TKR #2.....Lessons I am learning.

Yesterday, I had a Total Knee Replacement on my right knee, 10 years after having a successful TKR on my left knee. 28 hours later I realize I have learned a lot with more hints, suggestions, mysteries, and solutions to be discovered along the way. I want to list these items for your review. Please let me know if you agree with my assessment and anything else you want to share that will help others making the same trip. What else should we be mindful about?

When was your TKR or when are you planning it? Thank you for sharing your creative and helpful ideas Here are my 24-hour learnings.

1. To be well prepared, do the pre-op exercises. I know it is 300 unique exercises held from 1-2, or 1-5 seconds in 2 sessions every day. And then there is that 5-10 minute one at the end. You will be so happy that your surgery leg is strong and sturdy.

2. Take the medications as prescribed or with approved substitutes if needed because of allergies. If you have any doubt about dosages or synergistic medications, please ask. Just because the pharmacy sheet or the internet describes a medication one way, know that there are good reasons for choosing the ones on your list. One antihistamine was kind of funky…..it just didn't fit. Then I found out that while it was listed for treatment of itchiness, it also dissipated my major pain medication, Dilaudid more quickly. Know that you must wait for anesthesia-related medications to disappear before you can move on to after-surgery dosages.

3. To prevent swelling, make sure your knee is kept above your heart. I sure didn't remember that one and it is so good to know. Use ice as directed. Just refrain from wrapping an ice pack too tightly around the surgery knee. I made that mistake …….oweee.

What assists will be most helpful? Do you need a walker….yes you do. And the worst thing that can happen is a fall. Walkers prevent falls. A raised toilet seat is a must to prevent strain and injury.
Be careful though…….we have only 21 inches in our commode room. Have you seen the stools for showers and the movable grab bars? Remember the goal is to prevent falling. As my surgeon said, "don't fall, I can't fix you."

And finally. Take time to heal……You cannot expect to be back on the volleyball court or in the swimming pool right away. Gold and tennis will have to wait. And you will be better off finding new and less rigorous activities to replace those that are no longer part of your activity itinerary.

What bothers you the most? What do you still not understand?

May you be free, protected and safe from inner and outer harm.

Chris

Interested in more discussions like this? Go to the Joint Replacements group.

Chris, great suggestions, all! One of the hardest to follow is getting your knee up high enough when you ice, at least in the beginning when your leg is inflexible following surgery. I hope everyone gets sent home with that stiff "doggy walker loop" stick that helps you place your leg up into bed, as well as using it for various exercises. It takes a lot of pillows or cushions to get your knee to at or above heart level while in a recliner. I was given my stick/loop during first PT in the hospital following the surgery, and I used it a lot during the first three weeks, would have been hard to get in and out of bed without it.

I don't remember how many kinds of pre-surgery exercises I was given, but I continued to do two of them, right after surgery in the hospital, and many times at home when I couldn't sleep at night due to discomfort. I alternated doing the foot flex about 5 times, then the tighten and pull the back of the knee to the mattress 5 times, and I would keep it up until I got tired. I think it helped work the muscles and relieve inactivity and would relax my legs so I might be able to sleep a little. Finding a comfortable position in the first few weeks is a challenge.

For those who are having a first TKR, I suggest keeping a daily diary and jotting down progress and feelings and concerns as you heal. I wish I had. When I had my 2nd TKR, I kept wondering if I was healing at the same rate, and it seemed like I had more initial pain than with the first surgery. But no way to tell, since time diffuses memories, and since my first knee was a success, I could easily have pushed the more difficult moments out of my mind. You can either keep notes on your cell phone, use the dictation feature if you have it, or just get a cheap little notebook to keep by your usual resting place and make note of any good or bad things for the day.

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Thank you Chris and DD. Using the toilet was incredibly painful. I purchased a bedside commode, took the pail off and then place the frame/seat over my toilet. What a blessing. I added a small foot stool, to rest my leg. BTW, I am 19 days post TKR. I have significant swelling, I sit in a recliner. Perhaps it’s not too late to try and get that leg more elevated? DD, can your loop gadget be purchased on-Line? I took Oxy the first week and now Tramadol. Doctor recommended taking it more frequently cause I was not sleeping and after PT pain was unbearable. Finally comfortable, nor pain free, but I can function. I exercise multiple times a day. I have good extension and 90 degree flexion. Mary

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@artscaping I had my first TKR in 2013 and my second one in 2017.

I was not given a list of exercises to do prior to my TKRs, I never heard of that from any doctor, I wonder if that's something new, and if so it's a big step forward. My orthopedist was very happy that I was doing my recumbent bike and jogging in the pool before my second surgery. The first TKR was by a different surgeon and that was never even mentioned.

My second surgeon, who I think may be one of the best in the country, felt those two things were the best exercises for prehab and when able, for rehab. I asked him about prehab and he asked what I was doing for exercise. When I told him those two things he said I was all set.

The thing I would stress the most, is to really do the exercises faithfully after the TKR. I think that I probably did not keep up with them as well as I should have and wonder if I had, if I would have better flex now.
JK

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@auntieoakley : I trust you are doing well with your second knee replacement. You are a veteran, both from personal experience, and so many other people adding their input. I had my right TKR 9/18, 85% happy with it. 100% functional. Just curious – if I would be faced with need to fix major knee pain in my other knee, I would -other than PT, etc. – try PRP, even stem cell injections, before TKR , perhaps even lowered expectations of activity, since I’m somehow getting older all the time. Again, my artificial knee works well, does not hurt, irritates the heck out of me because it clicks, and I can’t kneel, and it feels like about 5 degrees off perfect alignment, sort of screwed on lopsided…….. so all those things would cause me to avoid a left TKR. Just wondering about your decision to go with TKR again. None of my beeswax, of course, Just curious if you had ever tried other options for either knee. Stay well, and go slay it. You know what to do – you can teach others what to do!

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@ellerbracke

@auntieoakley : I trust you are doing well with your second knee replacement. You are a veteran, both from personal experience, and so many other people adding their input. I had my right TKR 9/18, 85% happy with it. 100% functional. Just curious – if I would be faced with need to fix major knee pain in my other knee, I would -other than PT, etc. – try PRP, even stem cell injections, before TKR , perhaps even lowered expectations of activity, since I’m somehow getting older all the time. Again, my artificial knee works well, does not hurt, irritates the heck out of me because it clicks, and I can’t kneel, and it feels like about 5 degrees off perfect alignment, sort of screwed on lopsided…….. so all those things would cause me to avoid a left TKR. Just wondering about your decision to go with TKR again. None of my beeswax, of course, Just curious if you had ever tried other options for either knee. Stay well, and go slay it. You know what to do – you can teach others what to do!

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I am afraid the tag went to the wrong Person. I would send this forward to @contentandwell

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@auntieoakley

I am afraid the tag went to the wrong Person. I would send this forward to @contentandwell

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Oops. my bad. I thought i had you and JK pretty much separated in my news feed. Of course I’m not savvy enough with an ancient iPad to easily get this moved over. Actually, I have no clue how to do this. I’ll check to see if there’s a forward option somewhere. Just for fun: first time I have seen black sweet potato vines flowering. Neat. ……. just an odd observation, but to me it was yeah? Finally something new, and good. Ignore otherwise in context of medical discussions.

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No worries, I sent it on. 😁

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I had my right knee done about ten years ago and my left knee done within the last five years. I have had a right shoulder replacement and carpal tunnel surgery on both wrists. I include that info as I have found commonalities in preparation and recovery.
Do the pre-exercises to the best of your ability. They gave me confidence.
Read and/or watch instructional videos. There are many on you tube produced by reputable universities and medical practices. Pre-surgery I learned what to expect. Post surgery taught me correct form, how to best negotiate sleeping, barriers in the home…tons of stuff.
I learned not to listen to horror stories or people who claimed to have no pain, etc. This is surgery to your body and relaxing, trusting your doctor, getting excited about benefits of the surgery, educating yourself and believing in yourself will make a world of difference.
Plan to need help and ask for it. Having a plan for someone to assist you for at least the first week to two weeks post op is comforting.
Use ice. I had the ice bucket thingy that forces ice water out and into a small mat that draped over my knees. Big blessing!
Be a good patient. Do your physical therapy.
Give time, time.
Any sacrifices I have made in modifying exercise, etc have been well worth it!
You can do it!

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@marymelba

Thank you Chris and DD. Using the toilet was incredibly painful. I purchased a bedside commode, took the pail off and then place the frame/seat over my toilet. What a blessing. I added a small foot stool, to rest my leg. BTW, I am 19 days post TKR. I have significant swelling, I sit in a recliner. Perhaps it’s not too late to try and get that leg more elevated? DD, can your loop gadget be purchased on-Line? I took Oxy the first week and now Tramadol. Doctor recommended taking it more frequently cause I was not sleeping and after PT pain was unbearable. Finally comfortable, nor pain free, but I can function. I exercise multiple times a day. I have good extension and 90 degree flexion. Mary

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@marymelba – the leg lifter's are available online from Amazon, they run from $7 to $10. Mine are similar to the cheap blue $7 ones, the hospital staff gave me one each time I got my TKR's. Do a search for "leg lifter after knee surgery" It's just a long semi-rigid strap with a hand hold at one end, and a loop for your foot at the other. Along with helping you get into and out of bed, and elevating your leg on cushions on a recliner, it also is used for rehab exercises with leg lifts before you start getting your leg strength back.
It's possible a well stocked drug store might have them too. I got more use out of mine when I did rehab for a frozen shoulder last year, I could hang it over my shoulder to do behind the back arm pull ups. The foot loop was easier to hang onto than the towel they suggested.

I am sorry to hear you are still having so much pain. I wonder if it is aggravated by the swelling. I elevated most of the time I was in the recliner since I was captive there anyway. My PT guy said that icing for three times a day for 20 minutes is enough, but I iced for longer and more often in the early days, because it made it more bearable, even for sleeping (or trying to!) Also, the hospital sent me home with a large flexible ice pack with a soft removable cover with velcro straps to keep it in place. I think that ice pack was what kept me sane and as comfortable as I could expect to be.

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@ellerbracke

@auntieoakley : I trust you are doing well with your second knee replacement. You are a veteran, both from personal experience, and so many other people adding their input. I had my right TKR 9/18, 85% happy with it. 100% functional. Just curious – if I would be faced with need to fix major knee pain in my other knee, I would -other than PT, etc. – try PRP, even stem cell injections, before TKR , perhaps even lowered expectations of activity, since I’m somehow getting older all the time. Again, my artificial knee works well, does not hurt, irritates the heck out of me because it clicks, and I can’t kneel, and it feels like about 5 degrees off perfect alignment, sort of screwed on lopsided…….. so all those things would cause me to avoid a left TKR. Just wondering about your decision to go with TKR again. None of my beeswax, of course, Just curious if you had ever tried other options for either knee. Stay well, and go slay it. You know what to do – you can teach others what to do!

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@ellerbracke I guess your post was intended for me?

I am doing well. I exercise and walk a lot and as a result I do have discomfort at the end of the day. I didn't always and I believe a couple of medications I take now contribute to that.

Regarding why I never considered other options to a TKR, the only "permanent" option that I was really aware of was stem cell and from everything I read and heard the success rate with that was only somewhere around 50% I think, and it's not covered by insurance. That's a lot of money to risk and then not have your knee be better. My husband does know someone who went that route and it was not helpful at all. I did do PT but that can only help so much. I had cortisone and then Synvisc too. Synvisc helped for a while but eventually it stopped helping.

@anncgrl I agree with you, don't listen too much to others. One other thing that I think is important is to not think that a replaced knee is going to be exactly what your perfect, natural knee was like. It is not. There will at times be discomfort. People need to accept that.
JK

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Last week I introduced my new series entitled TKR #2 with a discussion entitled "I'm still learning." It has been 10 years since my initial TKR. The entire process has changed. Identification of the what's and the whys are easier with contemporary technology. Robotic guided techniques make the surgery more accurate, faster, and minimally invasive. As I move into recovery and rebuilding, I am still learning. Knowledge is power and I am finding out that as a patient, I am responsible for asking the right questions, researching the plausible answers, and helping to resolve the medical issues by paying attention and following instructions and guidelines.

#1 this week was to learn how to use one of the assists……a walker. My PT noticed that I was leaning over the walker with my behind sticking out….very uncomfortable and not very stable. She showed me how to place my body inside the walker so that I am standing straight instead of leaning over. Wow…what a difference.

#2 was a thorough evaluation and shared decision about post-surgery medications. I am highly sensitive to opioids and have only found one, Dilaudid, that can be helpful in a surgery situation. My current surgeon and his Rx designee reviewed my previous surgery injections. An exception was made because of my experiences and Dilaudid was designated as the pain control opiate for surgery. We had another review of medications for post-surgery and recovery which included an appropriate dosage of Dilaudid. No one started with a self-prescribed answer and we all shared the decision-making process that led to an appropriate starting point.

#3. Introducing medical cannabis to the post-surgery options for pain and comfort control was also at the top of the list for shared decision-making. My choice of medications for small fiber peripheral neuropathy (SPN) has included medical cannabis for 5 or 6 years. An integrative approach was designated for post-surgery that included medical cannabis and ensured a positive and healthful response.

I am very impressed with the compassionate and caring approach of my providers. As I discover more "Let's get it right" opportunities…..that enable the best decisions, I will share them with Connect members. Please add your positive experiences and/or provocative questions.

May you be mentally healthy
May you be physically healthy
May you have peace and ease.
Chris

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@artscaping

Last week I introduced my new series entitled TKR #2 with a discussion entitled "I'm still learning." It has been 10 years since my initial TKR. The entire process has changed. Identification of the what's and the whys are easier with contemporary technology. Robotic guided techniques make the surgery more accurate, faster, and minimally invasive. As I move into recovery and rebuilding, I am still learning. Knowledge is power and I am finding out that as a patient, I am responsible for asking the right questions, researching the plausible answers, and helping to resolve the medical issues by paying attention and following instructions and guidelines.

#1 this week was to learn how to use one of the assists……a walker. My PT noticed that I was leaning over the walker with my behind sticking out….very uncomfortable and not very stable. She showed me how to place my body inside the walker so that I am standing straight instead of leaning over. Wow…what a difference.

#2 was a thorough evaluation and shared decision about post-surgery medications. I am highly sensitive to opioids and have only found one, Dilaudid, that can be helpful in a surgery situation. My current surgeon and his Rx designee reviewed my previous surgery injections. An exception was made because of my experiences and Dilaudid was designated as the pain control opiate for surgery. We had another review of medications for post-surgery and recovery which included an appropriate dosage of Dilaudid. No one started with a self-prescribed answer and we all shared the decision-making process that led to an appropriate starting point.

#3. Introducing medical cannabis to the post-surgery options for pain and comfort control was also at the top of the list for shared decision-making. My choice of medications for small fiber peripheral neuropathy (SPN) has included medical cannabis for 5 or 6 years. An integrative approach was designated for post-surgery that included medical cannabis and ensured a positive and healthful response.

I am very impressed with the compassionate and caring approach of my providers. As I discover more "Let's get it right" opportunities…..that enable the best decisions, I will share them with Connect members. Please add your positive experiences and/or provocative questions.

May you be mentally healthy
May you be physically healthy
May you have peace and ease.
Chris

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Hi Chris-thank you for sharing your knee replacement story! You've got it right utilizing a team approach with your surgeon along with their medical staff. It's no longer just the dr's word or orders if you will. Modern day patients are armed with a wealth of information right at their fingertips. A team approach in healthcare lends itself to optimal patient outcomes, and a meaningful relationship with the healthcare provider. I'm very happy for you in your post surgical experience thus far. Continued success to you.

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