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Total knee (TKR) or hip replacement

I am a Registered Nurse with an extensive 20 year background in Emergency medicine and home health.  I have taught patients about many disease processes and health maintenance and improvement.

In 2009, I was rear-ended in an automobile accident and had several subsequent arthroscopic procedures to relieve my pain.  Due to those surgeries as well as osteoarthritis, I ended up at the ripe old age of 50 requiring a Total knee replacement.   

I worked with a personal trainer for 4 weeks prior to my surgery strengthening my leg and trying to get my weight under control in an attempt to have a speedy and easy recovery.  I improved my intake of protein, hydration and reduced my fat intake.  I strengthened my quadriceps and hamstrings as well as my calf muscles.  I was ready!  My MD said the recovery was to be 6-8 weeks.  However, I quickly converted this to 3-4 weeks due to the fact that I am younger by at least 10 years than most TKR’s, I am a nurse and know what to expect, and I had worked very hard to improve my health prior to the surgery.  I expected to be able to work from home via computer by the second week and just knew I would be back in the office in 4 weeks.

I was admitted to the hospital on a Monday at 7am, surgery was 3 and a half hours long and I was up doing therapy in my room by noon.  I had therapy every day for 4 days in the hospital.  I was asked about my home environment and had extended therapy to negotiate the 20 steps I have to go up to my bedroom and shower. I was trained in the use of a walker.   I had a therapy appointment set, in an outpatient setting, for the day following discharge at noon.  I was discharged with prescriptions for pain medications, muscle relaxers and anticoagulant therapy.  I was also sent home with exercises to perform every couple of hours while awake.  I was given paperwork about blood clots, pain, nutrition, activity and wound care.  I had my son come in from out of town to help me get to therapy the first week at home.  I arrived home Thursday afternoon and I was overwhelmed with weakness.  Just getting from the car to the house, left me completely breathless.  Getting up to make something to eat was so daunting I would rather go hungry.  Had my son not been there, I would not have eaten for the first 3 days.  Going to the bathroom left me feeling like a newborn kitten. I negotiated the stairs easily because of the training I received in hospital, but once I got upstairs I had no equipment to help me get around.  (You don’t take the walker up with you), I needed something upstairs or someone to bring up my walker.   I was emotional and feeling frail and weak.  Taking pain medications left me disoriented and at times I wondered if I had taken a dose or not, or if I had taken too many.  I began putting out the maximum doses I could take in a day because I just couldn’t remember when I took them.  On Friday morning I woke up and was sure there was no way I could go to therapy.  I hurt, I was afraid.  I went and felt so much better.  If I had the option to do it at home I would have jumped at it.  The ordeal of getting in the car, negotiating doors and getting inside made me feel I had run a marathon.  When I got home, I slept through dinner I was so exhausted.  (Remember, I geared up for this, I was strong and ready!)

The second week of recovery and therapy flew by.  I still needed help with meals.  I still couldn’t remember 15 minutes after taking pain pills if I had taken them or not. I began developing strange bruising all over my leg, I was told this was normal, but I kept needing to reassure myself.   I was completely unable to compose an e-mail and work was out of the question.   My son needed to go home and get back to work.  No way could I drive at this point.  I called on my youngest son to come for a week.  Each day I got stronger.  The end of week 2, my son had to go back to work.  I began driving to therapy.  I was able physically to drive but I had to forego pain medications and by the time I got home after therapy I was in excruciating pain.  I began working from home on the computer, but I was still unable to sit up for longer than 2- 3 hours at a time.  Overall, my recovery took 3 months. 

Now consider an older patient, without benefit of having a medical background.  These patients have multiple diagnoses and have an extensive medication list.  Now they have 4-6 new medications to incorporate into their regimen.  They do not understand all the issues associated with these new medications.  Anticoagulant therapy alone requires education and monitoring for safety.  Therapy is paramount to obtain full function of the knee.  Home health aides are needed for patients living alone.  Negotiating around their home presents challenges.  Depression is common after anesthesia and while taking pain medications which are depressants.