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[TKR] Strange New World

Discussion in 'Knee Replacement Recovery Area' started by Denny39, Dec 24, 2018.

  1. Denny39

    Denny39 senior
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  2. Didot

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    I’ll continue to follow your progress. It helps to bring hope to those who are some weeks behind you.


    Sent from my iPad using Tapatalk
     
  3. HoneyB

    HoneyB senior

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    From one engineer to another, my two non-OEM, third-party, after-market replacement components are custom-designed components rather than COTS components. Going with the custom knees was a leap of faith for me because they haven't been around long enough to have good life-cycle data, and the COTS knees my surgeon uses have a great track record.

    Since you're considering having a second TKR, I can confirm for you what many have said on this forum; no two knee replacements are alike, even when they're in the same body. I had an extremely hard time trying to not compare my two. My physical therapist for knee #2 asked if I had created an engineering spreadsheet in which I was comparing the two. I hadn't, but probably only because I didn't think to set that up during PT for knee #1. He grimaced when I'd bring up the physics involved between the weight machines and my knees during my PT sessions, and would tell me to stop "re-engineering" the exercises. I just wanted to make sure he knew what he was doing to me since I'm short (5'0") and seemed to be at or just beyond the lowest height adjustments for some of the machines I was using.

    I didn't sleep more than a total of two hours in a 24-hour period for the first seven weeks with knee #1. It was horrible. It felt like torture. Thankfully, sleep returned more quickly with knee #2.

    It sounds like you're having a great recovery. Keep it up!
     
  4. Lindylee

    Lindylee graduate

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    @Denny39 Hi Denny, just wanted to say how much I've enjoyed reading your posts. Love your attitude and sense of humour and so much of what you went through is exactly what I'm experiencing now - the same sleep (or lack of) pattern, the other knee being much better after surgery. Is it still better or has it regressed? My surgeon offered to do my right 4 months after the left. For the few days I was thinking 'never again'. By the end of week 1 I was thinking 'not before September' and this week I'm thinking my right knee feels fine and I might stick with the status quo! I have a theory that the right knee saw what happened to the left and thought 'no way Jose!' It's been encouraging to read your, and others, story(ies) and know I'm not alone. My surgeon was quite up front about pain and recovery timelines, but it's good to have real stories.
    I hope you've managed a good night's sleep and wish you well as you go forward.
     
  5. Denny39

    Denny39 senior
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    @Lindylee Hi Lindy. Glad I have been able to offer a little distraction and hopefully some encouragement. The first two weeks are called the “Dark Days”; There is another name for the next two, but I can’t remember it right now. What I do remember is that nothing was a whole lot of fun for the first 4 weeks. If you follow the Bonesmart guidelines for PT, Ice and elevate (Toes above the nose) regularly, things will begin to improve at a slightly accelerated pace after 4 weeks or so. I am at 8 weeks and 3 days now. That is about 4 weeks ahead of you, and I know that from where you’re at now, looking ahead 4 weeks probably seems like about 2/3 of eternity. But as I noted, this recovery timeline does have predictable milestones, and I found out, as many had assured me that it would be, 8 weeks is a milestone.

    I think your theory that the Right knee saw what happened to the Left one and decided to go on its best behavior is solid. That’s exactly what my wife said when I told her it was no longer bothering me. She said, “of course not; It’s scared to death”! Unfortunately, it seems to be forgetting the lesson, and it now appears that September will probably find me saying, “Here we go again”. X-rays showed both of them to be substantially below original factory specifications.

    It sounds like you are doing very well considering the inevitable bumps in this road we’re on. But it will get better and easier and we will some day before long join the club of those who are (FINALLY) glad they did it.

    @donnag1108 made a comment about hanging on to those “little victories” for encouragement. That really helps. You will realize that today, you can sit, or stand, easier and with less pain than 2 days ago; you may have gained a degree or two of flexion. Those are the landmarks to hold onto. Hang in there. Keep going. Stay focused. This too shall pass; you will be you again.
     
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  6. Celle

    Celle FORUM ADVISOR Forum Advisor

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    @HoneyB - Please don't use abbreviations such as "OEM" and "COTS". They may be familiar to you and Denny because of your profession, but they are probably not familiar to most of our members.

    We have an area, How To Use This Forum , that has various articles on how to use BoneSmart, including this one:
    https://bonesmart.org/forum/threads/forum-etiquette-being-polite-when-posting.20128/

    In it, one of the requests is this:
    3. avoid use of abbreviations and "texting language." Remember that BoneSmart is an international forum. What is a common abbreviation in your country or area may be totally unknown to others who come along and read your post. By the same token, not all parts of the world are familiar with the abbreviations used commonly when texting these days. The abbreviations for joint replacements (TKR, PKR, BTKR, THR, BTHR) are acceptable but pure text-speak such as
    u for "you"
    w for "with"
    r for "are"

    and so on are not acceptable here.

    In the BoneSmart library, this article lists alphabetically the abbreviations and acronyms that are acceptable on BoneSmart.
    abbreviations and acronyms

    Thank you for understanding.
     
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  7. NavyGunns

    NavyGunns FORUM ADVISOR Forum Advisor

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    I would also suggest that an explanation of the acronym be included when first used just to ensure proper understanding if not common to everyone else. Us engineers and technical geeks understand but that doesn’t cover most folks.
     
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  8. Denny39

    Denny39 senior
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    @HoneyB
    Ain’t it fun, “tweaking” those PT guys. I had 2 of them say “I knew you were an engineer! You guys always want to know everything and analyze it to the Nth degree. I really freaked her out when I used the “SPM” (steps/strokes per minute) to calculate how many I would need to go a mile.

    Sleep is still a problem, but not as bad as it was 2 weeks ago. I have actually had few pretty good nights without any sleep aids. When I get desperate, I take a Morphine tablet when I go to bed, but that is down to once or twice a week now.

    I will probably have the other one done in September. Even though I have already been through it, I suppose I should still be braced for a few “What-the-heck” surprises. Makes me really glad that I only have 2 legs.
     
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  9. Denny39

    Denny39 senior
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    @HoneyB
    By the way: What’s your engineering field?
     
  10. Lindylee

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    @Denny39 Thank you for your kind words of encouragement. I agree with @donnag1108 comment. I felt like cheering when I finally achieved a knee extension!
    I'm married to an engineer and try to keep him away from my medics for the very reason that he always wants to know all the technical aspects of any procedure and by the time he's finished with his questions I've forgotten mine! Hope you have a good night tonight.
     
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  11. HoneyB

    HoneyB senior

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    Sorry, everybody. COTS = Commercial-Off-The-Shelf. It's an item "anyone" can buy as opposed to, for example, a piece of military equipment.

    @Denny39 - I'm an electrical engineer and work in the field of electromagnetic interference reduction/electromagnetic compatibility.
     
  12. Elad1002

    Elad1002 senior

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    @HoneyB
    I did not know the difference and went with a commercial off the shelf knee because I left it up to my surgeon, wish I had known better. I'm worried about the metals now.
     
  13. Denny39

    Denny39 senior
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    @Elad1002
    Having spent 52 years in the metal working industry, before my TKR I was naturally curious about the metals. As a Class A general machinist back in the 70’s, I was briefly involved in the manufacture of joint replacement components. The metals most frequently used are Cobalt-Chromium and Titanium. These metals have been in use for orthopaedic applications for decades. They are used not only for artificial joints, but plates and screws for broken and shattered bone repair. Adverse reactions are extremely rare. Custom implants would most likely use the same materials. The custom part would most likely be only in the design, although there are ceramics that are sometimes used.

    You can google the question if you would like more information, but You really should not be overly concerned. TKR has a very high success rate, all things considered.
     
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    Last edited: Feb 9, 2019
  14. Denny39

    Denny39 senior
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    @HoneyB
    I majored in electronics in High School, but wound up in the Metal-working industry. After 16 years of proto-typing aerospace parts, primarily for NASA and JPL, I morphed into a Manufacturing Engineer for high volume production. Now retired, I work from my home office designing Tooling and Fixturing, and Project Management. I love being able to go to work in my bathrobe at 8:30 or 9:00 in the morning.
     
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  15. HoneyB

    HoneyB senior

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    @Elad1002 - No need to be concerned. Four friends and I got knee replacements at about the same time. Two of us got custom knees and the other three got off-the-shelf knees. We're all doing equally well. The materials are the same, and I was happy to hear that the custom knees were made from tried and true materials. The difference is that, with a custom knee, the patient gets a CT scan, that scan is used to 3-D print a mold of the patient's bone structure, and the custom knee is built to exactly fit the patient. It's kind of like if your shoe size is 6-1/4, you don't have to pick which works best between a 6 and a 6-1/2. With standard knees, the surgeon picks the closest size and makes it work. With the custom knee, it's correctly sized and ready to insert. It supposedly results in an easier, faster surgery and an easier, faster recovery. I think my recovery might have been faster in the first few weeks, but leveled out with that for standard knees after that. Don't fret about it. As I said, the custom knees haven't been around as long so I have to hope mine last as long as the tried and true standard knees.

    @Denny39 - I've worked from a home office for 32 years, since my oldest child was born. When I was offered that opportunity 32 years ago, after taking a leave of absence from my job to be with my baby, I figured my home office job would last 6 months to a year. Now I'm at 32 years and counting. It has its pros and cons. I was home with my children, and now my grandbaby, but I'm never really away from work. My customer is open 365/24/7 so it's easy to get caught up in work during non-work times. I've always had a separate room as my office and had regular work hours. I've worked with people for many years without them ever realizing I was working from home. I started out in 1987 with an IBM PS2 computer and a dial-up modem. Things have come a long way for teleworkers.
     
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  16. Denny39

    Denny39 senior
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    Had to do some thinking last night. Came home from dinner and crashed into my comfortable chair, a bit frustrated and maybe even a little bit discouraged. About 3 weeks ago, someone said to me, “You need to get rid of that cane”. The absurdity and in-appropriateness of that comment for some reason just didn’t register, and I let it roll around in the back of my mind. I still haven’t “gotten rid” of the cane. I do walk around the house without it a lot; sometimes even forgetting where I last used it and left it. Then when I need it, I wind up searching for it. In the morning, I can usually walk for awhile, almost without a noticeable limp. But as the day wears on, the pain and the limp increase. After sitting for awhile, I have to stand still and steady myself before taking those first two or three precarious steps, and by the end of the day, I am obviously a handicapped person.


    So I wound up asking myself, “Am I really making good, or even satisfactory progress; or am I kidding myself and reaching for straws?” Then I realized that I was blaming everything on my still almost brand new knee. So I started focusing on just that new knee, and how much progress it has made.


    l When I sleep on my side, I usually pull my knees up toward my chest. 3 weeks ago, I still couldn’t do that. Now I can, and it doesn’t hurt.

    l I still have an easy 135 degrees flexion with only minor discomfort.

    l Almost all of the swelling and peripheral muscle and tendon pain is gone.

    l When I put my full weight on it, there is a sharp pain just below the Patella, but as soon as I take the weight off, it immediately goes away.

    l It’s not real easy, but I can put on shoes and socks unassisted.


    So why am I still not seeing significant improvement in the way I walk? I realized that my new knee is actually an innocent victim. There are others factors at work here. I have had a chronically bad low back all of my life. I was seeing a Chiropractor in Grade School. At age 40 I was told that I needed back surgery. When I said no, the surgeon said, “You can have it now, or you can have it 5 years from now, but you’re gonna have it”. I never had it. L4 & L5 self-fused about 6 years ago. But with all of that my back has never really been a serious handicap, and many who know me have no idea I have that problem.


    But also, for all of those years, it was supported by 2 good knees and strong legs. Now, with my Right knee just as bad as my Left knee was Pre-op, my bad back now has no substantial support, and neither do my seriously compromised knees.


    So the problem is somewhat more complex that I had originally realized. Instead of the problem being confined to “My lower Left mobility quadrant”, my whole drive train is a mess! I now see, as Paul Harvey used to say, “The REST of the story”.


    It made me wonder how many others who are having doubt and discouragement issues in what is still an early stage for a long-term recovery, may not be seeing and considering all of the factors at work, “The whole story”. For some, there are identifiable causes, lousy PT being not an uncommon culprit. But for others, it may be comforting to focus specifically on the progress of the surgical recovery, and factor in other things that may be going on.

    I now realize and am somewhat resigned to the fact that with my Right knee definitely needing to be replaced as well, I’m probably looking at another 1 1/2 years before anything like full recovery. My choice is between spending that 1 1/2 years in rehab, or learning to navigate a wheel-chair. As the Johnny Cash song goes, “I don’t like it, but things just happen that way”.


    But I have concluded that my new (and newly exonerated) knee is apparently making satisfactory progress.
     
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  17. NavyGunns

    NavyGunns FORUM ADVISOR Forum Advisor

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    @Denny39, great analysis of your current situation. Before I had my PKR, most people didn’t know I had a bad knee unless I either told them or they were with me when I’d do something it didn’t like. Many asked me why I was having my PKR when I was still able to do so much without much pain or issue. Part of it was I was starting to see signs of it bothering me more and more. I also didn’t want to wait till I was much older and at a point pain and activity wise where recovery would be more difficult.

    From what you’ve shared, I would agree your knee is doing very well but the rest of your issues are now more highlighted as a result. Get your other knee fixed. That will help with your back.
     
  18. Denny39

    Denny39 senior
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  19. Jockette

    Jockette FORUM ADVISOR Forum Advisor

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    It is so hard to tune out comments like, it’s time you give up the cane. Nobody knows that time but you.

    I had one of my favorite friends ask me when I was going to give mine up. I didn’t need it at home but for some reason, I was not confident without it if I was out somewhere, and my balance was still off at 3 months. Though she’d had a hip replacement, she hasn’t had a knee replacement.

    I did fall to her peer pressure and used it less, especially when I was around the people in my 55+ community, but it’s sad that others, even as well meaning as they are, and as much as some of them truly care about us, put pressure on us. They probably have no idea how shaky our confidence is in our recovery that we were totally unprepared for.
     
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  20. NavyGunns

    NavyGunns FORUM ADVISOR Forum Advisor

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    @Denny39, good luck! My bet is you’ll start getting anxious and wish it was sooner the more your right knee heals!
     

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