TKR Second guessing second TKR

bertschb

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I just scheduled my second TKR (right knee this time) and I'm wondering now if I should go through with it. Some background...

I had my left knee replaced in October 2016. It's fine. Back in February I went on an easy 4 mile walk. An hour after I finished the walk I got up from my chair and noticed my right knee was swollen and hurt. What the heck? I've never had any problems with this knee. For the next week or so I had the same symptoms I had with my left knee. Very swollen. Pain behind and around the knee. Reduced range of motion. Popping when twisting slightly. I waited a month and resumed walking. Walked half a dozen times over a couple weeks. Short walks (1.5 miles). No problems this time.

Fast forward to late May. I started doing short walks again and my knee started swelling up and hurting again. I could only walk about a mile and I had to turn around and go back home. So, I made an appointment with the surgeon that did my LTKR. He took X-rays that showed bone on bone on one side of my right knee. He asked me what I wanted to do about it. I told him I wasn't interested in meniscus repair, removing fluid or injections as none of those things helped for more than a few days with my left knee. I said we might as well replace the joint since it will only get worse. He was fine with that.

On June 5th we arrived in Palm Springs where I have an area I love hiking so I started doing a daily 5 mile hike up into the foothills. There are a number of steep uphill/downhill sections on this particular hike. Although the swelling reduces my range of motion, I have no problem completing the hikes. It hurts behind my knee when I return and sit down for the rest of the day but it's no big deal. So my knee is doing better now with 5 miles hikes than it was with short 2 mile walks last month.

Which brings me to the title of my post. There is a nagging doubt in the back of my mind about whether I really need to have my knee replaced. My wife and I talked about it last night and we both know my knee won't get better and if we do it now, we control the timeline rather than waiting until it gets really bad and I'm forced to have surgery when it doesn't really fit our schedule.

I'm not really looking for advice because I am going forward with surgery. I'm more curious if anybody else has second guessed their surgery after scheduling it. I had my left knee replaced because I couldn't walk more than a couple hundred yards without pain. As I type this, the back of my right knee hurts a bit but I was able to do my 5 mile hike this morning no problem. I do a lot of skiing, mountain biking, hiking and golfing and I can't have my knees stop me from doing these things that I love.

Did most of you wait until you basically could no longer walk before you got your knee replaced?
 
Your story is very similar to mine, although there was a 10 year gap.
The second knee had poor days and bad days, but the main consideration for me was that I knew what was coming if I allowed it to. I was 71, and the new knee would definitely see me through and I wanted the remaining years to be good ones.
I could have struggled on with increasing pain, but I don't like pain, much.
There were days when I wondered if I should be a burden on our NHS, but in the fullness of time, I have not one solitary regret.
I only have one life to enjoy.
 
Thanks for the reply @Tykey

Glad to hear you have no regrets. I also want my remaining years to be good and I need two good knees for that! It took a long time to recover from my first TKR. It took forever to regain my ROM. I'm hoping that doesn't happen again with this other knee. It was almost six months before I could ride my Mt bike!
 
@bertschb,
Welcome back to BoneSmart, good news is no two knees are alike, even on the same person. Taking care of your knee earlier means there is less damage for the surgeon to address, hopefully leading to a smoother recovery the second time around.

When members are slow to gain ROM, I use your recovery as and example, it really helps to give them hope that things will get better with time. Grateful you shared your first TKR story and ROM challenges.

You have been added to the July Sparklers!
 
@bertschb definitely go for it...Prior to my left knee being replaced 8 months ago I differed whether I should wait several more months as it didn't hurt at all but knew deep down come Winter I would be back in pain as was bone on bone, after having had my knee replaced the surgeon casually mentioned it wouldn't be long b4 my right knee would follow suit. Since my left knee is getting stronger I'm noticing my right knee and complaining more of pain etc.
As we are still young and these new components last far longer I would get mine done in a flash but unfortunately at the moment there is rather a long waiting list and I don't want to have to go private as our public health system is top class.
 
@bertschb
How are you doing with your new right knee?
Hope all is going well and this recovery has been uneventful.
 
@bertschb
How are you doing with your new right knee?
Hope all is going well and this recovery has been uneventful.

Hi Pumkin. So nice of you to follow up! I chickened out on the surgery. As my surgery date approached, my knee continued to get better so I cancelled it. I was able to ride my mountain bike daily for the last two months with no problems. Last week I sold the bike and ordered a new one. Since I'm an exercise junky, I started hiking again while I wait for the new bike. My knee didn't like that at all! It's super swollen and sore now. What I've decided to do is wait for my knee replacement until I can no longer ride my bike. I don't need to hike as long as I have a mountain bike.

If the recovery from my LTKR would have been just a couple months, I probably would have gone ahead with surgery on the right knee. But my recovery was soooooo looooong. Just didn't want to sit around again for six months waiting to ride a bike again.
 
Thanks for the update! Glad your knee settled down and you are able to ride your bicycle.
I understand your hesitation after your long slog of a recovery.
Enjoy your new bicycle. Easy on the hiking until you receive your bike.
 
Six months? A lot of us took longer than 6 mo., I'm one of them. I've mentally committed 1 yr. to my second tkr. Sounds to me like your quality of life is being affected, you love those hikes but suffer afterward. It's your knee, your decision but unfortunately it's not going to get better, only worse.
 
Hello @bertschb and welcome back.

AS Pumpkln said, I also use your history of slow ROM gain to illustrate to people who are concerned that ROM can continue to improve over a long time period, so thank you for posting it.

No two knee replacements are the same, even on the same person.

Let me tell you what happened to me.
My first knee replacement was deferred for 9 long, painful years, because at that time, my surgeon believed I was "too young". To me, those were lost years, at a time when I should have been activly enjoying life and participating fully.

By the time I finally had my knee replacement, some of my muscles and tendons had shrunk, and I had lost a lot of condition and muscle strength. I had a long and painful recovery, but when that recovery was over I finally had back the life T'd been missing.

When my other knee needed replacing, my surgeon offered me a partial (PKR) as only one compartment of my knee was bone on bone. I opted to have a TKR instead.

AS my surgery date drew closer, I began to wonder if I was jumping the gun and having this TKR too early. Yes, I had pain, but I was still able to walk normally and do almost everything I wanted to.
I asked my surgeon if he thought I was doing the TKR too early and he told me that my knee was "clinically ready for replacement."

I asked him again after the surgery and he told me that my knee was definitely ready to be replaced and that it was starting to show signs of inflammation as well. Within a short time, I would have started to feel a lot more pain and I would have lost much more mobility. I hadn't got it done too early.

The recovery for my second nee was so different from my first recovery. I had gone into surgery with muscles and tendons still in good condition and that made a huge difference. I had a much easier recovery and I didn't encounter nearly as many minor problems. I think that I had a relatively easy recovery.

It sounds as if your knee is still working well for you, so you probably made the right decision in postponing surgery.
I just want to warn you against waiting too long.
 
What I've decided to do is wait for my knee replacement until I can no longer ride my bike
Exactly what I did. In my case though it was a mistake, my knees had been ruling my life for ages beforehand, I just hadn't realised.

Again my take is that if it's inevitable, best ASAP. Then recovery starts. Until The Day, one's just marking time.
 
Hello :) I understand the hesitation on getting the surgery done sooner than later. I mean you definitely can work around your schedule if you do on your own time, but waiting, who knows what will be going on. The pandemic could worsen and you may be forced to wait and who knows how long that will be. Looking back I wish I had not waited 2.5 years to get my left done. The right knee is a champ and recovery once past those 4-6 weeks went well. My left kept deteriorating and recovery has been harder for sure and working it around my work and kids school schedules was not fun. The pandemic is what actually made me go ahead and get it done, though I had to wait til June when they reopened for elective surgeries.
 
For me, I'm going to wait until the knee is consistently in pain and keeping me from my normal, daily activities. Right now, it's mostly no pain. I'm doing strengthening exercises to give the knee more stability. I will milk it for all it's worth before doing another TKR. That said however, once it's clear that there are more more bad days than good, I will start preparing mentally for another knee replacement. The first knee was very slowly degrading for about 7 years. Then in the last year, it suddenly got much worse very quickly and stayed that way.

With this second knee, it has different kinds of symptoms, so am not sure how to gauge it's progress. But I think I'll know when it's time and won't let it drag on and on, so maybe will have an easier recovery for being proactive. But who knows??? :fingersx:
 
My knee was getting worse and worse, but I couldn't decide. Then one day I went exploring our beautiful seaside town of Whitby. There is an old derelict Abbey on the headland, the one where Dracula's body was kept. It was at the top of a very long flight of steps. I wasn't too bad going up, but the knee gave up as soon as I started to come down. I could hardly manage it, hanging onto handrails, walls, and even the floor on occasion. As soon as I stepped off the final step, I sat down and phoned my GP and set the wheels in motion.

So yes, one day you'll know its time.
Good luck.
 
This thread is almost exactly my situation. Background is 3 surgeries in high school, 55 now, quit high impact sports at 32 and now play golf, cycle / spin and hike primarily. I don't typically have daily pain, but rather a dull burning sensation, and mobility is not impaired unless I have a flair up from doing things like walking a round of golf instead of riding. But, my arthritis is level 4 as confirmed by x-rays and my biggest issue is ROM and a lot of bone spur growth. My flexion is around a 105-110 and extension is ~ 8. Extended driving and long plane flights in crowded seats can be murder. I have consulted with 2 surgeons who say medically my knee is ready and up to me as to when. I've cancelled 2x in years past for same reasons bertschb and One Trick Pony cited. I think I will go forward this time, but have significant doubts everyday and good to hear others thought processes.
 
Six months? A lot of us took longer than 6 mo., I'm one of them. I've mentally committed 1 yr. to my second tkr.

Longer than 6 months before you had enough ROM to pedal your bike??? Wow! I thought I had the record :)

I had no problems with discomfort shortly after my TKR surgery. Only took pain meds for maybe a week? I could walk no problem. My problem was ROM and because my ROM was so poor, I couldn't pedal my bike for 6 months. I'm not worried about walking, hikes, golf, etc after surgery. I'm worried about how long it will take for ROM to improve enough to ride my bike.

Because everybody else seems to regain ROM so much quicker than I did, I'm wondering if my surgeon might be part of the reason for my slow recovery. I'm considering going with somebody else.

We have a neighbor who had his knee replaced 10 days ago. His ROM is already around 100 and he thinks something is wrong! He's freaking out and very disappointed. I told him it took me more than 6 months to get past 90 degrees.

Everybody has different expectations and different outcomes.
 
In my case I definitely waited too long. If I had replaced it 10 years earlier when I needed 800 mg of ibuprofen 3 times a day to function. I didn't want to do it at 50 because I was hoping to never need a revision. Not only do I think my leg, weak from limping for years, made my recovery more difficult that it could have been, but compensating for a bad knee wore the hip on the same side out.
 
I also waited for nine years too long, because my surgeon told me I was "too young."

My knee got much worse and I became almost housebound.
That was the most difficult of my 3 recoveries.
 
So yes, one day you'll know its time.
Good luck.

I saw one surgeon who said he liked to hear some magic words before doing a knee replacement, and those words are "I can't go on like this". My own thought is I wish I had done it sooner, and I'm not sure I was even to the "I can't go on like this" stage. If I was having only occasional pain, I'd probably tough it out like you decided. I'm glad I did mine, but I know some people have worse recoveries than I had.
 
I waited too long as well waiting for the "magic" 60 years old. My recovery was much more difficult than it could have been and I wore out my hip compensating for a bad knee resulting in a hip replacement as well.
 

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