct treatment would be to let it rest and heal. BUT, he said, this is not the way to treat a knee replacement. After knee surgery, he said, it’s important to get in there and work it so it heals correctly. Okay then. Pretty sure I’m gonna cancel the appointment tomorrow.
(He also said he’s waiting on a Covid test to come back, since he was exposed. I asked if he was vaccinated and he said no, but he wears an N-95 in people’s houses. That right there is the real deal-breaker.)
 

Jamie

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I think your idea to cancel the appointment with the therapist is a good one. You don't need someone who potentially has COVID, is unvaccinated, and thinks the body can recognize when it's been injured in a car crash versus surgery and adjust it's healing accordingly. Trauma is trauma. I'd say "Three strikes, you're out!" When you are ready for therapy, you can search around a bit to find someone who meets your expectations.

You mentioned having your grandson. I know that sometimes there are requirements a person must meet, but I must let you know that it's not usually a good idea to be a caregiver when you're trying to heal from a knee replacement. This adds extra stress and activity that could be part of your pain problem.
 
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Vinca

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Grandson is 14. He can cook a little, vacuum, take care of the cat, etc. He’s good company, too. Mostly he just plays on his computer, but jumps up immediately when I call. Also, he’s strong enough to lift me if I fall. :)

I’m so glad you agree about the therapist! Covid cases are up in our area- it would be too stressful to have an exposed unvaccinated person in my house.
I’m feeling pretty good this afternoon- got three hours of sleep and, thanks to Bonesmart, I have a Tylenol technique to augment my pain control. Very nice...
 

Jockette

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That is so nice that your grandson is such a help and willing to be with you!
 
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Vinca

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I am very lucky. My son and daughter in law live about five minutes away. I’ve kept their kids about twice/month since they were little. So blessed to be part of their lives.
 

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