I need a TKR: Do I do it, or go as long as I can?

I had an RTKR on Dec 6, 2021 - almost 11 years after receiving my first recommendations for TKRs. I ruined both knees playing basketball and when I could no longer play ball, I started running and after several ultras my knees got so bad that lead to a visit to the orthopedist. I decided against TKRs - scared away by the horror stories I'd read in various Joint Replacement forums ... and I switched to biking as my primary exercise. Unfortunately, as good a cycling was for my knees, both knees continued to deteriorate and on a trip to Croatia last year, I finally cried uncle and resolved to finally new knees. The attached image is of my knees prior to RTKR.

As my orthopedist said, "when you're ready for the procedure, you're ready for it and not a minute before" , in reference to "mental readiness" --- and I totally agree. Once I made up my mind to get it done, I prepared myself as best as I could in the 3 months before surgery --- stretching (focusing on extension and flexion), strengthening (quads, hamstrings, glutes), etc.

Surgery went well and rehabbing has been going pretty well and the knee is now painless (but not without discomfort from the tight band of swelling that is slowly diminishing but will probably be around for another couple of months). That said --- the first few days post-op, the pain can be very intense ... and varied - dull numbing, dull throbbing, sharp throbbing, etc. It is best to mentally prepare yourself for the worst. I've found PT to be very important as the Physio's would push me in ways I'd never do myself. I've also found that daily stretching and to the extent then possible, strengthening, were very helpful.

In a couple of months I'll go in for my LTKR and hopefully the experience won't be too far removed from the right. But - I need to remember the financial cliche - past experience is no guarantee of future results.

@carolasc : the main limitations are those issued by the orthopedic surgeon: no running/jogging, and no steep downhills. Either would put too much pressure on the knee - in the long run, certainly. I have on occasion needed to navigate steep terrain (in ski resorts, for example), no consequences, but I would not want to do this on a regular basis. It is irritating that it does not feel good at all to kneel with the TKR, even though there is no restriction for doing it. Other than that, I’m pretty much free to do what I want. I was lucky that I quickly got back to a very good flex/ability to bend the knee almost as much as the other one, and in spite of the expected painful aftermath I was driving myself to the grocery store within 8 or 9 days (as soon as I was off opioids), started walking short distances on the road on day 7. Ditched walker after 3 days, crutches after 5 (and those only outdoors, to guard against falls). Indoors no walker, cane, or crutches after day 4. Oh… it was my right knee, and yes, I was able to drive pretty much right away. Biggest problem was getting OUT of the car (Camry, so not a nice, high SUV).
Almost exactly 4 months after the TKR I was traveling, by myself, with a full-size suitcase, during the winter and snowy/icy sidewalks, and riding trains sometimes, during visit to family in Austria.

@carolasc :Did I mention I had a great outcome? Perhaps “lucky”, perhaps doing pre-surgery exercises, being willing to do all the assigned rehab exercises, every day - and no kidding, it hurts a lot. Drove me to tears sometimes, but I toughed it out. So I did not want to sugar-coat the immediate period after the TKR. It stinks. However, today I truly sometimes forget that the TKR knee is not my own. Try to get a good relationship with your surgeon, and ask him endless questions if you feel you need to. And already find a physical therapist to prepare you for the surgery that you click with. I had “my guy” who guided me through some shoulder surgery rehabs, and we just work well together. Big help if you can establish a relationship like that - you’ll spend much more time with the PT person than you ever do with your ortho. That’s it. Good luck!

Well I was a active , heathly 65yr old male . Played basketball , rode bike, walk and swim in ocean and had my own house painting business. At the time of my 1st TKR I was fit and ready, did all the pre- therapy , got myself mentally ready , I just wanted that bone on bone pain gone . Well that pain is gone but it was replaced by a far worse nerve pain that is so server I can;t walk one step without pain. Now I do push myself thru this to go to a store or go out for a certain reason but since TKR I have never taken a walk for pleasure, worked or stepped on a bball court. I have been told by numerous doctors that the TKR is fine it's the nerves around it that have ruined my life as I once knew it. So I would say know that like any surgery things don't always go as planed

@happyat76 I am thinking that since your original post was quite a while ago you have probably already decided and either had a TKR or chose not to.

I had my first TKR in 2013. It went well. I had a second one in October of 2017 and that also went well. There is no way I could have escaped the first one, I was limping badly and in pain all of the time. I wasn't quite as bad before the second one but I knew I was headed there so I chose to have it done. I have read if you are going to need to have one, then it's best for your recovery if you do it before the pain and arthritis get overly advanced. So now I have two fake knees. My only regret is that I think I didn't do quite as much PT at home as I should have and my flex is not what I would like it to be. Other than that I am happy with both knees. I very infrequently have any discomfort from either.
JK

@sprinrosa64 : I am sorry to hear that you had such a bad result with the TKR. It must be debilitating to have had high hopes for a pain-free, or at least easier knee motion, and end up with nerve damage. In a way I was unlucky to have not known this Mayo forum before deciding on my TKR - would have changed or altered time-line, maybe, and questions to put to my ortho, but on the other hand, I am also at least a little concerned that I may have panicked from some of the negative outcomes/results

and not have the surgery. At some point there may be a good bit of chance involved regarding the outcome, even with the best of preparation, surgeon’s skill, and physical condition. Again, I really am so sorry that you ended up with this permanent pain.

Ellerbracke thanks for your thoughts, I try to understand life goes on and I should count my blessing and be thankful for the wonderful people I have in my life but just some days , well lets just say I question it all PEACE

I am also considering a TKR as I have bone-on-bone knees too. From those who have had TKR and PT and feel it was a success, I would like to ask these questions:
1. After having TKR can you go up and down stairs easily? Carry something up & down stairs?
2. Can you get up off the floor easily?
3. Can you get on your knees at all?
4. Could you attend a yoga class, a water aerobics class, go for a 1-2 mile walk, go hiking, ride a bike, etc?
5. Travel easily?
6. Walk in the yard, on snow, or uneven ground?
7. What are your new limitations?
Thanks for any insight!

Hi Carol,
I am 61 years old and have just had a TKR. I had bone on bone from years of activity after a tearing my left ACL at 18 and having it reconstructed when I was in my mid-30s. I am quite active and found that I couldn't hike anymore. Running was out of the question. So I decided to do it. Having said that I did get steroids for a few times, but after they became less effective I went to OrthoVisc and PRP (Platelet Rich Plasma). After two cycles of treatments I decided the tune ups were to difficult to manage 2x a year.
To answer your questions:
1. I am 9 weeks out of recovery and can go upstairs and downstairs carrying things (while holding the railing).
2. I can get up off the floor -- I like to do core and yoga
3. I can kneel (but put a soft towel under my knee to relieve the pressure).
4. Yes, I attend yoga and core. I hike 5 miles easily now. I have been riding my bike (10+ miles) when I have time.
5. Travel - easy peasy.
6. I'm walking on uneven ground now. Haven't had snow yet. I live in VT so soon!
7. Limitations: I don't think I am allowed to run again, but I have let go of that. I have heard of people that play tennis though, so I'm looking forward to that in my future. Maybe next summer.

I would say it is best to do it when you are healthy and strong. I was worried that the longer I waited the less in shape I would be. And the recovery would be more challenging. I took spin classes up to the day I had my surgery to give me the best shot at recovery well.

Best of luck with your decision!
Jennifer

Thanks for your positivity - it is so good to hear such a good outcome as I feel more people wish they have never had tkr after doing it. I think one of the biggest fears I have is getting back into my home after surgery - I live in a split entry home, 7 steps from the garage into the house and 7 more up from the entry to the main level. Most people tell me it’s impossible to do the day of surgery or even the day after. I am so glad you are doing so well - thanks for your reply! It gives me hope.