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.
posted by Mike Cuthbert at 2:23 PM
15 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.
Mike,
Wow. This is some of the best information i have found on the net. I am 35 and in constant pain after a very tramatic fall doing Red Cross First Responce at the State Fair here in NC. I have approx. 25% of my miniscus left if that and I am bone on bone. But being I am only 35 they are not even thinking TKR at this point. They are talking about doing a Knee Realignment and a Microfracture. And then if that does not work then they are talking either partial or full replacement. What could you tell me so I can get them to skip the next proceedure and just replace the knee joint? They have gave me a disibility rating of 8% which I cant seem to find any thing on. So I will continue my path and hopefull they will do the right thing this time. Which will be #4 for operations on this knee.
Take Care.
I have read the blog with great interest.
I had a total knee replacement on Oct 10 of 2007. That was on a Wednesday morning, it started about 8:30 am. I was in my room and on my feet by 3 pm of the same day. Left the hospital on Friday, on crutches. Came home to a two story house (bathroom was upstairs) to start my recovery. I used the steps as a type of therapy and tried to go up and down at least 10 times each day from the day I came home.
After the second day home gave up the crutches for a cane, it was much easier to work the steps. And after 5 days with the cane I gave that up and was walking without anything.
One week after the operation I went to story hour with my granddaughter. Nine days after, went to lunch with the family. At ten days went and played cards for the evening.
I drove myself to my 3 week post-op appointment. And haven't stopped since.
I have worked very hard on my recovery and today at almost 6 months post-op I went for a 3 mile hike on the trails.
I am not a super-hiker or anything like that but I am determinded that this is not going to stop me.
I haven't taken any pain meds since 6 weeks post-op. Again I am not looking for the martyr award, but I did not feel that I needed them.
I have handled my own therapy, using the book from the doctor as a guide. Trying to get my leg as straight as possible and also to bend it as much as possible. Right now it is almost as straight as the other, and it can bend as much as the other.
My biggest problem at this point is kneeling on it, as the scar is still tender. Gardening seaso is almost here and I would like to be able to work outside comfortably.
Good luck to all, and remember that you will get out just what you put in.
By the Way, I am a 56 year old grandmother that is determinded to be up o my feet for many years to come.
I am a 55 year old grandmother and had a total knee replacement on both knees March 4, 2008. I went to an outside facility to start my rehab and it was well worth it. I was up walking without a walker or cane 10 days out of surgery. My Pt ws a motivator and the environment made me feel as I was among friends. I am now doing the out patient rehab at a facility in my hometown and am blessed again with an excellent PT indiviual.I will see my doctor the 24 of this month and I expect to be reduced on time with my PT. I take 1 Hydrocodone before my therapy and I have reduced the amount of pain meds that I need. The only time my knees relly hurt is when temp goes up or down or rain is in the picture and we have had alot of that lately but most people are more than amazed to see how well I walk with no walker,cane but I tell each one who thinks that it will be a easy. No it takes motivation. Family7 who are suportive and wonderful medical staff. I'm looking forward to time becuase I have been bone on bome for many years and this has been one the biggest blessings of my life.
Im 4 weeks post op for a total knee replacement, 48 year old male, good health before surgery. I see by other comments that I seem to be doing pretty good as I read others comments. I am just recently married and my wife is havong a hard time with not being able to sleep in the same bed, we can start out together, but thenthe pain and having to lay a certain way disturbs her sleep. I know that this may seem a little strange but has any one else had the same problem?
I do go to PT 3 times a week and it seems to be going real well,at 110 degrees bend and -1 degree extension. My therapist is awesome and says Im doing great, But sometimes I seem to go backwards as far as swelling and pain. But she said this is normal...Thanks
Hello,
I have found all of your stories interesting and informative. I have had 2 recent knee replacements at age 51. On on Nov. 15th,2007 and the second on January 31st 2008. The second one was much more painful.
On the day of surgery as I was returned to my hospital room a new nurse came in and told me I needed to get up and walk a little. I knew this was normal precedure and I complied with her request and asked if she would be using a gate belt. She said "no need" well.... I fell hard with my knee up under me.
I don't know what if any effect this had on recovery.Recovery was rough. 3 months post op I dislocated same knee 2x in a 4week period while sitting in a chair with wheels.
I ended up having a new spacer put in to replace the "loose" one.
I am only a week out from that surgery and I am getting pretty depressed and really questioning my decision to have TKR in the first place.
Any words of wisdom? encouragement? or shared experience?
Thanks.
Had my right knee replaced mid February 2008 - Today I still have some pain - but my movement is good - Some days the pain is less - sometimes more - I am hopeful as time goes by, that I will have a full recovery - But til now - it seems like slow progress - My doctor told me to give it a full year and all would be well - I hope so - I need the other knee done as well
7 Jul 2008 - Just ran across this webblog - I'm six weeks post-op tomorrow from left TKR. 48 year old female, bone-on-bone. Basically, an 80 year old knee in a 48 year old body. It's been a mixed mental situation but a good physical one. My surgeon is extremely conservative, so tomorrow marks my 'off the walker/out of the TED hose'. I graduate to a cane, and hopefully, start improving my lousy sleep patterns. That's been the biggest drawback since I got out of rehab, four weeks ago. I don't sleep for more than 1 1/2 hours at a time. Movement of the knee causes pain (since it's been in one position for an extended period), so it wakes me up to change the position. I still have both vicodin and oxycondon pills. I stopped taking both on a regular basis, but will take them if the pain spikes for some reason (weather changes, to help sleep). I don't get cleared to drive until I see my surgeon in week 9, so I have plenty of time to take meds before PT. I start out-patient PT this Wed. I currently have a 127 degree bend (after exercise) and a 1 -2 degree straightening. I still have little stamina and lost a great deal of muscle tone (in addition to the 17 lbs and 13 inches I've lost). So, I'm starting light weights and very, very slowly to move on my elliptical. I did 9 minutes yesterday (in addition to my regular walks) and it was okay.
I too have encountered some serious mood swing problems - but I have a very supportive husband and I'm able to telework for my job, so that makes a huge difference. I do believe this will be worth it, but I surely don't want to do it again!
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