Total Knee Replacement Advice Needed

[harllee]

DH has decided to move forward with total knee replacement and has an appointment (on March 3) with a highly recommended knee surgeon at Duke. I know several people on this Forum have had knee replacements and so I am looking for advice and suggestions for my DH. We have both have had both Covid vaccines, so that is a help. DH is age 70, is at a good weight and has been physically active all his life. DH has psoriatic arthritis (has had it all his adult life) and this disease causes his joints to be inflamed and swell, especially his knees. DH is on Methotrexate and Humira for his psoriatic arthritis and over the years he has been able to live a fairly normal life. X rays have shown he is bone on bone for both knees for years but he has been able to delay knee surgery by getting Euflexxa shots every 6 months. But the last time he got the Euflexxa shots (6 month ago) the shots did not help very much. DH is having pain walking now, has had to give up long walks and golf and recently he has had to start using a cane. His main aerobic activity is bike riding and he rides almost every day.

What suggestions do those of you who have been through this have for DH? What questions should he ask the surgeon? How can he prepare his body and mind? How can I help him? What can we do to prepare our house? Any advice will be greatly appreciated.

 

[aja8888]

I'm pretty sure WR2 and Chuckanut had a knee replacement in 2019 and they will help here. I specialize in replacement hips....(2)

 

[Brat]

Line up a great Physical Therapy team. My DH had both knees replaced at the same time so he was able to negotiate PT services before the surgery and several at-home visits after surgery. Hard to know if home visits are available in the era of Covid but no harm in asking.

 

[Chuckanut]

Here is my story: https://www.early-retirement.org/forums/f38/chuckanuts-total-knee-replacement-story-98581.html


It's probably more than you may wish to read, but it will give you a good feel for the surgery and my recovery experiences. Needless to say I am glad I had it done.

One thing I would add is this: Durring my first year of recovery I had not realized how much strength, balance and flexibility I had lost leading up to the surgery. After babying my knee for two+ years, my new normal was rather pathetic even with a much improved knee. I have taken advantage of this Covid lockdown to work on building strength in both my legs as well as balance.

My knee will never be 100% which I define as how it would had been had I never injured it way back in my 20's. But, it had declined to about 20%, any walk over a mile resulted in returning home in great pain. Today I am at 80%, not as good as new. I can do 5 miles easily, but as I said above, I need to regain and keep more balance, flexibility and strength. Like most of us, as I have grown older I find my body is not as forgiving of lack of exercise, injuries, and poor health habits.

Now excuse me while I do my daily regime of lunges, wall sitting, clam-shells and side raises. Did I mention stair hip-hiking?

 

[nap470]

I had total knee replacement 2 1/2 years ago. I was 57 at the time, so on the younger side. I now have 100% of the movement that I had prior to surgery, and none of the pain. I no longer run, although I have no restrictions on any sport activities. I do walk and hike the woods a lot. The only issue for me is kneeling on that knee or getting up from being on the floor or ground. The surgeon told me that over time that most of the feeling/sensations would return to that area, but a dead spot would always remain. I have no restriction for kneeling, it just doesn't feel comfortable because there is no feeling or sensation. Other than that, I walk straight now and am very happy. You need to tell the TSA person that you have had TKR before you go through airport scanners.

Prior to surgery, the surgeon had me take a heavy dosage of iron tablets for 3-4 weeks to build up. Then some antibiotics closer to surgery. The number one thing post surgery is rehab. For me it was an in-home therapist for 2-3 weeks, then to a therapy place 2 miles from my house. Their main goal is getting bend radius and flexibility before scar tissues forms. You have to do the exercises! If it means taking the painkillers to get through it, then you do. They will have you out of bed the same day of surgery walking some. I had to step up three steps, walk around the hospital wing floor, and bend the knee a certain radius before they would release me. Sounds crazy, but it wasn't so bad. Three weeks after surgery, I went on a college tour with my daughter. It was 8 hours in a van (DW drove), then 2 days of walking the Vanderbilt campus and restaurants in Nashville. I really did overdue it on that trip!

I was fortunate that I had a friend who had the same surgery from the same doctor a year before. He kind of took it upon himself to be a mentor and coach. The hardest thing for me post surgery was sleeping. I am a side sleeper and you can't do that for at least a few weeks. I was so exhausted that first month from lack of sleep. The pain medicine actually kept me awake, so I minimized that before bed. The other thing I recommend is having a bed on the first floor if you sleep upstairs. It's also best to sleep alone for a while. We set up a bed in our downstairs living room for a while.

My apologies for the long message. My surgeon told me that in the first month post surgery, that 90% of his patients question why the had it done. At 12 months post surgery, 90% question why they waited so long to have it done. I am very happy with the outcome, and my other knee that I thought would need surgery shortly after has felt better than it has in years.

 

[W2R]

What suggestions do those of you who have been through this have for DH? What questions should he ask the surgeon? He should do the research to find a top notch knee replacement surgeon in your area. The surgeon told me everything I needed to know, and set me up for the knee replacement classes at the hospital that explained all the details.

How can he prepare his body and mind? My surgery had been put off for so long, that I took the soonest date possible. I didn't have any time to prepare my body and mind, and frankly for me that made no difference.

How can I help him? You'll be the designated caregiver, and will need to accompany him to the classes that I mentioned, that the hospital gives for knee replacement patients and their caregivers. You will need to bring him home from the hospital. Make sure the seat in your vehicle will tip back a bit since he won't be able to bend his knee a whole lot for that ride home. Try to get in your vehicle without bending your knee, and you'll see what I mean. When he gets home, check on him a few times each day to see what (if anything) he wants you to do. If this is his right knee like mine was, then you'll need to drive him to his surgeon appointments, PT, and so on, after the surgery until he is given the "go ahead" to drive himself. You'll learn about all this stuff in the classes.

What can we do to prepare our house? There is so much info on this on the internet and in the classes that I don't know where to start. I was glad to have a walk-in shower with sturdy grab rails. Also I had just bought a new recliner, and it was great to rest and recover in during the daytime.

Any advice will be greatly appreciated.

I wish him the best of luck! Since my surgery I have truly enjoyed having a good, solid, sturdy knee. It used to be wobbly and therefore I fell too often, but I haven't fallen since my 2019 knee replacement surgery. As for all the information you want, don't worry, a good surgeon is not going to send the two of you home after the surgery without giving you lots of verbal and printed information.

Here's my knee replacement surgery thread which has more info than you probably need or want. The relevant part starts on post #145:
https://www.early-retirement.org/forums/f38/yet-another-knee-surgery-thread-83517-8.html#post2260536

 

[Winemaker]

DW is on the list to get hers done. She has to decide when it's going to inconvenience her the least.

An employee of mine had both of his done at 57, after his rehab, he was back to work underground in a coal mine. He never missed a beat, and was still working when I retired 6 years later.

 

[harllee]

I had total knee replacement 2 1/2 years ago. I was 57 at the time, so on the younger side. I now have 100% of the movement that I had prior to surgery, and none of the pain. I no longer run, although I have no restrictions on any sport activities. I do walk and hike the woods a lot. The only issue for me is kneeling on that knee or getting up from being on the floor or ground. The surgeon told me that over time that most of the feeling/sensations would return to that area, but a dead spot would always remain. I have no restriction for kneeling, it just doesn't feel comfortable because there is no feeling or sensation. Other than that, I walk straight now and am very happy. You need to tell the TSA person that you have had TKR before you go through airport scanners.

Prior to surgery, the surgeon had me take a heavy dosage of iron tablets for 3-4 weeks to build up. Then some antibiotics closer to surgery. The number one thing post surgery is rehab. For me it was an in-home therapist for 2-3 weeks, then to a therapy place 2 miles from my house. Their main goal is getting bend radius and flexibility before scar tissues forms. You have to do the exercises! If it means taking the painkillers to get through it, then you do. They will have you out of bed the same day of surgery walking some. I had to step up three steps, walk around the hospital wing floor, and bend the knee a certain radius before they would release me. Sounds crazy, but it wasn't so bad. Three weeks after surgery, I went on a college tour with my daughter. It was 8 hours in a van (DW drove), then 2 days of walking the Vanderbilt campus and restaurants in Nashville. I really did overdue it on that trip!

I was fortunate that I had a friend who had the same surgery from the same doctor a year before. He kind of took it upon himself to be a mentor and coach. The hardest thing for me post surgery was sleeping. I am a side sleeper and you can't do that for at least a few weeks. I was so exhausted that first month from lack of sleep. The pain medicine actually kept me awake, so I minimized that before bed. The other thing I recommend is having a bed on the first floor if you sleep upstairs. It's also best to sleep alone for a while. We set up a bed in our downstairs living room for a while.

My apologies for the long message. My surgeon told me that in the first month post surgery, that 90% of his patients question why the had it done. At 12 months post surgery, 90% question why they waited so long to have it done. I am very happy with the outcome, and my other knee that I thought would need surgery shortly after has felt better than it has in years.

Thanks for the good advice. We live in a one story house so no interior stairs. There are 3 stair steps to get into the house but once you are inside no stairs. One issue is our bathrooms--they have the tub/shower combos so you do have to step over the side if the tub to get into the shower and I was wondering if that is going to be an issue for my husband. Regarding pain killers when DH has had to take them for other surgeries in the past he got very constipated. Did you have that problem?

 

[harllee]

I wish him the best of luck! Since my surgery I have truly enjoyed having a good, solid, sturdy knee. It used to be wobbly and therefore I fell too often, but I haven't fallen since my 2019 knee replacement surgery. As for all the information you want, don't worry, a good surgeon is not going to send the two of you home after the surgery without giving you lots of verbal and printed information.

Here's my knee replacement surgery thread which has more info than you probably need or want. The relevant part starts on post #145:
https://www.early-retirement.org/forums/f38/yet-another-knee-surgery-thread-83517-8.html#post2260536

W2R, thanks for the info and good to know your knee has turned out so well. One hesitation that DH has is that we know 3 different people who had to have their knee replacements redone (one was for cement failure, one was for hardware failure and in the third case they never could figure out why the replacement failed) and naturally this makes DH nervous.

 

[harllee]

Pre Covid I tried to attend most of DH's appointments and took notes since he has a complicated health history. Since Covid I have not been allowed to attend his appointments. I hope I can attend all the knee surgery appointments.

 

[W2R]

Pre Covid I tried to attend most of DH's appointments and took notes since he has a complicated health history. Since Covid I have not been allowed to attend his appointments. I hope I can attend all the knee surgery appointments.

There's something to ask the surgeon! I hope you can too, because having Frank there with me not only gave me a lot of support and encouragement, but also helped me to remember what was said.

 

[aaronc879]

After the surgery if you are not doing PT you should be icing the knee. Get an ice machine. I think W2R mentions it in her thread but there are lots of different ones you could use. It is a must to ice constantly for many weeks or even months after surgery. Sounds like you DH is already doing this but make sure to be as active pre-surgery as possible. You want your surgery leg as strong as possible because you will lose a lot of muscle mass and it's hard to get it back so the more you have to start with the better off you are. Eat lots of protein as it helps with recovery. Try Ensure or other protein drinks and bars, things that are easy to consume without relying on others or risking hurting yourself making. Good luck

 

[W2R]

After the surgery if you are not doing PT you should be icing the knee. Get an ice machine. I think W2R mentions it in her thread but there are lots of different ones you could use.

Yes!! I think this was the most important purchase I made. I got this one and I thought it was fabulous:
https://www.amazon.com/gp/product/B0040OD2IO/ref=ppx_yo_dt_b_asin_title_o05_s00?ie=UTF8&th=1

At the hospital they gave me another brand of ice machine for free, which I guess Medicare paid for. I never used that one because I loved the one in my link above so much.

 

[omni550]

Pre Covid I tried to attend most of DH's appointments and took notes since he has a complicated health history. Since Covid I have not been allowed to attend his appointments. I hope I can attend all the knee surgery appointments.

Perhaps DH could record his appointments and any other meetings with doctors on his phone...so you both could listen to the replay and make any needed notes?

omni

 

[timo2]

I'm just about one year and two weeks since I had my left knee replace. It took me about a year to recover well. This particular website helped me the most https://www.yourorthomd.com/apps/search?q=knee+replacement but I used other websites also.

My experience:
1) start the knee rehab exercises now, before the operation. Not only will a stronger knee make for a better recovery, it will be easier to follow the rehab exercises when you know the routine while it hurts like heck. And if the hospital has a pre-op rehab meeting, go to that.
2) The ice!!!. There are a million different opinions on ice for the swelling. I had stocked up on FlexiKold Gel Ice Packs, but what worked the best was frozen vegetables. Family size packs of frozen peas and green beans. A bunch of them. The frozen vegetables held the cold the longest without being so cold they damaged the skin. When one set thawed out, other ones came out. The hospital gave us a little saddlebag type pouch for holding ice that we put them in on each side of the knee, but any wrap or method of holding the veggies will do, and then I put on on top of the knee. The gel packs just were too cold initially and lost their coldness much much faster than the frozen veggies (did I mention family size). After a the swelling went down, then the gel packs were suitable to use.
3) do the opioids the give you. That's the only way to be able to put up with the pain to do push it to get the range of motion back, unless you have a very high pain tolerance. You have to get the range of motion back as fast as possible. The drugs are regulated, so they won't keep giving them to you forever anyway. Once they started cutting back on the opiods, I put myself on tylenol and advil regimen (I used a smartphone app to make sure I dosed properly, and alternated the products.
4) Go to the hospital rehab as much as possible. They have the good equipment there. I have a crossfit with the pedal and arm motions that helped me at home. It was several weeks until I dared to use me treadmill. Work at home is important.
5) yoga style stretching motions helped me also. and I used a yoga strap at home for work outside rehab , and also a small exercise ball under my ankle. Here are yoga strap videos https://www.yourorthomd.com/orthopedic-knowledge/another-way-to-stretch-your-knee-replacement
6) Once the doctor told me the incision point was healed over, a genuine CBD cream helped my knee feel better. It helped the puffed up skin not hurt and helped with a little of the pain.

7)It is amazing, but the subject of how to ice the knee is a little controversial. Here is one study on the ice machines, and why I didn't worry about not having one.

"Conclusion: The study found no additional benefit of consistent cryotherapy using the icing device over intermittent ice bags on postoperative pain, PROM, nausea or vomiting, opioid use, blood loss, lower limb function, or length of stay, despite significant differences in patient-reported compliance and satisfaction."

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4403323/

 

[harllee]

Perhaps DH could record his appointments and any other meetings with doctors on his phone...so you both could listen to the replay and make any needed notes?

omni

Good idea if I am not allowed to attend the appointments

 

[aaronc879]

There's something to ask the surgeon! I hope you can too, because having Frank there with me not only gave me a lot of support and encouragement, but also helped me to remember what was said.

I just reread your TKR thread. Looks like you were planning to have your other knee done last Spring but Covid stopped that. Do you plan to have the other knee done when Covid is less of a concern?

 

[StillFiguringItOut]

Good idea if I am not allowed to attend the appointments

You could also be part of the appointment by being on speakerphone so you can ask questions during the appointment.

 

[harllee]

You could also be part of the appointment by being on speakerphone so you can ask questions during the appointment.

Another good idea! DH was actually thinking of getting the surgery about a year ago and then Covid happened. And he has waited and waited and now we have the vaccine so he hopes he can go forward.

 

[nap470]

Thanks for the good advice. We live in a one story house so no interior stairs. There are 3 stair steps to get into the house but once you are inside no stairs. One issue is our bathrooms--they have the tub/shower combos so you do have to step over the side if the tub to get into the shower and I was wondering if that is going to be an issue for my husband. Regarding pain killers when DH has had to take them for other surgeries in the past he got very constipated. Did you have that problem?

We have tub/shower combos in our house and it was not much of an issue. He will be surprised at the amount of movement he will have. Just watch his balance getting in and out. For the first few weeks you cannot get the stitches wet so you literally have to wrap your knee with Saran wrap when you shower. A nurse will show you/him how to change the bandage. It's not hard and is really just a long strip. They provide them too you. As far as constipation, it can be an issue. My doctor's instructions were to start on stool softeners at the same time I started on the increased iron intake. So it was not an issue for me. The doctor gave me a binder with step by step instructions from the initial visit through post surgery recovery, including exercises and recommended schedules. The hospital may give you a second copy or a slightly different one.

As others have said, icing the knee is extremely important, especially after exercises. Icing machines I've heard are great. I bought this Torex cold pack because it remains very flexible when frozen. I highly recommend it. It was the same one as the therapist used.

https://www.amazon.com/Torex-Mojility-Professional-Reusable-Over-sized/dp/B00851X3GO

I iced hourly because I was always flexing my knee trying to increase the bending radius. I was so obsessed with the possibly of not getting full range of motion back that I'm sure I over did it some times.

One other item you may consider. If you have lower height toilets, you might consider a seat that raises him up a little. There is some discomfort sitting in that position for the first few weeks.

Again, good luck and don't get overwhelmed with the whole process. It will be worth it. It gets better each month and after a few months he will be pretty normal and by a year it will feel quite natural...but as strong as a tree trunk.

 

[timo2]

I iced hourly because I was always flexing my knee trying to increase the bending radius. I was so obsessed with the possibly of not getting full range of motion back that I'm sure I over did it some times.

One other item you may consider. If you have lower height toilets, you might consider a seat that raises him up a little. There is some discomfort sitting in that position for the first few weeks.

Again, good luck and don't get overwhelmed with the whole process. It will be worth it. It gets better each month and after a few months he will be pretty normal and by a year it will feel quite natural...but as strong as a tree trunk.

I purchased the arms for the toilet. raising the toilet is good, but I didn't do that. It would have been good in hindsight. I also got a firm chair with arms, but I didn't really use it that much.

DW clearly thought I was overachieving on the exercises. I used the ice bags to come up with ways to continue extending my knee. I had a lot of problems getting the knee extension back, but then I started wondering what my extension was in the first place. I'm not sure I started with total knee extension, but no one measured it beforehand. When I do the other knee, I'm going to have the extension measurements done beforehand also.

 

[Bob_Walter]

Yes!! I think this was the most important purchase I made. I got this one and I thought it was fabulous:
https://www.amazon.com/gp/product/B0040OD2IO/ref=ppx_yo_dt_b_asin_title_o05_s00?ie=UTF8&th=1

At the hospital they gave me another brand of ice machine for free, which I guess Medicare paid for. I never used that one because I loved the one in my link above so much.

I use that ice machine nightly for other ailments. When my elbow hurts from doing yard work, I use it on that. Other nights I use it on my knee or hips, whatever hurts, including back.

I don't think most people realize how invaluable this little ice machine is even if they don't have surgery. The pads are thin enough where I just lie on it for low back pain, for example.

 

[Z3Dreamer]

No info on TKR, but a big thumbs up for Duke's outpatient orthopedic surgery unit. Organized, well thought out, good communication. DW just had ankle surgery there one week ago! No pain.

 

[W2R]

I just reread your TKR thread. Looks like you were planning to have your other knee done last Spring but Covid stopped that. Do you plan to have the other knee done when Covid is less of a concern?

The knee that was replaced took a lot of the workload off the remaining knee. So, it got better too. Of the two knees, the replaced one is better than the natural knee. But I no longer feel like I need to get the other one replaced. I'm not ruling it out for the future, but presently I no longer plan to have it done even if COVID vanished tomorrow.

(Now that's a nice daydream! I wish it would. )

Sorry I took so long to answer. I drifted off to sleep and napped for a while.

 

[Telly]

DW had both knees replaced earlier last year at age 65. Our take-aways:

Find a surgeon who does many many of these per year, that it is their specialty.

The better shape a person's muscles/tendons/flexibility is BEFORE the operation, a better time they will have of it in PT. Those who waited too long to have TKR done might not recover their original flexibility. DW took ONE pain pill at home, and shunned the rest. A person was lined up to get with DW before release from the hospital, to give here some recovery stuff, including gel-pack freezable things to strap on. It's like the person who designed them didn't know how they would be used, too generic. Far and away the BEST were the ice packs the hospital used, they were white cloth-ish rectangles, flexible material, integral pocket for ice chips to be poured into, don't overload, as getting it to form to the leg is important. Has a fold-over flap seal (which, simple as it is, the hospital staff had a tendency to not seal it smooth, ice water would leak onto DW and her hospital bed!). We took those home, as they are throw-aways for the hospital. At each end, they have a pair of cloth straps to tie onto the patient. DW thought those were great! No ice machine, even though some people, not hospital people, told us an ice machine was "a must, don't do without it!". It wasn't.

PT three times a week was about right, plus do ALL specified exercises at home, no excuses! As a previous poster said, the PT early on is important, stretch stretch stretch! Or else suffer the results. No sitting around as an invalid. Her recovery was pretty quick, none of this months and months stuff. Her longest issue was swelling of knee, and also ankle primarily of one foot only. Surgeon said the swelling will go down in time. Wrap with an Ace bandage, the non-stretchable kind, 2" wide was DW's favorite type.

As they say, HKMV... His Knees May Vary


EDIT: House make ready - I looked around and removed any tripping hazards, within reason. I ordered up from Amazon a DRIVE-brand two-wheeled folding adjustable walker. From Wal Mart I got an adjustable shower seat (plastic seat with metal legs) chair with back. DW did not want to use the shower seat, but she agreed to have it there in with her in the shower stall after I convinced her that if for any reason something went wrong or whatever, it was better to do a controlled SIT down than an uncontrolled fall down!