My Unique And Successful Journey of Two Knee Replacement Surgeries

The following is a summary of my experience during 2 recent Knee Replacement surgeries. Both surgeries were tremendously successful – life changing. I have spoken to many people that had the surgery but never enjoyed the full recovery I have with both knees. I did each knee separately about six months apart and mentally dedicated my year to preparing my body for the rest of my life. I was 63 years old when the knees were replaced, and I just knew I couldn’t go ten to twenty more years in my current mobility condition.  That decision gave me the strength I needed to undertake the climb of what looked like a very, very tall mountain.  I can tell you now with the year in the rear-view mirror that it was worth every bit of pain, sacrifice and inconvenience.  I can now regularly take three-mile walks, play golf and exercise without any hesitation. It’s hard to quantify for you how joyful that it, but I suspect you know what I am taking about. The only thing I can’t believe is how long it took me to make the leap – what was I thinking limping around for so many years?

To be clear I am not a doctor and have no medical training.  This is written from the patient’s perspective, not the doctor’s perspective. I am sharing my experience based on the medical advice I was given and followed rigorously.  If you decide to utilize any of these methods, I strongly urge you to consult with your doctor beforehand. Your body condition is surely different than mine in some manner. 

It was suggested that I write some of this down for others considering the surgery as most of us approach this unknown with some anxiety and fear.  What’s it gonna be like?  How painful is it?  How difficult is PT?  How long until I’m up and walking? So, I have done just that in this document to help you navigate your journey.  I was given remarkably great advice in my preparation phase, and I am very confident that it made all the difference in the world in my experience relative to those I spoke to prior to my surgery.  If I based my decision strictly on what I was told before surgery I could easily have talked myself out of the procedure. I am glad that I didn’t.

Pre-hab

Ironically it was my Primary Care Physician – not my surgeon – who guided me on a path to ‘pre-habbing’ my knees in the run-up to surgery.  His key message was to prepare for surgery as if it’s an athletic event you are working up to like a 10k or marathon.  Use the time prior to the event to prepare yourself to be successful during the event. That laid the groundwork for his comment that woke me up completely – ‘You’re first day of rehab isn’t the day after your surgery.  It’s tomorrow morning in a pool… water walking.’  He went on to say I needed to water walk 5-6 days a week for 30-40 mins.  The daily routine is 4 sets of 10 laps each walking in a pool of walking Forward, walking Backwards, walking Sideways, and walking like a Drum Major with your knees breaking the surface of the water in an exaggerated manner.

Water walking is very easy, usually kind of pleasant, but still a bit monotonous.  But the payoff was HUGE for me – a total game changer.  Put your ear buds in, get in the pool and start walking in the water the day you make your decision to move forward!

Why water walking?  Why not just do more regular walking in runup to surgery?  The answer is that your damaged knees are typically in a bone-on-bone condition and won’t allow it over extended period of time – it’s simply too painful to for a long-term solution.  Over time as your knee joint degraded, the rest of your key leg muscles develop ‘compensatory walking’ to address the hobbled limp caused by the damaged knee joint and this adjustment causes the hip muscle and glutes to get out of whack, atrophy, weaken, get strained.  Prior to my surgery, my legs (thighs, glutes, hips) did generally feel tired often – no juice or pep.  In short, they were atrophied. The water walking allows those key surrounding muscles to walk normally and re-establish strength, muscle mass, rhythm so that the new knee is dropped into a healthy/functioning ecosystem of sorts.  This allows the post-surgery PT to go more smoothly – only focused on regaining flexibility and strength in the muscles aggravated during the surgical procedure, not the actual rebuilding of supporting muscles. 

Anecdotal Evidence

My surgeon was out of state and I rehabbed in the home of some great friends who lived in that area – it was a blessing. The surgeon’s process was they didn’t review my knee until the 5 week mark at which point they would release me if everything looked good.  So, I had a physical therapist come to the house 3 days a week for a 30 – 40 minute session for 5 weeks. On week 4 my therapist went out of town and missed 2 or 3 sessions.  When she returned she told me we were gonna do the ‘tough one’ to prepare me mentally. The tough one is standing solo on your repaired leg, not holding onto anything for balance and the lifting your non-surgical leg about 40 degrees up and returning it to the ground for 10 reps.  It’s hard because you aren’t mentally confident you can do the balancing act without support for that long and its physically difficult – your leg trembles, it’s hard to balance and concentrate on lifting the other leg, and a little painful.  I told her I already completed that exercise the previous week with her substitute.  She was incredulous and asked how many reps i had completed?  I told her I did 10 reps and her eyes got real wide – really?  I said ‘Yea why’.  She told me that the dirty little secret is that no one ever does 10 reps – after 3 or 4 reps most patients ask if they can pick this up again at next appointment which they obviously agree to.  So, not only was i able to complete 10  reps, but I had performed the ‘tough one’ a week prior to schedule.  I fully believe that I was able to balance on the trembling leg and get through the reps due to my adjacent muscles (quads, glutes, hips) being strong enough from the water walking work I had done.  They were ready to go day 1 after the surgery and it paid off.

For my 2^nd surgery I asked my surgeon’s PA if he would see me in week 3 vs the standard week 5 checkpoint and he agreed – stating the 2^nd surgery is easier due to having gone through it before, successful first surgery, etc. At the 3 week appointment he tested my joint and leg strength by holding my extended ankle in his hands and providing firm resistance to me lifting up, pushing down, and side to side.  He replied – ‘Wow this is great for 5 weeks.’  I said, ‘Doc – don’t you remember?…. This is week 3’.  He thought about it and recalled our agreement and said ‘This is REALLY great for week 3!’  He then asked me to get up and walk back and forth across the exam room which I did. Again, he told me it looked great – balanced, steady, strong.  But then he realized what he was watching and asked ‘Where is your cane?’  I told him I hadn’t used a cane since day 8 or 9 after the surgery.  To which he said – ‘Well, you’re definitely all set and ready to go.  Good luck!’  And that was that.

It’s only 2 data points to be sure, but both from professionals who deal with knee replacements every day in the course of their work.

Ice

Ice is your best friend – gotta apply it to the knee basically every hour of every day for 30 mins each in the initial four weeks and regularly throughout the days thereafter.  I used those blue ice pads you keep in freezer and wrapped them with an ace bandage to keep them tightly in place around the knee – my brother was my ‘coach’ and could put 2-3 ice pads on knee and secure with an ace bandage in seconds.  After 1-2 weeks, I could do the same solo.  Icing becomes monotonous and a hassle after a short time but it is so worth it.  The ice reduces the swelling; the reduced swelling combined with ever increasing flexibility from PT sessions (I did 3 per week for 30-40 mins) is your PATH FORWARD.  You have to be religious about both icing your knee AND doing the PT – both are easy to do but a bit monotonous due to the repetitive nature of it all. 

Pain

For the surgery day and a half of the next I felt no pain of any note.  This is because during surgery you are given a nerve blocker.  The blocker wears off by end of day 2 and you can feel it. You’ll feel tempted to move freely about the cabin with this lack of pain but try to resist and stay off your leg as you may be aggravating it more on Day 2.

On days 2-6 I’d say my pain ranked 6-7 at the highest although at this point, I had started taking my Oxycodone prescription to manage my pain.  Every day or two thereafter it seemed to diminish by a half point and was never again harsh at all, but not zero. After the first week my pain was very low grade. It was more the feeling of stiffness/swollenness that is uncomfortable but not painful per se.

I typically sat during the day with my feet on an ottoman usually slightly elevated.  If I sat upright with feet on ground at a dinner table or rode in a car, etc. my leg would start to throb after 30-45 mins.  Over time it throbbed less and would take longer to start throbbing, but this was the bulk of the actual pain I experienced.  It just takes time for the throbbing sensation to melt away – it stuck with me for 6 or 7 weeks post surgery a bit less so every day.

Sleep

I found the nights to be quite long.  Always had to get up a few times to use bathroom.  That requires turning the light on, getting a lay of the land you have to navigate, carefully getting out of bed, getting hold of the walker, navigating to bathroom, etc.  It’s wise to use the help of your coach on this especially the first few nights.

Also, you generally have to sleep on your back for most of the recovery.  I was directed to sleep with my knee elevated by pillows.  I’d also put an ice pack on when going to bed as well so right off the bat with your knee elevated and a pack of ice strapped to it – it’s not conducive to just dropping off to sleep.  It’s aggravating/frustrating to not be able to simply change your position in bed to get back to sleep like normal.

My scar was closed with Surgical Tape – no stitches/staples although this practice varies by Doctor I gather. Tape has a very light presence about it which is great.  But even the feel of the bedsheet running across my knee/scar as I shifted in bed was quite noticeable.  It wasn’t painful – rather, it was intensely ticklish.  Also not conducive to dropping off to sleep.

For all of these reasons, I found myself lying awake for periods thru the night.  I kept my phone nearby and listened to podcasts to get drowsy and fall off again. So, if podcasts aren’t your thing maybe books on tape etc. to keep you company if/when you find yourself awake in the wee hours.

Post-Surgery Rehab – Physical Therapy

I tried to do something each day I didn’t / couldn’t do the day prior. If I went up/down 4 stairs on Monday, I would walk up/down 10 steps on Tues.  If I walked with my walker to the end of the driveway Monday, I’d do so again on Tuesday and continue on the sidewalk to the first house/mailbox, then turn around. Do these things with someone walking along side you – either with a hand on your elbow for steadiness or just close by for your confidence. It’s a mindset of incrementalism but it does compound quickly over time and your body/muscles respond to the challenge. 

Driving is a thing with the right knee as you obviously use your right foot on the gas pedal and brake. I was advised to drive when I felt comfortable doing so.  But the real limiting factor is the Oxycodone – you obviously don’t want to be driving under the influence of opiates.  So, your pain level will guide you on when to ween off of the Oxy, and being off the Oxy is the greenlight to begin to drive.  I experienced no issues from the very first day I got behind the wheel.  It is – as they say – like riding a bike and there was no muscle memory loss or ramp up to driving. But… driving for an extended period brings the leg throbbing I mentioned above into play such that running around doing errands was quite doable in week 4, but driving 3 hours was not comfortable.

I also was blessed with fantastic physical therapists that visited me at the house 3 days per week for 5 weeks and helped me understand the goals, process and measurement methods.  When they set a goal, I did my best to hit it exactly, never trying to exceed it and risk starting over. On the day after surgery, I sat in a chair.  The PT timed me getting to my feet, walking 10 ft with my walker and returning to my chair to sit down – 28 seconds.  On my final day of PT in week five, my time was 8 seconds – no walker, no cane.  Look ma – no hands!  You do make progress incrementally every single day.

Flexibility is the main goal post surgery.  The muscle strength follows suit quickly behind the flexibility.  Regarding regaining strength, your focus should be on ‘range of motion’ versus the amount of weight you can lift.  For example, don’t sit to do seated leg lifts and try to do 5 reps of 120 lbs. when you have returned to gym post-surgery, post PT clearance.  Rather set the weight at or near the lowest weight and do 3 sets of 20 executing a full range of motion slowly in a controlled fashion.  Do this repeatedly over the following weeks upping the weight by a small increment every few days/weeks – but always focus on low (but increasing over time) weight, slow pace, full range of motion.  This builds muscle memory and strength in the recovering joint.

When walking with. a walker, cane or unassisted post-surgery:

1. Decide what you are going to do before you put yourself in motion – getting up from a chair, walking up/down stairs, etc. As an example if you are seated, ensure there’s a clear path forward – no shoes laying around, an ottoman in your path, etc. Avoid a slippery floor areas ( that may have some spilled water on it) and wear socks with rubber traction strips on them all the time.  
2. I often sat in a chair with arms on it so I could assist my stand up w/ my arms – it’s helpful as your knee isn’t immediately strong enough for a full unassisted stand-up from chair.  Or ask those around you for a hand up a little longer than you actually need one.  A fall could be a big setback so be humble in your progress. Incrementalism!
3. Move slowly and deliberately in your steps/motion, but commit to the move mentally – once you start….finish/complete the motion with confidence. Your muscles are re-learning their ‘memory’ and this will become 2^nd nature very quickly.  You will quickly build a library of stored motions that you rely on and are repeatable.