Knee Replacement - How did you know it was time?

[TripleB]

For those of you who have had knee replacement surgery, how did you finally determine it was time to have it replaced?

I have osteoarthritis in my right knee as well as a meniscus torn in two places. My doctor told me there was no use repairing the meniscus since the osteoarthritis is the bigger problem of the two.

I've been going through a year of injections (cortisone shots, rooster comb injection) and have had my knee drained once. I had about six months of pain before starting with the injections. The injections work until I play again and then the pain on the inside of my knee returns.

To be honest, my knee doesn't give me a great deal of pain while I'm playing (unless I go over the 3 hour mark), it's usually the two days after I play that I have trouble walking without a lot of pain.

My doc said that after I have it replaced, I probably won't get back to the mobility/quickness I currently have.

Everyone I've talked to has said they were glad they had it done (after their physical therapy time was completed), but if I'm going to be slower after it's done, the two days of pain may be the better option right now.

Again, just curious as to how you determined it was time to have your knee replaced?

Thanks!

TripleB

btw: I'm 6'2", 192 pounds, 55 yo

 

[socallefty]

btw: I'm 6'2", 192 pounds, 55 yo

Seems early for a knee replacement. Take Advil before you play tennis like the rest of us at your age.

I have arthritic knees also with one meniscus surgery in the past and one more recommended by my ortho a few years ago that I didn’t do. Have also done multiple cortisone and HA shots. What I’ve found is that my knees hurt more on the days when I don’t play - don’t ask me why, but it sounds like you have the same experience. I have the least pain when I play tennis daily which is what I do when I’m not traveling.

When I am on a trip on a lot of flights, trains and car journeys, my knees are much more painful. I don’t have an explanation unless it is the lack of tennis related endorphins and more work stress.

 

[Cindysphinx]

I have had two meniscus surgeries on my right knee, with grade 3 bone on bone in one spot.

Only one thing helps: spinning.

I decided to try spinning about four years ago because a friend told me it helped him. The difference was amazing. Now, I have no pain in that knee, no NSAIDs. But if I go a couple of weeks without spinning, the pain starts to come back. I got a Peloton so I could spin without needing to get to a gym.

I don’t love spin, but I dislike a knee replacement more.

 

[Injured Again]

@TripleB What your ortho is telling you is a lot of what I've also heard - that a knee replacement will ease a lot of the pain but that unless you've been significantly disabled with knee pain for quite a while, that you will lose some explosiveness and speed. And of those I know who have had two knee replacements, it's way worse after the second in terms of loss of agility. My ortho basically says it's up to me when I want it done. At some point, it will be the discomfort of daily living activities that will drive me to have it done rather than my ability to athletically perform.

I know multiple doctors at our club and now that I'm back to 90% of my previous capability, they're all pretty much in agreement that it's unlikely I'll have the same agility with a knee replacement though it certainly is possible. So I'm working really hard to see how long I can postpone the inevitable.

By the way, I've been reading more and more literature about cortisone shots degrading knees. It started back with studies four or five years ago, and more studies are validating that. Here's one example from a few years back:

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)

The mission of the NIAMS is to support research into the causes, treatment, and prevention of arthritis and musculoskeletal and skin diseases; the training of basic and clinical scientists to carry out this research; and the dissemination of information o

archive.niams.nih.gov

When I got my cortisone shot, I felt like it set me back two or three weeks in the healing progress. I was still in the recovery from the acute injury phase and though I've had dozens of cortisone shots that have all been highly beneficial, the one to my knee was the opposite. When it comes time with my other and currently good knee that I have to go through the insurance protocol of PT, OTC NSAIDs, cortisone, HA, and then surgery, I'm going to push hard to skip the cortisone step.

 

[Fintft]

To be honest, my knee doesn't give me a great deal of pain while I'm playing (unless I go over the 3 hour mark), it's usually the two days after I play that I have trouble walking without a lot of pain.

Now you scared me, as this has just happened last evening...
Good luck!

 

[LOBALOT]

Can one play tennis after a full knee replacement?

I am sure I have them in my future. Hips too.

 

[Mongolmike]

Can one play tennis after a full knee replacement?

I am sure I have them in my future. Hips too.

5+ years full knee replacement...going strong. No pain. Can run around like a little monkey. Ankles, lower back, wrist and shoulder are all much more problematic at this point.

Doctor knew I played tennis, post surgery he advised against it, but l told him quality of life, l will continue to play. Was completely honest. He nodded, said he completely understood, laughed and said, "See you in 10 years."

I did stop jogging and basketball, took up biking, in-line skating, and elliptical bike....non or lower impact stuff.

My favorite incident post surgery....going for a simple volley, low, reaction lunge to my right (right knee replacement)...made the volley, but was stunned...shocked....that l felt no pain or discomfort. After years of pain and hobbling, years of alternate treatments, months of painful rehab...doing a simple volley painfree almost made me cry. Seriously. I knew then that l had made the right decision, and the hard rehab would pay off.

Other people l know had replacements, and for different reasons, it really didn't work out that well. Biggest reasons l see is they tried to rush back onto the courts too soon, and/or did not work rehab hard enough (probably because it is painful). Rehab sucks, but if you don't attack it hard, don't waste your time/effort/money with the surgery.

 

[LOBALOT]

5+ years full knee replacement...going strong. No pain. Can run around like a little monkey. Ankles, lower back, wrist and shoulder are all much more problematic at this point.

Doctor knew I played tennis, post surgery he advised against it, but l told him quality of life, l will continue to play. Was completely honest. He nodded, said he completely understood, laughed and said, "See you in 10 years."

I did stop jogging and basketball, took up biking, in-line skating, and elliptical bike....non or lower impact stuff.

My favorite incident post surgery....going for a simple volley, low, reaction lunge to my right (right knee replacement)...made the volley, but was stunned...shocked....that l felt no pain or discomfort. After years of pain and hobbling, years of alternate treatments, months of painful rehab...doing a simple volley painfree almost made me cry. Seriously. I knew then that l had made the right decision, and the hard rehab would pay off.

Other people l know had replacements, and for different reasons, it really didn't work out that well. Biggest reasons l see is they tried to rush back onto the courts too soon, and/or did not work rehab hard enough (probably because it is painful). Rehab sucks, but if you don't attack it hard, don't waste your time/effort/money with the surgery.

I am glad to hear you are playing. I would make the exact same decision. I cannot live without tennis.

I am sure though I will go through all the pain, indecision before getting there though like most.

I have been doing 3 2Hr Organized Practices a week where they run us around like crazy and then mixed dubs and one other impromptu dubs match and my knees just bark at me. I had to take a break last week so only hit once as I was not able to walk. They are better this week.

My hips and back aren't great either but I really need to play. I have lost around 60 lbs since the pandemic just from not going out and having fun with friends and want to keep the weight off and I am not a gym rat.

 

[Mongolmike]

My advice, which is easy to say/hard to do is:

Lose weight.

Strengthen legs and work on flexibility/range of motion

Get gel injections (if you can afford them...they are expensive and often "out of pocket"), early. If you wait til everything is deteriorated, the injections don't do much.

Cortisone shots don't fix anything, they just reduce inflammation and some pain reduction. They can help in short term, but do nothing to correct underlying issue.

Reduce impact sports...jogging, basketball, volleyball, wallyball, etc. If you play tennis or soccer, you are gonna have soreness, so maybe reduce other activities so you can still play your favorite sport.

Word of mouth orth doc. Talk to people you interact with about who did their replacement. The good names will be repeated. For the people who say the replacement did not work, or the doctor sucked, etc...evaluate the messenger. Do you think they are the type to work thru the pain of rehab? Did they brag about getting back on the court in only 2 months?

For those who rush back early and act like it is a good thing, or a manly thing.... I say this: if you broke your leg, you would be in a cast and not playing for 6-8 weeks. Then it would take a few more weeks to restrengthen the leg. Normal. But for a replacement, it's not a broken leg....your "leg bone" is literally chopped in two. And a significant section is removed. Then you get metal pieces hammered into the top and bottom pieces. Who in their right mind would think that is something to rush back from? I was walking without crutches or a cane after about 30 days. I didn't start playing doubles until about 6 months AFTER that. I didn't feel like l was my new 100% until about a year after surgery date. Take your time, do the rehab.

 

[LOBALOT]

My advice, which is easy to say/hard to do is:

Lose weight.

Strengthen legs and work on flexibility/range of motion

Get gel injections (if you can afford them...they are expensive and often "out of pocket"), early. If you wait til everything is deteriorated, the injections don't do much.

Cortisone shots don't fix anything, they just reduce inflammation and some pain reduction. They can help in short term, but do nothing to correct underlying issue.

Reduce impact sports...jogging, basketball, volleyball, wallyball, etc. If you play tennis or soccer, you are gonna have soreness, so maybe reduce other activities so you can still play your favorite sport.

Word of mouth orth doc. Talk to people you interact with about who did their replacement. The good names will be repeated. For the people who say the replacement did not work, or the doctor sucked, etc...evaluate the messenger. Do you think they are the type to work thru the pain of rehab? Did they brag about getting back on the court in only 2 months?

For those who rush back early and act like it is a good thing, or a manly thing.... I say this: if you broke your leg, you would be in a cast and not playing for 6-8 weeks. Then it would take a few more weeks to restrengthen the leg. Normal. But for a replacement, it's not a broken leg....your "leg bone" is literally chopped in two. And a significant section is removed. Then you get metal pieces hammered into the top and bottom pieces. Who in their right mind would think that is something to rush back from? I was walking without crutches or a cane after about 30 days. I didn't start playing doubles until about 6 months AFTER that. I didn't feel like l was my new 100% until about a year after surgery date. Take your time, do the rehab.

Thank you very much for taking the time to provide guidance. I really appreciate it.

 

[LuckyR]

Thank you very much for taking the time to provide guidance. I really appreciate it.

My wife's orthopedist said every pound of weight lost is 4 pounds off of your knees.

 

[LOBALOT]

My wife's orthopedist said every pound of weight lost is 4 pounds off of your knees.

Thank you. According to that I have lost 240 pounds so far! I can't wait to tell my doctor!!!!

Of course then he will bring up the salt intake and the drinking etc.

 

[PigPen]

@TripleB My orthopedist also told me that if I do a knee replacement, my movement would be compromised. I have been doing gel injections (Durolane now) for years and stretching everyday for quite some time as well. After 2 meniscus surgeries (first one was over 30 years ago), my osteoarthritis grade has been 4 (most severe for 10 years). I also have a bone on bone condition on the outside of the knee. As a result of my issues, the knee does not bend well and I cannot fully straighten my leg when I sit on the floor.

Through it all, I can still play at a reasonably high level at 60 years old. I feel the keys are to keep the legs strong through resistance training and manage the inflammation through icing, acupuncture, medication and/or supplements.

Do you take any supplements? Do you ice your knee after you play?

 

[TripleB]

@TripleB My orthopedist also told me that if I do a knee replacement, my movement would be compromised. I have been doing gel injections (Durolane now) for years and stretching everyday for quite some time as well. After 2 meniscus surgeries (first one was over 30 years ago), my osteoarthritis grade has been 4 (most severe for 10 years). I also have a bone on bone condition on the outside of the knee. As a result of my issues, the knee does not bend well and I cannot fully straighten my leg when I sit on the floor.

Through it all, I can still play at a reasonably high level at 60 years old. I feel the keys are to keep the legs strong through resistance training and manage the inflammation through icing, acupuncture, medication and/or supplements.

Do you take any supplements? Do you ice your knee after you play?

Thanks for the advice!

I ice the knee but don't take anything except Aleve.

Like you, my right leg (the one I have the knee problems in) won't straighten flat and stays swollen most/all the time. Most of the time when I try to bend it back more than 90 degrees there is extreme pain on the inside of my knee. It took me 11 days after playing to get to the point where I didn't walk without a limp.

Again, thanks for your help.

TripleB

 

[PigPen]

Thanks for the advice!

I ice the knee but don't take anything except Aleve.

Like you, my right leg (the one I have the knee problems in) won't straighten flat and stays swollen most/all the time. Most of the time when I try to bend it back more than 90 degrees there is extreme pain on the inside of my knee. It took me 11 days after playing to get to the point where I didn't walk without a limp.

Again, thanks for your help.

TripleB

How often do you ice and for how long? I try to ice for at least 20 minutes after playing or working out. Not sure how much the supplements are helping, but I saw a a physiatrist specializing in tennis injuries and pain. He recommended Tumeric (the brand matters) and Flax Seed Oil as well as to keep moving.

 

[atatu]

I'd like some more opinions on the idea that if you get a knee replacement your movement will be compromised, because that doesn't really make sense. It seems if you're limping around and you can't run for shots, etc. then a knee replacement is going to improve your movement, not impair it. I've heard more stories like @Mongolmike's which suggests that knee replacement does not compromise movement (compared to pre-surgery).

 

[LuckyR]

@TripleB My orthopedist also told me that if I do a knee replacement, my movement would be compromised. I have been doing gel injections (Durolane now) for years and stretching everyday for quite some time as well. After 2 meniscus surgeries (first one was over 30 years ago), my osteoarthritis grade has been 4 (most severe for 10 years). I also have a bone on bone condition on the outside of the knee. As a result of my issues, the knee does not bend well and I cannot fully straighten my leg when I sit on the floor.

Through it all, I can still play at a reasonably high level at 60 years old. I feel the keys are to keep the legs strong through resistance training and manage the inflammation through icing, acupuncture, medication and/or supplements.

Do you take any supplements? Do you ice your knee after you play?

Uummm... your movement seems "compromised" right now...

 

[Mongolmike]

I'd like some more opinions on the idea that if you get a knee replacement your movement will be compromised, because that doesn't really make sense. It seems if you're limping around and you can't run for shots, etc. then a knee replacement is going to improve your movement, not impair it. I've heard more stories like @Mongolmike's which suggests that knee replacement does not compromise movement (compared to pre-surgery).

I've shared earlier my opinion on why some may or may not have a successful replacement... but to your question, it isn't just being able to run around a court.

More important, but more mundane, is being able to walk fast without worrying is my knee going to "give out" from an impingment. Walking up and down stairs in a normal gait, not one step at a time. Being able to sit in a theatre or on a flight without heavy knee discomfort from not being able to move it for extended time. Getting in or out of a car, or a low sofa without having to literally crawl your way out. Etc.

If any of this sounds like your current condition, then do what you can to set yourself up for a successful replacement, because if it works, your total quality of life rises dramatically, including tennis or skiing, hiking and biking, heck, even pickleball!

 

[atatu]

I've shared earlier my opinion on why some may or may not have a successful replacement... but to your question, it isn't just being able to run around a court.

More important, but more mundane, is being able to walk fast without worrying is my knee going to "give out" from an impingment. Walking up and down stairs in a normal gait, not one step at a time. Being able to sit in a theatre or on a flight without heavy knee discomfort from not being able to move it for extended time. Getting in or out of a car, or a low sofa without having to literally crawl your way out. Etc.

If any of this sounds like your current condition, then do what you can to set yourself up for a successful replacement, because if it works, your total quality of life rises dramatically, including tennis or skiing, hiking and biking, heck, even pickleball!

First let me say pickleball sucks and I would rather play tennis at a 2.5 level that resort to that. With regard to the rest on your post, thanks, that is exactly what I was wondering about. Also let me add that the first few steps after getting out of bed are pretty bad.

 

[SteveI]

First let me say pickleball sucks and I would rather play tennis at a 2.5 level that resort to that. With regard to the rest on your post, thanks, that is exactly what I was wondering about. Also let me add that the first few steps after getting out of bed are pretty bad.

Good Morning Sir:

While I love maybe things about the concept of pickle ball and how it works for so many, it does not work for me at all.

As far as knowing when one might be ready for a full replacement, I have been doing time in PT with a fellow I know from tennis. He played HS and collage tennis in my area and was a very good stringer in our local pro shop before getting his degree in PT. He knows me and about my former tennis and fitness. I am not sure if you have gone the PT route as of yet, but I would give that your best effort. I did not go directly to my surgeon. I have had both knees scoped and the right one was done about 14 years ago. My left one 6 years ago. I am trying to rehab both, lose as much weight as I can and eat as clean as I can. I take an number of supps for joint issues.

My former self as of late was not trying to play singles..only as bit of doubles, drilling and doing coaching and teaching. I ride a bike, inside and outside..walk and hike.
I am trying to get back to that level in the next 6-8 weeks. Going to PT 2 x a week and doing as much as I can with their app at home to compete their workouts.

The main thing is to determine what functional level of activities your are trying to get back to and communicate that to the PT staff. My experience has been very good so far. I have done PT on both after each surgery so I have some experience on how it should go. I am hopeful in my recovery. Three weeks ago I was having trouble just doing household tasks. I am much better now and moving forward. Hope that helps in someway.

 

[PigPen]

Uummm... your movement seems "compromised" right now...

Compromised somewhat but the orthopedist informed me that my movement would be worse if I opted for the replacement.

 

[Injured Again]

Thanks for the advice!

I ice the knee but don't take anything except Aleve.

Like you, my right leg (the one I have the knee problems in) won't straighten flat and stays swollen most/all the time. Most of the time when I try to bend it back more than 90 degrees there is extreme pain on the inside of my knee. It took me 11 days after playing to get to the point where I didn't walk without a limp.

Again, thanks for your help.

TripleB

A couple of things. First, have you tried wearing a compression sleeve on your knee throughout the day or when you sleep? The ones that have a patella centering hole are nice but typically seem to be made out of neoprene which makes it hard to wear for a long time. I got a cloth one that was one size too small and it works great for me on those days when the knee is grumpy. I used to wear it overnight and my knee would be much better in the morning. Now, I only wear it during days when it's not good but it sure does help.

Second, are you able to ride a bicycle or exercise bike? That smooth, large range of motion seems to really help. Even on my worst days, five minutes of 90 RPM pedaling and most of my discomfort goes away entirely for an hour or more.

Not saying you should do it, but even when my knee was swollen and stiff, I'd stretch it pretty forcefully several times a day. Like you, my PT measured my knee angle and said I was 15 degrees from being able to fully straighten it. With my medial meniscus tear and cartilage loss, I also had a lot of discomfort beyond about a 110 degree angle bend. But over the past couple of months of stretching, I can get my knee almost to fully straight, and can now amazingly squat fully down and get back up, even if that is a bit painful. I found that for me, even when the knee was swollen and stiff, that working it didn't make those things worse so I kept at it.

Good luck!

 

[LuckyR]

Compromised somewhat but the orthopedist informed me that my movement would be worse if I opted for the replacement.

Get a second opinion