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Total Knee Replacement

post #1 of 11
Thread Starter 
After many years of pain in my right knee I finally succumbed to a total knee replacement three weeks ago, Nov 17.  I am 23-days post-op, as they say.

My recovery has not gone as planned.  On the day I came home from the hospital (four days in) I was trying to get comfortable at night and heard a loud POP come from the knee.  It turns out that my MCL tore as a result of the abuse it took during the surgery.  So, now I am recovering pretty well from the TKR but am also dealing with the MCL and wearing an "unloader" brace full time.

The good news is that I am now walking pretty well with one crutch and putting full weight on the knee.  I've been on my road bike which is on a wind trainer and can pedal all the way around now.  The doc says that's the best thing I can do to strengthen the leg.  Fifteen minutes a day for now with no resistance.  I'm also walking slowly on a treadmill.  A week ago I wanted to commit suicide because I was in such pain and had such limited range of motion.  The brace did the trick.  The MCL was very painful because it was holding my knee in the wrong position and with the unloader brace it's now positioned correctly so it can heal and I can walk.  My mood is much better now.

After six weeks the doc will make an assessment as to whether I have to have surgery to repair the MCL.  I'm not too keen on it and am hoping it heals itself.

Going in, I had small hopes of being out cruising the blues by mid March, but I've put that on hold.  I'm reluctantly saying good bye to the 09/10 season and plan to come back with a vengeance next year.

I'm curious if anyone else has experience with TKR.  My doc is an avid skier and knows that I've been a pro for many years.  He tells me that "anything but the big bumps" will be in my future.  But, I'm wondering about powder and crud and would like to hear from others who have been through this.

Any encouraging words would be appreciated as I am living vicariously through all the Epic Ski members and their posts.

Ski fast and laugh often,

post #2 of 11

I have had both knees replaced; one in '07 and the other 1/09. The MCL aside, my advice is to sit this season out. My PT told me it takes about 9 months for the bone to heel completely. So I resisted skiing the very end of the 08/09 season. I started this season with a bang! New boots and new footbeds. What a difference in my skiing! I even took a private with one of the top RMD women Masters racers. She couldn't believe the difference in my skiing. Now I can ski ice without skidding, something I was never able to do before.

I used cycling as a rehab for both knees. I was riding up to 2 hours a day, five days a week. I started a number of different interval excersizes after about 10 weeks ost surgery. Intervals like tempo, steady state and muscle tension to name a few.

Remember, the key to success is to have patience and don't push your rehab.

Rick H
post #3 of 11
My wife recently had a TKR at age 47,  and is about 4 mos. post-op.  She still walks with a limp,  but is making progress.  She is still doing PT once per week,  uses special splints to help regain flex and extension,  but is back to doing most things at the gym (e.g., riding stationary bike,  eliptical trainer,  weights,  etc.)

I'm hopeful that by spring,  she'll be ready to hike,  bike,  and otherwise be relatively normally active.

That said,  she will never ski again.  Because her knee is now a mechanical device that is slowly wearing out,  rather than being living tissue capable of healing and regeneration,  she and her surgeon do not believe it wise to engage in activities that cause excessive wear/tear or put her at risk of mechanical damage.  Hence,  her activities will be limited to low impact excercise,  and she will avoid activities with significant risk of accidental injury - skiing definitely fits that category.

I know many people do resume such activites with their mechanical joint(s),  but from what we've learned,  they are taking more risk than seems prudent.

I'm sorry to be discouraging,  but I would urge you to be very careful in making such a decision regarding your future health and mobility.  I wish you the best of luck in your rehab.  A TKR is one of the most arduous rehabs of all joint replacements,  but most people eventually reach the point of deciding it was "worth it".  My wife hasn't yet reached that point,  but is still making progress.

Best regards,

post #4 of 11

I have to disagree with you on all  your points. I have 2 TKR and a THR. The hip was done 12 years ago and has about 800 ski days on it. It shows no sign of failure. The post-op rehab was quite a piece of cake. The most difficult was streching the new knee so that I got 120 degrees flexion, so that I could ride my bike. That was the same with both knees. Once I got on the bike, I was able to enhance the recovery to get my conditioning back.

Running or jumping are out of the question as is skiing big bumps. As for the other issues, they are personal choices. If your wife wants to eliminate skiing, that is her choice. It certainly is not mine,nor my wife's (2 TKR 3 years ago) As for wear, our devices are blue and chrome colbalt. the sliding surfaces are a form of teflon. The wear is minimal.
post #5 of 11
Thread Starter 
Thanks, guys...

From my discussions with other avid skiers they tend to agree with RickH.  Over the past ten days I've been able to ride my bike on an indoor stationary trainer and am up to 20-minutes/day and then I do another 20-minutes at a 2 mph walk on the treadmill concentrating on heel first motion.

I saw the doctor today and he said that my progress post-TKR is way ahead of schedule, but the MCL doesn't seem to be responding.  He thinks another month will show dramatic improvement in the MCL and gives the probability of surgery at 25% which sound good to me.

Regarding wear and tear, the way the doctor explained it to me is that it's like getting your brakes changed.  The TKR is like getting pads and rotors and that somewhere between ten and fifteen years, depending on how active you are, you'll need the pads replaced.  That's relatively minor surgery compared to the TKR.  

Skiing it too much in my soul to ever give it up, even if it means cruising smooth blues and blacks the rest of my life in packed powder.

Thanks again for your comments,

Best regards,

post #6 of 11

You can spend the rest of your life improving you technique. Or try some different adaptations on what you do now. Whatever, it's fun and it is skiing. I spent the month of November (4 ski days) at Loveland, watching race teams train and applying their skiing to my own. I found it to be fun and informative. My trenches are nowhere near as deep! Someday, I hope.

One thing that has come out of all thisis, I can now hold an edge on ice. Something that I couldn't do prior to the last TKR.

post #7 of 11
Thread Starter 
Five days later... update.  Four weeks and five days post-op.

My progress has been amazing over the past few days.  I'm now up to an hour on my bike on the wind trainer and am doing 30-minutes on the treadmill at 3mph now.  Muscle tone is beginning to come back but the quad is a sorry version of what it was five weeks ago.  I'm now entering a new phase of my physical therapy.  Whereas, the first month was dedicated to range of motion, the next six weeks are dedicated to strengthening and I'll be going to a PT outfit within a Gold's Gym.  I'm looking forward to it.

Next week I am heading back to my place by Waterville Valley and am looking forward to hanging out in the locker room and base lodge with all my buddies.

Rick, I see you are from Craig. I am a former instructor in Steamboat way back in the 70s.  I still have lots of friends there.
post #8 of 11
VW skier, 
You have been quiet.  I am new to epicski and have been having my own challenges.  I had TKR 9 weeks ago and had a set back about 4 weeks out, my ROM got stuck at 90% and was pretty locked up.   Surgeon pushed me to do manipulation (basically they put you out and bend knee/tear scare tissue) to get ROM/Flexion going (apparently 5% or so of  TKR require manipulation)

The manipulation caused a significant set back  in progress and I experienced a lot of bruising in my quad and significant strain to the adductor and tendons.  I have pursued PT vigorously since then (about 10 days or so ago) under incredible pain levels 8+.   I am making progress, but very, very slow.  I can get to 90-94% flexion on my own now (lot of work though) and PT can get me to 105% with some pain.

My quadriceps is still very tight and seems to have some very tight knots in it, making it harder for ROM

I was able to cycle backwards a few days after the manipulation and then could not, then PT pushed me through it and I literally cried in pain.  Last week I was able to do a few rotations on my own, but with a lot of pain.  Today I could not do any  and I am a little worried that I am going backwards.   Or it may be my fear or anxiety of hurting myself/having pain.

PT also recommended dyna-splint (like you have, but Othro said he did not believe in them)

Finally, I have been on narcotics 9 weeks now and am worried about long term effects and how I am going to get off of them.

I had envisioned skiing again in March and rode 30 miles on my bike3 3 days before TKR.  I am 52 years old and was very active prior and an avid skier

Was TKR a mistake.  Will I get better.
post #9 of 11

I got stalled in my ROM. My PT had me doing flexion stretches 10 minutes every hour. That really helped. I used a nylon strap around my ankle and pulled until I got to 4-5 pain level. You will notice that as you do this, your ROM will increase slightly each time. As the tendons and muscles stretch, it will feel like slack in the stretch. That is when to add a little more pull.

Skiing again in March is pushing by about 6 months. I was told by my PT to wait at least 9 months after surgery, to allow for the bone to completely heal. I did and I am making up for a lost season. My balance and strength has never been better.

Rick H
post #10 of 11
Rick H

Thank you for responding fellow new-englander.  Doesn't seem to be too much action re TKR on this site.  AM  I posting correctly?

I am a bit better now.  Did some aqua-therapy on my own.  Really helped.

Upped my meds for PT and have now had 2 days in which i made 15 backwards stationary cycle rotations (huge for me!; could only do a few last week and incredibly painful)

PT believes he got me to 100 on table today.

I will ask him about your proposed idea and hopefully try it out.

March is probably too early to ski, just a vision maybe.   Perhaps bike in April?

Pleased you are doing better.  

thank you and happy new year

Edited by stoneforeside - 12/31/09 at 6:18pm
post #11 of 11
I would guess that you will be ready to bike as soon as you can comfortably do 20 minutes on the stationary bike...forward.

Rick H
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