The TKR Experience (or...Wish I Had Another Kidney Stone)

Most Important...  Everyone heals at their own pace.  Don't judge yourself by anyone else's progress.  This is between you, your PT and your doc.

That being said...here are some "ballpark" estimates...

1. Medication...  Take your pain meds.  This is not a test of endurance.  Need 'em?  Take 'em.  Ballpark... Most people are off the the opioids in 4-6 weeks; some need them longer.  800mg Ibuprophin or Tramadol (both RX) after that if you need it.  The opioids will make you constipated and possibly dependent.  Nobody wants something highly addictive in their medicine cabinet; toss them as soon as you can.

2. Pain... A TKR is really, really, really, really painful...no getting around it...especially the first month.  Don't measure your pain levels daily...monthly is better as you'll see dramatic changes from the longer time span.  Ballpark... The worst of the pain will probably be gone within 90 days...but again, everyone's different.   

3. Assistance...  Crutches, walker, cane...whatever you need for as long as you need it.  Ballpark... Most people are off of all those items within 90 days but the sooner the better.  Gotta start to learn how to walk on your own again...sometimes, you have to push it. (NOTE: This may not apply to people with previous hip/knee/leg problems or to the elderly.)

4. Pysical Therapy...  Gotta do it.  Your therapist will work with you to both straighten and bend your knee.  Full range of motion is zero degrees straight and greater than 120 degrees bent ( 0 / +120 ).  I started at -14 / +84 and finished 9 weeks of PT at -1 / +128.  Ballpark...  Depending on age, previous conditions, individual circumstances, you should shoot for the full range of motion goal.  If you can't get there at PT (I was still one degree from straight), finish the work in the gym or therapy pool.  The closer you get the better...but again, everyone's different.  You should consult with your doc and PT.  Who wants to walk with a limp or a cane the rest of their life???

5. Exercise...  After PT, ya gotta rebuild the muscles in your leg, especially the quad.  Walking, swimming, stairs, whatever.  You have to rebuild your strength to support the knee.  Ballpark...  Since it's during and after PT, this work usually falls within the 3 to 6-month range for most people.  My daughter has been an ACSM- and ACE-certified personal trainer and graduate nutritionist for the past 16 years.  Her recommendation: Build endurance before strength.  Warm up on a bike for 30-45 minutes (set the seat high enough for full leg extension)...then do your stretches.  For your exercises, start with NO weight but perform 3-4 sets of 12-15 reps each until you are at ease with every exercise and are not tired out by them.  Use your good leg to stabilize yourself during the the exercise...don't use the good one to fake the reps.  The idea is to get the bad leg as strong as the good one before you fully exercise them together again or even isolate the bad leg for exercise.  Once you can't tell one leg from the other (feeling balanced and not relying on the good one), start adding weight...slowly....like 5 pounds at a time, again using the good leg to stabilize yourself.  Any pain, strain or swelling means you did too much too fast.  Back off...you'll eventually have equal strength in both legs.  PS: I guess people with BTKRs can do both legs together...I'd have to ask her.

6. Swelling...  This is the knee's way of telling you that you overdid it.  Back off, ice, elevation, rest.  Ballpark...  Everyone does this at one point or another.  Listen to and learn from your body.  Avoid pushing it too far.  There's a fine line between progressing and heading off the cliff.  Everyone has to find that sweet spot for themselves.

7. Sensations...  There will be numbness at the incision site.  Nerves have been cut.  Ballpark...  Crapshoot; normal feeling may come back or it may not.  Some people have an uncomfortable sensation of the knee rubbing against clothing or sheets.  Hint: Wrap the knee loosely with an Ace Bandage or buy a "knee sleeve" and slide it on over the knee.  Easy Fix.

8. Sciatica...  If you've never experienced this intense pain from your back, through your hip and then running down your leg, be thankful...be very, very thankful.  On occasion, the sacroiliac (SI) joint on one or both sides of your hip will lock up and pinch/inflame the sciatic nerve.  This happens because we change our gait to compensate for the knee pain.  In layman's terms, "you threw your back out."  Ballpark...  Some people get it, some don't...another crapshoot.  Possible solutions: steroid injections, Celebrex, Lyrica, 800mg Ibuprophin, chiropractic, therapy pool, accupuncture.  Whatever works; talk to your doc.  It's temporary but painful; cross your fingers and toes that you don't experience it.

9. For simple discomfort that doesn't need RX painkillers...  Aside from the standard OTC pain meds, here's a suggestion: Voltaren Gel (diclofenac) is a nonsteroidal anti-inflammatory drug (NSAID). It works by reducing substances in the body that cause pain and inflammation.  Voltaren is used to treat mild to moderate pain, or signs and symptoms of osteoarthritis or rheumatoid arthritis.  I use this almost every night; just rub it in.  Works in 10-15 minutes. RX only.  Get your MD to write a script for lots of tubes (I got five right out of the box.).  Checked with a few pharmacists about an OTC pain relieving cream...they all told me to get my doc to write a script for Voltaren.  Don't think about it; just do it.

10. Post-Op Depression...  No one..NO ONE...talks about this, not even the docs.  Found out the hard way when I had my hip replaced in 2009.  Hospital, rehab facility then home.  Started crying and couldn't stop for three days.  Called my MD cousin.  Told me that it was Post Operative Depression.  This is a KNOWN condition that occurs frequently in people who have had an operation that removed an original part of their body.  Not so bad for appendix, gallbladder, etc.  Moderate to severe for hips, knees, shoulders, etc.  Really bad for heart transplants, traumatic brain injury, etc.  For us, it's a definite possibility so be prepared.  Blown away for three days with the hip until I knew what it was.  Gone in 24 hours because I was now aware of it.  For the knee, I was totally prepared.  Kicked its butt.  Remember...this is a definite possibility so be prepared.  If you start feeling really sad and you're crying all the time post-op...now you know.  Get out of the house into some sunshine.  Take extra Vitamin D.  Eat healthy; hydrate.  Do not let this get to you and do not start anti-depressants.  This is a temporary condition.  Concentrate on pain management and rehab...PT and gym...endorphins do wonders in combatting depression.  Get on top of it, wrestle it to the ground and beat the everlovin' crap out of it.

11. Long Recovery...  That "swollen look", popping and clicking sounds, stiffness...all normal.  Ballpark...  All of this should resolve in 12-18 months...or maybe it won't.  Who the hell knows...I'm just thankful that I'm walking again and not in a wheelchair for the rest of my life.  Goal...get back on my skates again.  After 44 years playing hockey, it's been too long.  I'll never play the sport again but just skating would be soooooo great.  Just have to see what happens.

12. Goals...  This is easy.  SHORT TERM (3-4 months): Get off the opioid pain meds; switch to non-addictive pain killers if you need them.  Use the Voltaren Gel.  Go to PT and get your full range of motion back (0 / +120).  Toss your walking aids.  MID-TERM (4-12 months): Rebuild your leg and core strength.  Complete any range of motion therapy/exercises so you are walking normally, especially up and down stairs.  Start adding close-to-normal activities, like walking a mile every day if that was your "thing".  Begin with a lesser distance and increase without any knee swelling.  LONG TERM (12-18 months and beyond): Set realistic goals for leading a fully normal life again...as if the TKR had never happened.  However, there may be activities that you once did and must now avoid.  For me, I can skate but not play competitive hockey ever again.  For others, running may be bad because of impact issues while speed walking might be a good substitute.  There are plenty of on-line resources that list OK, possible and "never again" activities for people with knee and hip replacements.  Your doc will probably have his/her own ideas but this is from The Mayo Clinic: "After you've recovered, you can enjoy a variety of low-impact activities, such as walking, swimming, golfing or biking. But you should avoid higher impact activities — such as jogging, skiing, tennis and sports that involve contact or jumping. Talk to your doctor about your limitations."  I saw one site that listed singles tennis as a no-no but doubles was OK becuse there was less movement and impact.  It's all very individual but the ultimate goal is to lead a healthy, active, productive life again...a far cry from lying in bed in utter pain one week post-op.

Did I miss anything?

43 likes, 339 replies