TKR My Story<

[NoShortCut]

Hi All! I didn't think I would get involved in doing any online forums as it's really not my style, but after reading a number of stories on this forum, I thought having some moral support wouldn't be a bad thing. Recovery is a long road and lots of things can and will happen along the way, thus it's nice to hear from those who have traveled this road to let you know it will all work out. So here is my story. I've had a bad knee for around 30 years. It started with a ski injury and through the years I have collected 8 different arthroscopies on my right knee, including an ACL reconstruct, patella shaping, patella realignment, meniscus tears, and my personal favorite, surgical infection clean-out. I have led a very active lifestyle and have no plans to slow down (much). My recoveries from each of these surgeries was very good and for the most part I returned to former levels of activity.

Around 5 years ago, my previous OS noted that I had exposed bone in several locations but to hold off as long as I could before seeking TKR. About a year ago, I felt yet another tear occur in the knee and when I visited the Doc, and he again said I should delay as long as I can before dealing with it. I agreed, but in the back of my mind, I wondered if he was gun shy with me because of the previous infection.

Anyway, I limped along and my back started to hurt, then I ruptured a disc in my back. I realized, my attempts to stay active were leaving me open to compensation injuries. At this time, I went to a new Doc at the urging of my wife (due to the previous surgical infection). I fully expected him to say that I should try to hold out for a few more years, but he didn't. He said, do you want to be able to be active again without pain while you are young enough to be able to enjoy it or do you want to wait and see how compromised you can get? I was dumbfounded that TKR surgery was now square in front of me.

I decided to wait a couple of months and had the procedure done on 11/5 so I didn't lose the best of the summer and fall weather. One of my demons since making this decision has been wondering if there was wisdom in waiting longer or if I was smart to do this while I was still in pretty good shape. While I made the decision to do it, I will forever wonder.

Surgery went well, but I noticed pretty quickly that I wasn't handing the pain meds as well as I had in the past. My scheduled one night hospital stay grew into 3 nights because of pain med problems. I was finding that when I stood up, I got light headed and my vision started to fade out. Blood pressure was fine and they suspected it was the narcotics. I tried several pain med options and combinations. Three days after surgery, I was sent home with only Tylenol and Celebrex for pain control. I didn't sign up for this, but am managing.

While in the hospital, I took a tumble and my incision pulled open towards the bottom. This area has been slow to heal so my PT had me going easy on range of motion until it was fully sealed. Had my two week check in with the OS's PA this morning and about all he had to say is that my range of motion should be better and I have more swelling than I probably should. I'm not sure how much I like this PA since he didn't seem to hear what I was saying about the bleeding incision but I do trust the PT that has worked with me since the beginning.

So here I am. As much as I want to be fully healed right now, I don't feel the need to rush anything and to just keep pushing along. I appreciate any words of wisdom or encouraging thoughts to help me along in this journey.

 

[Jockette]

Hi and Welcome to Bonesmart, we’re glad you joined us. This is the best place for support and information regarding joint replacement!

I will leave you our Recovery Guidelines. Each article is short but very informative. Following these guidelines will help you have a less painful recovery.

Knee Recovery: Guidelines
1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now; they are almost certainly temporary
2. Control discomfort:

rest
elevate
ice
take your pain meds by prescription schedule (not when pain starts!)
don't overwork.​

3. Do what you want to do BUT

a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you
b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.​

4. PT or exercise can be useful BUT take note of these

the BoneSmart view on exercise
BoneSmart philosophy for sensible post op therapy​

5. Here is a week-by-week guide for

Activity progression for TKRs​

The Recovery articles:
The importance of managing pain after a TKR and the pain chart
Swollen and stiff knee: what causes it?

Energy drain for TKRs
Elevation is the key

Ice to control pain and swelling
Heel slides and how to do them properly

Chart representation of TKR recovery
Healing: how long does it take?

Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

There are also some cautionary articles here
Myth busting: no pain, no gain
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds

We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery.

While members may create as many threads as they like in the majority of BoneSmart’s forums, we ask that each member have only
ONE Recovery Thread.
This policy makes it easier to go back and review the member’s history before providing advice, so please post any updates or questions you have right here in this thread.

 

[Pumpkin]

@NoShortCut ,
Welcome to BoneSmart, glad you joined us!
Your avatar says it all, this is a marathon not a sprint.

range of motion should be better

There is no rush to obtain ROM, for some it comes slower, some faster. Everyone heals at their own rate, do not compare your recovery to anyone else.
Glad to hear your PT does not want to push anything until your incision is fully healed.
Be sure to read the articles Jockette left you, lots of great advice.

 

[NoShortCut]

There is no rush to obtain ROM, for some it comes slower, some faster. Everyone heals at their own rate, do not compare your recovery to anyone else.

Thank you for the encouraging words. I came into this thinking that by working harder, I could recover faster and I see it doesn't work that way at all. It seems the knee can only recover at the pace it's ready for. The other day, I did my exercises and really pushed the edges of my abilities and ended up paying for it. The next day, I had not only lost what I gained the day before, but even more and I was so sore I could barely do anything else. I have since backed off and focused on my exercises, but only in smaller steps. Seems to work much better.

I'm now at 17 days and I can finally sleep on my sides when I want to. I can walk around some without the cane and many movements are becoming more routine instead of a struggle. Leg extensions can be done but after 2-3 of them, I get an incredible stabbing pain along the medial side of the knee cap and need to stop. Is this common? How long until it subsides?

I also seem to have an issue with my fibula getting in the way of some leg movements. My PT thinks it's part of my body's protective instincts that I learned when I compensated for walking on a bad knee. When he manipulates it, the pain disappears.

Is this common to or is it more unique to my history? I guess I have some bad habit to unlearn in future physical therapy.

 

[Roy Gardiner]

I came into this thinking that by working harder, I could recover faster and I see it doesn't work that way at all

The one most important lesson of all, well done.

I guess I have some bad habit to unlearn in future physical therapy.

PT is good for helping with gait, stance and identifying and dealing with all one's body's bad habits. It's much better for that than simply doing exercises which (a) largely you don't need and (b) you can do just as well on your own.

 

[kmak81230]

Welcome to BS @NoShortCut!

Sorry to hear you had such a bad time early on with the pain meds and falling in the hospital. I wouldn't question one bit your timing in getting this done. Sounds like your ability to do your activities of choice was being compromised.

I wondered about that same thing prior to having my first one done 18 months ago - I play ice hockey, cycle a couple thousand miles a year, and do lots of hiking in the mountains. While I might've waited longer to start this process, I was finding myself doing less of the activities I loved, so have no regrets.

Like you I thought my relative good health and fitness level would make the recovery a breeze - HA! My knee had its own timeline - which was a long, slow recovery. I worked my first TKR too much which probably didn't help. This time (#2 done on 11/13) I am taking it easy. You'll find that you will have lots of aches and pains at different places and at different times - I think it is all part of the long healing process. Roy is correct in that a good PT can help you with good gait, proper functional movements, and things like balance.

Hang in there - this recovery requires amazing patience.

 

[Jockette]

I am going to tag @Josephine
our forum administrator and nurse director to address your concerns.

 

[NoShortCut]

I wouldn't question one bit your timing in getting this done.

I very much appreciate your perspective and support. I know I was dealing with problems and side effects, but I always felt I could wait longer if I had to. But I would be spending that time having to avoid doing a number of things I love doing. I find it interesting that you are also a biker. I finished a 550 mile week-long ride less than a week before my TKR. Everyone thought I was nuts, but it allowed me to do something that didn't hurt (much) instead of sitting around stressing about the upcoming procedure.

This time (#2 done on 11/13) I am taking it easy. You'll find that you will have lots of aches and pains at different places and at different times - I think it is all part of the long healing process.

You are very brave in doing #2, but it tells me that the healing process is outweighed by the benefits you found resulting from doing #1. I wish you the best in this recovery and hope it goes better this time around.

I am going to tag @Josephine our forum administrator and nurse director to address your concerns.

Thank you!

 

[cherterr]

Be glad you did not waste time..wasting away!!! I pretty much lost 10 years because I was a sissy..(but I like to think I ended up with better 'equipment' improvements due to time.)
Best wishes for a great recovery!

 

[Celle]

Hello @NoShortCut
I have a picture to go with your avatar - and it's also appropriate for recovery from a knee replacement:

 

[Josephine]

The other day, I did my exercises and really pushed the edges of my abilities and ended up paying for it. The next day, I had not only lost what I gained the day before, but even more and I was so sore I could barely do anything else.

Ah - learned your lesson the hard way, did you?


I'd really like to offer you some structured advice but in order to do that, I also need to ask you some questions. Are you willing for me to do that?

 

[skigirl]

I am glad to hear that you are not pushing yourself. Think about it, if you exercise an inflamed, hot knee what could happen but more inflammation? At your stage of recovery, my doc pushed me to rest on my back for two hours for every one hour that I was up and about. Rest is an important part of recovery and elevation is key to dealing with the swelling.

Ice to control pain and swelling
Elevation is the key to controlling pain and swelling

 

[Softtail]

You will get a lot of terrific advice here, so read a number of recovery threadsto see the different paths different bonesmarties have taken on their recovery process.

My recovery was a pretty active approach, using exercise and PT , and it worked really well for me , but I may be more the exception than the rule. You are unique, so you will have to pick the approach that appeals to you, and see how it feels. You can always change it, i.e., less aggressive or more so, and eventually your knee will heal.

I was prepared to pay the piper if my more aggressive approach caused excessive pain or swelling but fortunately it has worked out pretty good. Either way as early on in your recovery as you are now, you will experience aches and pains from different areas as you heal, so unless you notice some kind of infection, or your knee pain increases exponentially, it's just part of the healing process.

Josephine has a wealth of information to share and I see she has contacted you so you are in good hands. Welcome to the forum

 

[NoShortCut]

Ah - learned your lesson the hard way, did you?

I can be thick in the skull sometimes. In partial defense of how it happened, even though I read the information posted on BS about not pushing it too hard too quick, it's easy to get caught up in differing advice gathered along the way. While my PT has been more consistent with the advice from BS, the PA I saw at my OS's office last week stirred me up into thinking I was falling behind and needed to work at it harder. I blame myself for letting myself fall into it.

I'd really like to offer you some structured advice but in order to do that, I also need to ask you some questions. Are you willing for me to do that?

I would love to get your advice. It is very kind of you to offer.

I am glad to hear that you are not pushing yourself. Think about it, if you exercise an inflamed, hot knee what could happen but more inflammation? At your stage of recovery, my doc pushed me to rest on my back for two hours for every one hour that I was up and about. Rest is an important part of recovery and elevation is key to dealing with the swelling.

I love this advice! It certainly contrasts the thought of doing as much as you can do and then resting.

My recovery was a pretty active approach, using exercise and PT , and it worked really well for me , but I may be more the exception than the rule. You are unique, so you will have to pick the approach that appeals to you, and see how it feels. You can always change it, i.e., less aggressive or more so, and eventually your knee will heal.

I've had 9 procedures on the same knee over a 30 year period. A more aggressive recovery worked for the first 8. Number 9 has broken the pattern. Just like you suggest, I'm changing my approach and listening more to my body rather than telling my body what it has to do.

 

[NavyGunns]

@NoShortCut, welcome to BS! As you’ve already observed, there is no shortage of help, advice, opinions, and just plain ole support from members and forum advisors here. Throughout our life we are faced with situations where we have to make decisions using the information and facts before us. Your path to recovery and rehabilitation of your knee is no different. You have the “experts” (your OS, PT, PA, etc) who will tell you what to do based on their education and training. In rare occasions will these experts also have the benefit of personal experience with recovery from TKR. That’s where this forum comes in. Here you will find all kinds of stories, some will be stories of success, some will be full of frustration, others will share their worries and concerns. What they all have in common is that they are stories based on personal experience. Where your own story will fit in will be up to you and your knee. Whatever path you choose to take in your recovery, just keep aware of the potential issues and consequences and don’t be afraid to change your approach if things are not the way you want them. Above all, listen to your knee! It will be real clear on what it likes and doesn’t like.

 

[Josephine]

Here y'go then!

It would be very helpful if you would answer each one individually - numbered as I have done - in as much detail as you can then I'll come back as see where you are ....

1. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine. And don't forget to factor in other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness).

2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?

3. how swollen is your leg compared to these?

4. what is your ROM - that's flexion (bend) and extension (straightness)

5. are you icing your knee at all? If so, how often and for how long?

6. are you elevating your leg. If so how often and for how long?

7. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and

8. are you doing any exercises at home? If so what and how often?
This is the most crucial question so please help me by using the format I have left as an example
(which means please make a list and not an essay!)

Exercises done at home
- how many sessions you do each day
- enter exercise by name then number of repetitions of each
etc., etc.

Anything done at PT
- how many times a week
- enter exercise by name then number of repetitions of each
etc., etc.

 

[NoShortCut]

1. Pain is highly variable. During normal rest, ice and elevation, I'll say a 2.
Sitting upright in a chair is a 3-4.
Walking when warmed up and stretched is a 3,
but walking when stiff is a 5.
Flex stretching exercises is normally a 3-4 but higher when the fibula misbehaves (6-7). Leg extensions or lifting a straight leg can easily jump to an 8 after 2-3 repetitions.

2. I had trouble with narcotic painkillers in the hospital (getting lightheaded and nearly passing out when standing). I was sent home with 2 mg hydromorphone 4hourly but quickly dropped it because of dizziness and intense drowsiness. Have been only taking 3000mg Tylenol (1 500mg every 4 hours) and one 200mg celebrex daily since day 4.
My primary doc has taken me off of ibuprofen and naproxin due to stomach erosion. Too many years of ibuprofen to deal with a bad knee.

3. Swelling is moderate around the immediate knee joint

4. Around 90 to 95 degrees flex and maybe 5-10 degrees extension.

5. I do about 3 sessions of 30 minutes with a Cryocuff a day. More if it's extra sore.

6. Full elevation (knee near heart level) is done about twice a day for at least an hour each time. Partial elevation (sitting with leg up) is done 6-7 times a day for between 30 minutes to 2 hours.

7. Most of my activity is simply walking from one room to the next, about once per hour. I have a flight of stairs that I traverse 3-4 times day, one step at a time. PT has me to the point where I can usually walk unassisted (no walker, crutch or cane) for short periods of time, but I use the cane when stiff, sore or while trying to navigate an obstacle like the stairs. I refill my own drinks, reheat leftovers, and do a quick washing of my own dishes. Folded laundry once while sitting on the floor.

8. Exercises done at home (reflective of at home PT):
walking numerous time a day with one 5-10 minute walk per day.
heel slides (not sure how often since I find myself doing them unintentionally)
lay on side, lift recovering leg, slowly flex and then extend lower leg, and relax leg (to degree tolerated) goal to do a set of 10 per day but I haven't completed a full set yet.
Very sort range leg extensions (mostly to activate muscles without triggering pain) x2 sets of 10
IT band stretches (lay on side and bring recovering leg into straight position as if I just kicked a ball. Leg is relaxed on pillow) x2 day
Lower back and hamstring stretches (lay on floor on back and use wall to hold legs upright) x2 day
ankle pumps (numerous times per day, again I find myself doing them without thinking)
glute sets (x2 sets of 10 per day)
hip abduction (x3 sets of 10 per day)

Done at PT: - Not started yet.

My chief issues (that I'm currently aware of) include a sharp pain along the medial side of the patella when doing leg extensions and trying to lift a straight leg, and pain along the fibula during flexion stretching. There are lots of other pains and weaknesses, but they seem more normal for being just short of 3 weeks.

Thank you again for any advice you can share!

 

[NoShortCut]

I was just reading through the BS library and it reminded that some patients in the hospital with me during my TKR had theirs done with robotic assistance. My was done the old school way. Does anyone know what the pros and cons are of each? I know my OS does a lot of TKR procedures and is well respected by his peers and yet he chooses to not use robotic assistance.

 

[NoShortCut]

Love the picture! Thank you!!!

 

[NavyGunns]

@NoShortCut, the pros and cons vary, I think, depending on the nature of your particular procedure. My PKR was done robotically (Mako). The surgeon is still actually doing the surgery but the robot helps to guide. For PKR, my research convinced me that robotic assist was the best approach as it helped to ensure the surgeon only removed the portion of damaged bone needed to achieve a good fit with the implant prosthetics. I also believe the incision size may be smaller (mine is about 4-5” long whereas I’ve seen some that are 8” or more). Beyond that, recovery is the same in every way.