Knee replacement in three weeks and one day

    Has anyone out there done this already?  I will be posting my adventure on here.
    I anticipate 3 days of misery, three weeks of "at-least-this-is-better-than-the-first-three-days" and progress, three months of intense work to get my new parts in optimal working condition.  That's if all goes as planned.
    No general anesthesia, just conscious sedation. I should be released 4-5 hours after surgery; again this is if all goes as planned.  
    Hope to get to know some of you better as I share this here.

 

Good luck with a short, productive, and bearable recovery period and an improved quality of life in the end!

My mother works in an Operating Room and I actually used to also work in the hospital. Knee replacements were a "bread and butter" procedure meaning that they were very common and straightforward.

The vast majority of people who have gotten total knees done were thrilled at the end result. In my neck of the woods, they have you standing and walking on the new joint the same day.

My two cents would be to follow the physical therapy to a T. If you put in the work, you will most likely have the best result possible. Every once and a while we had someone come back in because they did not work the knee and ended up having to bust through scar tissue to get their range of motion back. You don't want to be that person.

I hope you have a good procedure and a quick recovery!

Good for you!! I wish you a swift and productive recovery.

Several people in my family have done this, and my mother recently replaced her hip. The one thing that seems to be absolutely imperative is to do the physical therapy religiously. It will hurt anyway, so do the therapy (besides, everything probably hurt even worse before the surgery!!).

And the lesson everyone seems to learn the hard way, including myself-- take the meds during those first days on the timetable prescribed, even if you're not hurting. When I had my hand done I left the hospital (after a nerve block and general anesthesia) with 4 different kinds of heavy-duty painkillers, two specific to bone trauma and cancer, staggered around the clock. When I asked the surgeon if it wasn't overkill she laughed and said bone surgery is a whole different ball game. And it was. You don't want to be agonizing waiting for the meds to kick in.

I wish you swift healing! Most everyone says it's the best decision they ever made. When I was in high school I knew an old farmer who had both his knees done at 70ish and went on to become a country dancing phenomenon (at least in our corner of rural NJ)!!

Everything Tereza and Timothy just said.   ALSO, your doctor may advise that you take some over the counter medication for pain. …Such as Tylenol or aspirin .  It is common for folks to think that is silly when they are on four major pain killers. Two things to remember …meds have multiple functions, and there is such as thing as break through pain.  The human body can be more than a little strange. Sometimes an OTC med will knock out pain that one of the more serious pain meds don’t seem to be handling. I have seen too many people in agony because they refused to take the OTC med.

My step mum had her knee replaced a few years ago and her hip 3 weeks ago. For the hip they have her exercises to do before the surgery which really seems to have made the past surgery physio easier.

Don’t forget arms /neck /shoulders too as crutches really can cause stress and pain in these.

Best of luck

John F Dean wrote:Everything Tereza and Timothy just said.   ALSO, your doctor may advise that you take some over the counter medication for pain. …Such as Tylenol or aspirin .  It is common for folks to think that is silly when they are on four major pain killers. Two things to remember …meds have multiple functions, and there is such as thing as break through pain.  The human body can be more than a little strange. Sometimes an OTC med will knock out pain that one of the more serious pain meds don’t seem to be handling. I have seen too many people in agony because they refused to take the OTC med.

I have heard that knee replacement is much more painful than hip replacement. A friend who reacted to some of the pain meds was in a very bad way for a while and almost refused to have the second knee done. She only went ahead when the doctors figured out a safer pain med approach.

A different friend's sister didn't have a replacement, just an incredibly serious break. Timing your exercise periods to coincide with when the pain meds are most effective was critical to her recovery. You can only learn that timing through experience! Some "exercises" were more painful than others, so she learned to be extra careful with the timing of those ones.

A general rule which may or may not work for this surgery, is that short, frequent exercise periods give better long term results.

I had one knee done last Oct. I am getting the pre-scans For the other knee done this Friday. Mad at myself for not doing it sooner. My experience was no pain the first three days and when the surgery anesthesia wore off  the pain came on. Bearable but definitely noticeable. The physical therapy after a month allowed me to make a full rotation on a recumbent bicycle and after that for me it was smooth sailing. I actually worked for a few hours starting the second day after surgery. There were two incisions that were made for the robotic apparatus that made the bone cuts exact and I think those hurt sometimes more than the knee itself. Elevate and ice, I was given a ice machine when discharged, get rid of area rugs to prevent catching on them. I was able to discard my handicapped placard after 6 weeks. Do not stop moving, being static is not a good idea. I was fascinated by the surgical glue instead of staples or stitches. I have used super glue on cuts before but was impressed on how well it worked on a large incision.

I haven't had it, but know several people who have, and all have said their only complaint was that they waited so long to decide to do it. You've got this! Hugs!!

Mine was September 2019.  It was a breeze.   No pain to speak of, no swelling noticed.  Physical therapy for a few weeks before to get it in shape and physical therapy for a few weeks after.  I didn't need a walker after 4 days but I used a cane.  I should have done it sooner.  I'm going to get the other one done this year if I can find the time to.  I'm not going to wait as long on this one.
I hope yours goes as good as mine did.
Good luck!

Timothy Norton wrote:My mother works in an Operating Room and I actually used to also work in the hospital. Knee replacements were a "bread and butter" procedure meaning that they were very common and straightforward.

The vast majority of people who have gotten total knees done were thrilled at the end result. In my neck of the woods, they have you standing and walking on the new joint the same day.

My two cents would be to follow the physical therapy to a T. If you put in the work, you will most likely have the best result possible. Every once and a while we had someone come back in because they did not work the knee and ended up having to bust through scar tissue to get their range of motion back. You don't want to be that person.

I hope you have a good procedure and a quick recovery!

   
    Your post was super encouraging.  I agree with you and your mother 100%; the procedure has come light years from what it used to be and hard work/physical therapy is key.  I will be walking with a walker and on stairs within a few hours of surgery.  
     GREETINGS from a fellow New York Stater!  I was so happy to see someone that hails from our beautiful, complex state that is so much more than Manhattan! From your growing zone, I assume you are live in the northern realms of amazing, beautiful, upstate!  I currently hail from 7b, northwestern Suffolk County, although we bought a property in April on the bluffs of north central Long Island.  More of that another day, another thread.

Tereza Okava wrote:Good for you!! I wish you a swift and productive recovery.

Several people in my family have done this, and my mother recently replaced her hip. The one thing that seems to be absolutely imperative is to do the physical therapy religiously. It will hurt anyway, so do the therapy (besides, everything probably hurt even worse before the surgery!!).

And the lesson everyone seems to learn the hard way, including myself-- take the meds during those first days on the timetable prescribed, even if you're not hurting. When I had my hand done I left the hospital (after a nerve block and general anesthesia) with 4 different kinds of heavy-duty painkillers, two specific to bone trauma and cancer, staggered around the clock. When I asked the surgeon if it wasn't overkill she laughed and said bone surgery is a whole different ball game. And it was. You don't want to be agonizing waiting for the meds to kick in.

I wish you swift healing! Most everyone says it's the best decision they ever made. When I was in high school I knew an old farmer who had both his knees done at 70ish and went on to become a country dancing phenomenon (at least in our corner of rural NJ)!!

Great advice, Tereza.  I am nervous about the narcotic heavy-duty painkillers, but I realize they may be necessary during the initial stages.  I was a nurse for more than 3 decades, and orthopedics is a horrifying yet beautiful mix of finesse and brutality, carpentry and art.  

Bryan Elliott wrote:Mine was September 2019.  It was a breeze.   No pain to speak of, no swelling noticed.  Physical therapy for a few weeks before to get it in shape and physical therapy for a few weeks after.  I didn't need a walker after 4 days but I used a cane.  I should have done it sooner.  I'm going to get the other one done this year if I can find the time to.  I'm not going to wait as long on this one.
I hope yours goes as good as mine did.
Good luck!

Thank you, Bryan!  this is just what I needed to hear! It's the recovery I'm hoping (and willing to work) for!

Christopher Weeks wrote:Good luck with a short, productive, and bearable recovery period and an improved quality of life in the end!

Thanks for the good wishes and encouragement, Christopher!  Everything you wrote is what I'm wishing for in a nutshell!

John F Dean wrote:Everything Tereza and Timothy just said.   ALSO, your doctor may advise that you take some over the counter medication for pain. …Such as Tylenol or aspirin .  It is common for folks to think that is silly when they are on four major pain killers. Two things to remember …meds have multiple functions, and there is such as thing as break through pain.  The human body can be more than a little strange. Sometimes an OTC med will knock out pain that one of the more serious pain meds don’t seem to be handling. I have seen too many people in agony because they refused to take the OTC med.

Thank you, John.  I never underestimate the power of the "multiple pathway" method of treating pain.  The Tylenol (acetominophen)/motrin (ibuprofen) can be amazingly effective, especially with some ice thrown in!

Rebecca Wedgewood wrote:My step mum had her knee replaced a few years ago and her hip 3 weeks ago. For the hip they have her exercises to do before the surgery which really seems to have made the past surgery physio easier.

Don’t forget arms /neck /shoulders too as crutches really can cause stress and pain in these.

Best of luck

Rebecca, this is so true, thank you. I need to be mindful of the other body parts that will be doing some extra work while my knee heals!

Robert Ray wrote:I had one knee done last Oct. I am getting the pre-scans For the other knee done this Friday. Mad at myself for not doing it sooner. My experience was no pain the first three days and when the surgery anesthesia wore off  the pain came on. Bearable but definitely noticeable. The physical therapy after a month allowed me to make a full rotation on a recumbent bicycle and after that for me it was smooth sailing. I actually worked for a few hours starting the second day after surgery. There were two incisions that were made for the robotic apparatus that made the bone cuts exact and I think those hurt sometimes more than the knee itself. Elevate and ice, I was given a ice machine when discharged, get rid of area rugs to prevent catching on them. I was able to discard my handicapped placard after 6 weeks. Do not stop moving, being static is not a good idea. I was fascinated by the surgical glue instead of staples or stitches. I have used super glue on cuts before but was impressed on how well it worked on a large incision.

Thanks for sharing your experience.  This fits almost exactly what recovery will look like!  Good luck with your next one!

    Two weeks.  My walker showed up on my porch yesterday.  Wishing it was a cane, will ask about it, but I am trying to view this whole process matter-of-factly.  

It will all be in the rear view mirror before you know it!!! Courage, my friend!

(i can still remember the two months before getting the tumor on my hand taken out and the whole mess reconstructed [second opinion surgeon said 'you just need to accept your hand won't work the way it used to' while the actual surgeon was the oncologist telling me I was nuts to not get the surgery done yesterday, but there were reasons I had to wait], it was a very rough couple weeks. I found myself a mantra and an image to use as my phone lock screen, and put it everywhere else I might see it: very simply: "What if it all works out?" And every time I thought I was too scared or losing my shit, I would take a breath and remind myself "What if it all works out?" And go figure, it all worked out. You sound like a tough cookie and might not need this sort of constant reminder, but if you do, I recommend it highly. You got this!)

Tereza Okava wrote:It will all be in the rear view mirror before you know it!!! Courage, my friend!

(i can still remember the two months before getting the tumor on my hand taken out and the whole mess reconstructed [second opinion surgeon said 'you just need to accept your hand won't work the way it used to' while the actual surgeon was the oncologist telling me I was nuts to not get the surgery done yesterday, but there were reasons I had to wait], it was a very rough couple weeks. I found myself a mantra and an image to use as my phone lock screen, and put it everywhere else I might see it: very simply: "What if it all works out?" And every time I thought I was too scared or losing my shit, I would take a breath and remind myself "What if it all works out?" And go figure, it all worked out. You sound like a tough cookie and might not need this sort of constant reminder, but if you do, I recommend it highly. You got this!)

Oh we all have our moments!  I'm a tough cookie, but I'm not afraid to drop my sword and cry for a while if need be.  I mostly think about how this is new territory for me: what will the pain be like? I had a hysterectomy (open, not laparoscope) and I've had worse pain from doing sit-ups.  On the other hand, if I bump my toe/foot, you'll probably hear me screaming down south of Capricorn where you are, hahaha!  Limited mobility will be interesting and a challenge.  What comforts me is that so many people have gone through this before, and I'll be able to coach someone else through it, like people are helping me.
Princess Axe is waiting to play!

I have seen a few comments implying a fear of becoming addicted to pain meds.   I began doing substance abuse assessments, teaching, and counseling in the early 90s.  To be sure, everyone is put together a little differently, and substance abuse is very complex.  That said, more often than not, as a general rule, I see value in the concept of an addictive personality.  To translate, if you have not had addictive experiences in the past, you are unlikely to have one being on a monitored short term treatment involving pain meds for a specific health issue.

I gotta agree with everything John has said in both his posts.  Treating pain is a serious but totally legitimate aspect of any surgery.

I of course don’t know what your pain prescriptions are, but a reasonable guess is that you will be on Norco 10 for pain.  Norco 10 isn’t a pain medication—it’s two.  The narcotic part is hydrocodone, a very strong oral narcotic pain medication (10mg, a large dose).  It is mixed with acetaminophen, the generic chemical in Tylenol, at 325 mg which is a single pill of regular Tylenol.  Hydrocodone targets endorphins which partially reduce pain, but are actually better at changing our emotional reactions to pain, or put another way, we still feel the pain, but the pain doesn’t feel so bad.  Acetaminophen bonds to substances P receptors, the receptors responsible for transmitting pain signals.  Acetaminophen (and aspirin, ibuprofen, others) actually block the pain itself through the effect is limited.  Together they make a very effective 1-2 punch against pain.


Having dealt with my share of pain in the past (thank you kidney stones!), my perspective is that Norco 10 is very good at stopping pain, or intercepting pain in progress.  But pain is like a fire—if you can catch a forest fire when the first spark ejects from a camp fire and causes a candle-sized flame in dry tinder, it can be put out very easily.  But if that candle sized flame is allowed to grow, the flame gets out of control and you need a much stronger “flame killer” to put it out—that’s what Norco 10 is for.

But if a couple of days have gone by and your pain is not gone but controlled, I personally don’t like Norco at this point—it’s too strong, hits too fast and tends to conk out too early.

I have been known to ask for a prescription of Tylenol 3 (or actually, I prefer Tylenol 4, a much less common formulation).  Here is my reason:

We have the big, serious pain under control.  We still need something to control pain, but we have put out the big fires and now Norco is just too strong, hits too fast and doesn’t last all that long.  Instead, if my doctor agrees, I prefer Tylenol 3 (or 4).  Tylenol 3 is 300 mg of acetaminophen plus 30 mg of codeine, a much less potent narcotic. (5-10 times less potent).  Codeine takes a little longer for peak onset, but lasts a longer duration.  I think it is great to control pain once the big pain Forest Fire gets put out.  And for reference, Tylenol 4 is 60 mg of codeine and I think really lasts well.

This is all long-winded, but in drug addiction, the most dangerous, addictive aspect of a drug isn’t how intoxicated it is, but how fast it has its main onset.  I would bet that codeine has about twice the time from swallowing to peak onset compared to Norco.  And my experience is that doctors are very willing to write another prescription for a generally weaker narcotic than a stronger one.  Also, codeine tends to not knock a person silly the way hydrocodone does.


I AM NOT GIVING ANYONE MEDICAL ADVICE!!  But I have had a fair amount of experience dealing with pain and I much prefer codeine over hydrocodone is codeine will work.  It might be worth considering, but of course talk to your doctor and see what she/he says.


I hope you have minimal pain, but if you need narcotic pain medication, maybe consider looking at this route—going with the weakest med that works.



Eric

Thank you all.  
    I am so grateful for all the information and insight.  It's really helpful and comforting.
I have a family and personal history of addiction so I have been substance-free for decades.  That being said, pain control is essential.  My husband and grown children (who weren't even around when I gave up everything) and friends will be gatekeepers if required, but none of us are anticipating that.  I've taken a narcotic pain reliever once while in the hospital and all it did was knock me out for 6 hours, no "high" or anything.  
    Off to actually go to the movies.  I never go, but this one is important to me.  😁😂
     

     

They gave me my appointment date today, Sept 14th. I am so ready, probably no skiing this year but it looks like the forecast isn't projecting much snow anyway.

Robert Ray wrote:They gave me my appointment date today, Sept 14th. I am so ready, probably no skiing this year but it looks like the forecast isn't projecting much snow anyway.

      That's good news! I know what you mean about being so ready; my world is very small right now.  And, yes, it seems like this winter will be a good one to "rebuild" for next year's skiing.  Do you know if you can recover at home with outpatient physical therapy or if you will be going to rehab afterwards?  So many factors affect that, including proximity of PT.  
       

I had the right one done just under a year ago. They had me up and walking within an hour after recovering from the anesthesia. Walked to my car and went home the same day. Recovery was at home. I went and worked the second day for 1/2 a day using a walker. Keep moving when you can, Physical therapy for me was once a week. The turning point was once I did a full rotation on a bicycle, after that I had full range of motion, with that knee. The left deteriorated to the point I figured I just needed to have it done. Before jumping to surgery, I did try injections and GAE which helped but was still not 100%. I have things I want to do so decided to bite the bullet with the surgery . Ice ice baby and elevate when you can.

Lots of wonderful advice above. My two cents:

Do the PT! Even when it hurts.

Opiates for a few days only, 2-3. Then stick to Tylenol or Ibuprofen (or both at the same time). Lowers risk for long-term-chronic pain.

After surgery they will probably order stronger pain meds the first night in the hospital. My experience (as a nurse) is that a single dose of IV Tylenol works better than the opiates in the immediate post surgical period. Ask your doc if that's a possibility. As someone above said, docs are usually happy to order something other than opiates if the patient requests.

Susan,

Good to know that you felt no euphoria.  I bet you still got pain relief but you were out for most of the time.  And again, I personally think going with the weakest pain reliever that works is useful for preventing any addiction.  

I also strongly recommend PT.  I have PT before and it is not only a part of pain relief, it’s a part of healing & recovery.

Good luck!!

Eric

Eric Hanson wrote:Susan,

And again, I personally think going with the weakest pain reliever that works is useful for preventing any addiction.  


Eric

Not only addiction, but also chronic pain. Plenty of evidence that opiates CAUSE chronic pain.
Get off them ASAP.

Thom Bri wrote:Lots of wonderful advice above. My two cents:

Do the PT! Even when it hurts.

Opiates for a few days only, 2-3. Then stick to Tylenol or Ibuprofen (or both at the same time). Lowers risk for long-term-chronic pain.

After surgery they will probably order stronger pain meds the first night in the hospital. My experience (as a nurse) is that a single dose of IV Tylenol works better than the opiates in the immediate post surgical period. Ask your doc if that's a possibility. As someone above said, docs are usually happy to order something other than opiates if the patient requests.

Like Robert above, I should be going home a few hours after surgery.  I SO agree about IV tylenol! (I'm a nurse
too).  That stuff works freaky good!  I am really going for the non-opiate, multi-pain-pathway-blocker route as far as possible.  It just makes for quicker recovery, less complications!  

Robert Ray wrote:I had the right one done just under a year ago. They had me up and walking within an hour after recovering from the anesthesia. Walked to my car and went home the same day. Recovery was at home. I went and worked the second day for 1/2 a day using a walker. Keep moving when you can, Physical therapy for me was once a week. The turning point was once I did a full rotation on a bicycle, after that I had full range of motion, with that knee. The left deteriorated to the point I figured I just needed to have it done. Before jumping to surgery, I did try injections and GAE which helped but was still not 100%. I have things I want to do so decided to bite the bullet with the surgery . Ice ice baby and elevate when you can.

This is so encouraging and what I will work for!
ICE is amazing,  I have my walker ready to go, PT is lined up and I will do all my exercises at home.  Move, move, move!
Repeating the old wisdom:
No pain, no gain!
Pain is just a place the will has been broken; work through the pain to find the growth!

Thom--Yes about causing pain and I can explain.

First, two terms:

Addiction--a self-destructive pattern of behavior where the behavior controls the person, not the other way around.

Chemical dependence--the body has made chemical adjustments to acount for the presence of a new substance that is foreign to the body.  If the new substance goes away--withdrawal.  But before that, tolerance.



OK, *Addiction* does not cause the pain (as in physical pain), its the chemical dependence.

Normally, just sitting, we all have sub-1 level pain (as in 1-10 scale).  Its below threshold.  We litterally don't notice it.  We have little drips of endorphins that help keep that irrelevant pain at bay.  This way we don't react to litterally every stimuli we encounter.

But use narcotics--drugs that act like and target endorphins--and we eventually get a tollerance and need more of the narcotic to get the same effect.  At first, this is rarely a problem.  But if the tolerance gets high enough, then the normal amounts of endorphins won't be sufficient because we have actually grown more receptors (which then have to be turned off), and we stop producing endorphins in the first place.  This is especially for the Mu variant of endorphines, something I can explain later if needed.

Note:  I have not yet mentioned chemical dependence.  Thats because even with just a sufficient tolerance, all those sub-threshold pains that once you were blissfully unaware, now they shine through with the intensity of something that is far more painful than it should ever be.  We get all sorts of aches and pains that were always there but previously sub-threshold.  Now they are very noticeable.  And how do you get ride of them?  Guess what is the easiest way--more narcotics, and its not hard to figure out where this cycle goes.


None of this is to say that narcotic pain medications are inherently bad.  As with anything, the "use as directed" rule applies.  Following a doctor's prescription actually matters.  And don't try to get creative with dosing without consulting your doctor first.

So Thom, if a way, they don't make or cause more pain, but they make existing pain much, much LESS tolerable than before when you just did not notice them at all.




Eric

Just another couple days for you. Mine is getting close, I go in next Monday. I am so ready for normal mobility again.

Robert Ray wrote:Just another couple days for you. Mine is getting close, I go in next Monday. I am so ready for normal mobility again.

Yes!  So ready.  I want to be able to do this with dignity, and without micro-managing my family who will be helping me with what I can't do.  Deep breath!