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Posted By : straydog - 7/12/2017 9:49 AM
Hi Abilene, I just saw in another thread that you recently had a TKR, wow. I do hope that you continue to do well with your recovery. I have a friend that will be having one done soon & she is terrified. I have been doing my best to support her. Please keep us updated on your progress.
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Posted By : Abilene - 7/13/2017 5:28 PM
Hello Susie, I'm sorry to hear your friend is terrified of a surgery she needs. I also have a friend in that situation. She has followed my progress and is feeling some better about it now. I went back to the same dr who did my other TKR five years ago, Dr. Weeden at Texas Hip and Knee. He is at a different hospital now. It's Clearfork Hospital. They only do surgery on hips and knees, a very nice place. I did very well with the first one and even better with this one. It's been a few days past four weeks and just today I graduated from home Physical Therapy. I see my dr again in three weeks and we expect he will be very pleased with my progress. Of course, I have to keep working on those exercises by myself, but I can continue that.

I know several people who have had both knees done at the same time, which just sounds awful to me. I watched a video from the hospital showing a woman who had one knee done, then seven weeks later had the other one done. That also sounded awful until now, I'm doing so well I can imagine doing it that quickly, but I'm very thankful I don't need to do that!

Doing any exercises possible before surgery was a great help to me. Whatever can strengthen those muscles above the knee was the most help since that's where the most post op pain was. Dr. Weeden gives his patients a list of exercises to try to do starting several weeks before surgery. My hospital stay was only one night. I was off narcotic pain meds in about ten days, off the walker in two weeks. I'm not driving yet, but could if I really needed too. Having home health provide PT was easier than having to go somewhere and I had a wonderful woman who really pushed me to get well fast! I hope your friend has someone at home to help her. If not a couple of weeks in a rehab facility might be a good option.
Posterior C3 - C7 laminectomy and fusion 2 rods and 10 screws, local bone graft from surgery site-lamina and other bony tissue 12/17/2013; Hyperthyroidism; Sleep Apnea;
Thankful for my husband of over 40 years

Posted By : (Seashell) - 7/13/2017 8:49 PM
Congratulations on your personal success with your knee replacement and recovery.

Recovery from a TKR is not a walk in the park. You point out a valuable aspect of recovery: pre-operative strengthening of the quadriceps and hamstrings is an essential ingredient for a successful recovery. Unlike the hip, the knee joint has no bony stability. The knee depends on the strength of surrounding musculature to provide joint stability. Pre-operative strengthening provides innumerable post-operative benefits. Many orthopedic practices provide pre-operative classes or educational booklets to provide pre-operative tips.

As to your suggestion that Susie's friend consider a several week stay at a rehab facility, that will likely not be a possibility. Total knee replacements generally are no longer applicable for inpatient rehabilitation services.

Times have changed and the prevailing medical model encourages discharge to home on the day of surgery or after a one night hospital stay. Medicare, at a minimum, requires a 3 day inpatient hospital stay to be eligible for coverage for inpatient rehabilitation services. A 3 day inpatient hospital stay for a total knee replacement is few and far between.

Home health, as you were provided, is a nice physical therapy option. Also, many orthopedic practices rent to their patients portable cryotherapy units to use at home to keep Post-operative swelling and inflammation at bay. The units have a sleeve that fits over the leg through which chilled ice water circulates through cells imbedded in the sleeve. Take-home cryotherapy units are quite popular and offer patients added comfort during the recuperative process.

Post Edited ((Seashell)) : 7/13/2017 9:02:31 PM (GMT-6)

Posted By : Abilene - 7/14/2017 5:14 AM
Hello Karen,
I did come home from the hospital with the cryotherapy unit. It was very helpful with the knee pain. It also has sleeves for each calve to massage them. I was to be hooked up to that whenever I was down for more than 20 minutes. I used that the first two weeks.

My pre operative booklet stated that stays in rehab facilities were less common to be approved now but if that was necessary they would help with it. My doctor is not doing any same day dismissals yet, but that's probably not far away.

A catheter was put in a few inches above my knee and medication added to it twice during my 24 hour stay. That was new from my previous knee surgery and probably greatly increased my early pain relief.

At home my pain was different but not greater than what it was before surgery. And the best part is, of course, that it improved from that point. A large water proof bandage was put over my incision and not to be removed until I returned to the doctor at 2 weeks post op. I could shower with it on-that was also an improvement over my previous surgery.

Susie, I hope more information will be helpful to your friend. I also hope she has a very experienced doctor. As you say here often, that can make a very big difference. Having an idea what to expect kept me from putting off this surgery too long. I did try the injections which help some people. They did not help me.
Posterior C3 - C7 laminectomy and fusion 2 rods and 10 screws, local bone graft from surgery site-lamina and other bony tissue 12/17/2013; Hyperthyroidism; Sleep Apnea;
Thankful for my husband of over 40 years

Posted By : straydog - 7/14/2017 10:25 AM
Abilene, so glad to read that your recovery is going so well. My friend is 65 & she lives alone & does not have any family that can check or her or help her out. This is a huge part of her fear immediately following surgery. Her dr has indicated her being put in a rehab hospital for a week or so for this very reason. Hopefully that will be arranged & something her insurance will authorize.

Isn't it amazing how much this surgery has changed since your previous one! Yes, having the very best surgeon is the most important thing of all. She has found an excellent surgeon, in fact 3 weeks ago he did a scope & did some repairs. He showed her the pics from the scope & explained what he found inside. At best he has given her a 6 month window on the TKR. She has suffered so long that she is ready to get it done & move on.

Keep us posted on how you are doing.
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Posted By : (Seashell) - 7/17/2017 8:31 AM
Your friend may have to private pay to have in-the-home care for a period of time following her TKR.

I would encourage her to contact home care agencies in her area regarding hiring a home care aide to provide support a few hours a day. Home care aides through an agency have the benefit of having background checks and the agency being licensed and bonded.

After my extensive inpatient hospital stay for an intestinal perforation, I hired a home care aide to live with me for several weeks. The home care aide did anything and everything around the house: Basic house cleaning, meal preparation, driving to the store and appointments, pet care for my tea-cup Maltese, Molly.

My insurance provided visiting nursing and physical therapy home care. The visits were daily to three times a week, an hour visit per discipline.

I would encourage your friend to look for resources outside of expecting her medical insurance to provide for home care.

Medicare will not pay for custodial care or recuperative care. It iwill be difficult to qualify a TKR as needing skilled impatient rehabilitive care. That your friend lives alone is not a qualifying need.

I had a nice experience with the home care provided by a licensed agency. Encourage your friend to start making inquiries and arrangements for part-time care at home. Rates will vary according to the area of the country (rural or metroplitan area) and by provider standing (RN, LPN, care aide). I paid about $22 per hour.
Pituitary failure, wide-spread endocrine dysfunction
Addison's disease
Mixed connective tissue disorder
Extensive intestinal perforation with sepsis, permanent ileostomy
Avascular necrosis of both hips and jaw
Receiving Palliative Care (care and comfort)

Posted By : Abilene - 8/1/2017 2:56 PM
I saw my surgeon for a 7 week post op check up. He was very pleased with how well I am doing, but not really surprised. He expects his patients to do well. I can walk easily with no limp, my knee is still swollen, I have to keep moving it or it gets very uncomfortable, there is more pain at night in bed than any other time. All this is considered normal. I am released to do whatever the knee will allow me to do. My home PT needs to only be done twice a week now rather than twice a day like I've been doing it. My next check up is at 6 months post op. He says i will continue to improve up to the 1 year mark.

He talked about how difficult it is now to get someone approved to go to a rehab facility, nearly impossible, but "we won't just kick them to the curb". Susie, I certainly hope your friend, and mine, can find a way to get the help they need after their TKR. Karen has some good advice.

I lost about 25 lbs down to a normal weight for me over the past year which probably made my recovery easier, plus those exercises I mentioned earlier. Something else the weight loss helped was to get rid of the Sleep Apnea mask and all that goes with it. That doctor didn't even test me again, just said with that weight loss, stop using it and I expect you will do well. Of course, he told me things to watch for and use it again if I awoke gasping for air or was overly tired during the day. I've not had any problems. So thankful for that!
Posterior C3 - C7 laminectomy and fusion 2 rods and 10 screws, local bone graft from surgery site-lamina and other bony tissue 12/17/2013; Hyperthyroidism; Sleep Apnea;
Thankful for my husband of over 40 years

Posted By : straydog - 8/2/2017 9:57 AM
Abilene, so happy to read about all of your progress in such a short amount of time. I totally understand the weight loss having an impact with recovery. Getting to lose the mask is fantastic, that is awesome. My husband developed sleep apnea from being extremely over weight many years ago. He had the sleep study & it was a mess. He refused the machine because of the mask. A year ago this past March he had the gastric sleeve surgery. He has lost so much weight as a result. The apnea is so much better since the weight loss. He use to flip & flop all night long like a fish out of water. Really interfered with my sleep too. The sleeve was best thing that has ever happened to him. He is diabetic, has been reduced to one insulin instead of two & the amount has been reduced & so many other of his medications have been reduced, what a blessing for him.

My friend is in the process of getting her surgery scheduled. Her dr says he can get her in a rehab for a week, that he has done this before & her insurance will cover it. He says he is not comfortable sending a senor home alone the first week. She is ok with one week, she would much rather be at home than inpatient somewhere. She had her knee scoped 3 weeks ago & that is when he told her, your knee is shot, your time has ran on on the waiting game. He went over all of the pics with her & showed her the bad areas. His protocol sounds very much like your surgeon's too.

Please check in & let us know how you are progressing.
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Posted By : straydog - 8/8/2017 5:33 PM
Happy Anniversary!! I just read that you & hubby just celebrated your 49th!! Last month we attended a close friends 50th. Their children threw quite an anniversary party for them. The kids rented a place across the street from Joe T's, really cute brick house that Joe T's rents out. Their daughter in law was in charge of all the decorations & she did a beautiful job. Their son made a video of pictures that depicted their 50 years together that was just amazing. We were so thrilled to be a part of their big day.

Take care.
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