Post Surgery: This is what TKR looks like 3 months out

Sunday, August 25

Friday was a milestone day:  three months to the day from my Total Knee Replacement surgery.  May 23 to August 23.  Only three months, and yet, it seems, a lifetime.  And a good time to reflect on where I’ve been and where I’m going.

Here’s the short story:  I am on the mend, getting better, if not every day, certainly every week. 

For the longer version, we’ll start here.  The first order of business post-surgery was to get into physical therapy and get my range of motion back.  In fact, just hours after surgery, a PT visited me in the hospital and gave me some basic exercises to do.  Heel slides for flexion.  Quad sets for extension.  Leg raises.  Ankle pumps.  The goal was to get to 0 degrees of extension (a leg completely straight) and 120 degrees of flexion.  Sure, walking was a goal too:  they had me up and walking with a walker just three hours after my surgery ended.  But there was also an admonition:  don’t get overzealous in racking up distance walking;  the range of motion is more important to start out with.

So today, I have flexion well under control:  I hit 136 degrees the last time I was measured, which is more than my first PT has ever seen in someone with TKR.  That may not be an entirely good thing, though.  The prosthetic knee isn’t really meant to go much beyond 130 degrees, and a likely reason that I ended up with bursitis may have been because I overworked the flexion and strained ligaments, inflaming the bursa where a ligament (or is it tendon) attaches. 

Extension:  well, that’s been more of a struggle for me.  I’m still fighting to get that knee completely straight, and I’m still going to PT with Karen twice a week to work on that. Now is the time;  I don’t want to give up on this now only to find myself with limited mobility in the future because I wasn’t willing to put in the hard work.  With lots of massage and pressure from Karen (this is painful - not your feel good massage!), plus some Pilates machine stretching, and the PT exercises I do at home, alone, I’m getting there - just really, really slowly.  A few days ago, Karen measured my extension at “almost 1 degree” after she had spent thirty minutes really working it.  When my friend Clay told me that he was in PT for 3+ months after his knee replacement, it sounded like a long time to me.  Now I’m scheduled out for at least another month.  It doesn’t feel so long when you’re on this side of the fence.

Progress is good on many fronts:  I’m walking now - up to three miles in one flat “hike” last weekend, and lots of daily walks that are more like one and a half miles.  (Our friend Doug, who has had his knee replaced, cautions me against doing too much walking too soon.  A few years after his TKR, he had to have a revision, and he thinks it was because nobody cautioned him properly against doing too much too soon.)  I’m on my stationary bike for up to 35 minutes now, and am working - very slowly, just to stay safe - on short little rides on the street as well.  I’m walking up and down stairs almost normally, although Ed sometimes points out to me that I’m not doing so evenly.  I’m back in Pilates class once a week:  Karen, my PT, watches out for me, making sure I don’t do anything stupid.  I’ve finally started to drive my own car again:  because I was afraid of my surgical leg’s ability to hold the clutch in traffic, when I first started driving, I drove Ed’s Prius.  Getting back to my own car felt like yet one more step in getting my life back.  And The Rolling Stones?  Making it to the concert and enjoying it, finicky knee notwithstanding:  well, that was just the cherry on top of all the other good stuff.

My knee on the left, Doug's on the right

So, all in all, after a good start and then a couple of scary and frustrating setbacks, it feels really good to be making solid forward progress.  In fact, Ed and I had not taken any vacation time this year because my knee was such an uncertainty.  But in the last few weeks, we’ve gained enough confidence in my mobility - and promises of increasing mobility - that we’ve put together plans to use up my vacation by the end of the year (my work vacation is “use it or lose it” within a calendar year) with lots of travel.  Life is looking up.

Back in mid-March, I had my last appointment with Dr. Thomas Noonan, who had taken care of my knee for ten or twelve years.  He had been telling me, since the first time I saw him, that I would need a total knee replacement someday down the road.  Now, in March 2019, we agreed that I had exhausted all of the more conservative treatment options, and now was the time.  I had lots of questions for him, including, “how long will recovery take?”  I almost fell off the exam table when he said, “one year”.

One year?!?  Really, a full year???  I couldn’t quite wrap my head around it.  So I chose denial, figuring that a year was what it would take for someone who wasn’t active, and who wasn’t really motivated to get back to an active life.  It was only in the weeks leading up to my surgery that I started to get worried that maybe a year was the actual time needed for recovery.  I reached out to several people for advice and counsel.  One person who had had TKR told me that it took a full year before they woke up one day and realized that they weren’t thinking about their knee most of the time.

The booklet from the hospital with
info on all things TKR.
I'm retiring this from the coffee table;
happy not to need it much any more.

Now, I’m finally starting to get it, and to accept that this is just a long, long recovery.  Although I’m sleeping through the night (most of the time) these days, I still wake up pretty much every morning with my first thought:  my knee hurts.  Some days it’s the whole knee, just achy throughout.  Some days it’s a stabbing pain, something that moves around.  This knee still tells me regularly that it’s not happy.  I can’t be in one position for very long before it starts getting cranky, and forces me to get up and move.  I still ice my knee, multiple times every day.  I still have Doug’s ice machine, and I use that almost every night - although I have to return it soon, since he has another friend going in for TKR in September, and she’ll need the machine more than I do.  

I still have lots of milestones to hit on this recovery.  I’m going to hike again, and not just on flat surfaces.  I’m going to cycle outside more and more and more;  maybe next summer I’ll do the Triple Bypass.  That’s a classic bike ride here in Colorado that is 120 miles and goes over 3 mountain passes.  I’ve ridden that event three times in the past, and had signed up to ride it this summer way back before my knee wigged out.  (Good thing I bought the cancellation insurance!)  I’m definitely going to ski again:  and yes, I’m going to do some bumps, even if I have to back way off.  I’m going to run, too:  who knows how much and for how long and whether I’ll do any races, but it’s just a part of my DNA that I’m not ready to give up on yet.

For today, though:  we walked to Keith’s Coffee Bar for our Sunday church of homegrown music, and I’m sitting on our front porch with blustery winds.  There are Blue Jays noisily calling and grabbing peanuts off the tray feeder.  A hummingbird - a female Broad-tailed, I think - just stopped by a feeder, sat for a minute or so to drink the sugar-water, and then dashed off.  Chickadees are chirping in our neighbor’s front yard juniper tree.  I think it’s time to take off my ice pack, since it’s not really cold any longer, walk inside, and do a few PT exercises before I tackle the NY Times Sunday crossword.  Life could be much worse.

My bionic knee, three months after surgery