After TKR, can I come home to two flights of stairs?

Posted by comeoutdancing @comeoutdancing, Sep 15 3:00pm

I am healthy and active at age 80. I have a TKR scheduled in October. I have a great caregiver, surgeon and physical therapist. I understand I come home on surgery day and will be in pain so must take the pain meds. Questions:
How can I 'hobble' up two flights of stairs that day to get into my apartment?
I am hoping to recover back to walking in a few days and biking, dancing and yoga classes in two months. Is this realistic?
I welcome your advice for a best recovery.

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Profile picture for genie15 @genie15

Dear dancing,
Two flights of stairs when you first come home? Are you serious?!
Try to take it easy the first few days. Don't undo the hours of very technical work the surgeon just completed by engaging in unnecessarily risky behavior. You are supposed to heal first. A surgery that's messed up by a lack of caution and care is much more difficult for the docs to fix and for the patient to recover from, and believe me, the first surgery is plenty to deal with. One recovery at a time, please.

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@genie15
Such wise words. I am ‘leaning’ toward a hotel room or B&b with my caregiver. Then get back to my walkup when it seems prudent.

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Profile picture for comeoutdancing @comeoutdancing

@steveinarizona I like the golf story. It ‘hits’ close to home.
I only have to get up once; my caregiver/partner will be there to help.
Going up stairs is what made me choose TKR. I pull up now. But can walk forever.
I’m happy to hear you had no pain post surgery. Isn’t that remarkably rare?

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@comeoutdancing Yes...very rare. And what makes it intresting is that I had a left hip replacement five years ago and had no post surgery pain then either. There is only one variable that applies to both: the same surgeon.

My surgeon is extraordinary. He was an engineer before becoming a surgeon and he is the primary inventor of the minimally invasive Superpath method of hip replacement (that is what he did for me). He also gave me the extremely rare bicruciate retaining knee implant (BCR). In 99+% of TKRs, the ACL is resected and in many cases the PCL is as well. In a BCR the surgeon retains both and protects them. But the implant is different and the surgery is more complex so you only want it if your surgeon is extensively experienced at it. There is a video on the internet of my surgeon doing a BCR in 2020 at an Orthopedic Innovations Conference and he has now been doing them for at least a decade. I think there are only a handful of surgeons in the US doing BCRs; I am aware of only three.

I attribute the success as follows: 5% for my work reviewing procedures and finding Dr. Chow; 5% for luck (good in my case); and 90% for the skill and experience of Dr. Chow.

Surgeons are professionals and like all professionals they vary in their skills. Find the positive outlier like I did and you will have maximized your chance of a great recovery.

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Profile picture for comeoutdancing @comeoutdancing

Thanks so much. I will ask the same questions of the medical team but wanted to hear from those who have lived this. I love the idea of the chair on the landing for resting. we are also considering a hotel or AIRBNB for the first few nights, since the steps are pretty formidable.
I will look for a video to prepare for the post op time.
I really appreciate this thoughtful response.

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@comeoutdancing
I am an active 71-year-old, 3 weeks post total knee replacement. My 2 levels of stairs are within my home, so I set up a bed downstairs in case I couldn't navigate the stairs. However, it turns out that I was able to go upstairs and preferred my adjustable bed in my bedroom. If you are just concerned about getting into your apartment on day 1, on the same day of surgery, I found that because there was a nerve block and other pain medicine, I was quite capable of going up stairs.
Alternatively, if you're unsure, and you have the option to go to skilled nursing/rehab for the first couple weeks, that might be a good solution, and you can get PT there.

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Yeah, no, Maybe...

I had TKA at 65 and was realized after 2 hours of recovery. Bad plan. THe three steps up to my house Weren't bad as long as I had someone's hand on my back. Getting in the house and getting onto the couch was OK. Getting off the couch to go to the bathroom that took a little more effort.

I was fairly reasonable shape and I'm used to being on my feet for 8 to 10 hours a day. But this knee surgery is brutal. And I don't think people should go home immediately afterwards either. The amount of drugs that you're given for the surgery is surprisingly high. And you might be extremely disoriented and woozy for the first day or two.

I went up one flight of stairs on the second or third day and I went up on my butt, one step at a time. That worked. But I learned the hard way about overdoing it a week later and tearing stitches. If you can't stay at an Airbnb or a hotel for a few days until your recovered from the surgery, and you must go up the stairs I would go up on my ass.

Either way best of luck and please do be careful about those infections.

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Profile picture for cybsister @cybsister

@comeoutdancing
I am an active 71-year-old, 3 weeks post total knee replacement. My 2 levels of stairs are within my home, so I set up a bed downstairs in case I couldn't navigate the stairs. However, it turns out that I was able to go upstairs and preferred my adjustable bed in my bedroom. If you are just concerned about getting into your apartment on day 1, on the same day of surgery, I found that because there was a nerve block and other pain medicine, I was quite capable of going up stairs.
Alternatively, if you're unsure, and you have the option to go to skilled nursing/rehab for the first couple weeks, that might be a good solution, and you can get PT there.

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@cybsister
Thanks for this info about the nerve block. I will check to see if that will be the case for me.
I only need to get up the two flights once - then I can plan future trips as I rehab. I had hoped to go out most every day for walks....we will see.

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Profile picture for gmooney @gmooney

Yeah, no, Maybe...

I had TKA at 65 and was realized after 2 hours of recovery. Bad plan. THe three steps up to my house Weren't bad as long as I had someone's hand on my back. Getting in the house and getting onto the couch was OK. Getting off the couch to go to the bathroom that took a little more effort.

I was fairly reasonable shape and I'm used to being on my feet for 8 to 10 hours a day. But this knee surgery is brutal. And I don't think people should go home immediately afterwards either. The amount of drugs that you're given for the surgery is surprisingly high. And you might be extremely disoriented and woozy for the first day or two.

I went up one flight of stairs on the second or third day and I went up on my butt, one step at a time. That worked. But I learned the hard way about overdoing it a week later and tearing stitches. If you can't stay at an Airbnb or a hotel for a few days until your recovered from the surgery, and you must go up the stairs I would go up on my ass.

Either way best of luck and please do be careful about those infections.

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@gmooney It's funny, I had an image of myself 'backing' on my bottom up the the steps. And thanks for reminding me about the drug effect. If I am 'woozy', I will necessarily be unstable. I will ask the care team for opinions but a hotel for a couple days is appealing.

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Profile picture for comeoutdancing @comeoutdancing

@gmooney It's funny, I had an image of myself 'backing' on my bottom up the the steps. And thanks for reminding me about the drug effect. If I am 'woozy', I will necessarily be unstable. I will ask the care team for opinions but a hotel for a couple days is appealing.

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@comeoutdancing
And when you get to the top of the steps, you must still (one-legged) get up on to your feet. Been there- not easy.

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Profile picture for steve161 @steve161

First I'm 80 and had TKR three years ago, not to different than your situation. I live alone on a small 55 acre farm, family & friends are close by for support. The land is dedicated to Wild Life Habitat Management requirements, so my list of tasks include mowing, plowing and seeding, clearing & trimming brush & trees, welding, light to medium construction, gardening, well you get the point.
Since my replacement surgery I've come to understand that there are many different processes out there to accomplish the same task, so here's what I went thru. My doctor was very sensitive to any bug bites or scratches close to the incision site, no recent injections, no dental work within a month prior to surgery and no fever at surgery time. All making sure that there wasn't any chance of infection that could spread to the surgery site. I actually showed up at the hospital the day of surgery with a very tiny undetected bug bit on the back of my knee, he smiled and rescheduled for the next month. My surgery was also a one day procedure but that included an overnight stay for observation before discharged. Hours after surgery I was up and out of bed walking with a walker as far as I could, which was all of 20' out and back. The next morning I added another 20' to the walk, also with a walker, that's when my doctor asked if I lived on the ground floor, my answer was I had a ramp giving me both access and escape of the house on my own if needed. It was a couple of weeks before I tried the stairs but only a few steps and that was with a cane. Took me months before I could barely get up and down those stairs without a cane but holding onto the handrail with a firm grip. Today I'm up and down without any problems.
Someone on this blog suggested that a rehab facility might be a good place if you had an issue with the stairs, I have a few words to say about that. Last year doing some construction on my house I had an accident, fell backwards off the porch, landed on my neck and shoulders. I ended up in a neck brace for 2 months. The neurologist having some concerns about balance had me check into a nearby rehab facility. On the surface the facility was really a senior care facility with mostly 2 patients per room with a percentage of rooms dedicated for short term rehab patients, like myself. You share everything with the permanent patients, some can barely move in a wheelchair or go to the bathroom by themselves. Eating rooms, exercise room and odd smells roaming the halls are all being shared with all residents. The attendants are not nurses, they're contract hires, that come and go on a very regular basis. There are nurses handling your medications, but if you want an aspirin or antacid that's not on your list you'll need to see a PA or doctor in a day or two on they're staff for a prescription. Bottom line I'd have a different plan ready, maybe a family member or friend who could put you up for a few weeks.
Don't get me wrong, my TKR was the best thing ever. I can now walk and sleep without pain, after a year I was able to go up and down stairs. There is still one issue I have, because there's no feeling in the kneecap I use knee pads when getting down on my knees. One thing to remember, knee replacement is the roughest recovery of all the joints, you'll need to give it time to heal and you don't want to go back to make repairs.

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@steve161: I'm sorry to hear you had a poor experience at a rehab facility. Your stay certainly sounded contrary to the goal of rehabilitation, which is to restore physical function, independence and safety in an environment that provides for therapeutic modalities suited to the individual patient's needs and comfort. Unfortunately, it appears your stay fell short of that. However, I would urge caution in using one experience to categorize all such facilities in a poor light given one such experience.

Firstly, it's important to recognize there are various levels of rehabilitation depending upon the amount of a therapy per day the individual has been assessed at being able to withstand: ususally this is between Extended Active Rehabilitation or Skilled Nursing stay. The latter tends to have a higher acuity of patients, meaning they do tend to be "sicker", requring greater medical interventions. There are staff ratios that do require licensed personnel on all levels. Private vs shared rooms vary dependent upon the facility selected. I learned and saw a great deal about these options and facilities when I worked providing pre-certification post-hospitalization for those patients who required such stays to provide for the modalities needed to maximize strengthening, mobility, daily functioning and overall conditioning to allow for a safe discharge to home. I personally experienced this myself after a hip fracture; I spent 5 days following surgery and a brief inpatient stay in a peaceful, clean facility where all patients had private room and benefitted from PT and OT that provided not me with exercises, information and additonal time to heal before navigating the demands of home life, that even those closest to me would not have had the expertise to handle.

It does help to familiarize oneself with available options for rehab within the community in the event that such a "bridge to care" in terms of safe discharge to home becomes necessary. Taking steps to avoid possible dissatisfaction can make achieving those goals that much easier.

I second your caution about giving time to heal and wish ongoing health and recovery to all undergoing joint replacements. In the event of any interventions that may require additional inpatient post-op care may it be with a more postive rehab experience!

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Profile picture for comeoutdancing @comeoutdancing

@steve161
Very helpful information. A full year. but also full recovery.
I have observed the same situation with others at those ‘rehab’ centers. I will avoid them, especially since I cannot afford the best care facility.
Your farm life sounds tough and beautiful. I teach partner dance and hope to get back to it. I know it will take effort and intention and some passion to get back on the dance floor.
These reports are preparing
My spirit for a comeback.

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@comeoutdancing thanks for your comments on my TKR thoughts and the farm. Like yourself with dancing I found something I love, and all the hard work I do for wild life doesn't even register. Because of what I do on the farm I learned to be prepared by talking to others who have experienced what I'm about to get involved with. My intent was to inform what could be and for you to add yours to the mix for the betterment of all. I wish you all of the success for surgery and recovery.

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@comeoutdancing
When I came home from the hospital after my overnight stay after TKR, (both knees, done a year apart) I had to come up one level of 13 stair steps to get to where our main living area, kitchen and bedr/bath is. We have a basement walkout type main entrance, and only rec room and extra bedrooms and bath are on that level, and I didn't care to be there much. Really bad house plan, but have lived there almost 50 years.
I managed to get up the stairs by hanging onto the railing and dragging myself along cursing and groaning while sticking my TKR leg out to the side. I had no trouble walking on the level, as I had been taken for two or three walks in the hospital corridor during my overnight stay. In retrospect, I should have BACKED up the stairs, good foot first, then pulling TKR leg up. That way you don't have to try bending the bad knee, just momentary pressure on it while the other leg goes up behind you.

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