Share stories of your TKR experience

SBrown

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Agree with the things already written, and will add a couple that surprised me. I got a bit of vertigo after mine. It has gotten much better but I'm not where I was pre-surgery. Did a lot of balance drills at pt and did great, no problems at all. When I would be moving in space, though, is when I was off. I posted this here somewhere, but the season after my TKR, I was terrified on chairlifts. I've been riding them, without bars, for 50 yr. That season, I had to have the bar or at least something to hold onto. It's better now but I still get spinny at times. I was really off balance last summer, fell a few times. That is back to normal.

The realignment of my left leg did hurt my turns; I needed to rearrange my ski boot.

Finally, my "good" leg wiped its brow and said, whew, glad that's over, I'm resting now. It really took a turn and now is my weaker, more painful leg. Oh well. lol. Anyway, no one told me about this stuff, so I thought I would add these to your list!
 

rcc55125

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I had TKR in both knees done in 2020. The left in April, the right in August.
I thought the cold compression machine was such a help with the first knee I bought a machine for the second. The first machine used cold water circulation, the second used the cold packs. The cold pack machines are much less expensive and seemed to work just as well.
I had no other medical issues and at 73 was in general good health so both operations were done as out patient procedures; in by 7 AM out by noon. I was walking at home in the afternoon with a walker. I was able to walk a little more every day and graduated to a cane in 5 days. After six weeks of PT I was able to drive a car. I was fortunate enough to have an indoor dry training slope (The Alpine Factory, Arden Hills MN) near where I lived and started training there once I completed the mandatory medical PT. I was on snow in December 2020.
I would recommend new boots and foot beds after TKR. My legs were quite bowed prior to surgery but straight after TKR. My stance had changed considerably.
I skied OK in 2020/21 and felt good at the end of the season. Once Covid restrictions eased I started working with a trainer in the summer of 2021 working on strength and flexibility. Last season 21/22 was really good. I could really feel the time in the gym. I'm looking forward to a better 22/23 season.

Now a plug for a young friend and ski trainer I have worked with in MN who has just received his PT MD. He is also a PSIA examiner so knows what a skier needs. If you are lucky enough to be in the Aspen area Dr. Joe Kagan is working at Aspen Valley Hospital Outpatient Orthopedics. If you tell him Ron sent you you'll get some good stories but I can't promise a discount.
 
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EasternSkiBum

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I was on snow in December 2020
Just the kind of story I was looking for. Thank you.... The dryland slope nearest me is almost the same drive as to the mountain nearest me.. just different directions. I'm lucky enough to be able to take the season off of teaching :( and just focus on get back to skiing:yahoo:. I'll be able to take it at my pace. My biggest concern is that by the time I need to go to the bootfitter it will already be kind of late in the season. Maybe not.... if swelling is gone and some balance is back by December.

I've chosen my PT.... and yes they are sports oriented.
 

Henry

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To add to what rcc said...walking is great. Go for walks as soon as you're able. Walk farther. Walk farther faster. Find stairs when you're ready. Keep working on the range of motion. Don't let your ankles or hips get stiff, either. (plug for yoga)

I understand what he said about alignment. I expected a change, but if there was one, it wasn't big enough for me to notice. Do get your alignment checked when you're ready to get on the slopes.

A doctor of physical therapy, DPT, is the current entry-level requirement for physical therapists since about 2020. It's 3 years post-grad. A physical therapy Ph.D is more research oriented vs. the clinical orientation of the DPT. It isn't an MD, medical doctor. I think the transition route from PT to DPT is a one year program. I've received excellent therapy from both DPTs and experienced PTs (knees, shoulder, knees, more knees, spine).
 
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EasternSkiBum

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I understand what he said about alignment. I expected a change, but if there was one, it wasn't big enough for me to notice. Do get your alignment checked when you're ready to get on the slopes.
I will thanks ... I'm very sensitive to alignment. It's gotten more difficult to initiate turns to my right over the years and I've had tweak's made to my footbeds to compensate. I'm sure I'll need new one's because of it.
 

RSTuthill

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Interesting thread. But I do not see any discussion of which TKA system that folks got installed. At my level of knowledge there appear to be three main categories: Posterior stabilized (PS), PCL cruciate retaining (CR), and medial pivot/medial congruent (MP/MC). Would anyone like to share their experiences if they know what they got? Asking for a friend (of course) who is trying to decide based on a lot of input but none from skier experiences.

And btw, none of these systems seem to retain the ACL, nor can I find any design features that would in some way mimic the ACL function.

This friend, btw, also has two artificial hips which have worked fabulously well. They actually markedly improved his ski technique since he had them done 13 years ago.
 

Henry

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ACL: https://pubmed.ncbi.nlm.nih.gov/9932189/
"Few prostheses allow preservation of the anterior cruciate ligament (ACL) during total knee replacement. We report a short-term, prospective, open study of 32 ACL-retaining and 93 ACL-replacing total knee replacements and compare the respective outcomes of both prosthesis types with a follow-up time of 2-3 years. Mean operative time, complication or revision rates did not differ, nor did the early and late clinical and radiological evaluations. This study does not support the suggestion that technical difficulties increase for ACL preservation. The clinical and functional results were neither improved nor worsened for ACL-retaining prostheses. There is thus no advantage, but also no inconvenience, in retaining the ACL according to short- to mid-term results of a gliding posterior cruciate ligament (PCL)-retaining prosthesis with ACL-replacement design. The possibility of an improved long-term outcome of an ACL-retaining prosthesis should be investigated further. "

And, I know no details about my TKR prosthesis.
 

jcjpdx

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I am a retired physician, not an orthopedic surgeon but I referred many patients for TKR over the years. A lot of good info has been shared already by folks with personal experience, so I’ll just give a short observer’s perspective. TKR’s often hurt like hell. The physical therapy hurts like hell in the early stages. Sorry. The patients that I had who were willing to work with their PTs through the pain had great results after about 3 months. (Just in time to for you to go skiing in January!) The people who did not fight through the pain but rather waited for the pain to go away usually did not have good results and often had chronic pain. Some people have less pain after surgery, I hope you are one of those. Good luck!
 

RSTuthill

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ACL: https://pubmed.ncbi.nlm.nih.gov/9932189/
"Few prostheses allow preservation of the anterior cruciate ligament (ACL) during total knee replacement. We report a short-term, prospective, open study of 32 ACL-retaining and 93 ACL-replacing total knee replacements and compare the respective outcomes of both prosthesis types with a follow-up time of 2-3 years. Mean operative time, complication or revision rates did not differ, nor did the early and late clinical and radiological evaluations. This study does not support the suggestion that technical difficulties increase for ACL preservation. The clinical and functional results were neither improved nor worsened for ACL-retaining prostheses. There is thus no advantage, but also no inconvenience, in retaining the ACL according to short- to mid-term results of a gliding posterior cruciate ligament (PCL)-retaining prosthesis with ACL-replacement design. The possibility of an improved long-term outcome of an ACL-retaining prosthesis should be investigated further. "

And, I know no details about my TKR prosthesis.
It does however simplify things for the surgeon to resect the cruciates since they are cutting bone very close to them.
 

RSTuthill

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My friend has decided on a Zimmer Medial Congruent knee. According to recent literature, recovery time is shortened with it due to less initial post-op pain allowing more PT. Anyone have experience with this particular knee?
 
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EasternSkiBum

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I am a retired physician, not an orthopedic surgeon but I referred many patients for TKR over the years. A lot of good info has been shared already by folks with personal experience, so I’ll just give a short observer’s perspective. TKR’s often hurt like hell. The physical therapy hurts like hell in the early stages. Sorry. The patients that I had who were willing to work with their PTs through the pain had great results after about 3 months. (Just in time to for you to go skiing in January!) The people who did not fight through the pain but rather waited for the pain to go away usually did not have good results and often had chronic pain. Some people have less pain after surgery, I hope you are one of those. Good luck!
Thanks for this. What I can tell you is that the use of multi modal pain control these days is better than it used to be. I'll likely get spinal anesthesia with sedation. Then they'll use a whole cocktail of drugs using local infiltration of the surgical area, this is supposed to be as effective as femoral nerve block without the drawbacks. This buys me about a 24hr. window of less intense pain. Then I get some oxy in addition to lyrica, meloxicam?, tylenol, and low dose aspirin (prevent clots so no mandatory TED). I've got lots of ice therapy ready.

Anyone have experience with this particular knee?
I'm an old science person and do a lot of research in order to understand what I'm in for. Truth be told you can find a study or 2 that shows that a certain product is better than the others. These are usually biased studies...isn't marketing grand. Everything I've been reading boils down to a simple formula. Find the best surgeon you can... one with a lot of experience that shares your goals. Then make sure you do the prehab/rehab. The prosthetic, the slight variations in technique, etc... are all relatively equivalent in the end.

Talk about marketing... I'm getting the smith and nephew 30year knee (at least it's supposed to last that long according to laboratory testing)..LOL. Honestly since I'm youngish and active it's worth a shot. I've got one week to go.... I'm not looking forward to it. I am looking forward to skiing with both legs again.
 

Rod9301

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Thanks for this. What I can tell you is that the use of multi modal pain control these days is better than it used to be. I'll likely get spinal anesthesia with sedation. Then they'll use a whole cocktail of drugs using local infiltration of the surgical area, this is supposed to be as effective as femoral nerve block without the drawbacks. This buys me about a 24hr. window of less intense pain. Then I get some oxy in addition to lyrica, meloxicam?, tylenol, and low dose aspirin (prevent clots so no mandatory TED). I've got lots of ice therapy ready.


I'm an old science person and do a lot of research in order to understand what I'm in for. Truth be told you can find a study or 2 that shows that a certain product is better than the others. These are usually biased studies...isn't marketing grand. Everything I've been reading boils down to a simple formula. Find the best surgeon you can... one with a lot of experience that shares your goals. Then make sure you do the prehab/rehab. The prosthetic, the slight variations in technique, etc... are all relatively equivalent in the end.

Talk about marketing... I'm getting the smith and nephew 30year knee (at least it's supposed to last that long according to laboratory testing)..LOL. Honestly since I'm youngish and active it's worth a shot. I've got one week to go.... I'm not looking forward to it. I am looking forward to skiing with both legs again.
Marketing, but i still think comformis, custom made hardware is the best
 
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EasternSkiBum

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Marketing, but i still think comformis, custom made hardware is the best
You maybe right... but there's the not so little matter that some insurance companies like mine (Aetna) doesn't cover custom due to the fact there's no evidence to justify it. It's a whole company policy... not an individual policy thing. They don't cover computer assisted navigation like makoplasty either.
 

Henry

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Do surgeons give a patient a choice of brand of new knee? Or does the surgeon use the brand whose rep took them on the best golf trip?

I'll likely get spinal anesthesia with sedation. Then they'll use a whole cocktail of drugs using local infiltration of the surgical area, this is supposed to be as effective as femoral nerve block without the drawbacks. This buys me about a 24hr. window of less intense pain.
My experience...the saw bones expected the cocktail of local anesthetic to last 24 hours, and mine lasted about 12 hours. Then it was an oxycodone tab every 4 hours, which wasn't enough, 3 hours worked better--and I had to campaign to get that. The best results I've heard of are from the patients who had a local anesthetic pump added to the procedure. It pumps in long lasting locals for a few days and may eliminate the need for narcotic pain relievers. Insider tip...if you get any electrical gizmo, either this pump or a vacuum pump to pull the incision edges together, recharge the battery during the day so it doesn't awaken you with its screech at 3 am demanding charging. I probably posted this before, but sleep is precious.
 

Prosper

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I had a TKA 04/2021. Eleven years prior I blew out my knee (skiing, of course) and had a typical ACL repair. During that surgery I contracted an unusual fungal infection. During the subsequent 4 years, the fungus pretty much destroyed my knee. After 4 knee surgeries over 4 years, the fungal infection was diagnosed, treated and cured. After that, year after year the knee arthritis and pain progressively worsened. During the 2020/2021 season I could only ski 1 day at a time and was pretty much hobbled for a week after that. I knew TKA was inevitable but was trying to hold out as long as possible since I’m relatively young for a TKA (50yo when I had it done). Since having the replacement, I’m pretty much back to my previous activities. Getting the TKA was probably the best medical decision I’ve made. Like many others who get joint replacement, I should have probably done it a few years ago. I skied 29 days last season and had no problems skiing multiple days in a row. In addition to skiing, I’m running, hiking 14ers, biking and playing tennis. The only sport I haven’t returned to is my 1st love, soccer, which I’m hoping to do in the next year or so. My hardware is the Zimmer Biometric Persona The Personalized Knee. It was a cementless process. My ACL was removed during the surgery to treat the fungus so not an ACL sparing process. The 1st 10 days after surgery were really painful, much more so than I expected. I have a very high pain tolerance. Make sure you have someone who can be at home with you around the clock for the 1st 2 weeks post-op. Sounds like you’re ready to put in the PT work so you should be good to go. Best wishes for a successful surgery and smooth recovery. Feel free to PM me if you’d like to hear more details about my knee journey.
 

SBrown

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My experience...the saw bones expected the cocktail of local anesthetic to last 24 hours, and mine lasted about 12 hours. Then it was an oxycodone tab every 4 hours, which wasn't enough, 3 hours worked better--and I had to campaign to get that. The best results I've heard of are from the patients who had a local anesthetic pump added to the procedure. It pumps in long lasting locals for a few days and may eliminate the need for narcotic pain relievers. Insider tip...if you get any electrical gizmo, either this pump or a vacuum pump to pull the incision edges together, recharge the battery during the day so it doesn't awaken you with its screech at 3 am demanding charging. I probably posted this before, but sleep is precious.

Yes, I had that, and I would say I never got above an 8 in pain, and even that was pretty brief. Second night was the roughest, that’s always the case IME.

My friend has decided on a Zimmer Medial Congruent knee. According to recent literature, recovery time is shortened with it due to less initial post-op pain allowing more PT. Anyone have experience with this particular knee?

Is that the one with the curved incision on the side? (Perhaps the medial side? duh) If so, I have heard good things, but last week I heard about a guy that was healing so rapidly that they overworked him in PT and it backfired a little bit. ie, he wasn’t as ready as he appeared, a few weeks ahead of “normal” schedule. Anyway, a data point.
 

Scotty I.

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About three weeks ago I tripped on a concrete sidewalk and went down hard on both knees - especially the one with the replacement in it. It is now double the size of my non-repacement knee. Normally I would go to the docter but, hey, ski season is almost here and I'm afraid of getting bad news. When you have a skiing addiction, you may find that your decisions make perfect sense while the rest of the non skiing world thinks you're a complete idiot.
 
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EasternSkiBum

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Since I started this I thought I would fill everyone in. I had a pretty uneventful surgery. It turns out that they don't keep the acl the prosthesis replaces that stability in its design. I did have a cruciate sparing design... as well as quad sparing procedure... although from the feel it's possible that the quad tendon may have been involved. I can fire my quads so I'm really happy about that. The thigh pain from the tourniquet is where the pain is. The joint is so tight I can't flex much yet. I came home same day as surgery...I need minimal pain meds...I'm sleeping...I'm getting around with my walker really well. I don't have any pumps or drains. My sutures will dissolve.. my skin was glued. They didn't use a robot or custom parts...I got Smith and Nephew oxinium with veralast. It's supposed to be their 30yr. knee... at least in lab simulated testing. Now as long as I get the rehab right I should be good to go.
Thanks everyone for the thoughtful conversation. I hope it helps others as well.
 
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EasternSkiBum

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About three weeks ago I tripped on a concrete sidewalk and went down hard on both knees - especially the one with the replacement in it. It is now double the size of my non-repacement knee. Normally I would go to the docter but, hey, ski season is almost here and I'm afraid of getting bad news. When you have a skiing addiction, you may find that your decisions make perfect sense while the rest of the non skiing world thinks you're a complete idiot.
I hope you heal soon and have a great ski season.
 
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