Total Knee Replacement, Anyone?

[homemadesalsa]

Sounds like you were more than ready for replacement. Best wishes for complete healing.

After a long painful four months I am back on the bike, trying to get that poor shriveled quad back to strength.

Have any of you spent time on the Bonesmart.org site? Thoughts on their approach?

Sent from my SM-A600A using Tapatalk

[rod9301]

Can't any more. But it's mstly because it would start bleeding again. They're also super right about the second night being the worst.

The most amazing advance to me is the lifespan. They're saying 20-40 years.

Who did the surgery, and what model, brand did you get?

And to get your legs really strong, i recommend using a electro muscle stimulation machine, but tens.

I had an Achilles tendon operation, and using my compex, i gained two inches in thigh circumference.

They work, but it's pretty intense, not something you do while watching tv.

And good luck

Sent from my Redmi Note 8 Pro using Tapatalk

[powdork]

Kyle Swanson. It was supposed to be the stryker tritanium but afterward they said they had to rebuild some of the tibia first and use some cement. I didn't think to ask if that meant a different model.

[powdork]

Day three much better than day 2. Probably walked about 1000 yards with crutches, o e crutch, and without. Celebrated with a beer.


Didn’t take an oxy til about 7:30 and just one.
Epidural headaches are the suck tho


Sent from my iPhone using TGR Forums

[splat]

Heal well, powdork.

[powdork]

Update - Day 8.
Day 1 - The surgery. Mostly a pain free day. The femoral and epidural blocks still working. Able to walk without using walker. Sprung a leak. Don't do that.
Day 2- Sent home around 10, after a quick change of the super bloody mepilex bandage and addition of steri strips. Back in the Dr's office to change the dressing. Added benzoin to help the new steri strips
Day 3- Woke up about 2 am in horrible pain. Thought about changing the bandage which was 100% full of blood but had no help and pain was at the level where i couldn't think straight to do it. Stuffed some more 4x4s and rewrapped. Tossed and turned all night. Sleep was barely achieved and the night was as close to a bad trip as you would want to come. That day things got a little better. Started to trim back the oxycodone dosage.
Day 4- Felt pretty good. The pain seemed to transition from acute injury stage to bone healing stage. It's the day the pain went from a consistent level to one which varies greatly. I walked unassisted a little bit (50 yards) and went for longer walks on the crutches (maybe 800 yards total). Didn't have oxy til about 7:30 and I paid dearly. Another night of fitful almost hallucinations. Going from laying or sitting to standing causes the blood to move to the owie zones. The itching started
Day 5 and 6- Started to get a handle on the drug schedule. Holding off on oxy til evening. That gives me three doses with one a little after bed time. Keep up with Vistaril and laxatives. Sleep is getting better mostly because I am able to straighten the leg more comfortably.
Day 7- First PT appointment. It was awesome. just a gentle scar massage and I was allowed to put the giant pillow under my knee for it. I hadn't had longer than 10 minutes pain free since the surgery and this was a full hour. I believe I was at 10-112 degrees ROM. I had only worked on starightening per Dr.'s orders to avoid more bleeding. The night was alittle rough since I ran out of oxy.
Day 8- First post op appointment. All is well. Pain is much more manageable although still requires managing. Afternoon was spent without crutches and I may be done with them going forward. They definitely still help during the 2-4 minutes it takes for the pain to resolve after standing up for the first time in a while.


Some tips-
-Other than the ride home from the hospital, I haven't had a caregiver. I would recommend one. Driving back to the Dr's on day 2 was not fun.
-Bananas. Actually anything substantive you can wake up and eat right away. When you wake up in the morning you will be in pain and you will likely need to take your meds, most of which definitely should not be taken on an empty stomach. So have something easy and filling ready.

[splat]

I hear ya on that caregiver thing. With my leg in a rigid straight brace non weight bearing for like eight weeks, living solo made everything excruciatingly challenging. So I checked into a suite at the Atlantis casino so I had maids and people from room service waiting on me. Worked out beautifully.

[Dantheman]

-Other than the ride home from the hospital, I haven't had a caregiver. I would recommend one. Driving back to the Dr's on day 2 was not fun.

You drove yourself to the Dr on Day 2? Holy. Fucking. Shit. AC's surgeon wouldn't let her drive herself for two weeks, and there's no way she even could have two days out. She spent two nights in the hospital and even being a passenger for the 45 minute drive home from Park City was rough. I was pretty much her full time nurse for the first seven days. No caregiver at all is nuts. Good on you for gutting through it, but, wow.

[powdork]

You drove yourself to the Dr on Day 2? Holy. Fucking. Shit. AC's surgeon wouldn't let her drive herself for two weeks, and there's no way she even could have two days out. She spent two nights in the hospital and even being a passenger for the 45 minute drive home from Park City was rough. I was pretty much her full time nurse for the first seven days. No caregiver at all is nuts. Good on you for gutting through it, but, wow.

Yeah it was kind of fucked up. Fortunately the drive was less than 10 minutes and it was the left knee. The trip to the pharmacy the next day on the other hand invloved shopping for more abdominal pads, gauze and a missed prescription, all in a soaked thru dressing/bandage. Once the lady behind the counter saw me I had my own personal shopper tho so that was nice.

So far the walking without crutches is working fine. I think stamina will be the issue rather than pain

[altachic]

Good to hear powdork!
I'm almost seven months out now. No pain, can straighten all the way but flexion(which was not even 100 degrees before surgery) is still my biggest hangup. I'm grateful for 120 degrees daily but I'd LOVE more!

I biked in Crested Butte for three days at just over five months out and just biked a bit in Mt Shasta. Have hiked to the top of Snowbird several times and I was back on my normal workout stuff by 2-3 months. I went into this knee replacement fit and ready and by FAR that is the biggest thing that has helped, besides being younger at 39.

I still can't believe you drove yourself on day two. I was meeeessssssssed up for a full week, stupid pain killers. I hardly ate, couldn't sleep and felt all sorts of out of it. I decided after six days to taper in three days and go strictly to Tylenol which worked out great. And I didn't sleep right until about 2-3 months out, which was expected. Hoping you recovery and rehab as smoothly as mine has been. It's take dedication and being diligent about PT...NOT over doing it and thinking about things in the long run of the life of these artificial parts.

[Norseman]

altachic, what were the factors that led to your tkr at age 39?

[Dantheman]

altachic, what were the factors that led to your tkr at age 39?

Stage 4 osteoarthritis. When the surgeon talked to me while she was in recovery he said the situation was actually worse than it appeared on the x-rays, which is hard to believe:

[altachic]

altachic, what were the factors that led to your tkr at age 39?

Genetics for a small part of it but I blew my ACL/MCL in 2003. After that is was pretty much all downhill with the osteoarthritis. Started out not a huge deal but as I lost A LOT of weight I thought my knees would be better but in fact that promoted me to be way more active and hard on them. The real deal arthritis pain started in 2014 and just continued to be painful night after painful night after a workout, especially the way I was working out from 2014-2018, destroyed it. Couldn't hike downhill, walk down stairs right, basically modifying everything. I've been coaching group fit classes and teaching spin that entire time and the fact that I had to STOP teaching spin was a huge red flag. I couldn't even pedal without extreme pain and modifying, which then made my hips hurt. The aching that no one tells you about with arthritis is insanely painful, at least for me. I did injections, PT, scope after scope with no padding left after my scope in 2015.

I saw two joint replacement docs and both after seeing my images were like...yeah, you've exhausted all efforts and this is the end of the road that we normally tell a 55, 65, 70 year old. Turns out after getting in there my doctor, who I LOVE (Dr Davis in Park City at Rosenberg Cooley) said it was worse than images even showed and that is saying something! No wonder I was in SO MUCH PAIN! He said I had a true 80 year old arthritic knee to boot!

So yeah, I'm already SO much happier now. Should have done it a few years ago.

Edit: DTM already posting those images above. That doesn't do it justice for how bad it actually was.

[Norseman]

Wow, thanks for sharing. I remember Dan posting the image previously.

I dont understand how ligament damage can instigate OA. Maybe cartilage metabolism shift? Can you shed light on that?

Also, you mention workouts contributing to damage. Was that powerlifting or something?

I guess I'm just trying to learn from your story to hopefully avoid a shitty time. Sucks to hear of strong active folks getting into big surgical repairs at a young age.

Glad you're feeling relief! Did you do both knees?

[altachic]

Wow, thanks for sharing. I remember Dan posting the image previously.

I dont understand how ligament damage can instigate OA. Maybe cartilage metabolism shift? Can you shed light on that?

Also, you mention workouts contributing to damage. Was that powerlifting or something?

I guess I'm just trying to learn from your story to hopefully avoid a shitty time. Sucks to hear of strong active folks getting into big surgical repairs at a young age.

Glad you're feeling relief! Did you do both knees?

Just one knee, thank goodness. I should also mention my left knee(my good one) started hurting pretty bad because of how much favoring I was doing for my right, it was bad. That was the last straw to get me into the surgeon to talk options.

I've had three scopes, ACL and now this. Those previous surgeries they kept cutting and cutting the meniscus so I was basically left with nothing after all of that. Plus, I didn't have super great padding to start out with after the ACL from what my Ortho of 18 years said everytime I went in. I knew it was just a matter of time.

Working out-A LOT of heavy lifting. Deadlifts, squats, cleans for a period of time. Also just functional fitness in general...box jumps, plyos of all kinds in and out of ladders, sprints, putting on a TON of gear on the spin bike, climbing really steep hills on my mt bike for extended periods of time and not listening to my knee when that stuff was bothering it. Overuse for sure. If I would have listened a bit closer and not tried to be a hero, I'd probably have more time.
Now though, I'm 100% comfortable doing those heavy lifts with very good form but not as heavy weight. I don't want or need to be a hero even though I still coach. I just want to keep this new knee feeling good for skiing (finally!) biking and functional fitness in my everyday life.

[Norseman]

Derp, I should've thought of the ol meniscus trim.

Thanks again for the tale, and best of luck going forward. Hope to share turns with you and Dan one day.

[powdork]

Day 15. Doing well. Been off the oxy for 5 days now except yesterday morning when I mistook one for my chewable aspirin. Yuck, but damn it felt good. Suture out today. Haven’t used the crutches in a week. There is still pain. ROM is 7 to 120. PT can be excruciating, especially the Game Ready Med4 Elite, which is just a modern form of a medieval rack used for torture. Not being able to sleep is still the crux right now.
Here’s some surgery detail I found interesting.
Some terms
PCL substituting size 6 femur: Size of the component used, and importantly that it comes with the Posterior Cruciate Ligament. I was a little freaking out when I read he removed mine but never mentioned adding a new one after making the bone cut. Then I caught that it was part of the unit.
Valgus Deformity: Knock Knee (Varus would be bowlegged)
Flexion Contracture: Incomplete ROM (In my case not straightening)





Sent from my iPhone using TGR Forums

[John_B]

For some reason that is super bizarre to read. I never thought a knee replacement was simple but holy shit they are doing a lot when they are in there.

[rideit]

So, it appears I am getting my other one done in November. Go Me!

[powdork]

^well shit that sucks.

For some reason that is super bizarre to read. I never thought a knee replacement was simple but holy shit they are doing a lot when they are in there.

If you really want to get into details, the surgical protocol has a lot more info but I'm not sure i would have wanted to know all of it beforehand
https://www.strykermeded.com/media/2...-technique.pdf

[powdork]

4 weeks out today. ROM at pt was 1-133 degrres so it's now just a matter of strengthening. I've been biking and mountain biking for about a week now. Nothing too difficult. Walking up to a mile per day. Main issue is swelling but that's mostly because I've been active. Stopped the oxi on day 10 and switched from acetamiophen/celebrex to ibuprofen last week. I'm pretty much done with that too.
Going down stairs still causes a bit of pain, but totally doable. Sleeping is still difficult.

[jerlane]

Day 15. Doing well. Been off the oxy for 5 days now except yesterday morning when I mistook one for my chewable aspirin. Yuck, but damn it felt good. Suture out today. Haven’t used the crutches in a week. There is still pain. ROM is 7 to 120. PT can be excruciating, especially the Game Ready Med4 Elite, which is just a modern form of a medieval rack used for torture. Not being able to sleep is still the crux right now.
Here’s some surgery detail I found interesting.
Some terms
PCL substituting size 6 femur: Size of the component used, and importantly that it comes with the Posterior Cruciate Ligament. I was a little freaking out when I read he removed mine but never mentioned adding a new one after making the bone cut. Then I caught that it was part of the unit.
Valgus Deformity: Knock Knee (Varus would be bowlegged)
Flexion Contracture: Incomplete ROM (In my case not straightening)





Sent from my iPhone using TGR Forums

FYI, they don’t replace the PCL. The polyethylene component used in this situation has a post in the middle that provides the posterior stabilization. It’s basically surgeons preference on what they use, but it’s not as complex as it might sound. The more common description is either CR for cruciate retained or PS for posterior stabilized. There’s no strong evidence that one is better than the other.

[powdork]

so when he says "box cut was then made on the femur for PCL substituting component", is that a hole for the post?

[jerlane]

so when he says "box cut was then made on the femur for PCL substituting component", is that a hole for the post?

Yes. It’s actually a cutout for the femoral component that has a recess in it that the post essentially sits in.

[rideit]

4 weeks out today. ROM at pt was 1-133 degrres so it's now just a matter of strengthening. I've been biking and mountain biking for about a week now. Nothing too difficult. Walking up to a mile per day. Main issue is swelling but that's mostly because I've been active. Stopped the oxi on day 10 and switched from acetamiophen/celebrex to ibuprofen last week. I'm pretty much done with that too.
Going down stairs still causes a bit of pain, but totally doable. Sleeping is still difficult.

Good to hear, keep it up!
In other good news, in 5 weeks I have gone from being convinced in needing a replacement to confidence that I don’t. I have basically zero pain anymore, and I believe it is in no small part to strength training. I’ll need it sometime down the line, but not yet.