Bilateral TKR Bi-Lateral good news story

[Skimottaret]

Hi all, I had a bi-lateral TKR done on 10 Nov 2020 and wanted to share my progress. Had done a lot of internet searching on bi-lats, and most of what I read or watched on youtube seemed to indicate months of sleepless nights, ongoing pain, instability but usually ok results after 6-12 months.. With covid I decided to opt for getting both done at the same time as wanted to take advantage of lockdown time as well as was concerned about not being able to get elective surgery done if the hospitals ran out of capacity. My surgeon said he used to do a fair amount of bi lats when in the NHS but as he has an excellent anaesthetist he partners with would be happy to do both of mine at once.

My surgery was done privately in the UK and the surgeon is very experienced, a practice owner, keen on sports and an avid skier who understood my desire to get as close as I could to my pre-arthritis days. I hope to get back to hiking/cycling/skiing at a good level, not just be able to "walk to the shops". He installed MatOrtho MKR "ball and socket" prosthetics. Over the last few years I did lots of yoga, stretching, cycling, and had 6 rounds of PRP injections but finally needed new knees as couldn't walk more than a mile or so with cycling getting painful due to ROM and my main sport skiing was very painful and almost couldn't do any longer.

The first 18 hours post operative were extremely difficult and almost overwhelming with pain. Two nights required in HDU with high dose morphine bolus but was discharged on day 4. Day 1 unable to get out of bed, day 2 walker, day 3 crutches and day 4 stairs. First two weeks lots of pain in the evenings and was only getting 2-4 hours sleep. Drug regime for first two weeks was 4 times daily.
1- 1x20mg Omeprozole, 1GR Paracetemol, 2x224 Naproxen, 1x75mg Pregabalin, 2x 50mg Tapentadol
2- 1xLymacycline, 1GR Paracetemol, 1x224 Naproxen
3- 1GR Paracetemol, 2x224 Naproxen, anti DVT SHOT
4- 1GR Paracetemol, 2x224 Naproxen, 1x75mg Pregabalin, 2x 50mg Tapentadol
1 or 2 x 5mg Oxycodone if required when pain spiked (needed first 10 days or so at night when couldn't sleep and woke up with burning pain)

I have home physio once a week and it was almost a full time job with four sets of exercises that took 40-50 mins each set, 20 mins of CPM on each leg and used an EMS muscle stimulator on opposite leg, followed by cryocuff on both legs for 20 mins. This was tough to do for the first two weeks as time consuming, tiring and painful. A few days I ended up dialling back the physio sets to 3 or 2 times daily after sleepless nights and replaced physio with passive movements using the CPM machine after consulting physio who has been excellent.

I had almost no bruising and limited swelling and wear TED socks 24-7 even when uncomfortable due to tightness.

By day 15 I had returned to my pre op ROM in both knees and almost sleeping through the night. Only pain meds are Naproxen, Paracetamol during day and Co-Codemol before bed. I have about 10 Oxytocin's tablets left but hoping won't be needed (but saving em up !). I am up and down stairs okay with crutches and walking 10 mins at a time.

Day 21 Surgeon review and my ROM is 115 in both extension 1 deg and swelling is way down. Dressings removed and wound virtually healed with minimal scarring.

Currently day 25 and walking outdoors 20-30 mins a day, CPM machine returned, 4x daily 20 min cryocuff/elevation and 20 min EMS, slightly less physio with more emphasis on improving my walking gait. Massaging the scar with bio oil now daily and only main issues I have is that my thighs are very numb and stiffen up easily if I overdo exercises plus I have put on 6 lbs of flab but overall I am delighted with my progress

I am no hero and not in ANY rush to get back to sports as I don't want to mess up my long term progress. I figure 6 months of hard effort will be needed, but I am happy to put in the physio and rehab effort. So far so good and I just wanted to put out a "good news" story for anyone considering bi - lateral as there doesn't seem to be much info online showing that it can work out just fine if you religiously follow the docs and physios advice.....

 

[Pumpkin]

@Skimottaret ,
Welcome to BoneSmart, glad you joined us!
I will tag @Roy Gardiner to come and talk to you, he had bilateral TKR, and is very active.

Glad you cut back with Physio, too much too soon can cause un-needed pain and swelling in the early days.

Here is your copy of the Knee Recovery Guidelines, the articles are short and will not take long to read.

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. At week 4 and after you should follow this

​

Activity progression for TKRs​

6. Access these pages on the website

​

Oral And Intravenous Pain Medications​

Wound Closure​

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.

 

[Roy Gardiner]

I hope to get back to hiking/cycling/skiing at a good level,

No reason not to. I don't like walking much (never did) and have never skied, but I ride my bike better than pre-op. Your knees will not stop you on a bike.

The key to recovery is what works for YOU and we're all different. Having said that, you're doing more than I'd expect at your stage of recovery. If you get swelling and/or pain after doing something, cut it back.

I figure 6 months of hard effort will be needed, but I am happy to put in the physio and rehab effort

Hard effort is NOT needed for healing and regaining ROM.

Imagine exercising hard in recovery for a broken leg or a sprained muscle; counter-productive, obviously, and would worsen the damage. It's much the same with TKR, you have damage needing healing, not unfitness needing training.

All you need is to help retain mobility (not fitness or strength) until healing is complete. This is done with gentle stretching exercises, without pain.

Exercises to regain ROM are *stretches*, exercises to make you fit are *training*. Stretching exercises are gentle and do not make you breath hard, sweat or have an elevated heart rate. Training exercises do this.

You cannot do training until healing is complete because it worsens damage to the ligaments and tendons that were affected by surgery. You can easily tell if this is happening because your knee will get stiff, will hurt, will swell up in the 24 hours afterwards. When this happens, stop.

Here is a longer explanation of the training/healing differences https://bonesmart.org/forum/threads/post-operative-exercise-–-the-bonesmart-view.25463/

Here are some ROM and extension stretches (there are loads, these are just examples) https://bonesmart.org/forum/threads/rom-and-extension-stretches.13159/

You can worsen progress by overdoing things; you can't really by underdoing.

But once again, take all this advice in and do what works for YOU.

My bilateral recovery diary is below in my signature.

Good luck.

 

[Skimottaret]

Bit of a setback. At 11 weeks I was doing alternating 2-3 mile walks / 30 minute indoor cycling coupled with either some ROM or strengthening exercises. I felt that my ROM had stalled at 112 L and 116 R but my physio wasn't too concerned and with swelling under control I was starting to regain leg strength and functional movements much better.

Sat at my desk for an hour and when stood up couldn't weight bear at all on L leg and the knee and calf ballooned up , quite painful. Rushed to Hospital to get a Doppler scan to rule out DVT and turns out I ruptured my Bakers Cyst. 10 days later massive bruising and continued swelling. Elevating and hoping to start walking again. I only post as this could have been a serious DVT and if you have similar symptoms ensure you get in for a scan quickly to rule that out.

ps I'm so thankful for my physio who swiftly diagnosed this and recommended calling the hospital to get in for a scan to rule out DVT.

 

[sistersinhim]

One of our staff had a burst Bakers cyst, @Pumpkln. She might be able to give you some pointers.

 

[Pumpkin]

My ruptured Bakers Cyst was much the same lots of bruising and swelling, I could barely walk. I wore a compression sleeve on my lower leg, it helped a lot. It was 2 months before the swelling resolved. I wore the compression sleeve daily for about 9 months.
You are right, you need to be seen ASAP to rule out blood clots when this happens.

Though rare, a ruptured Bakers Cyst happened to me again in late November, recovery for the second one was about a month, I am still wearing the compression sleeve.

Baker's cysts and other knee bursae

 

[Skimottaret]

My surgeon told me after the rupture that it was very unlikely that my rehab exercises and routine as prescribed by my physio had anything to do with the rupture. I have not been pushed to "overdo" anything by my physio. She makes the point that not doing enough during rehab won't get back my ROM, strength or functional movements to be as good as it could. Striking a balance between doing enough to heal and not overdoing exercises and putting you back due to swelling needs constant monitoring.

Letting "nature take its course" isn't enough in my view.. I teach skiing for a living and once the knee joints are healed I will be putting in some hard work on S&C work to ensure my mobility and athleticism gets as good as good as I can possibly attain. As a patient who has had numerous MSK injuries, physiotherapy has been a normal part of the recovery process and it works well for me.

Anyways, hopefully this thread helps someone in the future. My bi lateral went very well and with the exception of this latest hiccup hopefully will have a great outcome.