Second TKR much more difficult than first

Posted by grlowejr @grlowejr, Nov 24, 2022

I had my first TKR, robotically assisted, in July 2022. It went wonderfully. I experienced the expected pain and discomfort following the surgery, but by the time I had my six week follow up with my surgeon everything was great — 130 flexion / +2 extension. So great that we scheduled my right leg TRK for six weeks out in October. The surgery was the same — robotically assisted cementless, fitted, Attune tibia and femur implants — with the exception of a screw from a previous ACL repair that was in the way of the placement of the tibial implant, which they were forced to drill out of the bone. But while the surgery was virtually the same, the pain, swelling, inability to get extension better than +8, (it was +10 prior to the TKR due to osteoarthritis and 5 previous knee surgeries), and sleeplessness has been completely different. I continue to follow the home exercise regiment my therapist has given me and continue to go to therapy 2X week all in the hope that one day soon I’ll start to feel/see progress from all the work. Does anyone have any experience with screw removals from previous surgeries in TKR procedures? It’s the one thing different between the two surgeries so I wonder if it’s responsible for the vastly different outcomes. Thanks in advance for any input.

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I had both my knees replaced this year as well - one in March and like you, one in July. Both were done with the Mako assistant.

I'm sorry to hear about your experience with the 2nd operation. I'm no expert, but I don't think the removal of the ACL and the screw from a previous surgery would have an impact. But because that's the only change and it involves the bone (femur, tibia or both), I'd ask about it.

It's still early and I know you know the importance of the rehab exercises. I suggest sticking with those and maybe up the icing and elevation post exercise (try the HurtSkurt from Amazon - great for icing and get two. If you're not, and you can tolerate them, ask your Dr. about Rx anti-inflammatory/pain medicine like Celebrex (which I used).

No two knees are alike. My first TKR couldn't have gone better. But with my second there was swelling for about three months, granted it kept going down. I think/hope that if you stay with your regimen, things will resolve.

Please let us know and all the best. Joe

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@grlowejr I'm glad you had your good experience first! Otherwise you may have been tempted to limp through life on one bad knee - no fun at all. Here is my take on the difference between the two surgeries - prior damage is slowing the recovery time. As are two surgeries too close together. For some reason, we always think we are the 1% who will sail through unabated, and resume life on our own optimistic schedule.

You probably have a lot of old scar tissue and damage from the ACL repair and arthroscopic surgeries, as well as those embedded screws. There may also have been nerve damage from the injury that led to the ACL repair, so the nerves are more sensitive to disruption. These will take longer to resolve than tissues in an undamaged knee.

I know surgeons will tell you three months between knee surgeries is adequate. The reality is that your left knee and your body are still healing from the initial surgery in July. Joint replacement is a major insult to your body, even though it is done often and successfully, it is major surgery. A lot of resources are recruited to replace lost blood, heal the incision and regrow bone and repair nerves - it can take up to a year. Then BOOM, 3 months in, you ask your body to double its efforts. The result is not fun.

I welcome anyone else to weigh in here, but I can tell you that when it is time to have my knees done, I will try to give the first a year to heal before I do the other one.

Hang in there, keep pushing, and you will get there. Is there anything you can do to make day to day life easier while you concentrate on healing?
Sue

How do I know? I did the same with my first hip replacements - in my 50's, healthy and active, I was sure I could easily handle it. The first one was a piece of cake, I was working from home in less than a week, back in the office at 4 weeks, and out on the dance floor about the same time. So at 9 weeks, we did the other - more pain, more tired, less mobility, finally at 6 months I regained some energy and was finally able to begin travelling for my work again.

When I had to have revisions on both hips, I was retired and able to rest more, waited 3 months between surgeries, and still took over 6 months to fully heal.

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Hi, Sue
I had both knees replaced this fall, 5 weeks apart. It is an experience that worked for me. I am 66, overweight,walk a lot and prior to surgery, did exercise. My first surgery and recovery went well. PT 3 times a week, exercises at home twice daily, walking, pain, lots of swelling and lots of rest, I did stop pain meds after 3 days and stayed with Tylenol. The second surgery followed the same course of PT, exercise, no pain meds, however the knee did have more damage and I experienced (whether related or not to damage, unknown) significant muscle spasms. The latter required a change in PT plan and meds.

At just under 3 months from date of surgery one, I can say this course and timing worked for me. Staying the course and COMMUNICATING with PT and nurse navigator are key. Plus daily, I mean daily stretching/walking if you can are critical. Rest is something I have learned to listen to my body to do, ongoing, and ice when needed. The biggest learnings for me 1) must communicate with my doctor, PT, nurse navigator (rashes, blisters, weird pain, everything) 2) I am rehabbing my legs not just my knees and to work accordingly.

Blessings to all for a healthy, yes it is long, recovery.

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@loreleiks

Hi, Sue
I had both knees replaced this fall, 5 weeks apart. It is an experience that worked for me. I am 66, overweight,walk a lot and prior to surgery, did exercise. My first surgery and recovery went well. PT 3 times a week, exercises at home twice daily, walking, pain, lots of swelling and lots of rest, I did stop pain meds after 3 days and stayed with Tylenol. The second surgery followed the same course of PT, exercise, no pain meds, however the knee did have more damage and I experienced (whether related or not to damage, unknown) significant muscle spasms. The latter required a change in PT plan and meds.

At just under 3 months from date of surgery one, I can say this course and timing worked for me. Staying the course and COMMUNICATING with PT and nurse navigator are key. Plus daily, I mean daily stretching/walking if you can are critical. Rest is something I have learned to listen to my body to do, ongoing, and ice when needed. The biggest learnings for me 1) must communicate with my doctor, PT, nurse navigator (rashes, blisters, weird pain, everything) 2) I am rehabbing my legs not just my knees and to work accordingly.

Blessings to all for a healthy, yes it is long, recovery.

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These are very useful comments for anyone anticipating a TKR. No two knees are the same, not even your own! I had both both knees replaced this year (Mako assistant was used for both). First recovery was a breeze after the first week. Second one had prolonged swelling - but as loreleiks mentioned, stay with the daily exercises, especially stretching (ankle slides and the like) to get ROM back. Good ROM is critical for long term positive outcomes.

And the therapy work starts the day of surgery. Once you are able, a PT will take you on a walk of the hospital floor (don't worry you'll have a walker).

loreleiks I hope you're better. Thanks for the post.

Joe

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