Minimally invasive knee replacement

[chrisrobt]

I'm happy to answer any question either of you may have; at five months, I'd say my new knee is now "mine" (It does take a bit longer in airports as they have to "wand" me)

Christine

[DemiWV]

Thanks, Christine, and Renee

After surgery, I will take a month off before I get back to work.  Christine, do you think I will still be using a cane a month after surgery?  Christine, do they stop you at the airport everytime? :-)
 

Renee, Good Luck and a quick recovery!  Will you let us know how your situation improves? 

Thanks,
Demi

[chrisrobt]

Thanks, Christine, and Renee

After surgery, I will take a month off before I get back to work.  Christine, do you think I will still be using a cane a month after surgery?  Christine, do they stop you at the airport everytime? :-)
 

I took my first flight two months after my surgery; I was using a cane at that time and they moved my husband and me to the first class security line once they saw my cane.  I have since flown this last weekend; my knee has set off the metal detector on all flights.

As you can tell by my reply above, I was still using a cane two months after surgery; I really didn't need it, but my PT encouraged me to use it so I would not get into the habit of limping without it.  I was driving 20 days post-op (to my first outpatient PT appointment)

Christine

[DemiWV]

Renee, how are you?   How are you feeling?

Demi

[renk]

Hi Demi
I'm feeling OK, thanks for asking but it's taking longer than I expected to feel better.  My surgery was 4 weeks yesterday and I guess I was being a little too optimistic and expected more but my physical therapist and doctor's physician's assistant tell me that I am exactly on target for someone 4 weeks out from surgery for both knees being done. I think I just expected more since I was having the minimally invasive surgery. I am walking with a cane now during the day, but by the time 6:00PM rolls around I need the walker because I feel so fatigued. I'm still having physical therapy 3 days a week but next week is my last week for therapy at home. Then I'll have to go as an outpatient somewhere. I'm doing more by myself now, too. I get into the shower unassisted and can make the bed and stuff like that, just little things. Sometimes I even take little steps without the cane during the day when I'm at my best. Still can't stand too long on my feet. My biggest complaint is sleepless nights. I am tired enough when I go to bed and fall asleep but wake up about an hour later with both knees hurting and this goes on all night long. It's very hard for me to get in a comfortable position. They tell me this is also a common complaint and should go away in time. I still haven't been out of the house (aside from my own backyard). My first appointment to see my surgeon since the surgery is July 18th and I hope I'm given permission to drive again. That will be 6 weeks since the surgery. I guess you're getting anxious for your surgery to be over. If I remember correctly, you surgery is the 11th?? Good luck with everything. I'm sure you'll do fine. I think mine is bothering me a little more because I had both knees done at once but that's the way it had to be. My first grandchild is due this week so I'm hoping to be getting around much better real quick! Whenever you get a chance let me know how you're doing after the surgery. I haven't been on the computer too much recently but I do check in every now and then.  By the way, just out of curiosity, where are you from? I'm in Philadelphia and I had my surgery at Pennsylvania Hospital by Dr. Jess Lonner. Take care and again good luck with your surgery.
Renee 

[DemiWV]

Hi, Renee,  I am so glad to hear from you!

I'm sorry you have not progressed as much as you expected.  I suspect I will be feeling the same as you.  I go between feeling very confident that I will soon be up and about painlessly and being concerned about post op pain not being able to sleep.  I am having surgery in DC at Sibley Memorial hospital and was told that I would spend 3 days in the hospital and 2-3 days in their rehab center, also fondly known as Sibley Hilton.   Yesterday my insurance called and told me that my policy does not allow for the rehabilitation center, but that a case manager would evaluate my case to see if they can create an allowance for this.     I have 4 steps to go up to catch the elevator to my apt.  I hope I will be ready for this when they let me out.   I am thankful that my husband can be with me the whole time until I go back to work.   That will help a lot.

I am sorry about you not being able to stay asleep.   That alone keeps you fatigued and slower in your progress.  I know about sleep problems that's tough!   

Renee, congratulations on the soon safe arrival of your grandchild!  How neat!  My sons are not married yet, but I hope that one day I will have grandchildren! 

You live in Pennsylvania?  I live most of the time in Northern VA, (due to work) renting an apt., but have a home in Martinsburg, WV. 

Please stay in touch, let me know when your grandchild gets here (boy or girl?) and how you are doing.  Tomorrow is my big day and I, too, can't wait to get it over with!   I will get on the computer as soon as I can.    It takes a lot to keep me off.

Renee, I hope your pain and sleep problems soon become a thing of the past.


Thanks again for the update.

Regards,
Demi

[DemiWV]

Hi, this is for anyone having had a TKR

I just had a MIS right TKR on July 11.   I spent 3 days in the hospital and one week in rehab.   I got home 2 days ago.   While you were in the hospital or rehab did they measure the degrees they were able to bend your knee?   Also after getting home, how long before you could do without the percocet?  In the hospital I could take 2 percocet every 4 hours as needed, but here my prescription says 1 as needed every 4 hours.  I tried to go off the percocet and  use just Tylenol Arthritis, but found that I hurt too much to walk around or do my exercises.   Any comments as to how to best handle the pain meds and how to get off them ASAP?

Also, when the physical therapy folks get to my house, what will they do for me?  Will they just ask me to do the exercises I am already doing?   Also, did anyone go home with a CPM machine?   I was due to get one but told the doctor that I was beyond the CPM machine.  Now with all my stiffness and swelling I see that a CPM machine might be just what I need.

Also, I have the perfect cure for the constipation that pain meds cause - equal amounts of Milk of Magnesia mixed with prune juice heated just a little. The taste is not bad at all!  I have not found anything more effective.

Thanks for your help.

Demi

[renk]

Demi
Glad to hear you're home and on the road to recovery. While I was in the rehab center, I had two physical therapy sessions a day and they did measure my range of motion every day.  My therapist that came to my home also measured my range of motion and extension.  Once I got to about 125 degrees with my flexing, she concentrated more on my extension, which is still at about 8. The home therapist did not do the same exercises as they did in the hospital, except for a couple, like the quad sets to tighten the muscles in my thighs and the leg extensions.  She was mainly concentrating on getting my legs to go totally straight.She came to my house for 3 weeks.  Now I am going to outpatient therapy but I just started so I can't comment on that much yet. As far as meds go, I was taking tylenol with codeine in the rehab and took it every 4 hours and I also took Ultram twice a day. I'm not able to take percocet because it makes me sick. I am still on the meds (6 weeks after surgery) but not as often. I take the tylenol w/codeine anywhere from every 6-10 hours depending on how I feel.  Whenever I tried not to take it I found that I really needed it.  I would say it's a little soon for you to stop, as well. I did not have a CPM machine at home. Take care and hope your recovery goes fast. I am 6 weeks past surgery and now walk without a cane in the house, however, I don't walk great. I take the cane whenever I go out anywere.  I am allowed to drive again and start back to work part time whenever I feel I am up to it. My main problem is still the sleeping at night.  I wake up with my knees frozen in a bent position and it's very painful to get them straight again. My orthopedic surgeon told me that unfortunately this is the last pain to go away.
Renee

[DemiWV]

Hi, Renee and thanks for the reply.

I am glad you are doing better but sorry to hear that you still can't sleep well at night and that your knees lock up.

Walking inside the house WITHOUT a cane?!  Wow, that sounds fabulous to me!  Great.   Renee, are you able to go up/down the stairs normally yet you know alternating feet?  If not, did the doctor or pt person give you any indication when you might be able to do that?

You had both knees done at the same time, right?   If so, knowing what you know now, would you do it again?

One more question, please.  Was your MIS incision down the front of your knee or on the side?

Someone told me they met a woman who had MIS TKR but the 2 incisions were only on the knee cap.  Have you heard of anything like that?

Renee, how is your grandchild?   Hope all is well and thanks again for your encouraging reply.

Demi

[renk]

Hi Demi

I started walking without the cane a little at a time in the house (sometimes because I would get up and forget)about a week ago but I should say that it's mostly during the day from about noon to 8:00PM. That's the time of day that I feel best. After that I still get tired and sometimes need the cane. During the night when I'm at my worst, I get up to stretch my legs and I need assistance then, too.  I asttribute wallking without the cane a little sooner than usual to the MIS. That is the one thing that the surgeon mentioned to me is that you're off the walker and cane sooner than patients that have traditional surgery when that muscle is cut above the knee.

I do go up and down steps alternating my feet.  Again, sometimes when I don't feel so great, like at night or first thing in the morning, I do one step at a time but my therapist encouraged me to really try and alternate my feet. She started working on that as soon as my home therapy started. She came to my house 3 times a week since I had two knees done.

Looking back on whether I'd do both knees at the same time again is really a good question.  A few weeks ago when I was at my worst, I was so sorry that I did both at the same time.  All I could think was that I'd feel so much better if I had one leg to use. There were times I cried, especially during the night.  Now that I am over the worst part I am glad I had both knees done at the same time and I'm glad this is over with.  My doctor tells me I'm doing great but I think I set my expectations a little too high and that's why I was disappointed. No one told me it would be easy but I was going by commercials on tv and different articles I read about MIS. It was not what I expected.  I'm just curious, but would you say the MIS is what you expected?

As far as my incisions go, they're not straight down the front of my knee. They're curved and off to the inner side of both knees along side of the kneecap.  So many of the nurses and people in rehab were so surprised by the size of my incisions because most had never seen MIS.

My new granddaughter is just great......thanks for asking.  She'll be two weeks old this Tuesday. If I'm correct, I believe she was born on the day of your surgery, the 11th?? All I knew is that I wanted to be at that hospital when she was born and I was there.  By the way, on the day she was born my husband found a wheelchair in the hospital because I couldn't walk far with the cane.  The following Tuesday I had my first postop appointment with my surgeon and I walked into that hospital with the cane.  That's just to show you how things improve each week. 

It sounds like you're doing good and I'm curious to know your feelings on the minimally invasive surgery and how you're coming along.

Renee

[chrisrobt]

Hi, this is for anyone having had a TKR

I just had a MIS right TKR on July 11.   I spent 3 days in the hospital and one week in rehab.   I got home 2 days ago.   While you were in the hospital or rehab did they measure the degrees they were able to bend your knee?   Also after getting home, how long before you could do without the percocet?  In the hospital I could take 2 percocet every 4 hours as needed, but here my prescription says 1 as needed every 4 hours.  I tried to go off the percocet and  use just Tylenol Arthritis, but found that I hurt too much to walk around or do my exercises.   Any comments as to how to best handle the pain meds and how to get off them ASAP?

Also, when the physical therapy folks get to my house, what will they do for me?  Will they just ask me to do the exercises I am already doing?   Also, did anyone go home with a CPM machine?   I was due to get one but told the doctor that I was beyond the CPM machine.  Now with all my stiffness and swelling I see that a CPM machine might be just what I need.

Also, I have the perfect cure for the constipation that pain meds cause - equal amounts of Milk of Magnesia mixed with prune juice heated just a little. The taste is not bad at all!  I have not found anything more effective.

Thanks for your help.

Demi

Demi, as you know, I had my MIS rTKR in Januaryso it's ometimes hard to remember what happened those first few weeks post surgery.  I was lucky in that I had little or no pain at all (including my two days in the hospital) except for the forced flexion and extension in PT.  Still, in discussing rehab with others, it is obvious that you will do yourself no favors by trying to get off the pain meds too soo.  I was unable to take Percocet (it made me have near hallucinatory daydreams and difficulty opening my eyes) but did well on Vicodin.  Still, I only took it before PT and at bedtime (it took months before I could sleep comfortable, but no due to pain)

I never had a CPM at home and the home PT measured my flexion and extension at each visit (even though I dreaded those measurements, the pain was never enough to put me into trears, and the pain never lasted once we were done).  Both home and outpatient PT concentrated on extension as there are fewer options to regain extension in the future.  I think you need about 120 flexion to ride a bike or easily go down stairs alternation steps.

As for that sleep problem, one difficulty was that I couldn't easily turn from side to side since I didn't have full extension; my hubby put an open box under the covers to lift the cover up and then I could more easily turn.  I still can't sleep on my right side; in the past, this was my preferred sleep position so alot of my sleep problems were due to having to learn a new sleep position.

Christine

[DemiWV]

Renee and Christine, Hi,

Thank you both for your replies.  I am feeling very blue and weepy today.  My Oxycod. pain med is not cutting it.  I get a little relief for about an hour and that's pretty much it.  There is never a time  when I have NO pain.  When you both were taking your pain meds did you always have pain, even if just a little or medium pain?   I forgot, what pain meds did you both take once you got home?  Did you both take Vicoden?  I am going to call my doctor as soon as his office opens to see if there is something he can give me to control the pain.  Since I got up this morning,  all I want to do is cry.  Is part of the pain med situation?

I have to tell you that I was let down by the MIS technique.   My expectations were way too high going into the surgery. Those TV commercials built me up to expect so much more.   I have a 4-inch incision down the front of my knee which begins at the top of my knee cap and extends down past the bottom of the knee.  For some reason I and another woman having the same surgeon thought that the incision would be on the inside of the leg.  We were wrong.   I don't know what the traditional technique for TKR is like to compare, but though my doctor tells me I am doing well, I had in mind that I should be doing much better.  I thought I should have less pain by now. 

I am having my first PT session at home today and with the soreness I now feel, I am dreading it.  Do either of you remember your flex range while you were in the hospital rehab?  I think with pushing the pt got me to 93.
 
Renee, how wonderful to hear that your granddaughter is doing well and that you were able to make it to the hospital; yes, my surgery was on July 11.  Tomorrow makes it two weeks for me and your granddaughter.  Renee, what are you able to do at this stage of the game?   What, if anything,  are you not able to do?  Do you still have pain?

Christine, how are things for you now?  Totally recovered?   Good as new?  Any left-over problems?  I hope not.  Are you able to do all those things you couldn't do before?

Thank you both for sharing your experiences with me, it helps.   In 5 min I will be able to call the doctor's office to ask about a different pain med.  Maybe that will be the solution for me.

Did either of you get into blue moods with crying during the day?   

Regards,
Demi

[renk]

Demi
While I was reading your last post, all I could think was that I could have written it myself!  I also cried many times and not just from pain. I was so disappointed in how I felt and expected so much more. Those commercials on TV are totally misleading and I would love to write a letter to the hospital that sponsors it to complain. I still had pain while I was at your stage even when I took the pain medication and sometimes now even 6 weeks later. While I was in the hospital I was on Ultram and Tylenol with codeine.  When I came home, I felt I had so much pain that I called the doctor and they stopped the tylenol with codeine and put me on Vicodin. The Vicodin did help a little more but still not as much as I wanted. It also made me more tired so I fell asleep easier but it didn't help me stay asleep. I still take the Vicodin about every 6 hours (sometimes I go longer if I'm feeling OK) and I take Ultram twice a day (once in the morning and once in the evening)

I was also surprised by the size of the incision. The incision on my left knee is 5 inches and the one on my right knee is 5-1/2 inches.  I also thought it would be along side of my knee but they are more toward the center and curves slightly off to the side of the kneecap.  I, too, thought I'd be so much better than I was. I still feel that way.  I get around with the cane and like I said before sometimes without the cane in the house but I definitely look like something is wrong with me. It's not like I walk normally yet. During the night when I wake up in pain and have to get up to stretch, I use the walker sometimes!  But I am getting better, there's no doubt about that.  I feel my progress is the same as someone that had traditional surgery except the flexing is better.  When I was in the rehab facility, my flexing was in the low 90's range but it quickly went up with the home therapy. My therapist said that was definitely because of the MIS.  She wasn't real familiar with the surgery but said my flexing was way better than the average patient that had traditional surgery.

As far as crying goes, the very first day of my home physical therapy, my physical therapist talked to be about how I felt and told me to expect to feel down at times and want to cry every now and then.  I was totally surprised that she said that because it's how I felt but didn't tell her. It made me feel so much better to know that it's normal. She said a lot of those feelings comes from just having surgery. I felt that I was crying because I was so disappointed in how I felt. I thought I would be feeling so much better then and still feel that way now.  But I don't want to discourage you because I do feel better than I was.  It's just such a slow process.  I hope I'm not confusing you more. If I can answer any more questions for you, please ask. I do hope you're feeling better and I know you will feel better soon.  If you would like to email me personally, let me know and I'll give you my email address.  Take care and stay strong.  It will get better...I swear.
Renee

[DemiWV]

Renee,

Thanks for your reply, I feel better after reading your post.  I had no idea that even with pain meds I would still be uncomfortable with pain.  I can't imagine how bad your pain was with just the Tylenol codeine and Ultram.  I know have both the Percocet and the Vicodin.   I know how Percocet works, I'll see if Vicodin is any better. 

About the MIS procedure, it was good to hear that your PT person said that the flexing ability was above average.  Maybe that is the only benefit?  I wonder if the pain would have been lots worse with normal TKR surgery?  I can't imagine how that can be!  Renee, how you endured both knees done at the same time is beyond me!  You are one tough gal!  I am thankful that my husband is retired home with me and does all the housework, shopping, cooking, etc.  It would have been scary to be on my own.

I tell you what, if I find anyone who is considering MIS TKR surgery, I will give her/him the low down on what to expect.  These commercials and lovely brochures and webpages paint everything so rosy that they set up the patient for a huge let down!       Also, my incision might be around 5 inches long, too, and the scar seems thick to me.  What about your scars?  Are they thick?   are they starting to fade?

Renee, thanks for the offer of writing directly to your email address, I would like to take you up on it.   I won't be bothering you every day with questions but it will be helpful for asking specific questions about what progress to expect. 

I'll use your personal email address when you send it to me.   How will you do that, through the posting?   I am very new to bulletin boards and postings so I don't know how that goes. 

I take your word and believe that I will get a lot better and have a feeling that I won't be able to make it back to my desk job on August 14..oh well.


Thanks.

Demi

[DemiWV]

Renee,

How many Vocodin you take?   I just took 1 tablet and it knocked me out and I slept for 5 hours!  I had plans to do my exercises but felt so tired I couldn't wake up.   Maybe the 2 Percocets will be better for me.

Demi