Knee replacement surgery

[jiminbartow]

Having spent 4 years in the Marines from 1972 to 1977 and running 3 miles a day, it destroyed my knees. It has been 48 years since my discharge from the Marines and I have waited as long as I can. I am almost a cripple and it has finally come to the point where I need to get knee replacement surgery. I will be having the right knee done on July 25 and the left one done when my right one has recovered.

I hope that anyone who has had this surgery can give me an idea of what I am up against and what to expect as well as tips to help in my recovery such as good exercises to do. Thank you. Jim Patrick

[Daisy Mae]

I haven't, but my dad and best friend have.

They were of the same mind...both said:

1) it was the best thing they did, and said they wished had done it sooner.

2) physical therapy afterwards was an absolute necessity, and not to be underestimated or ignored. My dad, being a doctor, was of course the worst patient and didn't do the full regimen, and ended up with (short term) diminished range of motion. So, his version of physical therapy was to sit in his recliner, leg stretched out foot on an ottoman, and bounced grandkids on his knee to straighten his leg LOL

So yes, the PT is what is all important for your recovery. Listen to your doc and your PT's, and you'll be up in no time.
For what you think (and is) some pretty serious surgery, both of them recovered very quickly, and both very happy with the difference.

Good luck!

[Allan]

Jim, I have had my right knee done, after having both hips done over time since 2000. The hips were a breeze. I should have listened to the physio and done the work on the first one. Second one I did work it and have much more rotation on it. My knee was more serious. It took longer to recover from and was more painful, but I was older too.
My wife had hers done on May I this year, at age 78. Her recovery is progressing, but nowhere near as quick as mine. and with considerably more pain.Hydrotherapy in the pool is her biggest help. Again, do the program your physio recommends to maintain optimum movement in the joint. Your recovery from the first will help in scheduling the second. Best wishes.

Allan from down under.

[jiminbartow]

Thank you. I should have mentioned that I am 71. Having been in the Marines and having been instilled with Marine Corps. discipline I have worked out all my life so I have a tendency to push myself hard, no matter how painful it is, plus, my wife is a very good nurse (though not an actual nurse) and will push me hard if I ask her to. She helped me fully recover from both of my rotator cuff surgeries in 2004. My house has a second story with stairs that have 19 steps. Would going up and down these stairs be good exercise? I know in high school the football coach made us run up and down the bleachers for leg exercises so I’m wondering if climbing the stairs would be a good exercise in this case.

[ewdysar]

Hi Jim,

Pay attention to your PT regimen. My sister had her left knee done 20 years ago at age 47. She figured that she could do better by pushing harder and doing “extra” PT. She ended up damaging the repair work, resulting in more damage to her knee than where she started. Since the first fix didn’t take, she opted out of trying again and accepted living with reduced mobility. With less movement and activity, her weight went up, and her mobility and general health continued to decline. I think that it’s a shame how things turned out, I believe that she could have done better.

Trust your team and follow their plan. More is not always better.

Keep crankin’,
Eric

[dlmyers]

Look up CPM machines. They exercise the knee without putting any weight on it.

[rondupree]

My wife had both knees done. In the short term, ice is your friend. We had a machine with circulating cold water that could be put on the knee and keep it chilled. Works as good or better than some pain pills. In the early stages you may still need some pain pills, definitely take them as prescribed. As others have said, physical therapy is a must. My wife could barely walk before her new knees. She walked two half marathons after the knees.

[TMiller6]

Between my wife and I, we have undergone five knee replacements. One for me; four for her.

Initially my wife had the minimally invasive metal wear surfaces with the plastic bearing surface installed in both knees. After a couple of falls, the metal to bone adhesive failed and there was a noticeable gap that was felt when she stood up. It eventually became painful to stand and walk so both knees were replaced with the joints that have rods that go inside the bone. She has had no problems at all after the revision. She does not kneel.

In my case I went to the same surgeon as my wife and underwent the the glued joint procedure that my wife had the first time. I told my surgeon that my life would be over without the ability to kneel in the garage so he retained my patella and I am able to kneel and stand up without problems. The knee is very durable as I demonstrated to my neighbors by stupidly falling off a Yamaha PW80 unto my neighbor’s lawn while returning it to my grandchildren after repairs. I also landed on my new hip and I came through okay.

The ice machine is disappointing. The disposable cooling pads always leaked after a few uses. Since my wife was the first user, I went to the hardware and brought home clear tubing and wrapped it in a towel. The fittings on the pad were reusable. We went through a lot of ice. The refrigerator could not keep up. The second machine came with a submersible pump. I dropped this pump into the water reservoir of a portable ice cube maker and left the plastic catch tray out. This way, the machine made ice and it fell back into the water dispenser side so it could be refrozen. My wife started sleeping well with this setup.

We both underwent physical therapy at a place a few miles down the road. It was valuable in that each time they force you to use the knee a bit harder. At the end of each session, they applied electrical stimulation for ten minutes or so. Both my wife and I went through PT. I ended up testing out of my last week by running up the stairs and arriving before my wife in the elevator.

Is my new knee perfect? No, but it functions much better than the one I got rid of. Go for it, you will be glad you did.

[Oldav8tor]

I've not had a knee replaced but have had discussions with my doctor about it. He told me that they've been getting the best outcomes with "Mako" robot assisted replacements. Smaller incisions, quicker recovery, the ability to customize knee replacements to each patient’s anatomy for a more natural feeling. You haven't said what you're getting but I thought I'd throw that out there. From watching others I can tell you that your best chance for a successful outcome it to do the recommended PT....Good luck!

[MarkS]

My wife had a knee replaced 3 months ago. She has had other surgeries, but says this was the most painful recovery. Also says it was well worth it. The first two days were the worst, then gradually got better. Started PT on day 3, 3 days per week. Her last PT is tomorrow. As others have noted, cold therapy to control swelling is important. She used an ice machine several times a day. The cold source is a bucket filled with ice and water, then pumped to a sleeve wrapped around the knee. Instead of adding raw ice every time, I placed four 12-ounce frozen water bottles in the bucket of water, and I can change out a set of bottles in under 2 minutes, refreezing the used bottles. Much easier than messing with ice and emptying the bucket each time.
The first two weeks she used a walker, then a cane for the next 5 weeks. At 9 weeks she walked 11,000 steps with the grandkids at Disneyland. It still gets sore, doc says it will take 9 to 12 months to recover to a point where she won’t think about it. It was about week 4 when she said it was better than her old knee. The big difference was that the old knee was only going to get worse, the new knee better.
She doesn’t like it much when I tell my friends she is like my old car; I just have to keep putting in new parts to keep the old girl running!

[Tim Williams]

From a orthopedic nurse perspective, do all your PT sessions as ordered that's 50% success of the surgery, move around, don't stay sitting all day long. if you have pets that sleep on your bed with you, temporary stop cause it can be a source of infection. if for the first few days if its more comfortable to sleep in a recliner with your legs elevated that's ok. these are a few things we tell post op knee surgery patients at discharge.

Tim

[Kevin Pharis]

Spent 7 years building and developing knee and hip implants along with associated rehab tracking devices. Cutting into the knee “capsule” is said to be the most painful surgery you can endure. Because of this, an entire industry focuses on producing slow release implantable local anesthetics. In the last 15 years, total knee replacement has evolved from a major surgery under general anesthesia, to an outpatient procedure done with an epidural and Tylenol, much thanks to these implanted meds.

As stated above, do your PT… no matter how much it hurts! Not doing your PT will hurt far worse! And for far longer! Icing is a wonderful thing, but be informed that with low tissue temperatures comes reduced blood circulation and healing rates. Avoid icing for long periods of time.

[George Mills]

Jim,

Good luck with it.

I did not have an elective knee replacement, but did have a patella that shattered into over 50 pieces and while I hung in a trauma frame for several days...a bright young ortho decided he was going to rebuild the patella using surgical superglue, new xrays when he ran out of pieces to find left-overs, some wire, and ligament 'helpers' which paralleled my natural ligaments that were bruised and torn. The post surgery? An identical regimen to knee replacement so...here is my view based on me!

1 - I was sort of well prepared as Uncle Sam had taught me all about pain management back pre-Vietnam days before I was 'inserted' with an ARVN para-engineer platoon assigned to do Air America ground stuff. Uncle kinda felt a one man DET somewhere west of TamKy just might wind up with a painful experience somewhere along the line. I then found in life that on the smiley/frown diagram, I'd come in at about 4 smileys less for what everyone felt the pain for something 'should' be.

2 - That said, I decided ZERO opioids and brain numbing drugs would ever be a part of my recouperation and I toughed everything out with 500mg Tylenol and meditation with eyes closed. That was me, but in your own concern, it can be done but oh-there were times I was on edge with eyes crossed.

3 - Therapy. ALWAYS look forward to it and prepare for it! ALWAYS sneak in extra private sessions like setting a chair in front of the sink and doing pull standups, you want to achieve 100% of 'limberance' back.

4 - You didn't say whether you were doing this VA or doing Medicare. Here's a trick that I learned, but I went Medicare. Take the full PT regiment offered, work it, graduate, and the next visit to the ortho guy tell him you don't feel right yet...surprise...you just may get another script to do it all over again!!!!! This 2nd time your analysis session will just show those areas not quite there yet in your opinion and the entire regiment focuses on those areas. Dunno how VA works, but...mention it if you go that route as worth a try!

5 - In my case I never got full range of motion during the first therapy. Seem to recall the number we were shooting 4 was like 137 degrees for a knee bend, and I stalled at like 130. Close enough to graduate...second time through at least half the work was getting that to stretch some more. Walked out with 137 and been limber since!

6 - Do pre-talk long with your surgeon on ligaments and menisci. There are about 16 trains of thought on what works best. It all pretty much is dependent on how things are when started (have the x-cross ligaments deteriorated over life?) and the vendor style of knee being used. Generally speaking... with a knee there is reportedly a trade off of appliance life vs natural stability of the device. Make sure you understand the device he prefers to use...with both its pro's and con's. Not that you can do anything about it...but well worth the talk.

7 - In my case I had existing ligaments saved and reinforced as they did the knee-cap, may not apply to what you are doing with a total knee, but of the 4 'helpers' they used on me I have already broken 2 of them because of me being me. My ortho has been sarcastic in a kind way...says he put them in right, I broke them in time, he isn't going to go back in and take them out unless I wake up one morning and one is poking through my skin! (Seriously, he felt they did their job during recovery with stability, I expected too much at the limits, they snapped one at a time according to the x-rays, and are basically benign and now along for the ride as the knee is fully stable.) I was told I'd never kneel again, but the Semper Gumby guy here went and did just that! My favorite T is my Hack and that became therapy lessons in and of itself! Getting in and getting out---just a big learning curve. ( I actually drove my '15 just a short while back and all was fine both getting in and getting out). Took a few years to get it right with the Hack...I can kneel if I have to!!! I have a 'kneeler' for garden work and lower myself slow...still won't use it for T work...a miss and hit on concrete is not acceptable to me, personal choice...I now get down and roll around on my back...lol

Again Jim, good luck---ask questions until it all makes sense

[jiminbartow]

At first, I arranged to have the surgery done through the VA in Tampa, which is over an hour away from my home. My Primary physician at the VA said the distance alone could qualify me to seek a closer surgeon through the “VA Community Care Program”. The VA surgeon could not schedule me until December and wanted to do the left and right knee surgeries one week apart and have me stay at the hospital for as long as it took to do the PT on both knees simultaneously until fully recovered which could take months. I did not want to wait until December and could not stay away from home for several months so I asked my VA Orthopedic surgeon to give me a referral to an orthopedic surgeon closer to home that I have used in the past, through the VA Community Care Program. My local surgeon was able to schedule me for out patient surgery on July 25 and I will have a physical therapist come to my house everyday for 2 weeks. My wife will pay close attention so she can continue the physical therapy after the two weeks are up. If necessary, I’m confident that I can request more physical therapy if we think I need it. I will have the second knee done as soon as I recover from the first surgery.

I appreciate all of the helpful input. I will definitely not skimp on the PT, will take the pain meds and endure what pain there is, use ice to minimize the swelling and do all I can to avoid infection including keeping pets out of my room. I have definitely learned a lot from your posts. Thank you all. I look forward to reading more posts and learning even more.

One thing I would like to know is how you take a shower without getting the knee wet? Sponge baths?

[BE_ZERO_BE]

 
Jim,

I've had both hips replaced 30+ years ago
I've had both knees replaced 10+ years ago
I've had my left shoulder replaced 8+ years ago.

My best overall advice - Do all of the physical therapy and all of the at home exercises.
The overall quality of your outcome is very much in your hands.

Best wishes for a speedy and successful recovery.

[TMiller6]

Jim,
In the shower, we have had success with plastic food wrap. My wife the nurse said it worked on patients and it will work on me. It did.

(Edited by my wife) “ Use a few layers of wrap and it’s easier ask a helper to apply it”.

[TRDxB2]

Exercise is thee key to both quick recovery and less discomfort down the road.
Pain
The pain you'll feel after surgery is from the tourniquet that they placed on your thigh. The knee feels more stiff than pain like. Some skin near the incision may loose sensitivity to touch, eventually returns much later. You will get some black & blue somewhere.
When I was getting ready to check out, the next day, the room nurse advised me to exercise several times a day to reduce scare tissue from forming. I did that & walked, with the walker, several times a day for about 200ft at a shot. When I got to PT they were amazed at how well I was doing & said they weren't going to need to schedule any extra PT time than normal.

At home
- a good ice pump machine used several times a day is helpful. They'll use when after surgery so you'll be able to decide.
- when resting its recommended to keep the leg raised. You'll need compression socks. They will give you one, ask for another for the other leg (should have both legs compressed)
- you need a chair (or toilet) with a seat at least 17-19 inches fro the floor, so you thigh knee angle is not less than 90 degrees. This helps a tremendous amount when you get up off the chair.
- my bandage was water proof. Heavy clear plastic like material. I showered every 2 days & just patted the are to preserve it. even thogh they gave some extra bandages I didn't need them. PT may offer to change them
- The walker was only need for a few days. I preferred to use walking staff (hiking stick) than a cane. Gives a better stride when walking and feels more stable. You don't see hikers climbing up a slope with a cane. I made several, very easy to do. Used an old broom stick, rubber tip for the bottom & made the grip out of paracord. The wrap needs to be spiraled for a left or right hand. The video shows a right hand. https://www.youtube.com/watch?v=400v8D- ... eRefresh=1 . I drill a hole on the top to keep the wrap from sliding. The staff height either elbow or shoulder. The staff or cane should be used on the good side (surgery on left knee, use staff/cane or right side).

The best exercise to stand from a seated position - they'll show you in PT. I had my left knee done & had considered doing my right. The exercises strengthened both legs that I'm putting off th right knee for another year.

[Norman Kling]

My sister when still in elementary school broke her femur. She had to lay in bed or sit in a chair for months. She was home schooled for at least a semester. Finally when it healed her foot turned out on that side and she walked on the side of her knee. Over the years the knee got very bad and she had a knee transplant. This was done when she was in her 40's. They straightened the leg so that the artificial knee pointed forward and her leg has been very well since. She is now 85 and still working fine. My knees are original and I am 89. They ache quite a bit but also have neuropathy, so walk slower now than before.
Enjoy what you have while you can.
Norm

[jiminbartow]

Thank you Norm. I would guess that your sister had her surgery in about 1985. I was not aware that knee replacement surgery went back 40 years, or that the knees lasted so long. Most sources say that the replacement knees have a life of 20 years. Hopefully, the technology has advanced substantially to the point where recovery will be swift and I’ll never have to have it done again. The fact that the replacement knees supposedly have a life of 20 years is one of the reasons I have waited until now to have it done. In 20 years, I will be 91.

[Norman Kling]

They have had knee surgery for many years. In the 1950's I knew someone who got a plastic pad in the knee. Not a complete replacement. But at least the cartridge was replaced. A man in our local club had knee replacement and got an infection which laid him up for months, but has been doing fine for quite a few years. He is able to drive his T's just fine and we toured together about a month ago. About 90 miles round trip on a very hot day.
Norm