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How my life changed after knee replacement

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my post-op experience: knee #2

Josephine
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4. Left TKR January 7, 2015 - S&N Genesis II with patellar button
3. Left arthroscopic menisectomy 4th October 09
2. Right TKR 17th March 09 - S&N Genesis II
1. Right arthroscopy June 06 ...

Had a spinal and femoral block, also an infiltration of local anaesthetic into the popliteal space at the back of the knee. This because studies have shown that most of the post-op pain comes from that place. Worked well for me!

Day after was feeling quite well. Got flexion of 90 already! Woopee!

It quickly became apparent that the femoral block had not yet worn off but the physios told me how to cope with that and to be careful not to walk without somebody in attendance. This was fine until later in the evening when I needed to go to the loo. A rather self-important staff nurse came to see to me and after about 4 steps, decided I was perfectly okay to manage on my own and before I could stop her, she left! So I managed the last few steps on my own, fortunately making sure the arms were down on the loo. Having turned and backed up to the loo, I went to sit down and mistakenly tried to put weight on the left leg which, of course, wasn't 'there'. As a consequence, I took a less than graceful and fearsome stumble onto the toilet where, not being properly positioned, promptly deposited my bladder-full on the floor! I was so unnerved, scared actually, I rang for the nurse and waited what seemed like an age for one to come. It was with some trepidation I got up again and back into bed. Later the nurse who had left me came back to get my meds and when I told her about the tumble and boy! did she ever undergo a personality change! She was on the defensive, insisting that the block was 'out' and no longer effective and that the physios had told her I was okay for weight bearing. When I tried to debate the point she got even more incensed and told me she'd been doing this job for 10 years and knew what she was talking about! I told her I'd been doing it for 50 years and one things I'd learned was to listen to the patient first before applying any blanket protocols or rules. I should say the exchange was 'somewhat heated'! Of course, I ended up in tears!

Day 8:
I am NOT a happy bunny today. Leg is as hard as a rock and I ache from the hip right down to mid-calf. Mostly the bruising, I suppose but I wish it would go away! Done a heap of elevating and icing and actually got my swelling on my foot down from looking like a lump of uncooked dough to something vaguely like a foot!

Day 12
Update is that I feel ILL and then some. Mostly, I think, because I have cellulitis in my left leg. I'm shaky, feeble, no appetite, full of pain, disinterested in everything, especially food! Can't even cope with phone calls because my fingers shake too much to dial a number. Strangely, I'm better when I'm up and about than when I'm sitting down. Most odd.

On the plus side, I am now able to get about the house with neither stick nor crutch (as my surgeon predicted!) though don't get too concerned, I do still use furniture and stuff for support and progress carefully. Today I had my carer* carry some laundry upstairs and hang it out in the spare room while I got on with my shower on my own. I have been doing it on my own all along but with the carer 'on duty' in the doorway just in case! So having managed that and feeling more like working to my own schedule instead of sitting about waiting for them to turn up, I told the agency I don't want them any more. My neighbour's been far more helpful to me than they ever have anyway, doing washing up and getting in shopping for me. Bless her heart, she's been a real gem.

Day 14
Had staples out today. Being rid of those and the dressing seems to have also removed a considerable amount of restraint from my leg bend. Was going to take a photo but I have discovered my camera has gone missing. Only 'other' people who have been in the house since I last used it were the 3 carers. Ho-hum.

Jan 24 - day 17
Well, the cellulitis wasn't giving up that easily! Had a flare-up a few days ago and had to have another course of antibiotics. It's still making me feel ill, sickly, anti-food and generally feeling very sorry for myself. Sorry can't be more upbeat than this.
Well, I had a really good day from 8am onwards. Did a little bit of tidying up in the kitchen and a lot of posting on the forum. But then at about 6pm, the pain suddenly returned like an incendiary and now I can't get comfortable any way I try. Legs up, legs down, sitting up, laying back, doesn't matter how, it hurts in different places each time. Mainly it's focussed on my calf and outer thigh which is the IT band area. I know it's that because sitting on an ice pack relieves it. But the calf, which is the principle area of cellulitis, just doesn't want to give up. If I rest my foot on a cushion to relieve the pressure on the calf, the knee complains because it doesn't like the stressed extension. If I lay on my side, the entire leg complains. Can't win. Only time I am marginally comfortable is standing or walking around (thus proving it's not a DVT!). I can't take any more pain meds until 11pm (it's now 8pm) so I shall just have to grit my teeth. I'm so desperate for a nap I could cry.

Jan 26 - day 19
Things have taken an upturn at last. The pain seems to have become more manageable though I'm still taking 100mg Tramadol and 2 paracetamol 4 times a day. I find that if I only take 50mg, it just plain doesn't work. But then, I'm not even 3 weeks out yet so still early days. I'm also able to get about with confidence (though still with care!) with neither crutch nor cane, even going up and down stairs. I can get up from sitting relatively easily and my ROM is about 110/0 which is amazing! And just in case you were wondering, exercising thus far has consisted of 2 or 3 heel slides every other day and one attempt to go upstairs sequentially which I managed but was a bit shaky so won't try it for another few days. I'm also sleeping in bed comfortably and getting a good night's sleep to boot!

I go for a post-op assessment on Thursday with the orthopaedic nurse practitioner (not the brightest spark of cheer in the group!) but since I haven't been out of the house since the 7th, my wonderful neighbour is going with me for moral support. I don't expect the nurse will keep me for long.

Only real problem I have is knocking in the knee. This isn't the clicking kind but a regular changing of gears, a kind of triple clunk. In fact, not to put too fine a point on it, it feels like a bag of marbles in there! The thought has crossed my mind that I may need a bigger spacer but I'll wait and see what 'sir' has to say about it.

Jan 27 - day 20
This time the only thing that works is 100mg at a time but that means only 4 doses a day - ergo 5-6hrly. However, I never had cellulitis last time either. That's probably the difference.

Jan 28 - day 21
I would also report that my flexion seems to have increased to about 110+ as of this morning and I have done ZERO exercises though I have actually done about 5 heels slide throughout this period just to see how things were progressing! Now I'm not advocating this for everybody as it's entirely possible I've just been incredibly lucky but it does show that, given the chance, our bodies are perfectly capable of returning things to normal without any 'help' from us!

Day 29 - day 22
I expect most of you have heard the old saying "the proof of the pudding is in the eating"? Well, today was the proof of that!

Yesterday my flexion measured at around 110. This morning I woke early-ish and turned over in bed, curling up and wrapping my legs round one another as you do. I was startled into full wakefulness by the realisation that my left leg had a more normal feel about it than before. No tightness or discomfort, no restriction. I later measured it with my goniometer and overnight it's increased to 123! I am flabbergasted, stunned, delighted and intensely satisfied! So much I feel moved to quote another little homily which, with a stretch of imagination, might compare ...

"Little Bo Peep had lost her sheep and didn't know where to find them.
Leave them alone and they'll come home, bringing their tails behind them"

I hope you get the analogy!

Jan 30 - day 23
Had a review at the hospital today carried out by a nurse practitioner. First comment - where are your TED stockings?! (took them off on day 2 because they were too tight! More of a risk for DVT than without in my humble opinion!

Then 'was I doing my exercises'. Now I know this young lady and she's not above launching into a scold rant so I said yes I was. She felt my knee for warmth and then asked me to lay on the bed and bend my leg. Her comment was that it was 'a little over 90'! That I argued with and she just shrugged her shoulders. No encouragement or positive input. What a waste of time!

I've had another teensy set-back. What with my regular meds, antibiotics and pain meds, I am now taking around 30 pills a day and my stomach is objecting! Today is the third day I've been nauseous and ended up having to ring the doctor for some anti-emetics. Yes, I know - yet another pill to take - but I really cannot stand having these days feeling totally bleah and fit for nothing!

Good part is that yesterday I only needed two doses of pain killers and thus far today I've only had one dose.

Jan 31 - day 24
Another bit of progress on day 24 - ROM now 115/0 and the need for pain meds as reduced considerably. I am now using paracetamol 2-3 times daily and the odd 50mg Tramadol - well I did today at any rate!

Feb 1 - day 25
It's passed with the aid of pills! However, just to prove that recovery really IS a roller coaster ride, while I was totally fine all day yesterday, on going to bed at midnight, the pain started up and just got worse and worse throughout the night. By 5.30am I had to give up and come back downstairs. I took 5mg Tramadol and paracetamol but 1½hrs later, it was a lot worse. I'd tried ice and moist heat but neither helped so ended up taking another 100mg Tramadol at 06.20hrs after which I crashed out (surprise, surprise!) and was relatively pain free. Needless to say, I slept all morning and didn't rouse till early afternoon. Hey ho!

Feb 2 - day 26
Had another rough day. Knee very hot and painful. Feeling very yucky, mouth like the bottom of a bird cage and a mouthful of food or drink made me very nauseous. So rang doctor who made a house call and examined leg. Is pretty sure it's neither a DVT or infection but just 'tissue kinetics'. What? Never heard that one before! But apparently it's the scientific term for the mechanism of controlled cell deletion, otherwise known by thee and me as healing! Still I was relieved to hear he was pretty confident it's neither of our most feared nightmares. But he had been prepared to phone the surgeon and pack me off to hospital as an emergency had he thought infection was a possibility.

Feeling a bit better this evening so thought I'd just drop in and explain my absence. But oh for a comfy settee or bed!

Feb 4 - day 28
I seem to have been having a good day and a bad day but these last two days have been better. In bed all night, slept well, only first night had to take pain meds in the night. That night I gave up about 5am and moved downstairs to the settee. I took my duvet with me and was so focussed on not getting my feet tangled up in it, I was half way down before I realised I was actually going down sequentially and not one step at a time! I was amazed! The next two nights (Mon and Tues) I had good nights in bed with no pain meds. Today I have done laundry and needed no pain meds at all. When I took the laundry upstairs to hang out, I went up and down normally!

My last dose of anything was 10pm last night! It's now almost midnight and I've needed nothing all day. This evening was a bit uncomfortable and needed to use an ice pack but even those are used infrequently now.

And need I remind you all, tomorrow I am 4 weeks out! Assuming this keeps up, I plan to go see the chiropractor on Friday as my back and neck are getting stiff. I also have ITB and hamstring issues which I've had since early this year and they are now really giving me gip! This will be my first drive out.

Feb 5 - day 29
I think I'm going to stop telling people about my recovery because every time I boast about a good day, it's followed by an absolute nightmare of a night! To related the sorry tale, was up late until about 1am and my knee started being painful - about 6-7. I took 50 Tramadol but after an hour, no effect so tried some ice which made things worse. Walked around a bit which seemed to make things ease so I went to bed. Once in bed it got worse again - by now it's getting to 8-9. Despite using ice and taking more Tramadol, by 4.30am I came downstairs and made a hot wet towel which was blissfully effective. Did this 3 times and then settle down on the settee and slept until 11am! Today I have mild discomfort but nothing more. Strangely this is only when I'm sitting. When walking, the pain is zero!

Feb 5 - day 30
Well, I did my first drive. I did take my neighbour who admitted she would enjoy the trip out. I was a barrel of nerves beforehand but, as I had expected, once I got on the road I was fine! Got to the chiro in good time and found a parking spot right outside his door! He has a big ol' flight of stairs up to his rooms which I took really slowly and carefully. My neighbour stood on guard by me the entire time, bless her!

Well, I told Greg my problem was all down the rear/outside of my leg from hip to ankle and then surprised myself by getting onto his couch face down! Didn't think I'd be able to do that but it was easy. Then he got to work! Heaven's above - he found tender, painful sites the entire length of my thigh, calf and even into the sole of my foot! It was like Chinese torture but in some strange way, you just know it's doing you good. The entire area was in a really bad state and I have to go back next week for another session.

I then went on to Asda and did a fair shop. I used an electric kart while my neighbour went on fetch and carry expeditions! Bless her heart! I go home about 2.30pm which means I has out nearly 4 hours. Not bad for a first trip out. and I have to say, I feel so much better already except I've been really, really cold - wrapped myself up in blankets for most of the afternoon! Seems I can't get a happy medium - I'm either roasting or shivering.

Oh yes, and I haven't had any pain meds since 4am yesterday morning! Not bad for 4½ weeks out!

Feb 7 - day 32
Well, 'rough start' continues. Last night I got quite bad pains around my knee.

So:
took Tramadol - 1 hour later no change
rubbed on Volterol gell - 30 mins later no change
tried ice - made it worse
then I remember Poppet telling me that the Chinese preferred heat for pain that wasn't immediately post-surgical so sat myself beside the microwave and rotated two damp cloths. That help a lot but the heat wasn't persistent enough so I got a hot water bottle and treated the back and sides of my knee with it - result

SUCCESS!!

I also came to the conclusion that this pain is nothing to do with the knee surgery but all to do with the muscle spasms in the biceps femoris and hamstrings which, as I said before, have been plaguing me for almost a year.

So, I retired to bed at 2am, slept right through to 9am and woke pain free.
Not only that but ROM in my left leg is now equal to that in my right leg!

Also, appetite has returned about 90% and the pain is still very low.

Feb 9 - day 34
whenever I post about a good day or progress, it is then followed by an absolutely abysmal night. And last night was no exception. I retired at 11.30pm and after only 30 minutes my knee started raging. This is now pain, I promise. It's a raging heat included with a kind of tightness along the scar like a cheese wire being pulled every and every tighter! I tossed and turned for ever and finally, at about 2am, I gave up and came downstairs to try the hot towels and hot water bottle again. This time it didn't work and I finally tried the last thing on my list which was the Gladwrap. That worked too! Wonderfully well. But now I tried to settle on the settee and though I had several blankets on me, the room seemed cold and I got totally chilled. I slept until about 8am and woke even more cold than before. And feeling sick and ill.

Imagine my surprise when I went into the conservatory and found it was roaring hot in there! The sun was shining and people outside were out and about in just cardigans! It took me ages to warm up.

I do hope tonight will be a better night, please God.

Feb 10 - day 35
I had a lovely night past night. I've actually found it unnecessary to actually wrap the Gladwrap right round the leg. A patch of it, sufficient to cover the wound and both sides of the knee, is quite enough. And since somebody kindly sent me a box of Gladwrap (we don't have it in the UK) and Gladwrap is lightly self-adhesive, the patch stayed put all night! So I slept from about midnight to 9am - long old night for me! But when I got up, I had a whole array of discomfort, hot wound, feel out of sorts generally, foul taste in mouth so no appetite, feeling really chilled so wrapped myself in blankets and about 20-30 minutes later, had a hot flush and threw them all off again! It's only settle down when I replaced the Gladwrap. Hope this means I shall have another good night tonight.

Feb 12 - day 37
Well, I got to see my GP today. My leg has been burning and driving me potty. I've tried everything: Tramadol, paracetamol, ibuprofen (singly and in concert), ice, heat (moist and dry) and diclofenac gel. Nothing touches it. The GP felt it and said 'it's not really that warm' to which I replied, you should try being on this side of it! It HOT!' and burst into tears. I never realised till then how much this is getting me down.

So I told her all the rest of it: not being able to eat or drink because of the foul taste in my mouth and feeling generally unwell and grotty. She assured me it wasn't infected (think I knew that but it was a relief to have it confirmed!) and asked me to prioritize the issues. Without hesitation I said the knee.

I also pointed out that this was NOT post-op pain as I'd had a few days without that and on no pain meds very satisfactorily. Then this suddenly flared up for no apparent reason. Her opinion was that it was nerve pain. Well shoot! - why didn't I think of that! It would fit in with the extra trauma done by the split in the skin at the bottom and that flap being everted in order to access the patella. Nerve pain - who'd have thunk it!

So long story short - I'm on gabapentin. I had one tablet as soon as I got home and have had a lovely restful sleep for about 1½hrs this evening! I just hope I can repeat it tonight. She also did a whole slew of blood tests just to make sure nothing else is going on.

Feb 13 - day 38
Well, the doctor was right because the gabapentin has worked wonders! Such blessed relief. But I am to take only one yesterday and today, twice daily the next two days and three times a day from then on. Jeepers, I shall be sleeping morning noon and night! However, I slept like a baby last night and felt well on waking.

I also saw my chiropractor this morning for round 2 and asked him to do a little work on the back of my knee as I appear to be loosing extension. I told him I'd been doing the exercise of putting my heel on a stool and letting the leg hang which that it was rather too tight and painful to do. When he got to it, he said he was not surprised as teh hamstrings and calf muscle leaders were very tight and angry and what I was doing was just making them even more so. Since he then spend about 5 minutes working on them afert which I was already back at 0, I felt he knew more than I did about this and I should stop always banging on about swelling being the culprit because, as the song goes, "in ain't necessarily so"! To be honest, it has tightened up again since but still not as bad as it was last night.

Feb 19 - day 44
Gapapentin seems to have plateaued out and though it's now roughly 40% less than it is during the day, at night it's a nightmare. I have to keep my leg out of bed as the duvet stokes the furnace, so to speak. But I can only stay like that by laying on my back so it's a toss-up between sore knee or sore back! Usually the knee wins!

So I took the advice of a US doctor on a website and explained my problems to him. I got an almost instant answer, very detailed and fulsome advice but the bit I really didn't want to hear was that there was a risk that this could develop into complex regional pain syndrome. NOOOOOO! Not that this hasn't been rolling around in the back of my brain but being told it is a whole other thing! However, he also said I was on a very small dose of gabapentin and it should be increased weekly until it took effect. He also said I should consider going to a pain clinic as well. Hmmm knowing our pain clinics, you can wait 3-4 months for an appointment! But I shall hold it in consideration. This is the third time I've used this website (once to speak to a vet!) and have always had excellent advice and information.

Feb 21 - day 46
Well, latest report: I saw another doctor at the surgery yesterday. I've seen him before and and kind of like his wry sense of humour but he has a tendency to type as you talk and then he misses things which is both annoying and disconcerting! But he examined my leg thoroughly, which neither of the previous doctors had, and made up his own mind for a change! He decided to increase the gabapentin from 100mg 3 times a day to 300mg twice a day. As a result of this, I had an absolutely fantastic full night's sleep! When I woke, the knee had lost about 90% of the heat that was in it! I hope this continues. I'll let you know.

Feb 25 - day 50
The neuropathy is settling down very well, leg is almost a normal colour and nearly all the heat has gone. Next question is - how long do I have to keep taking them and will the neuropathy come back when I do.

Yesterday I managed a walk around Sainsburys but when I went to Asda I used a martkart which then went out of charge as I left the check-out to take it back! After this my leg was quite tired so I left the rest of my plans and came home. Hence my absence from the forum on Monday.

But I have to report that I am walking about quite normally now, no limps or anything, and doing stairs normally. No aches or pains most of the time except occasionally at night when I might have to take a couple of paracetamol (Tylenol) but that's not every night. I have told my manager I am available for telephone clinics if the need should arise and can return to work in the beginning of April. Yippee!

Feb 27 - day 52
Well, had a teensy bit of a scare last night. Knee got a bit swollen, painful, red and hot. Couldn't tell if it was the neuropathy, something else or both! Went to see the GP and she said yes it was hot, swollen and red and though she wasn't convinced there was any infection she wasn't prepared to say it for definite. So she wanted me to be seen by my surgeon. She was about to send me to A&E but I wasn't prepared to go on that particular merrygoround and said I'd phone the man direct. She was curious why I hadn't already done so and I explained that I didn't like to take advantage of contacts like that! (I worked with the man and he did my other knee). She said she felt after all the years I'd give to the NHS, I'd earned a few 'strings' to pull and packed me off home to try my luck.

Rang a few places and discovered he was on leave as was his secretary but I spoke to his colleague's secretary, told her my woes and she said she'd have a word with him and see if he'd see me in that afternoon's clinic. She said she'd ring me around lunch time. I thought 'yeah, year, that's the last I'll hear of that!' but at 1320 she did ring and asked me if I could get to the hospital by 2pm.

I made that and actually got seen by Shaun's Fellow who examined my knee closely and declared that it was just about the same as any other TKR at 7 weeks! But he did order some bloods, just to be on the safe side! Good man!

He was also in admiration of my 123/0 ROM whereupon I confessed to him that I had done zero exercises. He looked aghast and wanted to know how I'd got that ROM if so and was I going to declare this at the clinic at the end of March when the physio and others would be there. I told him, I can't wait!

So I'm home and relatively happy. Next appointment is with the boss on 31st March.

Mar 4 - day
8 weeks tomorrow. I've finally conceded the need to go back on some pain meds and am taking 1,000mg paracetamol and 50mg Tramadol at night and 1,000mg paracetamol in the morning. That sees to make things more comfortable.

Latest report:
ROM: 125/-5
Stairs: doing them normally most of the time
Walking stick: only used outside on a 'just in case' basis
neuropathy: appears to be under control with the gabapentin
sleep: soundly!
appetite: okay most of them time!
Comments
Mimistans
So Glad to hear someone else had the problem of freezing and then getting hot. Thought I was losing my mind!
Rocovering
the hot/cold thing is happened to me too! and sometimes it gets to the point where I am shivering under a blanket or sweating the next ten minutes and not knowing what the heck to think. I'm always aware of the possibility of DVT but so far no other symptoms.
SarahD
Josephine how are you now? are you glad now you had it done!

I’m looking at post op stories for inspiration because i am
going in soon to have one knee replaced. I’m in the uk.
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