Four months of a new knee

I had a total knee replacement surgery four months ago and want to document what it was like for me. We’re all different, so this is only one person’s story, but most of the articles you find on the Internet are from the perspective of the health professionals, not the recipient, so I thought it would be worth it to add my two cents.

Total knee replacement is a bear of a surgery and recovery, especially in the beginning, is decidedly not easy. Meaning the first few weeks really, really suck.

The surgery was the result of my knees getting more and more arthritic as time went on, despite endless physical therapy and injections. The surgical knee was my left. Makes sense, since I’m left-handed and the left knee is my dominant one, so of course it would take more damage from life.

It is a tiny bonus that if you have the surgery on your left knee and drive an automatic you can start driving way sooner than if it’s the right knee. Worth thinking about when planning your surgery and recovery.

The thing that blows my mind and will always blow my mind is that a total knee replacement is now performed on an outpatient basis. Reported in at 6 a.m., then home before lunch. Because think about what a knee replacement actually is: Your knee is flayed open, the ends of the bones are sawed down to remove the parts damaged by the arthritis, they cut off the meniscus, ACL, and TCL, they polish the back of the patella, and they do all that without cutting the quad muscle. The prosthesis has for-real spikes and is hammered into place in your bones. Spikes!

That is hardcore. And now it can be performed outpatient. It also makes you realize why full recovery takes a year for most people. It is a lot of damage for the body to absorb and recover from.

So be patient with yourself.

Interesting tidbit I wasn’t aware of: After the surgery, if you feel your knees with the back of your hand, the knee that has had the surgery is several degrees warmer. It’s really noticeable. Lots of activity happening in there.

With total knee replacements being so common, the actual process of having the surgery done is very much an assembly-line operation. For me personally, everybody was competent, professional and did their jobs like they cared. But they do get a bit jaded so while you’ll hopefully get all the information you need, at least for me it was very much a laundry list without much organization by importance. Things that could seriously hurt you if you aren’t aware mixed in with “eh, this might be good to know.” But of course, you need to read it all. Only get one body and all that.

My personal post-surgery list by importance:

• Yes, you absolutely must have somebody with you after the surgery, and not just for 24 hours. Really. You will need assistance.
• You need a walker at least the first few days. Do not think you can muscle through. Your knee has been cut.
• The bed must be as close to the bathroom as possible.
• Stairs are 100% out of the picture.
• Have a comfy chair or couch to camp on during the days so you’re not just in bed the whole time. Mindless entertainment is your new friend.
• Eat something nice the day before surgery. Your appetite will be shot for a while from the drugs and discomfort.

As it was explained to me, the goal for recovery is for the patient to be pain free, but in discomfort. Discomfort keeps you from hurting yourself. The definitions of these words differ between people. But for me it held. I kind of freaked out when I went to the pharmacy to pick up my pain killers: Tramadol, Gabapentin, and Diclofenac. That’s it. Some googling told me Tramadol is kind of a weak-sauce opiate, so I was a bit nervous about that.

But it worked fine. I was in discomfort, holy hell was I in discomfort, but not at all what I’d call pain. (Like the pain of trying to walk with bone-on-bone knees.) Just uncomfortable. But uncomfortable always. The first few weeks are, not to put too fine a point on it, terrible. The knee is uncomfortable and your sleep is completely shot since every time you move the discomfort wakes you up.

At least for me it became a total focus for my entire mind. Obsessed with the knee. Which I guess makes sense since the injured animal should focus on its current biggest liability. But it’s a bit scary to become that focused on a single thing.

I suppose as testimony to how dialed in the whole knee replacement process is, the big fear these days is blood clots. You’re mostly bedridden and your knee is a ball of inflammation, so of course blood clots are a potential killer. As part of checking out I received a pair of Intermittent Pneumatic Compression Devices with instructions to wear them for 72 hours. Fortunately the devices had timers so I knew exactly how many hours they’d manhandled me. The devices are battery-driven so they need to be charged and they do make noise. After a while I found them too annoying to sleep with, so I wore them religiously while reading or watching TV until my 72 hours were up. Because I do wish to minimize my risk of a blood clot at the cost of a super extended annoying weak massage.

Also as part of the blood clot fear, you will probably be issued with thigh high support socks. They also get annoying after a while, but keep wearing them until the doctor says to stop.

I was also kind of surprised I wasn’t prescribed any antibiotics, what with, you know, the brutality of the surgery, but once again, it was dialed in. Didn’t need them. Science FTW again!

Once past the first few hard days, recovery started to get easier. You need to do your PT no matter what it feels like, but at least for me the PT wasn’t too bad. No pain, just discomfort. Lots of discomfort.

After a while though, recovery started to become linear. A little better every day. Not much, just a little, but better. Every day. So I just stayed with the icing, the PT, the light entertainment, and the space my knee was taking up in my head, until it got so much better. Just not being in pain is amazing, let me tell you! After all these years of getting a little bit worse every day, to have that reversed and get a little bit better every day is amazing.

Note that you lose a lot of strength in the knee. Again, think about what kind of surgery this is—the amazing thing is that you can walk at all. Your recovery will be easier the better shape you’re in, and especially what your Range of Motion is. ROM is the obsession of everybody in the knee replacement biz. ROM determines success. If the range of motion in your surgical knee is over 120 degrees, you are considered functional. If it’s 130, you are doing great. If it’s 140 the other patients all want to beat you up in the parking lot. The ROM is what all the PT is about.

So the better your ROM before the surgery, the easier recovery will be. I know, I know, you’re having the surgery because you’re in pain from your knee, so increasing the ROM in that knee is a bag of hurt. Nevertheless. Nevertheless.

Also after the surgery, the surgical knee will feel weird in new and exciting ways. Ways you will have time to ponder while you’re sleepless at night. Like something is moving in there. Like it’s itching deep inside. Like there’s an extra pulse in there. It will also most of the time feel like somebody or something is squeezing it lightly.

The most unexpected thing for me though is the feeling when I get on my knees and put a little weight on the surgical knee. It doesn’t hurt, really, but it feels so incredibly wrong, just so wrong, that it takes a lot of effort to remain kneeling. No pain, just the weirdest feeling of some kind of Elder Gods Mountains of Madness body horror situation. It’s upsetting.

Also let it be known your knee will be stiff when you wake up in the morning. Your body wants to protect injured parts and not use them, but counterintuitively you need to use the knee to make the stiffness go away. But you don’t want to. You want to protect it. But you have to use it.

Remember: The recovery is linear. Motion is lotion. Hang in there.

I hope this is useful for somebody. Obviously don’t take medical advice from random sites on the Internet.