TKR Winding Road thru Recovery

Bruiser

new member
Joined
Oct 10, 2023
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52
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Greetings Bonesmart’ers.

As seems case for many on the site, I found this amazing resource after I went under the knife. My decision to proceed would be the same, timing / surgeon the same - eyes would have been much more open!

My right knee journey includes…
* youth/high school soccer in the “just tape it up” days
* meniscus tear clean out 2015
* ACL in 2016
* Oops I did it again ACL revision in 2018, after a bent knee full force “landing” took out 1”+ chunks of cartilage on femur/tibia
* toughed it out til 2023… tried injections w no success
Surgery on 10/4/2023 late pm, home by noon following day.

I’ve found that TKR is a giant machine, with very defined pre-op processes and polished pre-op messaging (email campaign, basically). What I’m experiencing after, not so polished with dubious protocols, tone-deaf PT and a tremendous of pain/discomfort.

Don’t get me wrong… I understood how brutal the procedure is (barbaric may be too strong) and expected pain. However, these new fangled pain management protocols that are ill-informed and full of opioid fear basically throw patients to the pain wolves - Tylenol and Advil are enough, trust us.

All that intra-surgery pain medicine that was going to make the first 3 days a breeze? Lasted 48 hours.

So, starting day 6 in the trough of disillusionment. On 3 hours of sleep. To the pain!
 
Hello there, @Bruiser, and welcome to Bonesmart. You have found the best place to learn from actual knee joint replacement patients! All of us know what you are going through and want to help you.

You are just beginning what will be a patience testing recovery. Expect ups and downs for many months, maybe even a year.

Each person is different as is their recovery. Most find that the Bonesmart approach works best for them, but others find that a more aggressive therapy helps them more. It's your recovery and your choice on how you recover. As you read more on other members' recovery threads, you’ll get a better perspective of what to expect. The following are our basic guidelines and should help get you started.

If you want to use something to assist with healing and scar management, BoneSmart recommends hypochlorous solution. Members in the US can purchase ACTIVE Antimicrobial Hydrogel through BoneSmart at a discount. Similar products should be available in the UK and other countries.

KNEE RECOVERY 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 the 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
the BoneSmart view on exercise
BoneSmart philosophy for sensible post-op therapy

5. At week 4 and after you should follow this
Activity progression for TKRs

6. Access these pages on the website
Oral And Intravenous Pain Medications
Wound Care In Hospital

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.
 
What I’m experiencing after, not so polished with dubious protocols, tone-deaf PT and a tremendous of pain/discomfort.
Now you know why BoneSmart was created. Unfortunately most surgeons do not see the post op process. They quote milestones and set unrealistic goals. PT use a check list - one size fits all.

Stick with us here. Listen to that knee and be your own advocate. PT should never be painful or aggressive.
 
Most of us are unprepared for all aspect of this surgery mentally and physically. Initially I joined bonesmart 3 months after my first replacement. What I realized strength, ROM, decrease swelling will show it’s self without PT. Had very few PT sessions, ( should have cancelled sooner). What is needed is rest, ice , elevation, pain control and confidence to trust yourself. Did very gentle stretches, walked around my house, and actively of daily living.
 
Hello and Welcome to BoneSmart! Thanks for joining us!
Please don’t underestimate the power of ice. :ice:I found it a godsend for pain control, icing pretty much non-stop in those first couple of weeks while I was sitting, which was often. I hope today is a good day!
@Bruiser
 
Waving hello - I too started my R knee with a ACL blowout (martial arts) followed by a total ACL blowout, surgery, etc and because of the medial meniscus damage had some bone on bone areas within two years.

I'm actually shocked your ortho team didn't prescribe opiates (plus Acet and Advil) at least for the first weeks plus tapering. I couldn't have managed without, so totally get how demoralized you must be. Yes, ice and elevation are your friends.

If you can get your pain under control, you still may find sleep elusive. It's a common problem.
When I couldn't get relief with diphenhydramine (Benadryl - OTC antihistamine used as a sleep aid) I ended up using two OTC things: the herb valerian (I found sleep teas with it as the active ingredient) and 3 mg of time release melatonin. Very effective.
 
I think if I were you, I would contact the surgeons office and stress to them that you are in pain and not sleeping.
I can't even imagine not having some help with my pain, post op.

You might even benefit by speaking to your Primary Physician's office and see if they can help you with pain and lack of sleep as the result.
It does get easier, hopefully this will all be in your backseat window soon.
 
I too would call the surgeons office (and then primary GP if the surgeon can’t help). Sometimes a hospital may have a protocol…but once discharged, the surgeons might be more open to prescribing opiates if they can operate at arms length to the “protocols” of the hospital. But then again, if it is the surgeon driving the protocols, could be more difficult. It is totally reasonable to need opiate-level pain control!!
 
Thanks for the support and encouragement... very appreciative.

Today is 8 days post-op, and I'm managing the pain as best I can with the prescribed meds. I re-read my Op Report notes from the surgeon and they noted a partial synovectomy was performed based on severe degenerative arthrosis.

I'm reading that as I got a little more than just the TKA, and wondering if that may be what is elevating my pain level? I'm icing as much as I can, keeping my leg elevated, doing my exercises when able. Last 3 nights sleep - 3 hours, 3 hours, 4.5 hours. Recovery so much more challenging without sleep. I'm just unable to get comfortable/stay comfortable. I've had frequent "fits" of must move my leg, move my leg in any direction and BAM, 8-9 pain not matter which direction I shift. I have a Lounge Doctor arriving later today... hoping that may help.

I'm not a newcomer to post-op pain. I had an ORIF left wrist (scaphoid non-union fracture) in November 2022 and I thought that surgery was going to be near max pain... was a crazy slow healer and was in a cast for 6 months! By day 8 post-op on that surgery I felt human... don't know I can say that with this one.

I'm really hoping I'm going to turn the "pain corner" soon. My inability to do most ADLs plus caring for me is wearing on my wife. Keeping my eye on the prize.
 
Hey @Bruiser , welcome to the club! Every bit of hard and soft tissue in your upper leg and knee has been traumatically disturbed. Don't forget the tourniquet, arguably almost as painful for me as the knee(have cycling quads, they must have had to crank on it to work) Your leg is probably a stuffed sausage atm. Those first two weeks were 'Hell' to put it mildly. No sugar coating it here....

I dislike opioid heavy meds as much as you do. I got into a solid routine of the prescribed meds with only taking the heavy stuff when pain was intolerable. Couple that with daily prunes or some type of heavy fibre to keep the intestines from binding up from the meds.

Rest, Ice, Elevate, Compression(if it actually helps you) for the first few weeks. I absolutely did not like the way PT paints everyone with the same brush. I would not worry too much about exercises for the first few weeks as opposed to just moving a little. I found moving my knee actually eased a bit of the pain from simply being stationary. Early on however, the more you move the more you disrupt your knee and the more it will keep protecting itself by swelling. Better to let it calm down and heal....

Get sleep when you can and where you can in whatever position is the most comfortable. Try to be nice to your family/caregivers <---- very hard... I was a bear:dubious:

You have just begun your journey and there are many on here who have amazing advice and stories to share. We are with you all the way. Its tough to be patient but it will get better.:friends:
 
I'm reading that as I got a little more than just the TKA, and wondering if that may be what is elevating my pain level?
This could be a factor, but this surgery causes a lot of pain early on anyway, even without extra procedures. When I had my PKR, my surgeon also did a lateral release, which I didn’t learn about until the one year mark, when I asked for a copy of my surgical report. Like you, I too wondered how much that affected my recovery, especially in the early weeks/months.
By day 8 post-op on that surgery I felt human... don't know I can say that with this one.
So many of our members, who have had previous procedures, say the same thing. A TKR is a whole different ball game.

My inability to do most ADLs plus caring for me is wearing on my wife.
You’ll be back to these ADLs soon.
 
Two weeks since my TKR. I had a synovectomy as I needed a plica removed. Got my staples out today and the surgeon seemed to imply that synovectomy is typically always done and that it grows back. I have a lot of bruising and swelling. Pain 8-9 at times was very common at day 8, especially evenings. A good night sleep still evades me, but the pain during daytime is much more manageable past 2 days.
My muscles are screaming and I’ve been taking Flexeril at night to help them relax and help with sleep.
You are in the worst part right now. Hang in there. Just keep the knee gently moving to keep tissues limber.

I recently tried a vibrating handheld massage tool around my knee (not on incision) to try to desensitize. It hurt to start but then stopped hurting. It seems to help. I also find I need to use heat on the thigh and hip area to reduce muscle tension, especially while icing. Icing numbs the pain but increases my stiffness.
 
Hi Bruiser,
Reassure your wife that you are doing all you can to make progress in your recovery. If you're spending more time together than normal, you both may be feeling a bit tired and anxious. If she's not taking any time away, consider suggesting she gets out, away from the home for a time daily to create some space for each of you. Hopefully after a walk, shopping or spending time with a friend she'll come back feeling refreshed. I think it's often difficult for us to view our partners as vulnerable which we certainly are when we are in early recovery and struggling to do normal things and regain our independence. Thankfully it's only temporary! I hope your pain eases soon and you begin enjoying your new knee. :)
@Bruiser
 
Happy One Month Anniversary, Bruiser!
Hopefully all is going well for you and you're happy with the progress you're making.
Let us know as time allows. Hope to hear from you soon. :)
@Bruiser
 
Hey Bruiser! We had the same TKR on the same day. Hoping things are better. I have good days and bad. I’m trying to come off the opioids (Tramado). I’ve not had any toda, but may take a half pill tonight. Sleeping is a problem. Lyrica was added to my evening routine and it has helped. I hear by the third month you’re glad you did this. Ugh.
 

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