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TKR: Notes From the Trenches

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While this is not related to amputation, at the urging of a couple of members, I am posting my experiences with a total knee replacement (TKR).

Everyone has different experiences, to be sure. Before the surgery I heard stories of people who were back to work in 3 weeks and others who were finally walking many months after replacement. My experience has been fairly middle of the road, from what I can tell.

I have severe arthritis in my feet and knees. In order to have the TKR I had to undergo arthrodesis in my right foot, but that is a whole other story. I chose to have the procedure for a number of reasons, and the decision process is a personal one for each patient.

The surgery was on August 15. It is a pretty straightforward piece of work. The knee joint is replaced with components made of either stainless steel or porcelain. Mine is a metal prosthesis, so I need to carry a card with me to show to airport screeners when I set off metal detectors.

The first thing one should know about this surgery is that it hurts. Yes, I know that ultimately the new knee will give me a pain free life that I could not have with the old one. But be prepared for things to be very unpleasant at first. I have a very high pain tolerance so was surprised at this part of the whole thing.

My doctor is very aggressive about rehabilitation. Because of some complications from anemia, I was not up and about until 2 days after surgery. Otherwise I would have been up the next day. It is important to move the knee as much as possible to keep the formation of scar tissue to a minimum. There are several ways to do this. I had a passive movement machine that flexed and extended the leg for me. The monsters from physical therapy had me up with a walker. That first shuffle down the hall almost killed me, but, blast it, I was going to take those steps!

Some doctors, like mine, will use an epidural during surgery and leave it in place for a day. This makes things bearable. There is a time where the pain will come. The trick is to manage it. I worry about using pain medication, but worried more about the discomfort, so I trusted that my doctor would do the right thing for me.

Three days post-op I was up and about with a walker. I managed to use the bathroom and just took the medicines. The PT monsters were still pushing things, but I had no problem telling them when I had reached my limit. Their stance seemed to be to let me go as far as I could.

I came home 4 days post op. I walked up my stairs and got into bed. The next day the home physical therapist came. The trick with this op is DO THE EXERCISES and DO THE THERAPY! I had no preset expectations as to where I "should be" only what my progress was from day to day. What can I do today that I couldn't do yesterday?

I was walking without a walker or crutches after 2 weeks. Standing still was awful. The pain from this procedure is not a dull ache that progresses; it comes on full strength all at once. I found that doing my exercises helped the pain.

After 3 weeks I started driving and was able to start outpatient physical therapy. I am pleased to report that I no longer hate my therapist. Yes, it takes some work, and yes, it hurts. The key is to do what I can, and be honest about what that is. I will push it only so much, but not wimp out either.

For example, the first time they put me on an exercise bike, I couldn't do a full revolution on the pedals. I still could not flex the knee that much. So I pushed as much as I could, then went backwards. Keep moving the joint. The next time I was on the bike, I did a full revolution after about 5 minutes of pedaling. It hurt, so I did not push it too much. The third time I got on the bike I was pedaling normally.

I worried about the amount of pain meds I was taking. No matter what I did or how I tried to scale back, the pain was too rough. I did substitute Advil for vicodin during the day as much as I could. Then one morning I woke up and the knee had stopped hurting. The exercise and therapy was paying off big time!

I am now six and a half weeks post op. My pain medication is Advil, with half a vicodin before physical therapy. If I need something stronger I will take it. I can flex to about 112 degrees, with the goal being 120. I can extend straight. Sometimes I stiffen up, so need to remember to keep on doing the stretches, and I am vigilant about doing the home exercises. There are a couple I really hate, but I see the payoff, so I do them. My next goal is mastering stairs. For the first time in over a year and a half, I walked up my stairs without having to put both feet on each step. Yes, it hurt a little, and I need to work on it, as well as downstairs, but I did it.

The measure of success is from day to day. Bless those souls who were driving trucks after 3 weeks. I am not one of them. And bless those who took months to walk unaided. We all heal differently. My scar is still pretty yucky and another patient who had her knee done a week before mine shows almost no trace of hers. It will all be OK.

Before surgery, people kept telling me "Anything will be better than the pain you are experiencing now." That may well be. The first few weeks/months are rough, and we have to be aware of that. But I can't put the old knee back in, so I might as well make the best of what I have now.

Would I recommend that anyone go through this? Ask me in six months. But I can tell you that I already notice the difference.

Sorry to be so long winded. Thanks for letting me put all this down.


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Thanks for sharing your experience, Maryl... it may not be "about amputation," but your recovery process is very similar to what most of us here have gone through... as is your level of determination! I hope your TKR continues to heal well and that it improves the quality of your life!

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