Walking after a Total Knee replacement

[johnw]

7 weeks post surgery as of yesterday. Still going OK. And I've now been driving again for a week, yay! Finished day rehab at the hospital on Thursday. Rehab doctor and physios all signed off on me going solo from here on. Walking pretty confidently now, unaided, but steep downhill and going down steps still presents a challenge. Going uphill or up steps is generally easy enough. Working on controlled descents of steps as the biggest challenge right now. Not yet pain free but improving slowly, and swelling still comes and goes. Constant aching has been replaced by some reduction in that but now with occasional sharp pain in tendons/ligaments, presumably as things continue to heal. Still struggling to get continuous sleep at night but there has been some improvement. Rehab doctor suggested trying Melatonin, which seems to help. Being active substantially reduces the pain level and is now more comfortable than being at rest, but I have to be careful not to overdo it. I'm back to mowing lawns and a host of other routine domestic stuff but the temptation is to keep going and going beyond what is sensible right now. We're going to Canberra for a week on Wednesday. I was originally planning some longer day walks in Namadgi NP before I decided to have surgery. But now I'm restricted to what my knee can handle atm, which is probably no more than 2 or 3 kms on flat-ish ground that isn't too rough underfoot. So will try some doddles around the lake and maybe some really easy short tracks further afield.

[johnw]

11 weeks post surgery today. I'm basically walking smoothly in most situations, and up to around 5 km distance before the knee starts to significantly ache/fatigue.
I did manage a handful of short easy bushwalks in the ACT over the Christmas break. Some had moderately steep inclines/steps.
My knee is fine on the flat and going up, but descending steps and steep inclines remains a challenge. Self directed physio exercises and practice will help with that but it takes time.
Aching joint/tendons, swelling, stiffness, and partial loss of balance all still remain but are gradually improving.
The medical advice is that those things should resolve by around 6 months, but sometimes it can take up to a year for complete healing.
I'm happy with progress and I'm now back to doing almost all my regular activities, except strenuous bushwalking and cycling.
In theory I can get back on the bike now and do some riding on the road. I already do regular stationary cycling as rehab in any case.
But as I'm right handed and use my left (operated) leg to mount/dismount I'd rather wait until I'm 100% confident of throwing my full weight on it.
I'm estimating that I should be able to start trying some moderately harder bushwalks by March or April.
The knee feels good/comfortable when I move around on it, walk or exercise but still have aching/swelling when stationary.
And trying to find a comfortable sleeping position is nearly impossible, although I've recently started getting more uninterrupted sleep than early on.

Last edited by johnw on Sat 20 Jan, 2024 1:02 pm, edited 1 time in total.

[Tortoise]

Hi John. Thanks for the update. It's good to hear how you're progressing. Sounds pretty positive.

[johnw]

Thanks Tortoise . I figure it may help others contemplating the same thing, and keeps track of my own progress.

[crollsurf]

Knee replacements are a real YMMV, but I'm wondering at what point is
1. Your knee less painful walking than before
2. When you can walk further than before the op.

[johnw]

Knee replacements are a real YMMV, but I'm wondering at what point is
1. Your knee less painful walking than before
2. When you can walk further than before the op.

Yes I agree, everyone's journey will be slightly different. And sometimes complications can hinder recovery.
A couple of my colleagues at the hospital rehab gym were still having some issues at 10 weeks.

1. It was generally less painful to walk than pre-surgery after about 6 weeks (going from memory).
Walking a reasonable distance, for example up to around 4 or 5 kms, is now almost completely pain free.
In fact it I have more discomfort sitting still, or trying to sleep, than doing just about any form of activity.
But the tendons, muscles etc around the artificial knee joint fatigue faster than pre-surgery.
So once I hit the magic unknown limit some level of discomfort will set in, although a lot milder than before.
It won't necessarily stop me walking, but I usually try to finish and rest as soon as practicable.
Apart from the handful of short bushwalks I did over the Christmas/New Year period most walking is still on hard surfaces.
That said I didn't find negotiating fairly rough, uneven ground too difficult, nor did it cause any significant discomfort.

2. Watch this space. In some respects I can already walk further, relatively pain free, than immediately before surgery.
Pre-op my knee had deteriorated to the point where it was frequently painful, and I was often limping, over just a couple of kms.
I was routinely cutting walks short because of the discomfort.
My guesstimate as to when I can resume longer distance, more difficult bushwalks is probably March or April.
I'm feeling cautiously optimistic about that because I feel significantly more confident and walking a lot faster over the past couple of weeks.
If and when I can get back to the same level as when I didn't have a knee problem at all is much harder to ascertain.
I put up with a bad knee for quite a few years, trying more conservative treatments etc.
And I have to take into account that I'm no longer in the prime of youth .

[crollsurf]

That all sounds good. I remember the same problem sleeping when I did my knee skiing. You could use a pillow, but I bought a proper cushion that was concave on both sides. I'd put it between my knees at night, and it made a big difference comfort-wise being a side sleeper.

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[johnw]

That all sounds good. I remember the same problem sleeping when I did my knee skiing. You could use a pillow, but I bought a proper cushion that was concave on both sides. I'd put it between my knees at night, and it made a big difference comfort-wise being a side sleeper.

I've been using an old Thermarest pillow I had lying around unused for years (too heavy to carry these days compared with other options).
So it's been relegated to knee duty. A bit on the small side but it's filled with compressible foam beads and fairly comfortable between my knees.
It doesn't slide around because of the suede finish.

[Rione]

I had a total knee replacement not too long ago. Getting back on the trails was a big deal for me, but it took a few months before I felt ready. Starting with shorter, easier hikes helped me ease back into it. I visited this physio clinic and those guys gave me personalized advice and exercises that really helped with my recovery. Just remember to listen to your body and take it slow as you get back into hiking.

Last edited by Rione on Mon 01 Apr, 2024 4:16 am, edited 1 time in total.

[johnw]

I had a total knee replacement not too long ago. Getting back on the trails was a big deal for me, but it took a few months before I felt ready. Starting with shorter, easier hikes helped me ease back into it.

We should start a club . I hear you, and appreciate where you're coming from.
Yes, most of the advice I've had has been towards being as active as possible, but balancing that with the current state of recovery.
Anyway I feel that I'm going really well now. Not perfect yet but I can see the light at the end of the tunnel getting much closer.
I started back at remote bushcare on the weekend, with a couple of easy-moderate day trips, mostly off track, wading creeks, a few steep descents, climbs etc.
No problems other than needing extra care negotiating fallen logs and so on. My new joint is getting better with unnatural lateral movements, but I still wince now and then.
I also did a solo day hike on my off day, a bit more challenging than any other walks to date but still in the easy-moderate range. Again no problems, and I really enjoyed it.
All on track but with many steps over some steep terrain. I even threw in a short exploratory side trip on an old unmaintained historic track.
I'm technically about a month away from completing the initial six month recovery phase. Recently started back with my regular physio for some coaching sessions.
He said I wouldn't need more than three, then good to go it alone. He also wanted me back on the bike so I've started riding again.
I was concerned about mounting and dismounting with my operated leg taking most of my weight. I need not have worried, there was no problem at all.
My current thoughts are that I wish I had had the surgery much sooner, rather than persist with trying to delay or avoid it.
Level of comfort, ease and range of movement etc are already far better than pre-surgery. On flat ground I can basically walk as fast as the rest of my body is capable.
I was astonished (and ecstatic) when I recently discovered I could do that, it's something I haven't been able to achieve for several years.

[Wazza12]

John, good to see you recovering so well.
Like you I did my knee many years ago xc skiing, two arthroscopes and much conservative treatment later I can no longer walk more than a few hundred metres.
Reading your posts has finally convinced me to "bite the bullet" and have a tkr. I got a cancelation and it happens next week.
I can only hope my recovery mirrors your recovery.
A question. Do you still use walking poles, if so how soon after the op did you start? I have used Pacer Poles for years and cannot imagine walking any distance without them.
So thank you for your reports, they have been a big help.
Warwick

[johnw]

John, good to see you recovering so well.
Like you I did my knee many years ago xc skiing, two arthroscopes and much conservative treatment later I can no longer walk more than a few hundred metres.
Reading your posts has finally convinced me to "bite the bullet" and have a tkr. I got a cancelation and it happens next week.
I can only hope my recovery mirrors your recovery.
A question. Do you still use walking poles, if so how soon after the op did you start? I have used Pacer Poles for years and cannot imagine walking any distance without them.
So thank you for your reports, they have been a big help.
Warwick

Best wishes for your surgery Warwick. Like me I'm sure you didn't take the decision lightly but it sounds like you made a logical choice. I'm sure your recovery will go well.
Not much time left, but if you can work on building up your quad muscles pre-surgery, it may help speed up the process although I can't say by how much.
Everyone's journey will be different. Although my recovery so far seems fairly quick and I'm happy with it, it can still be frustrating at times not yet being at 100% capacity.
Be patient in accepting that you will have some downtime and some limitations while allowing yourself to heal (actively) and you will do well.

Poles/Aids Post-op - You will need a walking aid or stick immediately to get around in hospital. In my experience they generally get you up and walking the day after surgery.
I started with a walking frame then graduated to crutches within 2 days, and to a single walking stick by around day 3. On the advice of my physio I had kept up with daily exercises right up until surgery, which probably helped the initial fast progress. Memory is getting hazy on details but I needed the walking stick after going home probably for about a month. We already had one from my wife's hip replacement a couple of years earlier (collapsible one, about $25 from Chemist Warehouse). Mostly I was actually able to get around without it, but the advice was to take it on longer walks just in case of fatigue etc. If your hospital or health fund cover includes rehab physio classes, my advice is to take them. You will learn how to cope at home, how you're progressing, and meet others who are going through the same thing. It can be good to compare notes and discover that you all have pretty much exactly the same issues, and not worry that you may have something abnormal going on. It can be amusing sitting in a room full of like individuals with walking sticks, all with a very swollen leg (or two) and a giant scar or bandage running down it. It reminded me of a strange race of humanoid aliens.

Poles for bushwalking - I've a had an on/off relationship with them for many years. But as my knee got worse I started to use them more frequently.
I have a small collection of them . I had mostly used just a single pole until I bought a Durston X-Mid 1 tent which needs two poles for support. That said I've only done one trip in it to date.
That trip I really needed two poles as my knee had deteriorated badly and it was a really steep walk in and out. I haven't tried the Pacer poles, my tent poles are cheap ones from Decathlon.
I started back with some really easy short bushwalks just after Christmas while we were on holiday in the ACT (my operation was on 4th November).
Since surgery I've used a single hiking pole for all but the easiest/flattest walks. Recently I bought a very cheap collapsible pole online, specifically to use on remote bushcare trips.
I just wanted something ultralight/packable for hiking in/out on steep, rough terrain to work sites, but in practice it was more of confidence thing than a necessity.
I also used it on the solo bushwalk I did last weekend but again, apart from one really steep section of an old track with many badly eroded steps, I would probably have been fine without it.
At this stage I will probably keep taking the one ultralight pole, as it stuffs easily into a very small day pack, and use it as needed (physically or psychologically).
I haven't done any overnight walks for a couple of years for various health and other reasons, but can see that further out on the horizon.

[johnw]

Quick update. I'm now a couple of weeks past the 6 month post op recovery period.
Mobility is now far better than pre-surgery and getting close to as good as it was before I injured the knee back in the 90s.
For most activities I now go about my business unaware that I've had a knee replacement.
The only time I really notice it is descending steps with very deep risers, or similar obstacles, but just take it slowly on those.
Swelling has all but disappeared and both legs are starting to look like identical twins again.
Occasional mild discomfort but it's very infrequent, and lack of sleep is long forgotten.
I can almost get the leg completely flat in a prone position which is one of the measures of progress.
Still doing physio exercises myself, more or less daily, and I have a final coaching session with my regular physio in a few weeks.
I think there is still some recovery to go but I continue to feel improved confidence with every walk or other activity.

[keithj]

Your updates are much appreciated john. Many of us will be heading down the same track as you have - it's good to know what we're likely to encounter along the way.

[Tortoise]

Yes, John. Thanks for taking the time and sharing the experience. Great to hear how well it's going.

[Penguin]

Stumbled across this thread by accident. I am booked in for Bilateral TKR Tuesday week. John, your posts are very much appreciated as a vivid lived experience.

I am apprehensive about surgery, sadly I am now in the situation where I can't walk more than a few kilometres after 35 years of inflammatory joint disease. Also I have gone from riding approx 150 to 200 km a week to be down to 40 to 60km a week now. As John pointed out, the recent loss of function and increase in pain over the last three months has been dramatic compared to the previous three decades of gradual decline. Having rolled the dice and decided for surgery I am taking the pragmatic view that even if I get back to where I was 18 months ago I would be happy.

Like those who have reported it here I am sure that rehab will have its ups and downs. I have also done a lot of reading (peer reviewed scientific literature), talked to my rheumatologist, primary care practitioners and several surgeons before deciding on bilateral rather than two individual surgeries. Both knees are equally affected. I am sure others have strong views about which is better, bilateral or two separate surgeries. In my friendship groups I have heard just about every argument why bilateral is way too risky. Unfortunately most of the presented arguments against bilateral TKR are based on very shaky assumptions. For me it really boils down to the fact that one surgery is slightly safer than two surgeries, I am in reasonable health so should cope with bilateral surgery and rehab is shorter. Unless there is a significant complication, after surgery you do have a leg to stand on!

Fingers crossed I will be back in the bush in three to four months.

[Penguin]

PS I have packed earplugs for the hospital.

[johnw]

Thanks Keith and Tortoise. I'll keep doing an occasional update until I think I'm as good as it gets,

Penguin, very best wishes for your surgery. Having met some bilateral people in hospital at at rehab classes I think you've made the right choice.
They were doing quite well but obviously recovery will be slower in the beginning. Most of them simply didn't want to go through the process twice.
I can't find it now but I read a medical research report online which found that the recovery progress of bilateral patients converges with single TKRs after a relatively short period.
I can't remember the exact timeframe but I think it may have been around 8 weeks. Anyway take it easy and be patient, however long it takes. I'm sure you will get the improvement you seek.
A friend of mine is waiting for bilateral knee replacement in the public system, been on the waiting list forever. I saw him last weekend, still doesn't have a date but hopeful by end of the year.

p.s. Something I forgot to mention. We flew up to the Gold Coast last week for a short break. My titanium knee abruptly set off the airport security scanner in Sydney.
It's a PIA having to then be sent back and take your shoes off etc but something you'll have to learn to live with.
Interestingly the full body scanners at Coolangatta airport are more advanced and are able to detect metal prosthetics without any drama.

[Penguin]

I can't find it now but I read a medical research report online which found that the recovery progress of bilateral patients converges with single TKRs after a relatively short period.

p.s. Something I forgot to mention. We flew up to the Gold Coast last week for a short break. My titanium knee abruptly set off the airport security scanner in Sydney.
It's a PIA having to then be sent back and take your shoes off etc but something you'll have to learn to live with.
Interestingly the full body scanners at Coolangatta airport are more advanced and are able to detect metal prosthetics without any drama.

The literature is very strong about the reduced risk of bilateral compared to two single. The difference in significant adverse outcomes is not huge but statistically signifiant in favour of bilateral over two independent surgeries. You are right about the rehab, a bilateral is on the same path as a single TKR at to the 4 to 8 week mark depending on other external factor such as success of surgery, overall health and motivation.

I am not looking forward to airports as I generally do not have any metal products apart from a watch. Yet so many times I have had to take off my shoes - they are Vibram Five Fingers for goodness sake. Do others have to take their socks off!!!!