1. < Joint Replacements

After knee replacement surgery

Posted by beatricefay @beatricefay, Jun 16, 2016

Had left knee replaced 9 days ago. Right knee two years ago. Having a problem with inflammation so hard to bend knee and exercise. Trying to ice and raise knee above heart. Doctor suggested getting compression hose. Anybody have this experience and can offer suggestions. So tired all the time from pain interrupting my sleep and painkillers. My insurance refused to pay for the painkiller recommended by surgeon so have to take one with more opiates. That's frustrating. Two years ago it was covered but now too expensive for me to use. Seems the drug companies, not our doctors are determining what we use.

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gailfaith | @gailfaith | Jul 23, 2017
In reply to @challie "This fall I'm undergoing TKR, my first. I'm currently talking with Mayo Rochester MN. (Was previously..." + (show)
@challie

This fall I'm undergoing TKR, my first. I'm currently talking with Mayo Rochester MN. (Was previously scheduled for 4/14/17 in Roch but 4/11 my appendix burst and I almost bit the dust.) Ten years ago my husband had both of his replaced (in Illinois--we've moved), six months apart.

Ten years ago: he used the passive motion machine for both knees, both in hospital and home; he had an electronic ice machine (like a cooler with a motor) that pumped ice water through the giant pads; he went to physical therapy for a few weeks, that after he had in-home therapy for a couple weeks. But my, how things have changed! Also ten years ago his doctor said if he didn't have TERRIFIC pain control he wouldn't do what he was supposed to and his knees would not heal properly.

For the most part the passive motion machines have been done away with as *many studies showed that a year or two after surgery there was no difference in those who used one and those who didn't. Many docs believe using your own muscles more quickly begins the resuming of strength more quickly. There is more to recovery than degrees of bend; strength matters too. So, no machine for me since doc doesn't believe in them. Guess after wrangling around with that giant machine after my husband's surgery, I'm inclined to think doing without makes sense.

The only people I know lately who've used an electronic ice machine purchased one themselves. I'm assuming this has to do with insurance. ??? They were a God-send for my hubby so I'll be getting one on my own dime whereas he was given (well, insurance paid) a new one with each surgery.

I'm now being told I will not have any official therapy unless my at-home, on-my-own post-op therapy is not productive. My Mayo doc said there are too many too-aggressive therapists, and there's nothing you can't do at home that's done the same with a therapist watching. It's discipline that matters--PLUS being very gentle with the leg that first while, which is apparently when we're most vulnerable to a therapist over-doing things. I have heard stories on both sides of this coin, but more than not people did admit their therapists pushed so hard, the pain was so bad, that they sometimes had to skip the next day's work. (Other side of coin: my husband loved his therapist who he partially credits with how well he did. He also had a terrific surgeon.) I've also heard there is a case to be made that we are more susceptible to infection at therapy facilities. I guess that makes sense.

Today pain meds and their abuse are under fire. However, if you're in too much pain to properly do your exercises, where does that leave you? I do know there's certain amounts of pain we just need to gut through. But good pain control so I can properly exercise will be something I'll go to bat for.

All this to say ... My how things have changed.

I wish everyone well and am firing up prayers and healing thoughts as I type. I notice nobody mentions Doc names. Perhaps there is a rule? It would be great to compare docs' thinking.

Jump to this post

@challie, @contentandwell Hi again. Interesting how many things you hear that are different and I wonder where the truth lies. I had heard that the discontinued use was because as the replacements lasted longer without the use of the passive motion machine (pmm)! I just had both knees x-rayed as I have a walking project as I am fighting to stay out of wheelchair due to my rare form of muscular dystrophy to check on the TKR's, now 13 and 11 years old. And though I had the pmm, neither show ANY signs of wear and since Aug of 2016, I now have walked 110 miles that I have actually measured with a measuring wheel tied to my left cane, and this does not include any other walking thru the day either inside or outside. Before I bought a measuring wheel the VP here at the retirement community measured with a 10 inch wheel the distance of the circular road on the South campus here. I bought a 4 inch wheel and though the total distance is 0.5845 miles, we differened only 1 FOOT from our separate measurements so I know my 110.6045 miles is pretty close to be the actual distance. We both measured to the 4th place! I just learned he measured it while on a bike and I when walking!!!!!!!! gailfaith

REPLY
Moderator
Justin McClanahan, Moderator | @JustinMcClanahan | Jul 23, 2017
In reply to @gailfaith "@contentandwelll @ hopeful33250 Yes, when using the passive motion machine, it is not like 10 minutes..." + (show)
@gailfaith

@contentandwelll @ hopeful33250 Yes, when using the passive motion machine, it is not like 10 minutes or whatever a day. It does take time (hours) but you can use it while you are asleep at nite. When I had it in the nursing home, I had it going whenever I was in bed. I work up from the surgery with my leg already on it! gailfaith

Jump to this post

I had a simple brace that you put on your leg. It had cranks on it you would "dial" to bend or straighten your leg. Basically you would just turn the dial and it would force your leg to bend or straighten depending on which way you turned the dials on the brace. The brace itself consisted of 4 straps that started at the shin area and when up to the upper thigh. You only wore it when you wanted to use it.

I was encouraged to use this because my recovery was so poor. In the end, I don't think it helped. I had really aggressive scar tissue formation, however, I think I am personally more to blame. I don't think I followed my rehab instructions thoroughly enough. Make sure you adamantly follow your surgeon's instructions, it really is the best way to achieve success.

REPLY
JK | @contentandwell | Jul 24, 2017
In reply to @challie "This fall I'm undergoing TKR, my first. I'm currently talking with Mayo Rochester MN. (Was previously..." + (show)
@challie

This fall I'm undergoing TKR, my first. I'm currently talking with Mayo Rochester MN. (Was previously scheduled for 4/14/17 in Roch but 4/11 my appendix burst and I almost bit the dust.) Ten years ago my husband had both of his replaced (in Illinois--we've moved), six months apart.

Ten years ago: he used the passive motion machine for both knees, both in hospital and home; he had an electronic ice machine (like a cooler with a motor) that pumped ice water through the giant pads; he went to physical therapy for a few weeks, that after he had in-home therapy for a couple weeks. But my, how things have changed! Also ten years ago his doctor said if he didn't have TERRIFIC pain control he wouldn't do what he was supposed to and his knees would not heal properly.

For the most part the passive motion machines have been done away with as *many studies showed that a year or two after surgery there was no difference in those who used one and those who didn't. Many docs believe using your own muscles more quickly begins the resuming of strength more quickly. There is more to recovery than degrees of bend; strength matters too. So, no machine for me since doc doesn't believe in them. Guess after wrangling around with that giant machine after my husband's surgery, I'm inclined to think doing without makes sense.

The only people I know lately who've used an electronic ice machine purchased one themselves. I'm assuming this has to do with insurance. ??? They were a God-send for my hubby so I'll be getting one on my own dime whereas he was given (well, insurance paid) a new one with each surgery.

I'm now being told I will not have any official therapy unless my at-home, on-my-own post-op therapy is not productive. My Mayo doc said there are too many too-aggressive therapists, and there's nothing you can't do at home that's done the same with a therapist watching. It's discipline that matters--PLUS being very gentle with the leg that first while, which is apparently when we're most vulnerable to a therapist over-doing things. I have heard stories on both sides of this coin, but more than not people did admit their therapists pushed so hard, the pain was so bad, that they sometimes had to skip the next day's work. (Other side of coin: my husband loved his therapist who he partially credits with how well he did. He also had a terrific surgeon.) I've also heard there is a case to be made that we are more susceptible to infection at therapy facilities. I guess that makes sense.

Today pain meds and their abuse are under fire. However, if you're in too much pain to properly do your exercises, where does that leave you? I do know there's certain amounts of pain we just need to gut through. But good pain control so I can properly exercise will be something I'll go to bat for.

All this to say ... My how things have changed.

I wish everyone well and am firing up prayers and healing thoughts as I type. I notice nobody mentions Doc names. Perhaps there is a rule? It would be great to compare docs' thinking.

Jump to this post

@challie I believe what you were told about the passive motion machines is the same that I heard when I turned mine in. Some patients feel they help but many do not. I would love to have one of the icing machines. Any idea of the cost if you cannot get a prescription? I plan to ask my surgeon about that.

I am sure there is more to recovery than flex degrees which for me never got where it should have but my knee is reasonably strong. It does hurt though still at times and I cannot flex it well. If I try to kneel on it, it really hurts and occasionally at other times too.

I had an at home therapist and he was great, definitely not overly aggressive but very helpful and very supportive. I have had him two times, after a knee replacement and then again after my transplant. They give you therapy to help you get back on your feet after transplant. The therapist I had at a center is also great. I had him two times but not for my first knee replacement. I think I have been very fortunate in that regard. I have had physical therapists in the past for other things and none were too aggressive except for one, the one I had after the first knee replacement. She was aggressive and pushed my knee to get it to flex more, to the point where I literally screamed. Seriously, that cannot be good. I was not working at the time but the pain was not so bad that it put me out of commission the next day.

Regarding to the therapy center I went to, I think it was a good center, I had 3 or 4 sessions a day of various types of therapy but I cannot honestly say how much that helped. This ortho though is very opposed to the centers because of the higher incidence of infections and now that I am on immunosuppressants there is no way I would risk that.

I have never heard of a rule about naming doctors but most people would not mention a doctor's name if they were going to say anything negative I think. With all the legal cases who would want someone to say they damaged their reputation? Certainly not me. I happily will mention my transplant surgeon's name - Dr. Nahel Elias. He is the best in my opinion. My ortho whom I am going to for the knee replacement is Dr. Wolfang Fitz whom I hear nothing but good about. He is one of the developers of the Conformis knee which is custom made for each patient -- no "pick a close knee off the shelf". He gives you other options, I would imagine he would have to because just doing his would be considered a conflict in interest probably. There are other doctors who use that knee also, you can find them if you google Conformis. Before the surgery you have a CT for them to use to manufacture the knee. That is done about 6 weeks prior to surgery.

JK

REPLY
maryx1937 | @maryx1937 | Jul 25, 2017
In reply to @challie "This fall I'm undergoing TKR, my first. I'm currently talking with Mayo Rochester MN. (Was previously..." + (show)
@challie

This fall I'm undergoing TKR, my first. I'm currently talking with Mayo Rochester MN. (Was previously scheduled for 4/14/17 in Roch but 4/11 my appendix burst and I almost bit the dust.) Ten years ago my husband had both of his replaced (in Illinois--we've moved), six months apart.

Ten years ago: he used the passive motion machine for both knees, both in hospital and home; he had an electronic ice machine (like a cooler with a motor) that pumped ice water through the giant pads; he went to physical therapy for a few weeks, that after he had in-home therapy for a couple weeks. But my, how things have changed! Also ten years ago his doctor said if he didn't have TERRIFIC pain control he wouldn't do what he was supposed to and his knees would not heal properly.

For the most part the passive motion machines have been done away with as *many studies showed that a year or two after surgery there was no difference in those who used one and those who didn't. Many docs believe using your own muscles more quickly begins the resuming of strength more quickly. There is more to recovery than degrees of bend; strength matters too. So, no machine for me since doc doesn't believe in them. Guess after wrangling around with that giant machine after my husband's surgery, I'm inclined to think doing without makes sense.

The only people I know lately who've used an electronic ice machine purchased one themselves. I'm assuming this has to do with insurance. ??? They were a God-send for my hubby so I'll be getting one on my own dime whereas he was given (well, insurance paid) a new one with each surgery.

I'm now being told I will not have any official therapy unless my at-home, on-my-own post-op therapy is not productive. My Mayo doc said there are too many too-aggressive therapists, and there's nothing you can't do at home that's done the same with a therapist watching. It's discipline that matters--PLUS being very gentle with the leg that first while, which is apparently when we're most vulnerable to a therapist over-doing things. I have heard stories on both sides of this coin, but more than not people did admit their therapists pushed so hard, the pain was so bad, that they sometimes had to skip the next day's work. (Other side of coin: my husband loved his therapist who he partially credits with how well he did. He also had a terrific surgeon.) I've also heard there is a case to be made that we are more susceptible to infection at therapy facilities. I guess that makes sense.

Today pain meds and their abuse are under fire. However, if you're in too much pain to properly do your exercises, where does that leave you? I do know there's certain amounts of pain we just need to gut through. But good pain control so I can properly exercise will be something I'll go to bat for.

All this to say ... My how things have changed.

I wish everyone well and am firing up prayers and healing thoughts as I type. I notice nobody mentions Doc names. Perhaps there is a rule? It would be great to compare docs' thinking.

Jump to this post

Very thorough report of good information for many.

REPLY
mari | @mari | Jul 25, 2017

ALL these mails re tkr just reinforce that I will keep pursuing stem cells - even if I have to go out of the country.

REPLY
11 replies
cheris | @cheris | Jul 25, 2017
In reply to @mari "ALL these mails re tkr just reinforce that I will keep pursuing stem cells - even..." + (show)
@mari

ALL these mails re tkr just reinforce that I will keep pursuing stem cells - even if I have to go out of the country.

Jump to this post

I would not let some of these posts scare you away from TKR. I found that while there is some discomfort and pain it can be managed. Icing is important as is doing the exercises at home that they give you. It helps to have a spouse or someone to push you to do your exercises when you just don't feel like doing them. I had one knee done 18 months ago and is mostly back to feeling normal. I had the other done 8 months ago and slowly improving. I can't kneel on my left knee but right knee no pain kneeling. Also I think it depends how active you are before surgery. Building up the strength in your quads and legs muscles is very important. Makes recovery quicker. I still have some pain in my knees but nothing compared to pre replacement. I can walk just about as far as I want to now. I have friends that have had TKR and not one regrets it. My Mom had both done almost twenty years ago and at 91 is still going strong. My Dr. at Mayo did a great job. It does get frustrating because recovery is slow but in the end is worth it. I think the best thing is to get moving after and ice often to keep swelling down. I did find that I had some depression after which I understand is fairly common. Some days did not want to get out of bed but you really need to push yourself. I am so happy to be able to go on long walks and hikes now plus I don,t have ugly crooked legs anymore, nice and straight. The scar from my first knee is barely visible. It is s hard road but worth it in the long run.

REPLY
beatricefay | @beatricefay | Jul 26, 2017

I agree with your reply. I've had two successful TKR and am very glad I had them done. It does not feel like my original knee (numbness, pain on kneeling), but I'd take that in place of the pain and limitations I experienced before. Perhaps I'm lucky as I've read about what can go wrong, which is unfortunate. Good luck to those who are considering it. I think it was worth the pain and discomfort.

REPLY
JK | @contentandwell | Jul 26, 2017
In reply to @mari "ALL these mails re tkr just reinforce that I will keep pursuing stem cells - even..." + (show)
@mari

ALL these mails re tkr just reinforce that I will keep pursuing stem cells - even if I have to go out of the country.

Jump to this post

@cheris I agree, building up strength is a huge factor. My ortho surgeon has said that too. When I was supposed to have this surgery before (but had to be turned away on the day of surgery due low platelets) I had asked him before about pre-surgical physical therapy, having heard that some people do that. When he heard I do water exercise and ride my incumbent bike he said I was doing the best things possible. I am no in-shape person really but I do keep the muscles around my knees pretty well exercised now and it has really helped even without the surgery.
Thanks too for pushing the icing. I really did not do that as much as I guess I should have. How long and how often did you do that?
JK

REPLY
win sturgeon | @cobweb | Jul 27, 2017
In reply to @mari "ALL these mails re tkr just reinforce that I will keep pursuing stem cells - even..." + (show)
@mari

ALL these mails re tkr just reinforce that I will keep pursuing stem cells - even if I have to go out of the country.

Jump to this post

Before my tkr i was in the gym building up my strength so that i was ready for what followed. Lot of good that did. Pain and lots of it. Yes , i handled PT very well but the actual bowling ball that was put in place did not sit well with my body. Thankfully stem cells has given me life for the other knee.

REPLY
JK | @contentandwell | Jul 27, 2017
In reply to @mari "ALL these mails re tkr just reinforce that I will keep pursuing stem cells - even..." + (show)
@mari

ALL these mails re tkr just reinforce that I will keep pursuing stem cells - even if I have to go out of the country.

Jump to this post

@cobweb Hi Win, I think the success of a knee replacement is dependent on two obvious things, the skill of the surgeon and the knee used for the replacement. The surgeon I used for the knee I had done a few years ago is supposedly good (he had a high rating on one the rating sites but I find that to be unreliable) but he used the same basic knee he has been using for 30 years! I suspect in that amount of time there have been improvements in these prosthesis. Mine hurts at times and does not have nearly the flex it should but to paraphrase what someone else said "it's better than how I felt before". I was in pain 24/7 and limping badly.
It never occured to me back then to check into the prosthesis also. From what I know now, the two best are the Depuy and the Conformis. I am sure there are others but I believe both of those to be very good.
JK

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