TKR is a gamble

Agreed. It is better to die on your feet than on your knees. I have heard many stories just like yours and I am sorry for the ill-fated recovery.

I stopped doing all the PT after being in it 3 times. I now just do the minimum....leg raises and pulling my heal to my bottom with the strap to stretch. Finally finding the right shoes for me also helped tremendously.

Would you be kind enough to share the symptoms and diagnosed problems you had with your unsuccessful TKR that required revision. I am almost 5 months passed my surgery date and have been having problems with deep hard clunking and what seems to be uneven smooth tracking of the patella which is obvious when I swing my leg from the knee down. Every time I see my surgeon for the routine follow up visits (beginning right after surgery), which are now monthly, he tells me everything is fine, lots of people have "clicking" (a word I've never used to describe what I am feeling), that it's just the parts rubbing together and his other patients just get use to it or learn to ignore it. At my 3 month check up I was crying out of frustration and he told me to see a psychiatrist for depression. I told him I'm otherwise a very happy person that I'm just frustrated because unless this clears up there's no way I will be able to get back to playing pickleball which is why I finally had the surgery to begin with. But I wanted to be a cooperative patient so I asked him what psych he recommended and he said to check with my primary care doc, which I did. She said I don't need a psych eval, I need a 2nd opinion with a different Ortho. Did that and was told I have patellar Clunk syndrome. On my 4 month check up with my regular Ortho I did not tell him I went for a 2nd opinion but asked him if I could have patellar Clunk and he said not likely. But he said I could have some soft tissue impingement but he would not do the necessary surgery for at least another 3 or 4 months to allow for more healing from the TKR. I don't want more surgery but I just can't handle this deep hard double clunk with each step. Difficult to even walk for more than a few minutes at a time without getting severely inflamed. I'm so bummed. It's the last thing on my mind when I turn in at night trying to fall asleep, and the first thing when I open my eyes.

Hi Sara, It seems that the only satisfaction we TKR recipients have is to discuss our problems with each other since the medical community is insensitive to our issues. Not to ramble on I’ll keep my thoughts in specific categories for clarification. Grab a cup of coffee and here we go.

Initial surgery: I tore my left ACL while running in Feb 2018 when my legs felt like a young mans. My Ortho said when reviewing the x-rays that I’m almost bone-on-bone and suggested a TKR during surgery.

Follow-up: The next 12 months were the typical X-Rays and the comment “everything looks good.” I related on every visit my pain, stiffness, clunking, swelling, and discomfort. At the end of 12 months my Ortho discontinued follow up’s even though the problems continued.

Physical Therapy: I did PT the following day after being released from the hospital for my 2nd surgery. I’ve found that different PT places have different methods with few exercises being the same. Following first surgery I had PT for9 weeks with 12 months of home exercises and attained 120 degrees.
The revision surgery was followed up with over 5 months (44 visits), and home exercises but no better than 105 degrees. My therapist stated this may happen with revision surgeries.

Clicking: I have a heavy double clunking. When walking as I lift my leg, and again when the foot touches the ground. No pain but terribly distracting. Note: When I mentioned clicking to my successful knee Ortho he said your knee will click but in almost 4 years it never did.
ROM: Following the first surgery I attained 120 degrees and post second surgery I’m at 105 degrees and not improving. Simple things like getting dressed is a challenge

Sleeping: Although my worst sleeping conditions are behind me I still have pain when I roll over.

Pain: Since I tore my ACL in Feb 2018 I’ve had pain, stiffness, and limited ROM 24/7.

Swelling: Going into my 11th month post-surgery still swollen and warm.

Revision surgery: I convinced the Ortho that the femur implant was misaligned (X-Ray) and a bigger model was implanted, the tibia was not changed. There was less pain and quick recovery compared to first surgery for the first four months when progress went south, e.g., pain, swelling, and, stiffness.

Dr. Visits: Same ole, X-rays & “everything looks good” and then I limp out of the office using a cane.

Depression: I received periodic status questionnaire’s following my second surgery that asked about level of depression. I couldn’t relate to this when my primary emotion was anger.

Limping: Feeling like an old man limping with a cane. I remember prior to TKR walking with a strut.

Present status: Constant 24/7 awareness of prosthetic knee since 03-13-2018. Can’t stand or walk for any length of time. Sleeping difficulty because knee discomfort.

I think modern TKRs for the most part result in a large majority of very happy patients. These are patients who keep their weight close to normal, exercise, prep for the surgery with a trainer or with specific exercises that a good surgeon will provide, and of course, follow post-op procedures and don't smoke.

TKRs started in the late 60s. The procedure itself and the technology have advanced quite far. The keys to a successful procedure are pretty basic - 1) do your research on the surgeon and find someone in their late 30s to mid 40s with a solid med school and residence pedigree, and a few years of experience and positive patient reviews. 2) Find a surgeon who uses robotic guidance for precision cuts during surgery. 3) Do exercises for 6 months prior to surgery to strengthen the muscles that support the knee, and 4) Do all of the suggested post op exercises, usually 3x/day and attend and participate fully in post-op PT.

Do all of this and the outcome will be overwhelmingly positive. The responsibility for a successful recovery from TKR is primarily on the patient.

TKR is not a gamble. The title of this forum is misleading.

How is it that I fit the first paragraph to a tee, and yet one knee is 99% normal and the other a disaster. With the second paragraph, again, I'm way ahead of you. Having had three surgeries and 7 years of reading and research I remain with the conclusion that there is always a risk.

I wrote this article to stress the point that TKR sees a lot of marketing hype with positive reviews from patients. Negative reviews are rarely seen. My research prior to my first surgery took me to a TKR seminar where the Ortho lecturer was asked many questions from potential future TKR patients in the audience. In his frustration receiving so many questions he blurted out "remember, your knee will never be normal."
I'm on a forum with retirees from the company I retired from and communicate with TKR recipients. The count is presently up to 14. Most of us still have issues from pain to limited ROM. The ones that claim they are happy with the results are those that have less pain than they had prior to surgery and ROM is not an issue with them. All in all, my research indicates that the positive reviews are mostly from TKR institutes.
Check out "bonesmart.org" for a better happy/not happy balance.

Yes and please let me clarify. There is aways risk with any surgery. Infection occurs in about 1% of TKRs, and that sounds low, but it's one in 100 on average. Surgeons do more than one thousand themselves each year, so that risk is real.

So is the risk of a surgeon, even a good one, making a mistake. There is also risk in getting a bad surgeon, so do your homework.

And finally, one TKR on the same patient can be fine while the other knee can present problems.

I do believe that for the majority of people who follow some common sense advice, the risks from TKR are very low, not a gamble at all and that most outcomes will be far preferable to never having the surgery.

I don't agree ouch, with all respect. I believe that a significant % of TKRs result in bad outcomes because patient don't do their part and blame the surgeon, hospital, OR staff, etc. - and then come and post here.

I still think this is a small minority of all TKRs. However the vast majority of people with bad outcomes will post on forums like this. Human nature I guess. Reading through this forum over the last 3 years, I see very little evidence of what you claim to see. There are many, many negative reviews of TKRs. I don't doubt you. I just don't see what you're seeing. You wrote "negative reviews are never seen". Not on this forum.