How well is pain controlled after total knee replacement?

Posted by connie1559 @connie1559, Sat, Jan 12 6:42pm

I'm scheduled for a right TKR on 1/21/19.

I own my own small business, and I'm the only one who does the accounting and other functions for a busy retail store.

I will have the surgery on Monday, 1/21, and barring unforeseen problems, will be released from the hospital on either 1/23 or 1/24/19.

I have deadlines on several things for my small business, including getting out W-2s, 1099s, CDTFA payments,and customer store charge account statements, as well as the renewal of my business's liability and work comp insurance. In addition, I will have to do payroll for my employees. I will probably have to work in my office several days between 1/25 and 1/31. I will be having PT appointments as well during that time.

I currently have a pain contract with my GP. I live in a rural area, so my GP is familiar with my ortho and his pain control protocol. My ortho will be handling my pain control, rather than my GP, for a period of time during the TKR process. My GP told me that the ortho will send me home with a few days supply of pain meds and then will "drop the ball on refills". Also, it is my understanding that no refills will be given without an office visit. It is a 3 hour round trip for me to visit my ortho or GP.

I have seen discussions in this joint replacement group when some post TKR patients have said they have extreme pain, and others have said the pain was not as severe as might be expected.

Is it realistic of me to expect that my pain will be well controlled with just OTC products and icing and elevation? I know that most TKR people have said that it's a good idea to stay ahead of the pain before PT with proper use of pain meds to maximize the benefit of PT. I have also seen a lot of posts where people have said the pain impacts their ability to sleep. If I'm going to heal, go to work, and get the most benefit I can out of PT, I'm afraid my pain will be pretty bad if my ortho is lax about refills.

Has anyone had experience with having to carry on a busy schedule after TKR, including the necessary amount of PT, without benefit of prescription pain meds? Am I fretting over nothing? Thanks so much for any answers. Good luck to all of us!

Can only comment on recent personal experience. Was discharged from hospital 40 hours after TKR. Ortho physician (who already did several other surgeries on me) allocated 42 Ocycodone pills. This version lets you add Tylenol if necessary. Which I did for a day or so. Final use of opioid pills was 22. I’d describe my general post surgical pain as at least average. Not sure if this helps or not.

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@connie1559, I encourage you to do your accounting work and tax form filings prior to your surgery. I say this as a former small business owner who has had two TKRs.

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@ellerbracke

Can only comment on recent personal experience. Was discharged from hospital 40 hours after TKR. Ortho physician (who already did several other surgeries on me) allocated 42 Ocycodone pills. This version lets you add Tylenol if necessary. Which I did for a day or so. Final use of opioid pills was 22. I’d describe my general post surgical pain as at least average. Not sure if this helps or not.

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This does help. Thank you.

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@capausz

@connie1559, I encourage you to do your accounting work and tax form filings prior to your surgery. I say this as a former small business owner who has had two TKRs.

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You’re right, of course. I plan to do as much as I can beforehand. This next week is a juggling act for me. I know by this time next month I’ll likely be wondering what I was worried about. At least I hope so. 😊 Thanks so much for your input.

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@connie1559

You’re right, of course. I plan to do as much as I can beforehand. This next week is a juggling act for me. I know by this time next month I’ll likely be wondering what I was worried about. At least I hope so. 😊 Thanks so much for your input.

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I wish you luck and hope all goes well. Wanted to add that the PT experience can vary tremendously from therapist to therapist (and of course depending on the patient). I had 3 home PT visits, and on day 12 after surgery I went to outpatient PT. I had worked with this particular group before with other rehab, and they trusted me enough to do all that was asked of me. They never tried to force the knee into painful positions, and I usually went there every 7 to 10 days to check on progress, and add progressively harder exercises. In the beginning you can expect to do 3 sets of 20 to 25 minutes of exercises at home, and with 20 minutes of icing afterwards it does take some time. After roughly 8 weeks I reduced it to 2 times daily. Now (4 months) just some stretching, otherwise walking, swimming, recumbent bike etc. As far as sleep and pain is concerned: yes, I will impact you. I found that if I iced the knee just before going to sleep and took 2 Tylenol it let me fall asleep ok. Not always stay asleep, but that happens – sorry!

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@ellerbracke

I wish you luck and hope all goes well. Wanted to add that the PT experience can vary tremendously from therapist to therapist (and of course depending on the patient). I had 3 home PT visits, and on day 12 after surgery I went to outpatient PT. I had worked with this particular group before with other rehab, and they trusted me enough to do all that was asked of me. They never tried to force the knee into painful positions, and I usually went there every 7 to 10 days to check on progress, and add progressively harder exercises. In the beginning you can expect to do 3 sets of 20 to 25 minutes of exercises at home, and with 20 minutes of icing afterwards it does take some time. After roughly 8 weeks I reduced it to 2 times daily. Now (4 months) just some stretching, otherwise walking, swimming, recumbent bike etc. As far as sleep and pain is concerned: yes, I will impact you. I found that if I iced the knee just before going to sleep and took 2 Tylenol it let me fall asleep ok. Not always stay asleep, but that happens – sorry!

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Thank you for such a thorough answer! I know I'll be OK and the pain won't last forever.

I have spinal stenosis, plus a Morton's neuroma that is intrusively painful. Add the knee pain (2 surgeries since 2010. The 2nd surgeon recognized the reverse bucket handle meniscus tear the 1st surgeon missed & did his best, but I'm left with a severe deformity that has caused a myriad of skeletal issues). I also have an autoimmune disease which has been flaring up more often as I age.

I'm in a lot of pain already and it impacts me daily. As silly as it sounds, I worry the pain from the TKR is going to overwhelm me.

I'm in my 60s now, and for most of my life I was active, fit and had a good attitude about dealing with pain.

I have been in so much pain the past few years that I feel as if I am not tolerating it at all. It just exhausts me. I'm looking forward to a good result and some relief at last.

Many thanks for your help.

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@connie1559

Thank you for such a thorough answer! I know I'll be OK and the pain won't last forever.

I have spinal stenosis, plus a Morton's neuroma that is intrusively painful. Add the knee pain (2 surgeries since 2010. The 2nd surgeon recognized the reverse bucket handle meniscus tear the 1st surgeon missed & did his best, but I'm left with a severe deformity that has caused a myriad of skeletal issues). I also have an autoimmune disease which has been flaring up more often as I age.

I'm in a lot of pain already and it impacts me daily. As silly as it sounds, I worry the pain from the TKR is going to overwhelm me.

I'm in my 60s now, and for most of my life I was active, fit and had a good attitude about dealing with pain.

I have been in so much pain the past few years that I feel as if I am not tolerating it at all. It just exhausts me. I'm looking forward to a good result and some relief at last.

Many thanks for your help.

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Hang in there connie. I hope you will have brighter days soon. I have lived with chronic pain from crohns disease and arthritis since I was in my late teens. Iam now 63.Have had many hospital stays, surgeries and doctor visits. Living with chronic pain and illness does take it's toll. My life is certainly not what I'd dreamed of, but it's my life. I have 4 wonderful children and now a grandchild.I have my bad days, and I try to cope best I can. You are stronger than you think. And you have women like us behind you. If your tired, take a nap. Read a book,try to explore other activities to occupy your mind till your stronger. You can do this,I know you can

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I had a half knee replacement on 1/7 and went home the same day. I took minimum oxycodon for a few days and switched to OTC Advil. I started in home PT on day 2 and office PT on day 8.

Having said that, I did not take enough pain meds. Person after person told me to stay ahead of the pain and I did not. Now I am telling you to do it. If you have too much pain you won’t do PT properly and you need PT. I am 10 days post op and going for my second PT in a couple of hours.

As far as working, I don’t see that as being too much of an issue if you can get driven to your office. The first couple of days post op you may be spacey from the pain meds.

Ice works wonders BTW. It is as good as pain meds IMHO.

Good luck. I suffered more than I needed to but I somehow feel suffering makes me more noble. It doesn’t, control your pain and do your PT.

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@bobnaquin

I had a half knee replacement on 1/7 and went home the same day. I took minimum oxycodon for a few days and switched to OTC Advil. I started in home PT on day 2 and office PT on day 8.

Having said that, I did not take enough pain meds. Person after person told me to stay ahead of the pain and I did not. Now I am telling you to do it. If you have too much pain you won’t do PT properly and you need PT. I am 10 days post op and going for my second PT in a couple of hours.

As far as working, I don’t see that as being too much of an issue if you can get driven to your office. The first couple of days post op you may be spacey from the pain meds.

Ice works wonders BTW. It is as good as pain meds IMHO.

Good luck. I suffered more than I needed to but I somehow feel suffering makes me more noble. It doesn’t, control your pain and do your PT.

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Thank you for such a detailed reply. I’m having a TKR on 1/21. I attended a pre-TKR class earlier this week and I was still confused about pain control.

The main thing this hospital uses sounds like it will be Tylenol. I have severe arthritis and I have been taking 800-1000 mg of Ibuprofen daily until I had to stop a few days ago ahead of my surgery.

Ibuprofen helps, but it certainly doesn’t completely control the pain I’m already having. I keep thinking now let’s add a TKR and expect a different OTC to help enough to take care of both the surgery pain and the pain from PT and the pain from my arthritis. I’m thinking the Tylenol won’t be able to do all that.

I do plan to use ice as my most reliable pain control. I’m a big fan of icing for pain.

I’m sure I couldn’t tough it out Iike you! I know there will be pain and I will have to get through it. But it’s true, staying ahead of the pain gets better outcomes. Pain never felt really is pain never felt.

In this day and age of labeling even legitimate pain sufferers as addicts, it adds a whole new layer of concern to having surgery.

Thank you again for such a great answer.

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@connie1559

Thank you for such a detailed reply. I’m having a TKR on 1/21. I attended a pre-TKR class earlier this week and I was still confused about pain control.

The main thing this hospital uses sounds like it will be Tylenol. I have severe arthritis and I have been taking 800-1000 mg of Ibuprofen daily until I had to stop a few days ago ahead of my surgery.

Ibuprofen helps, but it certainly doesn’t completely control the pain I’m already having. I keep thinking now let’s add a TKR and expect a different OTC to help enough to take care of both the surgery pain and the pain from PT and the pain from my arthritis. I’m thinking the Tylenol won’t be able to do all that.

I do plan to use ice as my most reliable pain control. I’m a big fan of icing for pain.

I’m sure I couldn’t tough it out Iike you! I know there will be pain and I will have to get through it. But it’s true, staying ahead of the pain gets better outcomes. Pain never felt really is pain never felt.

In this day and age of labeling even legitimate pain sufferers as addicts, it adds a whole new layer of concern to having surgery.

Thank you again for such a great answer.

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I agree on several counts. First, intially take the Oxycodone or whatever is prescribed in indicated intervals, usually about every 4 to 6 hours, not matter what, for about 3 days. Then taper off if pain permits and switch to OTC medicine. A head start of low pain is great! As far as fear of addiction: I think the concern is overblown if taken for acute pain after surgery. I had 4 surgeries, opioids each time, each time took about half the allotted number of pills, but started out with a 7 day supply. My physician is always smiling when I turn in the unused portion at the first post-op visit. (Yup, I usually keep 4 pills for “just in case”. Have never touched them.)

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Hi @connie1559 – Welcome to Connect! Great bunch of people here with tons of experience and sharing hearts. I am 68 and I share your concern about pain & meds. I had my right knee replaced April 2017 and I'm having my left knee replaced the 29th of this month. Last time I was fine with the meds prescribed. This time, my surgeon said the law had changed and that while I'm in the hospital, they can only give a certain dosage UNLESS the patient is in pain and asks. So he told me once and then reminded me before he left to ASK. You can count on me asking. I do not suffer well in silence. LOL. Also, the nurse told me they could only prescribe 7 days at a time and they couldn't call it in – it had to be a paper prescription picked up and then taken to the pharmacy to fill. That is a real downer for me since we live about an hour away from the hospital. Fortunately I have a friend who lives near the hospital and I'm going to ask her to pick up my first refill.

In case it helps, here is what my progress looked like last time. This time I'm having robot-assisted surgery. My doctor says that gives more accuracy in the surgical precision and he's found that it cuts recovery time somewhat.

Last time, my surgeon kept me in the hospital (Mayo Jax) for 2 nights. In the hospital, I used the walker. I also had to learn to go up and down stairs since we have stairs front & back in my house. Right before I was released, I was at 105 degrees flexion.
– I started in-home PT once I was home. Also, iced my knee after exercise and kept it above my heart as much as possible. One week after I was home, I traded the walker for a cane. I could do 10 minutes on the stationery bike.
– 10 days after surgery, I could walk around outside with a cane. I'd gotten to 120 degrees flexion, but I still lacked about 5 degrees on total extension. Extension was the hardest for me.
– 2 weeks after surgery I could walk around anywhere in the house w/o a cane or any aids. At 2 weeks, I got the stitches out. It hurt. (Take some Tylenol before you go for stitch removal!)
– 3 weeks after surgery I got 100% full extension. I also got completely off pain pills during the day so I was allowed to drive. This meant I could start going to out patient PT. By this time I could walk outside w/o cane.
– By 5 weeks, I was walking 1 mile every morning. (Prior to surgery I walked 2 – 3 miles each morning.)
– By 6 weeks, I could walk 1.5 miles. I still limped noticeably when tired. Also, still occasionally needed to take pain meds at night in order to sleep
– By my 8 week check up, my right knee had become stronger than my left. So my operated knee was officially now my "good" knee. I had 125 flexion and 100% extension. I was released from PT the following week.
-By 12 weeks, I felt pretty much completely normal. I didn't limp anymore although there are things I still can't do comfortably including kneeling on my operated knee and twisting it sideways.
Hope this helps. As others have said, every surgery is different, but I'm keeping my fingers crossed that my left knee recovers as well as my right one did.
Good luck with your upcoming surgery. Please keep us posted.

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@connie1559 Hi Connie, sorry for the late response. Your surgery is scheduled for today so obviously, you will be reading this after it.
I was in a great deal of pain after my second TKR surgery, less after my first TKR. My ortho is very conservative about narcotics so he gave me some but did not want to give me a lot. I have heard that ibuprofen is as helpful as the narcotics but the only OTC pain medication I can take Tylenol, and in a limited amount. More than likely you will NOT have extreme pain. After my first TKR I was doing all kinds of normal things within a brief amount of time. I have no idea why the second one was more painful, but ironically it's the better of the two now so it was worth it.

The good news is that the extreme pain lifted very suddenly about 6 weeks after my TKR and things have been great ever since.
Every surgeon has their own guidelines for their post TKR patients. My surgeon has an extremely high success rate but his guidelines are a bit different than typical. He does not want the patient icing for the first six weeks because icing prevents the healing blood from going to the site. Of course, after six weeks you probably do not need to ice anyway.
He is also opposed to vigorous PT. The in-house physical therapist had worked with patients of this doctor before and he was impressed with the doctor's success, so he was fine with that we did some very helpful exercises. When I started to go to outpatient PT that physical therapist was lost as to what to do so that was pretty useless.
I hope by the time you read this you are back in your bed and feeling fairly well. There is actually an ortho doctor about 45 minutes away from me who does TKRs as outpatient surgeries and he too is quite successful!
JK

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@connie1559 – Just wanted to wish you well on the surgery today. Hope it went splendidly and that your pain is managed nicely. Please keep us posted. Wishing you the best!

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@bobnaquin

I had a half knee replacement on 1/7 and went home the same day. I took minimum oxycodon for a few days and switched to OTC Advil. I started in home PT on day 2 and office PT on day 8.

Having said that, I did not take enough pain meds. Person after person told me to stay ahead of the pain and I did not. Now I am telling you to do it. If you have too much pain you won’t do PT properly and you need PT. I am 10 days post op and going for my second PT in a couple of hours.

As far as working, I don’t see that as being too much of an issue if you can get driven to your office. The first couple of days post op you may be spacey from the pain meds.

Ice works wonders BTW. It is as good as pain meds IMHO.

Good luck. I suffered more than I needed to but I somehow feel suffering makes me more noble. It doesn’t, control your pain and do your PT.

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I had my right TKR one week ago today, 1/21. I was taking pain meds as prescribed and doing really well. This morning I decided I didn’t need the prescription pain meds, so I only took 2 extra strength Tylenol. BIG mistake! I could barely get through PT, and I couldn’t get the ROM I got yesterday. You are absolutely right about staying ahead of the pain. Today’s pain was as bad as the pain I had when I woke up in the recovery room. I learned a lesson, and I will be smarter next time.

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@connie1559

I had my right TKR one week ago today, 1/21. I was taking pain meds as prescribed and doing really well. This morning I decided I didn’t need the prescription pain meds, so I only took 2 extra strength Tylenol. BIG mistake! I could barely get through PT, and I couldn’t get the ROM I got yesterday. You are absolutely right about staying ahead of the pain. Today’s pain was as bad as the pain I had when I woke up in the recovery room. I learned a lesson, and I will be smarter next time.

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I did the same thing and had the same problem. I think we have all been brain washed into thinking if we take prescription pain meds we going to end up being junkies. I am calling BS on that. I set myself back and wish I had not done it. The chances of me getting hooked on prescription pain meds is close to zero as I don't get much out of them including pain relief. I think you have discovered that you should do what your doctor thinks best about pain meds and hopefully it will make you better sooner.

Liked by connie1559, amytro

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