What can you do to extend the life of your TKR and mobility?

Posted by Chris Trout, Volunteer Mentor @artscaping, Jan 14 10:00pm

Today, more folks are committing to TKR. Why?

  • More of us are more active than those who have proceeded us.
  • More of us are in the 50- 65 age group that begins to encounter wear and tear issues and then discovers a surgical option that promises they can run marathons, play pickleball, rollerblade, and dance the night away or at least that is what many of us think.

I read about members encountering some pretty severe TKR rehabilitation issues, e.g. pain, scar tissue, pinched nerves, revisions and then more scar tissue, tight bands, numbness, and even neuropathy.

People talk about post-operative options….from Epsom salt baths to ice machines, physical therapies, and for scar tissue, Myofascial Release Therapy.

Along the surgery and rehab path, we encounter decision points. The answers come from shared decision making with medical providers and clinicians, family and caregivers, and of course, your surgeon.

How do you prepare your body for TKR so that it is ready for rehab exercises and treatments? That’s easy…..be in the best shape you can be and don’t put it off so long that your leg becomes unsupportive.

How do you manage post-surgery pain and care for the best outcome? What is recommended and what works? How long? What if it is too painful? How can I get my ROM to be better NOW?

It is essential to make sure that we understand the treatment for scar mobilization to keep the scar and tissue moving. Failure to do that means the scar will reach to surrounding tissue and grow bigger and bigger, causing decreased ROM and increased pain.

And what is the most important decision you will make?

When I was ready to leave the hospital, my surgeon sat down with me and said, “Chris you have a decision to make. You must decide whether you want your new knee to last 5 years or the rest of your life?”

I chose the rest of my life and then I learned about returning to my normal activities as slowly as possible, e.g. at least one year to be totally safe. He also told me that he would communicate with the physical therapist and approach exercise gently. As far as getting ready for a mountain hike, he simply said…..“you can go up…..just don’t come down….too hard on your knee”. Guess that says it all. Choose your answer carefully.

What did you do to have the best recovery possible? What tips would you share with others?

@artscaping I exercised a lot to prepare for my second TKR. It got delayed for a couple of years due to other medical issues so I had plenty of time to get in better shape, and to lose some weight. After surgery I just followed instructions. My doctor also insists on gentle PT. I don’t think I exercised quite enough though because my flex is actually reversed after I lost my in-home physical therapist.

I think the most important thing to do if you are planning to have a TKR is to find the best possible surgeon you can find who uses the most successful methods available. Things have evolved a lot in the last few years.
JK

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I am about 9 months post op right TKR. I think what helped me was faithfully doing the rehab exercises as explained to me by the physical therapist at the hospital. I stressed the knee getting into the front seat of our car when leaving the hospital and that made the first few days difficult. Early on I think regular walking in our driveway helped me the most – got me outside and gave me the incentive to do the rehab exercise daily. The one tip that would have helped me had I listened and understood was ice and elevate. I did ice and elevate but not enough according to my surgeon on our followup visit. After the visit I got more serious about icing the leg and knee and keeping it elevated as much as possible during the day.

Since the second or third week post op, I started using a recumbent exercise bike for 20 to 30 minutes daily (not cardio just for flexing the knee) and it helped strengthen the knee and leg. I'm now mostly using an elliptical for 30 to 60 minutes a day (15 to 20 minutes at a time during the day). I think the weight bearing is better for me than the bike now but occasionally still use the recumbent exercise bike. I still have problems going up and down the stairs and about 80% of the time it's one step at a time unless my energy level is up and I'm feeling really good.

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I am 90 years old.I have TKR on each knee. It was the best decision I have made, As a physical Therapist, a bone on bone replacement is a no brainer.I had a new (then) procedure. When they cut the knee open, they took the serous exudate(juices) and put it in a centrafude. They took the bone pieces out and put in the replacement. When closing, they poured the treated exudates back into the wound. The net effect is my incisions have a much more narrow scar and healed. faster. I do not want to mislead you. It is the most painful of surgerys for the first 1-3 days. But gentle, gentle, gentle assistive movement with the physical therapist and immediate ambulation will regain enough mobility and range of motion for pain pills to keep you comfortable. A Home health PT will follow up. Then you go to an out patient for follow up. When the medicare maximum is used, you continue on your own home program. The reason why going up or down a hill is important is this. When you go up the knee is fixed by your wieght. When you come down, the forces favor the femur moving forward on the tibia. If you do not have the ligament that goes from the anterior femur to the posterior tibia, the joint slides forward. Most knees are able to save the cruciate liagment. My wife had a sloppy surgery and no cruciate ligament. She could nevet go down a hill. !0 years later, my right total knee was done with out a cruciate and it is just as stable as the left. My advice: Get a specialist who does total knees every day. Do not get a surgeon who does them periodically. The reason is not ability but the fact more equipment and access to cadaviar tissue is avialble with those seeing more servere cases. Your main concern should be your ability to have surgery and your educated knowledge on how that surgeon is going to cut and replace below, above and below, cadavia ligaments and the state of the ligaments on the side of the knee. Replacements are rocket science more than when I had mine, so good luck. Remember, only a guy who does them all day.

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Very helpful to read this. I have not been able to walk downhills safely for many years, and since my TKR cannot do that at all. I made a lot of mistakes with choosing surgeon, although I live in Alberta and was given no choice of who I saw. I did not ask questions as I felt very intimidated by doctor who spoke mainly to my husband who was with me in appt. For my second knee, I am going to research surgeon and will pay privately to get the right one. I will ensure I also get adequate physio and after care, as I had none with first knee. Thanks for the tips

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@glasgow46

Very helpful to read this. I have not been able to walk downhills safely for many years, and since my TKR cannot do that at all. I made a lot of mistakes with choosing surgeon, although I live in Alberta and was given no choice of who I saw. I did not ask questions as I felt very intimidated by doctor who spoke mainly to my husband who was with me in appt. For my second knee, I am going to research surgeon and will pay privately to get the right one. I will ensure I also get adequate physio and after care, as I had none with first knee. Thanks for the tips

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$20,000 is a lot to pay if you have medicare and suppliment it cost O.

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Chris: You brought up all the important points in connection with TKR surgery and recovery. I was in excellent shape before surgery, did some weeks of specific pre-hab exercises, had an experienced surgeon, and an outstanding physical therapist. On my part I did all the post-surgery rehab exercises, added some of my own, went for short outdoor walks 7 days after surgery, and started water exercises and swimming at 5 weeks. Yes, there were times of setbacks, and pain, and frustration, but just today I was amazed how far I have come at 16 months. Currently I’m in a ski resort (walking, not skiing), but by its very nature the village is on the side of a mountain. To get down to shopping, or to catch a bus, I have to navigate about 1/3 mile fairly steeply downhill on a narrow public road. It is taxing, to say the least, but it is eminently doable. Of course this is a necessary exception, as a general rule I stay away from anything but gentle inclines, but I was pleasantly surprised how stable the TKR knee feels. Guess I’m both lucky, plus being rewarded for good post-surgery work.

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Good for you. Good recovery reflects on your tenacity. aqnd a good surgeon.

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I had my TKR in 2016. The one thing that is most important its to keep that knee moving, strengthening, and stretching the muscles and tissues around it. I work out. If I miss a couple of days the knee will feel like mashed potatoes are surrounding it. As soon as I walk, work out and stretch it feels normal again. DO NOT sit around. You must move or the knee will tighten up.

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@lecoeur13

I had my TKR in 2016. The one thing that is most important its to keep that knee moving, strengthening, and stretching the muscles and tissues around it. I work out. If I miss a couple of days the knee will feel like mashed potatoes are surrounding it. As soon as I walk, work out and stretch it feels normal again. DO NOT sit around. You must move or the knee will tighten up.

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Good advice.

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