Knee Replacement - Anyone else?

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!

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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!!

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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!

Really pleased to see and read this thread on here as I may be heading for a TKR too. I find out a week today whether that’s the case or not but having read this thread has helped to calm some of my misgivings.

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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!

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This is great advice!

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

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

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.

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.

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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.

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.

Yes, I agree.I have had a THR and a unicompartmental surgery ,both on left leg.
I was happy to stay in overnight for the knee and 2 nights for the hip.
The hip was fairly unpleasant and painful, and I was glad to be there, as they could monitor and adjust my pain meds etc., and reassure me when I was anxious.
The only thing I didn’t enjoy ws being woken up at silly o clock (having not slept much) to have meds etc!
I live in UK where similar to you in Oz.