little red canoe
graduate
Like you Cratchit I thought Josephine did no exercise. I didn't read her threads. Did you?
TKR Ten weeks later . . .<<'
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Try reading them. Especially the first one. She came home alone, was dumped at the door by a taxi, took her own bags inside, climbed her stairs a couple of times and had her nesting area all set up by the time her brother arrived, to help for a few days. It's true she did no formal exercises, but if what she did is not exercising, what is?
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Cratchit
senior
I did actually, which makes Josephine's signature all the more misleading as it states that she did 'no exercise', a claim which she herself promotes. Of course ADL is a form of exercise but my point remains; for some this is not enough and with a changing profile of the TKR patient, this may be the case more often - and in this l am referring not just to age but to sports and activities which exact a cost upon the joints hitherto unseen.
Karri, Celle and Jamie are all saying the same thing regarding strengthening exercises at my stage of recovery and l agree with them; their advice is grounded and sensible and l'm grateful for it. The issues here, however, are more than just exercise v ADL v whatever.
Spex10
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I agree with @Cratchit. Her points are regarding a specific group of people who are different from the typical knee replacement candidates of yesteryear. So many people have told me that I'm 'too young' for TKR and that they thought it was something you had to be in your 70s/80s to have. I suppose that all the exercise and sports fans among us have worn our poor knees out or like @Cratchit have had accidents on top of 30+ years on their feet on the wards.
I know that I need to exercise my new knee now but am held back by my old one. Ain't life grand!
I know that I need to exercise my new knee now but am held back by my old one. Ain't life grand!
little red canoe
graduate
I had to have a TKR for one reason. Result of an accident. The other knee is not in need of replacement. I spent 46 years with out medial cartilage as a result of a skiing accident in 1971.
Funny that knee never hurt till a couple of years ago and then only occasionally. Then in 2015 things got much worse.. Making paddling and portaging a canoe excruciating. Until then I spent 70 nights on canoe trips usually alone.
I think ADL till four months are fine.. Now I am home just shoveled 25 inches of snow and my knee is not quite ready for that but it had to be done.. It continues to be winter with temps below freezing for the next week at least.
I don't know what a typical knee replacement patient is. My neighbor had his done 20 years ago at the age of 39 and my sister in law 20 years ago at 53. The former is a marathon cyclist now and ice climber.
I don't think age has anything to do with anything but I see a lot of ageism in posts.
Funny that knee never hurt till a couple of years ago and then only occasionally. Then in 2015 things got much worse.. Making paddling and portaging a canoe excruciating. Until then I spent 70 nights on canoe trips usually alone.
I think ADL till four months are fine.. Now I am home just shoveled 25 inches of snow and my knee is not quite ready for that but it had to be done.. It continues to be winter with temps below freezing for the next week at least.
I don't know what a typical knee replacement patient is. My neighbor had his done 20 years ago at the age of 39 and my sister in law 20 years ago at 53. The former is a marathon cyclist now and ice climber.
I don't think age has anything to do with anything but I see a lot of ageism in posts.
Spex10
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Maybe TKRs are typically done in younger people in the US? I suppose its a very expensive operation so NHS needs to make sure a replacement lasts as long as possible so avoids doing it too soon. I certainly know several people who have terrible knee pain who have been told they are 'too young'!
Technology has moved on though so maybe with that and shorter operating times and less time in hospital costs will come down? Hope so for the sake of those leading such restricted lives due to knee pain.
Technology has moved on though so maybe with that and shorter operating times and less time in hospital costs will come down? Hope so for the sake of those leading such restricted lives due to knee pain.
KarriB
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I think it all depends on the OS here in the US. Some like you to wait until you're older, but others are willing to perform TKRs on younger individuals. My best friend, Susan, was 51 when she had her TKR which was due to a sports injury when she was younger. Susan does have RA, but not OA, so chances are she won't need the other knee done.
@Cratchit and @Spex10
We do realise that some people have expectations of being more active and athletic than others, and that some are younger.
That doesn't alter the fact that during a knee replacement the knees receive just as much trauma, no matter whether you are 40 or 80. That means that your knees are wounded and need time to heal before they are subjected to a lot of demanding exercise. Over-zealous exercise won't make them heal faster, and it can impede progress at that stage.
By all means go on to do more rigorous exercise if you wish, but not until your knee has had time to heal sufficiently. In the first couple of months, the activities of daily living are sufficient exercise. At that stage, it's unwise to do lots of exercise aimed at forcing the knee to increase ROM, because the knee simply can't bend until it has healed enough for much of the swelling to go down.
Have you read the revised version of the mantras? We don't call them that now. We call them recovery guidelines. You might find them more acceptqble:
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:
3. Do what you want to do BUT
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
We do realise that some people have expectations of being more active and athletic than others, and that some are younger.
That doesn't alter the fact that during a knee replacement the knees receive just as much trauma, no matter whether you are 40 or 80. That means that your knees are wounded and need time to heal before they are subjected to a lot of demanding exercise. Over-zealous exercise won't make them heal faster, and it can impede progress at that stage.
By all means go on to do more rigorous exercise if you wish, but not until your knee has had time to heal sufficiently. In the first couple of months, the activities of daily living are sufficient exercise. At that stage, it's unwise to do lots of exercise aimed at forcing the knee to increase ROM, because the knee simply can't bend until it has healed enough for much of the swelling to go down.
Have you read the revised version of the mantras? We don't call them that now. We call them recovery guidelines. You might find them more acceptqble:
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.
elevate
ice
take your pain meds by prescription schedule (not when pain starts!)
don't overwork.
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.
b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.
5. Here is a week-by-week guide for Activity progression for TKRs
By the way, I had my first knee replacement when I was 59 (considered young at the time) and my last when I was 72. I've done it when both young and elderly. I can't say I experienced much difference between the recoveries, and I am pretty active now.
little red canoe
graduate
Well I snowshoed some four miles. My knee feels fine but the rest of me is so out of shape its embarrassing!
I think its time to
stop fretting about the knee
and worry
about the rest of me.
I think its time to
stop fretting about the knee
and worry
about the rest of me.
Spex10
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@Celle thanks for the updated guidelines. I entirely agree about letting knees heal. TKR is certainly a most traumatic shock to the body and recovery time is important.
I wonder whether muscle tone differences between previously fit and active 50 year olds and more sedentary 80 year olds makes a difference to recovery time? I had heard that it was easier for older people with poorer muscle tone to achieve good ROM than younger ones whose muscles and ligaments are stronger at the time of the operation thus offering more resistance. I was very jealous of two older ladies who were operated on at the same time as me. Their ROM was so good and mine just got worse!
I wonder whether muscle tone differences between previously fit and active 50 year olds and more sedentary 80 year olds makes a difference to recovery time? I had heard that it was easier for older people with poorer muscle tone to achieve good ROM than younger ones whose muscles and ligaments are stronger at the time of the operation thus offering more resistance. I was very jealous of two older ladies who were operated on at the same time as me. Their ROM was so good and mine just got worse!
I know that muscle tone does play some part in recovery. I waited 9 years for my first knee replacement, because of the perception that I was "too young". During that time, I lost muscle tone and strength and some of my tendons and ligaments distorted. Although I had a PKR, not a TKR, my recovery took a long time. I didn't have any problems with ROM, but it took a while to regain muscle strength. I did, eventually, become very active again and that PKR served me well. I gave it a hard time in my daily life and it lasted 11 years.
I learned my lesson and I had my last TKR as soon as my knee was ready. I lost no muscle strength. Again, ROM wasn't a problem and, because my soft tissues were in good condition pre-op I think I had an easier recovery.
I have frequently read that older people don't seem to experience as much pain post-op, but otherwise I don't think their age makes for an easier recovery. It's likely that they have also acquired some tendon and ligament distortion, which can take a long time to resolve post op. I'm thinking of people whose knee wouldn't straighten fully. It takes a long time for their soft tissues to lengthen again.
I don't think muscle tone affects ROM. What's happening inside the knee itself affects that - trauma and swelling.
Having said all that, I have to remind us all that every knee is different and every recovery is different. I don't think that we should generalise.
Want2hike
member
That's where I am. As both my knees deteriorated over the last two years, I gained weight and got out of shape as my activity was limited. My knees are now fine but I'm still a bit slow and the rest of me aches after hiking because I'm still too heavy and out of shape.
Spex10
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Gosh I wonder why older people don't experience as much post op pain? I'm 62 but didn't seem to experience as much pain as some of the people I've read about on here. Of course pain is subjective and hard to exactly compare but I was d/c on paracetamol only and didn't take them for longer than a few weeks. After my MUA I was fine too. Maybe I'm just old for my years!!
Josephine
NURSE DIRECTOR EMERITA
It's a misnomer that any group of people do/don't experience more/less pain than another. The only thing I know for sure that influences post-op pain is how rough or gentle the surgeon was with the tissues during the surgery. I've seen plenty of examples and not only in orthopaedic surgery.
jaschembra
post-grad
My 84 year young mother had her TKR last July and mine was January. She never took pain medication prior and took very little post surgery. One thing I've discovered- regarding my upper body strength and overall stamina, I was much better during recovery than my mother. However, it is my thought that if you only took the knee joint into account, age makes no difference. A TKR is going to heal and recover (during those first few months) at its own pace no matter your age. I had thoughts going into this journey that if my mom was xyz at 12 weeks, I would be xyz at 6-8 weeks... well, that's just not the way it works! In my opinion. 
little red canoe
graduate
I think that is part of why I am so tired. For a while my back hurt too. Thankfully that is past.. But I am still OOS( out of shape) due to not wanting to walk for the last year.
I think my surgeon was pretty gentle. I would recommend him again.
@little red canoe - I edited out your repeated quote of my post.
My knees are fitter than the rest of my body. I definitely lost some condition in the past 5 years. I'm not sure if that was the result of the surgeries, or because I'm getting older.
My knees are fitter than the rest of my body. I definitely lost some condition in the past 5 years. I'm not sure if that was the result of the surgeries, or because I'm getting older.
newlybionic
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I had two TKR on the same knee in 8 months ( a total revision by a different surgeon) so I was basically the same age for both. Even though my revision was a tougher surgery since they had to chisel out the old prosthesis first and cut more bone I believe that because the second surgeon was much more adept I had far less pain Post op. After a couple of weeks I had cut back all pain meds to tramadol at night. So as far as I am concerned I truly believe it's a skill of the surgeon. Lest you think I am an old lady just gardening I work on my feet 10 to 12 hour days as a nurse. It is quite labor intensive.
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OP
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Cratchit
senior
Wow, what a lot of interesting discussion I`ve missed since I`ve been concentrating on my tooth!
I think age is only an issue in as much as it seems (in the UK at least) that surgeons are performing TKRs at a much younger age, ie when they`re needed as opposed to at an age where they will likely see you through the rest of your life. Technique and other advances prostheses etc have made it a much more successful procedure in the hands of a skilled surgeon, though I still shudder at the thought of having a TKR as a day case!
Celle, thank you for posting the updated recovery guidelines - it does seem more appropriate to call them a guideline rather than a mantra as the former seems quite rigid and the latter, just what it is, a guideline! I think we have similarities in that I have good ROM but need to work on strengthening. You said that 'I learned my lesson and I had my last TKR as soon as my knee was ready.' What does that mean in terms of planning for surgery on the other knee? I ask because my non-operated knee is sans cartilage, creaks like an old gate and is prone to giving way. It is damaged simply due to carting and compensating for the damaged (L) knee for all these years. When did you know your other knee was ready? It`s encouraging to hear how active you are and how fit your knees are.
little red canoe my body, too is so out of condition! I think I lost a lot when I stopped riding after my pony died. There`s an incredible amount of workout involved in just caring for and riding a horse which I hadn`t really appreciated at the time or the extent to which my body would change once I was equine-less. Summer is approaching so opportunities arise, (R) leg permitting!
Newlybionic, I simply cannot imagine having two TKRs on the same knee within 8 months, I really can`t. How do you find the 12 hour shifts? What kind of nursing do you do? I`m hoping to have a phased return to work week commencing 27th March then used my accumulated annual leave to further reduce my hours over the few weeks between returning and retiring.
On a very positive note, my knee has been amazing since I`ve been taking all these painkillers for my tooth! It is less swollen and more bendy and I haven`t needed to use the stick at all this week. Even the incision is much better, reduced in size and no longer sensitive. My tooth, however, oh man! I had root canal fillings x 2 yesterday and a temporary dressing/filling left in situ. The gum, which had developed a very large, bulbous swelling on it since the other tooth was closed, was incised and drained and left open and has continued to drain nasty tasting yellow gunk ever since. The swelling on my cheek which extended to just below my eye and up the side of my nose, has reduced considerably and is now much more comfortable. I haven`t been prescribed antibiotics but previously I have had penicillin, which it was resistant to and metronidazole which seemed to shrink it before it reformed. Interestingly, during my TKR I had a shot of teicoplanin and this was most effective in dealing with the swelling. Not a pleasant thought! Luckily I like gunk and stuff so have been quite happy to milk this bad boy. I can`t deny that it is painful though. I`m just relieved that finally, after 10 months, there seems to be good improvement. I just hope it doesn`t return.
I think age is only an issue in as much as it seems (in the UK at least) that surgeons are performing TKRs at a much younger age, ie when they`re needed as opposed to at an age where they will likely see you through the rest of your life. Technique and other advances prostheses etc have made it a much more successful procedure in the hands of a skilled surgeon, though I still shudder at the thought of having a TKR as a day case!
Celle, thank you for posting the updated recovery guidelines - it does seem more appropriate to call them a guideline rather than a mantra as the former seems quite rigid and the latter, just what it is, a guideline! I think we have similarities in that I have good ROM but need to work on strengthening. You said that 'I learned my lesson and I had my last TKR as soon as my knee was ready.' What does that mean in terms of planning for surgery on the other knee? I ask because my non-operated knee is sans cartilage, creaks like an old gate and is prone to giving way. It is damaged simply due to carting and compensating for the damaged (L) knee for all these years. When did you know your other knee was ready? It`s encouraging to hear how active you are and how fit your knees are.
little red canoe my body, too is so out of condition! I think I lost a lot when I stopped riding after my pony died. There`s an incredible amount of workout involved in just caring for and riding a horse which I hadn`t really appreciated at the time or the extent to which my body would change once I was equine-less. Summer is approaching so opportunities arise, (R) leg permitting!
Newlybionic, I simply cannot imagine having two TKRs on the same knee within 8 months, I really can`t. How do you find the 12 hour shifts? What kind of nursing do you do? I`m hoping to have a phased return to work week commencing 27th March then used my accumulated annual leave to further reduce my hours over the few weeks between returning and retiring.
On a very positive note, my knee has been amazing since I`ve been taking all these painkillers for my tooth! It is less swollen and more bendy and I haven`t needed to use the stick at all this week. Even the incision is much better, reduced in size and no longer sensitive. My tooth, however, oh man! I had root canal fillings x 2 yesterday and a temporary dressing/filling left in situ. The gum, which had developed a very large, bulbous swelling on it since the other tooth was closed, was incised and drained and left open and has continued to drain nasty tasting yellow gunk ever since. The swelling on my cheek which extended to just below my eye and up the side of my nose, has reduced considerably and is now much more comfortable. I haven`t been prescribed antibiotics but previously I have had penicillin, which it was resistant to and metronidazole which seemed to shrink it before it reformed. Interestingly, during my TKR I had a shot of teicoplanin and this was most effective in dealing with the swelling. Not a pleasant thought! Luckily I like gunk and stuff so have been quite happy to milk this bad boy. I can`t deny that it is painful though. I`m just relieved that finally, after 10 months, there seems to be good improvement. I just hope it doesn`t return.
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