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[TKR] It's The HoneyB's Knees

Discussion in 'Knee Replacement Recovery Area' started by HoneyB, Mar 20, 2018.

  1. HoneyB

    HoneyB senior
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    I'm new to this forum and 4 weeks post-op. I got a left TKR with a CONFORMIS custom knee. I seemed to be progressing very quickly the first three weeks, but seem to have stalled this week. This thread has reassured me that all is probably still ok. My extension is very near straight, and my flex is about 105. I can pedal an exercise bike all the way around, but slowly. I don't have a lot of pain, but my knee still feels very stiff. I kept my 2-1/2 year old grandbaby for 12 hours today so that was a knee workout of a different kind.
     
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  2. HoneyB

    HoneyB senior
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    I'm 4 week's post-op with a Left TKR with a CONFORMIS Custom Knee. I'm just wondering if anyone else has this custom knee and how your recovery has been. I have almost complete extension, can flex to 105, and in PT I'm pedaling a bicycle and stepping up onto a platform leading with my new knee. Except for aches in my calf and foot at bedtime, I have minimal pain, but still have a good bit of stiffness. I'm walking without a walker or cane. I can't take NSAIDs so my only help for swelling, as far as I know, is icing. I sleep very little due to the bedtime aching. Is that normal?
     
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  3. Beckadeez

    Beckadeez senior

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    It’s normal to still have swelling. I’m 8 weeks out and still swollen. I don’t have a Conformis knee, by the way. I’m amazed that you’re doing step ups so early. I’m still having issues stepping up with my surgery knee and if I do too much, my knee hurts. And 105 is awesome!
     
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  4. Beckadeez

    Beckadeez senior

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    And most everyone on this forum has trouble sleeping.
     
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  5. Jockette

    Jockette FORUM ADVISOR Forum Advisor

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    Welcome to Bonesmart! 105 is great for 4 weeks and so is almost complete extension. Because our recoveries can vary a lot, some of us don’t achieve that until later.

    Swelling can last quite a while and/or flare up depending on our daytime activity. I found that doing too much during the day causes pain at night. Even if you can’t see it, the stiffness is a form of swelling.

    4 weeks is still very early, even with a good ROM and accomplishments at PT. There’s still tons of healing that has to happen. Resting, icing and elevating at this point is still very important.

    I read on another thread that you took care of a 2 1/2 year old for 12 hours. That’s a lot of activity. I could never have done that at 4 weeks.

    Another advisor will come along with some very good recovery articles to read, they are short but very informative.

    Best wishes to you as you recover! Hang out with us and ask any questions you have. We understand recovery because we’ve all been there.
     
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  6. Celle

    Celle FORUM ADVISOR Forum Advisor

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    Hello @HoneyB - and :welome:

    Yes, we've had several people here who have had the Conformis knee and done well. All will have made progress at slightly different times, because no two knees are alike.

    No matter what sort of knee replacement you have, complete recovery will take about a year, although you'll feel much better long before that.
    You do need to be careful not to do too much, too soon. Increasing your activity too early can actually slow down your progress and contribute to swelling and pain.

    You'll see that I have copied a couple of your posts from other threads, so that we have as much information as possible in your own recovery thread. Please continue to post about your own knee in this thread from now on.

    I have some reading for you - lots of informative article. Do be sure to check teh one about activity progression carefully.

    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
    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

    Please don't be overwhelmed by the list. The articles are not long and they and contain information that will answer many questions and help you make your recovery much easier on your knee and on you.

    We are here to help in any way we can: answering questions and concerns; supporting and encouraging you from start to finish.

    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.
     
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  7. sistersinhim

    sistersinhim FORUM ADVISOR Forum Advisor

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    Welcome to Bonesmart! It's really too early for you to be taking care of a 2 1/2 year old. All you need to be concentrating on right now is healing your knee. Doing too much too soon will slow down that healing. If you say, "No, not yet." to that babysitting for the next few months, you'll be much better sooner.
     
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  8. Eeek

    Eeek senior

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    I don’t have a conformis, I have a medacta. I was reading the conformis literature and it made me laugh a little. I’m pretty sure that OS do not spend time in the OR pulling prostheses off the shelf and figuring out which one to use while the patient is on the table. I would hope most OS plan a little better than that.

    Having said that, I’m sure it’s a fine knee - a custom knee sounds like a good thing.

    Medacta knees range over a standard size (there might be 6 or more sizes) but come in a box with custom cutting blocks 3D printed based the patient’s CT scan. As i understand it, the cutting blocks guide the OS to make the best fit between patient and prosthesis. So both the knee and blocks are a single use piece of equipment, sterile, etc, marketed as “my knee”.


    Conformis is also a single use, custom cutting and prosthesis design if I am reading correctly.
     
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  9. Babushelen

    Babushelen junior member

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    I’m looking at doing my left knee in the future so I’m paying attention to these kind of custom knees and minimal invasive procedures and recovery times.
     
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  10. HoneyB

    HoneyB senior
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    The CONFORMIS knee is a patient-specific, custom-sized knee. A CT scan is used to build a 3D mold of the patient's knee. The custom knee is built from that, and the knee kit includes single-use, custom cutting guides and tools. I asked my surgeon what he would do if he found during surgery that the custom knee did not fit properly. He said that had not happened to him thus far, but if it did happen, he would use a Stryker "off-the-shelf" knee. As it turns out, he said that my CONFORMIS knee was a very good fit. My hesitation with the CONFORMS knee was that it has only be around for about 5 years. I'm an engineer so "life cycle" statistics were important to me. I hope the CONFORMIS knee turns out to have good durability with a good life cycle. My physical therapist said that, based on her experience, CONFORMIS patients usually have 90-95 degrees flexibility two weeks after surgery. That's where I was 2 weeks after surgery. Unless something unexpected happens, I plan to have a right TKR using a CONFORMIS knee in May 2018. So far, the TKR experience has been less painful, but more time consuming, than I had anticipated. I appreciate the input from everyone. I read threads on this forum for hours before joining. I'm finding it to be a great source of information and encouragement, and for letting me see that what I'm experiencing is normal - and that "normal" does not mean everything happens at the same time for everybody.
     
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  11. Eeek

    Eeek senior

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    @HoneyB - yes! Less painful but all encompassing! And more tiring!

    So the conformis is a custom prosthesis, plus custom cutting tools, all single use, whereas others (like mine) are standard prosthesis with custom cutting tools, also single use.
     
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  12. Jajakio

    Jajakio senior

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    Yes, I had the custom conformis knee done almost 9 months ago. I was pleased from the beginning. I left the hospital with 95 degree flexion. But it was down to 85 a few days later as things swelled. As far as I remember I was 0 extension from the beginning. PT didn't seem challenging after the first week. I made rapid progress for the first few weeks but stuck at about 98-100 from about week 3 to 5, then it picked back up and started improving again. I went back to work maybe 10 hous a week at 5 weeks and was full time by 9 weeks. But I can work at home on the computer 3/4 of the week if I need to and could control my own schedule to a large degree. I was taking short walks down my street at 2 weeks and pedaling the bike from about 10 days. And yes, I was pretty stiff until about 10 or 12 weeks out.

    The best thing was, it felt like my knee from the beginning. My knee with a bad sprain, but still my knee. A couple of other people who had previous knee surgeries warned me it would be a big improvement but for them it never felt 100% natural. Nearly 9 months out and no stiffness, no clunking or clicking, it really does feel like my knee.

    But I have to say, I was told by my surgeon everything went twice as fast and i would be totally healed by 6 months where it usually takes a year. I did not find that to be true in my case. Initially I found I was well ahead but the difference tapered off somewhat as time went by. I was fast with some things and slow with others. It took me nearly 4 months to sleep on my side comfortably all night. And while I was off opiates completely in under 4 weeks, I didn't sleep well for a couple of months. Although sleeping poorly in the beginning seems typical for many of us. I'm still improving although I've had normal activity for a good while. I don't want to sound negative though. I think I've had a fantastic recovery with no real setbacks except for some back pain for a few weeks earlier on. I can do a full day of field work with a lot of walking, come home and cook dinner and then work on a furniture refinishing project until bedtime as I did this week. My new knee is now my good knee and the non operated knee is a bit stiff and reminds me of where my right knee was 5 years ago. It will have to be done sooner or later and I will definitely be choosing another conformis knee. I think some of it is overhyped but I feel like it was the right choice for me.
     
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    Last edited: Mar 21, 2018
  13. Oomworthy

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    I was a little misdirected regarding the 'custom fit' claims of the manufacturers (all of them!) but my surgeon explained it more that there is less fudging than there is to get a standard prosthetic to fit, and the finished job is much 'neater' with the custom. As somebody who makes all sorts of things in the workshop - usually out of reclaimed materials rather than custom built from new - I'm aware that little bits of overhanging material, slightly misaligned joints (still talking about woodwork etc), and gaps between mated surfaces can all add up to problems over time. @HoneyB is an engineer so will know what I mean.

    Having a standard knee fitted well by a good surgeon will probably (usually?) have a similar end, and leven long term, result to a custom fit, but as the CT/MRI scan gives the best possible fit - better than the human eye could manage - I can't imagine choosing a standard and putting all of my faith in the surgeon alone.

    My surgeon is on a compliance panel so he must know a thing or two about the statistics side. Grading results on a curve with a staged assessment to judge compliance with future performance is a standard model in engineering - otherwise we'd never try anything new - so I'll put my faith in technology and a surgeon's decades of experience working together.

    I hope your progress picks up again very soon, @HoneyB - I'm sure it will.
     
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  14. SusieShoes

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    I think a custom knee makes great sense. You describe those reasons perfectly and I wouldn’t be surprised if in the future all knee replacements are custom-made (and 3-D printed) and surgically implanted by robots. Technology for the win!

    Recovery is quite a bit more than how well the implant fits, though, and I think that’s something people often overlook. An implant could be put in that perfectly mimics the original knee structure and the recovery from that operation still involves cut bone, tissues and disrupted physiology. Bodies still are going to heal at the rate bodies heal, no matter what implant is put in. Short of new procedures that instantly knit soft tissues, for example, or accelerate cellular growth, there’s probably a limit to how much “faster” recovery can be.

    That’s why promises of faster healing are a bit misleading no matter what kind of implant is used. Time-consuming is a great way to describe it!
     
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  15. Oomworthy

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    Now if we can just combine CT scans, 3D printed custom implants, tied into robotic surgery, and finished off with stem cell assisted rejuvenation...
     
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  16. mlwreader

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    I had this thought last night after watching PBS newshour's piece on advancement in 3D printing. There are amazing new things ahead, no doubt.
     
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  17. sistersinhim

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    And made with no more metals!
     
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  18. jboles

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    I was actually going to have the Conformis knee, until I found out about my metal allergies. :sad:
     
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  19. HoneyB

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    I can tell that Tuesdays and Thursdays are usually going to be rough on my knee. I work from home (have been working from home for 30+ years) and take care of my 2-1/2 year old granddaughter from about 6:00 a.m. until about 6:00 p.m. on those two days. In my "new knee life," I started back to doing that in week #3. She's getting a lot more TV and video time during my recovery than usual, but I do spend a lot more time on my feet when she's here. I wouldn't trade my time with her for the world, but my knee is very stiff tonight. I predict that I won't have a record-breaking day at physical therapy tomorrow.
     
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  20. kneeper

    kneeper FORUM ADVISOR Forum Advisor

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    It sounds like you are quite busy with work and the granddaughter. It's a lot to ask for a month old knee. Do you nap when she naps? Are there any other options/helpers that could either take a day or help you out part of a day so you can rest and elevate?
     

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