My Journey To Recovery After A Successful Knee Replacement
On December 15th 2010, I went into hospital for a total knee replacement operation. I was only in my early sixties but had had trouble with arthritis for the past ten years. I had tried the non-surgical therapies to control the pain of the arthritis but nothing seemed to work any longer. Tablets and steroidal injections, etc, had managed the pain over the last ten years or so but having tripped and twisted my knee, a new X-ray showed that there was no cartilage left between the femur and the tibia on the inside of the joint. My surgeon thought it was time to offer me a total knee replacement. After discussing this with my wife ( who was going to have a lot more work around the house and looking after me) I agreed to go ahead with it and was duly placed on his list. All I had to do then was to wait for a call from the hospital which would mean I could have the operation to replace the knee joint.
In this article, I will only briefly describe the operation but more importantly I will take you along with me on the journey to full recovery.
It has now been 2 years since the operation and my last progress report will be posted later this week. I now have a fair degree of pain free movement and am not physically affected by the lack of movement that I do face. The major issue is that I do not kneel on the joint at all which means I do have difficulty rising from the floor without some support from nearby furniture or similar. Was the operation a success, was it worth it? See the last progress report and the guest book below for the answers.
DISCLAIMER: I am not medically qualified, this page represents my own experience in recovering from this operation. I do not claim that everyone will have the same timeline for their recovery.
This image is licensed under the Creative Commons Attribution-Share Alike 3.0 Unported license. and shows an MRI scan of a knee joint with osteoarthritis.
Total Knee Replacement Procedure - A Brief Explanation
Very briefly the procedure entails cutting away damaged, arthritic bone from the femur and the tibia. Replacing these damaged parts with new mating surfaces will ease the pain of the arthritic condition, sometimes the patella is also re-surfaced. The muscles and lligaments are not affected.
A diagram of the bones in the knee joint, muscle and other names obscured for clarity.
There are many far more detailed descriptions of the operating procedures on the internet but it is not the intent of this article to try to do this here.
The image is licensed under CCby2 France and shows the new inserts in place. The strap shown is to help keep the model together and is not part of the procedure.
Rather than embeding a You tube video of an actual operation I have listed some if you are interested; if you do not have a strong disposition or maybe you are due for this procedure, then the image alone could well be unsettling. I have therefore decided to simply add this list rather than the embedded video.
Please be warned read the description for each video if you may be upset by it, especially if you have yet to undergo the operation yourself. It is not as bad as it may seem though, and the vast majority of people have few problems. Your doctor/surgeon will advise on any risks.
- An actual operation - total knee replacement
A live operation, showing why the procedure is considered such major surgery - Not for the faint hearted !
- Pre-operative information about the procedure
This will inform potential patients about the procedure but using diagrams rather than actual film is easier to watch for those affected by the video above
- Animated operative procedure
Another animated video, which shows the work to be done in a quite short video.
After The Operation
You are offered different anesthesia options before the operation; either to be put to sleep during the procedure or to receive a shot in the spine to deaden all feelings below the waist. I opted for the latter but was also given a relaxant to "make me feel drowsy". It actually made me feel so drowsy that I fell asleep whilst being prepared in the theatre and missed the whole operation.
Waking up after the operation, I did not feel any pain which was due to the drugs being pumped into the system. A little contraption that was worn on the wrist which would inject more painkiller as required ( by the patient) but was quite safe as it was programmed not to provide more than a given amount in a given time. I remember being wheeled back to the ward and before long I did start to feel the pain. I soon got used to using the device on my wrist.
My operation was the last of the day and so after being made comfortable I was left for the night. In the morning patients were encouraged to get out of bed ( not forgetting the exercises) and very soon the physiotherapists were helping to get you on to crutches and walking (?) around the ward. I actually had no problems with this but had tremendous difficulty with some of the exercises which required the leg to be straightened, However it seemed that bending the knee was considered more important as a measure of success at this stage.
over the next couple of days the physios returned to help with getting up and down stairs with the crutches, and with other tasks that one would be required to do at home, including simple but necessary tasks like sitting on the toilet.
The use of the painkiller injections were discontinued after one or two days and tablets were the source of pain control. Talking about tablets, laxatives were offered when the tablets were dispensed, the painkillers were known to cause constipation. I did not however need to take up the offer as I drank plenty of fluids and kept quite regular.
I was walking quite well with the aid of the crutches and I had a knee bend of 90 deg, which was the required target for discharge. So after four nights I was allowed home. Before the operation, any need for special facilities or help had been assessed by the team and as I lived with my wife and had all required facilities there were no issues for early release. Five to ten days was accepted as normal.
As an aside, the day I left hospital we had some of the heaviest snow that the UK had seen for fifty years. My son managed to come for me before the snow got too thick as of course I would not be able to drive for quite a while.
The photo is licensened by Wiki Commons user Bobjgalindo under the Creative Commons -Atrribution/Share-Alike License. The photo shows a patient recovering from anesthesia but it does not show the author!
On Going Home.
The Start Of The Recovery
These days you are encouraged to start exercising the new joint as soon as you can after the end of the operation. Then as long as you can bend the knee through 90 degrees, use the crutches to get around, handle the stairs and manage to sit on and get up from the toilet you will be ready to be discharged from the hospital. Depending on your particular circumstances, you may need to attend physiotherapy sessions or see a phyiotherapist in your own home.
I was discharged on the 5th day following the operation and sent home with a list of exercises. It is important that the exercise schedules are followed diligently, as the speed of recovery can depend upon this. If the knee is not exercised scar tissue can form around the implant restricting movement and necessitating further surgery to clear up the problem. Early pain in the exercises is to be expected and pain relief tablets are prescribed for this. A good tip is to arrange to take the pain killers and wait 10-20 minutes before exercising, to allow for the full effect of the medication.
In my own case, my knee swelled up considerably on the second and third day after my discharge and the maximum bend I could obtain was reduced considerably. Unfortunately, the physiotherapist who came to see me at home had seen the 90 deg which I could manage, on the first day. She had then signed me off as not needing to be seen again. The situation was compounded by the fact that my discharge from hospital was on the 19th December and My next appointment was not until new Years Eve. By then the bend had reduced to something like 55 degrees, and this seemed to worry the physiotherapist. But on New Years Eve it was difficult to even contact my surgeon or his secretary so It was another 5 days before I saw the Surgeon. Further X-rays showed that the inserts were OK and that there should have been no problem. Lots of Physiotherapy was prescribed.
You can see the very neat scar I was left with, the off-centre angled line is very deliberate to give better access to the bones once the skin is held back by the retractors. The dressing is very compact and is designed to just fit over the cut
This next photograph shows the bruising that came out a few days after the operation on the back of the knee
. The white pressure stockings are worn on both legs after the operation for six weeks to prevent deep vein thrombosis (DVT) one of the likely problems with the operation.
Note: Re Swelling and Bruising
Observations After My Second TKR
Just a quick note here about the post-op changes which will be noted in the whole leg.
I have suggested above that the swelling "and bruising" may have been partially the cause of the problems which I experienced in the early days after the operation. Having now had a second TKR on my other leg, I now know that this is a common feature following such an operation. I was not warned of this however on either occasion, which is somewhat surprising. Maybe it is so common that they did not deem it necessary.
In fact the bruising on my second operation was much worse as can be seen from the accompanying image.
But this time because of my prior experience, I made sure that I overcame the pain from the bruising and made good use of the exercises to maintain a good degree of mobility in the knee.
Expectations After A Knee Replacement Operation - What Will I Be Able To do?
Many people will want to know what can I do after the operation and how long will it take before I can do it? A very important consideration. Of course everybody is different and recovers the use of the knee at different rates. In order to give some idea of what your doctor expects for the first few months or so, I suggest watching this video.
You will find from my experience as detailed below that my recovery was slower than average for some things but better for others. The video mentions walking, driving, sports and simple things like kneellng. Use it as a guide but not a precise roadmap. But do remember that exercise is the key to full recovery.
After The Operation - Beginning Simple Exerecises
The quicker that exercises are started, the easier and quicker will be the recovery and use of the joint.
A run-down of suitable exercises are given here but You Tube videos may help to understand the movements and the degree of movements involved in the exercises.
- Getting back to normal after the operation
A quick look at some exercises which will help your leg return to normal functioning
- Useful advice for post-op recovery
A short video giving advive based on the acronym RICE; rest, ice, compression, elevation.
- Two simple exercises
Two simple but critical exercises
- A different view on these two exercises
In order to keep the leg as mobile as possible. the movements here must be worked on despite the pain; check with your doctor if pain killers are needed
A weekly Diary
First of all, let me remind you that every single person is different and with so many variable in the procedure everybody follows a very personal path to recovery. However, I was very keen to understand how I was doing compared to other people and wanted more than the third hand apocryphal tales which everyone was keen to relate. So I hope this will help anybody about to undergo this operation or who has just been discharged from hospital.
weeks after op. ----max knee bend -------------------------- comments
1 -----------------------90 ----------------------discharged on 5th day after operation
2 -----------------------55-----------------------knee swollen, start physio on Simex machine*
3 -----------------------60 ----------------------clips** out, first regular pool sessions
4 -----------------------70 ----------------------continue on machine
5 -----------------------87 ----------------------starting to be able to lift leg off bed
6 -----------------------90 ----------------------introducing new exercises
7 -----------------------92 ----------------------more exercises introduced, swimming on back
8 -----------------------100 --------------------muscles noticeably firmer (bad leg)
9 -----------------------110 --------------------thinking about returning to work
* unfortunately I couldn't take a picture. The thigh is strapped down to a seat and the foot is attached to a lever. This lever straightens the leg on the up journey, and bends the knee as it reaches the bottom of its movement. The whole thing is variable to allow different angles for different sized people. The pain is excruciating and all you can do is sit back while it puts you through your treatment cycle, 15 minutes at a time.
** Clips are used to hold the skin together when the wound is closed. I do not have a picture of my own wound, but the following photograph is from Wiki comons and shows the clips. I have to say that my wound looked much more tidy than this.
photo credit: Ravedave , Wiki CommonsCreative Commons Attribution/Share-Alike License
The maximum bend obtained at the knee is used as a measure of progress. It must be 90 deg before discharge and is considered a minimum for unimpaired use of the knee. But as can be seen by my results above it can be much better.
Throughout this period I have diligently carried out the exercises that I have been given by the physiotherapists to do at home, the list has been added to as the weeks passed and the muscles became stronger. I have been going to a pool for exercise and lately swimming twice a week and the weekly session in the machine - I will try to get a photograph, or at least its name (I believe my physio called it a Simex or possibly a Cimex machine). It is absolutely essential that the exercises are done as if the leg stiffens up it is far more difficult to regain the movement at a later stage and further surgery may be necessary.
Something I did diligently was to keep a diary of medication and exercises. Especially in the first couple of weeks as I was injecting pain killers as well as taking two different tablets and there were a number of exercises, which grew by the week. This meant that I always knew when and what. No chance of wondering if I had taken a tablet or done the full range of exercises.
Back To Work
How Did This Affect My Recovery
I was intending to keep a weekly diary, but after the tenth week or so, progress was not so rapid or marked.
I did return to work at the start of the 11th week after the operation. I think that this was quite good but my job is quite sedentary and I thought that I could manage it. the problem, yes there was a problem, was that it interrupted the regular physiotherapy exercise schedule that I had been undergoing.
At first I was eased into the job by giving me lots of reasons to get up and walk about, in this respect my employer was very helpful. However at the end of the day, I was conscious about missing out on the exercises and tried to make up for it by perhaps doing more than I should have done. This in itself caused problems by working the joint too hard. I was finding that the day after I had been at work ( I do 3 days per week) I felt quite bad, the joint needed resting. This led to a viscious circle and in the end I wasn't sure wether it was a lack of or too much exercise which was stopping any further improvement. After a couple of weeks, I had to stop and take account of where I was. I had completely stopped my regular exercise schedule and was wondering wether I had been wrong to go back to work so soon.
After discussing this with my physiotherapist, I came to the conclusion that whichever it was I needed to get back to a regular schedule. I was able to make use of an exercise bike and a small stepper-machine. these formed the core for a new schedule. The exercise bike was difficult to use at first and I found that I needed warm-up exercises before I could make a complete revolution of the pedals. The physio helped there by getting me to point my toes downwards, I am not sure why but it helped. I went for a session one morning ( no warm-up) and did not think I was going to be able to use the bike when he asked me to mount up. After his advice I did manage to get going and this was a turning point for me.
It really set me back on the road to recovery. I still have to warm-up and take it easy for the first 2-3 rotations of the pedals but once I have started I have no difficulty. Having been sorted out on the exercise bike I found that I was much more motivated to start the other exercises. the regular sessions now include:-
- the exercise bike
- the stepper
- doing squats leaning against a large ball between my back and a wall to keep my back straight
- more stretching exercises to improve the maximum bend
- sitting with my leg on a stool and weighted to straighten the knee joint
- standing on the operated leg and bending and straightening to exercise the muscles
I am also trying to get in lots of walking and attending a pool regularly for swimming. It is now 5 months since the operation and I am now feeling far happier. Work is still an issue but I do not try to make up for the break in the regular routine, I just do what I can during the day. For example, I walk up and down stairs as much as I can. The stairs at work have quite a low riser so that I can walk down with help from the bannister whereas I still cannot walk down stairs at home yet.
All in all the phyio seems happy with my progress and yet I know others who seem to have achieved a faster recovery. I take heart that everyone is different and am looking at the long term. The medical staff say 8 -12 months is acceptable before everything is back to normal. I am now coping with all the physio throws at me although I still have a problem with simple walking. I do need to concentrate on bending my knee as I walk otherwise I start to walk like Marshall Dillon's deputy ( who remembers that TV show?) with a straight leg. The resulting limping affects my back very badly, so you might think that I would remember. However it is not easy, the first few degrees of movement in the knee are still painful. I am still taking pain killers although they are not as strong as the ones I took on leaving hospital.
More on my recovery to come in the weeks ahead.
By the way, I have been driving, albeit short distances for a few weeks now. I do not have an automatic and need my left leg to use the brake and clutch. The next big step will be to get back to normal driving, and being able to cope with greater distances.
Six Months After The Operation
A Progress Report
At this stage I am still not able to completely straighten my leg, see the photo here where I am sitting with weights inserted into a kitchen glove positioned over my knee. I do this at least twice a day, 3Kg weights for 20 minutes. One of the issues is that I could not completely straighten the leg for a long time prior to the operation, and the muscles have probably contracted because of this. Therefore it is not just because of the operation and getting back to a normal ability may therefore take a considerably longer time for me than is normal. It is likely to be a very long, slow process.
This had, and still does cause a slight limp which means I walk with an uneven gait. I have now been referred for physiotherapy by my consultant's team, to try to overcome this problem which is leading to acute lower back pain. I will keep this thread up to date as I work through this physio.
My consultant is otherwise satisfied with progress and tells me that the pain I am still getting is quite normal. reminding me that I was told that it would be 8 - 12 months before I would be back to normal.
I am now using stairs normally both up and down ( although getting down is sometimes difficult if I am having a bad day), I am also driving fairly normally now, my wife still does a lot of the longer journeys but I do feel that I could manage. Sitting in low chairs, etc is a problem especially getting up again; but is not impossible with a little forethought. Sitiing for too long ( how long depends on a number of factors) still gives me problems when I get up to walk. I need a few steps before the joint is working.. It very quickly becomes stiff with inactivity. So, yes progress is definitely visible but is frustratingly slow.
The only way forward is to keep exercising.
A Quick Update At Seven Months
Starting To Feel Depressed
Things have not been going too well since the last update, I have been trying to reduce the number of pain killers that I am taking but this is making me very grumpy according to my wife. I am still getting a lot of pain but aside from that the knee joint is becoming quite stiff and making it even more difficult to walk properly. I have had my first visit to the physiotherapist for my back and am seeing him again tomorrow. However overall I am becoming quite frustrated and depressed. I don't seem to be as mobile as I was before the operation and it is really getting me down. Although I know that the medical staff keep telling me that it is commonly 8 to 10 (12?) months before getting back to normal, I had hoped that I would have seen more improvement by now. With the slow rate of progress I am not sure that I will be back to "normal" any time soon.
Before the operation I was asked to fill in a form which would be used to track the progress of the op and its effects. One of the questions was, "Do you class yourself as being disabled?". My initial answer was a resounding no. OK I had lived with pain and some loss of facility for several years but I was not disabled. However I recenly completed a progress report, filling in a similar form and answered YES to this same question. There are lots of things that I can not do, which I would have been able to do despite the arthritis.
This has really bought home to me how frustrating the last seven months have been, to have gone through so much pain and anguish to now have an uncertain future. I really do feel depressed about the lack of progress. My wife tried to persuade me otherwise last night but we ended up arguing about our respective views on the matter - not a good ending.
So it's back to the exercise machine for now, I will let you know if I feel any better soon.
On The Road To Recovery - It Is Easier In Your Own Home
I found a static exercise bike very useful for exercising my knee once I had gotten sufficient movement in the knee to be able to use the bike efficiently. I did start using it in the fine weather months but eventually created a space indoors. I was lucky to have a large kitchen and an understanding wife.
At first riding for a few minutes at a time, I built up a schedule of exercises. Most machines offer the option of changing the gearing making it harde/easier to peddle to ring the changes. You will find your own limits but you have the option of stopping if it becomes painful, and of course, you are conveniently at home.
Outlook At 8 Months
Daily Exercises Continue
I must have been very down last month, I think that I am not quite so depressed now and am accepting that the remaining recovery is going to be very slow and frustrating.
I am still taking painkillers, although not so many, just to make sure that I can get throught the exercises. I keep leaving them off but after a while I do still feel pain in the knee, I will just have to try to get over this and see if I can get used to it, in case it is simply a reaction to the tablet itself. I keep hearing that they can be addictive and after all this time I need to be certain that I do really need them. A number of people have told me that they had stpped taking them at this stage but each individual is different.
Basically I am finding that I am doing things which I couldn't do even a few weeks ago, like coming down stairs one foot after another, so progress is apparent but frustratingly slow. I am finding it easier to ride my exercise bike, I don't need to "warm-up" first, and this I am finding is one of the main exercises which I am doing. Together with walking, 45 minutes to an hour several times a week. I will walk where I can rather than using the car, it takes slightly longer but helps with the routine.
The other exercise I am spending time on is to use a stepper machine. Both this and the bike belong to my son but they are really helping. If I miss both of this for a couple of days, the leg stiffens up. I find it important to keep loose by exercising the joint on these machines. I have to say that I am spending most of my exercising on the above three general exercises, and far less time on the specific exercises that I had been given, such as stretching and bending. Time is the enemy. I have a list of about 22 exercises for my knee which I have been given over the past few months and now I am collecting exercises for my back.
I am doing the ones which seem to help me cope, and for now the back exercises are my priority. I have also found that swimming ( or trips to the pool) have for me been a waste of time. I can do all the exercises at home without the expense and time spent getting to a pool. Also lots of short exercise periods that I can manage at home are better than just one longer period at the pool.
I mentioned seeing a physiotherapist about my back last month. Because my leg will not straighten fully, my one leg is half an inch shorter than my right when walking and this has been putting a lot of strain on my lower back. The answer is a small heel pad. After putting this in my shoe I immediately felt much better, I am still limping but my gait has been evened up. I can now walk without back pain, this in itself has raised my outlook. It is so difficult to feel good when even a short walk leads to massive pain.
Alternative Exercise Possibilities - To suit Your Space And Pocket
Not everyone has the space for a static bike at home despite their undoubted benefits.
Walking is a great alternative but there are less troublesome and less expensive alternatives which you may care to consider for your exercise. And don't forget, the pace and degree of recovery is dependent upon strict exercising. There are, as I say, easy alternatives, swimming and walking, but exercise is a must.
Outlook At 9 Months
Seeing The Light
As the ninth month startes to fade, I am beginning to thing that the recovery process is entering a final stage. As I have mentioned above I was told by the medical teams that 8 - 10 months was average although 12 months was also quoted as things started to look very difficult. But here i am nine months after the operation and i am really beginning to believe that I shall see a useful degree of improvement in the knee joint.
I am still exercising as much as I can, probably not as much as I ought but life has to start afresh sometime. I now use the exercise bike and the stepper and walk as much as I can when I have the time. These general exercises are doing me some good and with the heel pad to allow me to walk without twisting my spine I am walking with a normal gait. This means that the knee joint is being used properly. I am using the stairs both going up and down in a normal fashion although coming down is still difficult on stairs with the higher risers. At home, I do need to be careful, but in most public buildings and shops I now have no trouble at all.
Some days I still get pain in the joint however, it is usually because of lack of use and quickly goes with a few steps or a little exercise. I hope that by christmas ( 12 months) I shall have no issues at all and be walking properly and without any issues at all.
Of course there is a downside, the "good" knee has taken extra punishment over the past months since the operation and now I am beginning to find I am feeling the same symptoms that I felt 10-12 years ago in the operated leg. Does this mean another operation is on the cards? Many people do find that having one knee replaced is a precursor to needing work on the other. I shall look on the optimistic side and imagine that it will be a few years down the line yet.
In conclusion, things are finally looking good and I am far happier than I have been since the operation.
EDIT: the next day and my leg is feeling very stiff, it is a roller coaster ride really; one day up and the next down. Just to add a little down side to the report.
Yes I know the picture has nothing to do with the operation but I just feel like singing!
12 months After The Operation
After eleven Months I did not have much change to report. Most of the above paragraph still applies. The only positive thing to report is that the use of the heel pad allowed me to walk without twisting my spine and I now walk easily and well without it. The straightness of the leg must have improved when walking. Apart from that I am still exercising to try and continue the improvement but the degree of maximum bend does not seem to be increasing any further.
I have stopped taking the pain killers (codeine and paracetemol) but am taking a much lower dose of an anti-inflamatory, ibufrofen. One day I suddenly realised that my leg was no longer the cause of my pain, I was continuing to take the tablets because of back pain and arthritis in my wrists/thumbs. I decided there and then to stop the medication and see how things went.
I have recently had a 12 month review with my surgeon and after a confirmatory X-ray, have been discharged from his list. We spoke about those residual issues but I was told that the tissues can keep on improving for at least two years. I was also told that I should be keeping to a regular exercise schedule to keep the joint supple and trouble free. I have also been told that exercise will help to maintain the "good" knee which is starting to give symptoms similar to those I had in the operated knee a few years ago. I shall be exercising regularly , I don't want another knee replacement any time soon if I can help it.
I will add to these reports over the next twelve months at three month intervals, hopefully the improvement will be maintained.
Fifteen Months After the Operation
At fifteen months the pain is now virtually non-existent during normal activity. I am able to walk for an hour or two without problems (I don't normally walk for longer than this but don't see any problem). I can happily walk up and down stairs in public places where the stair risers are not too high, at home I do need to be careful coming down because the stairs are steeper. The only real issue is that the knee "feels" stiff so that I never forget about it. This however could be a good thing, preventing me from trying to do too much with it.
I do not kneel on the knee despite some writers saying that this should be possible. I feel happier not doing so just in case. I can kneel but prefer not to. I did however find myself running to catch a bus last week with no problems.
As for exercise I am still spending time on the exercise bike, several times a day when I can for just a few minutes at a time. It does help to keep the joint supple. It is still a little limited as far as movement is concerned. Not quite straightening properly ( a couple of degrees short of straight) and bending 105 degrees without pain. These limitations do not affect normal use as I infered above.
I do feel that the procedure has worked well for me and would not be put off having the other knee operated on if necessary, most people do say that the second knee eventually wears out when one has been replaced. If I had known before the operation what I know now, I would probably have waited until I had retired from work. I have a sedentary job and feel that the recovery would have been much faster if I had not been limited during the day.
Eighteen Months After The Operation
Still Feeling The Effects
I am happy to report that I am, within the limitations of the movement in the new knee, now living a fairly normal life. The amount of movement in the knee has remained at approximately 105 degrees which means that some things I do have to be careful about. One issue is sitting at a table in a restaurant (for example) if there is a limit on how far I can move the chair back. It can sometimes be a problem, LOL. But I am now walking quite normally and also using stairs with no problems. I often climb stairs two at a time for the exercise. it is still important to keep up with exercise as the tissues can still form scar tissue for up to two years, I was told. So I am still using my exercise bike - and it is still in the kitchen.
I did try to help my son with his garden a couple of weeks ago and did some pretty heavy digging, things were OK at the time but I did suffer some pain in the knee the next day and for a few days afterwards. Note to myself.... Ask doctor about lifting heavy loads. Otherwise apart from some stiffness, I do not have any of the pain which was due to the arthritic condition. I do notice the stiffness if I have been sitting for prolonged periods or first thing in the morning. It does soon wear off however.
The biggest problem now is that I am seeing early signs of trouble in the "good" leg. I had been expecting this and nearly everyone I have spoken to, who has had this operation, says the same thing. Once you have had one knee done, the other seems to take on more stress and will soon need the same teatment. I hope that this will not be necessary for a few years yet, but indications are that it could well be worse, rather than pain at present, it sseems to be starting to let me down at inopportune moments. For example, it can give way whilst I am simply walking along or more sinisterly, when I am coming down stairs. I will need to keep an eye on things and I guess get the leg x-rayed at some stage to see how bad it actually is.
In any case, I will not have it done until I stop work. I still think that my sedentary job prolonged the recovery after the operation,
I will add one more report in another six months time unless something untoward happens, and I guess that will be my last progress report. Thanks to everybody who has read my story.
Recovery From Total Knee Replacement - Links To Detailed Discussions
Some links to similar stories, most of these do not carry on past the first few weeks. I know that everyone is different but I am still having to exercise regularly at 18months or my new knee starts to feel very stiff. And on occasion (and yes rain does affect it) I still get a certain amount of pain.
I will be adding more as I read them.
- Step-by-step: the road to recovery
Recovery of a double-TKR patient over the first 40 days
- General steps to recover from TKR
An overview of the treatment and steps to recovery
- Things I wish I knew
A forum thread, interesting details of post-op issues. For me I recognised the need to learn to walk properly rather than limping, which was easier
- Issues on returning to work
A fairly negative read, lots of questions from recovering patients who are feeling that recovery isn't going right or quickly enough. A side of the coin I do not recognise, most people I talk to have had much more positive experiences, more so than m
- recovery timeline
Overview of the time line of recovery for TKR patients for the first 3-4 months
Interim Report At Twenty Months
After Complete Knee Replacement Operation
I did say above that recovery is a little bit of a roller-coaster ride. I had in my last update been quite upbeat and looking forward to normality. Or at least as much as I could imagine after the operation. In fact the degree of bend had continued to something like 120deg. However I have been noticing a stiffening of the joint and the area around the operation scar is still very sensitive.
The sensitivity I can live with, if I wear rough trousers I often put a small length of tubular bandage on the knee to prevent chafing. A nuisance but that is all. The increased stiffness however was worrying me. I was sure that I had not damaged the joint but remembered that I had read that scar tissue could be expected to form internally for up to two years. Now I had been using my static exercise bike regularly but I wondered if this was actually enough.
I decided to retrace my steps and do more bending exercises such as squatting (very hard on the knees) to force the knee to its maximum bend; and standing on one leg (the operated leg) and bending it to lower the body, holding for a short time and then straightening up again.
After a couple of days the stiffness was much less. I believe that I had continued exercising but being too easy on myself. I will be doing much more to stretch the knee and make it work much harder. I intend to see my doctor to see if he agrees with me about this. It does however seem that holding off the exercising may have been too early for me.
7th october 2012 Update
I have continued with the "hard" exercises (stretching exercises) and found that this has been very beneficial. What surprises me is that I had been doing the lighter exercise routine (mostly flexibility) exercises for some time without apparent problems. It seemed to catch up with me slowly. I am now doing a combination of these routines as mentioned above which appear to have overcome the stiffness and occasional pains. I have not yet been to see my doctor (I know just like a man!) but will be talking to him soon. I have a number of questions which I now want to ask and will report the answers in my next update.
Two Years After A Successful Operation - Final Report
My Final progress Report
Two years after the operation and I think the knee (new ?) is as good as it may be going to get.
So where am I now. First of all,I do not have the nagging arthritic pain or the occasional time when the knee locked up completely or gave way. So it must be considered a success, and I am very happy with the result hence the photograph. I don't often smile in photos, or so I am told!
My exercise regime is now much less rigid, I have gotten used to exercising when I feel like it now. Maybe not a good thing but I do not seem to be suffering from it. I do walk everywhere when possible, at least half-an-hour several times a week, so the leg gets some use. When I do these walks, I always try to walk so that the knee is locked into place as I stride forward. Also I always try to climb stairs two or three steps at a time to make sure that the knee is stretched and used to take my whole weight as I raise up to the next step. So I suppose that I do get plenty of informal exercise.
I still feel the stiffness in the knee but I am often told that I am now walking properly, friends and family notice a marked improvement. The stiffness is always with me, just sitting down at a table or getting into my car can be quite diffcult in limited space because I cannot bend the knee as much as I used to be able to. I have come to accept this as a price for the lack of pain. The maximum bend achievable had virtually stopped improving some time ago, so I do not think it has anything to do with a change in my exercise regime. I guess that the maximum achievable is now close to 120deg as opoposed to 135-140 deg in my good knee. But these are my own approximations using a piece of cardboard and measurement by eye. Probably poor guesstimates, but it gives a relative change since the operation.
So what else can I say? This has been a very personal record since everyone is different and will have their own issues and time scales. I know people who had the operation at a time close to mine who made quicker progress in early days and also those who had more difficulties, some relatively serious. If you are considering this procedure I can only say it has been successful for me. Albeit a very long and sometimes painful process, You must talk to your own doctors and surgeon who can give you specific information on the procedure and potential outcomes. Will offer help through the early stages and explain the exercises, etc which you should adhere to. I have found that the exercises were of paramount importance. I can only say that I have found it helpful and am happy with the outcome. Not ideal, but the pay-off was more than worth the effort.
I can run on the leg for short distances, I haven't tried any extended running. I can twist on the foot, maybe not to be recommended but dancing should be possible though I am not a dancer. I do not kneel on the knee, sometimes a nuisance but I do not want to damaging the knee. The only real issue is that I find it difficult to raise myself from a prone position on the floor, without help from a handy chair or some other solid object. Answer; do not lie on the floor. Apart from this I have to say that I am always aware of the knee, but that means that I do not do anything to take risks with it.
I hope that this diary has been of use to anyone contemplating the operation or recovering from it. I will try to answer any question that you may have - please leave questions in the comments book below. I can't answer any technical questions but will try to point you in the right direction, based on my experiences and subsequent reading / research.
30 Months After The Operation
The Value Of Exercise
I did not think I would be making any more updates, but after two and a half years I am still finding that exercise is crucial.
I am now doing almost everything I did before the operation. Except for kneeling on the new knee It does not really trouble me at all. I am aware of it at all times but it does not really limit me. I cannot bend the knee as much as I used to but that is something I can work around. I drive, walk easily and without pain, do the housework to my wife's requirements. I have decorated one or two room and done the gardening without problems.
The joint always feels "stiff" but is only a problem if I stop doing the execises. And I have been tempted to try easing off a number of times over the past several months. I usually find that I then tend to suffer from increased stiffness and even a little pain. But I have to admit that a short course of exercise usually eases the symptoms and I exercise regularly for a while until I get lazy again.
It does not work however, sooner or later I start to feel the twinges and stiffness, and need to start again. I find it best to simply do a few short stretches and strengthening exercises. I tend to use the bottom of the stairs as a handy gym:-
1) Bend the leg by putting the foot on a higher stair, and lowering your body by bending the other knee.
2) Straighten/stretch the leg and bear down on the knee to add a little pressure.
I do this several times alternating the bend and stretch.
3) I then do a few squats and
4) finally standing on one leg (the operated leg) and bending it, holding for ten seconds and standing up straight again. It helps to stand on the bottom step and hang the good leg over the edge. Do this five times or so.
These exercises take ten minutes maximum and prevent the stiffness and pains. If I was not so lazy I would do them every day without fail, but I always seem to be so busy. I have to admit that the exercise bike and the stepper have not been used for some time.
I did see my doctor and mentioned that exercise seemed to help. He did not reply but looked at me with his eyes rolling, as if to say, "Foolish person, you have said it all". Of course he was too polite, but I got the message.
And the message is, keep the exercising up. Not only does it help the operated knee but also helps if the exercises work on the good (?) leg as well. I really need to make sure that I can find that few minutes daily - and that means every day.
The photograph is of my garden after I had cleaned it up this spring, a lot of hard work but the knee took it and I feel really good about it.
42 Months After The Operation
Time For The Next Knee
Everybody says that if one knee needs doing the other can't be far behind. And in fact this has proved to be very true for myself.
After only a year of normal mobility (I guess this is a very subjective assessment) I now find that I am in constant pain from bone-on-bone contact in my other knee. I will be seeing a consultant in a matter of a few days and expect him to recommend a replacement. I might have put it off a while, but not walking with a proper gait has affected my first replacement. I am actually experiencing pain in both knees although a different form of pain. The pain in the replaced knee is eased by rest; whereas the pain in the second knee does not ease easily simply by resting. This is most obvious at night when I find it difficult to sleep because of the constant pain.
So here we go again! I will record the early days after the operation much better this time and maybe if recovery is any different, I will start a second diary. I do know people who have had both knees replaced and the experience can be very different. I am hoping for a much faster recovery this time and will be doing all I can to make sure of that. The main thing that I can do is to make sure I put in a lot more to the exercises in the early days, which is possibly where I ran into trouble last time because I eased off due to the swelling that the knee suffered last time. Anyway, my fingers are firmly crossed.
UPDATE: I saw the consultant and yes he has put me on his list for a TKR, should be 15-18 weeks before the operation, but that's the NHS for you. Although I will be having the operation in a very local private hospital. I have heard that the physio services were much better immediately after the op. from people who have been there. That was enough for me to select to go there for the operation. The same surgeon that performed my first op. will also do the other knee.
I have a date,going for a pre-op assessment next week with a date for the operation in four weeks. I am starting to get nervous about repeating the whole process but I guess it will all be worth it in the end.
UPDATE: I am now days awayfrom the second operation. I have decided to record it in detail just incase I need to create the second diary. I think I have an understanding of the learning from my first time, I am hoping that knowledge will give me the knowledge to improve the recovery this time. It willl be interesting to chart any differences. I will include a link as and when the diary is started. Wish me luck!
If you have had a similar operation or maybe just a view on the lens, why not take a few minutes to share it with everybody.I for one would appreciate it very much.
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Would You Like To Share Any Experiences?
Frogimore on November 28, 2018:
I am 9 days post op. I have just found your writings. I guess this was some years ago but it seems that little has changed in recoveery terms. So reassuring to hear your story which covers all my doubts, fears and aspirations. I particularly like your ups and downs of mood, which is just what I am experiencing. The most daunting is that the deed is done, the consequences will happen but I probably can influence them. I am a 75 year old woman who was an active runner/exerciser until the arthritis got me. I am determined to get back to something near this and am off to my first physio review today. Everything so far has been on the NHS through a private hospital. I will now consider ongoing private physio..
Virginia Allain from Central Florida on May 21, 2017:
I found your account very informative. Not sure I'd have the dedication to exercising that you did. I liked that you included the psychological issues that go with such a major operation.
Don Bobbitt from Ruskin Florida on October 30, 2016:
Excellent, Excellent, Excellent article.
Being 70 myself, I am lucky enough at this point not to need this popular surgery yet.
But, I am watching a friend (77 years old) go through this same process, and his recovery has been quite an ordeal for him, both physically and mentally, or so it seems. He is over 2 months post surgery and gets around very slowly with a cane. He is still getting therapy and his experience is not encouraging to me at all.
Aaron scott on November 28, 2015:
I had total knee replacement five and a half months, and still having a lot of stiffness and pain. I still do my exercises, but stopped the meds. My question is by being given a pain blocker right after surgery instead of ice, because my leg was so swollen. And by it being so swollen I couldn't start any kind of exercises until the swelling came down, which was some two to three weeks later. Could that have some effect on healing, or could I make up for the lost time with hard work by exercising?
Nancy Tate Hellams from Pendleton, SC on April 27, 2015:
It was very interesting to read about your Knee Replacement surgery and recovery. I had mine done 15 years ago and although I still have limitations, I consider it a success. When I had it done they told me that it should last 10 years so I keep waiting for that day when it gives way but so far so good.
John Dyhouse (author) from UK on January 14, 2015:
Within reason that is a positive attitude. I waited ten years from the first real pain/symptoms before I was ready for the operation. I was hoping to have fully retired before "taking the plunge". Another three years and I had to have the second knee replaced. Although that was a much easier recovery. Six months on and I am considering another article.
Sandy Mertens from Frozen Tundra on January 14, 2015:
I have been told that I am a good candidate for both knees. But as long as I can walk it will be put off. Glad it all went well for you. Or so until it left off here.
John Dyhouse (author) from UK on December 09, 2014:
That is interesting about the moist heat, I have just had a second knee done (got the matching pair now!) and the consultant and physios are still banging on about ice-packs. Thanks for the observation.
Paulette/ email@example.com on November 29, 2014:
i had total knee replacement on 10/30/14 , 5 days in hospital ,been in pure misery until this day I used moist heat ,two times today no ice ,wow what a huge difference, I'm going to be okay now , with Gods help I just know I'm only going up now , I have to stretch out the thigh muscle and the calf , plus all these nerves and tensions that were cut , thanks for all your prayers , this 66 year old woman is going to get through this after all, every one break away from some of the ice packs ,give hot moist heat a chance , God bless you all
Terry on November 09, 2014:
I had TKR on right knee on Sept.9, 2013...left knee on Nov. 22, 2013. Is still in my opinion the worst decision I ever made in my life. Stayed in Rehab until Jan.9, 2014. Both legs generated scar tissue only a few days after each surgery. Went through two (2) Manipulations, which was just as painful. Came home on Jan.9,2014, still on Morphine and Oxycotin for pain. I took myself off both medications on Sept. 2, 2014, 13 months later. I just last week started walking with a Cane. I can tell all the details but your lens is so spot on. Therapy was so painful and I could not straighten either leg. I didn't walk out of Rehab after three months. Just as some people say in your Lens the surgeon said the X-Rays looked good. He sent me to Pain Management and they did a diagnostic test to determine if I was a candidate for an injection in a nerve close to my spine. By the time the surgeon sent me to Pain Management I was addicted to Morphine and Oxycotin. The surgeon at the Pain Management Clinic said that because I had been on Painkillers for so long and my pain level was so high that the injection in my back would not help me. And yes I do all the exercises on an incumbent bike and a regular stationary bike and a treadmill. If I do exercises my legs are so swollen that I can't walk. If I sit and don't do exercises my legs are so swollen I can't walk. I did Ice for months with no relief. I chose to continue exercising for the obvious reason. To try to overcome the pain. I took 4 Ibuprofen every 6 hours with no relief. Went back to the Doctor and he said in order to do the exercises I needed to take Tramadol. It does take the edge of the pain. By the way during this time I have lost 38 pounds. I can not do my job anymore because I can't sit or stand for very long because my ankles and calf's swell to the same size. My back hurts so bad and I have never had back aches. Thank the Lord that my husband works. This has altered our life's in so many ways I can't explain. I know this is so negative. I am sorry. I just want to make sure everyone knows that if you can prolong doing TKR do it. I did not do any research before my surgeries and the surgeon said I would be home in 5 days with a Physical Therapist coming to my home. He lasted until I was out of insurance. The total bill was $194,000 and $16,000 out of pocket. Please be aware of the consequences that might occur with having this surgery. I don't know what the future will bring. I hope one day I will be able to walk without assistant. I am only 62 and wanted to do the surgery so that I could play with my Grandchildren without pain from Osteoarthritis. I feel so alone because I hear the same thing from people.."Well I don't understand why you can't walk my sister had it done and was walking a mile 3 days later. Sorry I don't think so, better talk to your sister again. Thank you for making me feel better about myself when I read your Lens. I feel so guilty that I had fail.
Chris Loterina on November 03, 2014:
Very well written lens, this article is indeed very informative to all visitors that would undergo the same experience... Thanks a lot for sharing!
Flo on October 23, 2014:
Thanks for your article. It has really helped me and has answered a lot of unswered questions that has been troubling me. It's been nine months since my surgery and I still have some soreness in my knee. My doctor recommended a second replacement one year later but after reading your article, I feel at ease to wait another year or two. Again thanks!
dinahlee39 on August 23, 2014:
Thank you so much for keeping your diary and sharing. I am having my TKR September 22, 2014. This has been fun to read too and love the singing pictures!!! :) :)
Justin Patrick Gonzales Lopez from Philippines on July 31, 2014:
I have had fracture on my left shoulder when I was young but I refused to undergo surgery because I thought the metal that my doctor will install within my bone would be lifetime...
John Dyhouse (author) from UK on July 20, 2014:
@Nancy Hardin: Thanks, thte issue I found was that I could not find this sort of thing elsewhere, even sites dedicated to these sort os procedures only gave potential experiences post-op for a short time. I have had many comments thanking me for describing what happened to them making them feel better about their condition. We are not all the same and some do take longer that the optimal time to recover fully.
Nancy Carol Brown Hardin from Las Vegas, NV on July 19, 2014:
This was a very interesting story. I've had relatives who have had this surgery, but I wasn't in their area during the surgery and recovery, so had no idea of all this. You did a great job of documenting, and from this, help can be found by those experiencing the same condition. Well done!
John Dyhouse (author) from UK on July 10, 2014:
@dhale: I still have problems but not as acute or as often now. Despite everything it has definitely been worth it. I am very positive about my second TKR in just a couple of weeks now.
dhale on July 09, 2014:
@John Dyhouse: Thank you for responding! Yes, I do sleep that way. The pain is really hard to determine where its originating because the spasm happens so fast (and only lasts 1-3 seconds probably.) I had a nerve block put in my leg for the surgery so it might be still healing from that. In spite of the discomfort I am SO grateful to have a new knee.
John Dyhouse (author) from UK on July 09, 2014:
@dhale: No I did not suffer from the pains which you describe. Do you lie on your back at night with your legs on a cushion? This was the recommended position.
dhale on July 09, 2014:
Hi, I am very grateful for the work you have done documenting your recovery. I have been much encouraged by it. I had a TKR left at the end of April. Successful, but to this day I can't get any more sleep than a restless 2-3 hours. Often completely sleepless nights (no napping) because of jolting leg pains when I just about drift off to sleep which immediately wake me up in great pain. It feels like my leg is having a seizure. Goes from my thigh to the arch of my foot. I have talked to the doctor 3 times about this and they tell me it will go away.
Did you experience any pain like this? I think its nerve-related. Thank you.
John Dyhouse (author) from UK on July 07, 2014:
@nidagal: I found that even after 12-13 weeks, going back to a sedentary job which stopped me from exercising regularly was not a good thing. You do need to move that joint for a good recovery.
I still feel the implant, and know there is an issue. But even when I get pain in that knee, it is by no means as bad as the arthritis pain. And I also sleep at night. Thanks for your story.
nidagal on July 07, 2014:
I had my knee replacement 2 yrs. ago. I was back at work after 5 weeks. A job where I sat for 10 hrs. daily. Despite doing my exercises twice a day I began having pain and stiffness in the knee. This was about 3 months after surgery. Surgeon wanted me to go back to therapy, but insurance wouldn't pay. He said that I have bursitis, and tendinitis in the knee. and was given a cortisone shot which made it worse. I have an exercise bike, and try to walk as much as possible. The knee is always sore, and stiff. I have been told that it is what it is. I have to wear a thick insole in my left shoe as my back gets out of whack from the longer leg. There is an up side :} I can walk much better than I did, and I can now sleep at night. My surgeon wanted to do both knees. Do not go there!
chronicbodypain on July 07, 2014:
John Dyhouse (author) from UK on June 07, 2014:
@shallee: I know how