Full Right Knee Replacement

molteni_man

Hi all,
Sitting in bed after a full right knee replacement this morning! On the Fasttrack scheme so might be discharged later today, most likely tomorrow morning.
Quick background-58 years old, pretty fit, warmed 10 years ago by the surgeon at my 2nd Knee Op that I would need a replacement- a lifetime of football, running, Squash, hill walking.
Knee/ leg had slowly become more painful, stiff and unable to bend and straighten. Cycling has been fine apart from stiffness after. A recent weekend in London with lots of walking really confirmed need for the op as v stiff and painful.
The Hospital RSH in Southampton has been truly amazing and have had first Physio- another one later.
Am getting lots of medical advice and realise how important to use this and absolutely follow.
But, would appreciate any practical tips/ suggestions from anyone who has had similar please. Any sharing of what worked for you and how you built up your cycling would be v helpful!! Thank you in advance!
Determined to get back ultimately stronger than before but know it will take time and that I must follow the medical guidelines.

baroid

Molteni_man.

Sounds like it has all gone well, good luck with your rehab.

Look forward to reading your posts.

Phil

molteni_man

Thanks Phil- much appreciated! - Didn’t make the Great Escape as still a bit of bleeding from the wound- but otherwise all good
BW

me-109

My Mam had one years ago and is in prep for a second one, both due to arthritis. Hardly a sporty background she put her mountain bike on my very old fan turbo for physio. Struggled getting over the top of the stroke as I remember but otherwise found it useful.

In a not too dissimilar way I had a pinned tib that requires slicing through the knee in the same way. If you've not been told it's likely you will lose sensation on the outside of the knee. I got back on the bike quite quickly but took ages to rebuild strength to be able to get out of the saddle or push much of a gear, so spin-to-win where you can and don't overdo the hills.

Good luck with the recovery.

exlaser

Hoped you discussed with your surgeon what joint to have . 😀
As cyclists and sailors need joints with more than the standard articulation if they want to continue doing these sports ( in general ) .

bm5

Best wishes for your recovery.

molteni_man

me-109 said:

My Mam had one years ago and is in prep for a second one, both due to arthritis. Hardly a sporty background she put her mountain bike on my very old fan turbo for physio. Struggled getting over the top of the stroke as I remember but otherwise found it useful.

In a not too dissimilar way I had a pinned tib that requires slicing through the knee in the same way. If you've not been told it's likely you will lose sensation on the outside of the knee. I got back on the bike quite quickly but took ages to rebuild strength to be able to get out of the saddle or push much of a gear, so spin-to-win where you can and don't overdo the hills.

Good luck with the recovery.

Thanks ME - 109. That’s useful to know. They identified use of a static bike. Was already left with some numbness on right leg when had the hip replacement so your shout re the knee is a good one! And good shout re the hills- booked ages ago to go to the Alpe d’ Huez area in late July/ early August before I knew I would be having the replacement. Got to decide what to do now. Checking in on this with the team tomorrow so can make a decision!
BW!

molteni_man

exlaser said:

Hoped you discussed with your surgeon what joint to have . 😀
As cyclists and sailors need joints with more than the standard articulation if they want to continue doing these sports ( in general ) . </blockquote

Yes good shout for anyone undergoing in the future. Luckily for me one of the team was an avid cyclist so fully taken into account! Already less pain but need to work on that flexion.

BW and thanks

molteni_man

Hi all - an update 2 weeks on from the op.

This has been a bit of a rollercoaster as 'other health stuff' has emerged so it hasn't all been about the knee.

I'll give a bit of context - I had a spinal epidural and felt fab straight after the op as per my original post - unfortunately no fast track out as my wound continued to seep and despite my best efforts I could not pee so my bladder kept filling which can be dangerous ultimately eventually had to have a catheter fitted . Catheter was removed the next day, but unfortunately the same thing happened so it went back in. A final trial proved unsuccessful so I was discharged on the Thursday ( 2 days later) with catheter fitted and told to return in one week. Was also prescribed Tamsulosin. I was told that this was not an unusual occurrence for men of my age after an epidural and above with the possibility of enlarged prostrate etc. But, this was a real low point and was certainly an added distraction physically and mentally on top of the knee.

I returned to hospital after one week and catheter was removed - one glass of water every 45 mins or so across the day and I began to pee again with increasing normality and volume. After four full pees I was discharged later that day around 3:00pm and pleased to say that all is normal although I remain on Tamsulosin and am about to undergo some tests re prostrate size - Consequence re anyone of my age and above ask qu's about epidurals and side effects - also interesting for cyclists and the possible links with an enlarged prostrate - studies are very inconclusive!! Epidurals put the muscles to sleep so I would be taking advice re having a general instead... but not sure if this an option.

Pre-ops had noted some highish blood pressure and this was something also beginning to be detected with previous ops on my parathyroid glands - my blood pressure went really high after the op so I am now on tablets for this too - great! I'm pretty fit, eat healthily, don't smoke and rarely drink - hey ho! Now also being investigated, but hopefully not serious!

And finally the knee itself! 2 weeks on and still incredibly stiff. There are 3 main stretches to be done in this period. I've taken painkillers - it has been painful but it is more the stiffness and what appears to me a lack of bend - I certainly wouldn't be able to turn a pedal in either direction if I tried - I haven't yet and won't until given the green light by physio. I use one crutch in the house and two crutches for short walks round the block. I am really trying to follow the advice given by physio. I go back to the hospital for the next Physio assessment/ set of exercises at the 4 weeks since op time.

Day 14 and have just had the metal clips removed and the Nurse remarked on how clean and healing well the wound was so some good news!

I get tired at times. I'm doing a bit of work on the laptop, put the leg up and focus on the good stretching exercises recommended.

Mentally with the worry re the catheter it's been hard, but I am always a positive person and know it's early days yet for movement re the knee. There's much to heal! Life pretty much goes completely on hold so important not to have any other stuff going on.

Again, if anyone out there who has gone through this do let me know. I got chatting to a lady this morning in hospital who said it was until about the 6 - 8 week mark where pain started to go and some movement returned.

Hope might be useful for anyone reading this in the future. I will update again.

baroid

Sorry to hear about your health issues Molteni_Man.
After my THR I also need a catheter but only for 3 days and despite drinking loads of water, 2 litres, I had trouble peeing the first time. I have been on Tamsulosin for 6 years now for enlarged prostrate but haven't noticed any side effects.
Recover well.

molteni_man

Thank you for your post and message and sharing baroid - that is really helpful to hear and much appreciated
BW!

webboo

I had a catheter fitted after my hip op. I suspected I might due both times I’d had surgery before I had trouble peeing. This time they scanned my bladder to check the amount of urine as they said once it gets above 3/4 of litre even if you start to pass urine, a catheter is probably needed.
Mine was only in for just over 24 hours. However since then I seem to need to get up more for a pee during the night. Whether this due to waking up more as I’m uncomfortable due sleeping in one position or with a raging erect…
I tried to look on the internet to see if this is a side effect or even possibly due to the blood thinners. But it’s not a good thing to have to google 😂

molteni_man

Again thanks for sharing webboo, whilst none of us want this side effect it’s reassuring to know that it seems not to be unexpected which is what the hospital told me. As baroid said Tamsulosin seems to work well and without side effects so far.
Again hope this helps others too undergoing operations etc.
BW as ever.

me-109

Sounds like you might be on the mend @molteni_man so good luck with that. All surgery and anaesthetics seem to come with some risks and uncertain outcomes, but I'll pass on some of your experience to my Mam. We were just talking about general vs local last night, so something else to consider (not that you generally get much choice!).

molteni_man

me-109 said:

Sounds like you might be on the mend @molteni_man so good luck with that. All surgery and anaesthetics seem to come with some risks and uncertain outcomes, but I'll pass on some of your experience to my Mam. We were just talking about general vs local last night, so something else to consider (not that you generally get much choice!).

I woke up feeling great after the local … much more wide awake than after a general and can see why they give this. Guessing it may be better/ different for a woman than a man… but certainly worth debating if as you say that is entered into! Good luck to your Mum and thanks for your wishes.

molteni_man

An update for those who may find it useful in the future if undergoing a full knee replacement.
Tomorrow will mark 4 weeks from the op ( 14th Feb 2023).
It’s been an interesting journey to date.
Saw the Physio for an assessment earlier today. He was happy with my progression which was reassuring, although I still think I don’t have much bend. I’ve worked hard at the stretching without trying to overdo it.
At the stage of Week 4 I have the green light to start walking with just 1 crutch outdoors and try and move around the house with no crutch at all. Walking with quite a limp with no crutch.

Stretching remains paramount- much more than walking. I can now progress from the 3 basic stretches on to more advanced stretching as noted in the book supplied by the hospital, including more ‘lunge style’ stretching and can also now get on a static bike and start to turn the pedals - there is no way that I can currently turn a full rotation with my right leg, but I’ll keep persevering! My advice is to follow the stretching given to you by the Physio and the hospital.

I have to continue with elevation of the leg and regular icing to try and bring down the swelling - knee and leg below can swell big time! Sitting here typing on the sofa with legs up!

I still get tired v easily at Week 4. I’m doing some online work, but set the timer to remind me to get up and stretch.

In hindsight, I would have done even more stretching of the knee before the op. My knee was particularly stiff with the arthritis.

So all in all, feeling a bit more positive, but still a v long way to go. I remain humbled by those who have permanent disabilities. My other reflection is that there is a big difference between a knee replacement and a hip replacement where I found that the walking really helped.
My next assessment comes at the end of Week 6. I’ll update nearer then.

molteni_man

Update! Exactly 4 weeks from the op.
Forgive me for posting, but I have achieved a breakthrough and need to share.
After a walk, warming up the knee with some stretching and movement I decided to get on the Wattbike with saddle higher than normal and just wearing trainers.With coaxing and moving the knee backwards and forwards many times using the left pedal stroke to move the right leg and then gritting my teeth somewhat I managed x 15 reverse full pedals - not consecutively, but in fairly quick succession.
I then did the reverse … and again with some real coaxing and by using the left pedal stroke to ease the right foot around I managed x 10 forward strokes!!
Really hard, but this has given me a real boost psychologically.
Only downside to today is that I am now on antibiotics for a small infection to the left of the scar at the bottom, but hopefully a week’s dose will sort this.
Ice pack now applied and leg up resting.

Tashman

I had ACL reconstruction 7 years ago so can sympathise with a lot of your recovery journey. i took cycling up again as a means of recovery having been a goalkeeper for many years in various guises. Keep up with the exercises and listen to the physios. My brother is one and much as it pains me to say, they actually know what they're doing!
I found keeping moving being a real boost myself and looking at small wins makes all the difference.
It sounds like you're doing really well and don't worry about the small infection, I also had that and the antibiotics dealt with it nicely. Only disappointment was it made the last 1cm of my scar wonky

baroid

Well done Molteni_man for turning the pedals over. Remember small gains leads to a big victory but don't over do it.

molteni_man

Thanks Tashman - super advice and words about those small wins.
Re the Physio for anyone in the future Practice Plus Group have a fantastic free app called Pocket Physio which gives you the recommended stretches pre op, post op to 4 weeks, past the 4 weeks and advanced from 6 weeks. There are two apps with the same title so make sure it’s the Practice Plus one ( They are a private company but I went through them with the NHS)
Baroid - thanks again - have posted on the hip replacement thread to you.Hope you are doing well in your own recovery.

molteni_man

Now 6 weeks + 4 days since total knee replacement ( TKR)
Saw my fab Consultant Mr Khan for a check up yesterday. This was a good time to get feedback on progress for sure. In his words I have made progress overall in line with expectations which was reassuring to hear. I will return in a further 6 weeks.
So what does this look like for anyone going through this TKR in the future?
Week 4 is definitely a turning point, or certainly has been for me.
From Week 4 I have definitely seen some solid if slow progress. TKR is definitely a ‘ slow burner’ for sure!
At this point now I am predominantly walking without a crutch. I still hold it in large crowds and on steep descents. I’ve been doing around 15 minute walks daily and am now allowed to up this.
For me the stationary bike ( Wattbike in my case) has been critical in r
helping to regain bend. From my last post post I am now able to ride for about 20 minutes with the saddle getting close to normal height. As ever getting the bend has been most important for me, but I’m starting to build a bit of a sweat up now and will need to start wearing some riding kit soon! I’m not concerned re current leg imbalance of 60% - 40% as I can see that it is slowly returning. Power is going up slowly 154 Watts for an 18 min ride which included a warm up… again not concerned re power but the bend. Have started to clip in after a thorough warm up- I pedal stroke on the back heel initially which is easier. Am keeping rides mostly private on Strava as pretty boring to read currently.
Haven’t been concerned re riding outside at all to this point. When I do venture out it will be a v flat one on my Brompton. It would be helpful if the weather improved too!
Walking is still’ ungainly’ and slow but confidence is growing. I can’t yet climb the stairs leading with bad leg unless I hold on to the staircase/ bannister. Descending is firmly slow and leading with bad ( right) leg.
I’m now allowed to drive having got permission from the Consultant yesterday. Took a short drive this morning- again not going to rush this- my wife can drive me!
Still get v tired at times.
Have put myself on a diet to try and stay at my normal weight.
Blood pressure is now coming down- effect of the tablets and a little more exercise I think. Blood pressure not connected to TKR just something I didn’t know about before op! Just as well has been diagnosed!
Watch out for your wife/ husband/ partner/ relative etc - it’s tough for them with the additional care - my wife has been fab.
If you have a friend etc going through TKR make sure you visit/ take them out for a coffee as days can be v long.
I’ve managed to do most of my work online, but be warned sitting at the computer is not good and I am strict about not sitting for too long.
I continue to ice and elevate regularly. The knee continues to swell and this is to be expected.
We were due to go to the Alps for cycling in late July/ early Aug ( booked before I knew about op) but realistically I think this will need to be cancelled until next year.
Mentally at the 6 week mark I am beginning to see the future ahead.
My biggest advice I can give is that TKR is a v slow process. You can’t rush recovery.
Hope might help others going through this in the future. Good for me to reflect.

me-109

My Mam had hers done Tuesday morning. She came out of hospital Friday evening - surprising since she lives alone now. We were hoping she'd would get packed off to a rehab centre for a couple of weeks. She's got what looks like Santa's sack full of drugs. Very early days and long road ahead, which she knows but it is 15 years since she had the other one done.

molteni_man

I wish her the very best me-109.
I’m guessing that having had one done already will be useful, but equally time does ‘ heal’ the memories of what everything entails too.
Everything seems to take much longer and it’s tiring planning every trip upstairs and remembering everything you need to take to save another’ journey’.
The meds were useful for the first four weeks and I’m not ashamed to say that on occasion I took the old Tramadol to get a good nights sleep which really helped.
Hopefully, you and family aren’t at too great a distance to support. A couple of large ice packs have been really good purchases. And a good supply of fresh fruit to ensure getting good nutrients and staying ‘ regular’ was also super helpful too.
I wish her the very best and do please message if there’s anything I can help with in terms of experience too. I found it really useful to talk to a friend who had a TKR a couple of years ago.
BW!

baroid

Molteni_man, from your post it sounds like you are making good progress hope you keep it up. As I have just found out riding outside is different to being on a turbo or Wattbike. Clipping or unclipping, stop/starts, change of gradient and wind all have a big effect. Sure you have it all covered.

molteni_man

Baroid. - thank you- I had replied but it isn’t showing. Hope your recovery still going well.
Yes re the outdoor cycling and the different things to think about definitely!

So, for all readers and for those going through the process of TKR in the future where am I at at just over 8 weeks?

Firstly just to say that TKR is a v slow recovery as I am really discovering.
What can I do at Week 8?
I can now climb stairs ‘ normally’ most of the time except for when I’m tired.
I did a 9 mile bike ride on Sunday on holiday here down in Cornwall. I used my Brompton as easy to get on and doesn’t require clipping in which I definitely wouldn’t contemplate at the moment. It was a little hillier than I would have ideally wanted being Cornwall. I probably only went outdoors as I don’t have access to an indoor bike whilst we are away and turning the pedals remains an important part of the stretching routine. I went further than anticipated but all was ok.
I have done a ‘good’ walk each day of about a mile and a half and hit 10,000 steps for the first time yesterday.
I drove most of the way to Cornwall from Hampshire without issues.
I am now really working on massage of the leg muscles using my fingers, hands, massage gun etc.
Ice and elevation remains v important as the knee still swells often causing stiffness due to size. You keep listening to your body and try to push it a little without overdoing it.
Above all else a good set of stretches around 4 times a remains vital! I’ve done loads of research on stretches and the blogs of others.

What can’t I do?
Frustratingly, walking down stairs normally remains v difficult/ impossible and I am now working on specific stretches to try and improve this. Descending hills is much harder than walking up them in the same way.

I think it is hard for others to realise the ‘ extra effort’ that is required in doing everything- walking requires lots of concentration and I’m still v slow. Once again my understanding and admiration for anyone with a permanent disability is right up there.

I return to work next week and have 3 big days’ on the road’. I’m going to find this hard as I have my routines for everything I have shared above and need to ensure I keep doing the exercises! It’s a bit daunting and am not sure what understanding there will be at work.

Mentally, I am in a better place now knowing that this is a ‘ long haul’ and that six months to a year is really the time frame for anything like recovery. I cancelled the holiday to the Alps in late July/ early August last week as just knew this would be a step too far - the Alpe d’Huez region is not known for easy cycling and it’s not an easy journey down there too. For once will do something easier!

Will post again in the future. Best wishes to all of you out there recovering from operations too!!

molteni_man

Snakes and Ladders!
13 weeks since the op. Just like the game of Snakes and Ladders there have been some real ups and downs since I last posted.

The ups -
*I've worked on really trying to stretch the leg and this is paying dividends with walking more normally without most signs of a limp - I hang oven gloves filled with weights over my knee with my leg straightened and see how long I can do this for - it really helps!
* I feel more normal and can see a way forward, although am realistic that this is definitely a 12 month and more process.
* I'm able to do some indoor and outdoor cycling - still v limited - DVT has restriced this (see below)
* The recent decent weather has certainly lifted spirits.

The downs
* A diagnosis of deep vein thrombosis has really set me back. I've had this for some time, but unfortunately it was diagnosed as a skin infection to begin with. Have now been on blood thinners for about a week and will need these for about 3 months or more to dissipate the clot. It has added to the general swelling which has restricted progress - anyone reading this now and in the future do always get checked out and do go back if not sure/ not clearing up!
Was meant to be flying out to Monaco today for a short break to see my son - I've had to miss because of the danger of flying with DVT - my wife and daughter should be taking off from Luton just about now - I'm really glad they've gone and was adamant that they should still go.
* As above the swelling can really restrict you. Leg elevation several times a day does help. At 13 weeks I continue to ice regularly. I've been lent a Breg vpulse machine by some friends, it compresses and provides cold therapy - a fab machine but v costly!
* The whole process of stretching, elevating, icing takes up so much time. Combined with being back at work there is an impact on partners with them having to do more - watch out for them too!
* Being back at work has been v good mentally, but need to watch out you still build in time for stretching.

So overall, this a long one. I'm ok, have certainly been depressed at times but slowly am beginning to see a way forward despite setbacks. I certainly haven't seen the advantages of the knee replacement fully but can certainly straighten my leg to a much greater extent than before - this was my biggest issue before the op.

My biggest advice to anyone facing this op would be to really focus on your stretching before the op.

Best wishes to all out there going through recoveries.

baroid

Molteni_man. Sorry to hear about your downs but hope overall the ups compensate for them. Hope you are keeping positive and are setting yourself little goals so that you know you are progressing in the right direction. These things take longer than expected, at least that is what I am finding, so just keep doing what you have described.

I will posted about my hip soon.

Cheers.

molteni_man

Thanks Baroid - this is much appreciated- I’ve posted fully on your hip replacement thread so you’ll find a fuller response there.

For all now and in the future,
I realised when coming off the thread that I hadn’t described the Deep Vein Thrombosis in case useful for anyone else out there.
Mine started with a large mottled red rash at the back of the calf. This was itchy and gave a ‘ burning’ feel.
I can see why the first Doctor gave a verdict of a skin infection and prescribed hydrocortisone cream. With hindsight I had a v tight calf which I suspect was caused by the blocked vein as much as the knee. My leg (s) ached and throbbed which I thought was them coming back to life, but now think was the DVT.
What ‘ threw me’ was the rash disappearing from the back of the leg… I put this down to the cream working…
BUT it was replaced by a large rash across my shin - this was less mottled, but still gave an intense’ burning’ feel.
I also had days of extreme tiredness which I think were because of the DVT.
11 days in of blood thinners I think I can feel slightly less tightness in the calf muscle and less of a burn.

I’m not a medical person so always get medical advice to check it out!

molteni_man

'The hip is a sprint, the knee is a marathon'

17 weeks since op - over four months!

Quick update as I grab lunch.

4 months does seem to mark a further watershed.

*I've managed some good walking and distance round London recently including the endless steps etc on the Tube too - my best day of walking for sure, generally walking better but important to keep the muscles loose.
* Knee bend and straightening are vital for good walking.
*I'm managing to cycle more and slowly pushing up the distances - nothing massive and not everyday 13 miles on Zwift on Sunday, 11 miles on the gravel bike yesterday.
* Still using flat pedals outdoors/ toe straps indoors - I tried clipping in the other Sunday indoors but it was painful - this was the day after London so might have been a factor. I'll try again but no need to rush this. I'm happy with flat pedals outside as I need to build up the confidence of unclipping from them too - will need to practice!
* I'm working hard on exercises still. Bending and leg straightening are important but also the quads in my right leg in particular. A bit more of bend... I almost was able to fully grab my foot this morning as I raised my leg to my bum... I will get there!! All muscle stretching is important as it all helps with the walking - hip flexors, calves hamstrings etc etc!!
* Still have the DVT - Blood thinners are slowly working, but calf muscle can seem like a rock especially if I sit for too long at the computer. lower leg swelling still occurs but not quite so bad. Knee will also still swell but not quite as big, nor for as long now. DVT not helping this.
* It's better to get up and do a bit of walking with the DVT as feet can also swell up.
* Still have days when get tired. Day after London was an example. It's hard work walking as nothing comes 'naturally' e.g. getting off the train, getting off the escalator. Also think the DVT can contribute to this.
* My more natural outgoing nature and overall confidence is certainly returning - I know I got down with this thinking I would not recover - I knew to expect this, but should have articulated this more. I feel much more like my old self if this makes sense! Performed well in a recent management meeting and felt sharp!

Certainly can see the way forward... but the quote re this being a marathon is certainly true.

BW

baroid

Molteni_man, I see what you mean about it being a Marathon not a sprint. It seems that you have a good attitude which I am sure will help in your recovery. Don't over do it as that could put your recovery back, I would say little and often , but you know your situation better than I do.

Phil Cavell in 'The Midlife Cyclist', well maybe not us, recommends his clients use flat pedals as this allows both legs to work evenly.

I am still struggling with flexibility and power that doesn't seemed to have changed for about eight weeks. Although yesterday I rode my second 50 since the accident, struggled on the steep little kickers.

Cheers
Baroid.

molteni_man

baroid said:

Molteni_man, I see what you mean about it being a Marathon not a sprint. It seems that you have a good attitude which I am sure will help in your recovery. Don't over do it as that could put your recovery back, I would say little and often , but you know your situation better than I do.

Phil Cavell in 'The Midlife Cyclist', well maybe not us, recommends his clients use flat pedals as this allows both legs to work evenly.

I am still struggling with flexibility and power that doesn't seemed to have changed for about eight weeks. Although yesterday I rode my second 50 since the accident, struggled on the steep little kickers.

Cheers
Baroid.

Hey Baroid!
Lovely to hear from you. 50 yesterday sounds v good- you’ll be building all the time, but it is the hills which demonstrate the muscle loss, but it comes again I promise! It just takes time and I think you’ll the benefits of this work soon! For reference I had a trip out to the Alps in August 2017 about 9 months after my fall and hip replacement and performed pretty well on some big days. I would have been coming up to 53 years old then.

Your words re little and often ring v true!!. I had a great gravel ride on Friday solo when I took the day off. I did about 35 miles pretty flat on an old railway line, and although tired before the coffee stop felt good. Did some gentle walking on Saturday and felt great doing this walking without any limp… BUT went with a friend yesterday who changed the route back after the cafe and ‘pushed’ me on some hills…. Not sure if it’s this, or too much time sat on the computer today ( which really doesn’t help I find) but not such a good day today.
Will go again tomorrow, but I’m going to have an easier week this week generally.

Take care and keep in touch!