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 Support Group.

@cstucky

Thanks for passing along the article. I’ve seen some too that don’t necessitate the need for antibiotics before dental procedures. I’d err on the safe side, however. As I stated in my earlier response, our family history is a bit bleak in regard to knee infections after TKR. One led to my father’s being confined to a wheelchair for the remainder of his life. Fingers crossed I can hold out as long as possible without getting a root canal. Thanks again for the article.

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So sorry to hear that - and in that case, safe is definitely better than sorrow!

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@artscaping

Good afternoon @glidefloss Yes, I did go back my Yoga Class. My Yoga classes are led by a lady I have been working with for eight years. Based on my physical capabilities she put together a program that takes into account my age and orthopedic struggles. I use that one every day and attend a Zoom class on Tuesdays. In the class, I only do what I can do.

However, I can do a pretty good Child's Pose and can walk on my knees across the carpet.

I would never be able to do the malasana pose. I just topple over. Makes me laugh to even think about it.

May you have contentment and ease.
Chris

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@artscaping : Chris - you are something else! I thought I was a poster child for super speedy recovery after TKR, but nothing compared to you. Those many years of yoga of yours certainly helped in every respect. My RTKR was 3 1/2 years ago, and I am very happy with it. 11 months prior to the TKR I had arthroscopic surgery on same knee, with disappointing results. After 7 months I was finally able to kneel normally again, but the pain when going down stairs, or inclines, never eased up, in spite of PT, cortisone, sinvisq shots. So - TKR. All good, except - you guessed it - kneeling. While I can kneel, it is not comfortable at all, and if I try to kneel and bend forward, reaching out as in cleaning behind toilet, or pulling weeds, and putting a lot of pressure on the kneecap, it is ouchy. How did you get to the point where you don’t seem to have this issue? And you can truly get all the way down to child’s pose? I still need a small pillow under butt to achieve this; because of long-standing back problems I don’t dare do an uneven/slanted version.

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@4russcoll

I had to have 2 teeth removed after TKR: 1 at 8 weeks and another at 12. Emphasis on “had to”. One due to pain and risk of infection the other due to pain and probable infection.
No problems w knee infection. Both times took 2G amoxicillin prior per ortho surgeon followed by a week of lower dose amoxicillin prescribed by dentist. There appears to be various interpretations within the surgical and dental community regarding when dental procedures become “safe” after TKR and the need for Amoxicillin. I consider the antibiotic to be in the “better safe than sorry” category and was very happy to use.

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I had a similar situation. Right after my first TKR in 2019, I discovered that I had a tooth infection. My surgeon and my dentist got together and I had to take an antibiotic one hour before the dentist appointment.
I have to continue that regimen every time I am having dental work. It’s especially important before a cleaning when the hygienist digs out the junk from around the gum line.
I had my second TKR in 2020.
My knees can be a bit stiff at times, but at least I don’t have the awful pain anymore!

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I have a question about what constitutes negligence with a surgeon. When I was being sold my first partial knee operation, the surgeon talked about how I would heal quicker, smaller scar, etc. He has 32 years in the orthopedic surgery field etc. Well, that surgery failed IMMEDIATELY the first time I was helped up my knee went out of alignment and it was very scarey and painful. Also I had to have the bandage replaced the first day because of bleeding - nurse said a stitch probably broke!

Surgeon kept me on bed rest first day and told me that I would probably be okay as scar tissue would hold it in place. Never happened. I could not extend legwithout knee going out of alignment. I had pain, tingling, burnng etc. but he never helped me with it. In fact my family doc came up with my using a mild sleeping aide so I could get some sleep! Then the surgeon hwanted to do a correction 3 months out and just straighten it (whatever that means). When I was surprised at another operation he told me not to worry it was only soft tissue! Tlhree_ months later he tells me a TKR is the way to go and scheduls it for what would have been just over 3 months out.

Second operation seemed to go well but still the buring, tingling etc. has continued for 10 months now, 13 months if you could from the 1st surgery. Not much help from surgeon. I got PT at home (due to Covid at the time) for I believe it was 6 weeks and he would not give me any more. Well I had done well, I still needed help with stairs, etc. All he seems interested in is setting up the surgery for my other knee. At my 3mth visit I asked for more therapy and was told to just go home and try using my cane more around the kitchen and I would catch on! Umm, I have no balance and with the other knee being bad it is not a good situation. I have continued with the exercises the PT gave me but I seemed to be losing ground and getting no where. At my 6 month check up same problems and I asked for PT again. As I said, his opening comment is when am I ready for the next knee to be done. His response to my request was that he is "saving the PT for after my next TKR"!! WTH! Told him I was still having difficulty with balance and using the cane and he again told me to go home and keep practicing. Never asked me to walk so he could see what was going on.

Well, hubby and I had enough and got a referral from my GP. This Surgeon is totally different from the first one. When I told him what was going on he was not happy (he already had the records and xrays.) He told us that there is a very high failure rate with partial knee replacements and he doesn't do them because it only leads to a second total TKR operation. He was also concerned about the lack of PT help. He was curious as to why the surgeon would do what he did. I had bone damage due to the first partial that had to be corrected and my new surgeon said that some kind of pin shoud have been put there to reinforce the bone.

One thing we told the surgeon about the first operation is that apparently the instruments (I guess they come in packages) had a hole and had to be resterilized - this was found out after I was already under. Hubby was informed about situation and that they were keeping me under sedation (twilight) until instruments were ready. When hubby asked why not use a different set, he was told that these instruments had been sent in for this operation and they did not have another set!! Again, WTH.illllity the 1st slurgeon has to do an operation that has a very high failure rate instead of the TKR? Then about the denial of the PT that I was begging for.

The 2nd Surgeon got me right into PT and it is helping but as most of the healing is already done I may never be completely right again.

Also, after the first operation the Surgeon said something to my hubby about he should have made a stitch or something tighter. Later he told him he would never do a partial knee surgery again. But that doesn't help me out does it.

My question is what responsib

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@SusanEllen66

I had a similar situation. Right after my first TKR in 2019, I discovered that I had a tooth infection. My surgeon and my dentist got together and I had to take an antibiotic one hour before the dentist appointment.
I have to continue that regimen every time I am having dental work. It’s especially important before a cleaning when the hygienist digs out the junk from around the gum line.
I had my second TKR in 2020.
My knees can be a bit stiff at times, but at least I don’t have the awful pain anymore!

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Good evening @SusanEllen66, My goodness, you have been a Connect member for quite some time. I am happy to meet you. On Friday, I have my first dental appointment after my TKR. I showed up first without amoxicillin and was sent home to make sure my surgeon gave me the correct prescription. You are absolutely correct that it is critically important for the cleaning.

Congratulations on being pain-free now. Do you still do exercises daily? Do they help with the stiffness?

May you have happiness and the causes of happiness.
Chris

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@artscaping

Good evening @SusanEllen66, My goodness, you have been a Connect member for quite some time. I am happy to meet you. On Friday, I have my first dental appointment after my TKR. I showed up first without amoxicillin and was sent home to make sure my surgeon gave me the correct prescription. You are absolutely correct that it is critically important for the cleaning.

Congratulations on being pain-free now. Do you still do exercises daily? Do they help with the stiffness?

May you have happiness and the causes of happiness.
Chris

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Hello Chris
Currently I am battling a relapse of my autoimmune disease, Polyarteritis Nodosa. It’s knocking me down and out. I just had 4 weekly IV infusion of Rituxin and am seeing progress.
I haven’t been able to exercise now because I just don’t feel well enough.
That said, my knees get really stiff if I sit in certain positions for awhile. Other than that the knees are great.
I’m happy I had them done although I would not have said that during the awful recovery time!

Thanks for your kind words. I’m trying to get myself up and out but need to be extremely careful with this Covid-19 situation.
Enjoy your day!

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@SusanEllen66

Hello Chris
Currently I am battling a relapse of my autoimmune disease, Polyarteritis Nodosa. It’s knocking me down and out. I just had 4 weekly IV infusion of Rituxin and am seeing progress.
I haven’t been able to exercise now because I just don’t feel well enough.
That said, my knees get really stiff if I sit in certain positions for awhile. Other than that the knees are great.
I’m happy I had them done although I would not have said that during the awful recovery time!

Thanks for your kind words. I’m trying to get myself up and out but need to be extremely careful with this Covid-19 situation.
Enjoy your day!

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Good morning and thanks for the update. I am glad you are still feeling positive about you knees. Here's a possibility......have you ever done the "legs up the wall" Yoga pose. It sure helps my legs lose the stiff feeling. Let me know if you need a picture or two. You can also just put "legs up the wall" in the search block at the top of the page.....press on the spy glass and you will see all the mentions of that pose.

May you have contentment and ease.
Chris

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@artscaping

Good morning and thanks for the update. I am glad you are still feeling positive about you knees. Here's a possibility......have you ever done the "legs up the wall" Yoga pose. It sure helps my legs lose the stiff feeling. Let me know if you need a picture or two. You can also just put "legs up the wall" in the search block at the top of the page.....press on the spy glass and you will see all the mentions of that pose.

May you have contentment and ease.
Chris

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Hi Chris, thanks for the chuckle today! “Legs up the wall” looks like a potential rescue call from me. I can just see me on the floor when the paramedics crash through my front door!
Seriously, I don’t know if I can do it but I’m willing to try. I live alone so no one is here to help if I need it…once I am able to have my family visit I will try to get it done!

Blessings!
Susan

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@4russcoll

I had to have 2 teeth removed after TKR: 1 at 8 weeks and another at 12. Emphasis on “had to”. One due to pain and risk of infection the other due to pain and probable infection.
No problems w knee infection. Both times took 2G amoxicillin prior per ortho surgeon followed by a week of lower dose amoxicillin prescribed by dentist. There appears to be various interpretations within the surgical and dental community regarding when dental procedures become “safe” after TKR and the need for Amoxicillin. I consider the antibiotic to be in the “better safe than sorry” category and was very happy to use.

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I wanted to thank all in this forum for their help with my concern about having a root canal 5 days shy of 3 months after knee replacement. I did some research and found a specialist a four hour drive away who does laser root canals. This procedure, according to my research, is supposed to yield less secondary infections. Good news was delivered at my appointment with the specialist. The tooth root looked fine and at this time no root canal is needed. Tooth sensitivity could have been the issue. I wanted everyone to know that the specialist said if you can wait for a year after a joint replacement it’s best, unless, of course, it’s an emergency situation. I’m super relieved and wanted to pass along this info. Good luck to all going thru knee replacements..

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@cstucky

I wanted to thank all in this forum for their help with my concern about having a root canal 5 days shy of 3 months after knee replacement. I did some research and found a specialist a four hour drive away who does laser root canals. This procedure, according to my research, is supposed to yield less secondary infections. Good news was delivered at my appointment with the specialist. The tooth root looked fine and at this time no root canal is needed. Tooth sensitivity could have been the issue. I wanted everyone to know that the specialist said if you can wait for a year after a joint replacement it’s best, unless, of course, it’s an emergency situation. I’m super relieved and wanted to pass along this info. Good luck to all going thru knee replacements..

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@cstucky and @4russcoll ......Thank you both for the updates. You are right....there seem to be different regulations and protocols. I finally had my first post-surgery appointment last week. Everything was fine and I understand why a TKR has much more risk of infection than hand surgery. However, the dentist is the one that brought up the issue, not the surgeon. Some dentists would prefer that you visit them before your TKR to make sure nothing gets overlooked. She assured me that there were no threats to my new knee.

Chris

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