TKR Rehab Starts now !

[Chillimac]

Hi Jockette, thanks for your reply. When I had my Uni Knee (left) done almost 4 years ago I had a “ Microfracture “ procedure done on my kneecap. My surgeon told me when I had the consultation for my recent surgery that I was one of the first in the UK to have this procedure.

It consists of drilling the rear of the kneecap I believe and the scar tissue that forms from that procedure then is supposed to restore the balance on a badly worn kneecap that was worn unevenly. I wasn’t aware of how badly worn my kneecap was at the time of having that surgery but my surgeon was correct.

Since having that done I’ve had no problems whatsoever with that knee since it healed and settled down at about the 6month mark. I trusted my surgeon to know what he was doing and what was best for me and my knee in that situation. Obviously I’d expect that certain types of surgery won’t work for everyone but I’m very happy with the results.

 

[Diva68]

I was intrigued by your questions, here is my experience:

1. Age— I had my TKR on my 49th birthday. I had been suffering with severe arthritis for about 4 years. I do feel that my fairly easy recovery has been helped by my age. My pain since surgery has always been tolerable, I did not experience the “brain fog” many report, I was tired and slept a lot more than I expected.

2. Mobility/Immobility— this question is more difficult to categorize. Prior to surgery, I was not using a cane or any other assistance device; however, I did plan all activities around my knee pain. Because of the pain was leg was getting weaker, I am glad I had the surgery before it worsened to the point that I was immobile.

3. Return to work— I am employed full time and had planned to resume my schedule after my recovery period. I am lucky, while my job can be mentally intense and stressful, it does not require much physical exertion. I returned to work at 4 weeks as planned. I liked having a date certain for my return. I was also returning with about half my sick leave left. This allowed me to leave a couple of hours early when I was especially tired and to take a day off each week for about a month after my return. If I were to do it over, I would have taken one more week before returning to work.

4. Drive for success— I imagine few undergo a knee replacement without being driven to improve their pain level and/or mobility with the surgery. I was driven to succeed. My quality of life had suffered, there are plenty of things I still wanted to do and my knee was limiting me. I love to travel, this motivates me to improve so that I can go places without having to think about my knee. During my recovery, I planned my next trip. I’m going to The Bahamas the first week of June. While, I plan to mostly relax beach/poolside with a frozen concoction, just thinking about the trip keeps me motivated. I am almost finished with physical therapy and have found it beneficial for me. I still go one day a week, ROM is great. Currently working on gait, balance and strength.

5. Results— I am very happy with my results. Pain has been minimal and less than pre-surgery. I gave up the walker just short of 2 weeks post op. At 5 weeks post op was not using cane at home or in my office, completely stopped using it at 7 weeks. Today, just shy of 3 months post op, I am wearing a new pair of booties with a two inch wide heel, a kind I was afraid I’d never be able to wear again. I gave the shoes a test run at home Saturday, wearing for a couple of hours and even cooking dinner in them.

 

[Jockette]

My implant is on the front of my femur. On the X-ray there is a spot that shows on the underside of the patella. I think he just smoothed it (is that the same as resurface?) there’s no mention of a button in my operative report. I did have a lateral release done in addition to my implant.

I suspect I have a patella mal tracking problem. My #1 concern that I expressed at my one year check was that I get an immediate, strong discomfort on the lower lateral side when I lean forward, like when loading or unloading a dishwasher, making the bed, etc. I also get that with turning movements, like working in the kitchen and in my sewing room. It feels like someone has jammed a hunk of wood into that spot. It can get very uncomfortable. My surgeon had nothing to say about that.

I am now using kinesio tape and that discomfort is less. I’m not happy I have to tape it, I never had this problem before surgery and I have not endured a year of recovery to tape my knee. My surgery was supposed to fix my pain of getting up and down from a chair and doing stairs. I now have more problems than I had before we “fixed” it. (I won’t go into my other issues. They are on my thread on page 26, I believe, if you’re interested. )

So I am quite frustrated that this is where I am at this point. Not at all the outcome I was expecting.

 

[Chillimac]

Hi Diva68 and thanks for your response. As I mentioned in my OP my experience with arthritis in both knees was (a) partly my own fault on my left knee. I didn’t understand the implications of delaying the surgery and paid the price in the pain I suffered in the 3 years leading up to the surgery. By the time it came around I was constantly taking very strong pain meds to get me through a 10 hr on my feet working day and (b ) Easier on my second go around with my right knee as I learned from my first experience but I still once again in the latter stages before surgery had to rely on pain meds to get me through.

I too believe my age helped. I was just 50 when I had my first knee done, was still active in the gym ( although I couldn’t do any lower body exercising) and that helped during my recovery. I was the youngest patient by at least a decade in the specialist class at my local physio dept , some of the other patients were still using walking aids at 6,8,10 weeks after surgery. I was able to walk unaided after 7 days, the physios put it down to my age and my physical strength but when I asked about returning to work earlier than first expected my surgeon wasn’t very happy at all ! He actually said “ are you prepared, for the sake of a few weeks to go back to work, on your feet for a long day 5 days a week and put everything you’ve had done, everything I’ve done in danger ? If you do return to work and it does break down on you, I’m sorry but I will not do any revision surgery on you “ I had to think about what he said and this guy is an expert, I had to use my common sense and take his advice. I’m hoping this go around is as relatively smooth as the first rehab. I guess I’ll know more on Thursday after my first Physio session.

They did say that some of the older patients don’t seem to have the same motivation, especially those that are retired as they don’t have a time frame to get back to work and earn money. I’m not sure if I think that’s correct but they’re the people that deal with patients day in day out so there must be some reasoning in there somewhere.

 

[Mutti3]

My turn :
Age: I am 67 years old.i had expectations of a good recovery.My husband had previously knee replaced I assist him during recovery.

Mobility before surgery: I knew it was important to get myself in the best physical shape I could get. I did yoga classes, lifted light hand weight. Joined a testosterone gym that I didn’t like, but I did upper and lower body machines. I had a few PT session to set up a exercise program for knee strengthening.
One aspect in my favor, only one arthritic knee.

Return back to work: have a sit down full time. I was on short term disability. Back to work at 8week. I worked from home,I did take a lot of rest breaks in the beginning.

Gotten result:I had full range of motion before surgery in the left knee. Of course the right, no arthritis. I was able to do a child pose with heel to buttock pre operatively. I could do most poses except I had no balance on left leg due to bone on bone slippage. Now post operative my range of motion left is 145( could be more, don’t know) I am 1 inch away from a child pose, but still hurts. I was very concerned to get ROM back. I mostly did. I showed my OS at my 8 week checkup my ROM , he was stunned.
I take walks, and practice yoga at home only.

Driven for success: I had a good physical therapist that push me physically. He pushed me, but I responded to that. I always pushed my self.i didn’t find BoneSmart until I had 3 1/2 months post operative. I had a lot of fatigue post operative that I felt was more age related. I could not change that fact! I am not a spring chicken !

I can walk pain free, very glad I had the surgery. I waited 3 1/2 years before surgery and obtain some relief by having cortisone injection.
Have slight swelling on the lateral side. A tight IT band I am working on. I am not finish , less than 1/2 Through this journey.

 

[mlwreader]

I am 73 and believe that my age impacted my energy level post surgery big time. I was, however, able to walk unaided from my bed to the rest room in skilled nursing after my surgery. I didn't even think about it, I just walked. Not sure what was up with that, but it was one of those things that the first time I did it I was halfway to the bathroom when I realized I wasn't using the walker. After that I just didn't use it at all in my room. I did use it outside the room, but was done with it at about the 3 week mark at home. And then I used the cane for a short while for balance, but quit that pretty quickly because I felt like I was going to trip over the darn thing. Also I achieved 120/0 numbers very quickly, by about 10 days post surgery.

Lest anyone think the recovery was then a breeze, not at all. I had plenty of incision issues (which you can read about on my thread), sleep issues, appetite and nausea issues. I work part time at home, and found it very difficult to sit at my desk. I wound up sitting on the couch with my leg propped up.

I don't think my age has impacted my motivation at all. I was housebound on a walker for months leading up to the surgery. Post surgery I mentally felt like skipping, I was so excited to have done it. I didn't skip, but my soul was skipping. LOL. I had to stop PT pretty early on because of my incision problems, and never picked it up again. I have relied on ADL's and walking. Granted my ADL's were pretty intense in Feb and first couple of weeks of March, because I moved. I don't think a generalization as to age and motivation is really accurate (my opinion only) but I do think energy is definitely age related. Although I read someone's post yesterday who is 70 years young and she participated in two extended hikes that very day, of I think about 3 miles each. Took my breath away! Can't remember who that is, darn.

Interesting comments. Thanks for starting the topic.

 

[sistersinhim]

@Chillimac, to answer someone, you don't quote the whole message. Just tag them and come down to the bottom of the page like I have you. Put the @ sign before their name with no space between the two. This is a partial quote that I will leave for you.

I was the youngest patient by at least a decade in the specialist class at my local physio dept , some of the other patients were still using walking aids at 6,8,10 weeks after surgery

Age has absolutely nothing to do with people using walking aids. Every knee is different going into surgery and coming out of surgery. Many have had numerous previous surgeries on their knees, like me. I've had 6 on my right and 5 on my left. Someone that has had only the tkr surgery might very well end up with less damage than I had, so healed quicker. It really depends a lot how much work the OS had to do inside the knee during the tkr.

I still carry a walking cane in my car, just in case I run into a situation where I might need it, such as icy walkways or overly crowded stores. I am not embarrassed by my having my cane with me at all. I am thankful I can walk!

 

[Chillimac]

Thanks for the quote heads up Sistersinhim. I wasn't having a pop at anyone in my posts about age or physical ability, merely relaying what had been said in conversations with various medical personnel over my time. I've also had numerous other surgeries on both knees way before I had the prosthetic implants, the first being way back in the early 80s but didn't see the point in listing numerous clean outs and debridements as I had them quite a while before the arthritis really took hold and became debilitating.

The questions I posed are there purely because I'm trying to see the different way the condition and treatment/surgery affects people individually. There will always be those that have relatively good experiences and those that have horrendous experiences I have a colleague who had their TKR 2 years ago and tells me it's the worst thing he's ever done and he bitterly regrets having the procedure. He says I'm the luckiest bloke he's ever met as I could walk without any aids, both in the house and outside, go up and down stairs and not really suffer any side effects, providing I iced and elevated if I'd been for a walk outside.

On the other hand my colleague still gets a great deal of pain and discomfort after walking relatively short distances or standing for more than half an hour. I'm certainly hoping I'm as lucky again this time but also realise this is a more invasive surgery. I'll have to rein my natural urge to push myself too much in to get the best out of the new knee. I'll be asking the physios on Thursday for their advice going forward.

 

[sistersinhim]

I didn't take your comment as singling out older people. I just wanted to point out that everyone's knee is different.

There will always be those that have relatively good experiences and those that have horrendous experiences

I am blessed to have had a fairly easy recovery. You want to read about a rock star, read SusieShoes thread! That girl put many of us to shame.

How is your pain? Do you feel you are improving?

 

[SuperSnapper]

@Chillimac I was interested to read you comment about microfracture. I seem to recall having this done to my knee cap at the same time as it was done to my femur. But could be wrong. My micro fractures were years ago but one knee lasted about 12 years and my original one done 17 years ago is still working for me! I had a partial medial replacement 3 years ago and it’s been fantastic. I was back out with my walking group at 3 months. Good luck with your new knee. I hope you get many years out of it.

 

[Chillimac]

Sistersinhim I’m very lucky I have got very little pain. On a scale of 1 to 10: in the morning after getting up it’s tender, pain at around a 4 but reduces once I get moving and do my exercises, ice and elevate. . I always try and do them soon after getting up and then drops to a 3 for the remainder of the day, exercising twice more per day, icing and elevating. I also ice and elevate while I’m watching tv in the evening for an hour or so. I’m taking paracetamol (Tylenol) 2x500mg 4 times daily now along with anti inflammatory 1x400mg and I’m hoping to reduce that as soon as I can. I’ve got a feeling the physio is going to give me a stiff test on Thursday,as I’m on The Enhanced Recovery Programme here, a more intense after surgery therapy my surgeon has volunteered me for ( I might not be thanking him for that after my first session!) so I’ll have to play it by ear and see how the pain is after that.

 

[Celle]

Age
I was 59 when I had my first knee replacement and 72 when I had the last one.
I don't think my age made any difference at all to my recoveries.

The knee itself takes just a long to heal fully whether you're 18 or 80. That's something that younger, active people often find hard to accept and I think they experience more frustration because their recovery is taking longer than they expected it to.

My mother had two knee replacements, one at 75 and one at 82. She made a good recovery from both surgeries and was walking without help after about a month.

Mobility
Pre-op mobility does have a bearing on recovery. I waited 9 long, painful years before my first knee replacement. During that time, my mobility gradually decreased until I was almost house bound. That resulted in loss of muscle strength and some deformation of my tendons and ligaments.
Consequently, my recovery was impeded, because those soft tissues had a lot more recovering to do.
However, I did regain full mobility and went on to live a very active life.

I needed a revision 11 years later. I went into that with muscles and tendons in good condition and, even though revisions can often be harder, I found my recovery was a little easier than my original recovery.

I learned from my first mistake, and had my other knee revised as soon as my surgeon said it was ready. That recovery was relatively easy.

I don't think you can assume that people who still need crutches or sticks at 6-8 weeks post-op do so because they haven't done their exercises. It's far more likely to be because of the condition of their knee and their general health before the surgery. Every knee is different. There's no way that you could know either the state of their knees before surgery, or the extent of surgery that they needed.

I've had 3 knee replacements, 3 good recoveries, and 2 different surgeons. Both of my surgeons have had the same philosophy :
They don't allow any formal PT exercises at all for the first month after a knee replacement. They say your knee needs that time, to start on its journey of healing. For that month, we rest, ice and elevate our leg, and walk around the house.
After that month, we just go to PT once every 2 weeks, where we are shown a few new exercises to do at home.
Their patients all do well and achieve good ROM and mobility, as I did.

After my last TKR, I did no exercises at all. I just let my activities of daily living (ADLs) be my exercise.
Both my knees are strong and reliable. They straighten fully and bend to over 125 degrees. I lead an active life and I can do anything I want to with my knees.

Return to Work
That can be a motivation for many people, but ti can also have a negative effect on recovery, causing some people to push for faster results.

I had no need to return to work, so I could allow my knees to take the time they needed.
However, I did have other incentives to return to full mobility - mainly the desire to continue travelling. I have a daughter who has settled on the other side of the world and I like to spend about 3 months with her every year.

Since getting new knees, I've travelled extensively.

Drive for Success
I think everyone wants their knee replacements to be a success. They wouldn't have gone through this major surgery if they didn't hope their knees would be better afterwards.

Some people interpret the drive for success as following a strict exercise regime. That can backfire on you, as over-zealous exercising can lead to irritated and inflamed soft tissues, and that can delay recovery. We see that a lot, here on BoneSmart.

Other people, just as motivated, realise that resting isn't "lying around, doing nothing." It's working hard, to give your knee the best possible chance of healing well.
It's not exercising that gets you your ROM - it's time. Time to recover, time for swelling and pain to settle, and time to heal. Your ROM is there right from the start, just waiting for all that to happen, so it can show itself.

I certainly had a drive for success. I wanted my active life back. I wanted to be able to play with my grandchildren, to travel to visit them, to lead an independent life, and to see the world.

Since my various knee replacements, I've travelled by land, sea and air, and visited most countries in SE Asia, South America, the US, Canada and Europe.

I'm 76 now and I don't plan to be a rocking-chair granny for a long time yet.

Results
I think those speak for themselves.

I walk well, with no stick or cane. I do carry a cane in my car, for use when the ground is wet or slippery underfoot. I'd rather use a cane then than have a fall.

My knees work so well that I seldom think about them. The only accommodation that I have to make for them is when I'm gardening. I can't squat fully, so I kneel on a foam pad.

After-thoughts
In all my musings, I'm convinced that the most important factor for the success of any knee replacement is the skill of the surgeon - skill in choosing the implant, shaping the bones to receive the implant, fitting the implant, balancing the tendons and ligaments, and in handling the soft tissues gently.

Both my surgeons have been meticulous and I attribute my good recoveries and well-functioning knees mainly to their skill.

 

[Chillimac]

Thanks for your reply Celle. The point raised about patients still using aids was brought up by a physio during a conversation in the specialist gym when I was recovering from my left knee surgery so I was merely relaying that opinion.

I too believe that the surgeon is a huge factor in the recovery, longevity and everything in between in surgery like this. I chose my surgeon on a recommendation from my friend, an orthopaedic nurse who started working for him when he first started performing surgeries for the NHS here in the UK. She told me he was doing things that other surgeons either couldn't make work or wouldn't do.

When I went for my first pre op for my left knee, the nurse doing my assessment saw his name on my records and asked how I'd managed to get him to do my surgery, my friend had had a word and smoothed the way, I was lucky. The nurse was saying there's no other surgeon in their geographical area that approaches knee surgery like he does, she said he uses cutting edge techniques and he's street's ahead of some of the older, more established surgeons on their rota.

I did my own research and he's very highly regarded in the British Medical fraternity. That was more than enough for me and probably why I've had only tiny hiccups in my original recovery and this recovery so far. Hopefully this one will continue in the same vein.

 

[kneeper]

There may be some people who are fearful of giving up their walking aids, but on the other hand there's no prize for a "quick graduation."

 

[Celle]

The point raised about patients still using aids was brought up by a physio during a conversation in the specialist gym when I was recovering from my left knee surgery so I was merely relaying that opinion.

Of course a physio would blame lack of progress on not doing exercises - physios have a vested interest in making people do their exercises, because it's their job and their income.

It's a pretty judgmental comment though, and it sounds uncomfortably like blaming the victim.
We have a lot of people here on BoneSmart who have been made to feel depressed and inadequate because a PT blamed their slow progress on not doing enough exercises.

While it may be true in a few cases, it's not something that should be taken as applying to everyone.
You need to know the facts of each individual recovery.
For example, someone who hasn't been able to walk at all for a couple of years would be pleased to be able to walk using crutches. Rather than lack of progress, that would be a huge improvement.

 

[Jamie]

@Chillimac.....would you be so kind as to share the name of your surgeon? We like to have the names of doctors like yours to keep for recommendations for others when needed. Also, I'm curious to know if @Josephine knows him.

 

[Chillimac]

Of course Jamie. The name of my surgeon is Mr Mohammed Aqeel Bhutta. He works for the Pennine NHS Trust as a Consultant Trauma and Orthopaedic surgeon and also has a private practice in the North West of the UK. There were numerous articles written about him in the wake of the horrendous terrorist attack in Manchester. Mr Bhutta was one of the specialist surgeons called upon for his skills to perform surgery on those injured that night.

 

[Josephine]

That's great but at which hospital? The NJR often doesn't show names, only hospitals.

It consists of drilling the rear of the kneecap I believe and the scar tissue that forms from that procedure then is supposed to restore the balance on a badly worn kneecap that was worn unevenly.

Nearly there but not quite! The object of this exercise is to make the bone bleed into the holes made. The blood naturally contains bone stem cells which can regenerate bone and cartilage. In fact, we were doing this using fine drills or even suture needles as long ago as the 1960s but we had no idea how it actually worked! So nothing new under the sun!

I'm so glade yours worked so well.

 

[Josephine]

Folks, this isn't Facebook so it's unnecessary to quote a post just to reply to it. Just scoot on down to the bottom of the page where it says "write your reply" and start typing!

Unless there is some specific phrase you want to address, of course - like I just did! Then do it like this How to quote a post.

Thanks for understanding!

 

[Chillimac]

Wow Josephine! As far back as that ? The only thing I can think is he used a new or different technique for him to tell me I was one of the first. I'll ask him when I see him in a few weeks for my follow up.
He works out of the Royal Oldham but does all his surgery at Fairfield and his private work at Highfield.