Total Knee Replacement: Please Help Me Plan for Surgery and Recovery
June 11, 2015 5:48 PM   Subscribe

YANMD/Visiting Nurse/Physical Therapist/etc., but I've got a lot of questions and more than a smidgen of anxiety about next month's total knee replacement surgery and recovery. Love to hear advice and suggestions from folks who've been through this as patients, family, friends, medical providers, ... I live alone with no local family, so need suggestions on group calendaring, scheduling, to do lists, errands, etc. for my friends helping me out. Inside: questions about recommended ways to co-ordinate and schedule help, what to wear, products to get, and plans to make, plus snowflakes.

My surgery's scheduled a month from now. I'm looking forward to a year from now when -- cross and toes, eyes and nose -- I'll be able to hike, dance, bike, etc. again. I'm NOT looking forward to the first three months of recovery. MeFites, please share your experience, strength and hope; your suggestions and advice; and your TLC.

First, some facts to set the stage:

Me: early 60's, female, BMI 35ish, diabetic. Had right medial meniscus surgically removed in 1970's. Turns out you really need one and bad things (severe degenerative arthritis) can happen without it. Been using an off-loader brace for several years. Conservative Orthopedist didn't want to do replacement before I was 60 to avoid multiple revisions, new replacements, etc. Second opinion MD occurred. This year, MD agrees it's time.

Level of physical fitness: Not great. I have been doing some leg and knee exercises most days for the past few weeks to strengthen the muscles pre-surgery.

Home: Live alone in condo in large, large, large 250+ unit multi-building complex. Some distance + stairs or slope to get to parking or front of complex. I've removed visible tripping hazards inside. I'm an indifferent housekeeper; still need to carefully cleanse all surfaces to sanitize place. Indoor/outdoor cat, indoor betta fish (cat ignores). Large urban area; bad traffic, little transit. Expect to have help from far-flung friends and neighbors, but no one living in.

MD/insurance. Large non-profit HMO (Kaiser). I suspect there's some need to make a really strong case for discharge to rehab facility instead of home. Strong snowflakey reasons I think it'd be better for me to discharge to rehab first, but won't know until discharge planning in hospital.

Level of knowledge re: surgery: adequate. I've read patient education materials, AAOS website, Medscape, etc. Will attend pre-operation "class" later this month.

Now, the general questions, followed by snowflake questions:

If you've gone through this, or been a provider for or partner/caretaker/friend of someone who has, tell me what it was like. What preparations should I make now? How can I see how my needs are met during the first three months following surgery? What helped you start to feel yourself again, mentally, spiritually, physically?

What were the things which you most needed to have at waist level?

What did you do to keep from being bored during your recovery? What kept you amused? What kept you relaxed? How long before you were up to reading a literary novel, playing Scrabble, doing your taxes, etc.? Seeing Shakespeare in the park?

Snowflakey questions:

Setting up a care-calendar, communication between friends from different parts of my life and different parts of town which can basically run itself while I'm groggy on pain meds, barely mobile, and not up to doing the coordination myself. I'm sure there must be something wonderful out there -- other than a Facebook group. Any suggestions? Difficulty level: assume I'm about as computer-literate as your favorite great-great aunt.

What should I pack to bring to the rehab facility (assuming I'm sent there)?

Post-surgery fashion and comfort advice, please.
Loose PJs or long nightgown or caftan at home? Loose pants, shorts, long skirts, dresses??? What to wear for PT? When were you able to get back to wearing jeans?
What shoes worked well for you right after surgery? A month after? Two months after?

I'm not sure whether Kaiser or rehab will use a continuous motion machine. If I have an option, would you recommend it?

I'm also not sure whether I'll be provided a continuous ice machine contraption (or whatever it's called). Would you suggest getting one even if it's not provided by my HMO/rehab?

I have a couple of gel ice packs, but am afraid they won't be enough. Got any recommendations for additional ones (size, brand, etc.)?

Will my health care provider give me enough Jobst hose (or similar anti-embolism stocking) to help prevent deep vein thrombosis, or should I get some (to use only with MD/PT approval)?

Recommendations for dry/no water shampoo?

Would one of those moveable. adjustable tray tables they have by hospital beds be useful? Is that something you get or rent from a home health care company? Something Kaiser home care might be cajoled into providing?

Anything else I should know, buy, request, prepare for, ...?

Thanks so very much for reading all this. I've got a busy weekend ahead of me, so I won't be checking this thread that often until Monday, but feel free to MeMail me if you need additional information or want to share something with me privately. Gratefully, Lefty
posted by LeftMyHeartInSanFrancisco to Health & Fitness (10 answers total) 3 users marked this as a favorite
Best answer: I didn't have knee surgery, but I DID have my gallbladder out and since something in my body doesn't work right, recovery was a bit of a doozy. So I really only have notes for general surgery recovery/cleaning aspects.

1) Definitely have some sort of tray or table. I have no idea about the rolling tray, but even a TV tray would be good. ALSO keep a small trash can near you. It's sooo much better to be able to throw away your trash near you rather than having it pile up around you or on your table. SO MUCH BETTER.

2) Make notes on your meds. Get a sharpie and write or underline if you're supposed to take at night or whatnot. I also tracked my pills on my iphone's notes so I could make sure I was taking them on time or not taking too many.

3) Of course, have a good, big water bottle. Staying hydrated is a big thing and getting up for each cup of water is a pain. And plan for easy food - something you can just reheat or pop in the microwave.

4) I bought a big ice pack at my local grocery store. I'm sure you can pick up decent sized ones. Get like 4 or 5 so you can not have to just switch them out immediately (Again, less things to worry about.)

5) Bathing. I just, once I was feeling well enough, took a cheap folding chair into the bathroom and filled the sink up with water and grabbed a washcloth. It was easy to sponge bath and then I stood up and rinsed my hair. I do have short hair, but that helped de-oil a bit. Personally, dry shampoo just makes my hair feel more gross. Put your hair in a braid or something if you can. Lay out some extra towels so you can not have to worry about splashes if you want to dip your hair in the sink.

6) Calendar - I haven't used it and my husband just stayed home with me, but here's how to set up a shared Google calendar. That might work for everyone
posted by Crystalinne at 10:45 PM on June 11, 2015

Best answer: From a general post-surgical perspective, while you're on serious pain meds you probably won't want to do anything too thinky, like read or do crossword puzzles. TV and movies are pretty good, idle internet surfing (like Facebook feeds) is perfect. When I had major surgery last summer I mostly surfed on my phone. It was about all I could handle for at least the first couple of weeks.

My mother had one knee replaced about 10 years ago. The pain was pretty bad for the first week. They kept her in rehab because she was in her mid 60s and lived alone. I think if you stress you live alone, depending on your insurance, you might be able to go to rehab. Try to get someone to help you settle in at home and maybe stay for the first day or two once you're out, so they can do the things you've forgotten and so there's a steady arm to get you around your apartment (like to the bathroom) until you're more secure on your feet.

DO YOUR EXERCISES AND PT! Even if it hurts. ESPECIALLY if it hurts. Do every single thing. Don't skimp. Especially the first few days. And if they aren't offering anything rehab/PT-wise the first few days, ASK. Because what buoys says above about getting better faster if you work on it is absolutely true.

When I had a torn meniscus and had surgery for it many years ago, I got one of those cold water thermos pack things that refreshes the cold constantly around the knee when you lift it up above the packs, and I loved it. It was never as cold as I wanted it to be, but it kept the swelling down to a manageable amount.

Mother has a rolling tray table and it was especially useful next to her bed, so she could keep everything she needed close by and not worry about trying to wrench around to the night stand. We bought it at a local medical supply store, and to be honest she still uses it all the time. Position it ahead of time to the right height and location and load it up with remotes, tissues, water bottles, meds, phone charger already plugged in with a nice long cord (available on Amazon), etc. Perhaps put everything in a basket to keep stuff from falling off the edge. Definitely get a good gripper thing. That's invaluable when you're not too flexible.

You might set up an account with the local grocery delivery service and try it out ahead of time. Gather any menus to delivery places, too, or set up an account with a restaurant delivery service like Foodler. The less fussing you have to do on pain meds, the better -- if you already have accounts set up and previous orders in there, the less you'll have to think about later.

The biggest thing I would have done differently pre-surgery is I would have found out more specifics about my post-surgery recovery. Surgeons are not your resource, here, because they spend about 10 minutes with you total after surgery (over several days!). They say non-specific basically useless things like "there will be some discomfort". Ask the nurses who work the ortho recovery wards. If I had asked the right people, I would probably have bought a power recliner so I could have slept in it. My surgery was on my chest, so sleeping was very uncomfortable. Eventually I slept in a comfy chair fairly well, but getting up was really hard and learning "sternal precautions" was hard once you already have the sliced open sternum. They might have advice for how to prepare your bed, how to get in and out of bed, how to use a crutch or whatever you need.

Re: cat. Problematic! How to clean litter box when bending is hard? Might want to see if you can get a pet sitter to come in a couple of days a week and do that for you. Feeding: just feed him/her on the counter. Propriety be damned. ALSO: cat winding under foot might be particularly problematic. Please be careful. No falling!
posted by clone boulevard at 11:22 PM on June 11, 2015 [1 favorite]

Word to the wise: you will be on crutches and unable to both walk and carry anything and this will get really annoying really fucking fast. You can loop a bag through a crutch safely to carry books, sandwiches, etc but that won't work for liquids. My solution was to get a tray, make a cup of tea, carefully lower the cup of tea to the tray whilst balancing on one leg, and then push the try to the couch with a crutch as I navigated my way back to the living room. Repeat for food and drinks as needed.

And yes, you really will be up and mobile faster than you think. They won't discharge you without basic mobility for safety reasons. You are unlikely to need a rehab facility.
posted by DarlingBri at 11:35 PM on June 11, 2015

Best answer: Ask about the use of a continuous epidural (like women in labor often use) for pain management postoperatively. Unless you have a medical contraindication to one I would really look into it; for me personally I would find another surgeon if it is not an option where you are going; it has been some time since I have been involved with joint replacements though, so it may be standard practice in most places now. I know surgeons I have worked with are really big on it because having an epidural in place allows for early PT including the passive motion machine immediately after surgery, and as others have noted, PT in the first couple of days makes a huge difference. I had a colleague/mentor who had both knees replaced, one with an epidural and one without, and he said there was no comparison; the epidural was far superior for postop pain management.
posted by TedW at 6:34 AM on June 12, 2015

Best answer: My good friend had a spiral fracture and subsequent surgery in her right leg, and I helped her out for about a month after the surgery.

You can set up a CareCalendar or Meal Train for your friends to sign up and help out during your recovery. Make a list of tasks & their frequency. You can ask a friend with more computer savvy to set it up for you. Since you are diabetic, perhaps you should write up a guide for what foods are best for you and what you like.

Make sure you have water and a snack (like a box of granola bars) by your bed so you are ready to take your meds when you need to. My friend would take hers right away in the morning, and then continue to doze in bed until they took effect. Having a journal for you/your friends to record when you took your meds is a great idea.

My friend wore a lot of loose stretchy cropped yoga-type pants and t-shirts. She had structured and grippy slip-on slippers, then athletic shoes when she was up to tying her own shoes. She had blankets and extra pillows placed on her couches, chairs and bed to arrange herself comfortably. Seconding the suggestion that you use an over-the-shoulder bag to wear or hang on your crutches for necessities.

Both my friend and I really like these Walgreens cold packs. Get at least 2 so you always have one in the freezer.

Perhaps plan to use your recovery time to re-read your favorite books and re-watch your favorite movies. You will be pretty groggy at first.

As for feeling yourself again, my friend really likes to be outdoors. So we borrowed a wheelchair (can't remember where we got it...) and took her for a spin around the neighborhood. We had lots of laughs trying to navigate the sidewalks and curbs. But she really appreciated being surrounded by trees and wind and green stuff.

Also, it's amazing what your body can do! Follow the directions of your doctors and physical therapists, and do your exercises. You will recover more quickly than you thought you could.

There's lots of great advice on this thread. Best of luck!
posted by stompadour at 7:27 AM on June 12, 2015

Best answer: My mom had a total knee done this year, similar age & health as you - I don't remember her ever using crutches, she went from a walker to a cane. I was surprised at how quickly she was up and mobile; she'd had bunion surgery years ago that was way worse to recover from. PT/rehab was absolutely key though, she was discharged from the surgical hospital to the rehab facility (Helen Hayes Hospital in West Haverstraw NY) and they made sure she could do all the things she'd need to do at home (get up & down the # of stairs by the outside door, how to get in & out of a car, etc.) before they discharged her.

I don't remember dry/no water shampoo being a thing. She wasn't able to shower in the hospital, but, they helped her use the shower once she got to the rehab facility (sitting on a shower stool, using a hand-held showerhead, I think). Once she was home she didn't need help washing - she sat on a bath stool in the shower, or washed her hair in the kitchen sink.

They did use a continuous motion machine sometimes at rehab, not sure about the continuous ice machine, but I think they would be too cumbersome for home use and not worth the time/expense.

Will my health care provider give me enough Jobst hose (or similar anti-embolism stocking) to help prevent deep vein thrombosis, or should I get some (to use only with MD/PT approval)?

Ok, I don't know if they didn't give her enough compression stockings or if this was just my Mom being quirky and having bad luck, but, she managed to get a massive contact dermatitis rash on her legs because she washed one pair of compression stockings by hand and didn't get the detergent all rinsed out. So, don't do that.

Mostly I just want to agree with the previous answers. With PT, her mobility came back very quickly. I think the tricky part in the beginning was the timing of everything -- meds, elevation, icing, exercises. She did have the live-in help of being married, and me nearby to help with getting from the hospital to rehab, rehab to home, and whatever driving errands I could do on the weekends since it was I forget-how-many weeks post-surgery before she was cleared for driving. But, I think if your friends can spring for having a housekeeping service come by a couple of times a week, and some Fresh Direct or other grocery delivery service, and your neighbors are there to help you get settled in back home when you're discharged and to help look after the pets, you'll be all set. (And, I bet if you post your location there may be Mefites in your area who would want to help out too.)
posted by oh yeah! at 7:38 PM on June 12, 2015

Response by poster: Thanks for all the great answers!

You've given me a lot of ideas and encouragement. I'm grateful. Most of you mentioned the importance of PT. You'll motivate me to keep it up despite whatever pain or discomfort I may have.

(Mods: Hope these individual shout outs are OK and not threadsitting.)

Buoys in the hood, thanks for sharing your mother's story and reminding me the road is really a lot shorter than I think. Great reminder about keeping hydrated, Crystaldinne, and tracking meds on the phone. Hope your brush with post-operative dooziness is well behind you now.

Clone boulevard, great idea to invite someone over for a welcome-home sleepover! My cat-loving neighbors will help out with kitty litter duty. I'm going to get one of those tray tables. Rose (the cat) will probably try to claim it as part of her vast above-the-floor empire, but at least it'll keep her away from my feet. DarlingBri, loved your solution to the trouble with tea. Maybe we could set up a competitive tea tray race. Pancakes on Shove Tuesday, eggs on spoons at multi-generational family reunions, tea tray crutch races for MeFites. I can see it now.

TedW, the epidural is #1 on my list of questions for my pre-op appointment. Thanks.

Your friend's lucky to have you, stompadour. Love the image of your wheelchair hike. I've looked at your calendar suggestions and will poll my friends on their choice.

Contact dermatitis on top of everything else, oh yeah!? Your poor Mom. I hope there were no long-lasting ill effects. I danced a happy dance when you told me that she'd been able to wash her hair in rehab. I'd thought I would have to wait until after they took out the staples (sutures?).
posted by LeftMyHeartInSanFrancisco at 2:09 AM on June 18, 2015

Contact dermatitis on top of everything else, oh yeah!? Your poor Mom. I hope there were no long-lasting ill effects. I danced a happy dance when you told me that she'd been able to wash her hair in rehab. I'd thought I would have to wait until after they took out the staples (sutures?).

The swelling from the dermatitis slowed her PT progress in the beginning, but no long term problems. And staples, yes, though I think there were internal sutures.
posted by oh yeah! at 9:40 AM on June 18, 2015

Response by poster: Well, my surgery is just a few days away. Tuesday the 14th at 10 a.m. PDT. If you're so inclined, please keep me in your thoughts.

Since posting here, I ran across an on-line community for hip and knee replacement candidates, patients, and family: It's worth checking out for tips, info, and support.

Thanks to the wonderful MeFi community for your tips, info, and support.
posted by LeftMyHeartInSanFrancisco at 8:38 AM on July 12, 2015

Good luck tomorrow!
posted by clone boulevard at 11:56 AM on July 13, 2015

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