Total Knee Replacement AMA

In 2023, I had two total knee replacement (TKR) surgeries. I had bone on bone in both my knees since 2017. Cortisone shots turned me into the Incredible Hulk, so angry, with minimal relief. I'm on the younger side for TKR but younger folks get TKRs. The main concern with getting them before 65 is the life of the implant - supposedly they last from 10-15-20 years. So that means I might have to go through another set of surgeries in 20ish years. 

Everyone has their own experience. Our bodies are similar but different. You don't even have the same knees on both sides, my left and right knees were different experiences. (The doc said, there is always an "easier" and "harder" knee - but you don't know which one it is until the second one.) My parents had knee replacements and their experience was different. Even Judi Dench had a knee replacement. It's becoming a totally normal thing.

The First One

My first TKR was really hard. It was my first surgery in 30 years, I had a stressful job (part time ED during difficult economic times), I knew there was going to be pain and recovery, but didn't really look into the details (because I did not want to). Part of what made the first one difficult was not understanding how my body might respond and how to address it. You're told to elevate and ice - and this is critical. But everyone has a different experience. I didn't realize what kind of impact the surgery would have on my calf and ankle until the day after when I saw the swelling and bruising. During my first TKR, my calf and ankle got very swollen and the swelling did not go down for six weeks, despite icing and elevating. I was later told by one of the PAs that the younger you are, the more possible swelling/pain you can have. (I guess you lose pain receptors as you get older.)

To help reduce the swelling the second time around, I elevated my leg for 85% of the day for the first week using a specific pillow to help elevate it. I kept my foot above my head/heart to make sure fluid did not get pooled in my leg and it worked. (TKR #1, I just elevated about 30% of the time.) Voila - very little swelling!

The second TKR was easier, but still not easy. The PT for my first recovery helped prep me for the second one. My legs were stronger so I walked sooner, but still struggled with bending my knee. I found the most bend gain after 6-10 weeks, once my soft tissue was healing. My first TKR barely got 120 degrees at 4 months post op, but 12 months later, I've got a good 130 degrees. I expect the same slow progress on bending the knee for #2. You do really need to give your body time to heal, reduce the swelling and inflammation and gently, consistently stretch.

Tips
(This is what worked for me, check with your doctor before trying these.)

1. Do PT/exercise/Pilates BEFORE surgery. I believe my second knee felt "easier" because that leg was stronger (it was also my less bad knee). I did a lot of pilates, swimming and as much walking as I could tolerate to build the strength in my quad, and the muscles around my knee pre-TKR.
2. Meal prep: Make 6+ weeks of healthy protein rich food. First knee, I hired a chef to batch cook healing food after 2 weeks and realizing recovery was going to take much longer than 2 weeks. For the second knee, I made 4 huge batches of bone broth veggie chicken soup, bone broth carrot soup, bison quinoa meatballs, a couple batches of prepared baked ziti and chicken enchiladas that I froze and could be easily baked. The goal was to have 6+ weeks of food (1 main meal a day) for myself and my husband (since he was taking care of me). This made is easy to have healthy food.
3. Menu: Part of my meal prep, was creating a fancy menu for breakfast, lunch, dinner and snack options. I also included things to do when I was bored and when I had pain.
4. TAKE THE PAINKILLERS! First knee I was like, I'll take them when I need them. My nerve block wore off and I had the most gut wrenching nausea inducing deep bone pain that completely reset my pain scale. 
5. Elevate: Just go out and buy the leg elevation pillow, you'll thank you. 
6. Ice: I got the DonJoy Ice Machine (universal XL pad and extended hose) and that worked great. The problem with the  During my second TKR, I hooked the electric plug up to a Apple Home Siri enabled plug, which enabled me to voice start and turn off the machine (after 20-30 minutes). In some cases, I would start the ice machine and then tell Siri to turn off the plug in 20 minutes and not worry about falling asleep.
7. Hot Showers & Hot Pads: While, the doc kept telling me to ice (something I had never done before), he also oked hot showers. I personally love a hot shower, so these really helped me relax. I also practiced bending my knee in the shower on a bench and often this was easier than outside of the shower. A few weeks after the surgery, I started using a heating pad on my thigh and calf to help to relax those muscles.
8. Sensation & eStim: I had a lot of physical sensation, even feeling the fluid go up and down my calf when I used compression socks. At times, the sensation was overwhelming, but it was not pain. I used an eStim TENS machine and that helped. I also had a lot of sensation return as my "nerves" turned back on and when I took a supplement to assist with nerve re-growth. I don't categorize nerve sensation over stimulation as pain per say, and painkillers worked inconsistently on it. The eStim TENS machine and icing did help calm the overstimulation.
9. Physical Therapy is Critical! Get home health PT post-op, and then go to your PT sessions. I appreciated the physical manipulation of my leg and massaging the tight muscles, but you also need to do the exercises at home too.
10. Take the time off. For my second knee surgery, I took off several months. I know it's a luxury to take the time off, but it has enabled me to recover at my own rate, sleep, do PT, and not push things. 
11. Sleep routine: When the pain was bad at the beginning, I took the pain meds and those usually knocked me out. But as the pain waned from OMFG to this F-hurts to not so bad during the day, but at night still waking me up - I came up with a relaxing sleep routing including a hot relaxing shower, calming music (ambient sleep playlist), Tylenol PM, aroma therapy, cozy fun PJs, tea, sleep meditations. Together these helped get through the gap between "all the painkillers" and none of the painkillers.
12. Massage: I'm a huge fan of massage. My calves, hamstrings and quads were so angry post-surgery and it felt like nothing could release them. Then I found a myofascia release massage/PT person and wow - this really helped. You can find one too via this online listing.
13. Hot Springs: I'm a hot springs fan, so as soon as I got the OK to submerge my leg in hot water, I went. The minerals in the hot springs really help my muscles relax, which helps my ability to bend the knee. One of my favorite hot springs is Tecopa Hot Springs, just south of Death Valley, CA. 

OK, that's it for now. Here's a link to my Amazon Shopping list if you want a quick list of what worked for my recover. 

Stay positive. I hope your surgery is uneventful, and you have a smooth recovery. Remember, the pain will fade with time and then you will be able to be more active and do the things you love. Get through the slog! And follow the doc's orders!