Total Knee Replacement

[Bull City]

I think I am going to need a total knee replacement. I would really like to hear from any one who has had one and learn what your experience was. I'm going to see the doc in a month.

Thanks.

[dieselrower1k]

I had a Total Knee Replacement in 2009, and it has only helped my athletic endevors (Weights, slalom water skiing, and rowing). The absolute key is killin' it in rehab.

[Bull City]

Thanks, Diesel. What can you tell me about the week after surgery?

[dieselrower1k]

The first two weeks are hell, but then it gets progressively better. If you can get past the first two weeks, it is all downhill from there. The first week you will still have drains in, you will be on Coumadin (blood thinners), anitbiotics, and PAIN KILLERS You have to take them as prescribed to stay ahead of the pain. DO NOT MACHO IT OUT!!! You can not beat this pain with guts alone. You will get constipated. Half prune juice and Phillips milk of mag helps After about a year, you forget you ever had knee problems. You will need to ice the knee at least 20' x 3 every day. More is better. As I said, you really have to approach rehab as if you are competing with it . It is painful and frustrating at first, but after 6 weeks or so, you will almost feel normal. I would guess you could be back in the boat in 10-12 weeks. Beware: your knee will swell after exercise for about 8-10 months. This is normal. ICE ICE BABY!
I really struggled with whether to pull the trigger, or continue to suffer (will I make it worse?) as I was only 50 at the time. Bone on bone and LOTS of bone spurs, and very limited ROM. Now at 56, I can do things I couldn't in my mid 30's (knee was bone on bone from 30 on).
As far as how it effects your rowing, I don't know. I've only rowed with it, having picked up the sport post replacement. I don't think I could have rowed before. I am able to get shins vertical now, I know I could not have before. It seemed like such a big, irreversible decision before, and now it seems like a no-brainer.

Good luck, feel free to PM me with any or all questions.

[AndyLynch]

Keep in mind, post-operative knee replacement range of motion is almost never equal to normal, non-operated upon knees. The single best predictor of post-operative range of motion is pre-operative range of motion. If you are getting your knee replaced because of pain, but your range of motion into flexion (bending the knee) is currently good enough to take a full compression stroke, you may reach equal range of motion post-knee replacement. But if your range of motion currently would prevent you from reaching full compression, don't go into surgery under the impression that your postoperative range of motion will be any better than it currently is.

[Sarge]

Had one. Had to. Diesel had very good points. But you can cut out prune juice and such by just taking a stool softener. Colease. Pain killers will hammer your system (and you will need them) and you should be on the softeners right up through when you stop taking the pain killers. The pain is very real.

Rowing is a great exercise for your knee. I have more range of motion than I did immediately pre-op, but only because I busted my butt and continue to work on it (4 years post op). Couple of quick points: right before you go in to have it done, throw out ALL of your shoes. The day before, get new running or cross-trainers. Then get new shoes once you are walking and such. Ice all the time. Get one of those circulating ice water machines...they are wonderful. Depending upon the leg, I would plan on not being able to drive for about a month.

Getting into the 1x the first time was a bit of a leap of faith. But I am very thankful I had it done. Good luck.

[Bull City]

Thanks, all. I'm 66. My knee problems began at age 39 when I tore my ACL plating soccer, which I began playing at age 13. I had a reconstruction, and after six months was able to continue playing. I have played 2-3 times a week ever since (with an older group) until a few weeks ago, when the pain just became too much.

My range of motion in the affected knee is so-so. I'm not expecting miracles in that department.

My main worry is the post-op pain and all the ghastly things associated with surgery. The ACL reconstruction was pretty bad for about 2 weeks.

Sarge, what's the deal with throwing out the shoes?

[dieselrower1k]

I think you may end up with improved, painless ROM, because the ostoarthitis is removed and replaced with a stable/strong knee. They will probably take a few bone spurs out as well which will contribute to a more normal functioning knee.
It will take some time to get where you want to be but you WILL. It will be one step forward and two steps back at first. Get your head right and attack this like you are training for an upcoming season.
Best wishes!

[loblaw]

I do about 75 knee replacements a year as a part of my practice. Everyone does differently but generally speaking, it's not much fun, especially the first couple of days after surgery. There's no sugar coating it, you can expect a lot of pain requiring narcotics to control despite nerve blocks and multiple treatment options for pain around the surgery. The nurses will stay on top of it as long as you don't try to go 'hero' and hold off and some people have surprisingly little pain so it's not like there is no hope but it's impossible to predict really. When it's bad, it's brutal.

So, uh, sorry, but best to be prepared for the worst! Usually starts to feel not bad after a couple of weeks though. Really work hard at the therapy too, although you don't gain much by pushing it to extremes in the first few days.

As for rowing, the implants aren't really designed to flex much more than about 125 degrees at the most (and a lot of people are around 100-120) so you can't get great compression but most people who get them can't do that anyway so it's at least an improvement and it's certainly good therapy.

Good luck!

[Bull City]

Loblaw,

Thanks for the info. I am definitely not a tough guy or hero. I remember the pain after my ACL reconstruction, and importance of staying ahead of it.

I had some scar tissue build up after the ACL reconstruction. Do you see that with knee replacements?

Thanks,

BC

[loblaw]

We do a lot of knee replacements on people who had ACLs done. Even though there is a reconstruction, the subtle change in the biomechanics must put abnormal wear through the joint so that it often degrades faster. Not every one of course but it's certainly a risk factor; the actual relative risk is probably quantified in the literature. I don't think it's known if having scar around the ACL reconstruction puts you at higher risk for a stiff total knee. We do them all the same, and some people just get a lot of stiffness and scaring around the artificial joint while others do fine. Regardless, you definitely have to work hard at the rehab to get the best outcome although some people really over-do it in the first week and cause problems. I had one guy fall off his bicycle a week after surgery and split the whole thing open! We had to wash it all out but it got infected later and then he had to have the whole thing re-done. It was a disaster.

Anyway, good lock, happy to answer any general questions, probably should talk to the person doing it/did it if you have anything specific related to your own case. A lot of people find those cold water circulating "cryotherapy" units really helpful for pain. You can usually rent them for not too much or buy them for about $250.

[Sarge]

Thanks, all. I'm 66. My knee problems began at age 39 when I tore my ACL plating soccer, which I began playing at age 13. I had a reconstruction, and after six months was able to continue playing. I have played 2-3 times a week ever since (with an older group) until a few weeks ago, when the pain just became too much.

My range of motion in the affected knee is so-so. I'm not expecting miracles in that department.

My main worry is the post-op pain and all the ghastly things associated with surgery. The ACL reconstruction was pretty bad for about 2 weeks.

Sarge, what's the deal with throwing out the shoes?

I lost all of the cartilage on the inside of the joint and had a pretty nasty bow leg. All of my shoes were wrecked. Now, the wear is even across the heel. I tried a slightly worn pair a while after the repalcement and after about 5 minutes pitched them too.

[Bull City]

I saw the surgeon a couple of days ago and was impressed with him and the operation (Duke Hospital, where I had my ACL recon). They are going to give me a series of hyaluronic injections to see if it relieves symptoms and schedule me for the replacement in early July.

This surgeon does an ACL-sparing implant which I would like but has not done one on a reconstructed ACL knee. His concern is the condition of the ACL graft. Mine dates from 1988 and seems to be doin fine. Any thoughts on this?

[Bull City]

Also... I would like to continue playing old man soccer. We play twice a week and I don't think I run more than 500 yards. There's no slide tackling or rough stuff. He said that while he couldn't officially say yes, go for it, he said it didn't sound unreasonable. What I forgot to ask was how would old man soccer be with a new knee but no ACL. Any thoughts on this?

I plan to drop him a note with these questions.

[Bull City]

I just got scheduled for July 6th for a total knee replacement. I'm starting a series of hyaluronic acid injections which may provide some pain relief. It's a viscous substance that acts as a lubricant; it won't grow new cartilage.

I've got some worries about the surgery, mainly infection, but I really need to get it done. Winter would have been a good time to have it done, but summer is OK too. It's too hot and humid to row.

I'd be interested to hear more from folks who have had or are contemplating this.