Knee Replacement - Anyone else?

Training
32

I have a question about Total Knee Replacement recovery. I find reading about the success others have had to be very encouraging. And instead of starting another thread, I thought I’d bump this thread up with my story/questions.

I’m 62 years old. Back in high school, I hurt my right knee wrestling. At the time, it was diagnosed as bursitis. Fast forward about 20 years and it was determined I had a tear in the meniscus, which I had repaired. Thru all this, I was able to ride but the knee would often be sore and ache. Fast forward another 10 years, the ache is worse and I’m told I have no cartilage on the outside of my knee. The solution was cortisone injections. Initially, it was one every six month. Recently, it’s been one every four months. Thru all this, I’d ask my doc about a new knee but she’d say I’m not ready for it yet.

Then this past winter, trying to straighten my leg muscles by lifting, I felt the dull ache turn into a sharp pain. I went to PT and it only got worse. Back to the doc. X-rays showed it was bone on bone on the outside of the knee. She agreed to the new knee and off I went to the surgeon. I had my right knee replaced on May 3. The surgery supposedly went well but took a long time. During a brief visit with the surgeon the day after, all she said was the operation went well and that I have VERY HARD bones. I stayed in the hospital one night then was discharged for home.

Now it’s May 22, two and a half weeks after surgery. I’m scheduled to meet with the surgeon two and a half weeks from now on June 8 for my first post op meeting. I’ve had PT come to the house three times a week since the surgery. It’ll be twice a week now till my June 8 meet with the surgeon. Assuming everything’s fine, I’ll have out patient PT after that.

Recovery has been slow and sometimes painful. Oxycodone is the pain med of choice. It came with a lot of warnings (understandably so) but it almost felt like I was being told to cut back even before I started taking it. Due to the warnings and knowing the addictive nature of the med, I probably cut back I little too much too soon. I’m doing better now balancing the med amount to the pain level.

I do my PT stretches two to three times a day and ice the knee three to five times a day. I can see improvement with the stretches; stretches I couldn’t do at all two weeks ago are now no problem. The bend in the knee is supposed to be at 90 degrees for my June 8 surgeon meeting. It’s already at 94 degrees.

So I can definitely see actual measurable progress. But for some reason, I don’t feel positive about all this. Kind of a head vs heart thing. My knee always feels stiff. Like there’s an ACE bandage wrapped around it. The leg still has some swelling although it’s WAY down from two weeks ago. On a couple of stretches, I sometimes get a clicking in the new knee.

For those who have gone thru all this, does my recovery make sense? Does it sound like things are progressing as they should? Or, is there something here that doesn’t sound quite right? Something I should be aware of?

If you made it this far, thank you for reading. And all your comments are truly appreciated.

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Thank you for your reply. It is very encouraging.

And congrats on your TKRs. Any idea why your two knees are responding differently? What’s your long term plan with your right knee? Live with it or have the doc go back in?

36

Slightly off tangent here, but I have been getting patella tendinitis off-on for the last couple of years cycling (most pertinently after spending the winters turbo training), its more discomfort I would say rather than actual pain, and when I am cycling is usually when its actually ok, its when I am walking around and particularly bending/squatting down it lets me know there is some inflamation there. I just have a niggling concern this will lead to long term damage / need for knee operations in the future - anyone got any advice experience of this?

I have been doing some gym work to improve glute strength and single leg control which is helping a bit, although I do think that the associated strength increases are just leading me to push harder (my FTP went up 20W this winter and the main difference was introduction of gym work). I am think of maybe dropping down amount of road biking / increasing MTB as I see that as a bit more of a whole body workout…

37

I don’t feel positive about all this. Kind of a head vs heart thing. My knee always feels stiff. Like there’s an ACE bandage wrapped around it. The leg still has some swelling although it’s WAY down from two weeks ago. On a couple of stretches, I sometimes get a clicking in the new knee.

The stiffness is from the swelling. If you can get > 90 degrees already, you’re doing well [experience of L and R TKR talking here]. Relax and look forward to pain-free riding. Are you doing exercises to rebuild your quads / glutes [such as squats, riding your bike]?

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I have my first post surgery visit with the surgeon at the five week mark. Up until then, all the PT has been at home. They’ve concentrated on stretching, mobility and stairs (I live in a four story house and need access to all four stories; stairs are my life!).

Assuming the surgeon visit goes well, I’ll transition to out patient PT where the strengthening and riding will take place.

39

I’m coming up on my one year anniversary - both knees replaced in June 2021 (54 yeas old). It’s been a long road back but mostly positive.

Last season had to be written off. I was able to ride a bit but nothing close to actually training. I also gained about 30 pounds, which I’m now working to lose, while at the same same time gain back muscle - it’s been a difficult balancing act.

That all being said, no regrets. Stick with the PT and keep stretching while building back strength. For me, being able to enjoy long walks and hiking with my kids has been the second-best benefit, right behind living pain free. Good luck!

40

I’ll add to the conversation. @craigmanning and I had our first TKRs about a week apart Sep '20 (although he’s a bit younger and a lot faster than me). Great to have a virtual partner to share real-time experiences with. You can read some of my posts about prep up this thread.

So now I’m almost 21 months out, and while riding with a chiropractor friend last week he mentioned he could see no sign in my pedal stroke of having a new knee. His POV is that it’s really 18-24 months before you can consider things fully healed, despite surgeons looking at a one-year mark. I have to agree with him, noticing that the last six months I’ve just felt “better.” FWIW, I had a pretty big power balance discrepancy up until that point (as much as 40/60 replaced/OEM) that has now mostly smoothed out. My OEM knee, which looked equally bad on the 2020 xrays but was less problematic, is telling me it’s not always happy. Spoke to my surgeon at the 1-year checkup Sep 2021, and he said when I’m ready, come in for a new set of xrays. Not quite ready yet, but considering the trade offs between longer recovery as I get older vs having surgery “too early.” BTW, I was thinking perhaps I pulled the trigger too soon on my first knee, but happy I had it done.

New knee is not perfect, but significantly better than before. Still some swelling/stiffness from time to time when I overdo it, but stable as can be and no issues with movements that were troubling before.

Also FWIW, been fairly consistent in the gym before and after. Now doing 2x5 hex bar DLs at 305#; which isn’t near 2x BW yet, but I think I’m pulling more than most 68-year olds in the gym who aren’t serious power lifters. (PS I have not told my surgeon so don’t rat me out…)

In terms of prehab and rehab some thoughts. I really appreciated [the perspective that Scott Johnson had on the Uphill Athlete.. He was very generous in an email exchange we had. Also three threads from their site that may be of interest:

https://uphillathlete.com/forums/topic/pre-knee-replacement-suggestions/

https://uphillathlete.com/forums/topic/one-month-after-knee-replacement-what-next/

https://uphillathlete.com/forums/topic/now-3-mo-after-knee-replacement/

Also highly recommend “The Surgery Series” by Kelly Starrett about his own TKR. Had a chance to visit with him in person at last year’s CrossFit games and again very generous with his time and thoughts. He a TKR program available at The Ready State. (note: this was published after my surgery so I have not personally purchased/used it).

And finally, if you haven’t checked out “KneesOverToesGuy” Good solid approach to prehab/injury recovery that works pretty well for me (when I’m consistent with it.)

42

its shocking how many people say theyre in less pain on post-op day 1 than they were before surgery, especially when you see how invasive the surgery is. When its time, arthritis is super painful. I do foot and ankle, but similar concept for ankle replacements. For my first 5 or so years out, everyone got admitted to the hospital for pain control afterwards. I started realizing how few people actually needed that overnight stay and now do a majority of mine as a completely outpatient surgery.

Cycling is actually really great for your knee after TKR. Maintaining ROM is super important. Most people are walking day of surgery and starting formal PT the next day. Biggest thing is not doing too much for the first 2 weeks to make sure your incision heals well. Follow your surgeons instructions!

43

While I haven’t had a knee replacement - I have gone through 4 x right shoulder recon’s and major surgery on both lower legs - calves lengthened + fused bones removed from both feet and implants in both big toes so they can move somewhat properly.
The best advice I can give is be patient, rehab takes time. The biggest mistake you can make (an I am definitely guilty of this) is to try and speed up the process and do too much too soon. Rehab relies on progression the same as training does - trust you doctors, physio’s and exercise scientists and follow their plan to the letter and you will minimise setbacks.
Since my 4th shoulder recon I have become an open water swimmer swimming several 5km races including Masters Pan Pacs (finishing second in age-group) and done a couple of marathon swims (10km +). You will get back to performing at a high level you just cant rush it. You will have to make rehab part of your daily routine though - i do rehab exercises every morning first thing out of habit these days.
Good Luck!!

44

This is a really great response, @Hampstenfan . Really helpful resources for everyone.

I can +1 the idea that it takes a full 24 months to feel “healed”. I’m coming up on 24 months post TKR #2. Four years post #1. What’s working for me so far is the basics: Lots of stretching, lots of foam rolling, just basic maintenance stuff.

I’m new to the Ready State and i like what i see so far. Wish I had that course before my surgeries. Thanks!

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Yes. At 53. Maintain motion and strength as possible before. Don’t return to strenuous or prolonged activity too soon. I did and whilst I thought I was Superman for the first 6 months I then had a 6 month stall

Ultimately I think I was doing a poor physio regimen and stalled as a result. I switch to a personal trainer who is a PT and the focus switched to functional rehab rather than specific muscle or motion targets

Concentrate on large muscle coordination especially glute chain as most rehab programs don’t. Maintain good soft tissue condition and avoid avoid avoid excessive work that causes inflammation/swelling. Get an automated ice bath sleeve and use it a lot.

I was back on the bike spinning only at 6 w. Didn’t resume training until almost 9 months post surgery. Even then it was very very gradual. Expect 18-24 mo recovery - remember that this operation is usually done on pretty inactive ppl so goals and expectations and time to teach them are much less. I wasn’t back on the bike outdoors until 18 mo - that was a confidence issue -especially unclipping.

Good luck!

47

This is great advice!

48

Are you saying you are a surgeon that does ankle replacements and you send people home the same day as surgery

49

That’s correct. Nerve blocks and Exparel take care of a large portion of post op pain.

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Lucky you aren’t in Australia. You’d be reported to the medical board. The point of staying in is more to make sure there are no complications and infection and get people started on pt. I am so glad I live in a country that actually puts health over money.

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This isn’t helpful. Increasingly joint replacements are done as out patients and patient satisfaction is higher. Pain control has improved so much without making ppl nauseated.

85% of my orthopaedic surgery is now outpatient vs less than half 5 y ago. Patient selection is important and some procedures cannot be done as outpatients bc they require monitoring.

Interestingly almost half of all surgery in Canada is now done as outpatient. And personally I’d rather be at home than in a hospital to recover if I could

So thanks

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Not sure what your reason for attacking is, but I unfortunately think youre misinformed. Outpatient joints are done very commonly in the USA, and we have the outcome scores to back it up. The patient satisfaction rates are as good or better, the infection rates and re-operation rates are no better or worse inpatient vs outpatient. Patients at our center leave surgery with a home Physical Therapist to start with them until they go to their outpatient PT.
When you have proper inclusion criteria and protocols in place to make sure its safe and successful, the outcomes of outpatient joint replacement surgery are very good.

PMID: 32127903, 30921822, 28390881, 31879471 are a few articles you can have a look at if youd like to learn about this.

53

Because sending someone home the day of a joint replacement would be considered extremely bad practise and risky here and I tend to agree. I’ve had 13 knee surgeries including a tkr. The only time I went home the same day was after arthroscopic surgeries. ACL reconstruction was next day, femur fracture was 4 days and tkr was 5 days and I would not want it any other way. I’ve seen a lot of people booted out early (mostly from outside of Australia) that either get an infection or can’t keep on top of their pain control and it has gone very badly. I’ve seen people having tkr’s re-done a few weeks later because of terrible infections and people do no pt because they can’t keep on top of the pain (and there is no one forcing them to do it at home). Yeah being hospital sucks but hell no I would never go home that soon and it would never be suggested that I did where I live.

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Its fine to have opinions based on your experiences, but please realize the standards of care differ in different parts of the world. If people were having poor outcomes going home from same day surgeries, we would have put an end to that a long time ago. Its not about money. I get paid the same if a patient leaves an hour after surgery or sticks around for 3 weeks.

Think of it like the deep dives in the podcast…Chad presents data from evidence based studies. It doesnt mean “this is what the article says so this is the only wat to do it”, rather it means “this is what the evidence says, this is a good starting point to base your training and see if it works for you”

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That is the point I was making. What happens over there is unheard of here.