Lessons for Those Facing a Total Knee Replacement
I am undoubtedly not typical of a knee replacement patient but, having gone through the procedure twice in the past five years, I feel qualified to offer some advice. At least, these are some of the changes in your life you might look out for as you go through the process of the replacement. Yes, it is not merely an operation; it is a process, the most important part of which starts in the recovery room.
1. Rehab is everything. The operation takes a couple of hours; the rehab takes months and months so plan to start rehab as soon as possible.
2. Learn to manage your pain in the hospital and don’t be macho or Amazonian about managing it at home. Pain wrecks rehab, destroys sleep and exhausts you. The professionals tell us that not managing pain also slows recovery drastically. My rule of thumb: when my pain goes over 6 and is clearly headed higher toward 10, I take the Percocet and track the time so as to not take any more than two in four hours. (Sometimes each dosage will last longer than four hours, but it’s amazing how often at the four-hour mark you can feel the pain start to return!)
3. Rehab hurts. Once home and started with a therapist or by yourself or at an outpatient rehab facility upon discharge from the hospital, learn to manage your pain meds. I take 2 Percocets an hour before every therapy session. Without the pain meds, the therapy is limited by pain and not as productive. The goal is to regain “Range of Motion” in the joint and to do that you have to take your knee beyond where pain would stop you. BUT—see #4
4. When your pain meds kick in, be careful not to over-stretch because the pain won’t be there to stop you. Learn to exercise to a stretch that you can feel even with pain meds. To go any further asks for pulled muscles that turn up only after the pain meds fade away.
5. Have the operation in the summer months, during re-runs on TV. You won’t want to watch much anyway and the only sports on during the summer, baseball, can help you get to sleep anyway.
6. Do not plan to read War and Peace during recuperation. I find my attention span the first few weeks was limited to a few pages of Dr. Seuss at a time. Similarly, don’t plan to write anything meaningful. Many pages of my journal have these odd dribbles of ink off the page where my pen went when I fell asleep during a short entry.
7. Welcome visitors but don’t be afraid to let them know when you can’t remember their names any more from fatigue.
8. Plan to start a diet. I lost twenty pounds in less than a month because I didn’t want to eat much at all and didn’t need to. I have suggested that my orthopedic surgeon market his “Joint Replacement and Weight Loss System.”
9. Sleep whenever you feel sleepy. Usual sleep patterns are destroyed anyway so take it when you can get it. You’re not going to be going anywhere during the day and, if you followed suggestion #5, there’s going to be nothing you’ll miss on TV anyway. The best nap is the one after PT!!
After writing that, I made myself so sleepy that I followed my own advice and nodded off. Next blog, nine more tips on handling a knee replacement, including the value of Mah-Jongg on your computer and the care and treatment of your Significant Other.
8 Comments:
Thanks for the good read...I am 5 weeks today post-surgery and guess I am expecting more --- or don't know quite what to expect.
My PT therapist is fantastic...had 6 weeks PT prior to surgery and 3weeks with this PT therapist
post surgery...the hospital (3 days) PT was adequate or better, and the next 5 days in a rehab facility were next to a joke. Then I got home and returned to the well-qualified, dedicated PT therapist who began manual work as well as exercise, and spent lots of time manually working on my knee.
At 5 weeks, I am getting around, but often am still wanting lots of "down" time, on the couch, feet up. I am using 1 crutch, go up and down the stairs once A>M> and once P>M>. Do formal PT 3 times a week each time for almost 3 hours now. Take pain pills on a limited basis....going out and about is not often appealing to me .... and on days off PT I do the advised exercises twice....I now drive myself to PT.... how does this sound for progress???? Am I lazy or just in recovery
Well you are scaring the heck out of me! I recently had a knee problem and felt fairly certain that any doctor would have leapt to a "knee replacement" diagnosis so I spent a lot of time with it myself (massage, rest, etc.) and it is about 85% back to normal now (interestingly, I am now having problems with my forearm from all that massage...). After reading this, I will make replacement the very last resort! I'm curious about just how bad it was before you had the surgery--I'm going to assume you were immobile at that point. It sounds horrendous. I now have more understanding about why people who have had knee replacement don't want to get out much (my neighbor won't even go for a short walk with me, although she seems pain-free now)--who would want to risk going through it again, as you have???
Thanks for the insight.
Mary Ann:
First, I must remind everybody that each case is different and I AM NOT A DOCTOR. Second, the pre-op PT is a VITAL idea and everybody should pay attention to what you did.
I’m amazed that you did six weeks—I did about three—and the most important was the arm stuff for managing crutches, getting out of chairs, pulling up in bed, etc. Sounds like you have an excellent therapist.
At five weeks and for some time thereafter, you will want and need a lot of “down time.” As I said, I couldn’t read nor could I avoid falling asleep at odd times. Sleep is now a bigger problem than pain for me.
It sounds to me as if you’re doing great and that you’re far from lazy. The crucial numbers, of course, are those for flexing and extending. If you are at >120 degrees of flex and near 0 for extension, then you’re in great shape. I’m currently at 124 and 0 with no pain either way. I am pleased.
DON’T PUSH IT TOO HARD! Every once in a while I do that out of frustration and it only sets you back. My doctor told me with the first knee that it would take a year to fully recover. I believe him.
Thanks a lot for sharing. I hope we can help others handle the operation and make good lives out of a temporary condition.
Mike
Peggy:
Wow! I certainly had no intention of scaring anybody!
I was bone-on-bone—no meniscus there at all and could barely make it down the street or upstairs without the likelihood of it giving way or suffering intense pain so I had no choice.
I waited too long the first time five years ago.
If you can handle the loss of meniscus without the replacement, great. I had no choice if I wanted to function or sleep. As for the lack of desire to go out, I don’t understand that as I LOVE getting out. It’s getting to the car and back that takes a little practice, and sitting for a long time is still a hard thing to do, but it’s getting better, along with everything else about the knee.
I hope you read Mary Ann’s account as she prepared beforehand and is working hard and making great progress toward normalcy.
Hey, it’s metal and it’s not you and sometimes it clicks when you walk, but compared to before? A piece of cake!
I am playing golf this weekend for the first time in almost three months. I could not do that without intense discomfort in the weeks before the operation. Would I do it again? Sure would, though I admit some relief at the realization that I have only two knees!
Thanks for sharing your fears. A lot of people have them, but the alternative to me, living with no cartilage and the pain that brings, is not a good one and eventually, not an option.
Mike
After two ankle joint and one hip joint replacement over a 30 year period I can still hear my surgeon say, "stop the percocet". He was right because I got "hooked".
Hi everyone,
I had knee replacement on Oct 8 of this month. I was on big time pain medication in the hosptial and continued with vidicon when I got home. My pain is still a issue. I take 2 vidicon every 6 hours up until a week ago when I decreased it to 1 every 4 hours. Everybody keeps telling me it is addiction so I cut back. I am always in a lot of pain and after my PT leaves it is worse. The vidicon keeps me up at night and I use a sleeping aid to get to sleep each night. My calf hurts so bad and my knee is stiff regardless of which way I lay in the bed. I have tossed and turned for the last 3 weeks and frankly the bed is becoming a last resort. my doctor changed my meds to davacet but these pink pills didnt do anything for me at all so I went back to vidicon. My question is when will I start to feel like I made the right decision for this surgery, as all I feel right now is pain and regret. I cant see the light at the end of the tunnel yet. I got my staples out a couple of days ago and I tell you that was the best thing since I had the surgery, as those staples used to dig and dig into my flesh and I couldnt take it anymore. My family is sticking by me, but I feel so depressed and always in pain.
Help.........no appetite, and the pain meds does not allow my bowels to move normally, I have to take a laxative every 2 days.
Dear Anonymous,
I value Percocet as a last resort only, but an often necessary tool.
I worry, too, about possible addiction which is why I have been careful, through both knee replacements, to use it only when necessary. I would NOT tell anybody to skip a painkiller if it blocked sleep or physical therapy unless they had a history of addiction.
This message was stressed by every medical person I met prior to and during the process of both replacements.
(This situation is being addressed currently in the ABC show “Brothers and Sisters” in which one of the characters has returned injured from Afghanistan and, a former addict, has begun to take painkillers and is taking too many.)
If there is a pain reliever that is more effective with less risk, find it with your doctor’s help, but I find Percocet, in limited and careful doses for pain, to be a great aid in physical therapy. I must also admit that I find the concept of taking Percocet for something other than pain confusing. Other than relieving pain, it does nothing else for me at all that a good movie or dinner with my family cannot do!
I had my first knee replacement about 5 years ago and everything Mike said was dead on. Work, work work during PT. If you have a choice of doctors ask the pt people who they would recommend. The know what the results of surgery are and know whose patients have problems. I had none and was lucky. Now biking 25 miles a day and the original knee is about to go and am looking at replacement in another couple of months. The more weight you lose the better you are, lost 35 and have another 30 to go.
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