Delaying TKR

Posted by dna41 @dna41, Aug 11 12:52pm

I have two bad knees and am scheduled for TKR on one of them in September. I have read so many posts about how difficult this surgery is and how painful. I am terrified of doing it. I previously had shots in my knee but stopped because the actual shot itself (to me) was excruciating painful. I can't do that again without more or different anesthetic to my knee. Does anyone know if there is an alternate pain eliminating way to have a gel shot? I'm thinking if there is, maybe I can just continue having the shots rather than the surgery. Any thoughts or suggestions on this?

Interested in more discussions like this? Go to the Bones, Joints & Muscles Support Group.

One other thing to consider is your age. Knee replacements today are lasting 15 to 20 years, or more, depending on how active you are and how much wear and tear the implant will endure. I tried to wait to have my knees replaced until I was old enough that I would probably only need one replacement per knee. One knee probably should have been replaced sooner than I did, but now 10 months out from the replacement I don't really think about it most of the time. My first replacement was not really over the top painful, while the second was quite painful at first, but now is not even bothersome. In sum, my life would be much different with more pain and more restricted activity if I hadn't had them replaced. I too had shot for a while, and they did allow me to postpone surgery. But, the second knee became very unstable, and bowed, so it was a question of function, in addition to pain.

REPLY

I can relate to bone on bone with no pain. I had the same thing happen. The last time my knee Dr. took xrays he said "Well, that looks terrible." That gave me pause. But even at that point he didn't tell me I needed surgery. Bone on bone does not get better, it only gets worse as we age. So at least consider getting knee surgery and don't wait until you are 85 like I did. My surgery went extremely well, but I am not sure most 85 year olds would come through it as well.

REPLY

Replying to Marianjw. You are close to my age, I turned 85 in June. I was glad to see you are on a recumbent bike. I used one for a month before my surgery and I think it really made a difference in my recovery. Are you getting PT too? If you decide on the surgery, get as much PT before the surgery as you can. If you do those two things, and if your general health is good, you should come through the surgery just fine. It's a big decision any way you look at it. If you decide to have the surgery, your Dr. will determine if you are in good enough health for a good outcome.

REPLY
Profile picture for gravity3 @gravity3

Great advice lawanna. I would add this....if you haven't already, find out how many tkr your surgeon has performed (experience is vital) and what her infection rate is. Good luck.

Jump to this post

Yes, I agree, great advice. Don't be shy, it's your knee and you need the best surgeon you can get!

REPLY
Profile picture for heyjoe415 @heyjoe415

Hi dna41,

I'm sorry for the pain you're going through. Been there.

I agree with Captain - to liberally paraphrase - the bark of a TKR is worse than the bite.

I had both knees replaced in 2022, 4 months apart at age 67. As Captain notes, this is a major surgery and the initial weeks, especially early rehab are hard. I had a diluted nerve block via catheter for the first two days after surgery to help with the worst of the pain. But my worst day in recovery/rehab was better than my best day pre-op. Each day in rehab the pain lessens until it's just gone.

If you haven't found a doc, I suggest finding someone in their mid/late 30s to their 40s, with a good med school/residency/fellowship pedigree, good references, and who have performed many, many procedures. These young Drs are very bright, current on the latest surgical techniques and tools, and they are ambitious and building a practice.

Just my opinion, but as soon as a person is bone on bone, in any joint, it's time for a replacement. Cortisone, gel, PRP shots are band aids. Of course, follow the recommendation of a trusted surgeon.

In addition to my knees, I've had my right hip replaced this March (2025) and just had my left shoulder replaced last week. The relief from the pre-op pain is incredible.

The key is doing all the rehab. I wish you all the best. Maybe you can replace your fear of surgery with faith in the process and the results of others. That's not a guarantee, but at least for me, the reward far outweighed the risk.

All the best.

Joe

Jump to this post

Wow Joe I just read your comment and it is exactly an answer to my thoughts this morning. I have had bone on bone both knees for 12 years and lived with Cortizone gel etc. it is now time I am scheduled for my first total knee replacement on November 24 now it’s interfering with my life before this I could get around with no problem. I’m a tour guided a museum. I could still wear heels, etc. now I know I have to get it done. I’m 68 years old soon to be 69. I am petrified of infection healing, etc. I have never had surgery except for my children where I had two C-sections many years ago I’m a daughter of a doctor which we are the worst patients. It never leaves you even after all these years thank you for your words. It just reinforced the fact that I have to go through with this. Thank you so much. I am anxious and at this point I just can’t wait till November because it’s just getting to me.

REPLY

I have found some relief with PRP shots.

REPLY
Profile picture for grrranny @grrranny

Which gel injection did you have? I had Gel One injection a week and a half ago, and it wasn't painful at all. Ultrasound was used to guide where gel went. Did your doc use ultrasound?

Jump to this post

Which gel injection did you have and, how long were you told that they would last.
I am thinking of having Arthrosamid injections as I was told by a friend that they were amazing pain relief that has lasted for years.

REPLY
Profile picture for heyjoe415 @heyjoe415

Hi Bill,

I don't believe that a good surgeon ever recommends surgery. My ortho surgeons have always given me explanations and options.

In my opinion, once a joint has no cartilage left and it affects a person's life, it's time for a joint replacement.

I think the statement that surgeons will always recommend surgery is mostly not true. It does happen though. 15 years ago I had sciatica. The surgeon did strongly recommend fusion and he was available within a week. His aggressive recommendation and immediate availability caused me to pull back and reconsider.

That was a lousy surgeon. Fortunately, their number is small. And 15 years later, the sciatica is gone and no vertebrae have been fused.

Your point stresses the importance of doing research and getting recommendations in surgeons. And when in doubt, step back and reconsider.

Thanks Bill.

Joe

Jump to this post

Thank You Joe,
I appreciate your thoughtful response. Perhaps the word always should not have been used. I’ve had surgeries that improved my life and two that made other conditions worse.
Nothing in medicine is for sure. We Try to do our best. So do almost all doctors.
Be well and happy.
Bill

REPLY
Profile picture for jajo @jajo

Which gel injection did you have and, how long were you told that they would last.
I am thinking of having Arthrosamid injections as I was told by a friend that they were amazing pain relief that has lasted for years.

Jump to this post

I had "Gel-One". Doc said it should last from 6-12 months, and injection could be repeated -- possibly several times: https://www.zimmerbiomet.com/en/products-and-solutions/products/restorative-therapies/gel-one.html

REPLY

I can relate to your comment about being very sensitive to pain. I had a horrible year after a knee replacement last year, but I learned some lessons: 1) If your surgeon does not offer you a detailed patient education class, video, or pamphlet, or refuses to discuss complications of the surgery and side effects of medication before you agree to the surgery, get a new surgeon. 2) Don't expect contact or help from a surgeon afterwards. They aren't interested. It's almost impossible to get any prompt help if you are in trouble and the minimum appointments they do schedule are too far apart. So, go ahead and schedule checkups with your family doctor at about three week intervals over the first four or five months. You can cancel if you don't need them all, but they are your failsafe. It's the fastest help you can get. It really helped me. 3) Do a search for physical therapists in your area who are board certified for knee replacement recovery or who have a Ph.D. There are lots of different opinions about how to rehab a knee after TKR. The physical therapist is not a doctor and it's really just you and the therapist who will get you well. Get the very best one in town. I know from experience that what some of them don't know will hurt you badly and delay recovery. 4) Get someone reliable, patient, and caring to be your coach. There's no getting through this surgery without one. They not only drive for months, but they have to monitor large numbers of meds on a 24 hour basis and remember all the instructions you get and help you practice the therapy. You won't be able to think or remember for weeks from all the drugs. You won't be driving for at least a couple of months. You won't be cooking or washing clothes or shopping. The coach is absolutely the most important person in your life after surgery. 5) Buy a large ice pack from your physical therapist (roughly 8 x 12 inches). It's going to be your constant companion. Also, arrange a comfortable way to elevate your leg above the level of your heart for 30 minutes 4 times a day. It's the only way to get the swelling under control so that your leg will bend. 6) Get on the Internet and read everything you can find about the surgery, the risks, the complications, the rehab, how the leg heals, and recovery physical therapy exercises. Use sites from big teaching hospitals like Cleveland Clinic, Mayo Clinic, Johns Hopkins, the National Institutes of Health publications, and professional associations for orthopedics. More info will help you deal with the roller coaster of unexpected events. It is easy to become overwhelmed and deeply depressed after this big surgery. It's a long haul. 7) Finally, prepare your family for a year of disruption. Someone else will have to take over things you normally do. It's very stressful for the whole household. Your days will be spent dealing with the miserable knee for months to come and nothing in your life will be normal till the following year. Don't believe all the advertising about how you will be walking and climbing stairs and getting back to your daily life in a matter of weeks. That's sales talk. Best of luck to you. Everyone who has been through this will be rooting for you to heal quickly.

REPLY
Please sign in or register to post a reply.