DETAILED ACCOUNT OF TKR EXPERIENCE

THINGS TO PREPARE BEFORE SURGERY





X-ray post surgery

X-ray before surgery



                                             

Before I went through a bilateral total knee replacement (TKR) surgery, the condition of my joints were already serious, literally bone on bone like the x-ray above on the left.  The surgeon  tells me the brand and model of the artificial joint that he will be using which is obviously carried by the hospital.  So there really is no option for me to choose from.  However, I was told to google and read about the product from the internet.  I did and found that it was a reputable company/brand with lots of experience.  I felt reassured.

He also showed me a replica of the artificial joint and explained the type of material its made of, how it works and how they implant it.  I even googled youtube and saw some videos of TKR surgery.  Yes, it looked gross and I felt really nervous.  If you cannot stomach such visuals, then please do not do it.  For me, I controlled myself and viewed the whole video as I wanted to understand the whole process.  So it was enlightening for me.

I asked my surgeon questions such as;  what will happen if I fall?.  Well, he said that if you fall, it would be just like any other ordinary people.  It depends on whether it was a minor or major fall.  If its a minor fall, you will end up with cuts and bruises.  If it was a major fall, then an x-ray would be able to tell you the condition of the joints. 

My friend who also went through a bilateral total knee replacement a few years ago, told me that I would need a walker immediately after the surgery and she was kind enough to lend me hers.  It looked something like this one below on the left.  It is height adjustable and foldable. Subsequently, I progressed to a cane and the one I bought from a pharmacy looked like this one below on the right.  I chose this cane because the height is adjustable and this is important to ensure good posture.  Plus, it is foldable so it can easily fit anywhere.

For those of you considering or have already scheduled a TKR surgery, it would be good to find a suitable chair.  I wish I knew about this before the surgery so that I could be more prepared.  You know, everywhere I went after my TKR,  it was like I  was on a mission to look for the perfect chair.  I have never been so observant of chairs. I can tell you which mall have more suitable chairs/bench and which one sucks.  So based on my experience, I found that a solid chair with armrest is the best.  This would ensure that the chair is sturdy and the armrest is very useful for getting up.  Also, the higher the chair, the easier to sit down and get up.  Here are some examples of suitable chairs I obtained from the internet.

While my PT said that I should not sit on sofas but I found that if the sofas or recliners are high enough and the seat is firm, then they are appropriate.   It would be better if they come with armrest for the ease of getting up.

As for beds again, the higher the better.  I found that the hospital bed is the best as the height is adjustable.  Of course, we cant have hospital beds at home but we can just make do with whatever we have.  Try moving furniture around so that you can grab hold of it to get up.  I have seen videos in youtube where people have made lots of ingenious improvisation to turn their legs on the beds and also to get up from it.  Again, these are things that we do not know unless we did some research.  Rest assured, the doctor would not tell you any of such information.

Another challenge is sitting on a toilet bowl.  Most modern toilet bowls are too low.  I could not even push myself up with the walker.  So I improvised by holding on to something solid near the toilet bowl.  If I knew this earlier, I would have installed a metal bar/handle near the toilet bowl.  You can also consider getting portable toilet bowl raisers like the pictures below.  I did not know this until I saw my mother using one.  Its quite high and easy to sit and get up.  I was also obsessed with the height of toilet bowls when I go out after TKR.  I resorted to use public toilets for the handicapped hoping that they will have higher toilet bowls with metal bars for support.  Its disappointing to find that most of such toilets are not user friendly for people after TKR.

As part of preparation for surgery, its important to strengthen the muscles of your upper and lower body.  This is helpful especially after the surgery as you would need a lot of strength to be able to move about with the walker, crutches or canes.  You also need a lot of strength to push yourself  up from a sitting position as the muscles around the knees take some time to strengthen back even with regular physical therapy.

BEFORE SURGERY

When I consulted my Orthopaedic Surgeon (OS), the x-ray showed that the condition of my knee joints were already at stage 4 out of 5, 5 being the worst.  My cartilage were badly worn out to the point that the joints were literally touching each other.  Spurs were also seen due to the damage of the joints caused by the grinding action when I walk.  This explains the increased pain that I was feeling of late up to the extent that I felt the pain even though I was just sitting down or sleeping.  Also, the pain medication doesn't seem to work anymore. 

This OS was recommended by the same friend who lent me her walker.  She had the same surgery on both knees about a few years ago and she was happy with the result.  She was in her fifties and her arthritis resulted in two bowed legs.  She tried everything that she could think of but nothing worked. Even her thought of surgery was criticised by friends and family members who warned her of the danger of complications.  Anyway, surgery was her last resort and she was courageous enough to go through it.  After her TKR, she has pain free knees and both her legs were straightened back to the right alignment.  I was really motivated by her experience and that's why I decided to seek treatment from the same OS.

On my first consultation with my OS, I had already decided to do a bilateral TKR.  There was no question of whether I should do one knee first and another later.  It didn't cross my mind because both knees were equally bad so, I just had to get it all done at the same time.  Now, I understand that most people who did one knee first ended up with one good knee because the fear of going back to do the other is too great.  My OS told me that its quite rare for someone like me aged 49+ going through such surgery.  Most people who do such surgery are in their 60s and above. Considering my age and a lifespan of 20 years for the artificial joints, I would have to do a revision probably when and if I reach 70 years.  I cringe at the thought of that but what else can I do?  Seriously, I wish the experts would have designed something that could last 40 to 50 years, I told my OS and he said that its possible maybe by the time I do my revision.  Then he laughingly said that he definitely wont be the one doing my next surgery as he would be as old as me, that is if both of us are still around...he..he...

Then he explained to me the time frame of when I would be able to walk, climb, squat, drive and travel overseas after the surgery.  Sounds good.  He told me that the risks for such surgery includes infection and deep vein thrombosis (blood clot).  On the day of the surgery, they have to make sure that my blood pressure is not elevated and no infection anywhere. He asked me to squat and I could do it but not all the way down.  So he said I could get the flexible artificial joints. I didn't know that there were any differences.  He explained that if I can't squat at all before the surgery, then there's no point giving me the flexible joints which is slightly more expensive.  I found out later that my friend got the ones that cannot bend because she couldn't squat at all before the surgery.  It seems that if we suffered from osteoarthritis for too long, our body structure would have been affected to the extent that not only do we lose our squatting ability but we end up with bad posture, back ache etc.  Wish I knew about this earlier.

Then my surgeon discussed with me about whether to use anaesthesia or epidural.  With epidural, he said I would be pain free for 24 hours after the surgery and thereafter, the pain would have been reduced by 50%.  With epidural, side effects such as nausea would be less prominent.  For anaesthesia, he said I will feel the pain immediately after the surgery and would have to wear a morphine pump which would be dispensed at a certain interval.  Anaesthesia would cause more severe nausea which is true for me based on my experience with other surgery in the past.  He said about 60% of patients would opt for epidural.  Actually, I prefer anaesthesia so that I would be fully knocked out and not know anything.  For epidural, I would not be fully sedated so would be semi conscious.  I weighed the options and decided on epidural simply for the benefit of the pain relief but was still nervous about it because I have not experienced it before. 

So a date was set for the surgery.  I continued working but have already stopped exercising as the pain was unbearable.  At this point, I regretted that I did not google or read relevant materials to find out more information of what I should prepare or expect before and after the surgery.  You will see why as you read more about my experience.

DURING SURGERY / HOSPITALISATION

On the day of the surgery, they took my blood pressure, blood tests, chest and knee x-rays.   Actually, I was more worried about my blood pressure because if it escalates, they would delay or cancel the surgery which was the last thing I wanted.  Fortunately, everything was fine.  The nurse made some preparation by cleaning and shaving my legs.  Then something funny happened.  I asked the nurse, "How is the doctor going to know that he is supposed to replace both knees?  I don't want to wake up to the horror that only one knee was replaced".  Then she said "Don't worry, after I cleaned your knees, I will put a plaster on each knee so that will indicate that both knees must be replaced".  Well, that was some relief to me at that time but it does feel a little silly of me now to have asked such a question.

 The Anaesthetist came to see me and asked all sorts of questions.  Finally, I was wheeled into the operating theatre and there I had my first experience of epidural.  I had to sit up on the bed and bend down towards the front hugging a pillow.  Then he started poking from behind my spine which took quite a while.  I had to ask "Why are you taking so long?" And he said, "The first time didn't work, so I am doing the second time".  Thank goodness, the second time worked.  I didn't expect that it would take this long to do the epidural.  The whole experience felt unpleasant to me.  Anyway, immediately after, I was told to lie down.  Then, I felt numbed from the waist down and I could hear my surgeon's voice.  I started drifting away.  In between, I could hear noises like drilling and hammering and my body jerking a little.  I would complain to my Anaesthetist as to why I'm not sedated as I could hear noises.  He would just say "relax and go to sleep".  Then I drifted in and out again.  Finally, I could hear the surgeon saying that its over.  I opened my eyes and I could see a huge cloth covering from my waist down. Guess the OS was behind the cloth doing his job.  Well, it really didn't felt that 4 hours had passed because the OS told me earlier that it takes about 2 hours to do one knee.  He came over and told me that "Your bones are really hard" and that he had a hard time cutting through.  So I said "Is that good or bad?" and he said "Of course, its good".  Well, now at least I know that I would not have brittle bone problems.

After the surgery, I was wheeled into a high dependency unit as I needed to be monitored for at least one night.  I could not feel anything but was drowsy and drifting in and out.  There were quite a number of patients in this unit and it was quite noisy.  As I was feeling drowsy, it didn't bother me too much.  My husband and some family members visited me for a brief moment.  I told them what the surgeon told me about my bones and they laughed.  The next day, I was more awake. A Physio Therapist (PT) came to visit and asked me to move my legs but they still felt numbed and I could not even move them.   Actually, they did move but I just couldn't feel it.  They brought in a portable x-ray machine and took an x-ray of my knees while I was lying down.   They took a test on my blood count and fortunately it was still okay.

I was looking forward to moving to a normal ward as I started to feel restless with the noises.  However, there was a sudden drop in my blood pressure and so I could not be moved.  Later in the day, when a room was available and my blood pressure stabilised, they finally moved me to a normal ward.  I still have the epidural tube and wasn't feeling any pain.  They said that it would be removed the next day and then I will be given oral pain medications. 

The next day, I was feeling restless.  My back was very uncomfortable.  They removed the epidural in the morning and then 2 hours later, the numbness was gone and I could feel the pain in my knees .  I remembered the doctor told my husband that the pain is actually reduced by half after the epidural has been removed.  All of a sudden, my knees didn't bother me but my back was making me very uncomfortable.  I knew I have some lower back ache problems but it was not that serious.  I only felt my lower back ached when I sat for too many hours in a stretch.  So it was unusual that my back was feeling terrible and I had only been lying down the whole time.  I kinda suspected that it was the effect of the epidural.  Maybe the poking caused some scarring.  When my OS visited me at the ward, the first thing I complained to him was my back.  He laughed and said that most people would complain about the knees.  He asked why I didn't tell him that I had lower back problems.  I told him that it didn't occur to me as it didn't really bother me too much before.  So he made an order for my back to be x-rayed.  He prescribed heavier doses of pain meds for a period of time including antibiotics and then he said these will slowly be cut down.  He showed me the x-ray on my knees and the result was good.  He also said that the most important thing is that I do not come down with an infection.  So far, so good.

I had a sudden urge to get up from my bed because of the discomfort in my back.  However, the nurses said I will have to wait for the PT to come. She came but was pregnant and could not do any lifting so she just observed.  So I told the nurses to help me get up.  They brought my walker and raised my bed so that it would be easier to get up.  Sitting at the edge of the bed with a few nurses around me, I tried to stand up.  I screamed ouch!!....ouch!!when I stood up a little and dropped back on the bed.  Good grief, I did not expect it to be this painful!  It was a sharp pain. What have I gotten myself into?  How did those patients in their 70s or 80s go through this? I thought to myself.  Then I remembered my friend telling me that the first time she got up was the most painful but after that, it got better.  I tried again the second time to stand up.  Ouch!!.....it was still painful ... and I dropped back on the bed again.  Okay, I have to psyched myself up.  I said to myself, I can do it!  If the elderly patients can do this, it would be a shame if  I cant do it.  The nurses were giving me a lot of encouragement.  The third time....deep breaths.....and with a big push.... I finally stood up grabbing hold of my walker.  Phew... Thank god!!! The nurses asked me to walk slowly within the room.  So I took baby steps and hey, it didn't feel painful at all when I walked.  My friend said that when she walked the first time after surgery, it was like walking on air.  Well, I did not feel that.  After a while with all the sweat dripping from my body as though I had just done a gym workout, the nurses asked me to sit down on a chair.  I sat down on the chair slowly and it was  quite painful, having to bend the knees.  I rested for a while and then tried to stand up to walk to the bed.  Oh boy, getting up was painful too!  Finally, got on the bed and rested.  I was so tired from this whole episode.  The nurses gave me a pain jab seeing that I suffered quite a lot.

Actually, I was told that the pain was from the wounds of the surgery.  There is no pain from the new joints at all. The new joints are functional immediately after the surgery.  That's why when I walked, there was no pain.  Apparently, the OS had to cut through the muscles, tendons, tissues, nerves etc. to get to the joints and then everything had to be sewn up before they close up the wound.  That is also why the muscles have lost its strength and so getting up and down would be a struggle until the muscles strengthened again with regular physio therapy.

Recently, I read another TKRer's blog and according to the blogger, she did not feel much pain when she first stood up to walk at the hospital.  I think the reason was that she had just taken some pain meds.   Another trick I learnt from some TKRers is that before you stand up for the first time at the hospital, ask the nurses to adjust the height of the bed to a maximum height until you are almost standing at the edge of the bed.  Then when you really stand up, it would not be so painful.  I don't know why the nurses and PT that were attending to me did not suggest this.  But for those of you who will be going through a TKR, just keep this in mind - raise the height of the hospital bed and take pain meds before getting up for the first time.

Later in the day, a PT dropped by.  He taught me some exercises and made me do them quite a number of times.  He said that I have to do these exercises a few times a day and continue to do them from home. He also said that when at home, do not sit on sofa chairs or any low furniture as it would pose a problem getting up.  So I am supposed to sit on higher chairs for ease of sitting and getting up.  At that point, I think I don't even have any higher chairs at home maybe the dining chairs but not sure whether they are high enough.

So far, I have been wearing diapers and haven't passed motion for a few days.  My OS said not to worry, its normal.  I cringe at the thought of trying to sit down on the toilet bowl and getting up.

Anyway, the next day, I tried to get up again from the bed.  So here comes.... one push and I was up.  Wow.... it wasn't bad at all.  How come the the second time around, the pain seemed to have lessened tremendously.  I was joyous.  The nurses were impressed.  And with the walker, I slowly walked out to the corridor and then walked up and down the corridor.  Family members of other patients were standing outside their room and observing me.  It was really pleasant walking up and down slowly and it gave my back some relief.  At first, I wasn't bending my knees when I walked.  So the PT corrected me and helped me to improve on my walk.  So my job here was just resting and walking.

My OS came by and was happy to see my progress.

The next day, they wheeled me to the x-ray room to x-ray my back.  The result was a slight deterioration in one of the lower spinal column.  So the doctor advised me not to carry heavy stuff, not to bend too much and try to lose some abdominal fats as this strains the back.  Strangely, I still feel that I had never had such discomfort with my lower back before. 

I continued getting up and practised walking.  Then I tried going to the toilet.  Surprisingly, I could sit on the toilet bowl. The trick was to spread my legs wider, so I don't have to bend the knees too much and with one hand holding on to the safety metal bar and the other on the seat of the toilet bowl, I lowered myself slowly to sit down.   Hey, it worked and afterwards I just push myself up with the metal bar.  That was a big relief. 

My family members, children and friends came to visit me regularly and each time, they will give me a lot of encouragement.  I saw a woman patient in her fifties opposite my room and I walked into her room with my sister.  I chatted with her and her daughter.  She had the same surgery like mine except with a different surgeon and she did it one day earlier than me.  She related that her knees were so bad she was limping when she walked and it was a stranger at an airport who approached her.  The stranger seeing how she walked suspected that she was suffering from osteoarthritis and recommended her to seek treatment from an OS.  So she did.  She got diagnosed and here she was doing a bilateral total knee replacement.  She was happy that she took this step to end her misery and look forward to a brighter future.

The next day, my surgeon came and check on my knees.  He removed the bandage and then sprayed something on my knees.  Now I can see my scars.  He was happy with the result and progress.  So I begged him to please let me be discharged.  I can't wait to go home.  It has been four nights already. Finally, he said okay and made arrangements for me to be checked out.  Happiness!!! I quickly called my sister to come help me to check out because I know my husband was busy with some business visitors.  HOME SWEET HOME..... here I come.

AFTER SURGERY / RECUPERATION

While coming home was a big relief, I noticed that my furniture and toilet bowls were not very conducive for my needs.  Fortunately, the height of my three seater recliner was quite okay.  The dining chairs were not high enough and the toilet bowls were too low.  My bedroom is on the first floor and I thought I should have no problem climbing up the stairs initially.  Now I stare at the stairs and got scared.  I was frightened enough not to try climbing.  My friend told me that she slept on the sofa at the hall downstairs for two weeks because she didn't want to aggravate her wounds by climbing the stairs.  I took that as an excuse not to climb the stairs.  However, my OS said that if I can bear the pain from the wound, its perfectly okay to climb.  At first, I thought no problem.  But now, I am chickening out.  I decided to sleep downstairs for a while.  So my maid and children carried my bed downstairs.  We rearranged the furniture to accommodate my bed.

I had to resort to wearing diapers because I was afraid that I would not reach the toilet in time.  I practised walking around the house with my walker.  Getting up was still a problem.  My overweight body may have contributed to the difficulty in getting up.  The muscles are not strong enough.  I believe if you have a smaller built, it may be easier.  My maid had to help me to push myself up with the walker.  Gradually, I had to improvise on which positions from the bed that would be easier for me to get up particularly, anywhere that I can grab hold of.  And luckily, my toilet downstairs has a metal bar below the wash basin.  So I grabbed hold of this bar when I have to get up.  I have quick showers twice a day with the walker nearby.  However, I faced a problem sleeping initially.  I had to sleep on my back because my legs could not turn.  I just couldn't lift them to turn my body to the side.  I was quite disciplined in doing the physio exercises a few times a day.  Suddenly, on the second night, I could lift one of my legs and turn to one side on my bed.  I was so happy its like a big achievement.  Then on the next night, I could lift my other leg to turn to the other side on my bed.  So a bigger achievement.  Actually, I realised that it was due to my muscles around the knees getting stronger.  Its such a relief to be able to sleep on the side.  But I can feel the tightness around the knees.

My daily routine was just watching the television and practising walking around the house with the walker. My knees felt so stiff and tight. I had to elevate my legs and ice on and on and off.  I still find discomfort in my back and now its even worse because I had to sit down for longer periods.  Time was passing so slow, I was starting to get bored.

On the 5th day at home, I suddenly felt like attempting to climb the stairs.  I asked my maid and my son  to help.  Grabbing hold of the handle of the stairs, I climb up slowly two legs on one step and finally, I reached upstairs.  Wow... to me its another milestone.  I was so happy I walked into my room with the walker surveying the surrounding which I missed so much.  Then, I walked into my children's rooms taking in all the environment.  Afterwards, I realised that coming down the stairs was much more scarier.  I had to hold onto the handle for dear life with both hands and slowly walked down step by step.

After one week, my husband took me to see the doctor for a follow up check.  The doctor was happy to see my progress.  He said my healing was very fast, no infection so its a good sign and able to bend 90 degrees.  He suggested that I try walking with a cane now and come back for checkup in a month's time.  And I would need to take another x-ray at 3 months.

The next day, I suddenly felt the need to be more independent.  Got rid of the diapers...what a relief!  Managed to go to the the toilet by myself.  Arranged the furniture in such a way that I could grab hold of them when I needed to get up.  It worked.  I could sit on my recliner by myself, put up my legs and get up by myself.  I actually moved the massage chair near to the recliner so I can hold the back of the massage chair which is heavy enough in order to get up.  This was great.  I felt a sense of independence.

I decided to move my bed up to my room.  Rearranged the furniture in my room so that I can grab hold of something when I need to get up.  Tried the toilet in my room.  I could grab hold of the table top in the toilet to get up.  So every thing's in order.  Each time I achieved something, I will be so elated and high five with my maid.

The following day, I wanted to start practising to walk without the walker.  This is so strange.  How do I do that?  I mean babies don't even have to think about this.  They just let go when the time was right.  So I thought I will try with the kitchen top which is quite long and behind the long sofa.  I will hold the furniture with one hand and practised walking.  Sometimes I just let go my hand for a few steps and held back on the furniture when I felt unsteady or almost falling. 

The next day, my husband left to play golf, my son went to work and my daughter went to school.  I was alone with my maid at home.  I practised walking along the kitchen top.  I let go of my hand and walked from one end to the other. I did it!  Happiness....high five with my maid again.  After that, I asked my maid to place some chairs along the kitchen to the hall.  So I walked one hand holding on to the chairs and eventually letting go of the hand.  The whole place was looking like a musical chair game. Anyway, its good to leave the chairs around because if I suddenly lose balance, I could grab hold of the chair.  So another milestone...able to walk on my own 15 days after the surgery.

In between, I had my family members, relatives and friends visiting.  Its always nice and enjoyable when people come to visit and I find the time passed faster.  However, most of time I was alone at home with my maid when my husband and children are off to work or school.  So it does feel lonely and hopeless having nothing to do except doing the physio exercises and practise walking.  The doctor gave me 3 months medical leave which seemed like a long time to me.  So with lots of sitting down and watching DVD or TV, my back was really feeling uncomfortable.  I had to resort to putting plasters which is a temporary relief but eventually caused rashes to my sensitive skin, so I had to limit the plasters.  Once in a while, my colleague would call and give me some light work to do like reviewing agreements as I worked in a legal firm.  I would be elated to do this.  I sat on my recliner with my legs up and started to review the agreements.  Upon completion, I felt a sense of achievement and the time just flew by.

On day 20 after the surgery, I suddenly had the urge to try driving my car.  I figured that with an auto car it would be quite easy.  So I engaged my daughter's help, struggled to get into the car and managed to drive.  Yahoo!!! happiness...another milestone.  I drove to the bank and asked my daughter to go down and withdraw some money for me.  Drove to the fruit stall to buy some fruits and then drove back home.  However, later I felt my knees were very tight and swollen.  Had to use the walker and elevate my knees, ice and took extra pain meds.  Guess that was the price I paid for this adventurous episode.  But I still felt it was worth it for having felt the sense of liberation.

After 3 weeks, my husband commented that my walk still looked stiff and unnatural. Maybe its because I was too conscious and afraid of falling.  I tried using the cane and it felt better and my posture was straighter.  Without the cane, I tend to bend forward.  I think its also because my knees felt tight therefore my upper body tends to bend forward first when I walk.  Sometimes, I still tend to limp especially when the knees are very stiff and tight.  Some family members will comment why I am still walking like this.  They think that by now I shouldn't be walking like this.  I felt angry that I have to justify myself by saying that I walked like that because my knees are so stiff.  Sometimes, I wonder why people have to comment when they don't even know how my knees felt and they have never done such surgery before.  The truth is that I felt hurt by all these comments.  Its not encouraging at all.  I became so conscious of my walk.  I just wished that people could be more caring and compassionate. Sometimes, I also felt lonely and miserable and I would get emotional.  I think I cried once or twice for a very brief period but quickly snap out of it.  I tried to remain positive so that I would not feel so miserable.

Over the next few days, I was feeling bored and together with my maid, I went to the sundry store and bought some stuff, to the market and to the DVD shop using the walker because I was afraid of falling down.  It was tiring using the walker as it seemed like ages before I could reach the destination.  Afterwards, I think I over strained my knees, they felt tight and swollen and had to elevate them more.  At home, I used the cane to walk around as its better for my posture.  The skin at the scar areas felt itchy so I apply moisturiser diligently.  Some days I slept well and other days, I have problem sleeping.

I continued practising walking without the cane.  Sometimes, I would do it in front of the mirror.  I tried to see whether there's anything wrong with my posture.  Slowly but surely, it does get better.  I started venturing out to the shopping malls and even ate at restaurants with my sisters.  But I have a big fear of chairs.  Everywhere I go, I have a tendency to look for higher and stable chairs otherwise, getting up would be a problem.  I even have a phobia with plastic chairs so I avoided coffee shops.

At 2.5 months, I decided to go back to work.  I work on a part time basis at a legal firm i.e. 3 days a week.  My office is on the second floor but I managed to climb up slowly with my cane for support.  I brought food for lunch so I don't have to go downstairs.  I was grateful and happy to be able to work again.  It gave me a sense of satisfaction.  But it was tiring having to get up many times.  Each time, I have to hold on to the side of the table to push myself up.  By the time I got home, I was so exhausted I could sleep very well.

At 3 months, I went for a follow up check with my doctor.  Did an x-ray on my knees.  He was relieved that there was no gap showing in the x-ray result.  He explained that if there is a gap between the joints, then they wont be stable.  He also explained that the tightness and the pain I felt at the knees were due to the muscles.  When the muscles are scarred (due to the cutting and stitching), they will contract regularly and this leads to the tightness.  So my last battle is to achieve maximum range of motion of 130 degrees (currently at 110 degrees).  If I can do that, my knees will be more flexible, I can squat better and the tightness will be reduced.  I told the doctor that I tried my stationary bike and one leg could bend enough to cycle but the other could not.  He told me that I must push through to break the tightness.  The more pain the better.  And I have to achieve this between 4 to 6 months thereafter, it would be difficult to squat.  He stopped my pain meds and said there's no more swelling.  So my next job is to work hard at my range of motion.

I started to practise squatting but eventually I find that its better to just sit down and pull my knees into my chest as much as possible.  I also tried cycling on my stationary bike and this time, I really pushed through my knees and while it was painful initially, it got better after some time.  Also started doing my walking DVD which is 30 minutes of walking and strength training.  Sometimes, my knees felt better after a workout but other times, they felt stiff and sore. But I continued exercising and even walked in the park.  All these activities made me sleep a lot better.  However, my walk is still not  natural and people commented that I walk with a slight limp.  I think that this happens when my knees feels stiff.  When my knees feels much better, I noticed that my walk will be more natural.

I started to go to coffee shops and eating at food stalls.  I have overcome the fear of sitting on plastic chairs even though it is still a slight struggle to get up.  I have wondered how long would it take for my knees to feel normal or fully recover.  I googled and found that some people say it takes about one year to fully recover.  That's a relief.  There is also a clunking feeling in the joints when I walked.  The doctor said that its the result of the metal rubbing against the plastic cartilage.  I read that this will reduce over time.

At 4.5 months, things have improved tremendously.  I could feel that my walk and posture have improved tremendously even though the stiffness is still there.  I started to use ankle weights to strengthen the muscles around the knees.  Strangely, I felt that the stiffness was like before the surgery.  In the past, with the osteoarthritis, if I sit or walk too long, the knees will feel very tight and stiff.  Now, it still feels the same except that there is no pain from the joints. So I can't complain as I am pain free from my knees.  Of course, there is still some pain from the wounds if you press on it.  I think this will take longer to heal as the wounds are a result of a major surgery.

At 6 months, I celebrated my 50th birthday.  My sisters threw me a birthday party at a nice fine dining restaurant with some live jazz music.  I had another separate gathering with my in-laws in my home to celebrate my birthday.  These were happy moments and I think the best birthday present was still my two new knees.  Now, I could walk for 3 km without stopping and at a relatively brisk pace.

At 7 months, I took a holiday in Hong Kong with my 2 sisters in law and a friend for 2 weeks.  We stayed at a friend's house in Hong Kong.  It was a good break but quite hectic with lots of bus, train rides and walking to the extent I even lost some weight which was a bonus actually.  I survived the trip but most of the time after too much walking and standing, my knees would feel stiff and sore but I cant complain because I can move around easily without pain. 

At 9 months, I went on a shopping trip to Bangkok with my daughter and my sisters  It was a short 3 nights trip.  Things there were so cheap, we ended up with heaps of stuff.  Food was good and cheap also.  Couldn't get enough of the tom yam soup.    It was easier moving around here as there are many tut tuts available.  These are 3 wheeler taxis.  As the tut tut was quite high, I could not bend my knees enough to climb onto it.  So the driver drove and stop along a curb so that it was easier for me to climb in.   My daughter really enjoyed the tut tut ride.  After too much walking and standing, I still felt some stiffness.  Soon after we got back, it was Chinese New Year and it was a joyous moment with festive celebrations.  My knees are feeling much stronger now and I am walking more naturally with good posture. 

Then finally, my one year mark came.... its 12 months already!   You know, the moment I became active again, I just stopped counting time.  And the time just flew by.  Looking at me now, no one would suspect that I have 2 artificial knees.  There is this old Chinese man who is a parking attendant at the market.  I usually park my car there and he has seen me from the early days after my surgery walking with a walker and then a cane at the market.  He would always ask me to be careful when I walk.  Gradually, he would comment on how I have progressed in my walk.  In fact, after a few months, he said that I walked normal already. I was glad and I know that was an honest comment coming from him.

Having gained weight from not doing more vigorous exercise since my surgery, I am trying to lose some weight now.  I started doing my Jilian Michael's DVD called the 30 Day Shred.  I had to start with level 1 all over again.  I used to do level 2 way before my surgery and was able to lose some weight.  Level 1 cardio includes jumping jack.  I thought I couldn't do it and should not do it for fear of the joints loosening or deteriorating faster what with my overweight frame.  But then I remembered that I read from the internet that most people who had similar surgery before had the same reservations.  They continued to do all sorts of activities like climbing, hiking, cycling, gym, aerobic etc and after many years, their x-ray results still show that the condition of their joints looking like they just did the surgery yesterday.  This sounds encouraging so I tried and could still do it.  However, some members of my support group said their doctors advised against jumping in order to prevent premature deterioration of the artificial cartilage. This confirmed my fears and in order to have a peace of mind, I have replaced the jumping part with some lower impact activities.

So the next big question is; are my knees feeling normal now?  I have seen lots of testimonies in the internet such as people saying that they are so pleased with the result of the surgery, they can't even tell which knee was the one operated on.  Well, I'm here to tell you that after 13.5 months, I can still feel the difference between my artificial and natural joints.  There is still the clunking sensation when I walk, sometimes more, sometimes less and the stiffness is still there but it doesn't prevent me from doing anything.  I don't really think about my knees but sometimes, its the stiffness that reminds me.  Nevertheless, I am grateful that I did this surgery because now, I have pain free knees, I can sleep better, I do not have to take pain meds anymore and I can do all the things I was doing before and more.  The only downside is that with the pain in the knees gone, pain in the other parts of the body seems to be more prominent now.  Guess we cant have the best of everything.

I will continue to update my posts from time to time.  If any of you readers have any questions, suggestions or clarifications, please feel free to drop me your comments. 

This is how my knees look like today at almost 14 months.  Fortunately, I only wear long pants so the scars doesn't bother me.

Scar Post TKR