Mako Robotic Arm TKR Day Two

Posted by saeternes @saeternes, Nov 27, 2019

Was discharged before 11AM making my entire stay under 24 hours. Lucky that the roads were clear and we made it home in a bit under 3 hours. However the vibrations from the road threw my knee into pain mode and I had to take the narcotic drugs before the time, by an hour. Interesting effect that I did not anticipate – a national freeway and no bumps I would have thought twice about before. Was able to walk up two flights of stairs, and using walker do a bit of moving around. I now realize how important it is to stay on top of the pain because if you wait to feel something, it will be too late and the pain will spring up like a baby dragon. So it now will be strict schedule for me at least for a week. Anyone else have that experience?

@ellerbracke

@saeternes : good news on the digestive front. You seem to be doing well, in spite of being without in-home therapy. I gave up walker simply because I did not feel that I needed it for balance, indoors. I had had arthroscopic surgery on that same knee a year prior to TKR, so both pain/rehab was a “been there, done that”. Well, not quite. TKR took longer, hurt more. But the basic exercises all get back to the basics: repetition, and proper form.
As far as the knee’s range of motion at this point – it is good whatever you can do right now. Would you like to hear extremes? Day after surgery the PT measured – after session – 105 degrees. And, to really blow everyone away, I had 0 extension after 4 MONTHS. Hope that gives you something to chuckle about, when grading progress.
Re. Socks: a bother, but not a problem. Glad you figured out the best way to put them on. September here in SC was still quite warm and humid, so my main complaint was the heat generated by the compression socks.

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Not sure how to “unlike” it. Did not mean to hit the little heart symbol. Butterfingers.

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@ellerbracke

Not sure how to “unlike” it. Did not mean to hit the little heart symbol. Butterfingers.

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@ellerbracke simply click the heart symbol again to unlike your like.

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@ellerbracke

@saeternes : good news on the digestive front. You seem to be doing well, in spite of being without in-home therapy. I gave up walker simply because I did not feel that I needed it for balance, indoors. I had had arthroscopic surgery on that same knee a year prior to TKR, so both pain/rehab was a “been there, done that”. Well, not quite. TKR took longer, hurt more. But the basic exercises all get back to the basics: repetition, and proper form.
As far as the knee’s range of motion at this point – it is good whatever you can do right now. Would you like to hear extremes? Day after surgery the PT measured – after session – 105 degrees. And, to really blow everyone away, I had 0 extension after 4 MONTHS. Hope that gives you something to chuckle about, when grading progress.
Re. Socks: a bother, but not a problem. Glad you figured out the best way to put them on. September here in SC was still quite warm and humid, so my main complaint was the heat generated by the compression socks.

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@ellerbracke my dr asks all his patients to use battery powered Vacu-Ease at night and when sitting longer than 20 min so I can avoid the compression stockings. They charge up for 18 hours pretty quickly. He wants is to use them for six weeks. I think the little whoosh sound actually puts me to sleep!

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@ellerbracke

@saeternes : good news on the digestive front. You seem to be doing well, in spite of being without in-home therapy. I gave up walker simply because I did not feel that I needed it for balance, indoors. I had had arthroscopic surgery on that same knee a year prior to TKR, so both pain/rehab was a “been there, done that”. Well, not quite. TKR took longer, hurt more. But the basic exercises all get back to the basics: repetition, and proper form.
As far as the knee’s range of motion at this point – it is good whatever you can do right now. Would you like to hear extremes? Day after surgery the PT measured – after session – 105 degrees. And, to really blow everyone away, I had 0 extension after 4 MONTHS. Hope that gives you something to chuckle about, when grading progress.
Re. Socks: a bother, but not a problem. Glad you figured out the best way to put them on. September here in SC was still quite warm and humid, so my main complaint was the heat generated by the compression socks.

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Obviously I did not mean to like my own post! Finger accidentally hit the little heart!

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@saeternes

Fortunately a bit of bowel action, although the word "action" is not exactly right. I start therapy next Tuesday, no in-home therapy. I am working hard at doing the exercises the therapist in the hospital gave me. I added those from the web only because I cannot do much on the leg raise, so I decided a few more wouldn't hurt. Yes, I have been very active most of my life, working out 4-5 times a week with bike and weights until adding more about 6 weeks before surgery. I also played soccer for years. Extension is not too much of a problem and I can pull my leg back beyond 90 deg flexion but it will not stay there. I have no problem getting my socks on – the hospital therapist told me that many people do not have the flexibility in their lower backs. He also told me to keep using the walker even though I feel I can walk without it, because people give it up too soon and end up subtly favoring the damaged knee, which develops into gait problems. Anyone heard this?

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Yes – sort of. I actually developed gait problems twice. The first time it was due to my TKR leg not being fully extended, so my PT forbade me walking for exercise. I substituted swimming and stationary bike. The second time, about 8 months after the surgery, I again had major gait problems. Turns out that the TKR leg is longer by 1/3”. Custom orthotics took care of that. I’m pretty sure with your precision surgery that should not be a problem. My PT showed me how one can fairly easily see if one’s gait is off: wear fairly tight clothing, walk normally toward a mirror, and pay attention to how close your arms swing at the sides. The “space” between my left arm and body was about 1” more than on the right side. Anyway, I’ll leave you alone now for a while, and will look forward to progress reports.

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@ellerbracke

@saeternes : good news on the digestive front. You seem to be doing well, in spite of being without in-home therapy. I gave up walker simply because I did not feel that I needed it for balance, indoors. I had had arthroscopic surgery on that same knee a year prior to TKR, so both pain/rehab was a “been there, done that”. Well, not quite. TKR took longer, hurt more. But the basic exercises all get back to the basics: repetition, and proper form.
As far as the knee’s range of motion at this point – it is good whatever you can do right now. Would you like to hear extremes? Day after surgery the PT measured – after session – 105 degrees. And, to really blow everyone away, I had 0 extension after 4 MONTHS. Hope that gives you something to chuckle about, when grading progress.
Re. Socks: a bother, but not a problem. Glad you figured out the best way to put them on. September here in SC was still quite warm and humid, so my main complaint was the heat generated by the compression socks.

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@ellerbracke I'm confused about the extremes – were your numbers good or bad? More later on setback today.

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@saeternes

@ellerbracke I'm confused about the extremes – were your numbers good or bad? More later on setback today.

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Both. The flex was pretty amazing for the 2nd day after surgery. By day 5 it was 109, and last official measurement at about 10 weeks was 132. And I took wayyyyy longer than most to get full extension.

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@babette

What you say is absolutely true! I think the medical community needs to be much more honest and direct about how painful a TKR is. Or, in my case, a revision of a TKR.

The challenge for me is weaning off the big meds. I'm 6 weeks out and still have pain, though *much* less than during week 1. I can't take narcotics on the days I have PT (I have to drive) and that's when I really need them! My surgeon has refilled my original Rx, but I have a feeling I may need them for some time as I can't sleep w/out them; pain wakes me up.

Best of luck as you move through your recovery!

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@babette : I meant to check back with you. Got caught up with @saeternes posts, mostly because I was interested in the maco type TKR, and its results. It must be close to 7 weeks now since your revision, and how has the progress been so far? You have a comparison as far as pain level, general recovery, mobility, is concerned compared to your first TKR. Can you already tell that things are better? In what way? I really hope that this time around you will end up with a good outcome.

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@ellerbracke

Hi and thanks for checking in! Yes, I'll be 7 weeks out as of this coming Friday. This experience has been completely different from the first disaster, which lasted 15 months. It's hard to describe how/why I know this is better. I just have a sense of well-being and slow, steady progress that I never had with my first TKR. At 2 weeks, I was at 0/110, had my stitches out and permission to drive by nearly 3 weeks out. Everything just feels in place and I'm approaching PT differently. I'm doing gentle PT with the support of my surgeon and a terrific therapist. My mood is better, my attitude is much more confident than it was the first time around. I still have some pain, usually at night and still take 10 mg Oxycodone so that I can sleep through the night. The only thing that's the same as before is that my scar is very sensitive. That said, it's improving much faster than it did before.

I'll start working on strength building and stamina next. (Surgeon and PT believe that early weeks are for working with mobility and flexion only w/ strength training coming later.) I still face stairs with trepidation (we have snow/ice on uncovered stairs in the winter here). I'm just beginning to take stairs the normal way even though I default to the step-together-step method a lot.

I attribute this all to the remarkable skill of my surgeon. He only does revisions and is a rising star in Boston (star may already have risen, actually!).

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@saeternes I know they say you should take something as soon as you feel the pain to stay on top of it but frankly I never do. The doctors are so cautious with the number of meds they prescribe that I also tend to feel I want to preserve what I have until it is unbearable. So far that has actually worked out surprisingly well for me. It sounds as if you are doing all the right things though and that you are on top of it. I never could take the pain meds at night because they keep me awake, and that is when I most need them. For OTC pain meds I can only take acetaminophen so that doesn't help much. During the day I was able to handle the pain most of the time except when I did too much. The doctor initially gave me either oxycodone or hydrocodone, I forget which, gabapentin, and tramadol. He only gave me the first one for a very short time, and the other two just slightly longer. He wanted me to start weaning off them almost immediately by cutting them in half.
I hadn't heard about giving up the walker too soon but it makes sense.
I don't remember my doctor ever saying to wear compression socks, but then my doctor has different philosophies than many other doctors. He does not want the patient icing for the first 6 weeks because the cold keeps the healing blood from getting to the wound. I was fine with that, knowing how well-respected he was, and hearing from my physical therapist that he had an impeccable success rate. He also wanted very gentle PT which my therapist was in line with. My outpatient therapist did not know how to handle that though.
JK

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@babette

@ellerbracke

Hi and thanks for checking in! Yes, I'll be 7 weeks out as of this coming Friday. This experience has been completely different from the first disaster, which lasted 15 months. It's hard to describe how/why I know this is better. I just have a sense of well-being and slow, steady progress that I never had with my first TKR. At 2 weeks, I was at 0/110, had my stitches out and permission to drive by nearly 3 weeks out. Everything just feels in place and I'm approaching PT differently. I'm doing gentle PT with the support of my surgeon and a terrific therapist. My mood is better, my attitude is much more confident than it was the first time around. I still have some pain, usually at night and still take 10 mg Oxycodone so that I can sleep through the night. The only thing that's the same as before is that my scar is very sensitive. That said, it's improving much faster than it did before.

I'll start working on strength building and stamina next. (Surgeon and PT believe that early weeks are for working with mobility and flexion only w/ strength training coming later.) I still face stairs with trepidation (we have snow/ice on uncovered stairs in the winter here). I'm just beginning to take stairs the normal way even though I default to the step-together-step method a lot.

I attribute this all to the remarkable skill of my surgeon. He only does revisions and is a rising star in Boston (star may already have risen, actually!).

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@babette It really does my heart good to hear you doing so much better. I firmly believe that not only does the type of knee affect the results but even more importantly, the skill of the surgeon. You and I both had excellent surgeons.

I have my three year check-up on Thursday. My knee had not hurt since shortly after the surgery but unfortunately it and my other knee are both hurting now, since having fractured my femur. I presume that's because I am walking in a compromised manner. I sure hope things will improve soon, I really don't know what to do about this. The fracture exacerbated an already existing bursitis which is now quite severe.
JK

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@contentandwell

@babette It really does my heart good to hear you doing so much better. I firmly believe that not only does the type of knee affect the results but even more importantly, the skill of the surgeon. You and I both had excellent surgeons.

I have my three year check-up on Thursday. My knee had not hurt since shortly after the surgery but unfortunately it and my other knee are both hurting now, since having fractured my femur. I presume that's because I am walking in a compromised manner. I sure hope things will improve soon, I really don't know what to do about this. The fracture exacerbated an already existing bursitis which is now quite severe.
JK

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@contentandwell you mean your femur just fractured from walking? And why are you walking in compromised manner? Maybe there are lots of posts here that I am not up with.

I have found I still need the meds at 3/4 dose I had at the hospital, otherwise the deep ache gets unbearable. There is something I have not experienced before about pain from bone injury, I would almost call it existential at the risk of seeming absurd. Perhaps any kind of basic injury to the skeleton can do that. In any case, I feel suffering through it is as damaging as taking the meds, so I am going forward.

A nurse called this morning and told me the swelling was normal (whole leg). Sure looks weird. Having small bowel movements that are not really movements at all – my spraying toilet is a big help. Threw up my laxative as I had no food with it. May have to try something else. The nurse also told me the therapist may take off my ace bandage and take a look at the knee. Happen to anyone? There is a thick pad under the bandage, for any oozing that may come out of the wound, and I would love to get rid of that thing. Anyone else have such a set-up?

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@saeternes

@contentandwell you mean your femur just fractured from walking? And why are you walking in compromised manner? Maybe there are lots of posts here that I am not up with.

I have found I still need the meds at 3/4 dose I had at the hospital, otherwise the deep ache gets unbearable. There is something I have not experienced before about pain from bone injury, I would almost call it existential at the risk of seeming absurd. Perhaps any kind of basic injury to the skeleton can do that. In any case, I feel suffering through it is as damaging as taking the meds, so I am going forward.

A nurse called this morning and told me the swelling was normal (whole leg). Sure looks weird. Having small bowel movements that are not really movements at all – my spraying toilet is a big help. Threw up my laxative as I had no food with it. May have to try something else. The nurse also told me the therapist may take off my ace bandage and take a look at the knee. Happen to anyone? There is a thick pad under the bandage, for any oozing that may come out of the wound, and I would love to get rid of that thing. Anyone else have such a set-up?

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@saeternes it was not a spontaneous fracture, I fell from having a pre-syncope episode.

My walking is compromised because my hip and thigh are quite painful. I had a very good recovery from both of my TKRs, no unusual swelling. I hope yours will go down soon and that it’s not a problem.
JK

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