Knee Replacement Surgery

[Matryeshka]

Tomorrow, my mom is having knee replacement surgery. We've done pro/cons, she's been knowing she needs this surgery for years and she's explored all the options.

We have cleared the furniture, a hospital bed is being delivered on Tuesday (she'll stay in the hospital till Wednesday), we have a path cleared so the bed can come in, we have a path cleared from the bed to the bathroom, and set up a bed downstairs so I can sleep downstairs with her. Her rehab is scheduled.

I know there is no painkiller besides just being knocked out that will help her, as you can't make bone feel better, but does anyone have any experience with things that ease discomfort just a little bit? Online, I've found lots of horror stories, and worst-case scenarios. I am not looking for those. I am also wondering the average length of time before she can be left alone--I've taken the week off of work; any longer than that, my job's in jeopardy.

[milanessa]

Is there a reason she's not recovering at a rehab facility?

My mother is the biggest baby in the world (seriously) about pain and things going wrong yet her knee replacement is the one thing she's never had a complaint about. Good luck to your mom.

[Matryeshka]

Her insurance sucks, and she's not old enough for Medicaire. She was trying to put it off until she turned 65, but three doctors have told her she needs to have it done and she needs to have it done NOW.

[suep1963]

My mom had her knee replaced in 1997. She came home a couple of days after surgery because I was here to take care of her and get her to her appointments. The only problem Mom had was her fibro has a flare up and it was difficult for her to bend her leg, but that got better over time. The important thing is for your mom to do the exercises and the rehab.

[Matryeshka]

Nevermind. Surgery cancelled; her potassium is too low. Rescheduled for next Monday.

[Aceon6]

Matry, when my uncle had his, he said that the recovery pain wasn't nearly as bad as the bad knee pain. He managed with Tylenol during the day and used a sleep aid at night so that the knee wouldn't wake him up. Once the swelling went down, he didn't have much pain at all. I think part of it is attitudinal as he was pretty much of a "suck it up" kind of guy.

eta, the ortho at our hospital told folks that they were safe to be alone if they could get from their recovery spot to outside in under 30 seconds. You might want to practice with your mother.... where to leave the crutches, the fastest way to get to a sitting position, the quick hop to the exit, opening the door, and getting at least 10 feet from the house.

[milanessa]

Since too much time off of work might be a problem, have you thought of working on the days she's in the hospital? That way you'd have maximum time with her at home when she may need you for personal care. (toilet, bathing, etc) Also, consider renting one of those hospital tables that swing over the bed. Twisting to reach something on a nightstand probably wouldn't be a good idea for her, at least not right away.

[Matryeshka]

My father is in stage two Alzheimers. He cannot be left to his own devices nor can he care for my mom. He's entered the wandering phase where he'll try to leave the house for no particular reason. He refuses to eat and someone needs to make sure he takes his medicine during the day correctly.

[skipaway]

When at home, pain meds about 1/2 before any rehab session. If ok, with Doctor and your mom's not allergic, she can alternate her narcotics with ibuprofen so that every 2 hours she's getting some sort of pain medicine.
Has anyone discussed anesthesia with you and your mother? Spinal anesthesia with sedation is a great way to go. She'll have depending on how quick your ortho doc is, about 1-1 1/2 hours of pain free relief in recovery until the spinal wears down. As soon as she starts feeling an inkling of pain, she should start her request for pain meds. Hopefully, she'll have a PCA pump with either Dilaudid or Morphine so she won't have to wait. Also, she'll have less nausea and be able to eat/drink sooner.
If she chooses General Anesthesia (all the way asleep) see if your anesthesia team does femoral or sciatic nerve blocks....can be an excellent pain reliever in the post op period.
I wish her well. When all is said and done...she'll be very happy with her knee replacement...we get repeat customers and they are almost to a T very happy.

[milanessa]

My father is in stage two Alzheimers.

I certainly understand that. (((Matry)))

[sk8pics]

Matry,
A friend of mine had her knee replaced when she was in her mid 50's. From what I have heard, the younger you are the more painful the recovery is, since you (presumably) still have muscle tone. She was in the hospital 2 or 3 days and then home. Due to a mixup with her insurance, she missed a couple of days of home P.T., and that caused a lot of problems in her recovery. (She was initially supposed to have home P.T. for a few days and then start P.T. at a physical therapy clinic. So make sure everything is lined up and approved so there is no break in any sort of treatment. My friend ended up having to have a procedure done with her sedated to get more range of motion.

Also, when I broke my ankle and had surgery, they did a spinal block and epidural along with sedation. And they left the epidural in until the next day, so I didn't have any post op pain for almost 24 hours, which was great. They might not be able to do that in your mom's case because they might want her up and walking sooner, but you might want to think about that. I remember someone telling me I'd had the Lamborghini of anesthesia when they heard what was used with me.

[madm]

My husband (age 61) had two knee replacements done at the same time 2.5 months ago. I was his caregiver full time. He only left the house 3 times per week for physical therapy starting on day 5 after surgery. I cannot emphasize how important the physical therapy is!!! Do it at a fitness facility (we have it available at our ortho center) and get an exercise bike for home (you can rent a used one if you don't want to buy one). Re: pain management, the Percoset he had didn't really cut the pain much. He just had to tough it out. He didn't get much sleep for weeks. He used two CPM machines for 3 weeks along with cryocuffs to cool the knees continuously (use frozen water bottles in the coolers - they last a long time). The Coumadin he took and the anti-embolism stockings he had to wear to prevent blood clots drove him crazy. His appetite/stomach was off for weeks, probably due to the medications. He used a walker without wheels for about 4 weeks, but many others we met in rehab got rid of the walker sooner especially if they only did one knee. Some people recover faster than others, and my husband took a bit longer than some others because his knees were a mess and needed major reconstruction and alignment. We ran into one guy who after 6 weeks was walking his dog a mile twice a day. This is not the case for my hubby who is not walking long distances - he mostly bikes an hour at home and does occasional grocery shopping now. He still has pain and swelling and will probably have this for quite a while. The swelling doesn't completely go away for about a year. Re: the home sleeping arrangement, we were not able to use the beds in our house because they are too low. I solved the problem by putting a queen mattress on top of another queen bed, making it 3 layers thick. Other items that were very handy to have were a grabber for getting objects off tables and the floor and pulling up blankets, a shower seat and shower bar for a walk-in shower, a raised toilet seat with arms, the walker without wheels (wheels will slip), and a male urinal (great for guys) so they don't have to hobble to the bathroom many times per night.

Re: leaving your Mom alone, she will need help for several weeks. However, since she's only doing one knee, she will have a good knee to stand on so she can probably manage being on one level of her house alone after about 10 days. She will not be able to drive for 6-8 weeks, so you'll have to supply groceries often and you'll be running her to therapy appts. 3 times per week. It's a good idea to have a lot of soup, crackers, and pre-made meals on hand. She won't feel like cooking and may not want to eat much. I also recommend keeping a log book and weekly pill dispensers to keep track of medicines - it's easy for her to get confused about whether or not she took something since she'll be taking an opiate for pain. Please note that she cannot take extra Tylenol since it's included in the Percoset and there's a max per day she's allowed. Also do not take any other over-the-counter pain meds while she's on Coumadin (they interact) and stay away from foods rich in Vitamin K (e.g. leafy vegetables).

My hubby started driving after 8 weeks and became quite independent after that. The turning point for him re: pain and mobility was about 4 weeks. Others we met in therapy said their turning point was about 3 weeks. It takes a while to recover, so don't be discouraged at the rate of progress. IT WILL GET BETTER! He isn't at the point of saying he's glad he did the surgery, but we expect him to be glad about it by this summer.

Feel free to pm me with more questions. Good luck!

[Matryeshka]

Where do you people do/live that you have this wonderful insurance that pays for all this stuff?

I appreciate all of your advice--thank you, thank you, thank you for taking the time. BUT. My mom's insurance is such that there really are no options re anasthesia or rehab. She gets a machine that she'll roll her leg on. She only gets two days in the hospital. Rehabilitation needs will be assessed after the surgery. I have to work. I do not work for a particularly understanding boss. If two other people in my department had not quit unexpectedly and we are currently devoid of interns, I would have to choose between my parents and my job. I can take a week, that's it. Luckily, now her surgery will be backed up to the Monday and Tuesday of Mardi Gras, so it will be seven work days plus the week-end, so nine total at home. There will be no ferrying back and forth for the next month. We will be paying (out of pocket) for a caretaker, but it's going to be the cheap end and honestly we can only afford two, maybe three weeks at the most. I would love to be there for her, but there's only so much I can do.

Machines, gyms, caretakers, etc. are not an option. I'm hoping for more practical advice, like the cold water bottles. Are there activities she can safely do when I'm not there? We'll definitely be doing the 30 second thing over the week-end.

[LilJen]

Get a list/diagrams of basic range-of-motion exercises from her doctors before leaving the hospital. Depending on her pain level and discomfort, she might be able to do some active ROM on her own (eg, sit on the bed with your leg hanging off, lift the leg, let it down, etc); otherwise, she might need help. SUCKS that insurance won't take care of some of this. Are there neighbors or friends, people in a group that your parents are a part of, who might be willing to come over in like 2-3 hour shifts for a few days, especially to make sure your dad doesn't wander off, leave a burner on, leave something in the way that your mom might trip on? Many hands make light work, so if a bunch of people can split up the duties it makes things soooooo much easier.

My dad has now had 3 joints replaced. Other than the stiffness he said the pain has really been no big deal. Like someone else said upthread: the failing joint hurt a lot more than the postsurgical pain.

[Matryeshka]

Most of the people my parents know either work or need help themselves. My father is much older than my mom, and unfortunately, most of their friends skew more towards older.

If it became necessary, there are two neighbors I can ask for help but they're the type of people who can be overly helpful. Once you let them inside, it's hard to get them to leave, though I can maybe get away with being more forceful since my mom's sick.

I will give this for my mom--she has a HIGH pain tolerance and will push through a lot, so I might be overly optimistic but I think she'll be OK.

I started this thread the day before so I wouldn't get a lot of horror stories, but now I have a week to prepare (again).

[rjblue]

I can't help with suggestions, but I can add to the positive anecdotes. My 75 year old mother-in-law had her knee replaced 10 days ago and now she considers it her good knee. The other one is scheduled to be replaced in 6 weeks. She has much less pain in the knee that has had the surgery, so rehab has been going well for her, and she is looking forward to the next replacement and pain-free walking.

[pamela95]

Ice. Ice, ice, ice. I’m currently studying in to work this field. My clinical placement last year was on an ortho floor, so I worked with a lot of hip and knee patients who were post op. One of the best things I can say to help with pain is to ice the knee. You don’t need any fancy ice packs. At the hospital I worked at, we used very large plastic baggies (not shopping bags, you want something that does not leak), we filled it ½ to ¾ full of ice, wrapped it in a pillow case, then placed it over the knee. This helps reduce the swelling and the pain. You have to remember though, with ice, never leave it on for more than 20 minutes, and always leave at least 2 hours in between applications (depending on the hospital they can have slightly different icing guidelines, the main point is not leaving the ice on the skin for too long. If you do, the cold could damage the skin.)

I’m not sure what your hospital does, but the one I was at had a book given to all knee patients. It had all the precautions listed, it also had pictures and directions with the exercises your mom needs to do. It’s very important she does these exercises at least 2-3 times a day. If she doesn’t, she has a greater chance of the knee becoming stiff and losing some of its bend, which leads to a limp. And I second the advice to always take the pain meds 30 minutes before doing any exercise. The Physio or the rehab assistant should be able to show you how to do these exercises so that you can help your mom do them at home.

Does your mom have a shoe horn (she should be wearing shoes in the house if she is walking at all, reduced the possibility of slipping) or a reaching tool? These are useful for getting dressed if she doesn’t have much bend in the knee. This reminds me, please bring proper footwear for your mom to wear in the hospital. No slippers, sandals, crocks or shoes without backs but instead some sort of sneakers (ones that can be loosened, in case her foot swells) is what we recommended. Remove any throw rugs, clutter, or furniture that could get in the way of her walker. We told patients that rocking chairs were the best to sit in because when you rock, you are getting some bend in that knee. A raised toilet seat could be an option if your mom is in a lot of pain and doesn’t want to bend her knee (toilets are designed low). Do not let your mom sit for long periods too. Make her go to the kitchen table for lunch etc.

And make sure you tell the Physio if you have any stairs leading into or inside the house. Lots of people forget about the steps up to the door. If you have any stairs at all, make sure that the physio or rehab assistant takes her down to the physio dept and practice the stairs. This will save you all a lot of stress and pain if she learns how to do stairs before you arrive home.

The most important thing of all is that you and your mom talk to the Dr and the Physio (and OT) about any concerns, ask questions and follow their advice. Good luck to your mom.

[madm]

Where do you people do/live that you have this wonderful insurance that pays for all this stuff?
I appreciate all of your advice--thank you, thank you, thank you for taking the time. BUT. My mom's insurance is such that there really are no options re anasthesia or rehab. She gets a machine that she'll roll her leg on. She only gets two days in the hospital. Rehabilitation needs will be assessed after the surgery.

I'm so sorry that your insurance may not cover all the extras your mom could benefit from. Our insurance is United Healthcare and we have a maximum of $3000 out-of-pocket per person for the calendar year. I believe my husband's two knee replacements cost about $45,000 total including the MRIs, surgeons, anesthetist, orthopaedic surgery center, physical therapy, CPM machines, cryocuffs, and walker. We are allowed 30 therapy visits per year per person. So we are out $3K but IMO it is a bargain compared to the actual cost. We are also lucky that I am retired and able to stay home as his caregiver. Without that, we would have enlisted a rehab facility, with insurance allowing a limited time there.

Re: the ice recommendations, we really liked using large bags of frozen peas above and below the knee, with bath towels and trash bags to shield the cold and contain drips. They are flexible and reusable and don't melt as fast as ice cubes in bags. The rehab center had some kind of frozen wraps that we really liked but I don't know if they are available in retail stores.

We also had two nights in the rehab center (a wing of our all-in-one orthopaedic center), and we had a physical therapist working with my husband while there to make sure he knew how to use the walker properly and how to go up and down stairs with both the walker and with crutches. Before checking out, he made sure my hubby could get up the two steps into our house.

If your Mom has no one to transport her to therapy appts, you may be able to get a senior transport to pick her up, or at the very worst, take a taxi. She will get a lot more out of working with trained therapists and professional equipment than she will by doing exercises alone at home, at least for the first 6 weeks post surgery. My hubby's therapists pushed him extremely hard and did things he would never try himself due to the pain.

[Whitneyskates]

My Dad had both knees replaced. It is a process but it is worth it, his knees gave him such pain but he hasn't had any since the surgeries. My Dad didn't experience a lot of pain post surgery, but of course everyone is different. They sent my Dad home with a pump that was attached to a brace that circulated cold water around his knee to help with swelling and pain. I'm pretty sure they will send your Mom home with something like that as well. Like I said, it's a process, but it's worth it. I wish you your Mom all the best!

[TheGirlCanSkate]

I just wanted to say I'm sorry. What a hard situation for everyone and you have a lot on your shoulders.

For positive news - my grandmother was home pretty quickly and able to get around okay. It wasn't a surgery she was looking forward to but she came out a ahead and since has done a lot of travel internationally and managed to keep up. She is in her 80's now and the knee bothers her again, but as she says - when you're in your 80's what doesn't hurt?

Her best advice would be to make sure your mom is at her ideal weight. She was 15-20lbs over her ideal weight and went on weight watchers and maintained the weight for over 15 years. when she gains a little she has more discomfort.