TKR Mewmew’s Dad’s Right TKR

[Jamie]

Is your Dad in any pain with his constipation? If so, you might consider going to the ER or to his GP today rather than waiting until tomorrow. You could also go to an Urgent Care clinic if there are any near you.

It’s too late in the game now, but it might have been better to have insisted the surgeon order Home Health for him for the first couple of weeks after surgery. This is good for most people because you get a range of medical professionals coming in to visit several days a week. One of them is a nurse who could have dealt with the constipation early on. I know from personal experience that it can be a real problem and sometimes needs more than the normal over-the-counter products to get resolved. Home Health also has a physical therapist and occupational therapist who visit armed with tips to make recovery easier for someone. A lot of surgeons don’t like Home Health because they want patients to have outpatient therapy so they are forced to move more. But, I believe it provides a good basis for a successful recovery and gives a patient just a little extra support. Plus you don’t have to get dressed, get in the car, and go to and from a PT appointment. For a lot of people that is too much activity all at once so soon after surgery. Just put this in the back of your mind in case he might need Home Health sometime in the future.

As for the recliner/couch issue, the ideas presented here are great. One other option to consider with his couch if it is rather soft is to purchase foam cushions to put on the seat. They not only can elevate the seating area, but also “firm up” a soft sofa. In addition, it’s possible to have some pieces of plywood cut at a home improvement store to fit under the foam (or the sofa cushions themselves) that make things more firm and easier to get up and down. If you go the foam route, just cover them with a comforter or blanket to make things more comfortable for him.

You’re doing a great job advocating for your father. He’s lucky to have you and I know he appreciates your help. He’ll begin to start seeing some progress and I’m sure that will give him hope that there really is life after knee replacement surgery!

 

[Layla]

We are concerned about your dad, How is he doing today?
@Mewmew

 

[Mewmew]

Hi all! Thank you so much for your kind replies. My dad might be lucky to have me (and my sister) taking care of him, but we’ve been really lucky to have him. It only feels right to take care of him! (Plus I used to be very sick when I was younger and in and out of hospitals, so I feel like it’s just as important to be his advocate now.)

I am sorry for my slow response, it’s been busy over here But as far as updates! Very good update—the constipation resolved late last night, right before we were planning on how long we’d need to be at the ER. I guess everything we gave him finally kicked in. He’s been on daily miralax and that’s helped with keeping him regular with the Percocet.

He’s still on a bit of a rollercoaster. He has increased stiffness and pain today. He’s not entirely sure why, I did say it may be because he’s doing too much PT exercises (even though, still even after ALL the times I’ve reiterated from this forum—I’ve even sent him this post and he’s read replies! He feels he doesn’t do enough. He’s just a bit stubborn like that.) or something else. I’m keeping an eye in case it’s a sign of something worse like a clot, but from everything I’ve read, that can be normal to have a bad day amongst good ones.

Is it normal to have more stiffness and pain after elevating and icing? He feels very good while it’s happening, but once we take him down, he is SUPER stiff. We use the lounge doctor and have asked his PT if he is in the correct position so I’m stumped.

Lastly, these are such great suggestions about seating and home health! Alas. My parents are stubborn and don’t want to spend more money on adjustments of the furniture. We’ve bought some stuff on our own for them but they’re not happy about that.

Home health for his next knee replacement will DEFINITELY be a suggestion, thank you!! We didn’t even know that was an option!

 

[Mewmew]

Oh and we got a leg strap for him! This has been relatively helpful because he still has log leg. I think once he gets a bit more strength back, he’ll find it more helpful as his leg is heavy to lift. I can tell he is very antsy to heal.

 

[mendogal]

I'm glad some things are going more smoothly!

It's normal to have pain and stiffness following overdoing those exercises. If he's doing them as written I guarantee it's easily twice what will actually benefit him.

Icing and elevating do reduce both pain and swelling - if done at least 45 minutes to an hour at a time. This early in recovery, it's most of what we do with our time!

Unfortunately, our new knees can stiffen with any prolonged immobility in any one position, and it's really hard for us to stay comfortable!

 

[Layla]

Whew! I am so happy he didn’t have to go to the ER.
I’ll bet you’re so relieved! No…he’s relieved!
And you’re right, recovery is like a roller coaster. Completely normal, so no worries about the ups and downs. You sound like a very loving family. I hope you all have a womderful Easter!

@Mewmew

 

[Jockette]

Personally, I am not a fan of icing! It always made my leg feel so stiff for a while afterward, but I did do it anyway because it was recommended. I know so many people say it helps so much, but I never thought it helped me much. This is one way we are all different and have to adjust to what’s best for ourselves.

When I fell last year and my PKR leg swelled up quite a bit, I only did a little icing. One reason was, the day I fell, my out of town kids were in their way here for several days, and I didn’t want them to know I fell, so I somehow managed to look good enough when they arrived and for the next 3 days! My daughter asked if my knee was bothering me, and I just said yes and nothing more. I just didn’t want them offering too many suggestions, I wanted to see what my knee was going to do, and I know how to take care of my knee. So I can relate to your parents‘ thoughts! (And yes, the next week I got X-rays and an orthopedic appointment and only had soft tissue damage.) I basically only iced for a while after they all went to bed, or went out for a while.

And, as the others said, log keg is very common, I think it was about 2 weeks before I could get my leg on my elevating wedge myself. So don’t worry about it, it will happen all by itself.

 

[Mewmew]

I'm glad some things are going more smoothly!

It's normal to have pain and stiffness following overdoing those exercises. If he's doing them as written I guarantee it's easily twice what will actually benefit him.

Oh that’s exactly what he’s been trying to do! We keep telling him to quit it early but he’s gonna have to learn on his own.

Whew! I am so happy he didn’t have to go to the ER.
I’ll bet you’re so relieved! No…he’s relieved!
And you’re right, recovery is like a roller coaster. Completely normal, so no worries about the ups and downs. You sound like a very loving family. I hope you all have a womderful Easter!

@Mewmew

Thank you and happy Easter as well! He is VERY relieved!! But yes, so many ups and downs.

Personally, I am not a fan of icing! It always made my leg feel so stiff for a while afterward, but I did do it anyway because it was recommended. I know so many people say it helps so much, but I never thought it helped me much. This is one way we are all different and have to adjust to what’s best for ourselves.

When I fell last year and my PKR leg swelled up quite a bit, I only did a little icing. One reason was, the day I fell, my out of town kids were in their way here for several days, and I didn’t want them to know I fell, so I somehow managed to look good enough when they arrived and for the next 3 days! My daughter asked if my knee was bothering me, and I just said yes and nothing more. I just didn’t want them offering too many suggestions, I wanted to see what my knee was going to do, and I know how to take care of my knee. So I can relate to your parents‘ thoughts! (And yes, the next week I got X-rays and an orthopedic appointment and only had soft tissue damage.) I basically only iced for a while after they all went to bed, or went out for a while.

And, as the others said, log keg is very common, I think it was about 2 weeks before I could get my leg on my elevating wedge myself. So don’t worry about it, it will happen all by itself.

Oh goodness!! I can see my dad doing what you did and trying to hide it for a bit so we don’t worry and bug him but I’m glad you turned out better than expected!! And goodness I hope his log leg wears off by next week. It’s also good to know about the icing as well, we’ll see what his preference is!

I wish we knew about home health. I’m so worried about leaving him on his own (we live in different states) when he’s not able to be safely mobile yet. Part of me can’t believe this is an outpatient surgery. I truly believe he could’ve benefited from even staying in a skilled nursing facility for a few days. I wish his surgeon mentioned these options.

 

[Mewmew]

I have a couple more questions… (if I should make a different post please let me know.)

My dad is experiencing a ton of burning pain in his leg. From what I searched, this might be due to nerve pain? But is this a normal type of pain sensation? It has just started. It’s relieved when he’s elevated and right back to being burning when he’s standing up.

Lastly, we’re running out of his pain meds we didn’t realize how little we had left until today, and of course, the surgeon’s office is closed. I don’t think we’ll be able to get a refill until Tuesday! Can we give him more Tylenol instead? I know it won’t be the same, but to help him until he can get a refill. We have 1.5 days left of Percocet.

Thank you all again!

 

[sistersinhim]

Good morning and Happy Easter! Burning pain while healing is a common thing, and yes, more than likely it is nerve related.

Your Dad can take 1000mg of Tylenol every 6 hours. Be sure to count all the acetaminophen, (Tylenol), that is in every thing he takes, including cold meds, and not exceed 4000mg a day. Many find that this is enough to help with the after surgical pain. There is also a step-down pain med called Tramadol that can be mated with acetaminophen for extra pain relief. Here's the chart for that:

The first is for 4-hourly doses and the second for 6-hourly:

 

[Freyagirl]

dad is experiencing a ton of burning pain in his leg. From what I searched, this might be due to nerve pain? But is this a normal type of pain sensation?

I’m at about the same place as your dad with hip#2. Lots of burning and tingling from nerve pain and from tightness due to swelling. I found that it got better as the swelling went down until the nerves started to really regrow at about 2 months.
It’s good for me to read your posts so that I try to remember to cooperate with my son’s suggestions. It’s hard to feel old and dependent, but there are so many ways that you can help us get better faster.

 

[Mewmew]

Sistersinhim, thank you so much for this chart! This will be helpful as we are about to run out of the prescription. I hope we get it soon. He just came back from the PT and they said he doesn’t have enough bend in his leg, and we’re going to have to push him to bend it more. This is not great for my dad to hear, because I know that means he will push himself too hard. I will do my best to advocate to listening to his body.

Freyagirl, I hear you! At some point, my dad really started relying on us a bit more in the past couple of days and he actually seems to be in better spirits for it. I know it’s hard (and your kids should respect your independence) but your kids are definitely here to make sure you’re supported! Wishing you lots of luck in your recovery.

 

[Jockette]

He just came back from the PT and they said he doesn’t have enough bend in his leg, and we’re going to have to push him to bend it more.

This is just so wrong! He is only days out of surgery, you can’t bend a swollen leg.

I strongly suggest you call around and find another PT office with a more updated approach and understanding of recovering from a joint replacement. This place is not going to be helpful to him if they are already unhappy with his bend this early.

This is what one of our members, TortiTabby, experienced:

(Just so you know, ADL means Activities of Daily Living.)

“At my six week appointment this is what my OS wrote in my visit summary: "She reads an online website called Bone Smart which states to not push through pain following knee replacement. If she were to follow this direction, she will have to learn to live with a knee that only reaches to 85 degrees of flexion. I believe this website is very misleading."

It has now been 20 weeks and all I do is ADL and this is what my ROM has done:
3.5 wks: 75
6 wks: 85
7 wks: 90
10.5 wks: 95
14 wks: 100
17 wks: 105
20 weeks (where I am today): 110
I am so thrilled it keeps improving and improving and I know now that I will get to my goal of 120 (or even better, dare I say!)


And,

“Just an update for those who are apprehensive about gaining ROM:
It has now been 26 weeks and all I do is ADL and this is what my ROM has done:
3.5 wks: 75
6 wks: 85
7 wks: 90
10.5 wks: 95
14 wks: 100
17 wks: 105
20 weeks: 110
26 weeks (where I am today): 120!!!
I did it! My goal of 120! No "pushing through pain", no PT after the first 3 visits, and most importantly to me: No MUA! My surgeon who said I would never get beyond 85 ROM without pushing through pain was wrong, wrong, wrong. I'm excited to see if it gets even better. “

 

[mendogal]

Oh no!

We have had members experience significant damage to their knees and legs directly due to aggressive PTs literally pushing on and manipulating them (in the belief that obtaining a "good bend" they could record in the medical record was their primary goal).

Bend happens when healing allows the swelling to go down. It's not something to fight for - that's counter productive.

My ortho team, who told me that in the early weeks "less is better!" as I progressed always focused on small returns of function, never asking about degrees of bend: what can you do today that you couldn't do in the recent past?

 

[sistersinhim]

He just came back from the PT and they said he doesn’t have enough bend in his leg, and we’re going to have to push him to bend it more.

If you push him more, his bend will get worse. Why? Because forcing his knee past where it is healed enough to do will just increase the inflammation. When that inflames more, the swelling and pain increase. You can not bend a swollen knee very well. Instead of increasing and pushing his knee, he needs to do a lot less of that and increase his icing and elevating. Can you bend a water hose full of water with the nozzle closed? Nope. Open up that nozzle and allow the water out, and you can bend and roll up the hose. The knee is the same way. Get that fluid out and it will bend better and with less pain.

 

[Jockette]

Also, keep in mind, there is no:

Myth busting: "window of opportunity" in TKR

This "six week window of opportunity" surgeons often speak about is little more than a myth. It presupposes that all patients have the ability to create adhesions which is far from the truth. It also ignores the simple fact that in the first 3-4 weeks after surgery, swelling reactive to the...

bonesmart.org

 

[Layla]

I am sorry to read this because the way you've explained your dad, like mine, also recovering from TKR...they believe and follow doctors / PT's orders because after all, they're the medical professionals. I want to leave you two accounts to go with the others that have been shared above to read and if comfortable you can forward them to your dad. Here is the first from current / recent member JusticeRider.

JusticeRider's message -
"I just want to add, for all those coming along, a note on ROM. I want to share this because nearly all of us have a tremendous amount pressure put on us to increase our ROM by certain deadlines, or else.

Mine has been extremely slow coming. First I had to wait out the swelling, which in my case took more than 5 months. Yes, months. At that point I began to see real progress. It has continued to this day. I have seen improvement in the last 2 weeks. It’s still going. A this point I think the limiting factor is tight muscles, ligaments, and tendons from 3 yrs of very limited ROM and actually about 25 yrs of somewhat limited ROM. Those tissues are slowly stretching.

I have had to be willing to let my flexion improve at a glacial pace, be very patient, and tune out the dire warnings of my surgeon, PA, previous PT, and some well meaning acquaintances. I refused painful PT and refused a MUA. I have absolutely no regrets. I know my body, and I believe those things would have caused a domino effect of swelling and pain that may have derailed my recovery long term and even possibly have torn soft tissue, etc. I now know I have the added challenges of hypermobility and an immune condition that causes an inflammatory reaction. I think a MUA would have been very harmful to me.

Instead of forcing it, I have relied on weekly massage and using my stationary bike as a stretching aid every single day. I have been very active, but I have ramped up really, really gradually. I have not measured my flexion, because honestly I feel almost a PTSD type of reaction around it. All I care about is function and what I can do. My knee is very functional now, and still improving. I love my new knee. I’m glad I let it heal on its own timeline even though it was so much longer than everyone (most of all me!) would have liked."

 

[Layla]

Member VolLady's message -
"I want to tell everyone that has went though TKR that it is a long journey to heal. I am going this spring to have my other knee replaced.

Please do not get discouraged and I know you will because I did with my first one and cried more than I had in a life time. Scared mostly.... Surgeons will not tell you everything that you will experience during your healing. It took me 7 months actually to feel more normal but not 100%.

For the ROM I only got to 112 at 4 months and still cannot bend it all the way back to reach 130. But I can drive, sit at a table, put my shoes and clothes on great without a ROM of 130 or 120. There is no swelling at all at 8 months but I still have some stiffness at times but I deal with it and walk. I also still ride my bike with no trouble.

I am telling everyone this because your body will heal without PT and pushing your limit beyond to the point there is more swelling and pain. I have decided when I have my other knee fixed this spring, that I will do my own PT since I have all the equipment and items that they use anyway.

I had a MUA at almost 6 wks., and regretted it from day one. Simply because it did not help me anymore with my ROM but it did set me back on healing. The swelling was awful. I will not have another MUA even if my ROM was 95 at the time.

I will go in with open eyes on this other knee comparing on what I went though with the first one. So, with all that said, I wish everyone a happy healing and let your body decide with healing than someone trying to push you until you scream with pain. Also don't worry about the ROM, it will come -- it might take a year or more, but it will come. I am 67 years old and I don't expect to get past 120, but I do what I want to do at 67. Oh! and I can even bend down with the knee need to kneel on it..... Best wishes everyone!"

 

[Mewmew]

Thank you all for sharing these stories and warnings! I’m taking them to heart and worrying about him now. He doesn’t have the same PT at every visit. It seems they all rotate each week, so I wonder if his one at the next visit will tell him something different. Layla, I think we do have the same type of dad!

I hate to say it y’all, but I don’t think I have much power here. My older sibling wants to follow the PT to the T and so does my dad. I’ve shared this forum with them multiple times but it can only do so much if they don’t read it. I’m also the youngest of the siblings, so I seem to get less buy-in for listening to what I suggest.

I hope to have a good update for you all in a month… I will continue to advocate my best for my dad.

 

[Jockette]

Well, time will tell and we’ll see how he fares while following PT to a T. As I said earlier, not all PTs are created equally, and not all the protocols are in our best interest.

I‘m sorry they might not listen to you, this is what I face when I talk to people in person, about the Bonesmart guidelines, they don't listen because they believe every word of every PT and don’t realize the honest differences. Unfortunately, all you can do is voice your opinion, which you’ve done, and now let it go. He might do ok, some do. But if not, he has to make his own decision.

I used to live in Ohio and one of my good friends there is a PT. It was 5+ years after moving to Delaware that I was back visiting in Ohio and saw my friend. It had also been 3+ years since my PKR. When I told her about the PT I had the first month of my recovery, she was surprised and said it was way too aggressive. This from a current PT! So yes, there are differences.