TKR Right Knee Total Replacement

[glorylee]

I had total knee replacement of my right knee on 3/6/24, and from all indications. I am doing great. However, I felt weepy for a couple of weeks prior to the surgery, then great relief after it was over, back to “needy and weepy” sometimes now. I see from the posts I’ve read that this is normal and makes me feel better.

‘’I live alone with my dog but I have a great support group of family and friends that visit, bring food, take me to PT, etc. and I don’t know what I’d do without them.

I did not realize before surgery how long the recovery process could be, and I’m feeling a little daunted by that. I’m a ”get her done” kind of person so it’s going to be hard to pace myself.

One thing that bothers me is the anxiety about possible infections, not doing the exercises correctly or enough, making sure I do everything right and don’t miss a step. This is my typical response to situations where I don’t have complete control, but it complicates things.

One specific question I have is how long do most people wear the surgical hose. My dr’s nurse said I can remove them at night after 1 week, but wear them in the day time for 2 weeks. The notes on my chart said to wear them until I go to my post-op which is Tuesday. The therapist said she sees no reason to wear them at all now that I’m up and moving around frequently. It’s difficult because they actually wrapped my legs from my ankle to right above my knee because the thigh high socks were rolling down.
so they’re hard to keep on at the right tension, and then I have to rewrap them myself when I take them off, etc. so…I’d really like to be done with them.

 

[Layla]

I will leave our Recovery Guidelines and type more in a post below -

KNEE RECOVERY GUIDELINES

As you begin healing, please keep in mind that each recovery is unique. While the BoneSmart philosophy successfully works for many, there will be exceptions. Between the recommendations found here, your surgeon's recovery protocol and any physical therapy you may engage in, the key is to find what works best for you.

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.

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.

2. Control discomfort:
rest
elevate
ice
take your pain meds by prescription schedule (not when 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 these
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
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?

Nutrition is of paramount importance. Available here are dietary tips, nutrition basics and additional food supplements. These articles are both general advice on food and specific guidelines aimed at people both pre- and post-surgery.

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.

 

[Layla]

Hello and Welcome, glorylee! Congrats on your new knee.

Aside from what sounds like Post op Blues Post op blues is a reality - be prepared for it it sounds like you're doing great! Thankfully you have your dog and the loving care of family and close friends.

I believe when we're early into our recovery and moving around less we have more time to worry about possible complications, but believe me, it will ease with the passing of time as you heal and become more engaged in life once again.

If you're tired of the compression stockings, contact your surgeons office and a member of his care team may give you permission to toss them as many surgeons don't even recommend them. It may be worth a try, especially since you're up and moving around often.

I wish you lots of comfort as you continue to heal and thank you for joining us to share your journey!
@glorylee

 

[benne68]

I’m a ”get her done” kind of person so it’s going to be hard to pace myself.

That's me as well! During my first TKR recovery in 2021, I really struggled to find my Patience Muscle. I repeatedly pushed too hard, overdid it, and ended up setting back my recovery. So the second time around (this past December), I vowed to give my knee time to heal and to give up my need to control my recovery.

Please read through the articles Layla shared above. It's great advice that -- and I can attest to the fact that it works!

 

[mendogal]

Hi!
If it helps, know that with my first knee replacement I was terrified of misstepping a tiny bit and breaking the implant!
Our minds go to funny places. Day or night, thanks to members living all over, some are on line pretty much all the time so come here with any concerns, fears, questions!

 

[EalingGran]

One specific question I have is how long do most people wear the surgical hose. My dr’s nurse said I can remove them at night after 1 week, but wear them in the day time for 2 weeks. The notes on my chart said to wear them until I go to my post-op which is Tuesday. The therapist said she sees no reason to wear them at all now that I’m up and moving around frequently. It’s difficult because they actually wrapped my legs from my ankle to right above my knee because the thigh high socks were rolling down.

The advice people get does seem to be very variable. They are a bit of a pain to put on- especially if you live alone. I was given a fancy metal cage thing that was supposed to help- but didn't find it that useful. I think the longer periods may be for older less active people who may be at higher risk of swelling and clots. Certainly the risks diminish if you are up and about and moving frequently.
Your advice seems at the more reasonable end- some people on here seem to be told to wear them for weeks....

 

[kiwicurls]

My surgeon doesn’t use the stockings at all. A far cry from my nursing days when we all wore them in theatre. Everyone on the surgical teams did!
I agree, as long as you’re up and moving hourly it shouldn’t be a problem but everyone needs to be guided by their own doctor.
Have a good weekend.

 

[glorylee]

I have another question. I’m having trouble sleeping at night because after a while of lying on my back, my leg seems to have little spasms where it moves involuntarily, sort of like restless leg syndrome. I can’t go to sleep when it does that, and when I finally do doze off, I wake up about two hours later, and the cycle repeats. I have my post-op on Tuesday and will talk to the doctor about it. Any ideas why this is happening and how to prevent it? Doesn’t happen in the daytime…

 

[mendogal]

Nope, the nighttime leg thing is really common after knee replacement. So is only sleeping 1 1/2 - 2 hours at a time!!!

Many of us find an oral dose of magnesium in the evening reduces the spasms. Some people feel it helps them relax.

Are you using a pillow or pillows in bed to elevate your knee? Most of us have to in order to relax as we don't have good leg extension for some time. A pillow is ok as long as there's no direct pressure right under the knee.

 

[mendogal]

Oh and separate from the leg itself...

Insomnia is a real bummer for many of us in the initial weeks after knee surgery. Definitely sleep whenever (and wherever it's safe and comfy!)

Icing, elevating, napping.... All help, but for some of us it was endangering our mental health. Before it gets there consider some nonprescription remedies....

If you're lactose tolerant, a glass of warm milk! If you're not diabetic, a teeny bit of honey makes it even more comforting... plus milk is high in magnesium! Helps us relax!

If you aren't a milk drinker, or want an easier way to, an evening magnesium supplement has been very helpful for some members.

OTC diphenhydramine, an antihistamine also used as a sleep aid (Benadryl) because it makes you drowsy; it's also included in some cold, flu, etc "nighttime" combination meds.

Low dose melatonin, sustained release - not for long term use but I have used for a week at a time without ill effect. It should be taken an hour to hour and a half before going to bed, and during that time stay in a dimly lit area to allow this hormone to activate.

Valerian root - an herbal remedy, it can be taken in capsule form but that dose might be high compared to my preference, herbal "sleep" blends that include a smaller dose of valerian and make me pleasantly drowsy. Plus the other tea flavorings make it nice tasting! Celestial Seasonings and Traditional Medicinals sell teabags by the box. Their sleep blends without valerian have never ever made me sleepy.

Be aware: even benign herbals and supplements can interact with your routine or post op prescription meds, either making their effects weaker or stronger. If you're on meds you may want to check with your doctor or pharmacist, or even check online for interactions.

 

[MSuki]

On the exercises, you don’t need to feel like you have to do a certain amount in a certain time frame or something bad will happen. You will want to do some of the basics but in reality most of your progress in the early days is healing, not from exercise. Read the articles and do some basics but I wouldn’t worry much about doing every set of every exercise the PT mentions because many PTs will give you way too much. If I did every exercise I was given I would have been doing about 100 leg lifts a day by week 3. I was doing well to do 10 total at home because I was always recovering from doing too much at physical therapy on my off days! Even much later when you are focused on strengthening there is not a time limit. Sounds like your personality is like many of us who tend go overdo not under-do. If so then the important thing is to listen to your knee when it says to stop.

 

[EalingGran]

Insomnia is a real bummer for many of us in the initial weeks after knee surgery. Definitely sleep whenever

Agree with @ mendogal but
If the herbal or OTC remedies don't work- then ask your GP for a prescription.
My GP agreed that knee replacement was a good reason for a month's worth of zopiclone. It was a life saver. I later used herbal valerian and OTC remedies. Obviously don't use more than one remedy at a time and check about mixing with pain killers as mendogal says.
The other thing that really helped me was icing before bed and resting my knee on the cool water jacket of my Aircast Cryocuff to sleep.

 

[sistersinhim]

how long do most people wear the surgical hose.

Even after 12 knee surgeries, I never had to wear those hose, so I think, since you're up and running around, you should be fine without them. But, be sure and ask your health care team first before stopping wearing them. They know your body much better than we do.

 

[glorylee]

I’m not sure where I’m supposed to post this so someone help me out if need be.

My TKR was on 3/6. My flexion is good. I’m able to walk without a walker or cane and not in pain. However, I’m really worried about the bend. At my first pt session, 2 days after surgery it was 95. I’ve had several sessions since then, and my last one it was at 102. Seems like it should be better than that by now.

I have to constantly remind myself. It to walk stiff-legged, but to walk heel to toe and bend my knee. After doing my home exercises and the formal pt, it loosens up and bends better for a while and then it becomes really stiff again. I’m terrified I’ll have a stiff knee for ever. I’m a worry wart by nature and I’m driving myself nuts!

I am supposed to be able to drive at the 4 week mark which is Wednesday and I think I’ll be fine with that.

 

[Jockette]

Your ROM number is just fine. The number will go up and down depending on swelling, which varies depending upon your activity. Most of us think our ROM should be better than it is, at any given time in this recovery.

I’m terrified I’ll have a stiff knee for ever.

You will not have a stiff knee forever. But the current healing stiffness can last for months. Try very hard to be patient and understand this is normal and nothing is wrong.

Stiffness/Tightness is a normal occurrence after this kind of major surgery. Your surgeon did major carpentry work and disturbed every millimeter of soft tissue in this area. You aren't tight because your muscle is underused and needs to be stretched and rehabbed. You're tight because your tissue has been disturbed and is healing...and full healing takes a full year or more, though you’ll feel better long before that.

 

[mendogal]

What you're experiencing is 100% normal.

I had significant stiffness on my first knee, with a huge setback of overnight painful stiffness during weeks 8-12 post op (in hindsight, due to too aggressive PT), that suddenly Just Got Better - though at 14 months it still stiffens if I stand too long.

My second knee gave me lots of stiffness for many long months, especially with sitting. At 9 months it's still slightly annoying.

Yet.... my range of motion is fine for anything I want to do, I can walk non stop pain free twice as long as my preop baseline (can do 3 miles nonstop and my goal is to do 5 miles by the end of the year).

Don't worry about numbers. Focus on function, and note each small milestone on the journey (first shower with no help or chair! First meal out! First walk up a hill! First drive!).

 

[mendogal]

About driving.... 4 weeks seems early.
Considerations include...
Are you on opioid pain meds? (I was)
Can you comfortably bend your R knee enough to get into the drivers seat? (despite very good ROM, that particular flex + angle was too much for me until into week 7)
Can you manage the ongoing flex/release to accelerate and brake in a controlled way?
Finally, if you had to brake really fast and hard, could you do so without damaging yourself (quads are not fully healed, not fully activating, and weak)

 

[glorylee]

I am not on any pain meds except Tylenol and haven’t been for a good while so that’s not an issue with driving. I plan to try it out on my long driveway to see how it goes before venturing out on the road and if that goes ok, only short trips to the grocery, etc. until I see how that goes.

 

[EalingGran]

Finally, if you had to brake really fast and hard, could you do so without damaging yourself

Agree with @mendogal that this is a real risk. It happened to me at a few weeks out of surgery when I was a passenger that my husband had to break suddenly and it jolted my knee. It was more painful and swollen for a few days.
The risks of driving vary a lot ,I guess, according to how busy an area you live in. I live in a very busy city suburb- where sharp braking is very frequently necessary.
The other consideration is that I waited for my 6 week check- to be advised by my surgeon that I was OK to drive and didn't need to inform my insurance.

 

[Layla]

Happy One Month Anniversary, glorylee!
I hope the driving is going well. It is so nice to regain that independence.
A great week to you!
@glorylee