Total Knee Replacement: The Good, the Bad and the Ugly

Growing up I remember doing class assignments that asked us where we envisioned our lives to be in five, 10, 20 years. Being diagnosed with rheumatoid arthritis at 18 and having a total knee replacement at 29 years old was not on my radar.

My life changed 15 years ago and I cannot say it has been an easy ride. It brought me on a path of pain, loss, grief and disability. On the flip side, it took me on a path of hope, faith, spirituality, healing, acceptance, strength, bravery and purpose. Ironically, that is more than I started off with. Through the negativity and darkness of my chronic illness, eventually light and positivity shone through on areas of my life I never thought would be whole again.

The moment that I would be plummeted into the depths of despair and darkness came over a year ago, with my first ever major surgery. The surgeon’s diagnosis that my knee cartilage was non-existent and I had a bone-on-bone knee was not shocking to me, especially since I had a limp, bent knee and pain for a couple of years prior. Intuitively I knew something was seriously wrong and x-rays confirmed it.

Since a total knee replacement is an elective procedure, I was offered two choices: either live with it or have surgery to correct it. Only if and when I was ready to do so, though. Being a young female, my quality of life was the main concern. The surgeon’s team suggested I not prolong the surgery for the possible risk of affecting my body’s alignment, hip and ankle joints, which work in tandem with the knee.

So four months after, I opted for the latter. During my surgery recovery I learned three things to be true of a total knee replacement: It is good, it is bad and it is downright ugly.

Here are my experiences with these three truths:

The Good  

You do for the most part get a new lease on life. It may not be exactly the same as before your knee was affected by arthritis or injury, but the quality of life improves significantly with this procedure.

The pain does disappear or lessen after recovery. A lot.

Total knee replacements, like hip replacements, have been performed by surgeons for decades. Though surgery in general is never a guarantee and without risk, orthopedic surgeons know a lot about the mechanics of this type of surgery. The shelf life is longer than many other joint replacements. This brought me comfort in my decision-making to go ahead with it.

You get everyone – well, mostly – to be at your beck and call when you come out of surgery and return home. Who doesn’t like to be pampered? After a gruesome surgery we do deserve a little rest and relaxation, right?

If you don’t have a lot of one-on-one personal support, there are many resources online. Before, during and long after my surgery, I found comfort in online support groups. It is true that each person has a unique experience with this procedure but at the end of the day, people in support groups can understand and empathize. That is a huge difference. Out of all the people in the world, you will find one or a select few whose story is eerily similar to yours.

The hospital you are scheduled to have surgery at should prepare you. I am the type of person who has to know every single detail before I do anything, especially this major. If you are the same way or just feel scared, lost and unsure, these mandatory pre-surgery classes are taught by either a nurse or physical therapist. No question goes unanswered, so ask away.

Humor and laughter will be your best friend and help you through any pain, frustration and tears you may shed. Don’t be too hard on yourself and your recovery process. Before and after my surgery, friends and family dropped off cards, flowers and stuffed animals that were meaningful. This put a smile on my face and gave me the push I needed to keep going. Listening to music, meditation, deep breathing, watching movies, reading and anything that can take your mind off your knee also helps.

One word of advice I received from somebody that helped put things into perspective before my procedure was, ‘’Do not be a martyr to your knee.’’ It’s easier said than done but when I found myself in this energy, I was mindful of it and changed my course around. Surgery recovery gives you a lot of alone time. You get to know yourself better and catch up on things you never may have had time to do before.

I had my surgery the week of Fourth of July. I am not sure why I decided on this, but I would not want to do that again mainly because I suffer from major FOMO (fear of missing out). However, I was hooked up with one of the best views to see the fireworks. My loved ones and I put the music on and had dance parties in the room. When life gives you lemons, make your own celebration, right? I didn’t let my surgery stop me from enjoying the holiday in my own way.

You come out a survivor and a warrior. If that isn’t badass in and of itself, then I do not know what is. We have a scar to prove it, too!

The Bad

The overall pain, overnight stay in the hospital, pain medication, coming off the anesthesia, swelling and bruising isn’t for the faint of heart. The second day out of my surgery I was expecting visitors, but the effects of the anesthesia wearing off were too much for me to bear and I had to cancel it. The pain medications ended up in a brown paper bag too.

Having to rely on busy nurses to give you your pain medicine like clockwork can get tiresome. I couldn’t stare at applesauce for a while after, because I got so sick of eating it at the hospital. Nurses had to watch me swallow my medicine each time which was annoying but is protocol to make sure patients take it. Trust me, I was going to take it. All that aside, I have major respect for nurses and especially those who helped me day in and day out.

Contrary to what people may think, your knee is not bionic. Though we are warriors and superheroes in our own right, our knee doesn’t do any special tricks. If I could kick through a brick wall because I had metal in my knee, I would have gone through with the procedure immediately.

It takes work, work, work, work – as Rihanna says. Recovery is a 24/7 commitment and the maintenance lifelong to ensure the new knee functions for years down the line. My surgeon told me I would have to make sacrifices once this was done. I didn’t realize what he meant until it was done.

Contact sports such as soccer, running, football, tennis and skiing are often not recommended after a TKR. Though there are many patients who say they have no issue with the former, it may decrease the shelf life of the replacement down the line. I wish I could partake in the sports I did before my arthritis; however, it’s just not physically doable anymore. So I am the designated cheerleader on the sidelines now with my tea in hand and that’s OK with me.

If you have autoimmune arthritis, recovery is different than someone who has osteoarthritis, sports-related injuries and other common surgeries from their youth such as ACL or meniscus tears. I have rheumatoid arthritis and the medication I take slows the healing, along with other underlying factors. Infection risk and complications are also higher for rheumatoid arthritis and chronic illness patients. I wasn’t able to take my RA medications or any supplements that helped with pain and inflammation either for a couple weeks before and one month after surgery. Talk about hell.

I had to have a manipulation six weeks after my total knee replacement because my flexion range of motion in my knee wasn’t at the optimal degree. The culprit? Scar tissue and inflammation.

My surgeon sent me home with a CPM, also known as a continuous passive motion machine. I had a love/hate relationship with this furry mammoth – the designated nickname I gave it. CPM helped reduce swelling and loosen me up before therapy and workouts, but I never reached the same number on the machine that my therapist measured me at for flexion. Talk about frustrating.

If you enjoy privacy or are a private person, beware. You will be exposed. Having people change your bedpan in the middle of the night, especially a hot male nurse, can be mortifying as a young woman. Afterwards, I realized how ridiculous I was being but it was all new to me then. After all, this was my first time I slept overnight in a hospital since my birth 30 years ago. Can you blame me? I hated that I had to have help showering, as it made me feel dependent. I am usually an independent person who likes to do things on my own terms and way. Showering is an extreme challenge with an incision in your knee, plus joint damage in your upper body making it difficult to prop yourself from a shower chair.

Surgery can make you feel weak. Ironically, you come out stronger than ever.

My surgery ended up being three hours. Usually, it only takes one hour and a half. Due to the extensive damage in my knee, the surgeon and his team had a lot of cleanup to do.

The Ugly  

This is a barbaric surgery. If you need more proof just go to YouTube and watch a real life one. Just make sure you are not about to eat or haven’t just finished eating. Do not say I didn’t warn you.

If having your knee cut open to the bone isn’t ugly enough, having to get up and go walking the next day is complete horror. The use it or lose it mentality is the ultimate slogan on the orthopedic floors. Having joint damage in my elbow, wrists and finger joints made this incredibly difficult for me. The second day I got up to walk, my incision bled through onto the gauze pad. I wasn’t ready and they do push you, mainly because they want to make sure you are safe to go home. Then there is the insurance company and hospital rule factors that limit the amount of days that can be covered.

Medicare and Medicaid are my insurance providers. If receiving social security benefits isn’t hard enough, coverage for continual physical therapy is a huge headache. Being placed in medical reviews, needing to send in proof that I do indeed need more therapy and being cut from social security benefits all at the same time is uglier than the whole surgery process itself.

Alternative and spa treatments such as deep tissue massage, myofascial massage, osteopathy and acupuncture all help with scar tissue, pain, inflammation and overall healing. However, they are often not covered by insurance, even when there is proof that these services help people. No insurance company unfortunately wants to pay for these services. Leaving patients unable to afford any sort of treatment, with limited funds for these services or in debt.

The younger you are, the faster your body builds up scar tissue. If you have autoimmune arthritis, a complication can arise that I now have called arthrofibrosis. Which is pretty much what they call a stiff knee. I am still fighting the scar tissue to this day.

woman walking outside

In your life you are going to face challenges, but you are not defined by those challenges. You are going to be defined by what you chose to do when faced with them.

Through the good, the bad and the ugly of a total knee replacement, I made it out of the trenches and I know you can too.

This post originally appeared on the Cure Arthritis blog.

Follow my total knee replacement journey on 365 Project Photos

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