TKR Pre-Op Expectations

Posted , 6 users are following.

You've been told you need a TKR...and that's scary.  Being on this site and getting to know what's ahead of you is a major step because the more information you have, the better prepared you'll be.  If your doc says that a TKR is your only option and your quality of life is pretty much zero, then you should consider getting the op done as soon as possible.  At 20 months post-op, I have no regrets, regardless of the three biggest issues: the intense but short-term pain, the amount of work it takes to return to normal and length of the recovery.  However...

There is Synvisc, and products like it.  After 4 knee scopes (two each side) plus arthritis left me hanging in my 50's, the doc used Synvisc (three shots, days 1, 8 and 15) to keep me going for 5-6 years when I was living in New Jersey.  Each round lasted close to a year.  Moved to the warmth of Texas in 2010 and that change in climate left me pain-free for another five before needing the TKR.  No guarantees but Synvisc worked amazingly well for me. I asked the doc about more of it in January 2016 before the TKR in March and he told me that the left knee was so bad that the injections would do very little for me at that point so I bit the bullet and did the op.  Just a thought...talk to your surgeon.

The most difficult part of facing the reality of a TKR is that, going into the op, no one knows how difficult or long their recovery will be.  There are very, very few people who have quick (less than 3 months) or lengthy (greater than 18 months) recoveries.  For the vast majority of us, this takes a year...accept it.  People typically return to work in the 4-6 month range depending on how well they've recovered, age, type of job, and many other factors.  You cannot expect to be "OK" in three months...you just can't.  You may be lucky and end up with a fast recovery buy you cannot count on it.

On the subject of returning work, a sedentary desk job is easier to return to than construction, delivery, nursing, etc., all those professions which require a lot of walking and leg strength.  Even those at a desk report a lot of pain and swelling when finishing the day after sitting so long.

The problem is that you cannot push a knee to recovery.  Try, and it bites you back...big time.  Pain, swelling, exhaustion, inability to walk, etc.  I once did 8,200+ steps at 5 weeks and paid for it with a "balloon knee" for three days.  The knee heals gradually.  It will take you up to 3 months just to get your ROM back to at least 0 / +120...then you have to rebuild the strength in your dead quads, glutes and core to walk properly, climb stairs, etc.  That takes up to a year post-op.  By 8 months, I was doing 11,000+ steps (5 miles) with no ill effects...but it took time, work, patience and a healthy respect for the new knee.  Most people report "feeling like themselves again" at 9-10 months and rejoice at their "full recovery" on their one-year anniversary...very common.

THIS IS IMPORTANT: For a TKR, there can be no expectations, no timetables.  It is the most Zen of all surgeries: "Your knee will be better when it's better."  Anyone promising you that you will be fully recovered and back to work in 3 months is delusional.  I'm not saying it's impossible as we've had a few of those unlikely success stories reported on the Forum, but those are very rare. 

So, if you have this question in your mind: "Will I make it through three months?", the answer is OF COURSE!  It will painful, difficult and challenging.  Will you be able to go back to work at that point?  The truth is: Not likely. The problem for you (and for all of us at the beginning) is that you never know the real answer to the question of time to recovery and no one can predict how recovered you will be any point in time. 

If you want to read about the realities of recovery from my personal perspective and after reading thousands of posts, I've posted a lot of discussions about pain, sleeping, depression and many more on the Forum.  Click on my name or picture and then "See All Discussions".  

The one great thing you're doing is educating yourself about the op.  Virtually all of us were told nothing pre-op and we all had the same impossible expectations to deal with afterward.  The truth is that it's a brutal operation with a lot of pain to endure in the first 30 days or so.  Then it takes a lot of PT and work at home to regain your ROM followed by walking and strength exercises to build back all that musculature.  All of this takes time...you just don't know how much at the beginning and no one can predict the length of your recovery.  

In the end, it's not scary at all.  You go to sleep, wake up and have a new knee.  Simple.  Then you start to walk IMMEDIATELY.  Manage the pain, ice, elevate, eat healthy, hydrate a lot, do the necessary work.  The pain will fade and you will find that all your original pain will be gone too.  In a year, you will be sooooo glad you took the time and did the work to lead a pain-free, normal life again.  Well, almost normal.  There will be things you will NOT do anymore like running, jogging and competitive sports...but that list is in another post...  I played hockey for 45 years and had to give it up...not easy emotionally but a no-brainer choice.  Stay strong...take your life back.

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9 Replies

  • Posted

    Hi, I know how well versed you are in so many things. Being 16 weeks P.O. now from rtkr I woke up this morning with a terrible right butt cheek pain. It does not radiate down the leg, just center of right butt cheek, my God is this a new thing now. Have you heard of anyone having this after tkr, I am truly depressed and beside myself😫😞

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    • Posted

      Could be a sign of sciatica...a pinched sciatic nerve.  Typical pain is in one of your glutes and then the pain usually, not always, radiates down the back of your leg, sometimes as far as the knee, sometimes father down.  Everyone's different.

      Can be caused by hip/pelvis misalignment (very common is TKR patient's as we walk "funny"...change our gait... to avoid the pain), locked SI (sacroiliac) joints in your hips or something in your spine (rarer, but I've had that happen too).  My sciatica came about 5 weeks post-op...everyone's different. 

      One good thing to try is some Voltaren Gel (RX in the US)...fantastic topical anti-inflammatory.  Ortho docs will prescribe this in a heartbeat.  Also, oral NSAIDs (ibuprofen, Aleve, aspirin, etc.) can help.  If it doesn't get better in a week or so, the least invasive path is chiropractic.  I've had lots of experience with sciatica and, except for one case that actually initiated at L4/L5 in my spine, the chiro fixed me up.

      Again, this is very common in TKR patients.  When we change how we walk to avoid pain, we always cause a misalignment in our hips.  If the pain is as severe and annoying as you say, I'm thinking sciatica.

      PS: Regular docs have no answer for sciatica.  Just drugs and rest.  Chiropractors actually fix the problem.  I'd start there.

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    • Posted

      Thank you so much for your reply. Everything you say makes sense. I am seeing my regular md on the 27 th, I will ask for Voltaren Gel. This has been a really lousy experience for me, I know it’s going to get better I just need the patience. This forum is a God send. Thanks again.
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  • Posted

    I will be 13 months Left TKR tomorrow and still feel my knee is not right. It is hard to describe: a pulling sensation down the shin, bone soreness? (not so much pain), tightness at a 125 degree bend. I am aware of it on an hourly basis. I only take 1 or 2 ES Tylenol occasionally. I have not seen the ortho surgeon since Nov. 1, 2016 and feel no need to go back. I would like new x-rays just to know everything is in place but if something was wrong....I would not do surgery again. Since I had a cementless TKR, I guess it just takes longer for the bone to grow into the implant. Kinda wish I never had the TKR at times.
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    • Posted

      In your shoes, I'd see the ortho for a "one-year checkup".  I had one to assure both the doc and myself that everything was fine.  Tightness (a "band-like" feeling) or stiffness (especially after sitting a long time) can persist to 18 months.  But this "pulling"...I'd see the doc.

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  • Posted

    Thx Chico

    Your post on this site have been an endless source of support and encouragement.

    I had my tkr 14 weeks ago and find this roller coaster journey physically mentally and emotionally so challenging.

    I returned to work after 6 weeks - a big mistake in terms  of managing my recovery. You did warn me!

    Being self employed with a large family I didn't believe I had any option.

    The upshot is I haven't been able to maintain a disciplined exercise regime. As a consequence I still am in pain most nights and feel I have plateaued  in terms of progress.  I can walk normally for a short time but a limp quickly returns and the joint and muscles are  constantly aching.

    I keep reminding myself this will take a t least a year but the manifest psychological damage worries me. I am  far more short tempered  and difficult with those around me. I have even shut off some close friends who I used to meet regularly for a quiet drink- I am just too exhausted every evening when I come home from work.

    If I am honest I am writing this now partly for cathartic reasons. The whole thing is getting me down and I think I am sinking into a depressive state.  I have stopped taking stronger meds 3 weeks ago as I was worried they would be addictive and feel it it would regressive to go back to them.

     I can't decide when  I get some scarce  down time at a weekend ( I have a large family and a stressful job that requires a lot of travel and consequently very stiff limbs ) if  I should go for vigorous exercise or just rest up to relieve the accumulated pain.

    Aiming to review again at six months and stopped daily / weekly reviews but sleepless nights like last night sparked this post.

    Thx again for your firm but sanguine support on this site. You are an important voice that genuinely stops me going over the edge.

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  • Posted

    Great post!

    I think i would add just that ROM may well take even longer, and may not get to 120...just because people tend to give themselves a very hard time about it!

    I am sure this post will be helpful to many people. You really are a star!

    Going through a TKR makes one appreciate the challenges, for sure!

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    • Posted

      People get hung up on ROM as the number itself.  Fantasy.  Have 10 PTs/Docs measure someone's knee and you'll get 10 different numbers.  It's because they "eyeball" it; there is no actual, objective measurement.  Forget the number and listen to your knee.  If you're on the floor and you lower your knee (flat) and you can feel the floor touching the back of your knee...that's close to zero...be happy.  If you can walk up and down stairs normally, without pain and without holding onto anything, be happy...your ROM is just fine.  

      It all comes down to activity and quality of life without pain.  That's the measure of success...  The rest is just a mind game.

       

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