Left Knee HIstory 1968
Severed left ACL due to gymnastic's injury. 1998
Arthroscopic Debridement Custom DePuy brace. 2002
ACL reconstruction 3 months physical therapy Very successful surgery 2004
Debridement Custom Orthodics Synvisc injections 2005
Synvisc injections 2006
Microfracture abandoned (no cartilage or meniscus) Debridement Cortisone injections TKARight Knee History 2006
Debridement indicates significant damage from overcompensation bone/bone in a few places future TKA indicated Cortisone injections "Wait for your "lightbulb moment." Surgery & rehab are challenging and you need to be highly motivated for success. I was concerned the surgery would relieve pain but reduce what I was able to do before surgery. At a TKA seminar OS wanted to know something I wanted to be able to do after surgery. I said I wanted to be able to get off the toilet without pulling the doorknob. Afterwards I was told I would gain a lot. I responded, “Yes I know that it is time when I wait for the handicapped stall if someone is in it". To which she replied, “Handicapped, that ought to tell you something.“ CLICK LIGHTBULB
I scheduled TKA the next day.Questions for my OS about TKA:
Pain management? How do I contact you after office hours? Unusual complications? Previous surgeries affect TKA? OK to take my daily medications before surgery? Hand numbed before insertion of IV? What do I do if I have problems concerning the way I am treated in the hospital? Staph infection rate at the hospital? Information on hospital ratings? Who will be involved in my care at the hospital? Experience of hospital staff with TKA? Will you coordinate with my physician? How do I evaluate physical therapist? What is not covered by insurance? How long have you performed this surgery? How many TKA do you do annually? How is it performed? Will you make the incision to the side of the patella so it won't hurt when I kneel on it? Use of new equipment or new procedures? Kind of implant to be used? What makes this one the best choice for me? Performance of this joint? Life expectancy of TKA? Likelihood of repeat surgeries? Learn more about this surgery? Test or procedures will be needed prior to surgery? How can I increase the success of this surgery? Exercise routine? Physical therapy before surgery to learn post-surgery exercises? Temporary handicapped parking permit? Donate my blood before surgery? What will happen before surgery in the hospital? Will you perform the surgery? Who will be involved in the surgery and what will they do? Type of anesthesia? Will I be awake? Length of surgery? Benchmarks for discharge from hospital? Arrangement for family to stay at the hospital? Anti-anxiety medication before the surgery? When can I return to: Using Hot tub Normal exercise Wearing Custom orthodics Work Pain medicine before physical therapy? Physiical therapy visits prescribed? Changes or arrangement at home before discharge? Passive motion machine? Cyotherapy unit? Does recovery depend on time needed for healing or physical readjustment? What causes the pain?TKA shopping list: FOR THE HOSPITAL:
in addition to the normal personal grooming supplies
dental floss mints hard candy gum short robe laptop movies wristwatch
long distance phone card Bible/ books note pad pencils tweezers
emeryboard cell phone lotion mirror pillow chapstick advanced directive
address/phone book comfortable tennis shoes and socks for PT
jogging suit to wear home all of your doctors contact phone # you may need to inform them of how you are being treatedFOR HOME:ELEVATED TOILET
( a must....for suggestions check out the thread: comfort height toilets)CRYOTHERAPY UNIT
ABSOLUTE MUST GET ONE
a big bedside table
big thermal cup with lid
laptop computer with wireless internet
socks with "tread" on the soles
phone next to the bed
TREADMILL a good one cost $$ you will either love it or hate it
RECUMBENT BIKE you will love it or hate itPHYSICAL THERAPY TO BE CONTINUED AT HOME AFTER SURGERY:STEP UPS:
stand at the bottom of the stairs and step up one step leading with the bad leg. Then step back down leading with the bad leg. I do 3 sets of 20SIT DOWNS:
stand in front of a chair and slowly sit down only barely touch the seat of the chair and stand back up. STANDING FROM SITTING:
sit in a chair and slowly rise to the point before your knee is straightened then slowly sit down. 3 sets of 20 RESITTANCE THERABANDS:
I use the blue one . I tie the tubing around the leg of my treadmill. I step into the loop and place the tubing behind the bend of my bad knee. I step back until there is resistance in the band. Then keeping my feet on the floor I slightly bend and then straighten the bad knee. 3 sets of 30 LEG LIFTS:
4 pound ankle weight Always keep the leg straight. Relax quad after each lift and reset quad before each lift. Make sure the quad is tight and in control of the motion. Each direction 3 sets of 20Bad side down:
lie on your side with the bad leg on the flat surface. Lift the good leg over the bad leg placing the foot of your good leg next to your bad knee. Lift your bad leg about 8-10 inches off the flat surface. Back:
lie on your stomach slowly lift the bad leg up about 12-18" and lower it slowly to the surface. Bad side up:
Lie on your side with your good leg on the flat surface and lift your bad leg 12-18" then slowly return the leg to the surface. Stomach up:
Lie on your back and lift your bad leg 18-24" then lower it down. STOOL SCOOTS:
Sit on a stool or chair that is on rollers. Using your bad leg pull yourself across the floor about 30 feet and then push with you bad leg back 30 feet. TREADMILL:
30 mins forward @ 3mph 10 mins @0.5 backwardRECUMBANT BKIE:
30 mins daily4 weeks before surgery
Scheduled TKA 3 weeks before surgery
Donated 1 unit of blood for surgery
Pre-surgery Physical Therapy appointment2 weeks before surgery
Chest X-ray pre-surgery blood work1 week before surgery
Appointment with Joint Replacement Center Educator
Pre-admitted for surgery
DON'T LET THE PAIN GET AHEAD OF YOU.....TAKE THE PAIN MEDICINES
[/b][/color]Day of surgery
Before surgery a pain patch and a patch for nausea were placed on me. An IV was placed in my arm (I am left handed so I had the IV in my right hand. I also requested my hand be numbed before the needle was inserted). I had a spinal (as I had for my other knee surgeries) and was awake during the surgery.
The surgery sounded like a construction site. The OS and his assistant commented that my knee was a “bad one”. He did MIS and did not cut any muscle other than a tiny snip in the quad so that he could properly place the joint. I had about a 10 degree slant (knocked-kneed) and he realigned the leg.
I am allergic to nickel
so a Zimmer high flex nickel-free joint was used. It has only been available since Nov 06 so I am am in the learning curve
. I would rather have this one than the ceramic one. The ceramic wears longer in the hip replacement but the knee replacement has a high failure rate.
During surgery a catheter was placed in my bladder and a drain at the incision.,
a cryotherapy unit (Iceman)
, TED hose and compression booties were placed on my leg. I remained in recovery long enough to have the blood that I donated since it was not needed in surgery. An x-ray of my knee was made in the recovery room.
I went into surgery at 11:00. I left surgery at about 1:00. I was in recovery for 3-4 hours. Less than 9 hours after surgery I was walking around the bed. bed
My leg was placed in a passive continuous motion machine for 4 hours. Then my knee was rewrapped the cryotherapy pad. My leg was in the cryotherapy pad, cpm machine or I was walking on it the entire time I was in the hospital. I had a soft diet for dinner. Since I had a catheter I did not have to get out of the bed to go to the bathroom
. I was given oral pain medicine when I requested it.Day 1
ASK FOR PAIN MEDICINE REGULARLY...ANTICIPATE PAIN
I was placed on a regular diet. The catheter, IV, and drain were removed.
The PCM was placed on my leg for a minimum of 4 hours a day.Occupational Therapy taught me how to take a shower without messing up the incision and how to get in and out of a chair. The first physical therapy session was walking in the room and sitting in a chair for 15mins. The afternoon PT was walking in the hallway for about 15 mins.Day 2
I rested between physical therapy sessions. The hospital has wireless internet
so I surffed the net and watched movies on my laptop. Today’s physical therapy was 2 longer walk in the hallway and going up and down a flight of stairs. Rehab came and coordinated durable supplies and scheduling PT when I left the hospital. My insurance covered 2 durable supplies. I got a walker and 3-1 commode (can be used as a stand alone unit or place over the regular commode)The coumadin clinic gave me information concerning blood work
for checking coumadin levels.Day 3
Physical Therapy today was walking and learning how to get in and out of a car. I was discharged with an Rx for 5 pain patches (replace pain patch every 3 days) and an Rx for demerol. Went home (100 mile drive) and started home PT exercises.
I needed medicine for pain
about every 4-6 hours during my hospital stay. I am on Demerol due to an allergy to percocet, tramadol, and vicodin
. At home I continued to need pain medicine. My OS insisted that I take pain Rx be taken before PT. I still take Demerol before PT and I need it for pain during the night most nights. I kept the cryotherapy unit on my leg 24/7 for the first 3 weeks.
TAKE PAIN MEDICINE BEFORE YOU LEAVE THE HOSPITAL TO GO HOME
Physical therapy was arranged for the wrong therapist so I had to wait Dec 26 to start therapy
. I am doing physical therapy with a therapist that specializes in sports medicine. He is the PT for TTU athletic department. This is the best PT I have had
. He is constantly assessing my exercises and changing the exercises continually based on my strength or weakness. I go to physical therapy 3 times a week ( 1hr session of which 30 is exercise) and I do two 30 minutes sessions of exercises everyday.Day 10
Staples removed (30) 10 days post surgery...
I cannot believe how good the incision looks. I don't think I have every seen an incision that looked this good this soon. The scar is low and the skin between the staples is completely closed and there is no drainage. I asked that the incision be made as far to the side as possible so the incision needed to be a little longer than usual. I didn't want the scar to run across the center of the knee so it would be more comfortable kneeling.
ROM prior to PT yesterday 115.
Walking on my own in the house (including stairs) and with 1 crutch outside.
Taking demerol 30 mins before PT (twice daily) I still need something for pain around 3:30am
most of the mornings.Week 2
I stopped coumadin.
My OS said after the first 2 weeks if you are moving around all I needed was a baby asprin. My Primary care physician had wanted me to stay on coumadin. Coumadin was giving me extra pain and was exhausting me so we agreed that I should stop it. I can't believe the difference it made. The pain decreased greatly only 2 days after I stopped coumadin and I have a lot more energy.Week 3
Swelling has decreased
and I don’t need the ice 24/7 but I still keep it ready. I have found that if I freeze 8oz bottled water (it takes about 6 for my unit) and use them with the crushed ice that it keeps the cryo unit cooling longer. Using the frozen water bottles is cheaper, easier and doesn’t make as big a mess as crushed ice
. I needed about 20# a day for the first 3 weeks.
PT said that he thought I would be released when I go back to the OS on Feb.7Week 5
I am having a very hard time regulating my activity
. I wake up feeling great then I over-do-it and have terrible pain. I just can’t tell when I need to stop. When I over-do-it I need 2 days of rest to recover. Since the swelling is down I now notice a sharp pain on the sides of my knee. It is not related to activity. It is strong enough that I do “UGH” it. I feel sure it is where scar tissue was removed or because my leg was realigned. Before surgery my “hurt knee” was twice the size of my normal knee. Now they are about the same size.
I don't know that I have honey coated this or not. I do know that I am a month out of surgery and I still need something for pain everyday. I go back to my OS in 2 weeks and I thought I would be ready to go back to work then. But if things don't get better quick
I am not sure I will be ready for a day of work this soon. My OS said not to go back to work until after my visit on Feb 6. He wants me to start back 1/2 days for 2 weeks. I think I will do what he says. This recovery has been to good for me to mess it up.
PT says I only have 2 more visits and he is sure the OS will release me from PT.
So I must be doing pretty good. My range of motion was good enough that I could actually ride a bike the second week out of surgery. Today I was able to ride the recumbent bike. It takes a greater range of motion.
I think I have found the way to "anticipate pain". I don't have pain until I have waaayyy over-done-it
. I think I can only add about an hour a week to be "up and about". I have tried it today and I must say the pain is really under control. This is the most comfortable I have been since I left the hospital
. My pain with this surgery is totally different than with any other surgery I have had. With other surgeries I could feel myself getting tired, but I can't tell when I am getting tired
. When the pain comes it's too late to do anything take pain Rx, go to bed and cry.
Pain is much, much better this morning
. I am still having trouble sleeping at night. Since I am not working I can nap in the day if I need. I am going to ask for something to use at bedtime before he releases me to go back to work. I went on my first outing since the surgery
. It was great to see something besides the inside of a house or PT gym. I am really tired but not in pain
. When I needed to elevate my leg I just got in the back seat and put my leg up. I needed to see if I could stay up longer if I kept my leg elevated. It worked. I guess I will find out for sure tonight. I don't think I will have pain. I am relying on the clock now and not how I feel. I am adding an hour or so a week to the time I am out of bed. This is week 4 so I am up for 4 hours a day.
It is working to use the clock to determine how long I need to be out of bed each day
. 5 hours works this week. Next week I am going to work up to 6 hours. I can honestly say that I think tka was a good idea. I am feeling better each day.Week 6
Yesterday before PT I had this "clunk" in my knee. PT said stop
I went to the OS today. The way I understand it is I am doing things that are not expected this soon after surgery
. (ROM 130+..no problems with foot-over-foot stairs.. except everything is slow motion and feels like rubber bands in my knee...released from PT and given OK to go back to work).
They think that during the days my pain threshold is high (which I beg to differ) that the muscles may be so developed that there is no problem with stability but at night the muscles relax that when I turn over in my sleep that my knee is compromised.
I know that I have had pain during the day but it didn't seem related to any specific thing. I have awaken at night with unbelievable pain
. When I get up and walk or bike the pain is less. It seems that my swelling is so little at night and my muscles are relaxed that the post that replaces the posterior ligament has more lateral movement than it is suppose to have at this time. So I am suppose to wear a immobility brace
at night until I go back in March. If I have any problems I am to call. I hope there won't be any more "unusual fixable" calls I need to make!
It is a really strange "pop" almost like a gun going off
. And when it "pops" again poof..the pain is completely gone
. It is just that I never know how long that will be..maybe an hour maybe a day. Anyway this is an "unusual" but not "rare" condition that is fixable. x-ray shows perfect placement of joint
. I just told them I was a very special person
...that sounds better than weird.
Went to my university's basketball game
. They gave me a tunnel pass so I don't have to fight 100's of steps
. We have front roll seats (for the last 30 years). They even made a set of steps that I can use to get off the game floor
. We won...I think that makes it a 2 way tie for 1st in the OVC conference.
I slept last night. I am not going to say I am getting use to the brace
. When they said immobility they really meant it
Going back to work 1/2 days on Monday. That is 6 weeks to the day after TKA. If I have any problems I have it worked out that I can go home. We are just going to take it one day at a time. Right now we (OS & me) are thinking 1/2 days for 2 weeks and then back to fulltime. I am a school counselor so I do have a flexible schedule and I can elevate and ice my leg as I need.
I have not needed pain med since I started wearing the brace at night
. I think the brace is "training" me to stand properly. After 40 years of hyperextending my knee for support
I don' know any other way to stand.
TAKE THE PAIN MEDS AND STAY AHEAD OF THE PAIN....DON'T THINK YOU CAN CHASE PAIN AND CATCH IT
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