TKR When do you know?

YiaYia Joy

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I am a 65 year old female with knee pain, both knees. The MRI of my right knee shows a complex ACL tear, multiple meniscus tears, no cartilage, and fluid, cysts, etc. I saw an orthopedic surgeon in July, and although he had not seen the MRI results (it was ordered by an ortho doctor who does not do TKR surgery), he did an x-ray of both knees and agreed that TKR would be in my future. He ordered PT for five weeks, and a followup visit with him this week.

PT has been very helpful. My therapist did see the MRI results and said it looked awful. So, although PT has helped me with pain management, I am not sure what to do going forward. My last PT appointment is this Monday, and I see the surgeon on Thursday. I know there is no repairing, or reversing the damage done, and I am tired of being afraid to move. I want my previous level of activity back. Do I push for the surgery, or continue to focus on exercise, pain management, strengthening for the long haul. I am tired of my knee problems ruling my life. I am tired of feeling like cripple, limping, and hobbling every time I exert myself just a little. Can anyone tell me when it is the right time to push for the TKR surgery???
 

58hippain

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You will know when its time. I pushed though hip pain for years. A few months ago the pain started effecting my quality of life, my part time job, my ability to play with grandkids, pain getting on and off pontoon boat. I had THR left hip one week ago Monday. The joy of those first few steps was incredible. When its time get it done,
 

Gingerbread

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I honestly wish I would have waited. But, I inevitably would have needed this as I was bone on bone as well, had a valgus deformity, pain that woke me at night a few times a week, and prohibition in some of my activities. I did not have severe pain when walking though, and could still do all my low impact exercises regularly.
I guess it really is dependent on what you can tolerate. This surgery can have a brutal recovery (my case) or easy (some people on here-which is amazing and awe inspiring!). Even though I am a nurse I was not prepared for the severity of this.
I would say pray for the best but prepare for the worst. This forum is a Godsend :)
 

Susie-Q

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I've always wondered this too. When would I know. I had my first one done 11 years ago and I was in a lot of pain prior, I even had my dr get me a wheelchair pass so I could park closer prior to surgery. My second knee has been slowly getting worse and worse over the years but very slowly. This year I finally wore it out doing a lot of work on our house getting ready to have my FILs 90th birthday party here. I was in so much pain after that party, I lost range of motion (I can't bend it more than 90 degrees) and even my flexion isn't as good as my other knee. I finally said I need to get it done. Now that it's on the calendar, I think it knows as it's hurting a lot more with dog walks, shopping, housework, etc. Very glad I have it scheduled even though I know the recovery will be long.
 

NightQuilter

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Welcome to BoneSmart @YiaYia Joy ! There will be others on here soon to outline many of our resources available to you as you decide how you want to approach your pain and future. One of the adages on BoneSmart is that when the pain is affecting your quality of life, it is time. You will find folks on here who have had a bilateral TKR - getting them both done at the same time. That is what I had for my hips and was scheduled for on my knees, but blood oxygen levels after the first knee made me come back for the 2nd knee. I put my knees off for 4 years with hyaluronic ("rooster comb") injections, which would give some relief. Were I to have to consider wait or go again, I would not put the replacement off. As you can see on my thread, post-knees, I have been able to hike a lot and am enjoying life.
 
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YiaYia Joy

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Wow!! Thank you. This is very helpful.
 

Daveboy1810

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Hey YiaYia Joy, Sounds to me like you are ready right now, and should schedule your surgery as soon as possible. The longer you wait the longer you will suffer and the shorter the quality time with new knees will be.
The doctor may offer a cortisone shot. I got one only to find out my insurance company would not pay for TKR unless I waited 3 months after the cortisone shot. Not sure if Medicare has the same restriction, you should check.
The other thing I would keep in the back of my mind is Covid-19. If this new variant gets really bad, elective surgeries may be put on hold. Also, My primary care physician told me I should limit my hospital stay because the variant is spiking in the hospitals in my area. I limited my stay to 1 night.
 
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YiaYia Joy

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I feel like I am about 90% sure it is time to move ahead. I had a cortisone and get injection on June 28th. The surgeon said he would not perform TKR within 3 months of this injection. He also said he would never recommend someone get cortisone/gel combination injection, which is what the other physician gave me. I am not sure why he said that, and was too surprised to ask. The questionnaires folks have sent me have been very helpful.

I am concerned about the Covid situation. Hospitals are getting overwhelmed again, and infection rates are on the rise. I was wondering if I would be treated as "outpatient" or if they would require an overnight stay.

I have prepared a list of "pros/cons", as well as a list of questions for the appointment I have this Thursday with the surgeon. I am interested to see what he recommends after viewing the results of the MRI had done in June.
 

Susie-Q

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@YiaYia Joy my surgery was just changed to outpatient. I had planned on staying one night in the hospital, which is actually an orthopedic-only unit. I met for my pre-op last week and was notified that if I still wanted my surgery on Aug 30th that I needed to do it as an outpatient. They reassured me that I was at the top of the list that they would recommend for that anyway because of my age, no other health issues, I'm still fairly active, etc. I agreed as I don't want it postponed or as @Daveboy1810 said, should surgeries be put on hold in the near future. Good luck!
 

Roy Gardiner

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I am tired of my knee problems ruling my life.
Decision made, then, IMO

My personal take on TKR:

- if your knees rule your life , it's time
- take charge, don't be dictated to; it's your knee, your future
- don't believe in either horror stories or miraculous recoveries that happened to 'a friend of a friend'
- there is no such thing as too young or too heavy or even obese for TKR
- choose a specialist surgeon who does several hundred TKRs a year. Ask the nurses, if you can; they know who's best
- all replacement knees are very similar, don't believe that a special new one will give magical recovery -- it's the skill of the surgeon that counts
- if you need two done, think carefully about the time gap between surgeries, it's not a trivial decision
- try to plan for at least 12 weeks off work
- your recovery is your time to be selfish and idle; plan to embrace this, you'll need it
- don't think you can work hard (even if you're an athlete ) to speed recovery, healing works at its own pace
- look at our FAQ (Frequently Asked Questions) thread and for full reference the Library index.

- finally, if there's any part of this that you aren't clear about, ask here; it's what BoneSmart's for.
 

Susie-Q

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I could swear my knee knows the clock is ticking......ADLs are getting more and more painful each day. :unsure:
 

Bikeknit

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I think, but am not sure, that in the U.S. doctor's have to demonstrate that they have tried conservative treatment (physical therapy, cortisone injections, ...) before knee replacement to satisfy insurance companies. So those of those who wait til the damage is extensive before seeking help still go through those treatments. And to be truthfull, both cortisone shots and PT helped me some. But you have the three criteria - pain, poor function, x-rays/MRIs showing severe damage. I suspect the surgeon will be fine with going ahead with surgery if you're ready.
 

jaspa

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I can tell you I probably waited way to long to have the surgery and should have had it done a few years ago (about 4 yrs) as now I can't go walking and didn't realize how bad it got due to being home because of Covid. Now I'm looking forward to it but getting scared too.
 

Susie-Q

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The closer I get, the more my knee is hurting. It's aching at night now too, I wake up and can't get comfortable. I realized today I can't walk my dog anymore, it's too painful.... :sad: I'm using the ice machine all the time now.
 

GZGirl22

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Cortisone helped me a lot and lasted quite a long time for me, but after 3 shots and knowing I was bone on bone, I finally had to face up to the need for surgery. When I had the last cortisone shot I scheduled the surgery for 6 months later (1st shot lasted almost 2.5 years, 2nd half that time, so I figured 6 months and it would be wearing off.

I benefited greatly from PT. After discharge I continued to do the exercises and increase the strength training. It helped a lot with both function and pain, but even with the cortisone my ability to walk distances went from 3-4 miles a day to 1.25 before the knees would grind. I was also getting a burning pain in the knees at night, sometimes bad enough to wake me. That made up my mind for me.

Plus I wanted to do it before my gait changed and started to impact other joints due to my compensating for the knee.

It is different for everyone but most folks say they wish they had done it sooner.
 

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