The TKR Experience (or...Wish I Had Another Kidney Stone)
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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
elizabeth_59334 CHICO_MARX
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CHICO_MARX elizabeth_59334
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There will be advances, setbacks and plateaus (the worst because you think you're stuck...you're not). Be prepared mentally for this...the depression is only an illusion. Stay strong, eat healthy, lose weight, hydrate a lot, finish the PT for the ROM and then hit the gym to rebuild your quads, glutes and core, sleep a lot (you're healing), don't compare yourself to anyone else. This is very, very challenging. Don't EVER give up on yourself!!! Walking with a cane for the rest of your life is NOT an option!!!
"Never give up. Never surrender." - Tim Allen, Galaxy Quest
mary12001 CHICO_MARX
Posted
I don't understand it. I had the operation 9 months ago and I feel like I've been in a car crash.
I was so much healthier before the operation.
Now I'm like a dying rat all the time.
I can't believe I was so stupid to allow a so-called surgeon to disrupt my life like this and deprive me of my health!!
CHICO_MARX mary12001
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It just takes a long time to come back. I thought I was done...I was wrong...
https://patient.info/forums/discuss/patient-heal-thyself--548806
It's not over 'til it's over...
Mkhp mary12001
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Hang in there Mary, I truly know how u feel. I have said the same things in my head many times, but,,,, we can't go back, so try to get over this small slump n devise some ways to renew your action plan. Chico is a very wise man, read his blog it is very helpful. I'm sick of this too at 8 months. New plan was to try the chiro. Will see how that goes??!! Seeing surgeon in couple days, will be interesting to see what he has to say about my pain goin thru my inner thigh and back of thigh oh yea the knee as well? Time will tell. Just at least try to keep up the exercises. Best of health to u, kat
shan99257 mary12001
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Oh Mary, I'm at 9 months too and feel exactly like you do!! I wish I'd never had it done! I feel like I will never get any better. I curse the surgeons who did this to me!! I thought my knee was so bad before surgery but that was nothing compared to this!! And they want to do my other knee!! HA!! Fat chance!!! My every day life is so much worse since the op. So many things I can't do that I could before!
philguud shan99257
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Feel you about the worst part! I haven't had a good nights sleep since I had surgery in July 2016. I understand that sometimes it gets a little worse but not five months later. And to add injury to insult I have to have a revision next month!
CHICO_MARX philguud
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People need to stop judging themselves by some imaginary time frame. This takes six months to a year...maybe more. For every one of us...
IT TAKES AS LONG AS IT TAKES!!!
There's no other way around it. You have to do the PT to get the ROM back and then the gym work to rebuild the atrophied quads, glutes and core. For the lucky few, it gets done quickly...for the rest of us, it takes a loooooong time. Be patient, stop judging, do the work. Yes, it takes a toll on you both mentally and physically. Be strong, eat healthy, lose weight, HYDRATE, exercise, take your meds. You can do it...or you'll walk with a cane in pain the rest of your life. Your choice.
shan99257 philguud
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roberta40 CHICO_MARX
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shan99257 roberta40
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I was only given 12 days notice before my op! Had been on a waiting list for 2 years before I even saw a surgeon.Then WHAM!! I had no idea what I was in for...physically or mentally. I live on a small island and getting to and from the mainland was so difficult for so long. It still is sometimes. I couldn't even get into PT for 3 weeks after I got home. ....
CHICO_MARX roberta40
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Post Op Depression...read that section. Once you understand it, it's gone. You will beat it down with a club!!! Totally normal but no doc ever mentions it before or after surgery.
roberta40 CHICO_MARX
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It's more that my life stopped suddenly..12 hour shifts at Nestle, days off consisted of running, hiking miles at a time, biking 50 miles, twice a week and swimming.....to nothing.......I don't know what to do with nothing...
CHICO_MARX roberta40
Posted
It's not nothing. It's sleeping so your body can heal plus PT/home exercises for the ROM and gym work for the quads. That's a lot after such a brutal surgery. Concentrate on what you have to do...not your life before this. The past is gone.
Just like I'll never play competitive hockey again, you may never do all those things you used to do AT THOSE LEVELS. Stop expecting it. Set some reachable goals, meet them and go beyond. In time, who knows what you will be able to do. Getting depressed about it accomplishes absolutely nothing.
The first thing you have to do is kick this recovery's a$$. Period. That's your one and only goal. ROM and quads. That's it. We can talk about it in another six months when you've gotten past the worst of this. Until then, work and heal.
mary12001 shan99257
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Hi Shan
I know I feel like they've aged me 20 years.
People say well has the pain gone but quite honestly I would rather have the pain then this total deteoriation of my general health and there is still pain there at times. At least before it was just my knee hampering my walking but since the operation my balance is all over the place. A few times I've nearly toppled over. I now feel like an absolute cripple. When will it ever end and I can wake up and just be normal again. I feel like I've lost the plot because everything becomes an effort. This has taken over my life in a bad way when I really thought it would improve it.
I had it done in Birmingham/ how about you??
shan99257 mary12001
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Oh Mary!! I feel exactly the same way!! It's uncanny! I'm in Australia. We have a public health system here which is great most of the time. But they'll have to tie me down and drag me to have my other knee done! I will not put myself through this again unless there is no way I can stand the pain of my deteriorating knee. I can live with it for now. As for the "new" knee....OMG!! I feel just like you...I'm crippled! And I see no light at the end of the tunnel. Depression over this has just become a way of life now. I also feel 20 years older than I was before. I get so jealous when I read of people sailing through this surgery with no problems. We'll just have to be here for each other!! I send you big hugs and try to have a Merry Christmas! xx
CHICO_MARX mary12001
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C'mon guys!!! How do you think I feel? At 9+months, I thought I was just about done (kidding myself, of course) and now I've got pain shooting down BOTH legs!!! MRI showed severe spinal stenosis L1 through L5 so I'm looking at back surgery in February.
You CANNOT let this get to you!!!
https://patient.info/forums/discuss/two-guys-with-canes-limp-into-a-bar--534980
mary12001 shan99257
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Thank you Shan for being so understanding.
Do you think we have an allergy to the metal used? Mine was cobalt chrome and I have read that cobalt is poisonous. When I mentioned this to the consultant he said I hadn't had enough for it to do any harm. He would say that wouldn't he??
It's just wearing me out all the time. Nothing is easy anymore. Some days I think it's going to give me a heart attack!
You too have a merry Christmas. I just wish I was there in the sunshine. It's raining and foggy here. X
Alison_Weaver mary12001
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Mary you have described my exact thought.
iam in pain all over my body.
my operation done in Middx.
iam a changed person, and feel with out doubt this operation has turned me in to a old woman, and not a happy one.
the worse thing I've ever done, give me my knee pain back, it was one part of my body.
now complete body in severe pain, Iam also wondering if I was allergic to
the replacement.
i don't even want to get up, so much pain, and extreme tiredness.
shan99257 CHICO_MARX
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Aww Chico!!! I'm so sorry to hear that mate! You n I are at the same stage post op. I just wish I had your fortitude! I do try to be positive...but it's extremely difficult. But just for you, I'll try and do better!! xx
shan99257 mary12001
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Oh Mary!! Don't say that!! An allergy??? NOOOO!!! I couldn't bear it!!
shan99257 Alison_Weaver
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Oh Alison! Mary, you and me!! What a trio we make!
Have you spoken to your doctor about all this? Do you think you might be suffering from depression? You'd be amazed at how many of those physical symptoms can be from depression. Talk to your doc. I've suffered from depression all my life and have been on antidepressants for over 20 years. (It's a genetic thing with me). This surgery has certainly set me back a hell of a lot.
In spite of everything, I wish you and your family a very Merry Christmas. xx
mary12001 Alison_Weaver
Posted
What is your new knee made of?
Perhaps we are allergic to the cobalt. I feel allegy test should have been done beforehand if that is the case.
I could kick myself because my dad who sadly passed away last year, told me not to go near any of them. He said I would just be used as a guinea pig. I tried everything rather than have it done. Acupuncture, steroid injections, PRP as well as trying to go down the stem cell route but I gave this up in the end thinking my knee replacement would be ok. I should have listened to my dad!
mary12001 shan99257
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Just a thought. This cant be right. I though you had surgery to make yourself better not worse!
This has destroyed my zest for life.
april99094 mary12001
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mary12001 april99094
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I could understand it if I had been in an accident and I was trying to recover but this seems to have been self inflicted - I was never this bad before and thought the operation would improve my walking not make it worse and destroy my general health as well.
I do believe in God and will keep praying . Happy Christmas x
april99094 mary12001
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shan99257 mary12001
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mary12001 Alison_Weaver
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Although I wouldn't wish this on anybody it's comforting to know that I'm not alone.
I only wish I had investigated the whole op beforehand not gone like a lamb to the slaughter.
A friend did warn me beforehand about the type of prosthetic knee to have saying that titanium was the best only stupid me thought she was being too fussy -
I hate my surgeon now and am dreading the appointment I have with him in February - I just feel like freezing him out.
It will be just a year since he 'hacked' my knee and took away my zest for living
shan99257 mary12001
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shan99257
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Oops! Sent that too quick! It's scary how you n I think alike!! Yep, everything you say, I feel the same way. I get out of bed every morning in agony and say "F*&% it!!! I'm OVER this!" etc etc!! It still reduces me to tears sometiems but most of the time I'm so bloody ANGRY!!! If I had this op done privately, I'd sue the b*st*rd! (Excuse language!)
But hey, at ;least we have each other to vent to!! Take care. xx
mary12001 shan99257
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Yep
just listening to the news about 'faulty' breast implants. wonder if it will come out one day about 'faulty' knee implants!
I mean one size just does not fit all!
xx
shan99257 mary12001
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Oh what a horrible thought!!
xx