TKR 2nd TKR on May 7

[Golfguy]

All,

I had a TKR on my left knee on May 7. This is my second TKR, as I had one on my right knee in Dec 2016. I was lucky in that one of the first people in PA to be able to get an elective orthopedic procedure in the first week that PA opened back up for elective surgeries after the coronavirus.

My main reason in writing is to thank the moderators and people who run BoneSmart, and to let the people who might be new here know that what BoneSmart teaches WORKS. I have friends who have had a TKR, and they are told by the surgical practice/PT group that they should be at 90% ROM by 7 days. My surgeon doesn't know of BoneSmart (he's a very good surgeon other than that) but his attitude on recovery is to treat the first 2 weeks like you have a mild case of the flu, do stretching exercises to the point of discomfort (not pain), and take the pain meds by the clock to stay ahead of the pain.

The most important thing I learned from BoneSmart during my first TKR is that there is only so much you can do on flexion or extension exercises when your operated knee is swollen twice the size of the other knee. Do what you can (don't do nothing) but know that you will make big gains in ROM and extension when the swelling drops.

For what it's worth, my ROM is at 80-85 and I'm currently using a cane to walk for 10 min 4-5 times a day. But I could not force the knee to bend to 90 without severe pain, and I'm not worried about it. Once the swelling drops in another 7 days, it will not be a problem.

 

[sistersinhim]

Thank you so much for your kind words. It obvious that you know what to do already, but I'll still leave you our recovery articles:

The following are our basic guidelines and should help get you started. As you read more on other members' recovery threads, you’ll get a better perspective of what to expect and what not to do, especially regarding PT.

Knee Recovery: The 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 a 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 history before providing advice.

 

[Gottamove]

All,

I had a TKR on my left knee on May 7. This is my second TKR, as I had one on my right knee in Dec 2016. I was lucky in that one of the first people in PA to be able to get an elective orthopedic procedure in the first week that PA opened back up for elective surgeries after the coronavirus.

My main reason in writing is to thank the moderators and people who run BoneSmart, and to let the people who might be new here know that what BoneSmart teaches WORKS. I have friends who have had a TKR, and they are told by the surgical practice/PT group that they should be at 90% ROM by 7 days. My surgeon doesn't know of BoneSmart (he's a very good surgeon other than that) but his attitude on recovery is to treat the first 2 weeks like you have a mild case of the flu, do stretching exercises to the point of discomfort (not pain), and take the pain meds by the clock to stay ahead of the pain.

The most important thing I learned from BoneSmart during my first TKR is that there is only so much you can do on flexion or extension exercises when your operated knee is swollen twice the size of the other knee. Do what you can (don't do nothing) but know that you will make big gains in ROM and extension when the swelling drops.

For what it's worth, my ROM is at 80-85 and I'm currently using a cane to walk for 10 min 4-5 times a day. But I could not force the knee to bend to 90 without severe pain, and I'm not worried about it. Once the swelling drops in another 7 days, it will not be a problem.

Great perspective! I’m hoping wisdom the first time around makes the second time easier. I’m glad that seems to be true for you!

 

[Jamie]

Thanks for the testimonial for BoneSmart. I'm so glad things worked out well for your first knee and here's to now having a "two-fer" by adding the second one. You may have noticed that things have changed in the joint replacement world just in the 4 years since your last surgery. The multi-modal pain management approach used by a majority of surgeons today really helps with post-op pain and swelling. Hopefully that is what your surgeon offered you as well. Take care of that shiny new knee and it will give you many, many great years!

 

[BellaSop]

Congratulations! I had my two TKR about 16 months apart. Last one Sept 2019. I told him I must have had a short memory because first one didn't seem too bad. Memory came back! Consider myself a I can handle this person at 62, former athlete and active person.
The difference for me in both is having home health come in to do PT with me. He did push me. I took pain pills before. But I was at 90° within 2 weeks. My issue with 2 TKR and a THR I feel I have lost lateral movement but pain is gone. Just need to keep moving so I don't feel stiff and cramped. Follow you exercises. Take meds. I got off pain pills as soon as my body allowed me.

 

[Golfguy]

Thanks everyone. I have a quick question - Why does the knee that was operated on feel like it could randomly "collapse" or buckle when walking? It can happen multiple times, or not at all, on any of my 10 min walks. I never feel in danger of falling, but I do have to catch myself. The same thing happened on the previous TKR, and it went completely away over time, so I'm not worried about it. But I am curious about what the biological or biomechanical reasons for it happening are. I'm 11 days post-surgery as I write this.

Thanks very much.

 

[billmo816]

Hi @Golfguy

Hope your healing continues to go well, I'm a golfer and having my right knee replaced on Wednesday, how long before you were able to play golf after your first TKR?

 

[sistersinhim]

Why does the knee that was operated on feel like it could randomly "collapse" or buckle when walking?

As your muscles and tendons recover and get stronger, that 'giving out' feeling will go away. It's a normal feeling early in your recovery. Those soft tissues were moved and shoved all around during this surgery and it takes a while for them to snap back. It is a time thing and patience.

 

[Golfguy]

Billmo,

I played 6 holes in a cart 8.5 weeks after surgery (Heat wave in Feb in Phila in 2017. It hit 70 degrees). Knee felt fine but my surgeon was less than happy with me. Did not go after any swing but was no pain on the swings. It swelled a little after playing and I had to ice it up but next day was fine.

I have a member-guest tournament on July 16 that I'm targeting to play. That's about 10 weeks from surgery. You will be back playing this summer!

 

[Golfguy]

Why does the knee that was operated on feel like it could randomly "collapse" or buckle when walking?

As your muscles and tendons recover and get stronger, that 'giving out' feeling will go away. It's a normal feeling early in your recovery. Those soft tissues were moved and shoved all around during this surgery and it takes a while for them to snap back. It is a time thing and patience.

Sistersinhim,

Much appreciated! Makes a lot of sense given how much trauma in the area.

Thanks

 

[Golfer1]

I know exactly what you’re talking about with that feeling that your knee could randomly buckle. Mine felt that way for probably the first six weeks after surgery. The moment I started to walk, my mind would go on high alert...concerned that my knee would buckle. My OS told me that the implant is incredibly strong, and that this feeling of instability was a result of the atrophied quadriceps muscle. I am now 13 weeks post-op from right TKA and that concern has faded. Although my quad is still weak, I’m learning to trust my new knee. You will too!

 

[Golfguy]

I know exactly what you’re talking about with that feeling that your knee could randomly buckle. Mine felt that way for probably the first six weeks after surgery. The moment I started to walk, my mind would go on high alert...concerned that my knee would buckle. My OS told me that the implant is incredibly strong, and that this feeling of instability was a result of the atrophied quadriceps muscle. I am now 13 weeks post-op from right TKA and that concern has faded. Although my quad is still weak, I’m learning to trust my new knee. You will too!

Thank you Golfer1! Makes sense that it's the quad muscle atrophy, and maybe some recovery from the tourniquet pain added in.

Hope you are out on the Robert Trent Jones Golf Trail!

 

[Celle]

It's not just the weakened quad muscle. It's all the other soft tissues around your knee. Although they weren't cut, they had a pretty rough time, being moved around and pulled out of position during the surgery. They also need time to recover and regain their strength.

 

[Golfguy]

Just a quick update. I hit the three week mark since surgery. I can tell everyone that the first week was terrible, the second week was a little better, and this week is when I feel like things started to turn a corner.

The Good:

• Extension at 0 degrees
• ROM at 95 degrees
• Walking without any help 10 min at a time, 3-4 times a day (but I sometimes feel like turtles will pass me)
• Pain is down significantly
• Can finally lift the operated leg onto the couch without crooking my good leg around the ankle to help.

The Bad:

• Still can't sleep through the night. Up every 60-90 min. Just can't get comfortable
• Can't go up steps normally (not enough ROM)
• Can't make a complete revolution on the bike (just go back and forth and hold stretch)
• Have MAJOR tight band feeling when walking

All in all this knee seems to be progressing a bit better than the first one. But no major differences between the recoveries of the knees.

 

[JennyLynne]

Great update! The good definitely outweighs the bad.

The sleep is tough- I hope that improves soon. I’m still taking meds at night and that helps me sleep, but it’s not a long term solution.

 

[VSing]

This forum is a wonderful tool. I too have forgotten what it is like to sleep all night. Or to even stay in one place all night! I go from the bed to recliner and back trying to get comfortable. I am 10 days postop TKR and I can walk unaided but I get the feeling sometimes that the knee is collapsing. My kneecaps have subluxed for years and that is the same feeling. Glad to know it won’t last forever. And glad I’m not the only one that feels like i have a brace on my knee from the tightness of the joint. Brighter days are ahead!

 

[Golfguy]

Thanks JennyLynne! I am in awe of you when I look at how many replacement surgeries you have had. Hope the recover on the latest TKR is going well.

 

[Golfguy]

Vsing, I can tell you from my first TKR that the collapsing knee and the tight band feeling are both normal and will go away with time. YI have them both right now. Good news is that you can keep increasing ROM while the tight band feeling is there

 

[kneeper]

Just a quick update. I hit the three week mark since surgery.

The Good:

• 
  
• Walking without any help 10 min at a time, 3-4 times a day (but I sometimes feel like turtles will pass me)

But you know slow and steady wins the race.

 

[Golfguy]

All,

Here is a 6 week update of my progress. I'll do it in the same fashion as my 3 week:

The Good:

• Extension at 0 degrees
• ROM at 120 degrees
• Walk for about 20-25 min twice a day (Turtles no longer pass me but I'm still not setting any land speed records)
• Began driving at 4 weeks (in my wife's automatic transmission SUV, not the manual transmission car I have. Too hard to get in and too low to the ground. Thankfully my much better half has been willing to swap cars with me.)
• Can put a sock on all by myself!
• Can go up stairs without holding onto a railing (but I do hold on because I'm not quite that stupid)
• Take Aleve when needed but off of narcotics in week 4
• Riding a bike for 20-25 min at a time a few times a week
• Have started hitting half-swing wedges at golf course

The Bad:

• Sleep is much better but still can't sleep all the way through the night. Still banished from the bedroom because I snore on my back and can't yet get comfortable on my side or stomach...
• Can't go down stairs yet
• Still have a slight limp when I walk. My surgeon explained why because of the difference between active and passive flexion.
• Have MAJOR tight band feeling all the time. It is my good friend and NEVER leaves me.

So far things seem to be going OK