This personal story was prepared by one of the KNEEguru Bulletin Board patients -

"My total knee replacement (TKR) surgery took place in March 2005. It followed 2 years of attempting to recover firstly from MACI surgery and then a traumatic event that destroyed my grafts and wrecked my knee. Further ACI treatment was not an option and the TKR was my only hope of a pain free existence.

I searched for information relating to TKR's in younger patients but was disappointed to find that very little exists. Everything I read was aimed at the older patient and I was starting to feel old before my time. At 44 yrs old I didn't want to read about raised toilet seats and rails in my bathroom, visits from social services etc.. I wanted to know how having a TKR was going to affect me at my age.

So why did I decide to have this surgery?

Simple - quality of life. I was no longer living the life I wanted for myself or my family. My surgeon told me I needed the TKR to fix my knee but that I was too young to have it done. Considering the falls down the stairs, the trips whilst crossing the road etc when the knee gave way, at times it felt like I would break my neck or get run over before my knee got replaced. It is, however, a double edged sword, you can get fixed but it will only last 10-15 yrs, maybe longer if you're really careful! I asked my surgeon at what point he would consider giving me a TKR, he gave me a list of which I can only remember a few, but included:

  • worrying about how far away from the shops the car would be parked when I went shopping.
  • Not being able to walk for a reasonable distance.
  • Sleepless nights.

It was only when he finished his list I realised I'd already got to that point!

 

How did I cope with the surgery?

I had already had open knee surgery through cartilage transplantation and my surgeon used the same incision. The TKR was no more painful and the pain was well managed with a PCA (patient controlled analgesia) pump. I could've done with something a bit stronger than paracetamol once the morphine was removed 24hrs later but the hospital staff were very reluctant to oblige! I never imagined I'd be using a zimmer frame in my 40's but it did enable me to start getting to know the hospital corridor. I got out of bed the day after surgery and took my zimmer frame for a stroll, my goal was to get to the hospital entrance so that I could see my dogs when they came for a visit. Day 3 I was using one stick and getting around my room easily. I was fortunate to receive hydrotherapy whilst in the hospital and this was fantastic, I found it much easier exercising in the water. I left the hospital 5 days later on a knee that was already feeling a great deal better!

The younger patient probably won't need a blood transfusion, will more than likely manage perfectly well in the bathroom/shower without the additional aids - they do of course make life easier but would only be needed for a very short time. The younger patient will probably not have a catheter. There may, however, be a drain inserted in the wound to remove excess blood, I certainly had one.

Once home I coped fine by myself, I certainly wasn't the invalid I expected to be from everything I'd read beforehand. I managed the stairs OK with the help of the rail and my stick, taking one step at a time. I cooked all the family meals as usual, took short walks with the aid of my stick, managed fine in the bathroom and shower without any special aids. My 24 staples were removed by my GP's practise nurse after 10 days and my wound was healed fine. Oh, and I purchased the aircast cryocuff. This is very useful to me even now!

There was no protocol to follow, just a single exercise sheet, physiotherapy was my decision which I found a bit odd following such major knee surgery. My immediate reaction was maybe it wasn't that important then and wouldn't bother, I didn't know how I would get to the appointments anyway. I soon found that my flexion wasn't improving very quickly despite doing my exercises and using the static bike so in my 2nd week I found a hydrotherapy pool and commenced weekly sessions.

After 2 weeks at home and daytime TV I found myself getting bored so went back to work part-time. I worked 5hrs per day until around week 4 when I returned full-time. My office chair became my exercise equipment and I continued with hydrotherapy sessions for a further three months.

At 1 year post-op I still get pain in the soft tissue, pain medication helps control this. My flexion has never reached the 120 degrees my surgeon wanted but I'm still working on it! If I push my flexion I get pain but so far have received no explanation for this.

Things I have found out since my surgery include facts like younger people often also have soft tissue injury and the pain from this can continue long after the bones have healed. Younger patients may have had many knee surgeries before they resort to the TKR and this can also affect the recovery time. Young patients need to know that their surgeon needs to be very experienced in doing TKR's, that there are many different prosthesis on the market and they need a surgeon who fits the one to suit them not a surgeon who just sticks to one manufacturer.

 

Was osteotomy an option?

The surgeon gave me a 60% chance of the osteotomy helping and even sent me for a 2nd opinion, 2nd opinion said it was a reasonable suggestion but when he wrote to my surgeon his suggestion was to do the osteotomy and keep the TKR in reserve in case it failed! Once I was a bit more honest with my surgeon about my level of difficulty he was adamant the TKR was the best approach. I have always found it hard admitting how much pain I have, my poor surgeon has been very patient with me!

 

Was partial knee replacement offered?

We discussed partial knee replacment after my first MACI failed. The surgeon thought I was too young. I went into hospital to have a 2nd biopsy for another attempt at MACI but my surgeon wasnt very enthusiastic about doing it. Instead he did a lateral release and microfracture, after that surgery he talked about a partial knee - but then when we talked again he said there was too much damage for the uni compartmental and it would have to be TKA. I think I missed the boat on that one!

 

Am I glad I had it done?

Definitely. By having the surgery I can now walk a reasonable distance, without a stick, continue to coach a sport I love. Most importantly my vitality for life has improved dramatically, it's incredible how years of knee pain takes its toll not just on yourself but those around you. I've found myself spending more time cooking and not opting for the meal that requires less standing time at the cooker! I no longer panic if I've left something upstairs, when upstairs I don't find myself gathering as much as possible to take downstairs just to save on trips!

I realise I have been very lucky with my speedy recovery and for this I am very grateful to my excellent orthopaedic surgeon and his team and of course my own will and determination!

There is one very important point I want to add - and that I think many knee patients miss and this is the fact the knee is merely a hinge, a method of bending the leg and that without the strength in the muscles to support it then despite replacing it patients will continue to experience problems with giving way etc.. I get very concerned when I read about patients giving up on their rehab but then expect a TKR! This will be a huge issue for a younger patient who will be expecting to get back to a reasonable level of activity quickly."

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