*Disclaimer – I’m not a doctor and this is not medical advice. It’s my experience and my decision making so your experience and decisions may and perhaps should be different. Listen to your doctors and family and faith. If you are addicted or fear being addicted to opiate pain medications – talk to someone about alternatives.*
I get a lot of questions about – and have been asked to describe my experience for other “young people” considering total knee replacement, so I’ve decided to download everything I can from the last 4 months of my own personal experience with having a total knee replacement at age 44.
Keep in mind the order of the items below may not be chronological…it’s how they spilled out during my first go ’round so I’ll come back and edit if anyone finds this article valuable. You may be far worse off than I was going into your decision for replacement. The doctor said, “I’ve seen people with your knee in a wheelchair and unable to walk – and I’ve seen guys play pro football for 8 years with it.” (Encouraging right…why not say “You big baby” at the end of that.) I’m kidding because my doctors have been amazing.
After trying all else and suffering chronic debilitating pain affecting my quality of life (and as importantly my wife and family’s quality of life), I decided it was time. I was not eligible for a partial knee replacement for various arthritic reasons. Along with the pain, I had range of motion restrictions which ultimately caused an obvious limp since my left leg was always bent 10% and wouldn’t straighten (and thus shorter) – and I could only bend it back 108 degrees (flexion angle). My left leg muscles were atrophying rapidly and the whole wicked system fed on itself. My doctor chose the “cementless” option where your bone grows into the new parts vs. being glued on. Recovery is longer and (maybe) longevity is better. I think people’s use/abuse of their replacement knees skew the longevity data too much to prove either is better. Your call.
The backstory isn’t that interesting on how I got here…let’s just say from age 12 until my replacement I had some kind of pain or discomfort. It started with Osteochondritis dissecans (os-tee-o-kon-DRY-tis DIS-uh-kanz) and that developed over time into osteoarthritis. The last 5 years were pretty bad. The last 2 years were really bad. The last 2 months were downright ugly (all pre-surgery). I had tried everything in “traditional” and some “homeopathic” medicine so no need to explain the benefits of the “____ root” and how it would have saved me.
Here’s the rundown and keep in mind, I’m not a doctor, listen to yours, and this stuff worked for me. You may be way better or have a completely different (or worse) experience. I’ve known people who’ve suffered for 6 months and it took the 1 year mark to feel “100%” or better than before. If you go that route and have a tough time – just talk about it or ask for help. If you’re like me – the pain I had previous to the surgery – was MORE than the pain post surgery and on meds. More on meds below.
- I went to work (desk job) 7 days after surgery (I worked at home for a few days, then went back into the office week 2). Not ideal. I’m not sure you want to sit and watch Netflix for 4-8 weeks. If you have the kind of job that you can take that much time off – excellent. If you get loopy on pain meds and can’t function well – stay home. Don’t drive. Get a ride, etc. I got a ride for a while then just only took meds during the earlier portion of the day and allowed enough time to wear off before driving home. Your doctor will probably tell you not to do this so don’t bring a printout of this and advocate for it. Also, your company or type of job may simply prohibit you from taking any kind of pain pills while at work. Follow your rules. Don’t get fired.
- I did what the doctor said to do post surgery:
- If you’re not sitting on the couch with it elevated and using the cooling machine (apparently ice packs are no more, shed in favor of cool “sleeves” that wrap around your appendage and flow a cooling solution through tubes using a machine that is semi-loud).
- Or using the stretching PT machine they give you…take your meds and be up walking around.
- I had my surgery on an outpatient basis which is apparently not that normal yet here in Iowa. It’s probably not as common if you’re older or have other possible complications either. For me it was awesome. So I was in at 6a and home by 3p. I had to do some PT with the guys upstairs to prove I could walk with crutches and put weight on it, etc.
- I used the crutches for a few days and started to get more confident and started using one only very quickly. My wife yelled at me and so did my PT guy so I did 2 crutches for about 2 weeks after that 🙂 One was fine for the next couple weeks when I was going out and about. After a month – I didn’t use them again.
- My PT guy kept reminding me that the inside of the knee would not be healed for many many more weeks. So, while you may feel pretty good on the meds and are getting confidence back with stability, go find a Youtube video of a total replacement surgery (or in my case the cementless “press fit” version). That will remind you that the doctor is really a carpenter with the coolest tools. It’s a big deal and there are bone saws and jigs and mallets involved.
- You’ll notice the fatigue factor is way more than expected. If you could walk 1-2 miles (in pain) before the surgery…you’ll tire way quickly afterwards. I was doing a mile by week 2 (remember – fully medicated and carrying a crutch in case I needed it) – but was pretty well spent after that and needed to sit. Sitting is what your brain wants. Movement is what your knee needs (unless of course the doctor tells you otherwise).
- After about 10 days all the “good meds” all stacked up together were done and I was only on one of them called Norco – 7.5mg/325. Two of those every 4 hours meant I could walk around with my crutches and not be in a ton of pain. There will be some pain but not unbearable.
- Swelling is pretty crazy at first. It also lasts for quite some time. I’m not back to “normal” yet 4.5 months in but very close except for right around the kneecap area.
- Your foot and ankle may bruise and turn black all over (in different places and phases) during the first couple weeks too. My ankle and calf would swell if I sat up in a chair for any length of time leaving awesomely deep “sock band” lines on your leg. Somewhere around month 2 that just stopped happening randomly.
- The epidural was so weird because it took until 3PM on surgery day before I could feel anything “from about the male parts down”…which included involuntarily relieving myself – all over – myself – in the surgery center and such for hours. It was actually kind of joke and we were all laughing a ton about this unfortunate side effect. “Get up out of bed…whoopsie.” The nurses were so great about it. This doesn’t happen to everyone I guess but it did to me. When you can’t really feel your bladder -but you know it’s full- and you can’t control it or your organs – well – they kind of do as they please. Again, I had an epidural with a sleepy type shot (like you’re having a scope) not general anesthesia so theoretically less risk, faster waking up to get home more quickly, etc.
- Walking into the operating room made me feel a bit like I was Fox Mulder on an X-Files case. There were people dressed in what appeared to be bio-hazard suits and others (I think the medical reps are fully dressed out to ensure no contamination of parts, etc.) I’d guess at least 10 people were milling about. I started to throw some jokes around that went over like an oxygen cylinder balloon. Next thing I knew after the shot and being laid down on the gurney – I was in recovery and feeling no pain.
- I had lost 30 pounds and was exercising through the pain and suffering for about a year before my surgery. Be in shape. THIS PART matters. If you’re a 150 pound male and 5’10” then perhaps you’re good. I was 260lbs. and got down to 230lbs. 210 would have been even better. Be strong going in – or as strong as possible.
- Do the Physical Therapy (PT). No matter how good you feel – do it. It hurts and you might cry. If you don’t you’ll cry more for a longer duration.
- My left leg had atrophied quite a lot. Quad and calf muscles were much smaller on that leg because I couldn’t bend my knee much and couldn’t straighten it all the way for years. I had 108 degrees flexion walking in. Now I can almost get 130 without trying hard after warming up. I can fully straighten too. If you have any of that going on – it will take months possibly before those leg muscles start to grow again noticeably. That has bothered me the most…but that’s why they tell you “At 6 months you’ll feel pretty normal but it will take up to a year before you’re really done done done.” The muscles are growing now because I can push harder and do more squatting and have my balance back. I still do mostly body weight exercise and use dumbbells and those “heavy bars” vs. any kind of heavy stuff in the “lifting zone.” I’m past that. I’m in this to be healthy and active and lose fat to be around for my family not set records and get huge. Isn’t it amazing how “staying healthy” can take over as a realistic goal vs. being injured or achieving some kind of other aggressive physical goal? More power to you if you’re still killing it in that area. It wasn’t in the deck for me.
- Sleeping can be a real pain especially in the beginning. I used ambien to knock me out. Ask your doctor about using it with the pain meds. He’ll explain why you can or can’t take certain meds together without hurting oneself. It took me at least 2 months maybe more before I didn’t wake up (even with the ambien) and try to find a comfy position and fall back to sleep. You’ll probably want a pillow between your legs. I just stopped that at about month three. Oddly, when my knees lay together while on my side they seem to “heat up” very quickly and it feels uncomfortable. That’s going away now. Sleep was possibly the worst part of my ordeal because I don’t sleep well anyway. Without the meds – I’d toss and turn all night and wouldn’t sleep an hour. It’s like all the day’s pain says a “howdy do” when you relax and lay flat and you have nothing to concentrate on but the knee.
- I used the pain meds like the doctor said I should (Norco/Hydrocodone). I took 6 doses of 2 pills daily so every 4 hours) for 2 months post surgery. The 3rd month they knocked the strength down to 5/325 mg (down from 7.5/325 each). Starting month 3 – they switched me to Tramadol (non-opiate) in an effort to help your pain while reducing chances of getting addicted to pain pills. That was the last prescription I had. I used the pain meds for all they were worth so I could do way more without the discomfort. Those pills don’t mess with my system like they do some people (constipation) so I could take them and was fine. I felt no “withdrawal” symptoms, etc. as I moved down the ladder of pill strength. As the strength of the meds decreased, I had to learn to deal with a little more discomfort – but that level dropped in concert with my pain level closely enough.
- How quickly you can “bend” is a function in my opinion of how much you use the PT machine they’ll give you – and how much you walk. I was at 100 degrees within a couple weeks. I did that machine 1-2 hours a day at first. Again – movement may hurt or be uncomfortable – but it’s a faster recovery.
- Use the cooling machine they give you as much as possible. Elevation above the heart blah blah. They tell you all of that.
- I wanted to do have the operation in the winter – so I didn’t miss any good weather here in Iowa. My wife convinced me to do it in August (mostly because I was in so much pain that I was angry all the time 🙂 but in the end – I was really happy to not have combined cold/ice/snow and freshly cut knee (risk of falling, tweaking, slipping, etc) I might have had a totally different experience if it was zero degrees out. Instead – we had a gorgeous (and hot) fall so I could be outside until mid December really moving around.