Total Knee Replacement Advice Needed

[harllee]

Bamaman, good luck to your wife on her foot surgery recovery. I was just thinking of the around the house chores that DH does that I will have to take over while he recovers from TKR--things like rolling out the trash cans, etc. Fortunately we have someone to do the yard. One of DH's jobs use to be cleaning the floor but a few months ago I got Rosie the robot vacuum so no floor worries (and she does a better job than DH did but don't tell him).

About your wife's knee block--did that give her any reason why it did not take? Did they not give her oral pain medicines in the hospital?

 

[stephenson]

Did anyone mention www.bonesmart.org? Great resource!

Also, here’s the story on antibiotics and joint replacements - https://www.ada.org/en/member-center/oral-health-topics/antibiotic-prophylaxis

“Practical Implications and Conclusions

The 2014 Panel made the following clinical recommendation: In general, for patients with prosthetic joint implants, prophylactic antibiotics are not recommended prior to dental procedures to prevent prosthetic joint infection. The practitioner and patient should consider possible clinical circumstances that may suggest the presence of a significant medical risk in providing dental care without antibiotic prophylaxis, as well as the known risks of frequent or widespread antibiotic use. As part of the evidence-based approach to care, this clinical recommendation should be integrated with the practitioner’s professional judgment and the patient’s needs and preferences.”

 

[Bamaman]

Bamaman, good luck to your wife on her foot surgery recovery.

About your wife's knee block--did that give her any reason why it did not take? Did they not give her oral pain medicines in the hospital?

My wife has been on pain management for 20 years. One doctor bows out and lets the surgeon take care of her meds when she has surgery. Unfortunately, surgeons of today do not know how to manage complex medicinal needs, and they leave them without sufficient pain medicine. Heck, some orthopedic surgeons don't give decent pain medicines at all. All doctors seem afraid the State regulators will come down on them for prescribing any controlled substances--no matter how badly they're needed.

We're 6 weeks since her surgery, and her normal pain medications are barely working. She's still up half most nights and often in misery. Hopefully the orthopedic foot doctor this week will allow her to walk a little--and get out of bed.

What we're saying is that doctors badly need to coordinate the use of medicines of patients undergoing extremely painful surgeries. And the mid foot fusion is much more painful than a knee or hip replacement--and recovery is much longer too.

 

[harllee]

Did anyone mention www.bonesmart.org? Great resource!

Also, here’s the story on antibiotics and joint replacements - https://www.ada.org/en/member-center/oral-health-topics/antibiotic-prophylaxis

“Practical Implications and Conclusions

The 2014 Panel made the following clinical recommendation: In general, for patients with prosthetic joint implants, prophylactic antibiotics are not recommended prior to dental procedures to prevent prosthetic joint infection. The practitioner and patient should consider possible clinical circumstances that may suggest the presence of a significant medical risk in providing dental care without antibiotic prophylaxis, as well as the known risks of frequent or widespread antibiotic use. As part of the evidence-based approach to care, this clinical recommendation should be integrated with the practitioner’s professional judgment and the patient’s needs and preferences.”

Bone Smart is a good resource, thank you

 

[harllee]

My wife has been on pain management for 20 years. One doctor bows out and lets the surgeon take care of her meds when she has surgery. Unfortunately, surgeons of today do not know how to manage complex medicinal needs, and they leave them without sufficient pain medicine. Heck, some orthopedic surgeons don't give decent pain medicines at all. All doctors seem afraid the State regulators will come down on them for prescribing any controlled substances--no matter how badly they're needed.

We're 6 weeks since her surgery, and her normal pain medications are barely working. She's still up half most nights and often in misery. Hopefully the orthopedic foot doctor this week will allow her to walk a little--and get out of bed.

What we're saying is that doctors badly need to coordinate the use of medicines of patients undergoing extremely painful surgeries. And the mid foot fusion is much more painful than a knee or hip replacement--and recovery is much longer too.

So sorry about your wife and her medical issues, sounds awful. I hope DH gets adequate pain management for his TKR. He has been hearing stories from friends who have had TKR and their experiences are all over the block--some have a lot of pain and need pain medicine, some have hardly any pain, just take Tylenol and are up and about in a few weeks. I guess everyone is different. Right now I can tell DH is in quite a bit of pain with his knee but he rarely complains and just uses ice for pain management.

 

[harllee]

DH had his preoperative appointments for his TKR yesterday (the surgery is scheduled for 4/13). I went to the appointments with him.

We discussed pain medications. The doctor told DH that the main pain medications he recommends are oxycodone and tramadol (as well as over the counter Aleve and Tylenol). The doc said he would probably recommend tramadol for DH, that he thought it would be adequate for DH's pain and that it had less side effects but that he would prescribe whatever DH needed. The doc also said that if he prescribes tramadol and its turns out to not be adequate he can then prescribe oxycodone.

Any of those of you who have TKR have any advice regarding oxycodone versus tramadol? The last time DH took oxycodone he hated it and became very constipated, he has never taken tramadol before.

 

[aaronc879]

DH had his preoperative appointments for his TKR yesterday (the surgery is scheduled for 4/13). I went to the appointments with him.

We discussed pain medications. The doctor told DH that the main pain medications he recommends are oxycodone and tramadol (as well as over the counter Aleve and Tylenol). The doc said he would probably recommend tramadol for DH, that he thought it would be adequate for DH's pain and that it had less side effects but that he would prescribe whatever DH needed. The doc also said that if he prescribes tramadol and its turns out to not be adequate he can then prescribe oxycodone.

Any of those of you who have TKR have any advice regarding oxycodone versus tramadol? The last time DH took oxycodone he hated it and became very constipated, he has never taken tramadol before.

It is important to note that everyone reacts differently to different medications. That being said, Oxycodone was the only pain med that did any good after my broken hip surgery and hip replacement surgery and can't imagine any less meds being adequate especially for a TKR. Tramadol is what they gave me when they wanted to get me off Oxycodone. It had all the side effects(constipation) of oxycodone with none of the pain relief. Tramadol for me was no better than Tylenol. If all I was given after TKR was Tramadol I would probably kill myself to stop the pain. Any DR that prescribes anything lesser than Oxycodone after major surgery shouldn't be able to practice medicine anymore IMO. That is unless your DH has a documented history of a much higher pain tolerance than the average person.

 

[nap470]

Harllee - I looked back at my list of medications and I believe my surgeon prescribed Celebrex for pain along with Hydrocodone (Norco) as the "hard core" pain medicine if I needed. I never even filled the prescription for the hard core pain medicine, only took about 1/3 of the container of Celebrex, and switched over to Tylenol as soon as I could. After the first week. I was fortunate not to have had too much discomfort. I was really paranoid of becoming reliant on pain medication since I had never really taken much for drugs throughout my life.

 

[Aerides]

A few days of the hard stuff shouldn't be a worry to get thru the first long weekend, and mix it up with weaker meds on rough days. I'd fill both scrips and have them on hand and see how he feels.

 

[W2R]

The doctor told DH that the main pain medications he recommends are oxycodone and tramadol (as well as over the counter Aleve and Tylenol). The doc said he would probably recommend tramadol for DH, that he thought it would be adequate for DH's pain and that it had less side effects but that he would prescribe whatever DH needed. The doc also said that if he prescribes tramadol and its turns out to not be adequate he can then prescribe oxycodone.

Any of those of you who have TKR have any advice regarding oxycodone versus tramadol?

I have NO idea. To me that just seems so overboard.

My surgeon did not suggest either, and prescribed hydrocodone and acetaminophen. He said to call him if I needed anything more. Well, it turned out that even trying to "keep ahead of the pain", I hardly needed any of either, except the first few days right at bedtime.

But then, your DH's surgeon is well qualified and maybe he sees a sound medical/surgical reason why your DH's TKR should be vastly more painful than mine was. I have no clue! I would imagine that each patient and each surgery is different. With his surgeon's qualifications I'd say go with whatever he suggests.

Harllee - I looked back at my list of medications and I believe my surgeon prescribed Celebrex for pain along with Hydrocodone (Norco) as the "hard core" pain medicine if I needed. I never even filled the prescription for the hard core pain medicine, only took about 1/3 of the container of Celebrex, and switched over to Tylenol as soon as I could. After the first week. I was fortunate not to have had too much discomfort. I was really paranoid of becoming reliant on pain medication since I had never really taken much for drugs throughout my life.

Right!! My experience was the same. Also Norco (hydrocodone) was my hard core pain med too.

Aaron mention constipation, and I think that is a very common issue after TKR surgery. Once it started getting to the point of being a concern and a little scary, I found that for me, just three (3) whole prunes took care of the problem immediately. Amazing! I think most people use Miralax but I went with prunes.

 

[harllee]

Thanks for all the good advice. Talking to friends who have had TKR--the pain issues are all over the block. I guess everyone is different. One friend only took Tylenol. One friend who had 2 TKRs says she had Oxycodone on the first one and Tamadrol on the second and she much better with Tramadol the Oxycodone. DH has a high pain tolerance level. I know he is in pain with his knee and he never takes any pain medication at all. I forgot to mention--he will have a pain block in the knee and that doc says that will last until he gets home to help control the pain.

 

[timo2]

Any of those of you who have TKR have any advice regarding oxycodone versus tramadol? The last time DH took oxycodone he hated it and became very constipated, he has never taken tramadol before.

I can relate my experience. The Oxycodone was necessary for me to push my knee exercises through the pain to get to the flexibility I needed to achieve. There is no way I could have started the rehab exercises without the Oxycodone. period. And the doctors all say the rehab must start immediately after surgery to recover adequate flexibility in the knee. I wasn't worried about becoming dependent, I was worried about getting my knee flexibility back, that was my number one priority. The authorities have done a good job of limiting one's ability to get continued prescriptions for Oxycodone. After a while, a person is basically forced to move on to tramadol. And then they push you off of the tramadol fairly quickly. I had purchased from Costco those giant bottles of tylenol and Advil, which I used a phone app to schedule alternate doses based on recommended safe dosages. It is one year and 2 months since my knee replacement. I have excellent flexibility back. I'm working on kneeling now. I can't imagine getting the results I achieved if I hadn't used the Oxycodone to allow me to do the rehab exercises immediately after the surgery. All the advice I saw said "don't take any time off from rehab". And after going through the experience, I agree.

 

[timo2]

Thanks for all the good advice. Talking to friends who have had TKR--the pain issues are all over the block. I guess everyone is different. One friend only took Tylenol. One friend who had 2 TKRs says she had Oxycodone on the first one and Tamadrol on the second and she much better with Tramadol the Oxycodone. DH has a high pain tolerance level. I know he is in pain with his knee and he never takes any pain medication at all. I forgot to mention--he will have a pain block in the knee and that doc says that will last until he gets home to help control the pain.

I also know one of those 'tylenol only' folks, and they came out OK and seem have good flexibility. But I think they were a bigger maniac about rehab than even I was. They did have the rehab person tell them to not push so much, and I also had that experience. I would hate for a lesser motivated person to be so worried about the drugs that they short themselves on their ability to do rehab.

 

[W2R]

Thanks for all the good advice. Talking to friends who have had TKR--the pain issues are all over the block. I guess everyone is different. One friend only took Tylenol. One friend who had 2 TKRs says she had Oxycodone on the first one and Tamadrol on the second and she much better with Tramadol the Oxycodone. DH has a high pain tolerance level. I know he is in pain with his knee and he never takes any pain medication at all. I forgot to mention--he will have a pain block in the knee and that doc says that will last until he gets home to help control the pain.

From what you said in this paragraph, I think you have a really good idea about what to expect.

I'd suggest letting the surgeon give you whatever prescriptions he thinks are correct, fill the prescriptions immediately when he comes home from the hospital. Then if he clearly doesn't need the stronger ones, just don't take them (running that by the doctor first, prior to the surgery). If your DH isn't sure if he needs the stronger pain meds or not, then he should take them because they say it's best to keep ahead of the pain.

Get a phone number to call in case he needs a prescription for stronger meds.

That's great that he is getting a pain block too!

As for the rehab at home for a few weeks after the surgery, I took a Tylenol right beforehand, and for me that was plenty. Not so after 6+ weeks when I had transitioned to their fancy facility across town, and was being treated by physical therapy students with zero experience; they actually injured me so at that point I quit because I had already regained every capability, and do not regret it.

Pain tolerance is probably a very individual thing. Being female, I went through childbirth years ago. After that the TKR surgery pain that I experienced seemed like child's play to me. I never, ever had as much knee pain after the surgery, as I had every single day for years and years before the surgery. But there's no guarantee that your DH's experience will be like mine.

 

[misanman]

As part of the surgery, they installed a small, battery powered pump that injected a numbing agent into DW's surgery site. She was allowed to take it home and we disconnected it and mailed it a day or two later. I think that helped immensely. She also took some Oxycodone right at first but pretty quickly transitioned to Tylenol because of the constipation side effect. She is a retired RN and is a believer in staying ahead of the pain by taking advantage of whatever the doctor made available.

 

[harllee]

Regarding the physical therapy and having to take oxycodone to "push through" the PT. DH's doctor at Duke says they have decided that is wrong. His philosophy is that if you have to take a narcotic to get through PT then you are doing too much. His big issue is getting the swelling down through rest, ice and elevation. He says that if you get the swelling down then the range of motion comes on its on. DH will have some PT but it will be very mild. The doctor says the main PT is walking.

 

[W2R]

Regarding the physical therapy and having to take oxycodone to "push through" the PT. DH's doctor at Duke says they have decided that is wrong. His philosophy is that if you have to take a narcotic to get through PT then you are doing too much. His big issue is getting the swelling down through rest, ice and elevation. He says that if you get the swelling down then the range of motion comes on its on. DH will have some PT but it will be very mild. The doctor says the main PT is walking.

What a terrific doctor! I like his approach. Also, in my case his views on swelling were 100% correct.

 

[Bob_Walter]

I suggest you get an ice machine like gameready. You wrap your knee and it keeps it cool all night/day.

 

[harllee]

I suggest you get an ice machine like gameready. You wrap your knee and it keeps it cool all night/day.

Yes, they are providing us with an ice machine to take home from the hospital (not sure what brand but Medicare pays for it) and DH plans to use it day and night as recommended by the doctor. They told me to put 8 bottles of water in the freezer, which I have done. I have bought some other things--like a shower chair and toilet riser. We have a walker. Doctor provided DH with arm crutches which the doc likes better than a walker and DH has been practicing with the crutches every day. DH is also doing some presurgery PT recommend by the doc.
DH is definitely getting ready.

 

[Winemaker]

My neighbor, late 50s nurse had TKR, refused to take any pain medication but just bit the bullet and suffered through it all. She is back to w*rk and doing fine.

DW had her knees 'scoped 3 times, hydrocodone for a few days. I realize a 'scope is not TKR.

I had my knee 'scoped 3 weeks ago, no pain meds at all.

 

[harllee]

I had a torn meniscus repair a couple of years ago. Tore it dancing. Had out patient surgery. Took no pain medicine, was walking the next day and back dancing in 2 weeks (don't tell my surgeon that!). Of course meniscus repair and TKR are totally different.

 

[Musica40]

Had knee replacement Jan 2019. All options for treatment were gone at that point. Fast forward two years later and I feel it was a good decision. Can't run but my quality of life has gotten better. Have to admit it was scary and I almost backed out, but in the end, it was the right thing to do.

 

[harllee]

Had knee replacement Jan 2019. All options for treatment were gone at that point. Fast forward two years later and I feel it was a good decision. Can't run but my quality of life has gotten better. Have to admit it was scary and I almost backed out, but in the end, it was the right thing to do.

Musica, what caused you to almost black out? I want DH to avoid that!

 

[nap470]

Aaron mention constipation, and I think that is a very common issue after TKR surgery. Once it started getting to the point of being a concern and a little scary, I found that for me, just three (3) whole prunes took care of the problem immediately. Amazing! I think most people use Miralax but I went with prunes.

Constipation from the pain meds definitely can be a problem....especially the heavier pain meds. My surgeon recommended Colace, which is an over-the-counter stool softener. I did take those for a couple of weeks along with eating prunes as W2R recommended. Again, I consider myself very fortunate not to have experienced that much pain. By far the biggest issue I experienced with my TKR was sleep deprivation for the first 3-4 weeks. Not being able to sleep on my side kept me awake almost every night.

 

[harllee]

Thanks everyone for the constipation advice--on the doctor's advice I have gotten Miralax and Sennecot. DH ready eats prunes and takes Metamucil so he is full of fiber! Regarding sleeping DH sleeps on his back anyway which should help. He is now sleeping with the lounge doctor pillow to elevate his knees to reduce swelling (DH really likes the lounge doctor) but the doctor says that is a no no for the first couple of weeks (not exactly sure why--maybe because he want DH to sleep with leg straight?). Hopefully in a couple of weeks DH can go back to the lounge doctor to reduce swelling.