After years of knee pain, orthopaedical doctor visits, physical therapy, and steroid shots I finally came to the point of total knee replacement surgery. I am in recovery for that surgery as I write this and decided to document the process for you google searchers out there searching for all the information you can find before going forward with committing to surgery. I may include some product links for items I've purchased and deem helpful. I am an Amazon affiliate and may receive a small compensation on qualified products.
Pre surgery for total knee replacement
In October I had a steroid injection then spent the next three months going to physical therapy (PT) to build muscle tone and my stamina just to walk a few blocks with less pain. I had an ulterior motive in that I was planning a trip to New York early December. The PT helped in that I knew how to stretch out the muscles that became stiff and painful but as the days passed in New York and I walked farther, climbed lots and lots of stairs and encountered more and more broken elevators the pain became almost unbearable. I could tell the steroid injection was wearing off and the Ibuprofen helped less than I hoped. Don't get me wrong here, I was still determined to enjoy my trip and kept going... just at a much slower pace with lots of sit down breaks. All the same, I kept in mind I had a scheduled appointment with my joint doctor when I retuned.
By the time I went to the scheduled appointment I'd made up my mind to agree to surgery. Making that decision has been a long road of doubt and concern but once I reached it I felt a ton of mental relief. We scheduled surgery 90 days out from my last steroid injection and I started the approval process.
The approval process for total knee arthroplasty
The approval process takes time, so be prepared for that. Here's a sample of my process.
- Surgeon gets insurance approval for x-rays, CT scan, surgery
- Surgeon schedules CT
- Surgeon schedules surgery day
- Surgeon schedules Pre-op registration
- Surgeon prescribes physical therapy and contacts your choice. My chosen physical therapist contacted me after surgery.
- Primary Physician physical and surgery release
- Blood work up
- Chest x-ray
- EKG
- I had a low heart rate so had to see a cardiologist for surgery clearance
- Primary sent clearance after getting Cardiology reports
- Cardiology surgery clearance after insurance approval
- stress test
- echo cardiogram
- heart sonograms
- results, clearance sent to Surgeon
It took several weeks for the approvals and all my doctors were very accommodating.
After the approvals were all received I met with the hospital pre-admittance clerk the week before surgery. The entire visit took about two hours. Below is a list of what I did.
- tour hospital
- pre surgery blood tests, mersa swab, covid swab
- CT scan
- paperwork
I took time to enjoy the week before surgery going to club meetings and social visits with friends. The grandchildren came to play and craft. I stocked my fridge and freezer with easy meals and snacks. I ate healthy and got plenty of vitamin C. The weather was snowy but I got some sunshine when I could. The snow melted away before surgery week but the threat of an ice storm had me concerned right up until the morning we drove the 30 miles to the hospital. I was first on schedule so my check in was 6:00 AM.
- Check in to day surgery
- sign more paper work
- answer more questions
- confirmation visit with surgeon
- meet and discuss process with anesthesiologist
- anesthesiologist administers spinal block and puts to sleep
- surgery 1-2 hours
- recovery room 1 hour
- spend 1-4 nights. I was there 1 night.
- Hospital stay
- Pain management
- PT
- learn how to get up from bed
- learn how to use walker
- short walk
- learn how to go to bathroom
- sit in chair 30 minutes
- learn how to get back into bed
- day after surgery, longer walk, small muscle stretches, how to maneuver stairs
- Dismissal
- Go over pain management
- Go over PT
- Go home
Day 1: Total Knee Replacement Surgery
The Surgery went exactly as planned. The team of doctors, technicians and nurses at the facility where I was were phenomenal. As soon as I checked into the day surgery waiting area I was given a hospital gown to change into. Two nurses with great sense of humors kept me distracted from my nervousness and anxiety while we filled out more paper work and I answered more questions. It felt like casual friendly conversation as they joked and asked more questions. Simple statements I made led to notations they took down to inform the surgeon even more completely on my status. I asked if I would have a catheter as I was concerned about incontinence. There would be no catheter but they made note for the doctor that was a worry for me. I kept my underwear on with an incontinence pad during surgery and thankfully there was no issue. They found out I am deaf in one ear and hard of hearing in the other and made note so that even after I was in my room the nurses were aware of it and made certain I was hearing and retaining all the instructions.
Pretty soon the surgeon came for a quick consult and confirmation I was prepared and ready. I met his assisting nurse, the nurse that assisted the anesthesiologist and the anesthesiologist himself. The anesthesiologist explained the spinal block process then rolled me to a room where I sat on the side of the bed while his assisting nurse wrapped her arms around me in a comforting hold while he administered the spinal block. For me, that was the most stressful part of the whole process. It only takes minutes but I was unnerved by it. The nurse was very good at her job and rubbed little circles across my shoulders while encouraging me to relax and stay still. The shots were done, the sleeping drug administered and I was out. The next thing I knew the surgery was over and the recovery nurse was asking me how I felt. I dozed off and on then recognized my husband and daughters voices in my hospital room.
I was given a lunch tray and ice packs placed on my knee. This is where I want to talk about the ice packs. At one of my doctor visits he talked about the advantages of icing the knee after surgery. He told me about an icing machine that was available to rent and that insurance doesn't cover the expense. He advised me I could rent that machine for about $350 for two weeks or they would utilize regular old frozen ice bags with similar results. There was no pressure at all about it. I went home and discussed it with my husband and a couple of friends who had knowledge about the icing. I googled advantages and disadvantages before deciding it was a good option for me. I found a plethora of machine options on Amazon. I chose one and ordered it so I could take it with me to the hospital and instructed. At the hospital I found out the one I had purchased wasn't usable there. It had an ice pad that had to be frozen and refrozen as it wouldn't stay cold long enough. The hospital couldn't do the freezing/refreezing because of cross contamination. So, they ended up providing disposable ice packs that worked fine while I was there.
Approximately five hours after surgery a Physical Therapist helped me sit up for the first time. She instructed me on maneuvering my leg over the side of the bed and standing up. I made my first walk to the bathroom learning each technique I needed for standing, walking with a walker, sitting down without falling and getting up again. I sat in a chair about 30 minutes then maneuvered back onto the bed and a reclining position. I dozed quite a bit through the afternoon and evening.
Day 2: Home after total knee replacement surgery
We were still concerned about the possibility of a treacherous weather coming into our area so I had to make decisions about rushing through the morning of day 2 and checking out of the hospital or choosing to stay there during the duration of a possible storm 1-4 days. I chose to go home.
I needed some physical therapy instructions before leaving so was taken on a walk from my room to the PT gym. I was pleasantly surprised at how easy that walk was. I spent about an hour doing some very simple exercises. They included sliding my leg side to side, tilting my foot up and down, pressing my heel into the bed, getting up and down from the bed and climbing up/down three steps. (I have 3 steps into my home). When that was successfully accomplished I walked back to my room and ate breakfast. Nurses took vitals and removed IV's. Instructions were given and repeated multiple times on follow ups, self care and pain management before I was released. The weather held off for my trip home, thank goodness. I was pretty tired when I got home and slept quite a bit.
Day 3: Using the artic ice machine vs ice packs
The doctor and nurses all made sure I knew how to manage my pain. They stressed that staying ahead of it was vital. My daughter in law drew a simple chart to help me keep track of what medications to take and when. That has proven to be very beneficial. Even though I heard and comprehended the repeated instructions from the doctor and nurses I became overwhelmed after I got home. I used the chart to check off each medication and even when I needed to do the PT exercises and apply ice.
That ice really helped with the pain and swelling. I quickly discovered that the ice machine I'd purchased was "OK" but inadequate. I now understood why the hospital didn't use it. The one I'd purchased was nice, but the ice pack melted after 30 minutes and had to be put back in the freezer before it was usable again. Inconvenient! I searched on Amazon again and read the descriptions much more closely. After narrowing it down to a machine design that has a small ice chest with tubes that circulate cold water through a pad specific for the knee I ordered a new one. While waiting the days until it was delivered I continued to use the disposable one I'd kept on my leg during the drive home. It developed a leak after a couple of days so I was especially grateful when the new one was delivered. The ice packs REALLY help relieve the aching and throbbing associated with the muscle healing. I have the timer on the machine set to circulate for 20 minutes on and 20 minutes off through the night. AH, sweet rest!
Day 4: After knee surgery home care
Medications, sleeping, short walking. Pain is pretty well managed below level 3. Some throbbing and nerve ending tingles.
Day 5: A level 10 pain experience
Taking medications, sleeping, short walking. I have little to no appetite but can't seem to get enough water! I had a level 10 pain moment when lifting my leg off the bed. I was using my good leg as the hospital therapist had shown me to support my surgery leg but it slipped off. My daughter quickly grabbed it as I couldn't keep it hovering in the air. The pain lasted only minutes but my panic was astronomical. The rest of the day my pain stayed under a 3-4.
Day 6: Using a chart to keep up with medications
Today I created a table with all the meds and things I need to do daily. I heard and understood the instructions repeated to me several times but keep getting confused. The chart my daughter in law made is for 7 days so I typed one up and printed of a couple for the next two weeks.
I'm still sleeping quite a bit but getting in the walking and toe wiggling exercises. Very little pain today.
Day 7: Another level 10 Pain moment
I'm sleeping a lot. The knee itself has no pain but the muscles are very sore and even painful. The new check off schedule is helping me remember to take the proper medicines in a more timely manner. No appetite but very thirsty.
I went to the therapy center to get my bandaging checked. Getting into the car was not easy. I am unable to bend my knee enough so had to maneuver and wiggle my body until my daughter could tilt my toe enough to slide into the car. Getting out was a similar ordeal. They were unable to change the bandage because I should have been given a specific covering before leaving the hospital. My husband drove back to the hospital clinic after therapy to pick some up for another trip to therapy tomorrow. At the end of the therapy session I had a level 10 pain moment. I had hooked the toe of my good leg under my surgery leg to support it as I moved it off the exercise table but inadvertently slipped it off much like what happened at home three days ago. I didn't have the strength to keep it suspended in the air. The muscles practically screamed out for me in pain. Fortunately the pain only lasted a minute or two and the therapist consoled me that I had not done any damage. Once I could breath normally again I was able to carry on.
Day 8: Changing the surgery dressing
I took all medications as prescribed and slept well. Taking walks about every two hours helps with the muscle cramping and tingling in the nerves. The ice packs give a lot of relief for what I can describe as stress pain. Pain that doesn't really hurt but feels like an irritating nagging knowledge it could.
Returned to rehab today to change the dressing. The therapists gathered around to inspect my incision as it had a new stitching method with what my doctor had called "zip ties". There were a some little blisters formed that the therapist photographed and sent to my doctor. I did some very gentle stretches. The muscle along the outside of my leg and up my thigh is extremely sore as well as the back of my calf.
Day 9: At home knee replacement care
I took all medications as prescribed and slept well, even napping several times during the day. I feel pretty good, am in good spirits and having very little pain.
Day 10: At home knee replacement care
I took all medications as prescribed and slept well last night. I spent more time sitting up in a chair with my family in the living room today. I am not very hungry, probably due to the pain meds.
Day 11: A rehab visit and wound care
I slept well last night. I took all the medications as prescribed and made the drive with my son to rehab. They had received instructions to lance and drain the little blisters that had formed along the edge of the incision and a couple along the bandage adhesive line. That was not pleasant but not painful either. The muscle at the back of my calf is tight and painful as is the muscle along the outside of my knee. The therapist helped me stretch the calf by pressing my toes up and in a bit. I still can not feel the muscle well enough to lift the lower part of my leg. I can swing it forward using my thigh muscle though so my walking gait is improving.
Day 12: Noticing improvement
I slept pretty well last night only waking to go to the bathroom twice. I took all the medications on schedule and performed the leg PT exercises plus walked. My daughter helped wash my hair in the sink. I noticed I was able to hold my leg elevated in a straight position behind me as I stood at the kitchen sink without pain.
Day 13: At home knee replacement recovery
Another day of little muscle stretches, leg elevation, ice and walking. I decided to try a partial shower keeping the leg covered and dry. It was difficult as the shower chair does not have hand rails making sitting down and getting up a task. I can tell I am definitely improving. There's very little pain and moving about is getting easier.
I skipped the morning pain med but not the night one. My leg felt achy and throbbed so I did as the doctor had instructed and kept ahead of the pain. My appetite is beginning to return too.
Day 14: Maybe falling asleep with the ice machine is not a good habit
Last night I woke twice to a kind of tidal wave throbbing from just above my knee down to my ankle. I also had pain in my left kidney. I had gone to sleep with the Active Ice machine running and I think I had moved enough to push the ice pack down a couple inches causing a tightness from the velcro binding behind my knee. I took a potty break then adjusted the ice pack into position, turned it on and took pain medication. I played a game on my phone about an hour then slept really well after that. This morning I did my stretches before getting up and taking a walk. I don't notice any pain so skipped the morning pain med.
When I got up I felt pretty good so used the little arm extension grabber rehab gave me to pick up some discarded clothing and put it in the hamper. Since I am still in the compression hose I scrubbed myself down everywhere else with a hot soapy cloth. Later I moved some dirty coffee cups and empty water bottles to the kitchen. Whoo hoo! Never thought doing some simple house chores would be so fulfilling.
I still needed help tilting my toe up to get into the car for the ride to rehab today but when I got there I was able to maneuver myself out all by myself. The therapist changed my dressing again. Cleaning and draining the blisters. There were no new ones. She sent photos to the doctor for confirmation that all is good. We completed some stretches and attempted some muscle stimulation with a little pulse machine but I couldn't handle it so she stopped.
When I got home I slept a bit, ate a light dinner and watched a movie before bed. I was unable to go to sleep so took a pain pill for the irritating throbbing making it's way down my lower leg and did some computer stuff. I'm really ready to get these compression hose off and sleep on my side for a change.
Day 15: A different kind of pain
Last night was not a good sleeping one as the nerve endings seem to be very active buzzing and hopefully healing. Last time I looked at the clock it was 2:00 A.M. As a result I slept a bit later and was groggy headed. That could be because I took a pain pill at midnight and then took extra strength Tylenol two hours later.
I realized my walking gait is improving today. I was able to lift my foot off the floor several inches unassisted and could kick forward without pain. I performed a few house chores without difficulty like putting laundry in the washer, wiping down the bathroom sink and sanitizing the toilet. I am feeling confident my recovery is going well.😊
I'll give you an update after my follow up visit with the doctor. I also hope this journal will help someone making the decision or in the midst of surgery have confidence you are not alone.
Week 11: Setback
I experienced an adverse reaction to the zip line used or possible the adhesive associated with it. Big blisters appeared along the length of the incision that developed necrotic tissue. The dead tissue was surgically removed. I've been through two rounds of Bactrim and then three weeks with a wound vac. The wounds have become smaller but still exist. At this point the Doctor has removed the vac and I am cleaning, applying Neosporin and new dressings several times a day. I am only this week allowed to start the bending exercises that will make it possible for me to drive and walk normally. It's been a long and discouraging road that I hope no one else experiences. My doctor is no longer using the zip lines on his patients.
Post Script: Part II Update
Provided below is an Amazon link to several ice machines for your convenience.
after knee surgery ice machine
