Managing LE during and after Total Knee Replacement

Hi Sher,

I see no one has answered yet, so while I have not personally had a TKR I may be able to offer a few suggestions.  I DO have bilateral LE, and my 86 yo father had bilateral total knee replacements just last December and recovered in my home for over 3 months.  Let me see if I can blend those 2 experiences into some helpful information!

Keep in mind, that in the US a single TKR patient is rarely kept in the
hospital more that 3 days post-op. Some are going home now on the
second post-op day if they pass their PT/mobility evals. My father was only eligible to stay longer because of having both knees done at the same time and being 85 years old. So that will somewhat limit your exposure to IVs and blood draws to the pre-operative screening and those days in the hospital.

MEET WITH SURGICAL/NURSING/ORTHO/PT STAFF PRIOR TO YOUR SURGERY DATE:

Most hospital knee surgery programs offer extensive patient pre-education, pre-screening (ie xrays, labs etc) and an opportunity to formally meet with surgical, nursing, PT and social service staff some weeks prior to your surgery.  In my father's case there was a 4 hour session about 3 weeks prior to his surgery in which they took his full history, did EKG, labs etc.(his knee xrays/MRI had previously been done the month before in order to have the custom prosthesis made).

In addition, we met with the nursing supervisor of the orthopedic surgical unit where my father would go after recovery.  We also met with a Physical Therapist who did an evaluation of my father's current mobility issues.  It is at these meetings that you are given opportunity to inform the medical staff of any specific medical issues or unique needs you will have during the operative and post-operative period.  That is when you should clearly inform them of your LE concerns and requirements, ie plans for IVs, blood draws and BPs.  Make sure they note on your record at that time to request signs over your bed and special hospital wrist bands noting the LE precautions.  

If the hospital you plan to have surgery at, does NOT offer this type of
comprehensive patient education session, then I suggest you arrange to
meet with the key staff members yourself a few weeks before your
surgery.

I do not know whether they will allow BP or IVs in the "good" leg because standard protocol is to maintain compression "knee highs" to both legs following surgery in addition to the sequential pumping units on your lower legs designed to prevent blood clots post-op.  I will tell you that I personally continue to use my right arm for limited IVs, BP and blood draw access.  I had a SNB with 7 nodes removed on the right 14 years ago, bilateral mastectomy almost 9 years ago, and early stage 0-1 LE in the right arm since 2012.  My left arm has had stage 2 LE for over 8 years and I wear compression 24/7 on that arm, so my left arm has not been utilized for any invasive access at all since 2006.  I have used my right arm for chemo, IVs, labs and BPs since 2006.  Yes, on occasion I have flares and have to increase my MLD visits and wear compression when needed, but have not yet experienced any infections or worsening of my LE in that arm.  This is a personal decision, but one that I am comfortable with for me.

You can discuss with OR staff about how they plan to do your BPs during the surgery and in recovery.  You can request that they do only manual BPs and not use the automatic cuffs, but my personal experience has been they do not do manual BPs in OR.  The orthopedic surgical unit may have manual BP units available but even they now commonly use automatic cuffs also.

ARRANGE TO HAVE A LE THERAPIST EVALUATE AND PROVIDE MLD/WRAPPING IF NEEDED BEFORE, DURING AND AFTER YOUR HOSPITAL STAY

If you currently have a LE therapist, it makes good sense to arrange a pre-surgery visit so she can evaluate both your arms and provide a good clearing MLD  session.  She might also have suggestions regarding your use of garments or bandaging during your post-op period.  While in the hospital, it is possible for your personal therapist to visit you there and help maintain your arms if needed.  Otherwise, most hospitals also have their own lymphedema staff for inpatients and can provide Eval/MLD to you as required with orders from your physician.  Definitely discuss the LE issues with your surgeon in advance and make sure he is on board for writing any necessary orders for PT.  If you prefer, you can also have your primary MD get involved if needed for orders during your hospital stay.

Once you are discharged to home, you will continue to be actively involved in PT exercises and using mobility aids like walkers and canes for a period of time.  You may also be sent home with a CPM (Continuous Passive Motion machine) that you will need to get your leg into 2-3x a day for periods of 30-60 minutes at a time.  Keep in mind that until you gain strength and balance in your legs, you will be using both your arms more heavily in a dependent position when using walkers, canes or just getting into a standing position.  Because there will be increased exertion to your upper extremities it is a good idea to practice good preventive LE strategies during this knee recovery period.  You may want to discuss with your LE therapist the need for increased MLD sessions and also you may choose to temporarily wear a class 1 compression garment on your right arm during the early recovery phase in addition to consider wearing daytime compression on your left LE arm. Let your body be your guide.  If your left arm flares or your right arm is getting achy or unusually tired, your lymphatic system is being overburdened and needs some TLC!

THE TKR JOURNEY

Just a few comments regarding your knee replacement.  If you don't know already, there is an excellent website where you can find tons of educational literature on knee replacements in addition to extensive patient forums for discussion.  The site is called BONESMART.ORG There are separate categories for Knee Replacements and Hip Replacements.  There is a Knee Pre-op forum and a Knee Recovery Forum where you can follow along with other patients in similar circumstances.  I used this site extensively during my fathers surgery and recovery and found it very helpful!

By the way, my dad had his knees replaced on Dec 9, 2013, was on the surgery unit for 3 days when he was then moved to the inpatient PT unit within the same hospital.  He spent 7 days on the PT unit and was then discharged to my home.  We had PT come to the home for 2-3x/week for 6 weeks and then dad went to outpatient PT for another 6 weeks before returning to his farm on March 15, 2014.  Dad turned 86 last March and by April was back on his tractors. By May he was cutting and baling Hay for the summer!  Yes, he still has soreness and tiredness in his muscles from his level of exercise, but the new knee joints themselves have given him back the ability to walk the acres of his farm without pain or fear of his legs giving out from under him.  He is still healing, but does not regret having the surgery at his age at all!

Good luck with your plans for surgery and I am expecting you to also have a wonderful outcome for both your knee and your arms!  A little planning, and lining up the right professionals to help advocate and assist you is the key!  Let us know how it goes...

Linda

P.S. This is a link to the bonesmart recovery post that I made to record my dad's progress.  I have photos included that might help give you an idea of what to expect after surgery.   

http://bonesmart.org/forum/threads/new-life-with-new-knees-at-85.22350/

Sher - I was just wondering how you were doing?

LindaLou53 - Thank you for the wonderful information.

I am in the process of preparing for TKR in both knees at the same time and have LE. This information is great.

haven't read this thread but I gotta tell u that I got a iv in my foot while getting my double mast.it was hard for the surgeon to find vein but they did.that way I had no IV in arms.