TKR Antpitta's LTKR - tick, RPKR - tick

[Antpitta's]

10 weeks post-op tomorrow and it's been a real up-and-down couple of weeks.

I had the 2 month post-op review with my O/S who was happy with my progress. As I am bone-on-bone in the remaining original knee I asked about his thoughts on timing for replacing that and he favours leaving until it becomes a problem the way the op'd knee had become but in any case try to leave minimum of a year between knees. I'm fine with that as the remaining knee is not close to how I ended up on the operated side by the end of last year. I also asked if he thought I'd be OK to make a trip back to the Andes (Columbia) in November like we did the same time last year: 3 weeks mostly at altitude but no steep trails and probably most days less than 5 miles total (I'm currently doing 2+ miles regularly on rough ground albeit at sea level) and his opinion was "no problem". I'm still not 100% sure but we will need to decide in the next few weeks if we want to book the guide we used last time - but need something exciting to look forward to/work towards!

So that was all pretty good, plus I've eventually got past 90 degrees ROM in the last few weeks and continue to (slowly) improve.

All was going well until I got stupid 6 days ago and massively overworked the new knee (without thinking) about it: we have a "hobby" farm (ie. all the farm work but without the big-boys-toys to do the physical work) and I spent the afternoon clearing out the lambing shed. This means pitch-forking 8-weeks worth of compacted straw & manure into a trailer which is a mixture of digging, lifting and rotating. Worse, because I am left-handed I by default dig primarily with my left (operated) leg so it was taking all the impact and doing most of the work. It felt fine until I stopped. The next day my knee was swollen (externally) for the first time in weeks & my ROM was probably 70 degrees at best. It has taken 5 days of almost total rest plus ice/elevation to work off. What an idiot - I think I just joined the ODIC for sure! Will try not to repeat.

Finally, had my first PT session with new physio. Nothing too exciting but I will just quote from the booking letter I got beforehand: "When a therapist asks you to agree to any form of examination, treatment or care, REMEMBER, you have a choice. You are always free to say NO or to ask for more information before you make up your mind. Before the therapist examines you they must ask for your consent or permission". The emphasis was theirs' not mine.

In practice I wasn't asked, the exercises were fine and repeats of others I've been "set" before and the therapist seemed happy with my "performance", but at the end she "reminded" me that "I only have a few weeks left to get more ROM before I likely start having problems with scar tissue"!! Thank goodness I found Bonesmart else I could well have walked out feeling pretty scared ...

Apologies again for such a long monologue but it feels good to get it all out!

 

[benne68]

Sorry to read that you landed on the ODIC bench, @Antpitta's, but don't beat yourself up -- we've all done it at least once (I did it multiple times ). As we start to feel better, it really is hard to find that line between doing just enough and overdoing.

Good for you for not letting the PT bully you into pushing ROM at 10 weeks. We have another member whose PT tried to scare him by saying that he only had 8 weeks to regain ROM!

I know you've read this before, but I'll share it again for reinforcement.
Myth busting: the "window of opportunity" in TKR

 

[mendogal]

A great update!

Yes, anybody who DOESN'T join the ODIC at least once as they test their changing limits isn't really trying

At seven months you should be ok to meet the challenges of the trip. You can work on slowly increasing walking, either by tracking time or distance, as well as increasing stamina.

If anything, the shlepping around airports, standing on lines, and prolonged sitting on the plane may be the more difficult experience. Many of us at seven months find standing and sitting harder than walking!

When the time approaches and you've decided to go, we have lots of tips on air travel!

 

[Layla]

Good to read your OS was pleased with your progress last visit. I imagine you've made even more progress by now. I hope you're having a good week. Happy Three Month Anniversary!
@Antpitta's

 

[Antpitta's]

Thanks @Layla for the good wishes: it was my 3 month-versary on Thursday and things are continuing on a positive direction. As noted previously my OS was happy at my 2 month check and after a month of weekly PT sessions in the "gym" at my local hospital so is my PT (a bit of a surprise as only a few weeks ago she suggested it was getting a bit late to improve my ROM)!

I do feel a bit guilty at times when I read about other Bonesmarties problems whether with sleep, pain, progress or whatever else as I've had so little problem with any of these (so far). It may have helped that my expectations were quite realistic: I know a few people who've had the same procedure and discussed their recovery and even the OS emphasised this is MAJOR surgery and recovery is not a question of weeks but months at least. That and of course the previous few months before surgery had become so painful and restricting getting through regular life that losing that pain was an immediate plus point.

The main thing I worried about during the first few weeks was how slow I was regaining ROM - but the support and comments on this forum reminded me there is no single path to improving that and to be honest I'd settle for that being "my problem" against all the positive effects. And my ROM has improved in recent weeks. The PT's insist on measuring each week but to be honest I take their readings with a pinch of salt as there is little consistency in how they measure each time and they currently reckon I have around 95-100 degrees with good extension (although they never measure that). For my part I've been judging ROM progress by how close I could get to full rotation on the recumbent bike I got pre-op. So, when about a week ago I completed my first rotation it felt like a surprisingly big victory!! Since then I've progressed to around 2 minutes (at lowest resistance) 3 or 4 times a day aiming just to improve movement not strength or endurance for the time being. That has meant more to me than any number of PT measurements as surely it's our ability to carry out basic day-to-day tasks that seem most important on the road to recovery.

Other than that I'm comfortable walking 2+ miles on rough ground, managed to mow most of our extensive lawn - a 2 or 3 hour task without a ride-on mower - and slowly getting back to regular activities on the farm. I'm fine going up stairs sequentially (hands free if I choose) and coming down sequentially with care (and a very slightly odd gait I reckon).

So all good with my much loved new knee (I ignore the occasional clicking as it's less noticeable than the noises coming from the unoperated leg). It's already clear which is the stronger and my favoured leg as I find myself leading with the operated leg in nearly all activities. The big decision coming up is likely to be how long I can wait before replacing the other knee as even now that is what is restricting my overall level of activity and realistically which walking-based vacations we can plan.

I'm truly thankful for have found Bonesmart: so much experience, information and advice out there which has been both useful and inspiring. Fingers crossed for positive outcomes for everyone planning, undergoing or recovering from surgery.

 

[mendogal]

You're really accomplishing great milestones on the bike and walking!

 

[Layla]

You're welcome! My pleasure checking in.

I do feel a bit guilty at times when I read about other Bonesmarties problems whether with sleep, pain, progress or whatever else as I've had so little problem with any of these (so far). It may have helped that my expectations were quite realistic:

Please do not feel guilty. I looked for positive updates as I tried to gather up the courage to schedule my surgery. So not only are we thankful that you're taking the time to share your journey with others here and happy that you're doing well, but positive and uplifting posts really do serve a purpose here. I am very happy for the great progress you're making and thank you for your kind words in regard to BoneSmart! I hope you have a lovely Sunday and week.

 

[Antpitta's]

Well it's been 3 months since I last wrote on here - and last week my new left knee reached its 6 month birthday. And to be honest I've never for a moment regretted the procedure (I just think back to the daily pain and restrictions of the old knee) and I don't feel any real restriction in how I use it. I still do a couple of sessions on the static bike and/or rowing machine daily and while I don't measure flexion routinely I reckon I'm about 120 degrees and pain free. I had a few weeks of "zingers" around the 4 month mark and still have a slightly numb patch on the outside/just below the knee - but all as I expected from reading others experiences.

Things felt so good at 4 months that I booked flights from the UK to visit my sister in Canada and also for my wife and I to go to Ecuador in November. There is a "BUT" coming in a minute ....

So all was going well - I could happily walk 2 or 3 miles with the only pain coming from my unoperated (but also arthritic right knee) which has slowly worsened all year - then about 8 weeks ago while mowing the lawn I got a sudden severe pain in my right knee (not that I would know but commented to my wife it felt like I'd been shot!) and ever since I've had continuous and increasing pain which is having more and more impact on my daily life.

The slightly odd thing is that I can still cycle/row with no pain but as soon as I am weight bearing on that knee I'm in enough pain to make walking normally almost impossible. Initially I tried a couple of weeks of almost total rest (with icing although there is rarely any swelling) but that made no difference. I've subsequently tried regular daily walking ignoring as much as possible the pain and also using a semi-rigid brace to try and stabilise the joint and/or spread the load more evenly. None of these have made any difference and by the time I got back from Canada last week I've found my potential walking range has dropped to barely 1/2km - and that with rest stops as required. At least I had no problems with the long flights (even in cattle class!).

I've always known that I'd eventually need the second knee replacing but had hoped to get a year or two between procedures but it's clear that isn't going to work. In the meantime I had an appointment arranged with the consultant who I saw this morning and after reviewing the latest x-rays and seeing the way I hobbled into his office agreed that at least for the interior compartment I'm very much bone-on-bone and that a replacement is going to be required. What I was surprised to find is that in his opinion the cartilage looks good on the other side of the knee and he strongly recommends going for a partial rather than full replacement.

I hadn't considered this prior to this morning but his argument is that the surgery/hospital stay/recovery are all quicker and in his experience the outcomes better. He did say that while he would prefer to operate on the expectation of performing a partial replacement that if once opened up a full replacement would be better he would go that route (an approach which makes sense to me too). We discussed in depth the mid/long term outcomes and in particular the odds of needing a further surgery (ie. partial to TKR) at a later date and that doesn't sound too worrying either. There is an added bonus as it would also be significantly less expensive - which is an issue given that to get this knee done quicker I would need to pay whereas my first knee was done totally free under the NHS. When discussing timing, given I shall be flying long-haul next month he prefers not to operate within 12 weeks of flying to reduce the clot risk but other than that I could more or less choose my own date in the new year.

One further thing came up in discussion. I have already booked an appointment with my doctors surgery a couple of weeks before our vacation to have a steroid injection in the painful knee. I mentioned this to the consultant and he is not at all keen: he personally prefers a minimum of 6 months needle free pre-op and ideally 12 months. The decision I have to make is do I try the injection in the hope of getting at least some level of pain relief for a 2 week holiday (and delay surgery further) or skip the injection so that I can get the knee sorted out much sooner. That's a difficult decision but my initial thought is that I know how much pain relief I got from the TKR and that is (hopefully) "permanent" - with the steroid jab there is no guarantee it will make a significant short term improvement but it does delay hopefully getting rid of the increasing pain in the unoperated knee.

I'd be interested to hear any opinions on how PKR compares to TKR if you've had both. One other interesting comment I had today was that while he reckons on average PKR recovery is roughly half that of TKR that he still expects recovery to take anywhere from 6-18 months. Anyway, I'm just hoping that whatever surgery I end up having that it goes as well as the first. It's a shame that reading other folks experiences here that two knees rarely behave the same!

Apologies for this post ending up more like a novel ...

 

[benne68]

his argument is that the surgery/hospital stay/recovery are all quicker and in his experience the outcomes better.

on average PKR recovery is roughly half that of TKR

The experience of our members really doesn't bear this out. While the surgery itself may be a bit shorter, the hospital stay and, more importantly, the recovery time are comparable.

I'm sure some of our members who have had PKRs will weigh in with their experiences shortly. Meanwhile, you can read some PKR recovery stories for yourself using the Search button at the far right of the blue toolbar.

 

[mendogal]

Your own surgeon reckons 6 - 18 months on a PKR.
The average then is a year.
That's just what we tell folks to expect with a TKR.

 

[Antpitta's]

Your own surgeon reckons 6 - 18 months on a PKR.
The average then is a year.
That's just what we tell folks to expect with a TKR.

Exactly. My point being that my surgeon suggests that kind of timeframe and not the "sales" type approach that in 6 or 12 weeks you'll be cured! He also said for some folk improvements can still happen in the second and third years (he is one of the two top surgeons in my region of the UK with excellent ratings and vast experience).

I feel like I've been extremely lucky to have a TKR that has gone so well without extreme physio or manipulations (after finding this forum a few days post-op I've followed the Bonesmart approach) and that from around the end of month four I've found I barely think about having a new knee at all - although maybe that's helped by the distraction of the old knee.

 

[Antpitta's]

The experience of our members really doesn't bear this out. While the surgery itself may be a bit shorter, the hospital stay and, more importantly, the recovery time are comparable.

I'm sure some of our members who have had PKRs will weigh in with their experiences shortly. Meanwhile, you can read some PKR recovery stories for yourself using the Search button at the far right of the blue toolbar.

Thanks for your comments/observations & for sure I'll be reading up other folks experiences on PKR's on this forum with interest - particularly as this wasn't even on my radar until yesterday as I kind of assumed that I was heading for a TKR on the second knee.

 

[mendogal]

It sounds like the medial compartment is what needs fixing (you called it "interior")?

Success rates are very good for that, and your surgeon's experience and your trust in him are real pluses.

 

[EalingGran]

What I was surprised to find is that in his opinion the cartilage looks good on the other side of the knee and he strongly recommends going for a partial rather than full replacement

Medial partials are the commonest and the results can be very good.
I had one of the rarer lateral partials and although I have had an excellent outcome the recovery wasn't any shorter than a TKR.
The main benefits of a PKR are better range of movement ( I have 150 degree flex) and a very natural feeling knee.
If your surgeon has done plenty of partials then I would go with his decision.

 

[Antpitta's]

It sounds like the medial compartment is what needs fixing (you called it "interior")?

Success rates are very good for that, and your surgeon's experience and your trust in him are real pluses.

Thanks @mendogal for your comments (and education!). I'm afraid I've been rather lazy in terms of learning the correct terminology: I've now Googled it and - yes - what I think of as the interior and exterior "bits" are correctly known as the medial and lateral compartments (I'll ignore the patellofemoral compartment for now!).

As for the surgeon, although I'd have happily used the same as for my left knee that involves multiple 2 hour each way drives whereas my "new" surgeon operates only 30 minutes away. I did a load of analysis in advance and two surgeons stood out based on experience and both professional and patient statistics so I'm very comfortable choosing someone with great stats and who carries out 3x the UK average annual TKR's & over 3x the average PKR's. Although we have (in theory and with some constraints) free healthcare in the UK the option to pay for the surgeon, hospital and pretty much choosing the dates that work best for you can be worth it if you can afford the cost.

Personally the rapid decline in right knee function is so dramatic and life-limiting that the cost isn't the main issue and I just need that fixed.

 

[Antpitta's]

What I was surprised to find is that in his opinion the cartilage looks good on the other side of the knee and he strongly recommends going for a partial rather than full replacement

Medial partials are the commonest and the results can be very good.
I had one of the rarer lateral partials and although I have had an excellent outcome the recovery wasn't any shorter than a TKR.
The main benefits of a PKR are better range of movement ( I have 150 degree flex) and a very natural feeling knee.
If your surgeon has done plenty of partials then I would go with his decision.

Thanks @EalingGran for your valued comments - particularly as you've been down that path yourself. My chosen surgeon has an excellent reputation (& personally multi-recommended) and specialises in both TKR/PKR with extremely positive patient-derived outcomes. He was perfectly happy with my c.120 degree left (new) knee flexion but said I could expect to exceed that with a right side PKR. Most importantly given I had never thought a PKR was an option he reassured me that the 10 year revision/onto TKR rate these days is barely greater than the revision rate for original TKR's.

All in all it gave me a lot to think about (and doubtless I'll spend too much time "researching" this with the help of Doctor Google) but my gut feeling is that if you're going to trust someone enough to open up your knee in the first place you probably need to trust their expertise to carry out the best surgery based on the state of your body.

 

[EalingGran]

he reassured me that the 10 year revision/onto TKR rate these days is barely greater than the revision rate for original TKR's.

This fits with what I have read and my surgeon said.
Also, according to my surgeon- one reason that revisions can be commoner with PKRs is that they are easier to revise. Therefore, surgeons may be more tempted to undertake a revision if there is any dissatisfaction.

 

[Antpitta's]

Seems like the 18th is a popular day! My right knee replacement is scheduled for 18th February. Currently my surgeon plans this to be a PKR (medial compartment) but with the pre-agreed option to be a total once he's got a proper look inside! Personally based on the deterioration of my right knee over last 3 months I'd be amazed to "get away" with a partial but I have complete faith in his judgement!

Please feel free to add me to the list. While I remember, should I just use my existing recovery thread for any post-op communications? If so I'll probably just suggest re-name/new title in due course.

 

[Jockette]

@Antpitta's
I‘ve moved your post above out of the Monthly team thread as we reserve that thread for surgery date information, and so members can see who else has surgery the same month. We prefer all other discussion to take place in a pre op or recovery thread, such as this one. Enjoy interacting with others who are on the same journey, here in this thread, and Best Wishes on your upcoming surgery!

You can start a new thread for your new TKR, or you can use this thread for updates on your newest TKR, and we can change the title. My personal opinion is stay in this thread since both TKRs are so close together, and you might be talking about both. Keeping it all here will keep your history all together.

 

[EalingGran]

Good luck for the 18th.
Keep us posted.