Hi everyone. Many of you have asked me about tkr revisions. I have not had one, so reached out to you for first-hand stories. Here is a compelling first-hand tkr revision story that provides helpful insight. Thank you, Amanda.
Most orthopedic literature describes the next step in knee repair after a total knee replacement (TKR) as a ‘knee revision’. It sounds simple, concise, hopeful. But, eighteen months ago, at age 61, I found my first revision experience anything but simple, starting when the metal began to loosen while swimming.
As I turned for another lap my knee locked and something ’moved’ inside the joint at the same time. Paralyzed with pain, I slowly made my way back home where I iced and rested for two days before carefully returning to my regularly life, including stair climbing, hiking and swimming.
Denial is an effective strategy for not facing required change. Looking back, I recognize that a three-year demise took place in which my knee was trying to tell me to soften my routine, add more rest periods, respect the real limitations of metal on bone.
Instead, I soldiered on even though monthly then bi-weekly then weekly acute ‘loosening’knee pain episodes would occur, and on a scale from 4-10, followed by swelling, immobility, a knee brace and crutches. Denying the need to always care for my TKR joint(s), I would gingerly use the knee, go full throttle, and then collapse with my ice packs, dismayed, but determined.
On March 28, 2018 my knee firmly ‘failed’ and declared war on my ego and on my lifestyle. I awoke from a pain-free sleep and simply stood up on the side of the bed. It was then that the knee slipped out of joint. I found myself hyperextending backwards and slipping forwards, struggling to find hand holds as I left the bed.
The joint was completely unmoored shifting right and left, backwards and forwards. The rudiments of walking were impossible: Lifting the left leg to place the heel on the ground and then moving forward from heel to toe while shifting weight to the opposite leg generated acute and paralyzing pain.
I was bedridden for days before I could move the knee without excruciating pain. The joint finally settled so that I could walk with a brace. Though I returned to basic physical therapy exercises, I knew I needed to talk with an orthopedic about a knee revision. The rest, as my blog details (www.revisedknee.com), is history.
True to its name, a typical knee revision surgery requires that the knee be fully revised. The previous incision used for your TKR is used to enter the knee. The metal components are removed and replaced by an entirely larger set: longer rods are wedged deeper into the marrow of your thigh and shin bones, holding a new joint capsule that is slightly taller than the first one, to make up for loss of damaged bone and bone material that chipped or ripped off when removing the original TKR.
Sometimes, bone wedges from elsewhere on your body are added to secure weakened or missing bone. You may lose whatever ligament fixtures you had from the previous replacement. Due to the increased complexity of a knee revision, post-surgical hospital recovery may extend by 5 to 10 days. Having household help is critical to your short and long-term recovery.
Physical therapy is – or should be- slow, avoiding use of additional weights or stiff Thera-bands. Regaining active mobility as you had with your TKR will be very limited. As my orthopedist described, “You will be able to perhaps walk to and from the grocery store (2 blocks), but do not expect to walk fast or much further in a day.”
While I built myself up to longer walks, I must always rest afterwards to allow any discomfort to subside, and sometimes for a few days. Daily discomfort is my new reality so reading, writing, teaching at home and online curbs it. I choose my social groups and outings carefully.
I toy with photography. And, finally, I have learned to slow down in order to protect my right (TKR) knee as much as my revised left.
To be clear with my tkr revision story: My experience with a knee revision is aggravated by an unusual 9-inch incision made for my first TKR, and to the side of the knee-cap. Additional muscle and soft tissue typically avoided with a now standard vertical 5-inch or so incision made down the middle of the knee joint.
(One specialist called my incision ’barbaric’.) This scar still aggravates my joint and compromises my mobility. I do believe that those with a standard incision may have more success with their healing than I have.
The description of a knee revision surgery itself forces one to pause before diving in. Depending on your history and current problem, other orthopedic options include arthrodesis or knee fusion, arthroscopy for minor repairs and cleaning, and knee manipulation under general anesthesia.
Long-term research on alternative strategies are in their infancy stages (Pre-TKR stem cell therapy, stem cell scaffolding, improved lower leg amputation followed by fitted prostheses). Those of us with TKRs have few choices when the joint fails. However, by adjusting your lifestyle, there is hope:
- Take any current TKR discomfort seriously. Once your knee ‘speaks’ of pain, listen.
- Begin a record of your joint discomfort periods. You will have no doubt when your knee fails, but arecord will give you the added certainty and confidence that revisions surgery is the right move at the right time, and not before. (See below)
- Enable your joint to do its best now, and surely later. Add knee-friendly isometric exercises targeting arms, spine, core and quad muscles. At the same time,
- Practice healing slowly by adopting more sedentary activities now such as crafts, reading, meditation, writing, stretching, working online.
- Embrace mobility devices including peoples’ arms, scooters, braces, canes and wheelchairs, etc. now to help you to live an unrevised life as long as possible, and a more satisfying revised life later.
- Attend to your soul as well as your body. Once you have a revision, fear of falling and worry will occupy a larger room in your conscience.
- An upturned tile, a sudden rise in the pavement, or a piece of gum on the floor now become criminal suspects, greying one’s outlook on life. What moves you spiritually may become a secured center piece in your life.
- Communicate your experience, your reality (re: your knee incident record). The medical profession and our peers need more information about living with a revised knee, from those directly affected.
- The more we understand how metal on bone really impacts our daily lives the more realistic (medical and social) care can be for all of us and for future generations.
To describe knee revisions as happy experiences would be dishonest, though revisions can offer relief, almost as often as TKRs With a solidly placed TKR you should not have to worry about having a revision if you allow the health of that replacement to guide your everyday actions.
Those of us with revised knees no longer wonder if a revision will solve our pain. We have to move forward with or without it, ideally using patience, creativity and flexibility to make the most of it.
Here’s hoping my tkr revision story helps you. Good luck!
Written By: Amanda Martin-Elbehri. Visit her website at https://www.revisedknee.com
Thank you for sharing your detailed insight, Amanda! I am confident your story will help others thinking about undergoing a tkr revision. Best of luck to you!
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WEBSITE NOTE: Booktoots Healing (https://booktoots.com) helps total knee replacement patients find support throughout recuperation and beyond. Its mission is for patients to understand they are not alone in their ordeal with either a tkr or other physicality concerns.
This multiple award-winning site is owned and operated by Marie Buckner, a published author, tkr blogger, and tkr patient who has been living with various physicalities for over 40+ years. She enjoys sharing her experiences to help others going through the same thing.