Total Knee Replacement and Hyaluronic Acid Shot experiences?

SteveI

Legend
What a terrible night of sleeping. The sensation is gradually returning to the skin on the outside of the incision, and for whatever reason it flares up at night when I get phantom itching and some zingers which feel like small electrical shocks. I never had this with my other surgeries. Between it and having to pee five times (my son bought a yummy but salty Mexican dinner from our fave restaurant so I drank a ton), I think I probably only got sleep in 30 minute segments. I woke up with the blanket flipped inside out!

And now my neighbor is hammering on their shed outside!
Have you considered a pain killer and sleep aid combination? I take them at times when my knees and back are really giving me issues.

Tylenol PM Extra Strength Pain Reliever & Sleep Aid Caplets. I use these.​

 

Injured Again

Hall of Fame
Have you considered a pain killer and sleep aid combination? I take them at times when my knees and back are really giving me issues.

Tylenol PM Extra Strength Pain Reliever & Sleep Aid Caplets. I use these.​


I am currently taking a naproxen a couple of hours before bedtime, and then a couple of Advil right at bedtime. I don’t seem to have any problems falling asleep but get woken up by the itching, and then can’t seem to get back to sleep because the itching is pretty intense.

I thought it might have been the skin regaining sensitivity and somehow being triggered by rubbing against the blanket or sheets so I wore a cotton knee brace. Nope, still got the intense itching at around 1 am. It’s a mystery why it only happens at night and almost never during the day.

I tried getting up and doing a round of exercises before lying back down at about 2 am but it still was itching. I think I finally got to sleep around 4 am.

I shower a couple of times each day so it’s not related to that. I apply vitamin E and lotion the skin a couple of times each day also so that’s not the trigger.

We have Tylenol PM so I’ll give that a try tonight. And I’ll keep a piece of sandpaper on the nightstand…
 

SteveI

Legend
I am currently taking a naproxen a couple of hours before bedtime, and then a couple of Advil right at bedtime. I don’t seem to have any problems falling asleep but get woken up by the itching, and then can’t seem to get back to sleep because the itching is pretty intense.

I thought it might have been the skin regaining sensitivity and somehow being triggered by rubbing against the blanket or sheets so I wore a cotton knee brace. Nope, still got the intense itching at around 1 am. It’s a mystery why it only happens at night and almost never during the day.

I tried getting up and doing a round of exercises before lying back down at about 2 am but it still was itching. I think I finally got to sleep around 4 am.

I shower a couple of times each day so it’s not related to that. I apply vitamin E and lotion the skin a couple of times each day also so that’s not the trigger.

We have Tylenol PM so I’ll give that a try tonight. And I’ll keep a piece of sandpaper on the nightstand…
The Tylenol PM should get you in a deeper sleep and the pain / itching should not wake you up hopefully. Keep the faith! Thanks for the updates. These pills are cheap and worth a shot.
 

andfor

Legend
What a terrible night of sleeping. The sensation is gradually returning to the skin on the outside of the incision, and for whatever reason it flares up at night when I get phantom itching and some zingers which feel like small electrical shocks. I never had this with my other surgeries. Between it and having to pee five times (my son bought a yummy but salty Mexican dinner from our fave restaurant so I drank a ton), I think I probably only got sleep in 30 minute segments. I woke up with the blanket flipped inside out!

And now my neighbor is hammering on their shed outside!
Hopefully last night your sleep quality improved.

Yesterday was my first time playing sets of doubles in 9 months. We switched partners each set, I won two! Full disclosure, everyone was rusty and the main goals were, fitness, fun and fellowship! HAHA. My movement was much better than last time I played a doubles tiebreak in October, duh. My lower back held out which was the biggest plus for me. My serve was decent, after double faulting and being broken in the first game, I managed to hold the rest of the session.

Going to try and book more formal hits like this weekly from here on out. Aside from being terribly boring and too cold, I've had enough of hitting against the wall and serve practice.
 

Injured Again

Hall of Fame
The Tylenol PM should get you in a deeper sleep and the pain / itching should not wake you up hopefully. Keep the faith! Thanks for the updates. These pills are cheap and worth a shot.

I took Tylenol PM last night and fell asleep promptly but woke up about 1 am with the itching again. I tried a heating pad and that seemed to help so maybe I’ll try that first thing if I wake up tomorrow. By the time I tried the heating pad, it was nearly 2 pm and I’d been up for long enough to make it difficult to get back to sleep.

The heating pad does seem to make the itching a lot better but then it makes my whole leg really warm. That makes it feel like it’s swollen, but that’s still better than the itching!
 

Injured Again

Hall of Fame
Hopefully last night your sleep quality improved.

Yesterday was my first time playing sets of doubles in 9 months. We switched partners each set, I won two! Full disclosure, everyone was rusty and the main goals were, fitness, fun and fellowship! HAHA. My movement was much better than last time I played a doubles tiebreak in October, duh. My lower back held out which was the biggest plus for me. My serve was decent, after double faulting and being broken in the first game, I managed to hold the rest of the session.

Going to try and book more formal hits like this weekly from here on out. Aside from being terribly boring and too cold, I've had enough of hitting against the wall and serve practice.

What do you notice about your movement on your knees? Are you conscious of them? Do they hurt at all?
 

Injured Again

Hall of Fame
So I seem to be stuck at between 125 and 130 degrees of flexion. 130 degrees seems to be the gold standard - you get there and that’s considered full range of motion. For me, I’d like more since I’m planning on some hikes where I will need to rock scramble and that needs a very deep knee bend. My right knee is capable of about 145-150 degree bend.

I don‘t think I’ve had that degree of bending capability in my left knee since hurting it a couple of years ago. That means that it’s going to be hard to get that range of bending now since the bending is limited by more than just the surgery on the knee.

I wish I had realized this prior to surgery. I placed most of my focus on building strength and that has paid big dividends. But it would have been better to work on bending flexibility more - to get to 145-150 degrees of bending prior to surgery so I could achieve that now. I will still get there but it just won’t be as easy.

So a word of advice to those who will be getting a knee replacement - get as much flexion as you can prior to surgery, because building range of motion is harder than rebuilding strength.
 

Injured Again

Hall of Fame
Overall no they didn’t hurt while moving. Did have a hard plant attempt to push off, then stumbled. Minor irritation, mostly a loss of balance due to lack of court movement etc.

That all sounds like things that will come back as you continue to play and work out. It’s inspiring to know it can be done!
 

Injured Again

Hall of Fame
I basically had my four week check-up today. I had zero degrees of straightening and 128 degrees of bending.

I’ve started doing one-legged resistance training, as doing exercises with both legs let me mask the strength differences. My surgical leg is much weaker and I’ve been doing numerous sets to try to correct that. The one leg presses have been pretty uncomfortable. There’s still swelling and the contractions necessary to do these lifts have squeezed out some fluid from deep within the quads. Consequently, I’ve developed bruising on my upper thigh. Having it happen this late is uncommon but not unprecedented.

I also had my gait analyzed. I have calf tightness that I need to stretch out. That tightness is causing me to lift my heel sooner than the other side. Also, my hip flexor also is tight so my left leg also doesn’t extend as far back during my stride. I need to work on these things now so when I start to run, I can do so properly.

When I am loose, I can walk down stairs without holding on and with almost normal step mechanics. I can walk four or more miles easily and with no swelling afterwards.

My scar is almost completely healed over. It’s fairly smooth on top but ropey with a keloid from the kneecap downward.

I still can’t fully actively extend my leg, and the itching at night is still a problem. I’ve gained six pounds and need to work that off. I have a hiking trip to Sedona in four weeks and I feel good that I’ll be ready for that. I’m also starting twice weekly ball machine sessions with movement, which even with the left leg weakness feels almost normal. I’m sure that I lost much of the strength over the past two years when my knee was injured and have been compensating all that time.

Thanks to everyone who has contributed to this thread! Hearing your stories has been very reassuring.
 

andfor

Legend
Quick post. Stopped by my PT clinic today to get a quick measurement. 5 months post op, 128 degrees on the right knee flexion, 129 on the left. Zero degrees both knees extension! Still improving!
 
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Injured Again

Hall of Fame
Have you ever tried intermittent fasting? A lot of people have had success using it to lose weight.

No, never have. I don’t think I’ll need to do it to drop the pounds. Just being able to do the things I wasn’t doing because of the knee will pretty significantly increase my calorie output.
 

Injured Again

Hall of Fame
I think I may have stumbled on the reason for my phantom itching. I had another sleepless night and when I woke up, the numb skin area was tingling, almost like a nerve overload. I’m wondering since it is in the process of rebuilding some nerve connections, if the rubbing against the blanket and sheets is overwhelming and overloading the nerves. I’m going to try wearing a cotton knee sleeve to prevent the rubbing. I really could use a good night of sleep.

I also noticed today there are a few times when I reflexively brace myself against the knee pain I had before, mostly when going down or up stairs, or twisting when bending my knee as it is forward over my toes. I caught myself after I realized that my knee doesn’t twinge on me any more in those situations. That just feels like such a huge win after two years of knee pain.
 

Injured Again

Hall of Fame
Lots of updates. Today was what my therapist considered to be my four week checkup so he really worked my flexion to see what I could do. After sweating a few buckets and chewing through a towel or two, I hit 130 degrees.

I hit against a ball machine for the second time prior to my PT session and found I had the most instability when backing up to give myself room to swing on the forehand. That backwards shuffling requires muscular control near full leg extension, which I still don’t fully have. So I got two more exercises. One is to walk backwards on a treadmill, and wow is that tough to do with coordination right now. The second is to stand with my right leg on the stationary side platform and to just use my left leg to drive the treadmill belt (it’s a fully manually driven treadmill) from foot contact all the way back as far behind me as I can maintain contact with a straight leg.

The hitting though, was pretty good. I’ve been spending so much time lifting that I’ve built up more core and upper body strength so I feel I can swing more easily yet generate more ball speed. The easy swing made it easy to have good timing. So I’ll try to get out there at least a couple of times each week.

I also had my walking gait evaluated. You can see in the videos I posted earlier that I was walking quite bowl-legged. Well, my left leg is now straight and so I can walk less splayed. My right leg was less bowl-legged and now I almost can walk like someone with two straight legs. Also because of calf and hip flexor tightness, my stride length pushback is shorter with my left leg, and I tended to lift my heel off the ground sooner. I need to correct these before I start running so I don’t carry these problems into my running stride.

I’m doing 6-8 sets of one legged leg presses and hamstring curls on a two day on, one day off schedule. I seem to be making about a 10% strength gain every three days so I am hopeful I will be roughly equally strong in about six to eight weeks.

The bad is that wearing a cotton sleeve did not do anything for the nighttime phantom itching. It is so bad I’m going to reach out to the ortho. My PT has not had any other patient who experienced anything as severe as what I’m having. It only happens at night - if I nap during the day in a recliner, I don’t have the itching. And I’m napping a lot because I’m having a terrible time sleeping at night between the itching and waking up every few hours to pee.

I was prescribed 30 days worth of Celebrex, taken twice a day, and that ends tomorrow. It will be interesting to see how much more swelling I have when I get off it.
 

andfor

Legend
Great progress! Will be interesting to see what your Ortho says about the itching and how you feel after the Celebrex ends. Hopefully your doc has a remedy that helps the itching. I did not get Celebrex post op, just some horse pill size naproxens. Celebrex is really good, if you feel more stiffness after you stop, do not be deterred, improvement will continue!
 

mcs1970

Hall of Fame
Bopanna credited his physiotherapist and Iyengar yoga with helping his longevity.

"I told her [physio] specifically what I needed, because I have no cartilage in my knees. It's completely worn out," Bopanna said.

"Yoga in a way not only strengthened my legs, my body, but also, I think made me calmer on the tennis court.

 

Injured Again

Hall of Fame
Just past 4 1/2 weeks. With a ton of emphasis this week, I got to 134-135 degrees. I've found if I lie on my side in bed with my operated knee on the bottom, I can use my other leg to help bend it and it doesn't seem to trigger the quad tightness. So I can bend it to that 135 degrees with only moderate effort, and then can repeat it in other positions which typically have put more strain on my quad.

I've tried taking an anti-histamine to quell the itching and it doesn't work. I have a message in to my ortho since I can't seem to get this resolved on my own.

Ball machine hitting is getting better. After some more gym days of single leg presses and walking backwards on the treadmill, I have a lot more stability near full leg extension, though I still am only able to straighten my leg to within about 5 degrees of straight. I still don't have the ability to fully straighten my leg like I can on my other side. I think I've mentioned before that this is just a time thing and not a rehab-effort thing, but I don't know that I've ever gone into more detail. So for those who have not yet had a TKR, there are a few things that have to happen during the surgery that impact leg extension capability. Skip the rest of this paragraph if you are squeamish. First is that your kneecap is in the way of getting to the joint, so an incision must be made through the muscle and the bands surrounding the knee to allow the kneecap to be flipped upside down and moved off to the side. The second thing is that to control blood loss from cutting into the muscle, a tourniquet of some sort needs to be applied to the quad muscle. So not only have you had two bones cut and drilled into, the kneecap has also been partially cut free, the quad muscle has been cut, and the tourniquet also causes additional damage to the muscle. All that takes time to heal.

So I can take a couple of good steps into the ball, and can backpedal out of the way of getting jammed. I've played short court and though the leg is still weak, that's been going fine. I can now walk up and down grades with almost a normal gait. That, and being able to walk down stairs with a normal gait, are going to depend on that last few degrees of leg extension.

Oh, and no Celebrex for two days now. I don't think I notice much difference. I'm on one 220 mg Naproxen in the morning and one more at night, and Advil two or three times a day depending on need.
 

andfor

Legend
Been hitting lightly every other week or so for the last few months. Last night played in a 90 minute clinic. The is the 2nd time I've played heavily on my two TKR's. Movement is still slow, but slightly better than my last doubles match from a couple weeks ago. Seems my low back is still slow to come around and similar to my movement, small improvement. I did notice my back and knees felt tired near the end. Good news this morning there was no muscle stiffness or sore joints!

While I'm doing rehab and strength training most days, I'm going to work to increase my cardio time on the bike, elliptical, walking, dynamic movement drills, etc. and that should help.

5.5 months post surgery the improvement curve is less noticeable as gains seem to be smaller. Still improving though. I'm debating skipping the spring USTA season and keep working to get my movement closer to a somewhat respectable 4.5 level. Enjoy the rehab journey!
 
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sherpa

Rookie
Hi, I'm also 5.5 months into this and so I am making really good progress, particularly in the last month or so. I'm playing competitive table tennis twice a week as well as one or two sessions of pickleball each week. Mountain biking is much easier in terms of getting on and off the bike and had my first serious go a tennis the other day. Even though I only played against the wife my movement and confidence got better and better the longer we hit. We are thinking of joining a mixed doubles comp shortly, which would be a nice way of easing myself back into competitive tennis.
 

Injured Again

Hall of Fame
@andfor @sherpa It’s fantastic to hear of your returns to tennis and other activities! It’s reassuring to know that the obstacles I have can be overcome with time and effort, and knowing that can sometimes make all the difference. Best of luck as you both continue to heal up more and get stronger.
 

Injured Again

Hall of Fame
So for me, I just passed five weeks yesterday. I have 135 degrees of bending, and can get to zero by muscular contraction alone if I rest my foot on a pad so my knee is suspended. If I were to sit in a chair and attempt to straighten my leg, I am about five degrees short. If I lie on my back, fully straighten my leg, then do a straight legged lift, my knee bends only about two degrees. So getting closer.

I‘m two weeks into resistance training. My hamstring strength is about 70% of my right leg. But leg press strength is still weak, maybe 50-60% of my right leg. I just got the clearance to start doing leg extensions and strength there is maybe 30% of my right leg, and I can’t get close to a straight leg with the added resistance.

I am walking up and down stairs normally and almost with an undetectable limp but I feel as though I land harder on my right foot as my left leg very slightly collapses at the deepest bend. I’m walking and hiking on smooth trails and doing five miles feels like a piece of cake.

I’ve started doing one legged lunges to the side and forwards/backwards. I also ran about 50 feet and can tell that I’m limited by quad strength, especially on absorbing the impact from landing. In shadow swinging with a racquet, I have two quick steps to each side with full control so I should be able to cover the middle two-thirds of the court, but as soon as there was a ball involved, that went to pieces and my movement reverted to knee-protection mode, even though there wasn‘t a need for that. It’s going to be a mental struggle to move like I can move.

I still have the phantom itching and now I’m getting zingers, which feel like little electrical shocks. So sleeeping through the night is still an issue. My ortho said he would address it with me in person at my 7 week checkup.

Though my knee seems to be tolerating the five or six hours of rehab every day, it gets stiff after just sitting still for 15 minutes. The good thing it only takes a few short minutes of stretching to get it back loose again. The little bit of swelling in my calf and thigh seem to be 95% gone so now it’s only above and around the knee area.

My scar is pretty ropey looking. It’s going to keloid pretty badly, but it isn’t adhered to the tissue underneath so it’s all good except for the Frankenstein look.
 

sherpa

Rookie
My stationary stiffness has all but gone now, it was very frustrating doing all the stretches etc and then leaving your leg in one position for a while and having it seize up on you. I had a knee reconstruction done on my other knee
forty years ago and the treatment was to leave your leg in a cast for six weeks ,post surgery, bent at ninety degrees. Needless to say when the cast was removed the leg was frozen at ninety degrees and to be quite honest the rehab for the TKR doesn't feel a whole lot different. Interestingly my surgeon back then [who just recently passed away] did not prescribe to doing any types of squat type or bending exercises, instead my only real exercise was to put as much weight as I could handle, wrapped around my ankle and then to hold my leg out horizontally for as long as I could. The reason I had to get a TKR was that I simply wore through the cartilage on my right leg basically subconsciously protecting my left knee for over forty years.​
 

andfor

Legend
3rd time playing sets of doubles again this last Saturday. Little less enthusiastic how it went. 1-2 in the sets, but the W/L is not my focus, just being out there is. My low back stiffness is now clearly my biggest challenge as it severely restricts my ability to move. For the first time playing, exercising, PT, etc. I felt a little pain on the lateral side of my left knee the following day. Most notable when walking backward on the treadmill and when trying jogging speeds. Guessing it's a minor strain or inflammation, and is a little better today. Good news is I was able to walk on the treadmill 35 min. ride the stationary bike 35 min. and circuit train (leg day) 45 min. yesterday without noticing the left knee.

Unless I have a breakthrough with my back loosening up soon, I'm skipping spring USTA league. Carrying me at this time is a heavy load! LOL. In the meantime I'll remind myself recovery is up through 12 months and I'll be more patient with myself.

Keep training and rehabbing! All the best to those who are recovering from whatever ails you!
 
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Injured Again

Hall of Fame
Been very busy but wanted to provide an update. I have my first appointment with my ortho next week exactly at the seven week mark.

Today was PT the day before six weeks. I now have 140 degrees of flexion and still at zero degrees straightening, though I still can’t quite fully extend my knee straight when in a sitting position. After three weeks in the gym, I’m starting to make some gains on quad strength, though clinical studies have shown that due to all that is necessary for a TKR, the average patient has 60% strength loss at 12 weeks.

My PT says my hamstrings are now a primary source of flexion resistance so I will need to do diligent stretching to get further bending. This next week will consist of balance exercises and stretching while continuing the gym work.

I’ve started live hitting and my timing is amazingly good but I’m still falling into knee protection mode when I have to move fast even though nothing hurts. I guess it’s just going to take a while before I can train my brain to move normally like I know I can.

I’ll echo best wishes to everyone rehabbing and recovering!
 

Injured Again

Hall of Fame
Got out today for a ball machine session. Shadowing movement has been going well but it falls apart when I'm on court trying to actually hit a ball. So the focus today was just on one or two steps of movement, and trying to be careful so I don't get into that "knee protection", peg legged movement that has become a really bad habit. I had pretty good success today and will try it again this weekend, and if all goes well and I don't revert to peg legged stepping, I'll start hitting against a live person next week.

Hitting groundies, I struggle more with spacing and footwork on my forehand side where I'm leading with my left (surgical) leg. A teaching pro on the next court was watching me and said that I should concentrate on using my hips and glutes to move, and to use my knees and ankles as levers. She's absolutely right - I'm so focused on protecting the knee that I'm not letting it move the natural way that it can to support what I'm trying to do with my hips and glutes to position my body.

Yesterday, I did a 4.5 mile hike on dirt trails which were wet and a bit slippery. First time in two years that there was no knee pain and I finished with just over 3 MPH average. Six weeks of relative inactivity have certainly taken a toll on aerobic fitness.

My PT has kinesiology experience so I recorded some video to let him dissect my movement. Of course, he's not a tennis movement expert but I'm hoping to get the major kinks worked out before I get lessons from the pros to get my footwork back to where it should be.


 

Injured Again

Hall of Fame
@Injured Again … brother you are a force of nature …

but 8-B


OMG, that is the greatest commercial! My daughter has a grand fur baby that we all adore and she will love that commercial as well!

I do struggle with patience, a lot. My wife and I had made travel plans before the surgery, the first being a hiking trip to Sedona from February 20 through March 4th. I told her in December that I would try to get back on the court for the first time after that trip. She rolled her eyes.

We also have a trip to Europe from mid-April through mid-May, and I said I would wait until coming back before starting to hit against live players. She rolled her eyes more, so much that I thought her eyes made at least a couple of trips around the inside of her head.

Those plans kind of went out the window! I guess I didn’t want to disappoint my long suffering wife.
 

Injured Again

Hall of Fame
@Injured Again Looks like great progress to me in such a short period of time!

I'm going to give double tomorrow another go! Looking for improvements, I'll take small ones!

Best of luck to you! I don’t think my progress would have been possible if I had bilateral surgery like you did. Having one good leg let me push knowing I could catch myself before falling or getting unbalanced. And even things like going down stairs or walking downhill. My good leg lets me stop my momentum and reset before taking the next step with my surgical leg. Without that, I’d probably have faceplanted trying some of the things I did. So even though I’ve had a really fast recovery, you’ve had a more amazing rehab having done both knees at once.
 

ByeByePoly

G.O.A.T.
OMG, that is the greatest commercial! My daughter has a grand fur baby that we all adore and she will love that commercial as well!

I do struggle with patience, a lot. My wife and I had made travel plans before the surgery, the first being a hiking trip to Sedona from February 20 through March 4th. I told her in December that I would try to get back on the court for the first time after that trip. She rolled her eyes.

We also have a trip to Europe from mid-April through mid-May, and I said I would wait until coming back before starting to hit against live players. She rolled her eyes more, so much that I thought her eyes made at least a couple of trips around the inside of her head.

Those plans kind of went out the window! I guess I didn’t want to disappoint my long suffering wife.

I am also married to an eye roller :rolleyes: :love:

You got this knee thing whooped … but I will drop in some patience humor anyway. (y)
 

Injured Again

Hall of Fame
I am also married to an eye roller :rolleyes: :love:

You got this knee thing whooped … but I will drop in some patience humor anyway. (y)
My wife is also an expert toe tapper and hand-on-hip’per!

And seriously, I do appreciate your patience posts! You started trying to help my wife out with a post in this thread on January 19th! So not only do you understand the importance of patience, you alao have the patience to deal with numbskulls like me who don’t listen!
 

ByeByePoly

G.O.A.T.
My wife is also an expert toe tapper and hand-on-hip’per!

And seriously, I do appreciate your patience posts! You started trying to help my wife out with a post in this thread on January 19th! So not only do you understand the importance of patience, you alao have the patience to deal with numbskulls like me who don’t listen!

The new addition for me lately is … “don’t be such a drama queen”. Not nice. :love:
 

Injured Again

Hall of Fame
The new addition for me lately is … “don’t be such a drama queen”. Not nice. :love:

My wife usually stands at a 45 degree angle, hands on hips, front toe tapping, and says “Really?!?” She says it with that particular tone that makes the boys shrink way up into their sack. I mean, she could have play Paul Atreides since she has “the voice”….
 

SteveI

Legend
Got out today for a ball machine session. Shadowing movement has been going well but it falls apart when I'm on court trying to actually hit a ball. So the focus today was just on one or two steps of movement, and trying to be careful so I don't get into that "knee protection", peg legged movement that has become a really bad habit. I had pretty good success today and will try it again this weekend, and if all goes well and I don't revert to peg legged stepping, I'll start hitting against a live person next week.

Hitting groundies, I struggle more with spacing and footwork on my forehand side where I'm leading with my left (surgical) leg. A teaching pro on the next court was watching me and said that I should concentrate on using my hips and glutes to move, and to use my knees and ankles as levers. She's absolutely right - I'm so focused on protecting the knee that I'm not letting it move the natural way that it can to support what I'm trying to do with my hips and glutes to position my body.

Yesterday, I did a 4.5 mile hike on dirt trails which were wet and a bit slippery. First time in two years that there was no knee pain and I finished with just over 3 MPH average. Six weeks of relative inactivity have certainly taken a toll on aerobic fitness.

My PT has kinesiology experience so I recorded some video to let him dissect my movement. Of course, he's not a tennis movement expert but I'm hoping to get the major kinks worked out before I get lessons from the pros to get my footwork back to where it should be.


Nice work. Bravo!
 

SteveI

Legend
I am also married to an eye roller :rolleyes: :love:

You got this knee thing whooped … but I will drop in some patience humor anyway. (y)
Wife is a Toe Tapper here...LOL. Eye roller and Harumph champion..... 3 tool athlete.. :) .

"What does Harumph mean?


expression of disdain, disbelief, protest

harumph (plural harumphs) An expression of disdain, disbelief, protest, or dismissal; a huff, grunt, or snort."
 
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ByeByePoly

G.O.A.T.
Wife is a Toe Tapper here...LOL. Eye roller and Harumph champion..... 3 tool athlete.. :) .

"What does Harumph mean?


expression of disdain, disbelief, protest

harumph (plural harumphs) An expression of disdain, disbelief, protest, or dismissal; a huff, grunt, or snort."

Cool … you are married to a triathlete.

I guess I get the silent version of Harumphing … the disbelief part.

Right before the eye roll … she does this … she would be terrible at poker:

 
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andfor

Legend
Well I'm not going to get into much detail about my wife's idiosyncrasies for fear of her seeing this! HAHA

Had a good Saturday of doubles! The knees where great! Moving backwards is a big challenge, but I believe that will improve with time in the gym and on the court. Back stiffness was a little better so I'm happy with that. Went 1, 1 & 1 on the doubles court rotating partners each set. One was tied at 6 all when we switched. Good news and bad news the day after yesterday. No residual soreness, but came down with some sort of stomach flu. Stayed on the couch all day so I missed my Sunday at the gym. Feeling much better today so will make that up tonight.

More little improvements, I'll take it! Keep rehabbing and working out. Have a great week!
 

Injured Again

Hall of Fame
@andfor A stomach bug has been making the rounds around here as well. So far I‘ve avoided it. But great news about your tennis!

I seem to have turned the corner on quad strength. My one legged squat strength and one legged leg extensions seemed to hit a plateau and I just couldn’t make any weight progressions. But now the last two sessions have been much better and I seem to have turned a corner. I’m now at about 60-70% strength of my right leg. I’ve seen studies where on average there is a 60% LOSS in strength at three months so I’m happy with the progress.

Interesting that now with a non bowl-legged left leg, I’m putting more pressure on my arch, and the arch support that I had in my left shoe is now just a bit too high. It also feels like I have about a quarter-inch leg length discrepancy but I’ll take to the ortho about that since they took measurements at my two week check-in.

I’m off in an hour for my first full court 90 minute hitting session. Hopefully I won‘t hurt anything!
 

Injured Again

Hall of Fame
Wow, it felt like old times on court! Though I never did run for anything, I was able to cover the middle 2/3’s of the court with zero knee pain. I actually don’t think I felt anything in my new knee at all. I did feel a twinge or two in my original knee though….

Only problem is that the balls came much faster than the speed I had set on the ball machine and so I was late for some of them. But the timing was no worse than if I didn’t play tennis for a couple of weeks.

The bad is that my feet need to be toughened up again. I got the beginning of a couple of blisters. Hopefully they will heal before Wednesday when I play again, and then Friday I play against the last guy I hit with the day before my TKR. Full circle!
 

djNEiGht

Legend
@Injured Again

good to read....

I'll go back and read more through this thread as surgery x5 will now consist of total knee replacement. I fell down wet stairs in August and haven't been able to walk straight since. A few "hurdles" to go through (other medical, insurance, and life in general) but hope to get this done soon. Even sometimes sleeping my knee(s) hurt
 

Injured Again

Hall of Fame
@Injured Again

good to read....

I'll go back and read more through this thread as surgery x5 will now consist of total knee replacement. I fell down wet stairs in August and haven't been able to walk straight since. A few "hurdles" to go through (other medical, insurance, and life in general) but hope to get this done soon. Even sometimes sleeping my knee(s) hurt

So sorry to hear of your fall and the need for a knee replacement. Let me include some other things that you may want to check up on before you actually have your surgery. Some of these things I didn't know to ask beforehand - I found them out afterwards even though I thought I was fairly thorough in researching the surgery.

First, just a brief recap of a knee replacement surgery. They cut off the bottom of your femur and the top of your shin bone, and then cut chamfers into the bone to match the chamfers in the implant. They then drill holes into these bones and the implant with the metal sliding surfaces is inserted. In between, they will place a disk of plastic that provides a bit of cushioning and helps the joint glide. In a typical knee replacement, they cut your quadriceps tendon because that holds the knee cap in place and the knee cap is in the way of getting to the bones underneath. Cutting the tendon can also mean cutting into some of your quadriceps muscles, which means a lot of bleeding, so they will apply a tourniquet to your upper thigh throughout the operation. All of this significantly weakens your quadriceps muscle, and studies show that typically there is a 60% loss of strength at three months post-op. It's a brutal operation.

You have two primary ways of attaching the implant to your bone. Most commonly used is quick setting cement. This hardens and is strong within hours. The other method is a press fit with a different, more porous type of material which allows bone to grow into and attach to the implant. The general consensus seems to be that for younger patients determined to return to higher level athletics, a press fit is better because it grows stronger over time. The cemented implant is about as strong as it will be soon after surgery and supposedly the cement weakens over time but this hasn't been definitively shown in any studies I am aware of. Using a press-fit slows recovery by a few weeks. I got a cemented implant.

There is also a type of surgery called "quad sparing", in which a "C" shaped incision is made that allows the operation to happen without cutting into the quadriceps tendon and muscle. This is typically used on smaller-boned and thin patients, so typically women much more than men. This can shorten recovery time by a few weeks. You may want to ask if this is a possibility - it was not for me. Quad sparing will also minimize the bruising you will encounter. My entire leg, from hip to ankle, was purple at one time. Despite the tourniquet, there is a lot of bleeding after everything is stitched together and the tourniquet pressure is released. This is also why you will typically be anemic and feel low in energy afterwards.

You'll also want to ask what type of implant will be used. There are some which allow greater range of motion - up to 155 degrees, which is about where the knee bend angle if you sit with your shins on the ground and your butt on your heels. I didn't know to ask this but I have my first checkup with my ortho tomorrow and will find out more then. Otherwise, I think a regular implant is good for about 140-145 degrees of bend. I'm currently at 140 degrees, but my right knee is capable of 150+ so if I want to work towards that, I have to find out if my implant is capable of that much bending.

Also, ask if your ortho does a robotically assisted operation. My ortho did not - he has used robotic assistance in the past but he feels he can do just as good or better job because of what he sees after he opens everything up. My ortho is incredibly skilled - he has done knees for several players at my club including a couple of doctors that have recommended him to me. Studies have shown that with a skilled surgeon, a robotically assisted operation does not generate any measurably better long term outcome.

From the time I decided to have the operation, it was four months before my ortho was available. During that four months, I worked my butt off to get ready. The two most important things are range of motion and quad strength. You will want to make sure your knee can fully straighten (zero degrees) and work on as much bending as possible because the range of motion you have afterwards is correlated to what you are able to do beforehand. I also started a leg press and leg extension build-up phase, even though these hurt like heck with my bad knee. I figured that my knee was getting replaced anyway so if I did critically hurt it, it didn't really matter. So I just put up with the pain and tried to get as strong and flexible as possible beforehand.

You will likely have a choice of a spinal block or full general anesthesia. I had the spinal block with a sedative through the IV and don't remember anything. Post-op recovery from the spinal is much faster. I was in the operating room at 3 p.m., out at 5 p.m., woke up around 5:30 p.m., and was walking by 6 p.m. As soon as I was able to drink, eat, and pee, I was sent on my way. I was home by 7 p.m.

Because you will be anemic and your body will have endured a lot of trauma, it is really important to eat nutrient and iron rich foods. I was told to try to gain a few pounds over the first couple of months, just to ensure my body had everything it needed all the time to repair the damage. Taking a calcium supplement is also helpful.

The spinal block will last roughly 24 hours. After that, the number one thing is pain management. If it hurts, you won't be able to make any rehab progress. And it will hurt - for me the worst days were three through ten. The number two thing is to minimize swelling. If it puffs it, it's going to hurt and limit your ability to gain range of motion. And it will swell up. And that leads to number three - gaining range of motion as quickly as possible. There is a generally accepted timeframe of several weeks after surgery where you should make the vast majority of your range of motion gains. After that time, the knee will have healed and basically the range of motion you got before that point will be almost all of what you can get afterwards.

Okay, let me finish this post now - I'll continue in a short bit in the next post.
 

Injured Again

Hall of Fame
Continuing....

Pain management - you will want to take the narcotic pain killer as prescribed for at least a couple of days. If you stop cold turkey and the pain comes on full blast, it will be hard to take enough to knock the pain back down to a manageable level without knocking yourself out. If you think you might be able to get off the narcotic, lengthen out the amount of time between pills and see if the pain is tolerable. Or, see how well you can go overnight when it's likely you won't be taking a painkiller for as much as eight hours. I was on oxycodone until day five. By then, I was down to one in the morning and one at night, and when it was still tolerable I quit completely. My prescription was for one every four hours, I believe.

Swelling - you will likely come home with an ace bandage compression wrap over your upper calf to your lower thigh. I'd recommend getting compression socks like you'd wear on an airplane. I'd also recommend getting additional 6" wide ace bandages to wrap your thigh. This, along with icing and elevation, will keep your swelling down. I bought an ice machine from Amazon. It was $180 or so and I only used it maybe two and a half weeks. But it was invaluable. The kind I got is a small cooler with a pump that circulates water through a pad that you wrap around your knee. You cool the water by freezing water bottles and putting it into the water that you fill the ice machine with. When you're not icing, you should be elevating. When you're not elevating or icing, you should be rehabbing.

I bought a used stationary bike with fairly short crankarms (I think they're about 165 mm). I pedaled this bike several times a day for several minutes starting on day two. There's a post of me in this thread doing just that on day five, I think. There were some days when it was extremely painful from the swelling but I went at it anyway and it always felt better by the end. I also walked at least once every hour.

One of the most difficult things once you are home is getting on and off the toilet. Fortunately or unfortunately, the narcotic pain killers are extremely constipating. You should take the Miralax or whatever they give you at least a couple of times every day. Practice getting up and down now using just your good leg and with your bad leg straight or nearly straight but not doing any work. If you can't do this easily, see if someone in your household can help you, or get some sort of toilet seat raiser or toilet set push up bars. If you do a lot of training before your surgery, you may be able to get up using just your good leg, with the help of a walker. Oh, and that's important - get a walker even though you may only be using it for just a few days. I graduated from the walker within a few days and used hiking poles (instead of a cane) for the next couple of days before being able to walk unassisted. But there were still times when the walker is useful, such as when you have to get up in the middle of the night. I used it to stand and support myself until I felt my leg would not give out on me. I've actually started using it again recently - I'm doing a quad stretch where I stand facing away from the armrest on my sofa, and I bend my surgical leg and put the instep on top of the armrest. I'll then lean backwards and squat down - this helps to stretch and lengthen the quads to make gaining range of motion easier.

You'll also want to get a stretching band. It's available on amazon for less than $10. It's basically a nylon strap with a bunch of holes in it so you can put your foot through it at various points. I use this every day to this day.

Some resources that you might find useful. There is a Doctor Adam Rosen who has put out a series of videos that I found extremely helpful. This one is worthwhile to listen to, especially from about 1:45 to the 3 minute mark where he talked about the necessity of rehab. That advice stuck with me during those tough times.


There are some physical therapists that I also watched. Two of them are Anthony Maritato and Samantha Smith. Their videos are pretty generic and right down the middle of the road - but they give good advice. They will not be as aggressive as someone trying to return to highly athletic sports. And that brings up the subject of PT. It's incredibly important and I would not be where I am without the excellent therapist I'm using. I saw him before to make sure I was doing everything I could to get ready for the surgery, and then starting seeing on afterwards on day five. He's a sports oriented therapist and has helped guide me back to full functioning.

And lastly, this one video is of a lady who is kind of my hero. I saw this video early on and thought if she can do what she did, I should be able to do it as well. Notice the incision on her knee - it's a "C" shape so she most likely got a quad sparing operation. Also, she never showed any of the bruising that results from cutting the quad tendon or muscle. My bruising didn't go away until after week four.


I'm sure there's lot that I've forgotten to mention but I hope this is a good start. Glad to answer any questions, though a lot is in the numerous write-ups I've posted. Best of luck!
 

Injured Again

Hall of Fame
And finally, my update from my PT session. I pushed just beyond 140 degrees bending. I said I felt like I had some major improvements in leg strength this past week and my PT asked me to do the one legged exercises he gave me a couple of weeks ago but which I've been unable to do properly because of leg strength inadequacies. I managed to do them all today, with good form and no knee pain! He then ran me through another series of exercises involving quick foot movements, because nerves are damaged and there's a new joint in there that the body needs to learn how to use. I did all of those exercises with excellent foot speed and balance. He then had me do deep lunges carrying a "tidal tank" on my back. The "tidal tank" is a large cylindrical container that you partially fill with water. When you move, the water sloshes from side to side and you have to use balancing muscles. I managed to ace that as well with it filled with 20 pounds of water. I was pretty hesitant to try these exercises as I thought the strength gains I made were not enough yet to support my 200 pounds of body weight so I was really pleasantly surprised.

I have my first check-in with the ortho tomorrow, at the 7 week mark. The PT is not sure how to proceed with me because none of his patients so far have gotten where I have in such a short time, and usually when patients are able to do what I'm doing, they are cleared to resume any kind of athletic training. But since I'm only seven weeks in, things like my quad tendon are not fully healed yet so he suggests continuing to be careful for a while longer, not trying to run yet, and see what my ortho says.

I have to admit that it's going to be hard to hold back but I absolutely do not want any setbacks at this point so I'll have to do that dang "patience" thing.
 

Injured Again

Hall of Fame
I had my seven week checkup with my surgeon and this will likely be the last of my regular posts here. He basically said I’ve had an extraordinary recovery, especially for someone of my age. Normally the next two appointments would be at three and six months but he says no need for those. Despite regaining the vast majority of my functional ability, he wants me to wait a few more weeks before resuming 100% activity.

My physical therapist is a sports movement specialist has given me a set of exercises for the next three weeks. After that, I’ll return to him for running gait analysis and then occasional checkups as I start my mov and agility training on court.

It also looks like my right knee will last a while. I do have some evidence of bone spurs and bone changes but I’ll be getting annual HA injections to stave off further degradation.

Thanks again to everyone who helped me keep my sanity during my recovery, and especially for helping me keep perspective.
 

mctennis

Legend
I had my seven week checkup with my surgeon and this will likely be the last of my regular posts here. He basically said I’ve had an extraordinary recovery, especially for someone of my age. Normally the next two appointments would be at three and six months but he says no need for those. Despite regaining the vast majority of my functional ability, he wants me to wait a few more weeks before resuming 100% activity.

My physical therapist is a sports movement specialist has given me a set of exercises for the next three weeks. After that, I’ll return to him for running gait analysis and then occasional checkups as I start my mov and agility training on court.

It also looks like my right knee will last a while. I do have some evidence of bone spurs and bone changes but I’ll be getting annual HA injections to stave off further degradation.

Thanks again to everyone who helped me keep my sanity during my recovery, and especially for helping me keep perspective.
Glad things are going well for you at this point. Make sure not to push things, better to be slower and get back as close to 100% as you can.
 

Injured Again

Hall of Fame
@Injured Again
i feel like i'm crying on the inside reading your last couple of posts. i really appreciate the time you took for all of that. lots of new stuff to me that you had posted and some I had heard here and there. I'm choosing my surgeon today within my network.

I hope that you’ve found yourself a great surgeon!

I didn’t mean to make things sound dire - it is a tough surgery but modern medicine is amazing. There is unfortunately a lot of luck involved that your body responds well, and that you find that fine line of pushing the recovery hard enough but not too hard to cause a setback. Best of luck!

I’m typing this on a flight down to Sedona, where we will be hiking for the next ten days. The flight is tough - my knee just doesn’t like to be in one position for too long, and especially in a seated position. This flight is only three hours and we have a ten hour flight in two months but the knee should be more accommodating by then.

I did have a minor setback this week. After my seven week checkup with my surgeon last week, I went too hard in the weight room and my knee started hurting. My muscles have healed enough that the weights I’m using are more than my knee can handle at this stage of healing. So I stopped for a few days and it’s much better. I still have a bit of weakness near full extension but I played the best tennis yesterday - better than anything in the last couple of years.

Best to everyone!
 
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