My Score Chart score tells a different story

[robert johnson]

I saw the Score Chart mentioned in a post by @Pumpkln and decided to take it.

This is what I came up with. It says there are 38 Activities, but for some reason, my total comes up to 36. In any event this is what I got:

1. Can do with ease: 14
2. Can do with some difficulty (using a cane): 9
3. Can do with great difficulty (have to put on knee brace/use cane/park close): 6
4. Unable to do at all: 4 (but two I couldn't do anyway, before my knee hurt )
5. N/A (I added this category): 3 (Three were things I'm just not going to do, no way)

When viewed this way it almost seems to contradict what I've said before that a person has to be in pretty bad shape to do a TKR. This makes it seem not so bad.

Or another way to look at it would be that just one or two of them are so important that they suffice on their own. Like the ability to walk long distances without assistance. I used to walk miles, now I have to park out front of a store/restaurant).

Plus, things can change rapidly. One slight twist in the wrong direction and all of a sudden I'm back to icing daily and a whole bunch of 2s become 3s.

 

[Pumpkin]

1. Can do with ease: 14
2. Can do with some difficulty (using a cane): 9
3. Can do with great difficulty (have to put on knee brace/use cane/park close): 6
4. Unable to do at all: 4 (but two I couldn't do anyway, before my knee hurt )
5. N/A (I added this category): 3 (Three were things I'm just not going to do, no way)

Looking at your scores, you have to use a cane for 9 activities, 6 items are with great difficulty, and you are unable to do 4 items. That is almost half of the items requiring help, extra effort, or assistive devices. That does not take into account the 3 you are not going to do anyway.
In the end for you, if this is OK, than it is not so bad. If you feel your life is limited than it isn't great.

Did you also take the Oxford Knee Score and the Tegner Lyshol Knee Scoring Scale?
The links are at the top of this page.
Score chart: how bad is my arthritic hip/knee

 

[robert johnson]

That is almost half of the items requiring help, extra effort, or assistive devices.

Good point. That can't be good.

Did you also take the Oxford Knee Score and the Tegner Lyshol Knee Scoring Scale?
The links are at the top of this page.
Score chart: how bad is my arthritic hip/knee

I just tried both a few times. The problem I have with that sort of thing is too many true answers would be "it depends." I have times when my score would be "Fair" to "Good" on Tegner and other times when it would be "Poor", like right after suddenly making a twisting motion. Then after a few days of icing 2 or 3 times a day, get back to where I was.

Same goes for the other test.

I've been like this for about 2 years, so I think it's gotten old. The scores do sort of agree with the mental debate I've been having though, and it seems TKR finally won.

 

[Jamie]

That's why this is called an "elective" surgical procedure. You get to elect when your life has become so dominated by your bad joint that you're not enjoying yourself. If you're thinking about your knee all the time, then life revolves around it. Once it's replaced and you have gone through recovery, your knee is the last thing on your mind for most, if not all of the day.....every day. But...in the end, it's your choice how you want to live your life.

 

[robert johnson]

That's why this is called an "elective" surgical procedure.

Wow. That's true, isn't it. Somehow that never occurred to me before. That's a sobering thought. Normally, you might consider something non-essential as an elective procedure, but you're right, it really is elective to have a TKR.

 

[birdwatchr]

@robert johnson
My score chart pretty much said I didn't need surgery, but the pain could get pretty bad at times. The doctor I was seeing for my knee had said he really wished I would consider knee replacement. I slowly said "I don't know. What would you do if it was your knee?" He replied that everyone is different, but referred me to the knee surgeon. When the surgeon said my care had been turned over to him, I was kind of mad, because I wasn't told the first doctor was "discharging" me. But later, I thought about it, and it was his answer. He would get it replaced. Nowadays doctors don't want to tell you that you "need" surgery. The surgeon just looked over things and asked me when did I want to have the surgery done? I suppose I could have said neverbut I set it up after talking to him. Yeah, I regretted it in the beginning, but now, almost 3 years later, I walk fine and have gotten back into regular exercising instead of sporatic exercising. Even though I had been keeping flexible, I can do even more flexibility stuff now. I've been told my other knee will eventually need replacing, and I will most likely use the same doctor, but right now the pain of it has gone away since having the first knee replaced. I think sometimes it's more of a combination of how much is being spent in doctor bills and how much the pain is keeping you awake at night, etc. to make the decision. I was getting my knee drained about 4-5 , maybe 6 times a year and the shots were hit and miss in terms of relieving the pain. I finally had enough, and after talking to the surgeon, took the plunge.

 

[robert johnson]

@robert johnson
I think sometimes it's more of a combination of how much is being spent in doctor bills and how much the pain is keeping you awake at night, etc. to make the decision. I was getting my knee drained about 4-5 , maybe 6 times a year and the shots were hit and miss in terms of relieving the pain. I finally had enough, and after talking to the surgeon, took the plunge.

I understand, and I'm definitely going through with it this time. I think my case was a little different in that I was never in pain just sitting there or sleeping at night or anything like that.

I could still pretty much do whatever I wanted if I put my knee brace on or used a cane, and only up until recently cortisone shots used to give me months of relief where I didn't even need a cane. Basically, something happened about a year and a half ago to tilt things in a slightly worse direction, where things went from being under control to where I'm always debating it. Like Jamie said (above) I went from never thinking about it to always thinking about it. I think the "something" that happened was when my cat suddenly got sick around July 2017, and for the next year I was constantly hauling him back and forth to the vet in his carrier. I remember the extra weight was wreaking havoc on my knee and cortisone shots stopped working. Plus the stress probably wasn't helping. We finally had to put him to sleep Sep of this year. My knee never really recovered.

 

[robert johnson]

@Pumpkln Have you ever heard of such a thing as icing too much? I don't mean in the sense of someone putting a block of ice on their leg until they get frostbite or anything like that. I mean too often, even if one leaves a pretty substantial interval between icing. Say a minimum of an hour.

For instance, say you use a Thera-Med pad that might stay cold for 20 to 30 minutes tops, and then there's really nothing cold about it. Is it possible to do that too many times in a day where you could end up causing problems with healing where it becomes counter-productive? I'm talking about during the first month or so when healing is taking place the most.

 

[birdwatchr]

@robert johnson
So sorry to hear about your kitty. Pets really help us get through things, and I know it was stressful to have to deal with his death. My heart goes out to you.

 

[Jamie]

I can answer your question about icing. After surgery ice is frequently used as a means to minimize pain and swelling because of the surgical trauma. It's not the same use as you might do after an injury. Following injury, it is common practice to tell patients to ice no longer than 20-25 minutes several times a day. But with a surgical incision, it is perfectly fine to ice your wound as much as is comfortable for you providing that you do not allow your skin to chill to the point of damage. This is why we recommend that people use a towel between the ice source and their skin or clothing. It's also why the ice machines like Game Ready or DonJoy have pads that don't get quite as cold as you can do with an actual ice pack. Icing is an excellent means to control pain following surgery and each individual needs to find out what schedule works best for them.

I used gel packs through the day and night for weeks with both my knees because it felt better than not icing. Obviously, during the day there were periods where I was not in bed or on the couch, so I wasn't icing then. But at night it was both front and back of the knee all night long. It really helped me sleep (although I was also using a heating pad on the small of my back to keep warm!).

 

[robert johnson]

I used gel packs through the day and night for weeks with both my knees because it felt better than not icing.

Jamie, does that mean you would continuously replace one with another cold one? When I use a Thera-pad after a half hour or so, it's pretty much body temperature. Seems like it would be hard to sleep.

Although, I don't know anything about ice machines, so maybe that's what you mean?

 

[Jamie]

My gel pads were very large and lasted several hours. During the night I would get two fresh ones when I got up to use the bathroom, about halfway through the night. Some people keep an ice chest beside the bed with replacements. I think the larger pads stay frozen a bit longer just because there is more volume of gel that's frozen initially. This is the type I used:

 

[robert johnson]

Thanks Jamie.

Thanks @birdwatchr that's very kind of you.

 

[Pumpkin]

I iced all night long, I had a Breg Ice Machine. Kept an ice chest by the bed to refill it in the middle of the night. Helped a lot with pain control. During the day was on and off with cold packs until they got warm, so I could be up and around the house.

 

[robert johnson]

I iced all night long, I had a Breg Ice Machine. Kept an ice chest by the bed to refill it in the middle of the night. Helped a lot with pain control. During the day was on and off with cold packs until they got warm, so I could be up and around the house.

When I think back on 2010, I hardly remember icing at all. I don't remember swelling much either. All I remember is that anytime I did PT or the exercises they sent me home with (Up and down a step on patio) the pain would increase (which I had drugs for) and my knee would look inflamed red. But I don't remember having the sense that I was battling swelling with ice at all.

Who knows, maybe I got lucky, maybe I just forgot because of the drugs. But I do remember from the day I got home from the hospital ROM was never an issue. It did feel too clunky because of the spacer issue (that I had replaced in May), so maybe there's a connection. I wonder if it's possible there's a trade-off between good spacer feeling vs. increase in the amount of swelling: the better the spacer selection, the more likely you'll have swelling at the outset.

It's an interesting thought.