Knee Replacement

[elr]

Anyone skiing after knee replacement surgery 

[thager]

Had mine done in Nov. 2020. Skiing better than ever without pain! Wish I hadn't waited so long.

[Rednucleus]

@cougfanhad both his done about a year apart. Just a 15 off hack like me but skis pain free and I have counted him making over 100 consecutive turns on Lake Curlew free skiing w/o a break!

Edited March 1, 2023 by Rednucleus

[LOTW]

What's the recovery time?

[thager]

I completed therapy before Christmas 2020 and was ready to ski in April. Was at 90% - 94 % through season. Felt 100% the next season. It does take time and depends on how hard you are willing to work.

[Stevie Boy]

@thagerDo you have any insight into which implant you had fitted and which procedure quad sparing or straight down the middle, robotic, custom jig or freehand surgery ?

[jimbrake]

Had my right (rear slalom leg) replaced February 7, 2018, when I was 59. Tried to get it done a few years earlier, but doc said "No, you're too young. Come back when you can't go up and down stairs". That was never going to happen, but when I went back to him in 2018, with that knee bone on bone, he agreed it was time, but he still thought I was on the "young" side. First 2 weeks post surgery were rough, next 2 weeks I could tell that it going to be OK. At the 4 week mark I was like "OK, this is going to be good". At 6 1/2 weeks I went surfing because I had a trip already planned. Three waves in the first day and I remembered "Oh yeah, my knee. It's fine". Started water skiing in late April (around week 10 or 11). Didn't try to get back on snow (which was the main reason I had it done) that spring and just waited 'til the next winter. It has been great ever since, especially on snow. Only minor complaint is that I think the procedure made my right leg 1/2 inch or more longer, which affects the hip alignment, which affects the low back, but that has been manageable. All other knee and leg alignment came out good. 

[coach3]

@thagerfront knee or back? Does wake impact hurt? 

[thager]

@Stevie BoyCan't recall implant right now but I will see if I can find my records. Was straight down middle freehand surgery by very experienced Doc.

 

@coach3 Is my front knee. LFF. Absolutely no pain at all.

Edited March 1, 2023 by thager

[Cnewbert]

This coming Monday, March 6th... the day after my 74th birthday... I will undergo a minimally invasive, quadriceps sparing, robot assisted unicompartmental knee replacement at the University of Florida Health Orthopaedics and Sports Medicine Institute.  I had a snow skiing injury 30 years ago where I tore the meniscus in this knee.  I did nothing about it for 10 years whereupon I finally had arthroscopic surgery to repair the tear as the pain had become nearly crippling.  By then the damage was done which I am paying for now.  The orthopedic surgeon I had been seeing for the past year or so and who had been administering the increasing ineffective hydrocortisone injections was recommending a conventional total knee replacement following X-rays and an MRI.  That would involve an 8"-10" incision down the middle of my knee, cutting my quadriceps muscle tendon and installing a full knee prosthesis.  But understandably I sought some second opinions and I had the opportunity to consult with a few leading knee surgeons who all believed I only needed a partial knee replacement.  I was particularly impressed with a surgeon at UF who I have chosen to perform the above mentioned procedure as an alternative to the conventional full knee option as the other surgeons were in Houston and Alabama and I live in FL only an hour away from UF.  My surgeon has cautioned that until they open the knee up and look inside, he can't be 100% sure the partial knee replacement is all that will be necessary and I appreciate his honesty.  But if things go as he anticipates he has told me I could be skiing in as little as 6 weeks.  The fact that with this type of surgery they only need a 4"-6" incision on the inside of my knee and they go in under the quadriceps as opposed to cutting through the quad tendon as they would with the conventional approach, post op pain is greatly reduced and recovery times are greatly accelerated.  Once I know which brand implant gets used and any other details of interest I will post them, as well as an update on my rehab progress following this type of minimally invasive surgery.

[Jody_Seal]

had a nice consult and conversation with a anesthesiologist yesterday who is getting ready have his knee replaced. in conversion i asked about Robot vs surgeon. he told me that his opinion, prefer the surgeon over the robot. reason being the robot just swipes a programed path with the router bit and the surgeon will better custom fit the device.

[OldGuysRule]

I am encouraged by the responses for this topic.  I'm presently recovering from full knee replacement on January 9th.  Have been doing the therapy with a professional and at home which is no "picnic!"  Therapist tells me I'm doing great. Started back on upper body machines this week and swimming laps.   I know I'm motivated!   I'm walking and doing steps with no issue.  Some degree of discomfort at night.  I'm no spring chicken but am in decent physical condition.   The elephant in the room is will I be able to water ski and snow ski again.  I think/am hoping to at least do recreational water skiing later this summer.  Competition may be out.....we will see!   I appreciated all the comments.

[Cnewbert]

@Jody_Sealthere's many robotic systems available and I haven't investigated them all by any means.  But with none of the ones I've looked into does the robot actually perform the surgery as your anesthesiologist seems to imply.  They are robotic assistants, designed specifically to help guide the surgeon for more precise implant alignment than is possible with the traditional approach, and without the need for the metal alignment rods placed into the thigh bone that traditional approach requires to obtain proper alignment.  The surgeon utilizing a robotic assistant remains in control of the actual cutting.  Even with the Mako system the surgeon makes the cuts with a hand-held tool as I understand it.

My surgeon at UF will be using the CORI robotic system, which employs a hand-held surgeon-controlled robotic sculpting device that receives feedback from its 3-D imaging at the rate of 300 times per second. The surgeon maintains complete decision making authority at every stage of the operation.  The robot doesn't do any cutting on its own or make any decisions on its own.  It is an assistant to the surgeon only. Exact implant placement is even more critical with the partial knee replacement I will (hopefully) receive, as the implant must be balanced precisely with the remaining bone and cartilage in my other two knee compartments.

The first knee replacements were done in 1968, 55 years ago.  In virtually all areas of medicine, technology has improved both techniques and outcomes.  I've chosen not to use 55 year-old procedures for my knee replacement, but rather to put my faith in the newer high tech approaches that require a smaller incision with no cutting of my quadriceps tendon, and provide greater precision of implant placement, less tissue disturbance in general and faster, more pain-free recovery time.  I fully anticipate walking out of the hospital the same day of my surgery.  There's a lot riding my this choice I have made, so I hope I have made the right one.

[T_C]

@CnewbertPretty sure you made a good choice. I had mine replaced in December of 20219. I had the surgery at 8:30 in the morning and was walking with one crutch at 3:00. Went home at 4:30. Skied my first set 90 days later and have been pain free ever since. Now if only cancer was that easy! 

[Ronny61]

There is some very good info from this place in California "The Stone Clinic"

https://www.stoneclinic.com/robotic-joint-center

 

I had full replacement on my right knee done 14 weeks ago at the Steadman Clinic in Vail Co by Dr Kim who is supposedly one of the top surgeons in Colorado. He does not use the robotic assistant and when I asked him about it he told me that he sees know advantage to it.

My new knee makes a popping noise that you can hear and feel, doesn't seem to affect anything in performance but sure is annoying. Dr Kim said that this is normal and if he set it to tight then it wouldn't work properly. Does anyone else that had a full replacement experience this?

[karlc1955]

Rear leg  knee replaced September 2022. Robot with Stryker 3d printed hardware.

Back on snow skis after 8 weeks, rehab was my fulltime job.

Back on the water in April no problems or pain. 

Also, single track mountain biking with no pain.

[LLUSA]

Had both of mine done 14 months apart at Andrews Sports Medicine in Birmingham by Dr. Lyle Cain. Dr. Cain used the Styrker Robotic Method, they seem to get a more precise fit and alignment with this system. After first surgery on Tuesday I was back at work on Thursday, second surgery took a week to return to week, but in reality the 6-8 week window is when the pain goes away and all that's left is therapy. I was fortunate I had therapy twice a day at the facility I operated. Fact is look at who does the most high profile athletes and make your choice.   

[Cnewbert]

I had my partial knee replacement surgery yesterday morning (Monday, March 6), and walked out of the hospital that same afternoon.  Yes, I had a walker to help, though I could have done without it except I'd give the attending nurse heart failure.  This morning, Tuesday, I remain completely pain free as I have been as soon as I woke up from surgery, but of course drugs help! I can walk completely normally, just carrying the walker off the floor as a back up.  I don't want to be macho and have a fall the would set me back from my goal of waterskiing in 6 weeks. They've given me a small waist pouch with a pump that delivers incremental doses of Ropivacaine through a catheter to the surgical site. It's a non-narcotic numbing agent that seems to work so well I may never need the hydrocodone, a powerful narcotic, they've prescribed for me to resort to if needed.  I just take some Tylenol, Celebrex and Gabapentin, all non-narcotic.  So the good news there is I can have a beer at night!

The surgery went astonishingly well!  I had a spinal and don't remember a thing.  While I was still knocked out my surgeon found my wife in the waiting area and Melanie said Dr. Gray was just radiant with how well it went.  He said it was a "high five all around" procedure, and that I now have the knee I was born with.  He says I will have 140º range of motion when all is said and done (I believe they test this on the operating table), and just the day after surgery I can extend and flex my leg considerably greater than expected.

The brief details of my surgery are that I had a unicompartmental, minimally invasive, quadricep sparing robotic assisted knee arthroplasty.  Of the 3 knee compartments, only my medial compartment was bone on bone.  The other two, confirmed during surgery, were surprisingly healthy especially for a 74 year old.  Thus, replacing the bad one now will in all probability preserve the remaining two for the rest of my life.  (The original damage was done 30 years ago from a snow skiing accident that tore my meniscus, resulting in slow and long term deterioration of the joint.)  The minimally invasive procedure involved a short, 4-6" incisive on the medial side of my knee instead of an 8-10" incision down the middle of my knee and leg and the metal alignment rod implanted into my thigh required by conventional knee replacement surgery.  The quadriceps sparing aspect means that instead of cutting the quad tendon and muscle to access the knee joint, they go under the muscle, with minimal disturbance and bleeding of the surrounding tissue.  The actually bone cutting is guided by the robot assistant that sends information from the 3-D computer modeling of my knee 300 times per second to the handheld sculpting tool guided by the surgeon. Apparently precise alignment of the implant is even more important with a partial knee replacement as the implant must be exactly positioned and balanced with the unaffected 2 knee compartments in order not to negatively affect their motion and function. My implant is the Smith+Nephew JOURNEY UNI which features the patented and award winning OXINIUM Oxidized Zirconium metal alloy surface, more than a decade in development. It's claimed to be twice as hard as the cobalt chrome implants most commonly used by other manufacturers.  Mind you, I take this all as an article of faith since I am a rookie when it comes to knee prosthesis,  but I have tremendous faith in my surgeon at the University of Florida Orthopaedic Sports Medicine Institute.  He and the entire staff were remarkable.  Only time will tell of course.

In addition to all the above, the surgical site is covered by the PICO negative pressure wound therapy system, a system used in a wide variety of surgical procedures besides joint replacement.  The incision  area is covered by a large air tight covering with a tube connected to a small pump that applies suction beneath the bandaging, increasing blood flow to the area and promoting wound healing. Lastly, they have me wearing anti-embolism elastic stockings intended to reduce the potential of blood clots.

That's all I can think of.  I've provided this much detail for the benefit of anyone else in this group contemplating knee replacement surgery.  Hopefully they will find this info helpful as they research the many excellent options presently available.  I definitely fall into the doing it sooner rather than later camp, for as you can see from the X-ray, only a small part of my knee was replaced, resulting, I'm told, with a completely natural movement, feel and function once the healing is complete.

[Cnewbert]

Just one quick follow-up to my long previous post.  My home PT left an hour ago, the first day after my surgery.  She said the 14 day post surgery PT goal for range of motion is 90º.  My range of motion measured 124º.  I believe that is testimony to the procedure that was performed on my knee.

[thager]

@Cnewbert That's amazing range of motion after surgery. Mine was 90 degrees initially and took the whole 6 weeks of PT and the (comfy chair) to get to about 120 degrees rom. My knee was pretty messed up though.

[Cnewbert]

@thager even 90º immediately post surgery is very good from what I've been told.  My PT said some people are in tears just trying to reach 70º.  How long ago did you have your knee done... how is it now... and how has your skiing been affected?

[BraceMaker]

Make sure you are getting the knee all the way straight.  So many people worry about how far they can bend it but fully straight is more important.

[VONMAN]

@CnewbertWow! Quite a journey. Glad you are doing so good. Didn't know you were having Knee problems. But good to hear it's been a positive experience. Six weeks seems really quick! At some time I know I will have to get my right knee done so keep us informed of your progress.

Ernie Schlager

[thager]

@Cnewbert Surgery was Nov 2019. Knee has been great. No pain and 100% strengthwise. Am skiing more consistently and better than ever, occasionally getting into -38 @ old man speed.  

[Cnewbert]

@thager that's awesome to hear!  Congratulations!

@BraceMakeryes, my PT has stressed straightness as well.  I was 5º yesterday, the day after surgery.  I was 3º today, so trending in the right direction and my PT is very pleased.

@VONMANmy knee has been sore for years, though never debilitating.  It hurt much more horseback riding than skiing (left/back leg), and horseback riding is the sport where I was most negatively affected by the pain. As it was bone on bone in the medial compartment, it wasn't going to get any better, and the hydrocortisone shots had ceased to have any meaningful effect. Getting this one joint compartment replaced at this stage may well preserve the rest of my knee in the years to come as I will have more natural function and movement with the partial knee replacement and therefore less stress will be placed on the other parts of the joint.

[BraceMaker]

Perfect you would be amazed how many folks get stuck with a 5 or 10 degree flexion contracture. Then they walk around bow legged sort of a weakness of the Uni in my opinion seems to cause a lot of revisions to totals 

[Cnewbert]

@BraceMaker good news… I was 0° today on my straightness. Still 124° on range of motion, but my PT said not to worry that it has stayed the same since I started out so far ahead of normal at this stage of recuperation.

Nerve block pump and catheter removed yesterday but hasn’t resulted in any increase in pain, which remains well controlled without needing the hydrocodone.  At rest there is no pain at all. Had my first look at my minimally invasive 4 1/2” incision today when the PICO dressing was changed on day 4 after surgery. I really do think this is the way to go if it’s an option for whoever may read this and may be considering a knee replacement.

[Cnewbert]

Progress report:  as of today I am just 3 weeks post-minimally invasive quadriceps sparing robotic assisted partial knee replacement surgery.  I now have a full 135º range of motion, which my PT says is completely normal for a healthy knee, and 0º straightness. Typical medical sources say the 4-6 week goal of PT is 90º with full range not expected for 8-12 weeks.  My PT is turning me loose early and says I need no ongoing outpatient care, but to keep up my home half hour exercises every other day or so.  I am fast-walking one mile around our neighborhood without aids or support of any kind.  My scar is healing nicely.  I still have some periodic minor discomfort, easily controlled with Tylenol, but mostly I'm unaware of any sensation at all. I hope to be skiing in 3 more weeks as my surgeon originally predicted, pending his approval. In any case, I'll wait until he gives me the green light but I am very optimistic! 🙂

Edited March 27, 2023 by Cnewbert

[Cnewbert]

I had my 4-week post-surgery evaluation with my knee surgeon yesterday. He said I was in the "upper stratosphere" of patients re: my healing progress.  I let him know that as a water skier, I was far more motivated with my PT than most!  He said I could start bike riding any time and I've ridden several miles in the last two days without the slightest ill effect.  

My surgeon also said my knee joint was stable and perfectly fine to water ski already. The cement used to bond the implant to the bone is 95% cured in 20 minutes, and fully cured in 24 hours, so there is no concern about the strength or integrity of the joint.  And since the minimally invasive technique he used disrupts so little surrounding tissue compared to traditional knee joint replacement, the entire healing process is greatly accelerated.

But while the incision looks completely healed to the eye, apparently the skin still remains somewhat porous at one month out, so he doesn't want me to immerse my leg in water for another two weeks to avoid any chance of infection.  At that point, when his originally predicted 6 weeks are up, he said to go ahead and start skiing, just use discretion based on how my knee feels.  

[Cnewbert]

5 1/2 weeks post surgery.  Incision healing well. I’m walking 1 1/2 miles a day and bike riding 5-6 miles daily. Still taking a little Tylenol daily for low level discomfort. Weather permitting I’ll be skiing again in just a few more days.  We’ve had a lot of windy weather in the weeks following my surgery so I haven’t missed tons of ski time with these  conditions.  

[Cnewbert]

Day 42... 6 weeks post surgery... arrived yesterday.  My surgeon had already given me the green light to ski and my knee felt good.  Not perfect, but good, and getting better daily.  So my wife Melanie and I hit the water without wasting another minute.

Now I don't offer this video clip as an example of good skiing, especially on this forum where there is such a distinctly high level of skier.  But the fact is, I was never a good skier to begin with before my surgery.  I'm 74 and didn't even start skiing until I was 68, so it is what it is. I just ski for fun.  While I'm sure my posture, timing and rhythm will come back in the coming days, the bigger challenge I face is gaining confidence in my new knee, actually believing it won't come apart on me when crossing the wakes or if I fall!  The mere fact that I can ski at all and have fun so soon after knee joint replacement makes me very happy!

So the point of my including the video clip is really more of testimony to my surgeon, Dr. Gray at the UF Health Orthopedic and Sports Medicine Institute,  and the robotic assisted, quad sparing, minimally invasive surgery he performed -- an approach my original orthopedist who had been treating my knee for a year with cortisone injections dismissed as a mere gimmick... hype... an opinion that other medical professionals also apparently share.  This guy wanted to do a conventional full knee joint replacement where my quad tendon would have been severed and no doubt I'd still be hobbling around, maybe still on crutches. I certainly wouldn't be skiing in just 6 weeks.  While I can only share my experience, I'm confident in saying I am proof this type of surgery is definitely no gimmick.

 

Edited April 19, 2023 by Cnewbert

[Rednucleus]

@Cnewbertwe really need to talk to@Horton about getting a "triple awesome" button installed, because that's what I would choose - looking GREAT!!

[Cnewbert]

@Rednucleusthanks!  But what is actually great is the medical technology that would allow me to start skiing again just 6 short weeks after getting knee joint replacement surgery!

[coach3]

@Cnewbertwhat brand of implant did your surgeon use? was it a Zimmer Persona? using the Rosa system?

[Cnewbert]

@coach3  I got the Journey II Uni Knee implant manufactured by Smith + Nephew.  It uses titanium for the baseplate tibial piece and a patented material called oxinium for the femoral component. They also make the CORI robotic system my surgeon used.  One big advantage of the CORI system is that it does not require a CT scan to map the knee. I'm told CT scans deliver a radiation dose equivalent to 50 chest X-rays.  Mapping is done at the initial stage of the actual surgery with the surgeon using a tool called a probe, which is basically an array-augmented hand piece with a fine-tip (the array allows the robot to know exactly where that tip is at all times—the surgeon just needs to indicate to it when he is touching your knee.  This map sends information to the surgeon 300 times per second as he operates the handheld bone sculpting tool.  I don't know if there is a "best" system, but my implant was so precisely aligned with the CORI system I had 124º range of motion the day following my surgery and it's improved from there.  I'm a little past 135º at present, 6 1/2 weeks post surgery.

[coach3]

@Cnewbert So glad for you, very impressive. I am headed in your direction soon, just trying to put if off another year or two. 

 

[Cnewbert]

@coach3 are you looking at a full knee or partial knee replacement?

[Wayne]

@Cnewbert thanks for posting this. I’m nearing some type of knee replacement The impact to being able to ski again keeps me in the mindset to delay it as long a possible. This is some useful information to have going into discussions with orthopedic surgeons and a reminder that we need to be medical advocates for ourselves. 

[coach3]

@Cnewbert Sadly a TKR. I was a candidate for a Partial years ago, but waited too long. I was run over by a boat and the prop tore into my leg and body. I can still run 32 off and a few more, but wake crossings are getting more painful on the front knee. Being only 66, I am trying to wait so as not to have to do a revision 18 years later. Maybe I can make to 70. 

In other sports, I can ride a bike 50 miles, and row for 1.5 hours or so. The knee is just quite loose. I have years of research on the topic. 

[Cnewbert]

@Wayne I don't know whether you are a candidate for a PKR or a TKR.  If you only have one bad knee compartment, medial being the typical one I believe, fixing that sooner rather than later can preserve the remaining two compartments.  I'm told a PKR will function virtually like a fully intact knee, whereas a TKR will have some differences, though I don't know enough to say what those would be.  So that might suggest acting sooner is possibly be the best option.  I mentioned above I resumed skiing last Tues just 42 days from my PKR and skied 4 days in a row last week total.  My knee felt better each day.  We don't ski on weekends on our public lake, and today we're knee deep (no pun intended) in the purchase of a lake house, otherwise we'd be back on the water with my knee feeling better than ever.

[Cnewbert]

@coach3  that's quite a story!  Sounds like you are lucky to even be alive, or not to have lost your leg entirely!  Amazing you can do so much after that.  Congrats!

[coach3]

@Cnewbertyou are correct on all. Grateful and have more than I deserve. Looking forward to seeing your story unfold this season. 

 

[Wayne]

@Cnewbert I had a meniscus tear when I was 17. Unfortunately they had to remove about 20% due to a very poor decision made by the ER to splint my knee with my leg straight until I could see a specialist. I had a second clean out surgery done when I was 37. After that I had about 40% of my meniscus remaining and osteoarthritis. My surgeon at the time said “if you were over 50 we would be discussing a replacement” but advised to protect it and preserve what I had left by modifying my behaviors. That has carried me to now, being 46 and still active but running for exercise is out of the picture. 
 

Until the pain or ability really starts to limit activities I was guided to hold off. Maybe that has changed and I should go for a consult.

[Cnewbert]

@Wayne so much has changed in knee replacement surgery since they were first performed in 1968.  The newest robotic procedures allow for more precise alignment of the implant, which is critical to the lifespan of the artificial joint.  As well, the implant materials have evolved tremendously, and are considerably more durable than before.  I would encourage you to go for a couple of different consultations, including surgeons who are experienced in robotics and minimally invasive techniques, and who specialize in sports medicine.  Good luck!