37 year old scheduled TKR in May

[daisey]

Hi All,
     I am 37 yo female and have recently scheduled TKR for Lt knee in May.  I am starting to get nervous about the surgery, but ortho feels this is best option due to my demanding job as paramedic.  This was a hard decision to make...but after it takes days to recover from a busy shift and not wanting to go out for the essentials due to the pain I feel I have made the right decision.  There is not a day that goes by that I do not experience pain and sleeping is out of the question. I have questions about using a femoral or spinal block during surgery -vs- general anesthsia.  What is the best option?  What is the true recovery time?  I am aware that my recover time will be longer than normal due to the demands of my job.  My surgeons only concern is that I will have higher expectations of the TKR than older patients and that I will out live the replacment.  Anyone who has had a TKR before the recommended age please share your experiences. 

[suntan toes]

Daisey,
My suggestion is to read the postings by the others in this forum. The time investment is worth it and take notes on the suggestions.  I have learned so much from this board because everyone has walked the walk.   Most of us are young TKR patients.  As you read through the threads you will realize that all recoveries are different no matter your history.  I am a 45 year old 37 days post op and feel amazing for 5 weeks out.  I had very high expectations for recovery but also had very realistic goals to just be able to do certain things I was unable to do....quality of life.  We are all here to support you and understand the pre-op nerves.  Check out Bombero, she's a young paramedic or firefighter.   READ READ READ!
Eileen

[teachmath912]

Daisey;
I am a 36 year old who is preparing for my 2nd tkr.  I had a left tkr last summer (at 35) and will have my right knee replaced this summer.  I am a teacher so summer is perfect since I have almost 9 weeks off!  Last summer I returned to coaching Varsity soccer just 7 weeks after my knee replacement.  I sat down a little at practice, but was basically on my feet for two 2-hour sessions each day.  The week after that I started school and taught all day before going to a 2-hour practice in the afternoon.  I got tired and my knee would feel a little stiff at times, but I was able to do almost everything I needed to do.  Granted, my job is not as physical as a paramedic, but coaching can be a pretty demanding position sometimes. 
As far as age- my Dr. has informed me that age is just a number and when someone's knee demands a replacement, then it is time to give it a replacement.  You can't spend time worrying about what could happen a few years down the line, you need to just go along with things.
Everyone's recovery is different.  I know there are people on here who talk about having flex of 130 degrees or higher, but every person is different.  My numbers are going to be different than yours and as long as you can do what you need to do, what does it matter what the numbers are? 
I had a spinal with femoral block  for my replacement last summer (and will have it again this summer).  My dr. does not do general anesthesia- but I had enough "Twilight sleep" to not remember anything before or during the surgery.  I woke up to wiggle my toes in recovery and then slept all the way through checking into my room and the next hour or so.
I was told by my Physical Therapists that I pushed it harder than some of their older patients and I often had to be told to slow down.  I got "grounded" twice... But, at the same time, pushing it was what helped me get to where I am now and what helped me have a great recovery.
I know that it is hard to go through this process at our age.  I know that outside of this board, I do not know anybody my age with a total knee replacement so I have no one to talk to about certain things.  That said, if you have any questions feel free to ask!
Good luck!
~ Kit

[daisey]

Thanks EIleen and Kit for the post.  I am trying to keep the nerves under check...but they get out of hand at times.  I just remember that the post-op pain will go away with time and what I am experiencing today will not with out the TKR.  Today has been a really bad day due to a weather change and all the running I needed to do for the Easter holiday.  I have felt like there was a knife jabbing in my knee all day and know that sleep tonight will almost be impossible. I am trying to use the narcotics only when absolutely necessary because I do not want to build a tolerance to them before surgery.  Did any of you do PT before your TKR? 

Thanks again,
Daisey

[Julie42]

Hi Daisey

Yes I had PT before my op they came to my house and gave me a few excercises to strengthen my knee.

Straight leg raises

Bending the knee in from a sitting postition

A rolled up towel under the knee and then straightening the leg.

Legs straight out and pushing the knee into the floor.

Sitting in a chair with your thigh supported and then straightening you leg.

Sitting on a chair with you leg striaight then bending back as far as possible.

These are some of the same excercises you will be given to do after your op.

Hope this helps all the very best

Julie 

[daisey]

Thanks Julie,
     I had an idea that it would probably be the same exercises I did for my other knee surgeries.  I have been doing those over the past few weeks.  I will probably call my ortho and get some orders to meet with PT prior to surgery.  Thanks for the info.

Daisey

[teachmath912]

I did not have PT before my tkr.  I never even had it for any of my other knee surgeries as I have always been so active and have always done so much on my own that my dr. did not worry too much about me being ready. 
Don't stress about things- and as the date gets closer, think positive things!  I have said before that I think recovery is at least 50% mental and the more positive you are, the better off you are going to be.
~ Kit

[Merry]

I have been in PT for over a year..will be about 18 months when I have my BTKRs in May. I could not imagine going through the surgery (and this is just my opinion and for my body) without it. What it also got me is a marvelous PT who has shared the good, bad and ugly with me (you do that after all of this time) and I feel really prepared (knowledgewise) for this. Without a doubt I will be biting my acrylic nails before the big day.

[daisey]

Kit,
    I agree definitely with it being a lot mental.  I am trying to be very positive!!  I got some exercises from PT to do this month before surgery.

Merry,
    I am already biting my acrylic nails...30 days till surgery and counting.  I have started my exercise for surgery.  I have a great PT, who knows how to push my buttons to get me motivated and where I need to be. 

Thanks for all the post,

Daisey

[JamesJamesJames]

Hi Daisey - I've not been on the site for a while but I am just 33 and I had my left TKR last October so I am now 6 months post op.  Like you I was really worried about what if it went wrong but I have to say its the best thing I ever did.  I've always been really active - first damaged my knee playing rugby.  I swim alot to keep fit as it was the one thing that didn't hurt my knee beforehand and I have continued to do a lot of swimming now - this evening I swam 3.75km with no knee pain at all.  Before the op I couldn't sleep or anything but now its perfect. 

I only had 3 PT sessions after surgery and was walking without a limp after about 4 weeks. 

During surgery I had a general and a ful leg nerve block.  In younger patients I believe the risks of a general are not as high - I'd have whichever you feel most comfortable with.

Good luck,

James

[daisey]

James,
     Thanks for the post,  I have been really nervous about this...but it is a big deal.  It helps my feelings to know people are out there going through the same thing.  Since you are at six months post-op I have a few questions.  My PT said I would be back to work on the ambulance in 12 weeks,  but my doc seems to have a different opinion.  He is talking more like 4-6 months just depending on my recovery since I do heavy lifting, lots of stepping up and squatting.  Could you give me an estimate of when you might have been able to do some of these task?  (I know everyone heals different)  I also have a pool and plan on using it lots this summer while I am unable to work.  I have read that it is really good exercise for the knee.  Any info on the recovery you or anyone else can provide please post, all information is appreciated.

Thanks,

Daisey

[Redwing]

  I also have a pool and plan on using it lots this summer while I am unable to work.  I have read that it is really good exercise for the knee.  Any info on the recovery you or anyone else can provide please post, all information is appreciated.

Thanks,

Daisey

Hi Daisey

I'm a swimmer and have been doing a lot of post op work in the pool.  Before my TKR which was 11 weeks ago I swam up to a mile two or three times per week.  This was practically my only exercise as walking was painful due to OA.  At 6 weeks post op I was able to start swimming again with light kicking and can't yet do breaststroke but it's fabulous to be back in the pool.  I do all the physio exercises I've been taught in the water and find it easy and beneficial, all those squats and lunges, walking sideways and backwards, standing on one leg etc.

Lucky you to have your own pool!   

[JamesJamesJames]

Hi Daisey - I was really nervous about it all too and that is only natural.  As your also young I think you will naturally heel quickly.  I think after 12 weeks you would be able to go back to work but you will probably adapt how you kneel which you probably do now already.  For eaxample when you kneel only kneel on one knee if that makes sense.  I do kneel on both knees when I have to but try to avoid if possible.  After about 8 weeks I swam 2.5km and then went on a 5k walk and I was absolutely fine.  To be honest as your going to have a TKR you must be having a lot of knee pain so I'll think from the moment your back in your room you will find that the pain is less than it was before.

Good Luck,

James

[daisey]

Thanks all for the information and encourgment.  As of today it is less than three weeks till the surgery.  I am trying to continue to work until surgery, but after this week I just might not make it.  It seems that the pain has really increased over the past few days and medication does not touch it.  I am so ready to get on the road to recovery. 

Hoping to have a quite, relaxing weekend of being really nice to the knee, except for the fact that I feel like there are hundreds of things that need to be done before surgery.

Thanks,

Daisey

[Plumb]

Just my two cents..  I would always take a doctors advice over a PT's advice.    The doctor is pretty much on target that  at 6 months you would feel on the better side of your recovery to start working in the field again as a paramedic.  Unless you have a sit down job and your biggest demand is getting up to go to a printer.   I say 8-12 weeks you start feeling human again..   But than again..   It all depends on what the outcome of your surgery is.    There are young folks zooming around and young folks who never regain the same range of motion and struggle for every movement.     I am fairly certain your doctor has told you the worse possible outcome and you weighed all the pro's and cons.   3 weeks to the big day..    It is a hard surgery..  I hope it provides you the pain relief and mobility you are seeking .

[bombero1969]

Ok, had to post real quick. I believe that you will be fine. It is a hard decision to make. This site has helped alot, the people here are wonderful and the information is phenomenal.

Right now I am 2 1/2 weeks into my formal PT out of a total of 5 weeks. I had a scope on the knee to repair a torn meniscus knowing that I have severe OA in there also. The first 3-4 weeks went very well, very little pain. Then boom, a set back. The pain and a major limp returned and I made a dash to the doc. He gave me a shot of cortisone and 5 weeks of Physical Torture, I mean Therapy. He told me then that if I return with any pain that we will proceed with a partial replacement.

So here I sit with ice on the knee, yes it hurts. The past weekend was bad when the weather changed to rain. i am dreading tomorrow since it has been forecasted to rain on Friday. AGHHHHH........ Oh well such is life. All I can do is move on. I know that after the PKR the knee will feel so much better.     

I am a Firefighter / paramedic, so the fear of not being able to return to a job that I love so much has been a factor. But it has subsided quite a bit after doing so much research. Sometimes being in our profession we know too much about medical problems and have made so many runs on those that are not doing so well after their surgeries. But so many more people have very successful operations than those that fail.

Yes we will probably outlive our bionical parts but we can do it with as much fun as we can stand. We can do it with a quality of life much better than hobbling around. Myself I would much rather live live now and be concerned about how fast I can get the scooter hot rodded when I am retired and old. I am sure that there are ways to get those things to be ticked out. LOL! 

So I am going to do it, become a bionical firefighter for life. Live life to the fullest and truck on. It will get me back out doing the things that I want to do.

Here is a link to a very recent study about activity levels and replacements: http://www.sciencedaily.com/releases/2010/03/100312071800.htm

Now I am not saying I will play rugby, football or start training for the Ultimate Fighter. But it does sound good to just be a firefighter and Paramedic. We have all heard of the benefits of strengthening the muscles around the knee, more stability, quicker recovery etc. In my opinion it sounds like the replacements last longer because the people are active, and a secondary benefit of being active is increased muscle strength. More strength more stability. Makes sense to me. What also makes sense is to not go over board with the activity, I mean do I really want to do extreme sports and add that extra risk of blowing it out? Not a bit.

Oh and one more thing. Suntan toes told you to read my post, I appreciate that. But to clarify something, I am male not a she. LOL! Had to set the record straight.

Hope everything works out for you as it has for many many people. You will be back making all of those sick call runs and the few true emergency calls soon. 

[daisey]

Thanks for the encouraging posts.  I have not thought about being in the medical field and knowing way to much and yes seeing the patients who tell you it was the most horrible thing they ever experienced.  I had that particular patient the other day. I guess now I am just anxious especially after this weekend with the rain.  I have been a trooper so far and made all of my shifts, but this weekend I could not kick the pain and had to call off and spend the days in the recliner with the heating pad and of course pain pills (which I hate to take).   Not to mention I have been off of the NSAIDS for a week due to the surgery date getting close. I go for pre-op this week and in 10 days it is surgery day.  I am ready to just get it over and get on the road to recovery.  By no means do I think it will be easy, but I know the surgery pain will eventually go away.   Just curious?? Bombero how long have you been a firefighter/paramedic?  September will be 18 years I have been riding the bus.  That is why my DOC said I have not been nice to my knees and if I want to continue I have to get something done ASAP.

Anxiously waiting,

Daisey

[bombero1969]

Completely understand what you are going through. I have been a firefighter paramedic for a bit over 15 years and I just retired in January from the military reserves as a medic. Many years of being rough on my body has taken its toll. As a kid jumping off of my parents roof, in the military doing the training and jumping off of tanks.  Of course performing duties as a firefighter has probably done its bit of causing pain also.

We rarely make runs on those that are not having any problems at all. In fact I can't remember many except for those that somehow walked away from a MVC, not speaking of the minor fender benders.

Keep up with the positive thoughts, you and the rest of us will one day be able to walk up-right once again.  We will be able to return to or normal lives and do the things that mean the most to us. Well except for jumping off of stuff.

I should have also pointed out that we may know way too much about the medical stuff but we also don't know it all. Another thing is that it is much different when we are the patient the, the one that needs to be taken care of. The longer we have done our jobs the more difficult it is to accept that we are now the one relying on others to patch us up and send us on our way.

Hang in there you will do great, and be back to doing great things for others. It is your time to be taken care of.

[Julie42]

Hi

How are you?

Hope all is welll

Julie 

[bombero1969]

So haven't seen anything new here on your post.

My PKR is scheduled for the 27th of May, only 10 more days.

From what I remember you had posted your surgery was in May and it was towards the end of the month.

Hope that you are doing great.

Bombero

[daisey]

HI ALL,
     Had the TKR on May 6 everything  went well according to surgeon.  I go wednesday for my first follow-up to really see how it went.  I have been in PT since the day of surgery and I am now going three times a week outpatient.  PT has been the worse part of the TKR.  I have had lots of swelling which I consider normal from reading other peoples post which makes the PT worse.  I have gained 102 flexion so far.  I am still using the walker, which PT says I will probably graduate to a cane this week if my OS agrees.  Just curious about how long after surgery did you guys have to take pain medication, especially for PT sessions.(I know each individual is different)  The main problem I am having is sleeping at night.  My OS gave me two different sleeping pills and nothing has worked.  Would be grateful for any sleeping suggestions.  Hope this finds all doing well and sorry it has taken me so long to post.

Daisey

[Redwing]

Hi Daisy, good to have you back!  I think 102 flex is pretty darn good after only three weeks! 

Re the pain meds:  I took a tramadol about an hour before each physio session for about 2 months, I didn't have  NASADS as I have had stomach problems in the past linked to them.  Pain medication for me gradually lessened from pretty much continuous for the first two weeks.  I am 4 months post TKR now and on days that I know I am going to be active I take one tramadol in the morning.  Usually that is all.  If I'm not going to be doing much either I don't take anything or take some paracetemol (I think that is tylenol to you). 

Re the sleeping:  You have joined the "UP at Night Club".  Most of us TKRers have been members.   If you read my "New TKRer........." thread  you can see how I coped and the advice I received.  When you progress to sleeping on your side with a pillow between your knees it gets easier; at least it did for me.

[Julie42]

Hi Dasiy

Wow 102 flex is fantastic .

Sounds like you are doing great. Unfortunately I am still not sleeping to well but it is improving very slowy I think its just something that is part of the course and will take its time .As for pain killers I am like Redwing I take them during the day if I know I am going to do a fair bit but I am cutting down quite a lot. Life is getting better. 

Take care

Julie

[bombero1969]

Glad to hear that everything is going good for you on your course of recovery.

[suntan toes]

dAISEY,
Congrats on your great progress.  I think everyone will agree that the pain meds are different with everyone but the sleepless nights are pretty much guaranteed.   I believe they are prescibed to be used by you when you need them.  As long as you need them, use them. In the beginning my pain came from trying to get ROM back so I took pain pills before PT.  Now I take Advil after because he kicks my butt in PT and it will be just muscle soreness later that day.  After my PT, I ice on top AND underneath knee.   I am 13 weeks and still get swelling after a busy day but I ice nightly.  I have found that the beach and grass are my enemies and I know after a lot of walking on either I will be paying for it later that night so I usually take a pain pill after I get home.  It's amazing that on hard surfaces I have no problem.  I also got "fitted" from a running store for sneakers($100) based on size, arch, stride pattern etc instead of me or a teenage kid deciding on what worked.   With those sneakers, I have no imperfection with my gait vs. sandles and my knee isn't even a thought. You'll figure it all out and it gets better every day especially at 4 and 8 and 12 weeks.  I also second Redwings pillow suggestion.  I have used it b/4 surgery and after.   My best friends are ice machine, pillow and sneakers.  Keep up the great work!
Suntan Toes

[daisey]

Good morning all!!!
Hope this finds you all doing well.  Just wanted to post an update.  Went back to OS last week and he was very please with the progress I had made.  SO this week in PT we are working on getting rid of the walker and progressing to a cane.  I talked with my OS about the tibia pain I keep having, he said it was completely normal and after surgery the blood drains to that area and irritates the bone.  He also told me that this pain would stick around for a while.  He also told me I might have some tibia pain from the implant he used.  He used the stryker - trialathon.  All and all I am doing good...just wish I could sleep at night.  I managed to get 110 flexion last week in PT, I was very pleased, but the knee was not.  According to my OS I get to start 8 more weeks of PT today and will return to see him in late July unless something comes up between now and then. 

Hope you all have a blessed day!
Daisey

[bombero1969]

Glad to hear that you are doing well. Last night was the second night home for me. I decided to sleep in the recliner as it is in a similar position as the bed at the surgery center was. Sleep is something that I wish for also. Can sleep for short little runs at a time all night, then feel like taking naps at night. I do not know what my ROM is but it is sounding as if your doing great. I agree that the ice feels great and so does the PT routine and the CPM that I brought home, well it feels good by working the stiffness out at least. Then it is back to the ice. Your ahead of me so I do not know if my input is of any help. Keep up the good work.

[ramesh]

[This post was deleted by KNEEguru because of spam]

[daisey]

Well,  almost eight weeks post-op.  It all seems to be going well.  Have a follow-up appointment first week of August.  That will be twelve weeks post-op.  Today has not been the best of days.  My grandmother passed away this weekend, so therfore I have spent lots of time standing and walking for the past three days.  I have had a good bout with pain and swelling, however I expected this due to the abuse I have put on the new knee.  The worst part of this is the other knee is giving me fits due to all the extra stress I have been putting on it. 

Here is update on PT.  I am at 124 degrees flexion, I am having real issues with strength.  I can do step-ups pretty good, but step downs are really dishing me grief.  PT said that it is due to lack of strength.  That is a big reality check for me, since I have to be able to do steps before returning to work.  But I have another month to work hard to get this strength back before returning to my doc. 

hope tis finds everyone recovering well.

Daisey

[UK Girl !]

Hi Daisey
Sorry to hear about your loss x
Good to see you are progressing well. Going down steps is always harder than going up, but you will be amazed how much stronger your leg becomes bu just practising it ( without overdoing it!)
You have great flexion! well done.
Eight weeks post op is still early days so don't worry about it too much - I went back to work at 10 weeks, I am on my feet all day and after the first week it was like I had never been off! I did (and still do four years on) make sure that I always elevate my leg when I finally crash in the armchair just to give it a really good rest.

anje x

[bombero1969]

Sorry for your loss.

Keep your head up and continue to work hard with your PT. Since I have already been back to full duty, I have driven the engine for the first 2 shifts, tomorrow I think I will try the box out and see how that goes. The knee does get sore and achy not to mention the stiffness when I keep it in one position too long. The only reservation the doc had on releasing me so soon is that most pt's think that since they are released that they do not have to do PT. Not true, my right leg is still much smaller than my left so therefore much weaker. The size matters to me, I do not want to be walking around with 2 different leg sizes, kinda looks funny in shorts. But with the visual and stamina difference I am definitely working out the leg as often as possible.

Short story, PT PT PT. Simply work out the leg, Pt is the key to recovery, and yes I still use elevation and ice on occasion.

You will be back on the rig in no time.

[daisey]

Yeppie...It is back to duty for me.  I never thought I would be returning to work in 12 weeks.  Only restriction is I have to do 12 hour shifts for the first two months, but I can deal with that if I get to return. Well here is to getting back to the swing of things.  Bombero let me know how it has been going for you after returning to duty.

Daisey

[Redwing]

That's great news for you Daisy!!

[bombero1969]

So glad to hear that you are back at work, isn't it a great feeling? Well we have had our busy shifts and then our lazy days. So far I had one shift that we were up all 24 hours running medical calls on the box, most were just normal calls but a couple were actually really good calls. Though I have become partial to the engine that I am assigned as engineer to. I get to be on the engine more than the box and that is fine to me. Last night (or early this morning 0430) we got toned out for a residential fire in a neighboring city. So I got to bunk out and ended up on the nozzle. It was my first fire since being back, and was so exciting and thrilling. To be able to perform such tasks and only have a complaint of the heat from the weather was wonderful. My knee held up much better than I was expecting, did not get sore or protest at all.

I am so glad that I had the surgery and would do it all over again just to be able to do all of these things.

Again congrats on going back to work.