Knee replacement!

[Biker52]

I am due to have a TKR on 26/07.

I have inflammatory arthritis and have been taking Methotrexate since February and hydroxychloroquine since November last year.

Since starting Methotrexate I haven’t had any flares….touch wood!

I am slowly tapering Prednisolone…1mg a day at the moment.

I will be contacting the Rheumatology nurse tomorrow for her advice but I would welcome advice on coping with the preparation for the op and also afterwards from those who have experienced the op.

I had a knee replaced a couple of years ago but I was without ‘complications’ then so I don’t know how different the experience is likely to be.

Thank you!

[Fruitandnutcase]

Can’t help regarding the link between inflammatory arthritis and the operation, but I’ve got a friend who has just had her first knee done earlier this year and I’d say get yourself lots of ice packs - I gave her some twist and freeze ice packs I got for my husband when he had his hip done a few years ago and she said they have been invaluable - she has had a couple of holidays recently the first of which was a bit of a nightmare as she had no access to ice packs. Next time she took the instant freeze ones - Koolpak Original from Amazon.

Also do your exercises religiously - you’ll already know how important that is - but don’t overdo them. My friend has had problems with swelling hence the ice packs - we have a very good local physio who helped her with massage.

Good luck with it all

[BoneyC]

Some surgeons ask you to stop MTX 2 weeks prior and allow 10 days to heal before re-starting, something to ask the nurse. Good luck.

[ruth_p]

When I had my hip revision in 2018 they didn’t stop my mtx just my biologic. Your rheumatologist will be able to advise you on your medication.

[Runrig01]

I worked as a ward sister on the elective orthopaedic ward, and the one most important thing prior to surgery, is doing the exercises to strengthen the quadriceps muscles. They will make the recovery afterwards so much easier. My Trust run a joint school where patients attend for a 1/2 day prior to surgery, where we reinforce that, and they meet the physios and OTs, and can discuss and purchase aids etc to help afterwards. The other important point is never be tempted to put a pillow or rolled up towel under knee, unless it’s part of your exercises, as it’s essential to get your knee straight in the early days. The bend will improve as the swelling settles, but getting a straight leg is important if you want to avoid a limp. As someone else mentioned ice will be your new best friend.

I would also speak with your rheumatologist and surgeon re your MTX. Most of the surgeons I worked with were happy to continue, and just stopped biologics, but I’d definitely check their views on it. I’ve also found that patients with inflammatory arthritis, manage better, I suspect because they are used to a higher level of pain on a daily basis. Depending on how badly your hands are affected, you may need a Zimmer frame with a gutter for your forearms, same applies to crutches and sticks, possibly with ergonomic handles. Good luck though, and hopefully you can recuperate in the garden afterwards.

[Connie49]

I had a TKR just before the first Covid lockdown, and was able to continue with MTX and Hydroxychloroquine throughout. I was hugely anxious that the surgery would trigger a flare, but a very nice doctor explained that that was unlikely to happen as a major source of inflammation in my body, aka my arthritic knee joint, had been removed. I’m pleased to say that he was absolutely right! Recovery was uneventful and I was in less pain than I had been prior to surgery. Work on strengthening your quad and hamstring muscles and follow the physiotherapists’ advice. Good luck!

[bakingD in reply to Connie49]

Interesting I have an awful knee and inflammatory arthritis but orthopaedic surgeon says I don’t need a knee replacement yet but it’s really bad so maybe I need a second opinion

[Biker52 in reply to bakingD]

I had an X-ray last September which showed mild to moderate osteo arthritis…which hurt far more than my other knee which was graded severe and replaced!

I mentioned the pain to the rheumatologist who gave me a steroid injection which didn’t have any effect.

At my next check up my knee was still hurting a lot but I was getting compensatory pain in my ankle and hip. The nurse wrote to my GP recommending a referral to an orthopaedic consultant which they did.

I saw the consultant last week who diagnosed severe arthritis and so I am having the knee replaced!

Perhaps you should get a second opinion before the pain worsens and other joints are affected.

[bakingD in reply to Biker52]

thanks but mine is different in that the synovial membrane of my knee is affected causing swelling pain etc rather than the cartilage I did get a second opinion just have to try to wait for methotrexate to start working 8 weeks in and no joy!

Good luck with your op I hope it goes well

[springcross]

Hi Biker. My hubby had a TKR in 2015 and was told, as Runrig has stated, that it was important to do the exercises prior to the surgery to strengthen the muscles. It's not far away now so good luck!

[minka]

Hi you a biker I am. The best thing you can do is look on u tube and do quad and most important VMO exercises. Get them as strong as I can.

[stbernhard]

Good luck with your TKR. I had one in 2019 and as far as I can remember, I didn't come of MTX. But we're all different and the advice from your rheumatology is best.

[Bella59]

Best of luck with your op.I've had both knees replaced 2011/2012.I found ice packs helped greatly.I used frozen peas wrapped in a tea towel for about fifteen mins several times a day.Exercises must be done to achieve a good bend.Take painkillers to help with the pain.I can't remember if i stopped meds back then.I had both hips replaced2021/2022 i had to stop Methotrexate,Prednisolone before first op.I was allowed to stay on 5mgs Pred for second op.It all depends on the surgeon.We are all individuals recoveries will differ.