Diary of a Partial Knee Replacement

[Tbear]

When I realized I needed a knee replacement, I began searching the web to find out as much as I could about the process but never really found an account that answered so many small but significant ( to me ) questions that could help me understand and get through the process. So my way of giving back to all those that find themselves in a similar situation is to share my experience. This is likely to be a bit long winded and only of interest to those getting ready to have knee surgery. I'd be happy to answer questions as I can for anyone who asks. I am 70 years old and very active in Pickleball. The medial side ( inner side ) of my left knee was bone on bone form osteoarthritis.
My Surgery was March 21. It began with a search for a reputable doctor and although I'm sure there are many, two names kept popping up in conversations with friends as well as posts on the internet. The two doctors were Dr. Duke who practices in Ocala, and Dr. Ngyuen ( pronounced ' Win " ) who practice down towards Orlando.
Dr. Ngyuen is noted for non-conventional type of knee replacement in as much as he enters the knee from the lateral side as opposed to across the top of the knee cap. His method alleges less pain and faster recovery times.
Dr. Duke is a more traditional surgeon having done over 5000 knee and hip replacements. I chose Dr. Duke mainly because of his long standing success in knee replacement and his ability to do the surgery within two months of my first visit.
I have nothing negative to say about Dr. Ngyuen. He is very popular and from what I understand it takes 4-6 months or longer to get on his schedule. I had planned to visit him but cancelled because I was so impressed with Dr. Duke.
My first visit to Dr. Duke's office was to be assessed by his Assistant. She took X-rays of my knee, put me through some range of motion tests, and told me that I had bone-on-bone on the medial side of my left knee and was a candidate for surgery. However here came my first surprise. She said that the rest of my knee, the patella and lateral side were absolutely fine. Also, since I was relatively fit and not significantly overweight ( I'm 5'7 and 176 lbs ) that the doctor might suggest a partial knee replacement ( also called resurfacing ) of just the damaged area. ( I wondered if Dr. Ngyuen would have suggested the same but will never know. )
In anticipation of surgery, his assistant gave me exercises to do to strengthen my quads and hamstring which I faithfully did for about two months prior to the surgery.
She made an appointment for me to see Dr. Duke about 3 weeks later and asked that I see my primary doctor to get clearance for surgery. ( Blood work, EKG, chest X-ray )
Dr. Duke's bedside manner is second to none. He explains everything fully, gives you various options, and treats you with the kindness and respect as if he were talking to his father. I was extremely impressed with his professionalism.
He confirmed his assistants notion that I would be a good candidate for a partial replacement. He said that two thirds of my knee was fine and that two thirds of your own knee is better than a totally artificial one. He suggested putting an Oxford partial knee on my medial side. He told me if I wanted a full replacement that he would certainly do it but his recommendation was to go partial. If someday for some reason I needed more work, a full replacement could still be done. I went with his recommendation for a partial.
The surgery was done at Marion Community Hospital. Five days prior to surgery, I visited the hospital to pre-register where they took the usual information from you such as insurance, next of kin, etc.; they also took one last draw of blood and said I would be called the day before the surgery to be told the exact time. The pre-registration staff was kind, professional, and overall excellent in their interface with me and my wife.


Sure enough, I was called the day before my surgery and was told to be at the hospital at 6:30 AM. When I arrived, I was immediately taken into my prep area with my wife to put on a hospital gown. I was given a mild sedative to calm my nerves, had an IV put in my arm and heart monitor patches applied to my chest. I had a visit from Dr. Duke who marked and initialed the correct knee to perform surgery on; I was also visited by the nurse anesthetist who said I would be given a spinal block as well as general anesthesia. Shortly afterwards I was being wheeled into the operating room. They transferred me to the operating table and I remember absolutely nothing from that moment until I was in the recovery room with a nurse by my side. I felt no pain or discomfort whatsoever. Shortly afterward I was taken to my private room for my overnight stay. I did realize I had a catheter in me which would be removed the next day. If all went well, I was schedule to be released the day after surgery.
Three hours after the surgery, a physical therapist came in and had me get out of bed and with the assistance of a walker, walk from the bed to the door and back. I still felt no discomfort or pain. I was constantly being given various kinds of pills; I'm not even sure what they all were...
The hospital room was clean, bright, and equipped with a central heart and Oxygen monitoring center and of course a call bell if I needed the nurse. My oxygen level dropped lower than it should at one point and they administered oxygen to bring the level back up. Apparently a side effect of the anesthesia. There was a TV and meals served at dinner and the following day for breakfast and lunch. The staff, through all the shift changes, were excellent. Professional, caring, and attentive to your needs. Hats off to the staff of Marion Community Hospital.
The second day the therapist returned and this time I walked all the way down the hall and back. I also went to a physical therapy class where they explained some exercises to do as well as how to climb steps as your knee begins to heal. I was still in no pain and beginning to think this wasn't so bad after all ... stay tuned!
I was set to be released except I had to prove I could pee before they would let me go. Seemed sort of odd that they remove the catheter and then want you to pee ( nothing left in the bladder ! ). So I drank a whole bunch of water but much to my dismay I still couldn't pee. They became concerned and did a bladder scan to determine how much fluid was in my bladder. They were concerned it was too full so they did another catheterization to remove the fluid. ( Creepy procedure for me, slight discomfort but not my favorite experience. ) A few hours later I was able to pee and they could then discharge me. They said that my experience with this was not an uncommon one after surgery and catheterization.
I was sent home with an ice machine that looks like a cooler with a leg wrap that pumps ice water around your leg. They also gave me some things to help me to get dressed and perform every day activities like putting your socks on.
I still had little to no pain but was warned that the anesthesia and spinal block actually take several days to fully leave your system and that the third day was often a difficult one with pain. - They were right -
Although I was on several pain medications including a double dose of oxicodone, the first night was a tough one for me. My knee became very swollen, stiff, and painful to move. Since I had drunk so much water during the day, I had to get out of bed and pee several times the first night and it was very, very difficult. Had I known, I would have just kept a urinal bedside so I didn't have to flex my leg to get out of bed. We bought one to have handy for the second night.
The first day home I had a therapist and nurse come to the house from Greystone. My knee movement was a mere 70 degrees. ( if your knee is at a right angle it is at 90 degrees; full range of motion is close to 130 degrees ). The therapist assessed me and performed some exercises with me to begin to get range of motion back. I was still in considerable discomfort trying to bend and straighten the knee. She also asked the doctor to give me a regiment of anti-inflammatory pills to help reduce the pain.
I was determined to get off the oxi as soon as I could, so I went from a double dose to one dose; today which is day 4 I am no longer taking it.
The second day home I had another visit from the therapist who put me through a series of exercises. My range of motion of my knee had already improved from 70 degrees to 95 degrees as the swelling began to subside.
So here I am on the third day home catching up on this diary. The knee feels the best in the morning after a night's rest and the worst towards the evening. I was able to shower today since they applied a waterproof dressing over the wound. I still need the help of the walker and expect I will for a few more days at least. I was told that falling is the worst thing that can happen and needs to be avoided at all costs. I'm fine using the walker until I can transfer to a cane.
Future posts won't be so lengthy as I give progress reports of my condition. As I said above, if anyone has any questions as simple as they may sound just feel free to ask.

[stan the man]

I for one would like to hear how you are doing from now on

[Carla B]

Yes, thank you for your diary. My husband had a partial knee replacement (inner knee) on February 7 at Ocala Regional. It sounds like what you had. His was outpatient surgery. His knee is doing well now but it was a shaky and painful start. He was told to report at 10:30 am, but surgery didn't start until 3:30 pm and he was discharged at 8 pm the same day. It sounds like Dr. Duke did you a great favor by telling you what to expect and keeping you overnight. Hope all is going well with your therapy.

[Happinow]

Although I am not in need of a knee replacement, I appreciated your candidness and detail. It was probably very helpful to many. You never know if or when you may need surgery! I hope you are doing well.....

[Tbear]

I for one would like to hear how you are doing from now on

I do plan to update my status from time to time. Its now day 5 after surgery and although I said I was off the Oxi, there have been some times where I have had to revert back to it because of pain.

The physical therapy exercises which are vital to regain range of motion and strength are very painful at the moment because my knee does not want to flex very much.

Today I will venture out to the pickleball exhibition at Rohan at 11 am. It will be interesting how I handle this.

Thanks for your reply and interest.

[Tbear]

Although I am not in need of a knee replacement, I appreciated your candidness and detail. It was probably very helpful to many. You never know if or when you may need surgery! I hope you are doing well.....

Thanks for your reply. I hope this helps those that have to face knee replacement in the future...

[Tbear]

Yes, thank you for your diary. My husband had a partial knee replacement (inner knee) on February 7 at Ocala Regional. It sounds like what you had. His was outpatient surgery. His knee is doing well now but it was a shaky and painful start. He was told to report at 10:30 am, but surgery didn't start until 3:30 pm and he was discharged at 8 pm the same day. It sounds like Dr. Duke did you a great favor by telling you what to expect and keeping you overnight. Hope all is going well with your therapy.

Thanks for your reply. I think I was lucky being one of the first surgery patients in the morning. I pretty much went right in when I arrived. Staying overnight ended up being really good for me because of the whole pee thing which needed to be sorted out before I left as well as the assurance that no complications were developing from the surgery.

[hoopsterdad]

after total knee replacement with dr. duke at west marion, a very efficient hospital, i checked out at 130 in the afternoon. at 430 sitting at our old friday's at the bar having a beer. next day rid of the walker, went to cane. hard work before, hard work after, and skill of my surgeon made for a great thing. my workouts at laurel manor make people wonder how i am able to go with a new knee. know your limits, work on the exercises that put less stress on joint, but keep moving. 120 degree flex, able to kneel and rise. i am very happy with mine. one will only get out of it what one is willing to put into it. no miracle cure, hard work. also, do not be afraid to lose a few pounds, if needed.

[Tbear]

after total knee replacement with dr. duke at west marion, a very efficient hospital, i checked out at 130 in the afternoon. at 430 sitting at our old friday's at the bar having a beer. next day rid of the walker, went to cane. hard work before, hard work after, and skill of my surgeon made for a great thing. my workouts at laurel manor make people wonder how i am able to go with a new knee. know your limits, work on the exercises that put less stress on joint, but keep moving. 120 degree flex, able to kneel and rise. i am very happy with mine. one will only get out of it what one is willing to put into it. no miracle cure, hard work. also, do not be afraid to lose a few pounds, if needed.


Thanks for the reply and advice! I intend to work hard to get the knee back into shape.

[bbbbbb]

[QUOTE=Tbear;1377536]When I realized I needed a knee replacement, I began searching the web to find out as much as I could about the process but never really found an account that answered so many small but significant ( to me ) questions that could help me understand and get through the process. So my way of giving back to all those that find themselves in a similar situation is to share my experience. This is likely to be a bit long winded and only of interest to those getting ready to have knee surgery. I'd be happy to answer questions as I can for anyone who asks. I am 70 years old and very active in Pickleball. The medial side ( inner side ) of my left knee was bone on bone form osteoarthritis.
My Surgery was March 21. It began with a search for a reputable doctor and although I'm sure there are many, two names kept popping up in conversations with friends as well as posts on the internet. The two doctors were Dr. Duke who practices in Ocala, and Dr. Ngyuen ( pronounced ' Win " ) who practice down towards Orlando.
Dr. Ngyuen is noted for non-conventional type of knee replacement in as much as he enters the knee from the lateral side as opposed to across the top of the knee cap. His method alleges less pain and faster recovery times.
Dr. Duke is a more traditional surgeon having done over 5000 knee and hip replacements. I chose Dr. Duke mainly because of his long standing success in knee replacement and his ability to do the surgery within two months of my first visit.
I have nothing negative to say about Dr. Ngyuen. He is very popular and from what I understand it takes 4-6 months or longer to get on his schedule. I had planned to visit him but cancelled because I was so impressed with Dr. Duke.
My first visit to Dr. Duke's office was to be assessed by his Assistant. She took X-rays of my knee, put me through some range of motion tests, and told me that I had bone-on-bone on the medial side of my left knee and was a candidate for surgery. However here came my first surprise. She said that the rest of my knee, the patella and lateral side were absolutely fine. Also, since I was relatively fit and not significantly overweight ( I'm 5'7 and 176 lbs ) that the doctor might suggest a partial knee replacement ( also called resurfacing ) of just the damaged area. ( I wondered if Dr. Ngyuen would have suggested the same but will never know. )
In anticipation of surgery, his assistant gave me exercises to do to strengthen my quads and hamstring which I faithfully did for about two months prior to the surgery.
She made an appointment for me to see Dr. Duke about 3 weeks later and asked that I see my primary doctor to get clearance for surgery. ( Blood work, EKG, chest X-ray )
Dr. Duke's bedside manner is second to none. He explains everything fully, gives you various options, and treats you with the kindness and respect as if he were talking to his father. I was extremely impressed with his professionalism.
He confirmed his assistants notion that I would be a good candidate for a partial replacement. He said that two thirds of my knee was fine and that two thirds of your own knee is better than a totally artificial one. He suggested putting an Oxford partial knee on my medial side. He told me if I wanted a full replacement that he would certainly do it but his recommendation was to go partial. If someday for some reason I needed more work, a full replacement could still be done. I went with his recommendation for a partial.
The surgery was done at Marion Community Hospital. Five days prior to surgery, I visited the hospital to pre-register where they took the usual information from you such as insurance, next of kin, etc.; they also took one last draw of blood and said I would be called the day before the surgery to be told the exact time. The pre-registration staff was kind, professional, and overall excellent in their interface with me and my wife.


Sure enough, I was called the day before my surgery and was told to be at the hospital at 6:30 AM. When I arrived, I was immediately taken into my prep area with my wife to put on a hospital gown. I was given a mild sedative to calm my nerves, had an IV put in my arm and heart monitor patches applied to my chest. I had a visit from Dr. Duke who marked and initialed the correct knee to perform surgery on; I was also visited by the nurse anesthetist who said I would be given a spinal block as well as general anesthesia. Shortly afterwards I was being wheeled into the operating room. They transferred me to the operating table and I remember absolutely nothing from that moment until I was in the recovery room with a nurse by my side. I felt no pain or discomfort whatsoever. Shortly afterward I was taken to my private room for my overnight stay. I did realize I had a catheter in me which would be removed the next day. If all went well, I was schedule to be released the day after surgery.
Three hours after the surgery, a physical therapist came in and had me get out of bed and with the assistance of a walker, walk from the bed to the door and back. I still felt no discomfort or pain. I was constantly being given various kinds of pills; I'm not even sure what they all were...
The hospital room was clean, bright, and equipped with a central heart and Oxygen monitoring center and of course a call bell if I needed the nurse. My oxygen level dropped lower than it should at one point and they administered oxygen to bring the level back up. Apparently a side effect of the anesthesia. There was a TV and meals served at dinner and the following day for breakfast and lunch. The staff, through all the shift changes, were excellent. Professional, caring, and attentive to your needs. Hats off to the staff of Marion Community Hospital.
The second day the therapist returned and this time I walked all the way down the hall and back. I also went to a physical therapy class where they explained some exercises to do as well as how to climb steps as your knee begins to heal. I was still in no pain and beginning to think this wasn't so bad after all ... stay tuned!
I was set to be released except I had to prove I could pee before they would let me go. Seemed sort of odd that they remove the catheter and then want you to pee ( nothing left in the bladder ! ). So I drank a whole bunch of water but much to my dismay I still couldn't pee. They became concerned and did a bladder scan to determine how much fluid was in my bladder. They were concerned it was too full so they did another catheterization to remove the fluid. ( Creepy procedure for me, slight discomfort but not my favorite experience. ) A few hours later I was able to pee and they could then discharge me. They said that my experience with this was not an uncommon one after surgery and catheterization.
I was sent home with an ice machine that looks like a cooler with a leg wrap that pumps ice water around your leg. They also gave me some things to help me to get dressed and perform every day activities like putting your socks on.
I still had little to no pain but was warned that the anesthesia and spinal block actually take several days to fully leave your system and that the third day was often a difficult one with pain. - They were right -
Although I was on several pain medications including a double dose of oxicodone, the first night was a tough one for me. My knee became very swollen, stiff, and painful to move. Since I had drunk so much water during the day, I had to get out of bed and pee several times the first night and it was very, very difficult. Had I known, I would have just kept a urinal bedside so I didn't have to flex my leg to get out of bed. We bought one to have handy for the second night.
The first day home I had a therapist and nurse come to the house from Greystone. My knee movement was a mere 70 degrees. ( if your knee is at a right angle it is at 90 degrees; full range of motion is close to 130 degrees ). The therapist assessed me and performed some exercises with me to begin to get range of motion back. I was still in considerable discomfort trying to bend and straighten the knee. She also asked the doctor to give me a regiment of anti-inflammatory pills to help reduce the pain.

RESPONSE

Hi and thanks for your summary of the knee event.
I will submit this to you, trying to be helpful. After my total left knee replacement, at Physical Therapy, the major effort was to bend the knee,,,,,,,,,,,,, bend the knee a lot.
This will stretch the ligaments and get all the items involved, lined up and working again. So, OK then I had to press the PT for some facts, like how far is enough. It took some pushing to find out that the magic number is 120 degrees. This way you will have the normal travel of the knee in daily use. So, then I chose to stop therapy and I made up a strap, it is a piece of webbing with a loop on the end. I lay down on the bed, have my wife hook up the loop to my foot and then I pull and pull and pull and I even scream. 120 degrees means the full ninety degrees down and then 30 more degrees. I MADE UP A CARDBOARD OR FOAM CORE PIECE, A TEMPLATE OF THE 120 DEGREES AND MY WIFE HOLDS IT IN PLACE TO CHECK THE ACTUAL ANGLE. Why?
Because I read a story in a medical journal that if you do not get the right angle OF BEND , they may have to put you under with anesthesia and a very big medical person forces your leg to the 120!!!!!!!!!!!!!!!!!!!!!!!!! OUCH
So keep it in mind and call me if you like and I can send you a picture of the strap, over a year now, I still use it.
This bend is very important for sure. Some people do not do the therapy and do not get the bend and they really are in for some hard times with the leg.
Good luck,,,,,,,,,,,,,,,, bbbbbb 352 775 9228

[Tbear]

[QUOTE=Tbear;1377536]When I realized I needed a knee replacement, I began searching the web to find out as much as I could about the process but never really found an account that answered so many small but significant ( to me ) questions that could help me understand and get through the process. So my way of giving back to all those that find themselves in a similar situation is to share my experience. This is likely to be a bit long winded and only of interest to those getting ready to have knee surgery. I'd be happy to answer questions as I can for anyone who asks. I am 70 years old and very active in Pickleball. The medial side ( inner side ) of my left knee was bone on bone form osteoarthritis.
My Surgery was March 21. It began with a search for a reputable doctor and although I'm sure there are many, two names kept popping up in conversations with friends as well as posts on the internet. The two doctors were Dr. Duke who practices in Ocala, and Dr. Ngyuen ( pronounced ' Win " ) who practice down towards Orlando.
Dr. Ngyuen is noted for non-conventional type of knee replacement in as much as he enters the knee from the lateral side as opposed to across the top of the knee cap. His method alleges less pain and faster recovery times.
Dr. Duke is a more traditional surgeon having done over 5000 knee and hip replacements. I chose Dr. Duke mainly because of his long standing success in knee replacement and his ability to do the surgery within two months of my first visit.
I have nothing negative to say about Dr. Ngyuen. He is very popular and from what I understand it takes 4-6 months or longer to get on his schedule. I had planned to visit him but cancelled because I was so impressed with Dr. Duke.
My first visit to Dr. Duke's office was to be assessed by his Assistant. She took X-rays of my knee, put me through some range of motion tests, and told me that I had bone-on-bone on the medial side of my left knee and was a candidate for surgery. However here came my first surprise. She said that the rest of my knee, the patella and lateral side were absolutely fine. Also, since I was relatively fit and not significantly overweight ( I'm 5'7 and 176 lbs ) that the doctor might suggest a partial knee replacement ( also called resurfacing ) of just the damaged area. ( I wondered if Dr. Ngyuen would have suggested the same but will never know. )
In anticipation of surgery, his assistant gave me exercises to do to strengthen my quads and hamstring which I faithfully did for about two months prior to the surgery.
She made an appointment for me to see Dr. Duke about 3 weeks later and asked that I see my primary doctor to get clearance for surgery. ( Blood work, EKG, chest X-ray )
Dr. Duke's bedside manner is second to none. He explains everything fully, gives you various options, and treats you with the kindness and respect as if he were talking to his father. I was extremely impressed with his professionalism.
He confirmed his assistants notion that I would be a good candidate for a partial replacement. He said that two thirds of my knee was fine and that two thirds of your own knee is better than a totally artificial one. He suggested putting an Oxford partial knee on my medial side. He told me if I wanted a full replacement that he would certainly do it but his recommendation was to go partial. If someday for some reason I needed more work, a full replacement could still be done. I went with his recommendation for a partial.
The surgery was done at Marion Community Hospital. Five days prior to surgery, I visited the hospital to pre-register where they took the usual information from you such as insurance, next of kin, etc.; they also took one last draw of blood and said I would be called the day before the surgery to be told the exact time. The pre-registration staff was kind, professional, and overall excellent in their interface with me and my wife.


Sure enough, I was called the day before my surgery and was told to be at the hospital at 6:30 AM. When I arrived, I was immediately taken into my prep area with my wife to put on a hospital gown. I was given a mild sedative to calm my nerves, had an IV put in my arm and heart monitor patches applied to my chest. I had a visit from Dr. Duke who marked and initialed the correct knee to perform surgery on; I was also visited by the nurse anesthetist who said I would be given a spinal block as well as general anesthesia. Shortly afterwards I was being wheeled into the operating room. They transferred me to the operating table and I remember absolutely nothing from that moment until I was in the recovery room with a nurse by my side. I felt no pain or discomfort whatsoever. Shortly afterward I was taken to my private room for my overnight stay. I did realize I had a catheter in me which would be removed the next day. If all went well, I was schedule to be released the day after surgery.
Three hours after the surgery, a physical therapist came in and had me get out of bed and with the assistance of a walker, walk from the bed to the door and back. I still felt no discomfort or pain. I was constantly being given various kinds of pills; I'm not even sure what they all were...
The hospital room was clean, bright, and equipped with a central heart and Oxygen monitoring center and of course a call bell if I needed the nurse. My oxygen level dropped lower than it should at one point and they administered oxygen to bring the level back up. Apparently a side effect of the anesthesia. There was a TV and meals served at dinner and the following day for breakfast and lunch. The staff, through all the shift changes, were excellent. Professional, caring, and attentive to your needs. Hats off to the staff of Marion Community Hospital.
The second day the therapist returned and this time I walked all the way down the hall and back. I also went to a physical therapy class where they explained some exercises to do as well as how to climb steps as your knee begins to heal. I was still in no pain and beginning to think this wasn't so bad after all ... stay tuned!
I was set to be released except I had to prove I could pee before they would let me go. Seemed sort of odd that they remove the catheter and then want you to pee ( nothing left in the bladder ! ). So I drank a whole bunch of water but much to my dismay I still couldn't pee. They became concerned and did a bladder scan to determine how much fluid was in my bladder. They were concerned it was too full so they did another catheterization to remove the fluid. ( Creepy procedure for me, slight discomfort but not my favorite experience. ) A few hours later I was able to pee and they could then discharge me. They said that my experience with this was not an uncommon one after surgery and catheterization.
I was sent home with an ice machine that looks like a cooler with a leg wrap that pumps ice water around your leg. They also gave me some things to help me to get dressed and perform every day activities like putting your socks on.
I still had little to no pain but was warned that the anesthesia and spinal block actually take several days to fully leave your system and that the third day was often a difficult one with pain. - They were right -
Although I was on several pain medications including a double dose of oxicodone, the first night was a tough one for me. My knee became very swollen, stiff, and painful to move. Since I had drunk so much water during the day, I had to get out of bed and pee several times the first night and it was very, very difficult. Had I known, I would have just kept a urinal bedside so I didn't have to flex my leg to get out of bed. We bought one to have handy for the second night.
The first day home I had a therapist and nurse come to the house from Greystone. My knee movement was a mere 70 degrees. ( if your knee is at a right angle it is at 90 degrees; full range of motion is close to 130 degrees ). The therapist assessed me and performed some exercises with me to begin to get range of motion back. I was still in considerable discomfort trying to bend and straighten the knee. She also asked the doctor to give me a regiment of anti-inflammatory pills to help reduce the pain.

RESPONSE

Hi and thanks for your summary of the knee event.
I will submit this to you, trying to be helpful. After my total left knee replacement, at Physical Therapy, the major effort was to bend the knee,,,,,,,,,,,,, bend the knee a lot.
This will stretch the ligaments and get all the items involved, lined up and working again. So, OK then I had to press the PT for some facts, like how far is enough. It took some pushing to find out that the magic number is 120 degrees. This way you will have the normal travel of the knee in daily use. So, then I chose to stop therapy and I made up a strap, it is a piece of webbing with a loop on the end. I lay down on the bed, have my wife hook up the loop to my foot and then I pull and pull and pull and I even scream. 120 degrees means the full ninety degrees down and then 30 more degrees. I MADE UP A CARDBOARD OR FOAM CORE PIECE, A TEMPLATE OF THE 120 DEGREES AND MY WIFE HOLDS IT IN PLACE TO CHECK THE ACTUAL ANGLE. Why?
Because I read a story in a medical journal that if you do not get the right angle OF BEND , they may have to put you under with anesthesia and a very big medical person forces your leg to the 120!!!!!!!!!!!!!!!!!!!!!!!!! OUCH
So keep it in mind and call me if you like and I can send you a picture of the strap, over a year now, I still use it.
This bend is very important for sure. Some people do not do the therapy and do not get the bend and they really are in for some hard times with the leg.
Good luck,,,,,,,,,,,,,,,, bbbbbb 352 775 9228


Thanks my friend. I'm right with you and agree 100%. I actually bought a goniometer to measure my knee flexure. It's like a protractor that measures the angle and what the PT folks use. I also have heard stories of people that ignore the PT and end up with poor range of motion. Dr. Duke implied that I should be able to achieve full range of motion perhaps because of the design of the Oxford replacement. My right knee exceeds 130 degrees and that's what I'm shooting for. However, it's a long ways away at the moment. The best I could do tonight was 90 degrees but it's only been 5 days.... thanks for your reply.

[slipcovers]

Try to get to the gym, or better, borrow a excercise bike. It really loosened up the ligaments. 20 minutes several times a day, especially before PT.

[Tbear]

I have signed up with a local gym and plan to hit the exercise bike as soon as my therapist gives me the green light! Thanks for your comment..

[Tbear]

Day 6 after surgery - Well I just finished my exercises with the Physical Therapist and my range of motion has gone from 14 degrees (knee not being straight) to 7 degrees. Zero degrees would be perfectly straight. And my flex has gone from an original value of 70 degrees to 100 degrees. The 100 degrees is with gritting my teeth and maximum flexing of my knee I can achieve.

So, its an improvement. Knee still gets very stiff and hurts when it is in a stationary position for any length of time. I am still taking oxi an hour or so before I do the exercises so I can achieve maximum benefit.

Still walking with the help of a walker and having difficulty walking 'correctly' in the sense that the knee doesn't want to bend like it is supposed to but all in all the progress is good.

PT person says the swelling has subsided somewhat but certainly hasn't gone away. She suggested there could be varying degrees of swelling as long as a year after surgery.

All in all, I seem to be on track with no complications so I can't complain.

Thanks to all the folks that have commented and given me their advice and support. I welcome more of you that have gone through this experience to share yours with me...

[Tbear]

The physical therapist came again today and after doing all my exercises she had me recline and checked my leg flex which was about 92. This was actually a regression from a few days ago.

I wasn't prepared for what came next. She manually applied pressure to the leg until I literally could not bear the pain any further. She did this several times, each time flexing the knee further. When she was done, the knee ( at least for the moment ) was at 105 degrees. The pain while she did this was excruciating.

I had heard from others that the physical therapy could be tough but now I have experienced it first hand.... and I'm sure I haven't experienced the worst yet..... to be continued...

[starflyte1]

I had a total knee replacement (front) and have full motion. A substitute therapist did the pain thing on me once. Never again. My knee is 100 percent.

[Carla B]

My therapist called it "manipulation." Beyond pain level 10.

[starflyte1]

T-Bear

How are you now?

[Tbear]

Wow, what a difference a week makes! As I reported in previous posts, the first week or so was pretty tough for me. The pain meds didn't quite hack it especially the first few days and almost any movement of the knee was associated with some degree of pain.

Yesterday I went for my post op follow-up visit with the doctor. All good news! the implant looks good and when the wound dressing was removed the incision was healing very nicely.

The last few days I have transitioned to using a cane and feel very comfortable with it. I almost feel I don't even need it, but for safety reasons I will probably use it for several weeks.

I can flex my knee with no external force to about 94 degrees; with external force ( but not the excruciating pain I felt before ) I can flex it to 113 degrees. A normal target is 120, but I should be able to get to 130 eventually which is my goal. Although less so, the knee is still swollen which inhibits range of motion. It just takes time for the swelling to go down. I ice it after exercising and additional 2 or 3 times a day.

I can walk essentially with no pain whatsoever because my knee is comfortably bending more naturally now.

I think my biggest mistake in hindsight, was to try and wean myself of the oxycodone when I really needed it the most. I actually still use it before my physically therapy sessions so I can max out the benefit of the exercise. I do plan to phase it out totally in the coming days.

I've been given additional exercises to begin to strengthen my leg as well as achieve higher levels of range of motion.

As people have commented in this thread, its up to me now to put in the work to get back into full strength and flexure.

The doc said I could go swimming next week; Unfortunately, my love of pickleball will have to be on hold for awhile!

I have some neat X-rays of my implant and would be happy to email them privately if anyone is interested.

TBear

[starflyte1]

Thank you for the update! Happy to hear all is going well.

[Carla B]

My husband has been dismissed from physical therapy. Knee flexion is 135 degrees. All is well with the knee but the back is another matter. Good luck to you and thank you for posting. What you've done is very helpful.

[Tbear]

My husband has been dismissed from physical therapy. Knee flexion is 135 degrees. All is well with the knee but the back is another matter. Good luck to you and thank you for posting. What you've done is very helpful.


Was his back issue related at all to his knee replacement or subsequent physical therapy?

[Carla B]

Back issue has been going on a long time. But went he went to outpatient physical therapy certain exercises they wanted him to do for the knee aggravated the back. He had a hard time making them understand he couldn't do some of the exercises. Regardless, the knee progressed very well.

[Tbear]

It will be 3 weeks tomorrow. I do PT 3 times a week with a PT person and the same exercises myself the other 4 days of the week.

I can flex my knee 116 degrees; with external pressure from the PT person it now goes to 121 degrees. ( grit my teeth and to the max of my pain tolerance ). A long way from 70 degrees the day I got home from the hospital.

The incision looks quite healed and much like the scar I will have going forward although it will probably blend as time goes on.

Walking exclusively with a cane; trying to re-learn my normal stride without a limp is a work in progress. Through the normal range of motion when I walk, the knee sort of feels like it has an ace bandage wrapped around it - not painful, just slightly stiff- just enough to impede a normal gait.

Tylenol is the pain med I primarily take as needed.

The knee is still swollen; Although the swelling has subsided, it still has quite a ways to go and I expect it will take another month or more to even begin to look normal again.

I ice it after the two exercise periods I do every day as well as 2 or 3 random times during the day.

I have another week of in home therapy and will then be going to an outside group - Florida Rehabilitation Specialists in Lady Lake.

I'm cleared to go in my pool now so hopefully as the warmer weather sets in this week that will be a treat for me...

This hasn't been a fun process, but I truly think when its over I will be quite happy. Before my surgery, I couldn't retract my knee more than 114 degrees under any circumstances. - and I'm already a 121 and hopefully headed for 130+.

Until next time -

Regards from Tbear

[bagboy]

It will be 3 weeks tomorrow. I do PT 3 times a week with a PT person and the same exercises myself the other 4 days of the week.

I can flex my knee 116 degrees; with external pressure from the PT person it now goes to 121 degrees. ( grit my teeth and to the max of my pain tolerance ). A long way from 70 degrees the day I got home from the hospital.

The incision looks quite healed and much like the scar I will have going forward although it will probably blend as time goes on.

Walking exclusively with a cane; trying to re-learn my normal stride without a limp is a work in progress. Through the normal range of motion when I walk, the knee sort of feels like it has an ace bandage wrapped around it - not painful, just slightly stiff- just enough to impede a normal gait.

Tylenol is the pain med I primarily take as needed.

The knee is still swollen; Although the swelling has subsided, it still has quite a ways to go and I expect it will take another month or more to even begin to look normal again.

I ice it after the two exercise periods I do every day as well as 2 or 3 random times during the day.

I have another week of in home therapy and will then be going to an outside group - Florida Rehabilitation Specialists in Lady Lake.

I'm cleared to go in my pool now so hopefully as the warmer weather sets in this week that will be a treat for me...

This hasn't been a fun process, but I truly think when its over I will be quite happy. Before my surgery, I couldn't retract my knee more than 114 degrees under any circumstances. - and I'm already a 121 and hopefully headed for 130+.

Until next time -

Regards from Tbear

With all due respect, you should ask your doctor and your Physical Therapist about your extra excercise on days when you don't have a PT session. I get the feeling that in your determination to heal and heal quickly, you may be overdoing it somewhat.
I had a TKR in 2013. I had daily in home PT the first week , along with daily walks. I then went to a rehab clinic for 3 or so weeks. I too would do exercises at home, a combination of the in home and rehab regimen. I mentioned the extra work I was doing and my therapist told me to Stop!!! He said my body and knee needs time to heal, especially after a rehab session. Too much too soon would cause continued swelling, pain, and inhibit the range of motion in my knee. Among other things. With that advise, my rehabilitation was a great success. I've read your posts from the beginning and hope for your complete recovery. I just sense IMHO that you may be slowing your recovery. Your doctor and physical therapist would be the sources to ask. Good Luck !!!

[Tbear]

With all due respect, you should ask your doctor and your Physical Therapist about your extra excercise on days when you don't have a PT session. I get the feeling that in your determination to heal and heal quickly, you may be overdoing it somewhat.
I had a TKR in 2013. I had daily in home PT the first week , along with daily walks. I then went to a rehab clinic for 3 or so weeks. I too would do exercises at home, a combination of the in home and rehab regimen. I mentioned the extra work I was doing and my therapist told me to Stop!!! He said my body and knee needs time to heal, especially after a rehab session. Too much too soon would cause continued swelling, pain, and inhibit the range of motion in my knee. Among other things. With that advise, my rehabilitation was a great success. I've read your posts from the beginning and hope for your complete recovery. I just sense IMHO that you may be slowing your recovery. Your doctor and physical therapist would be the sources to ask. Good Luck !!!


Thanks for sharing your experience and for your advice. I'll double check with the PT person Wednesday; she is well aware that I do the exercises on the " off " days and as My wife and I recall it was her recommendation. I totally agree that there is a point that I could do more harm than good. Perhaps that will come into play more when I start working with weights and resistance machines but I will definitely check and comment back to you. I should be talking with the docs office tomorrow to arrange visiting the outpatient rehab place and will ask them.

It will also be interesting when I begin with the new rehab facility the end of next week to see their philosophy.

Thanks again for your interest and response.

Tbear

[bagboy]

Thanks for sharing your experience and for your advice. I'll double check with the PT person Wednesday; she is well aware that I do the exercises on the " off " days and as My wife and I recall it was her recommendation. I totally agree that there is a point that I could do more harm than good. Perhaps that will come into play more when I start working with weights and resistance machines but I will definitely check and comment back to you. I should be talking with the docs office tomorrow to arrange visiting the outpatient rehab place and will ask them.

It will also be interesting when I begin with the new rehab facility the end of next week to see their philosophy.

Thanks again for your interest and response.

Tbear


That's great !!! I wish you nothing but the best in your recovery.

[Tbear]

That's great !!! I wish you nothing but the best in your recovery.

Well I had a chance to check about the frequency of exercise/PT and it seems to play out like this....

Both my doc and the therapist advise doing the PT exercises everyday twice a day - ice after each plus 2 or 3 more ice sessions during the day. What is clear, however, is I'm not to do anything more or DIFFERENT than they are prescribing. In other words, don't go on the internet and come up with additional and different exercises that promise to quicken your recovery.

As I mentioned, I begin PT with an external group on the 21st so it will be interesting to see both what exercises they give me ( it will be at the 4-1/2 week mark ) and their recommendations for frequency.

As of this morning, my PT lady can ' force ' the knee to 123 degrees ( ouch); I can force it to 121 degrees using a strap; and I can achieve 116 just using my leg muscles.

Every degree gained is both a struggle and huge accomplishment...

Regards from..

Tbear

[Tbear]

Week 4 - Well I had my last in home PT today. I can retract my leg to 120 degrees; the Therapist can force it to 127 ( my maximum threshold of pain tolerance ).

Her assessment was that I am walking quite naturally now ( don't need the cane, but she still insists that I use it ).

Off all meds although I do take some Tylenol before my PT sessions in anticipation of her stretching my knee ( ouch ).

Only feel a slight tightness during the normal range of motion needed to walk. Although the swelling continues to subside, the knee is still not back to normal and does vary based on the exercises that I do.

Friday I will begin therapy with Florida Rehabilitation Specialists in Lady Lake. If anyone has had experience with them, please let me know..

The incision area and scar looks really good and continues to blend with the knee. I'm applying Maderma once a day to the scar to facilitate its healing. I'm also applying suntan lotion since the area is quite susceptible to sunburn.

Tbear

[Tbear]

Five weeks - The knee continues to heal without complications. No more cane; walking normally now with no discernable limp or abnormal gait. Scar looks very good; blending in with the skin nicely. I'm putting Maderma on it once a day and also massaging it with cocoa butter.

The main surprise, was that when I began with my new out of house therapist, he has continued my treatment with a totally different approach moving forward.

First of all, no more tear jerking yanks of my knee to see how much flexion we can squeak out. He feels that I have plenty of flexion for 5 weeks and over the coming months as the swelling continues to subside I will get more flexion as the result. Instead, he is concentrating on stretching my hamstring.

He explained to me that the hamstring is the key to flexion of the knee and we would work on improving that for awhile.

A typical session consists of a few minutes of ultrasonic treatment of the knee followed by a targeted massage of specific areas of the knee to continue to break up scar tissue. He then stretches my hamstring in a controlled fashion by laying out the leg straight and while pulling in my toe, compresses the knee. I can feel the stretch, but this is far less uncomfortable than when my previous therapist pulled my knee towards my butt.

I am ending the session now with 10 minutes on a type of machine where you sit and push pedals first with one foot than the other. Its call a stepper, but not the kind you stand and climb on. I've never been one to use machines so most of you probably know what I am talking about more than I do.

He is suggesting that I take 20 minute walks - in a pool every other day! I'm already taking 2 twenty minute walks around the neighborhood every day.

Although I feel like I can be more active, he explained that the bone is re-modeling ( growing into ) the serrations on the surface of the implant. That together with strengthening my muscles is what needs to happen before I get back to sporting activities. The doctor said I can chip and putt at six weeks; play doubles pickleball at 12 weeks.

I really feel the worst is behind me and I just have to put in my time and follow the advice of the doctor and therapist and things should be fine...

Tbear

[Tbear]

Well its been six weeks since the surgery and I must admit that a bit of confusion is setting in...

The knee is still slightly swollen and as a result my flexion is staying about the same - around 115 degrees with no discomfort at that position. My PT person does not want me doing further flexion stretches, only extension stretches.

I've been reading various sources on the internet about swelling and its treatment ( always dangerous to read stuff on the internet ) and there seems to be several schools of thought.

One suggests that swelling ( within reason ) is good in the sense that it is the body's way of handling the healing process of the trauma to the knee. As such, trying to reduce the swelling too much or too soon with frequent ice sessions can actually slow down the healing process.

The classical school of thought - RICE - Rest, ice, compression, and elevation, suggests that is the best course of action and anything you do to increase swelling should be avoided. Do not exceed your threshold of discomfort by either exercise or daily activities because that leads to more tissue irritation and swelling which you want to avoid.

There is a web site called bonesmart.org that essentially says leave your knee alone and it will heal just fine. Your range of motion is there and will come back as the remainder of the swelling subsides. It strongly believes that the expression 'no pain, no gain' is a total myth.

So what the heck do you believe?

At the moment my knee feels great when walking and doing daily activities. I still can't put full weight on it in the sense of climbing stairs but it seems clear that for at least several more weeks not putting excessive stress on the joint is the right thing to do to allow the bone to grow into the implant (remodel).

My current physical therapist seems to be of the school that only extension stretching is needed at this point. He also has me taking 20 minute walks in a pool as well as 10 minute sessions on a horizontal stepper machine with increasing resistance each week.

So perhaps I'm no longer obsessed with the rest of the swelling rapidly subsiding if in fact physiologically it is needed to complete the healing process. Let me be clear, the swelling that occurred right after surgery is long gone and I'm referring to some residual swelling that is impeding my flexion from continuing to improve towards my goal of the 120-130 range.

I'm in that frustrating phase where I feel good and want to do more athletic related things but I know that I can't for another six weeks or so.

I need to stop whining though; I met an individual the other day that had his knee replaced in November and he can't move it past 60 degrees of flexion and is still in PT 5 months later. He said his knee also 'slides' side to side slightly. He showed me pictures of his leg after surgery and it looked like a truck ran over it - severely bruised from his hip to his ankle - couldn't believe what I was looking at... His surgeon plans to go back in to figure out what's wrong.

I'll continue to count my blessings.

Tbear

[Tbear]

When researching information about my partial knee replacement, one piece of the puzzle I could not wrap my arms around was how much it might cost me personally.

I have the Villages United Health Care Advantage insurance policy and all I could find out was that I wouldn't have to pay more than the maximum $1900 which was my out-of-pocket deductible.

For the benefit of those following this thread, I can now share with you what the hospital and doctor sent to the insurance company, what they paid and what I paid.

The largest bill was from the hospital - $84,828 of which insurance allowed and paid $8,595. I was in the hospital technically for 1 day with an overnight stay as required by Medicare and I paid a hospital copay of $150.

My doctor billed $2,800 for the surgery of which insurance allowed and paid $1,196. I paid nothing.

There were also some smaller charges from labs and another physician which I think was the anesthesiologist who charged $475 and was paid $142. None of which I had to pay.

The home physical therapy I had ( 13 sessions at $90 /session ) was paid in full by insurance and nothing out of my pocket.

The physical therapy I am now taking externally charges $180 per session but insurance allows and pays only $35 per session. I also pay $15 copay per session.

So all in all, my out of pocket for this entire ordeal has been very little. Adding in some copays for pain meds and the rest of my PT ( which ends the end of May ) I will have paid about $350 out of my pocket.

Someone opened up a scary thread in this forum called Medicare to allow Balanced Billing.

Tom Price who is the new director of HHS ( Health and Human Services ) is a former physician and as a congressman has been trying to pass legislation that would allow doctors and hospitals to charge their patients the difference between what Medicare allows and what they submitted. He is now in a position with a Republican house and Senate to try push something like this thru.

It would be disastrous for seniors. I haven't seen any actual action yet by Price to do this since he took his new position.

Imagine if I had to pay the difference or even some percentage of the difference between $84,828 and $8,595! I couldn't have had this procedure done on my knee.

We seniors need to keep an eye on this one, no matter which political party we favor!

[Tbear]

Its been 8 weeks and 2 days since my surgery. Today was my last PT session with Florida Rehabilitation Specialists ( I highly recommend ).

The final readings say my knee can flex to 128 degrees ( measured to the point of mild discomfort ) and the straightness reading is minus 3 degrees ( meaning my knee straightens past straight by 3 degrees which is perfect ).

I've begun to ride my bike and continue to do pool walking as well as hamstring stretches. I see the doc on Monday for my last checkup before heading to our summer home in MA.

I am expecting to be cleared to phase back into pickleball in about 4 weeks. Physically I feel like I could play now, but I'm sure the inside of the knee still needs some additional time to heal.

Unless there is some type of dramatic news, I'm likely not going to provide any more updates on a weekly basis. I'll probably give a heads up several months down the road to provide closure....

I hope sharing my experience has helped or will help those of you that are considering whether or not to have your own knee fixed. I'm so glad I took the plunge. My advice is - don't wait too long, it will just make it worse...

I can't speak highly enough of Dr. Duke and his staff.

I strongly suggest doing your homework when selecting a surgeon. Consider the experience of your doctor and be sure to research whether or not his methods are conventional. if they are not, research whether his methods have been peer reviewed and published in medical journals and are being adopted by other surgeons in the country. Consider whether there are long term statistics about your potential procedure and resulting implant.

Make sure you ask around. Its amazing how many people in The Villages have had knees replaced. I've learned an awful lot just talking with people about their experiences and whether or not they were happy with their selection of a surgeon.

I'll still be checking the forum so if anyone every has any questions feel free to ask...

Tbear

[Chi-Town]

128 and -3. That says it all. Good for you.

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