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Offline keith55

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TKR recovery on your own
« on: September 05, 2011, 03:12:05 PM »
I'm new to this forum so here's my knee CV:  :)

1. Diagnosed (from X-ray) osteoarthritis in left knee in 1998 after it blew up during a demanding walking holiday in Snowdonia.
2. I don't recall getting much advice from GP at the time. Naively, I didn't realise how important this would be in the future.
By the time I'd had the X-ray and seen the GP the knee had settled down. I cut out the mountains but still walked in the hills.
3. Fast forward to autumn 2011 and following a routine 6 mile walk I had pain in my kneecap which wouldn't go away.
4. The knee had been noisy for many years and I had found standing up for a long time increasingly hard - all insidious signs
of the progress of the OA.
5. I saw a knee specialist privately and he told me TKR in the long term. Severe deterioration (grade 4 bone on bone) in the
patellofemoral joint with some involvement in the tibiofemoral joint including osteophytes (bony outgrowths).
6. I saw the same specialist on NHS shortly after (Oct 2010) and asked him more questions about the TKR operation and he surprised me
by offering the TKR operation - I blurted out yes without having really thought that far thinking this was my chance
(I'm only 55 now so I thought I was too young to have it offered to me).
7. A GP came to see me about another matter and off his own bat counselled me against having the op as I was better than most of
his patients. I bailed out of the op which was set for March 2011.
8. I have seen the knee specialist again - he told me that a) He wouldn't have the op if he were in my position
b) I was better than most of his candidates c) The deterioration is slow. d) I have to grin and bear it
9. I have had my other knee and hips X-rayed - all OK.
10. I'm seeing the specialist again on Sept 13 having written to ask him about patello-femoral replacement, which he has never
mentioned - there may be a good reason why it is not a good idea for me.

My current condition:  :(
1. 24/7 nagging toothache like pain in kneecap sometimes with pain at the sides of the knee at the tibio-femoral joint
[I'm taking 2 X 500mg paracetamol 4 times a day and using ibuprofen gel as painkillers]
This pain refers upwards especially at night. If I wake up at night I find it hard to get back to sleep.
2. Virtually full bend and full extension with my left knee for which I am thankful.
3. Walk unaided in my flat but use a walking stick outside - rough ground and even gentle slopes add to the pain.
4. Do 2 X 15 min PT exercises, 10 minutes (in 2/3 instalments) stationary bike and >=20 min walk each day. Knee catches painfully
after about 3/4 minutes on stationary bike.
5. Walks in the countryside much curtailed. Group nature walks out since I can't keep up (and nature walks are naturally
only gentle rambles).

Questions  :-\
1. TKR is described as a last resort yet reportedly 90-95% of candidates benefit for as much as 20 years or more. Many become
pain free. I don't understand this apparent contradiction (apart from the hellish recovery process and the risks of blood clots,
infection etc)
2. Does anyone ever "respond" to conservative measures with grade 4 OA?
3. I live on my own and reading the many diaries it is apparent that support from family/friends is needed in the weeks following
the op. I could hire nursing support but I'm not sure what would be needed. Then there is the needed emotional support
that a paid nurse would not provide. Advice please - especially from others who have done this on their own. I'm not convinced that
the NHS and the surgeon take this aspect seriously. For example, I gather you can be sent home with only 70 degrees of bend
and less than zero extension.
4. I suffer from diverticulosis so constipation leads to pain. I have tried opioid painkillers but came off them because of this
and also because of uncontrolled limb movements, hearing voices and vivid nasty dreams - I was becoming someone else. It seems that
to stay ahead of the pain in TKR recovery you need to take such painkillers: I don't trust the NHS to be able to find what will work for me during the short hospital stay.
« Last Edit: September 05, 2011, 03:17:53 PM by keith55 »

Offline kneepaincure

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Re: TKR recovery on your own
« Reply #1 on: September 08, 2011, 02:33:50 AM »
That certainly sounds like a tough decision to make.. Hang in there and I'm sure you'll get some answers from more experienced people here..
Have had tilted kneecaps for many years, and occasional patellar tendinitis.

Offline Brambledog

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Re: TKR recovery on your own
« Reply #2 on: September 10, 2011, 01:02:25 PM »
Hi Keith55,

I can't offer advice on TKR as have no knowledge of it other than as something I'll probably be having somewhere down the line! I was diagnosed just over a month ago with severe patellofemoral arthritis though, so know the type of pain you're describing all too well. It was diagnosed during an arthroscopy, and I ended up staying in for 3 days instead of just the one as they did a lot of resurfacing and took biopsies. I definitely needed my husband afterwards, and although I can cope with basics now, I still rely on him for housework, shopping etc and I can't drive yet.

I know what you mean about the painkillers. I had a couple of morphine doses which my body rebelled against, and the other drugs gave me constipation so I stopped them ASAP! Like you I'm just on paracetemol (my physio laughed when I told her) although I add on codeine if the pain is worse or I've got a physio session.

I think you're right to get as much info as possible before making a decision. I'm 40, and although it's early days for me and I don't yet know what my knee will be like long-term after the op healing, I'm already questioning the PKR/TKR option, although obviously I'd rather not have it ever. It's normally delayed until around 60 because of its lifespan, but I question the wisdom of spending the next 20 years in pain with a decreased quality of life, waiting until I'm old enough to have a decent knee!

Good luck with everything, hope you get some answers and an improvement soon! Have you checked out Whitey85 (tkr post op)? He's had a TKR and he's put a lot of detail in about the recovery period - very useful.


2009 - diagnosed coeliac
Aug 2011 - L knee arthroscopy
Aug 2011 - diagnosed PF arthritis L knee
Nov 2011 - diagnosed CRPS L knee
Dec 2011 - MRI R knee, PFOA is worse than L!
June 2012 - no surgery 'til TKR's
Nov 2012 - CRPS spread to L foot/thigh, increasing pain
- Worsening pain/symptoms R knee