Share stories of your TKR experience

[EasternSkiBum]

I read way more than I post in these forums but I need some moral support right now. Long story short... at the end of last season I decided I need to do something so I don't have another ski season like last. I have a post traumatic knee (28years ago) that has finally broken down. I started on the journey to find a knee replacement at the end of April... I've finally got a surgical date for late Sept. Timing sucks I know. I plan to be back on skis by the end of Jan. /early Feb. So share good stories.... tips.... cautions... whatever you've got. I'm a fighter and have been skiing "gimped" for several years.

 

[RiderRay]

Ask your ortho surgeon to prescribe cold compression therapy post surgery. It does a wonderful job of reducing swelling, controlling pain and promoting faster recovery.

 

[scott43]

Not TKR, but a friend's wife lobbied for a hip replacement at age 38. She had congenital issues that had caused degeneration. Wouldn't give her one, too young. She finally found a surgeon who understood why wait when she can do physical things now?? Damn the future at 65 when it would wear out! She had it done and was able to ski etc again with her kids for years. To me that's awesome. So you got that to look forward to.

 

[Henry]

The usual suggestions apply...do all the physical therapy plus a bit more. Work diligently on range of motion. Get both legs in the best possible condition before the surgery with pre-hab as needed. When you're able after the surgery work on range of motion, balance, strength as much as you're able. Don't do too much and don't harm it, but work it right to the limit. When you get back on the ski hill cautiously test your reasonable limits.

It's probably too late to make any changes. A coach I respect greatly got a Conformis brand replacement and highly recommends them:
--quote--
Conformis utilizes your individual CT scan data to manufacture a knee replacement implant designed just for you.
• Individualized, patient-specific knee implant fit: Conformis implants are designed based on your anatomy. Off-the-shelf knee implants are designed based on a set of pre-determined measurements, and the “closest fit” is selected at the time of surgery.

•Maintenance of the natural joint line: did you know you have two joint lines in each knee? One is on the medial side, the other is on the lateral side, and they can be different heights. Conformis is the only technology that maintains both joint lines through the use of individual polyethelene inserts rather than a single piece used in off-the-shelf implants.

• Designed for optimal bone preservation: Preserving as much of the patient’s natural knee as possible is important and the unique design of the Conformis implant allows for optimal bone preservation. The implants are patient-specific and have been shown to be thinner than off-the-shelf implants, without sacrificing strength. A thinner implant allows for less bone and healthy tissue removal.
--end quote--

I got a different brand of prosthesis, Smith+Nephew, mainly due to problems related to the upset of everything at the beginning of the Covid pandemic. For unknown reasons mine was very slow to heal, but it's turning out very well. Last winter, a year and a half after the surgery, I was skiing better than every. Everything else crapped out on me by the end of the day except my hardware store knee.

 

[Mazama]

I have a few friends who have had knee replacements. One didn’t turn out right as the range of motion was limited by weak PT. Two others were very successful. Both successes had a “range of motion” exercise machine ordered by the Dr for delivery the day they went back home. They are also called Continuous Passive Motion machines. They used this multiple times a day. The second thing they used was an electric icing device which was used daily. Both devices made a huge recovery difference and both can still ski! Hope this helps!

 

[silverback]

My insurance denied the CPM machine. Something about latest studies showing that results were not different with it or without. If I had it to do over, I’d have just bought one on eBay.

 

[LosCrusher]

I'm 52. (been skiing since I was 9 y/o FWIW). Long story short, in 2014, I was diagnosed with stage 4 osteoarthritis in both knees - essentially had the knees of an 85 yr old. I could not walk down stairways or even step off a curb without being in severe pain. I was recommended a great surgeon at the Hospital for Special Surgery in NYC. Before deciding on surgery, we tried viscosupplementation, steroid injections, and of lots of PT. Nothing took and so it was time to get with the robot. Both procedures went extremely smoothly and each time I was up and "walking" the same day.

A couple points from my experience:

- As Henry alludes to, pre and post-surgery PT is prob the most important aid in recovering properly. It's imperative to break through scar tissue while it is still weak, to aid in getting back as much range of motion as possible. Osteopathic manipulative therapy may also be beneficial.

- You'll be icing the knee for quite some time. Its vital to recovery. You may want to consider getting a quality elastic gel pack. Just makes things alot easier. Also acupuncture works wonders.

- It goes without saying these days, but can never be overstated - please be careful with any pain meds if they are prescribed. I got hooked bad and suffered through several years of opiate addiction. Ended up in detox/rehab in Tampa where I finally kicked them.

With all that said, for me personally, having knee replacements was one of the best decision I've ever made. I'm skiing better than ever with greater confidence.

Best of luck!

 

[martyg]

Search out a PT with a PhD or that has completed their fellowship, and specializes on performance outcomes.

I believe that current peer reviewed scientific studies show that icing is not something that will aid recovery. It acts as an analgesic, but does not speed recovery. Ice will make you more comfortable. You need to create the optimal environment for cell growth through killing yourself in the gym, and then getting your diet and hormone levels dialed by working with true professionals in that field to speed recovery.

Note on pain meds: avoid ibuprofen. It inhibits the enzyme that cuases swelling. That same enzyme plays a roll on cell division. It may be a matter of a few points of difference, but if you are about a performance outcome, a few points is everything.

Best to you.

 

[mdf]

My insurance denied the CPM machine. Something about latest studies showing that results were not different with it or without. If I had it to do over, I’d have just bought one on eBay.

That's a shame. I haven't had a TKR, but I used a CPM after ACL surgery and feel it helped a lot. I had to request one for the 2nd knee. Even if the CPM doesn't statistically improve the average outcome, it makes it easier to get to a good outcome.

 

[RiderRay]

As I stated in my post above, cold compression therapy is the way to go. It entails a machine that has a reservoir that holds water, and has a compressor. A wrap goes around your knee and connects to the machine with several hoses. The machine chills the water to 40°F, circulates it through the wrap and compresses intermittently. I have delivered, set up and serviced thousands of them and patients swear by them. The ones that you add ice and water to and use a manual bulb for the compression, similar to a blood pressure cuff, are not nearly as effective. In conjunction with a CPM, I have witnessed spectacular outcomes. Just to be clear, I am no longer in the business so my opinions are strictly from much observation.

 

[mdf]

Much as "evidence-based-medicine" sounds like a good idea, I think that in practice comparisons such as "CPM or no CPM" are so overwhelmed by the numbers of people who just don't do the rehab that the real benefit gets lost in the noise.

 

[Brian Finch]

^this

plus - re CPM - there’s a statistical benefit in preventing a manipulation later, but it’s like 1% improvement; in practice the issue w CPMs is that the thigh is pretty fleshy and most ppl just lay the leg in the machine. No where near degree of motion is created as one thinks, whilst the patient lays in bed an excessively long time. Thoughts are better to be up & moving.

FWIW (& I see a lot of under rehabbed knees as consults & destination clients), week 1-2 after the operation of going to outpatient, ya want to be in the clinic 3x per week - no exceptions. The window of opportunity to get that joint moving closes quickly. Modification of tissue requires holds / contractions at end range in the 2 minute + level ; good old time under tension.

Its also a good idea to interview your PT before surgery. Ya want one that will manually mobilize, facilitate & stretch not put you on a series of equipment with a clipboard.

Just my thoughts, not medical advice.

 

[meff]

Had my left knee done five years ago, should have done it earlier. I didn't have a CPM, but had in home PT for the two weeks post surgery and then in clinic 2-3x a week for a few months.

I had my knee done when I was significantly heavier, so probably used way more bone than is ideal but back then I didn't have many options. Now at a lower weight am quite active, hiking, biking in the off season with no issues.

From a skiing point of view, post replacement I had to have some boot work done to get back into alignment, and the first season back it took a few days to get confidence back.

 

[EasternSkiBum]

You guys are awesome... thanks for the advice. CPM isn't used much these days because it doesn't have enough evidence to justify it. Custom knees aren't covered under a lot of insurance plans for the same reason. The surgeon is going to be using a smith and nephew journey (unless he sees stuff that changes his plans after he opens me up).. I think the new one that they call the 30 year knee, of course that's marketing since it hasn't been around that long. I am prehabing and I'm looking into a sports performance group for the rehab that has several DPT therapists. I have to make a pre surgery appointment anyway. I have a gravity feed cryo cuff from my scope I had done 7years ago. While I agree that an automated one would be superior I'd rather use the money for more rehab....although I will ask about insurance coverage for one. I remember how ice was my best friend after the scope and it still is after a day on the hill.

I'm sure I'll need new boots and footbeds.... I've been adjusting things for years as my right leg has slowly deteriorated and angled in somewhat. The old injury was to my lateral side which is where I'm hard bone on bone now. I also have limited range of motion at both flexion and extension which is the main reason I'm replacing it. I am working on that now too. Last ski season I was teaching 4 days /week and had additional days beyond that... by the end of the season my right quad was significantly smaller than my left. I was also developing some weird movements in response to my guarding of the right leg. It wasn't pretty. I was also having difficulty loading low lifts.. my knee didn't want to bend that much, and forget walking down stairs. Right now I plan on skiing the the second half of the season. Whatever that means.

 

[martyg]

by the end of the season my right quad was significantly smaller than my left. I was also developing some weird movements in response to my guarding of the right leg. It wasn't pretty.

That atrophy and those compensation patterns are reason #1 why it is so important to get on these things, suck it up, and get surgery done ASAP. Once you start rebuilding, you are starting at a disadvantage with muscle size and density already compromised.

NOTE: about a year and a half ago I suffered a really heinious knee injury. 10 weeks after surgery I am still hobbling around the gym. Another gym goer, who had a total knee replacement, was walking up and down stairs 8 days out from his surgery. My buddy had a partial a year or two ago. He just won his age class in a very competative mtn bike race against former Olympians and national champiosn. It seems that science has this repair figured out.

 

[Living Proof]

I'm now 30 months post TKR, stopped skiing for several years due to pain on lateral side of right knee. Surgery was done in March, played golf 7 weeks later. Had hoped to ski the first winter, Covid put those dreams to bed, but, my knee was healed well enough. Skied last winter, knee was solid, never a problem, however, I had a part time job in a gym and got great instruction on strengthening and stretching legs and body. I would highly recommend using TRX devices both before and after replacement. My coach gave me specific exercises to increase strength and knee flexation. I used phone to video her techniques and progression.

Prior, do strenghting as described above, I would concentrate on groin muscles as mine just screamed in the first few weeks of hobbling around. Stationary bike is good as that will be part of your rehab and helps cardio.

I asked my Doc about getting off opioids ASAP. He gave me a strong anti-inflammatory that I started 5 days post. There are downsides to this for some, was able to wean off quickly, but, they helped when flair ups occur.

My Doc wanted me to rest for first week w/o PT. Did a month, hit the benchmark for bending knee quickly. Ended PT early due to Covid concerns. My PT's experience is that most are about equal at 6 weeks even if in different rehab procedures. A prime goal was not to limp, I spent much time using a walker and concentrating of regaining a normal stride. Walk on soft uneven surfaces like grass to build strength in the small muscles that balance you. Overall, my experience and recovery was better than most.

One aspect of trying to ski at 3 months is do you have the leg flexibility to get into and out our your boots. Also, the vibrations from skiing on hard snow are stressful, I would use only narrow waisted short skis to start.
Best wishes for quick recovery, be cautious and smart.

 

[EasternSkiBum]

That atrophy and those compensation patterns are reason #1 why it is so important to get on these things, suck it up, and get surgery done ASAP. Once you start rebuilding, you are starting at a disadvantage with muscle size and density already compromised.

I agree.. surgery is Sept.21. I actually made the call around May1 after first seeing my sports medicine guy who said nothing left to be done at an arthroscopic level. It took until July 28 to finally meet the surgeon.

My Doc wanted me to rest for first week w/o PT. Did a month, hit the benchmark for bending knee quickly.

Did a month w/o PT? I love the fact that your Doc is so progressive. I'm going to Johns Hopkins but they still want that PT scheduled for day after surgery etc... It seems like surgeons these days are all over the map on how to best rehab.

One aspect of trying to ski at 3 months is do you have the leg flexibility to get into and out our your boots. Also, the vibrations from skiing on hard snow are stressful, I would use only narrow waisted short skis to start.

I'm giving it 4 months... I've lost flexibility and worse... I've lost extension. It's difficult for me to comfortably pedal a stationary bike. I can barely do a full rotation with no resistance and I feel like I'm hitching my hip a little to do it. Last season I was finding it difficult to click into a binding because of the extension loss. I'm doing a lot of bending and stretching in addition to strengthening now pre surgery. I think I've gained some flexion back, I've definitely gained strength... but my knee feels resistant to straightening. It's not even painful to try and straighten it.. it just feels locked and won't go. I put weight on it.. I push through the heel. It's somewhere between 5 and 10 degrees of contracture. I already ski a sub 80 ski 98% of the time... and being in the mid atlantic hard snow is becoming a rarity... although groomers are plentiful. Lucky me... I can go back to skiing at my pace on the days of my choosing. I will stay away from crowded days and crappy days.. (which will mean a sabbatical from teaching this year). I've become one of those Vail lifers.. so I don't have the stress associated with having to get my money's worth out of a lift ticket. Of course the cost of gas to get there and back is another thing. Actually just going to the mountain and hanging with friends will be worth the drive for my mental health.

 

[Henry]

And...opiod pain killers cause constipation. If you take one of the opiod products take a dose of laxative each day starting on day 1. Stool softeners might work for you, and might not. Start with a Miralax type product.

 

[Henry]

More on knee recovery:
--A DPT told me about their two sayings. "If physical therapy doesn't hurt, you didn't do it right." And, "You gotta want this more than we do."

--That DPT told me that the bone starts to grow into the prosthesis, then physical therapy breaks off the new growth bits so it'll regrow even more bone bits. Then those get broken off so more regrow, etc. I can't document this, that's what he told me, and partly why it PT is painful.

--I was given a Breg Polar Care Cube blue square ice water bath circulating machine. It has an ice water reservoir, a pump, and hoses to a wrap that goes around the joint. Any of these takes a lot of ice. For the Breg we found that the Fiji brand bottled water is in square bottles and four fits the machine just right. Buy a dozen bottles of this or a similar size. Freeze them, put four frozen ones into the reservoir surrounded by cold water, the four thawed ones you just took out go into the freezer, and you have a rotation system of ice that your home refrigerator-freezer can handle.

--If you're sent home with an electrical pump on your leg... Some are to pump long lasting local anesthetic into the surgery site for pain control without narcotics. Others are a vacuum pump to pull the skin together so it doesn't have stitch scars. In any case, recharge the battery during the day. You do not want the battery low voltage alarm screeching in the middle of the night. Don't ask me how I know this. Sleep is precious.

--Plan what tattoo you'll have on the incision scar. You might want shark's teeth marks, or maybe red baseball stitching, or how about a big zipper pull?

--For control of pain and swelling consider alternating hot and cold therapy; discuss this with your PT: "If you use both ice and heat, apply heat for 15 to 20 minutes, then a few hours later use ice for 15 to 20 minutes. Do this at spaced intervals throughout the day. By rotating between each temperature therapy, you’re reducing inflammation and loosening muscles simultaneously, increasing your chances of pain relief."
https://connect.mayoclinic.org/blog...g/newsfeed-post/using-heat-and-cold-for-pain/

 

[EasternSkiBum]

Thank you Henry for all the wonderful advice. I don't think I'll be sent home with much equipment since insurance doesn't like to pay for much these days. I do have a gravity design cryo cuff I received after my scope 7 years ago. So I'm familiar with them.

Plan what tattoo you'll have on the incision scar. You might want shark's teeth marks, or maybe red baseball stitching, or how about a big zipper pull?

Well that's easy.... I'm also a scuba diver so shark's teeth is a no brainer. I've got a nice curved scar on the lateral side of my leg from the original injury.... I used to tell my scuba students it was the quarry shark that got me (right before we went into the quarry to certify them) LOL..