Should I cancel my TKR surgery?

I’m six months post-op from right knee TKR and ambivalent about having had the surgery. I’m a 69-year-old woman in good health at a normal weight. I had bone-on-bone arthritis in both knees but, while my left knee hurt only when I walked more than a mile, my right knee hurt all the time, even at rest, and often with throbbing pain. After trying all the pain relief options my orthopedist offered, none of which helped, I opted for TKR. I’ve had worse pain and inflammation and for a longer duration than the average patient. And despite being as conscientious as I could be about prehab and rehab, I’ve achieved flexion of only 102 degrees so far. I can’t walk downstairs normally, can barely cut my toenails, and need an elaborate process to get in and out of the bathtub. I did Pilates for 15 years and loved it, but now I can’t do many of the movements. I still have a lot of pain from the surgery but I hope that will go away once I’m 12-14 months post-op. If the pain doesn’t subside, the surgery will not have been worth it. But even if I end up pain free, I’m not sure having such restricted movement will have been a good trade off.

Hang in there James. At 4 weeks you're still at the beginning of a long recovery. Take your meds so the pain is bearable.
I'm also 67 and I had left TKR 10 months ago. It does get better. Keep up with the stretches and PT. I felt the same way you do at 4 weeks. I also needed an MUA at 6 weeks because of scar tissue. At some point, I said to myself that this wasn't going to go as fast as I wanted it to. It's a tough surgery and everyone's recovery time is different. My plan is to get back to doubles tennis. Hopefully, I'll be there in a couple months.
You will feel the knee get better, just give it time...and plenty of ice! Best of luck! You've got this!

I am so sorry for all that you are going through. You sound like me. I have always walked 2-3 miles often and exercise frequently. I was in terrible pain after my TKR and would never do it again. My other knee isn’t in great shape but I would never subject myself (or my husband, who was my caretaker) to such a rough and painful surgery ever again. I empathize with you and hope that your pain will diminish with time. All the best to you. MaryAnn from Boston

If I were you, I would go to PT for as long as your health care plan allows and strengthen the quads, glutes and calves. All of these muscles support the knees. In addition to that, I would suggest that you ice your knee for 20 minutes every hour or two and get a knee support. I would do *everything* that I could to avoid a TKR. I did one for my right knee and I regret it……..long recouperation, lots of pain……..a very rough surgery!

Thank you so much for your kind note, MaryAnn. Given my experience, I recommend the following:
1. Surgeons should be required to disclose the risk of limited functionality at the initial consultation. Mine didn’t and, months later, a knowledgeable acquaintance explained that many surgeons don’t because fewer people would opt for surgery. She told me this risk is disclosed in the consent form people are given when they’re already prepped for surgery.
2. Patients should be offered the opportunity to pay for a weekly call or Zoom with a case manager to discuss their progress and address their problems. Many of us are accustomed to paying weekly for professional services, such as therapists and personal trainers, and would jump at the chance to talk to someone who could make sure we’re progressing appropriately, at least during the first year post-op. In my case, I would have liked a case manager to make sure I had adequate physical therapy, adequate pain relief, and an effective sleep aid; and to immediately recognize and treat the keloid on my scar. My hospital-affiliated rehab facility scheduled me only once a week, which caused me to miss out at a critical phase of recovery and angered my surgeon when he found out at my six-week checkup. I was quite ill after surgery—I had a vasovagal episode on day 16 and many of my lab values were out of range—so maybe the therapist limited my PT for that reason. But he should have consulted with the surgeon. A case manager would have told me the PT was inadequate and sought the surgeon’s advice. On the subject of pain and sleep, I felt abandoned by the surgical team and ended up working with my personal physician, although she didn’t have expertise in joint replacement recovery. Given their specialized knowledge, I believe I would have had a better experience if the internal medicine physicians at the orthopedic hospital could have helped with recovery in addition to doing pre-surgical testing. A case manager could have sought their advice.
At any rate, these are my thoughts.

Don’t cancel. I had my right TKR done in January 2023. I didn’t think it was worth it at 4 weeks, but 6 weeks it turned around. I can now go up and down inclines and steps, it’s very freeing. I feel younger because i can do things i didn’t think possible again. We give up lots of things slowly and don’t realize how a bad knee restricts our movements. I’m back to pilates and yoga and i only had the right knee done. Left is still bone on bone, but right knee supports me very well. I am considering doing my left knee, but my movements are no longer restricted.

I, too, regret having had a TKA. My less than optimum outcome was due to a cascade of difficulties, beginning with an ill advised and likely unnecessary meniscus repair (I was 73 at the time). The orthopedic surgeon thought I would need a TKA within a few years, decided , with no operative permit signed for the ‘extra’ procedure, to do a microfracture (using a sharp tool to make the bone bleed to theoretically cause a cushioning substance as articulating surface in the joint.) I woke up from anesthesia and was told I could not bear weight for 6-8 weeks while it healed. The pain did not go away. I contacted Mayo Clinic in Jax. and was told they had an opening for a TKA . This would be less than a year after the previous surgery. I agreed to have this done, thinking it may finally put an end to the painful knee. I had much difficulty with the PT following the TKA…it was quite aggressive. I felt that my progress was slow and at 3 mos. post TKA had a manipulation under anesthesia. Then more PT….weeks and weeks. My extension was normal or within 2 degrees. However, the flexion went from a best of 115 to 3 yrs. later 85 degrees. I decided to make one last attempt to regain flexion and had arthroscopic lysis of adhesions with an MUA on 3/25/25. I was told the MUA resulted in 125 degrees of flexion. At this time, in PT , I have only achieved 86 degrees flexion. Yes, I am sadly one of those who are greatly affected by arthrofibrosis…genetically and due to too much surgical trauma inflicted on the joint. There are many articles and research addressing this unfortunate occurrence. In layman’s terms, the body doesn’t turn off the ‘healing process’ and continues building fibrotic tissues. There are differing schools of thought on how to address rehab on patients with arthrofibrosis and predicting and preventing it from occurring in the first place.
I am just hoping to regain enough flexion to be able to resume riding a bicycle…115 degrees and maybe a little modest skiing (I was a ski instructor for 12 yrs.) Good luck to any and all who suffer from the scourge of arthrofibrosis and the “blame the patient” game that sadly often accompanies the condition!

The teacher at our local Y water aerobics has two VERY bad knees (she was also a runner until very recently), and so far she has avoided TKR and gets around very well. She has done the hyaluronic acid injections a lot which have worked well for her; but she was in a lot of pain. If you have no pain and can get around, I don't see why you would get TKR. Me I have lots of pain every day all day, and I am hoping to get TKR soon as possible. Good luck.

I completely agree with all of your thoughts! Like you, I didn’t have a lot of support from my surgeon either. It was my primary care who helped get me through that horrible experience. Take good care and thank you for your very wise reply. MaryAnn