PKR Mike61's Recovery

[Mike61]

Well, had my left medial partial completed yesterday morning and was home by about 5:30. Was able to get to about 90 degrees and close to 0 during hospital pt (thanks to great pain meds and nerve block). Had home pt visit today, where I was told I needed to relax and let the process happen…I was trying to push too much. At this point, I am scheduled for two weeks of home visits (5 total) and then outpatient pt. The BIG warning was to be ready for the surgery meds to wear off, of which I can already feel a difference…

 

[Layla]

Hello and Welcome to recovery! Congrats on the new knee.
Please go s-l-o-w and easy with the PT. Your knee needs to begin healing from the controlled trauma of major surgery. I am happy to hear the PT wanted you to relax because all overly aggressive PT will do is cause you pain this early on. Take your meds on schedule, use ICE liberally and get lots of rest. You don't need to be doing much more than getting up and walking around for five minutes or so every hour or two in these early days and that's normally accomplished by trips to the bathroom or kitchen for a drink or snack.
Wishing you lots of comfort and a smooth recovery!

 

[Layla]

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]

Let us know if you'd like a different thread title and we will edit accordingly.
@Mike61

 

[benne68]

Welcome to the Healing side, @Mike61! It can be a shock when the anesthesia and nerve block wear off, so it's good that you are expecting it.

was told I needed to relax and let the process happen…

My surgeon told me that my only job the first two weeks was to rest, ice and elevate so I would heal. The rest, he said, comes later.

Wishing you lots of sleep!

 

[lrj]

First day isn't too bad. Then the next few are rough. At this point, just finding a way to get comfortable can be an accomplishment. Try to get outside every day, even if it's just for 5 minutes. Meet a friend at a park. (That one may be a few weeks away) Celebrate the small accomplishments along the way.

 

[Mike61]

Agreed with the trying to get comfortable comment. Sometimes sitting, some laying, trying a little bit of everything. I am trying to move (walk around the house with my walker) every hour, just to move. 2nd home pt comes today, so we’ll see what she says.

 

[Layla]

Still early days, Mike. As you know from experience the weeks begin clicking on by. Good to hear you're moving around every hour or so. I hope you have a good PT session today.
Don't let them push or hurt you.
@Mike61

 

[Mike61]

Good pt session. She repeated what I have seen here, push but not too much. Got a baseline extension and flexion…extension was 1degree (goal 0) and flexion was 82* with 90* being the goal for the end of next week, then on to outpatient pt. Worked quite a bit on my gait, which needs some help after years of compensating. Obviously, that is a longer term goal.

 

[benne68]

Sounds like you have a therapist who understands that pushing into pain is counterproductive, @Mike61! That's great.

Don't worry too much about your range of motion numbers at this point. You are only a few days out, so have lots of swelling inside that knee. Inflammation restricts your flexion. So keep icing and elevating -- and don't overdo the exercise -- to reduce the inflammation.

As the swelling goes down, you'll see gains in flexion without having to force anything!

 

[Mike61]

What is the best method people have found for weaning off of pain meds? I have been prescribed Oxycodone 5mg every 4 hours, 500,g acetaminophine, and an anti inflammatory (once a day). I have eliminated the oxy during the last two days, and used two during the night (Which helped with sleep and pain). Is it best to extend time between oxy doses vs eliminate does and rely on the Tylenol? Other than last night (when I missed a oxy dose) pain have been fairly manageable during the day and somewhat at night.

 

[mendogal]

It's very common to have a transitional period in which we use acetaminophen (and NSAID if tolerated) during the day and the opioid in the evening/overnight. For some people this phase can last quite a while.

If you're already going all day without it, and just using it once at night, you can simply reduce that to one pill and stop whenever you realize its not needed at all for pain control.
Make sure you keep the total acetaminophen at 1000 mg every 6-8 hours.

If days or weeks later you've overdone things and it really hurts, it's fine to take an oxy as needed.

 

[Mike61]

Thanks. Am contemplating eliminating the one nightime oxy, but it does give me some really good sleep! Last pt session had me at 90 degrees and extension of 5, so like all things, a little give and take. I started riding my assault bike yesterday, pedaling backwards, heel on the pedal, and very, very, slowly.

 

[Mike61]

I am not quite 3 weeks out and had my first outpatient pt yesterday. I have been working out at home, doing upper body weight training/trx and doing prescribed leg wpork to improve knee function, cutting the grass and taking the dog for runs (he runs I walk slowly). After yesterdays PT, that includes, heel slides (or some version), quad activation, half squats to a bench and up, calf raises, and hamstring stretches. All leg work is following the guidelines of push till feel a stretch and then a little more. Should be uncomfortable but not super painful. I like this philosophy and feel it is best for getting long term improvement. As of yesterday, range of motion is -5 extension (improvement) and 155 flexi on. I stopped using oxy completely after 1 week and have stopped using the walker and cane after a week and a half. Pain has been pretty minimal, I use extra strength Tylenol and ice 4-5 times a day. Sleeping at night is still pretty restless..but naps help catch up!

 

[mendogal]

Sounds good.
I'd be cautious about the half squats until six weeks postop,the timeline for even minor athletic sprains and strains to heal.