Hi--I believe I am well qualified to respond to this question because I am a nurse with appreciable experience in orthopaedic nursing. I also have an underlying, genetic connective tissue disease which has required me to undergo numerous surgeries. I am now 50 y.o. When I was 29, I underwent an uncemented right total knee replacement because of advanced arthritis. At age 28, I underwent major hip surgery which was a derotational femoral osteotomy done for an unstable hip joint. At age 45, I underwent cervical spine surgery because I had 4 vertebrae in my neck which were partially dislocating and causing compression of my spinal cord and much pain. I also had 3 cervical spine discs which were herniated and causing me considerable pain. I therefore underwent spinal fusion of multiple cervical vertebrae and removal of multiple cervical spine discs.
To answer your question, in order of pain sequence severity, the total knee replacement was by far the most painful procedure and the most difficult to endure. The immediate post-operative pain was significant. This is because there are always many bone cuts required and done to the femur and to the tibia in order to place and fit the prosthetic knee joint replacement. The incision for a total knee prosthesis is quite large and the amount of bone surgery done is appreciable. Frankly, I was in agony for about the first 5 days. I was given morphine injections of 15 mg. of morphine and 50 mg. of Vistaril every 3 hours for the first 48 hours. By the third day, I could manage OK with 10-15 mg. Morphine and 50 of Vistaril injections about every 4 hours and by the 4th day, I was still requiring Morphine and Vistaril at times, but I was able to begin taking Tylox 2 capsules every 3 hours. Tylox contains a derivative of Morphine and is a potent analgesic. I can tell you, when I awakened in the recovery room following the total knee surgery, I was in absolute agony. For the first 2 days, I hurt so much I didn't talk to anybody. The swelling of my knee was massive for about the first 3-4 days. For me, physical therapy was begun on about the 3rd day. I was on crutches, assisted by a physical therapist who placed a gait belt around my waist as a safety precaution to help me ambulate. I was able to place only a minimal amount of weight on this leg because the pain was practically barbaric and going through PT while I was an inpatient and after I returned home was a daily challenge. I knew I had to reach the point I achieved 90 degrees of flexion of the knee in order to be able to climb steps and have a knee which would function properly. I can tell you, (from patient and my personal experiences as a patient) bone pain is the worst of all pain. The total knee surgery and rehabilitating from this surgery was painful and a long process. Each day became better and better and I became more functional with the knee, able to manage getting in and out of a chair with more ease in time, able to manage simple tasks like getting on and off the commode more comfortably but this did not happen until the swelling greatly diminished and once the staples had been removed. For probably a month after my surgery, I continued to require Tylox 1-2 capsules every 4-6 hrs. for pain. I always took my pain medicine before meeting with the physical therapist each day for home PT. After the therapist finished my daily home treatment, I would rest and a few hours later work hard again to get my knee bending and do the exercises I was instructed to do. I will be candid here and tell you the surgery is rough and you will be in considerable pain for a while--Everybody is different, but everybody who has been through bone surgery will also tell you it is the worst pain there is. The rehab requires great commitment and being tenacious and working hard every day. However, the benefits are so worth it all! It was worth all the terrible pain I endured and the long hours devoted to recovering and rehabilitating to make my knee one that is functional and today does not hurt anymore. The awful pain I endured that led to my surgery is long gone and so is the awful pain I endured after surgery and during rehab.
The GREAT news today is that most hospitals have PCA's (Patient Controlled Analgesia) which enables an immediate IV delivery of pain medication. A prescribed amt. of whatever drug and dose of Morphine (or other analgesic your surgeon prescribes) is automatically infused into your vein and when you have pain, you can push a button and have more of the analgesic released into your vein, usually you can push the button every 15 minutes for more pain medication. This is a very safe delivery system and there is a "lockout" feature on the pump which prevents the possibility of your receiving too much medication. In other words, your pain medication is very, very carefully calibrated. Therefore, there is no waiting for a nurse to come and provide an injection for painrelief so you should be well managed with pain situation if you undergo a total knee. Fortunately, the vast majority of hospitals today have pain specialists and there are nurses who are certified pain specialists who do nothing but look after and ensure patients are comfortable and have adequate pain control!
Next, regarding the hip surgery I had, this was a major surgery indeed, at least as major as a total hip replacement. (Essentially, my femur was severed into halves and then the femur was rotated about 30 degrees, then I had about a 10" screwplate screwed into the femur in multiple areas). I had multiple bone cuts to the femur, about a 14" long incision on the outer aspect of my hip and because of the nature of my underlying disease, my surgeon did not want me weight bearing on this leg for almost another 3 months after surgery. When I awakened in the recovery room, the pain was severe, but I didn't require injectable Morphine but for perhaps the first 48 hrs. and after that was able to convert to oral medications. I was taking Tylox (1-2 caps) every 3-4 hours for probably another 10 days after I no longer needed morphine injections. Then, I took Darvocet for a few days and then required nothing further for pain relief after that.
Regarding the spine surgery I underwent, I had been in considerable pain prior to the surgery and my surgery was about 12 hours long and there were many complications during the procedure. My very soft vertebrae crumbled in some areas when an attempt to place screws and a metal plate was done. Therefore, I required extensive bone grafting, initially from the bone they harvested from my own iliac hip site and then from the bone bank because such a significant amt. of bone was required to stabilize my cervical spine. Honestly, I was awake about 3 hrs. after the spine surgery was completed and my neck truly didn't hurt that much at all. In fact, the nurses kept asking if I was in pain and I kept saying my neck was really OK, it actually felt better in the recovery room than before I had the surgery done! Now, my hip where the bone graft was harvested hurt a lot-- but I can't say I was in agony-- I had a morphine pump to use but didn't need it for the neck pain. I used this because of the hip pain. I was in ICU for 3 days and think that I didn't use the pump anymore after the first 24-36 hrs. In fact, I asked if I could be switched to oral medication because I really was doing well with the pain situation.
Everyone has a different threshold for pain tolerance. I have always been told that my pain threshold is very high and I know that it is. I am being as candid as possible here because I have "been there and done this surgically." The knee was the worst, the hip surgery was the second worst and the cervical spine surgery the next worst--but again, really, the spine surgery wasn't that bad I didn't think, what was kind of yucky in those early hours post operatively was the iliac hip bone graft site and that hurt a lot for a while.
What is important for you to know is that in very recent years, surgeons and nurses have come to realize there is absolutely no need for any patient to suffer in agony because of being in pain immediately after surgery or while recovering from surgery in the hospital and at home recovering. The management of pain today is better than it ever has been because many of us as health professionals have a far better understanding of pain management. ALAS the outright and unfounded "myths" and largely once disproportionate hoopla being overly concerned about "addiction" has been disproven. There is now clear, well documented in reputable medical literature evidence that "addiction" to narcotics in any patient who undergoes major surgical intervention and related post operative pain-- even those who medically require narcotics during convoluted recoveries very rarely become "addicted." So, there is no reason whatever for any patient to be suffering unnecessarily following any surgical intervention. If you decide to undergo a total knee replacement, please discuss your concerns about post operative pain management with your orthopaedist. If you find yourself in a situation whereby you are uncomfortable following surgery, by all means report this and request that your medication(s) be adjusted. There are many hospitals with wonderful pain management team members and their purpose is to aid other health professionals and help ensure that you do not suffer unnecessarily. Your surgeon does not want you to suffer needlessly and he/she can see you through whatever your pain management needs.
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SUSIE S.
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