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What is the best case scenario for walking unaided

Discussion in 'Knee Replacement Pre-Op Area' started by robert johnson, Jan 1, 2019.

  1. robert johnson

    robert johnson member
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    When I first heard of Outpatient TKR (I got an email about it from my Orthopedic Center), I thought for sure they must have revolutionized the operation since I had mine in 2010.

    So, I made an appointment to go talk to my OS about it to see what the operation was like that enabled them to do it as outpatient surgery. I asked my wife to come so we didn't miss anything. When I asked him what they did, he quickly told me it was the same operation, with the addition of a pain cocktail injected into the knee at the time of surgery that kept you pain free easily into the next day.

    When we pressed him on whether they're really willing to go home the same day (I was in Hospital 3 days my first op), he said, oh yeah, we're not kicking them out, they want to go home. Apparently, they've done hundreds of them like that.

    We forgot to ask what happens when all the pain relief wears off, but I guess it's predictable after having the two biggest bones in your body sawed and shaped and what else they do to your muscles to accomplish it. I think it's safe to assume all those people went directly to the pharmacy to fill prescriptions so that they were ready.

    But it raises an interesting question in my mind, and I was wondering what the members here have experienced: What is the best case scenario that anyone could imagine, or has heard about, for walking unaided after the procedure? No walker, cane, or crutches. I'm curious if anyone has heard about anyone dispensing with aids in the first few days. If my memory serves me, I think I used a walker for about 2 weeks, and then a cane for another week or so.
     
  2. kneeper

    kneeper FORUM ADVISOR Forum Advisor

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    Everyone is different as far as how long they use walking aids. You may or may not be the same as your last knee. But there is no prize for getting off the walking aids; it's all about being safe, stable and not unnecessarily straining your leg.
     
  3. Celle

    Celle FORUM ADVISOR Forum Advisor

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    It's actually not wise to walk without a walking aid in the early days after surgery. At that time, your muscles will be weak and your tendons will have to adjust to the new knee. Consequently, your muscles and tendons will not give your new knee sufficient support and it's possible you could fall.

    Don't rush to get off the walking aids. They are a necessary aid to healing your knee and achieving a normal gait again.
     
  4. robert johnson

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    @Celle I understand. I'm not going to take any crazy chances, that's for sure. I was just wondering if there were any "He climbed Mr. Everest in his first year" kind of stories out there about getting off walking aids.

    I don't go up two steps on a ladder anymore, unless someone is seriously spotting me.

    @kneeper being on blood-thinners, I don't plan on taking any foolish chances. I tend to bruise easily, and I have a fear of banging my new knee on something causing bleeding below the skin layer.

    I was even planning on having a discussion with my doctor about how long I have to worry about such a thing (bleeding in parts you can't see).
     
  5. Jaycey

    Jaycey SUPER MODERATOR Moderator

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    Not on this board. Sure there are "hero" stories everywhere. But most members here want reality. And this reality of walking without any aids just after major surgery is just fiction.
    Sounds reasonable although for some this may be pushing it. Everyone is different.
     
  6. Smokey253

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    My OS stated the same thing that it would be done as an outpatient surgery! I about fell over and even asked him if he realized that this procedure was for a TKR and not the torn meniscus surgery that I had in August! My main thought was blood clots and pain management namely the later . I felt like a drug dealer in making sure I have plenty on hand! He assured me that if for any reason they felt an overnight stay is warranted then so be it. We will also be on blood thinners again immediately following the surgery and that I will be well supplied with the needed pain management drugs. The procedure has vastly improved with new tools which means less time in surgery and less blood loss. He also stated that my knee will be numb for 24 + hours like what your OS said. He also confirmed that people get much better rest in their own nests and they want to go home as soon as possible. But I also have to admit I was floored at this statement! When are you looking to get yours done?
     
  7. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    Wwalking unaided after the procedure? I wouldn't recommend it. But mostly because, as Celle said in other words, you will just have had major surgery which is a big shock to the system. That alone will make you feel weak and wobbly and that's mostly why you'll need crutches or sticks. But you shouldn't need them for long - about 4-6 weeks perhaps.
     
  8. skigirl

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    Be sure to get the oral pain meds and take them on schedule even though the Pain will be managed with the inter joint relief. Mine wore off early and i had been too stupid to take the pain meds and so had about 2 hours of intense pain before it was managed.

    I really never used any walking aids. My house and doorways were too small for a walker and I used crutches outside the house for the first week or two. But, each person is different. I was a ski instructor and my legs were very strong.
     
  9. robert johnson

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    You and me both. I may have even said, "You gotta be kidding me! That's insane!" Luckily, I have a friendly relationship with him, so he takes me lightly.

    I'm officially scheduled for Mar 8.


    @skigirl Thanks for that. That's kind of what I was wondering. I thought there might be some people whose leg strength made it possible. Not that I plan on jumping right into it, but I feel like I'm much stronger legwise this time around with all the bike riding I've been doing.

    And yes, we will be prepared with drugs. That much I can tell you!
     
  10. poptarts

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    I had a TKR on 12/24/18. I was in and out of the hospital the same day; they never even fed me a snack or meal. I felt great! I went home and walked, did light housework, all unaided, around my house. Little did I know that the "hospital" medications would wear off by the next day and the real pain hit from overdoing it the day before. Of course, I had pain medication so it was not too terrible. I rarely used the walker, maybe three times, and stopped all together. I use my cane in the middle of the night for bathroom breaks and when walking outside for the first few times. I hated using the walker and cane but thati's my ego speaking.

    My surgery was at Kaiser and all the TKRs are same day discharge.

    And, yes, I was very willing to go home the same day to my own bed and away from the constant interruptions of hospital staff and noise.

    Good luck to you!
     
    Last edited by a moderator: Jan 6, 2019
  11. robert johnson

    robert johnson member
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    @poptarts thank you for your story. This is a very important answer for me, and you got right to the heart of my question. While you were still under the effects of all the anesthetics in your leg from same-day surgery, you could actually walk. It wasn't until the next day when they wore off that you felt the pain from walking and were a little less sure of yourself.

    That is exactly what I was wondering. You hit the nail on the head.
     
  12. poptarts

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    @Robert... Glad I was able to help.

    Today, I took my third walk outside since surgery; without my cane or walker, and accompanied by my daughter.

    If I go venture out in the public, I plan to take my cane. Mainly as protection and on the off chance I lose my balance. I would say I'm 99% confident that I do not need the cane. Although I do need to be careful because I am not picking up my surgical leg as much when I walk so I imagine I could trip on something.

    I was told by multiple professionals that the worse pain is Day 2 and 3. Since then, my pain level has been on the scale of 2 and 3. For Day 2 and 3, I took the pain meds religiously and slept a lot.
     
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  13. robert johnson

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    I don't think I'll be quite as confident as you @poptarts (you're doing great). For one thing, I've been using a cane for a couple of years, so I'm not going to take too much for granted. But now that you've confirmed my "proof of concept" question about walking while still under the effects of the magic drug shot in the knee, I am going to test the limits while I'm still in the hospital, to see what it feels like to walk without any aids, although I'll have the walker with me just in case.

    I may end op staying in the hospital one night, though. I'm confirming a few things right now. Apparently it will cost me much less (basically nothing) if I'm there overnight, as opposed to "outpatient", since I will have double coverage if I'm "in-patient". That's a little disappointing, because I was looking forward to going home the same day after I heard your answer.

    Either way, I learned something from your answer that I plan on using. My hope is to go home first thing in the morning the day after the operation, (unless they tell me otherwise for some reason).
     
  14. Celle

    Celle FORUM ADVISOR Forum Advisor

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    Actually, it's not the drug shot in the knee that restricts your walking at first. It's the spinal anaesthetic and the femoral nerve block.
    This article explains:
    Anaesthetics - spinals, femoral blocks, GAs and everything else

    Walking without aids from Day One is unwise. At that stage, your muscles and tendons will still be traumatized from the surgery and they will not support your new knee implant adequately. You are likely to fall. There's a good reason why they give you the walker.

    Wait and see how you feel before you plan to rush home. Make sure that you can walk to and from the bathroom, negotiate stairs, and get out of bed and back in again. Also, you need to be on a regime that controls your pain effectively.
     
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  15. robert johnson

    robert johnson member
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    I had the femoral block twice, so I expected that again this time, and it would seem to me that there would be no reason why the OS would bother to explain that to my wife and I again. No, our recollection of the conversation we had with him was that this was in addition to the femoral block.

    He was explaining it in the context of "outpatient surgery" and how people are willing and able to go home right after the surgery, while we were aghast because I was in the hospital for 3 days last time. His exact words were, "we give you a drug cocktail in the knee, so you won't feel anything to at least the next day."

    I don't remember the femoral block lasting more than a few hours.

    Oh, I'm not that crazy. I'll definitely have a walker until I'm sure what's going on.

    But there must be a reason why so many people (like poptarts) are going home the same day compared to years ago when at least 2 nights was the bare minimum. For my TKR I stayed 3 nights. For my spacer revision, I stayed 2 nights, and that first day home while I was changing my shirt, I got all wobbly and almost fell down. It startled me enough to call the nurse that released me to see what she made of it.

    I'm not going to do anything foolish, but I am intrigued by this whole outpatient thing.
     
  16. skigirl

    skigirl SUPER MODERATOR Moderator

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    I think it is great to get out of the hospital where strange infections lurk and get right home. I loved being home right away. I stayed one night the first time and did not like it-, it was much more comfortable to be home. I am in great shape--even better shape when i had my knees done 10 years ago, so I never had a problem walking unaided. Since you have been using a cane, you may well need something to stablize you after surgery. If you got dizzy then probably your blood pressure dropped. I had GA so did not need for a spinal or a femoral nerve block to wear off. Had one of those, never again. So, when i woke up I was completely alert and able to get right out of bed. Everything depends on you, your fitness, your reaction to anesthesia, the type of anesthesia you have. Each person is different, so hearing the stories of others is fun but they are not a predictor of your recovery.
     
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  17. robert johnson

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    That's interesting skigirl, because I also had GA but they still did the nerve block in the leg. Not the spinal where you get the saddle effect as it wears off (had that once and hated it) but just in the leg.

    I think the nurse told me my white blood count was low/borderline (could be remembering that wrong) and that's why I got dizzy. That second operation, only 3 months after the main TKR was harder on me.

    You're right about the cane making me think I better be careful, but strange as it might seem, I'm healthier now than I was in 2010. I weigh 25lbs less, ride my bike every day, and eat better. So, in a way, I'm looking forward to doing this. I have a positive attitude about it now because I'm more confident that my left TKR knee can take the lead. I was never sure about that years ago.
     
  18. robert johnson

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    @Celle You know you could be right about it just being a the nerve block, because we just remembered something else he told us. When he was talking about the nerve block, he said I'll still be under GA but this time instead of doing the femoral block in the upper thigh/hip area like last time, they do it just above the knee.

    So maybe that's the only difference. I'm going to ask him again. My wife writes everything down, but she turns the notebook around as she's doing it and writes in all different orientations. It's great if you're a fan of Salvador Dali, but I usually have to ask her to decipher it.
     
  19. Jaycey

    Jaycey SUPER MODERATOR Moderator

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    This "out patient" trend in knee and hip replacement procedures has been building for awhile. I attended a conference where surgeons were discussing this and I raised the concern that "one size doe not fit all".

    It's clear that for some select few patients this might work. But others need time for things to stabilise, to get the pain management cocktail right and gain the confidence to move around on their own. As skigirl said - it's all about how a patient reacts to major surgery.
     
  20. robert johnson

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    We were blown away by the whole idea of outpatient TKR and almost didn't believe him when he told us about it. But he made it very clear that they don't push it. The people who go home the first day want to go home, like skigirl. He even said they can stay if they want to, nobody is being "kicked out."

    But, I get the concerns. There's no telling how rocked I am by the surgery itself, and not just whether or not I feel pain in my knee when I wake up. I'll do what they think makes sense at the time. It wouldn't surprise me if I end up feeling that I need to be observed for awhile.
     

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