TKR Red Flags and Self Assessment | My Knee Replacement Recovery

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In this article I’ll share some warning signs that slowly crept up on me over the years telling me that I might be a candidate for TKR. At first they were subtle warnings and in time they created problems and caused pain.

Some things seemed like minor inconveniences and I didn’t give them much thought. I became used to the associated pain and discomfort and I accepted them as part of the aging process.

Now that I look back, the aging process had something to do with it but what was really happening was that my knee was slowly deteriorating and I had accepted the pain and discomfort as “the way life was”.

I was putting TKR off and little did I know that it would dramatically improve my quality of life. As you read this you may relate to a few or many of my examples. If so, take the self-assessment I suggest later on in this article.

Red Flags and Warnings That It Might Be Time for TKR

I’ll begin by sharing some of the earliest difficulties I encountered over a period of 40 years.

Everyday dressing activities changed

what to wear after knee replacement surgeryI can remember as a child that I could put my shoes and socks on sitting on the floor or even standing up. As time went by I had to be sitting down to take off and put on my shoes and socks.

If I went to the beach and went barefoot I had to find a bench or sit on the back of my SUV in order to put my shoes back on. The same thing was true at the golf course when I would change from street shoes to golf shoes.

I found that I couldn’t balance on my right leg in order to change shoes standing up.

Shoes and Socks

While we’re discussing shoes and socks, I used to wear flip-flops for about half of the year because we lived in a warm climate.

As the years went by, the thin soles and their general lack of support began to cause pain to my knee. I began wearing tennis shoes more often and I was even willing to pay more for high-quality shoes with gel and air cushions.

It wasn’t just my shoes and socks. Trying to balance while standing and putting on underwear and long pants went from being difficult to impossible. Loose fitting athletic shorts were much easier to put on standing up.

For this reason once I started swimming regularly I always wore loose fitting shorts to make the change in the confined locker room easier.

Related: Best Shoes for Knee Replacement Recovery

Waiting In Line

Waiting in lines for an event or at a bus stop without a bench bothered my knee. I found myself always trying to shift the weight to my left (good) knee. When traveling the same thing happened when I had to stand on a moving train or subway.

This was especially telling at the airport when I boarded crowded trains with luggage. I had a difficult time keeping my balance without holding on to something.

Walking on hard surfaces

Walking on hard surfaces was another problem. On hikes I tried to stay off roads and paved trails. My knee felt much better walking on even dirt paths. Malls and Big Box stores with concrete floors were also uncomfortable and I tried to spend as little time in them as possible.

Walks on the beach were fine if I could stay on the damp flat even surface near the water. If I had to plow through deep sand to get to the water’s edge, I struggled.

I also like to swim and body surf in the ocean. As the years went by, getting in and out of the ocean while trying to keep my balance with shifting sand and moving water became a difficult feat. Any prolonged activity that I played on concrete like tennis and pickleball often caused my knell to swell.

Related: My Swimming Workout for Bad Knees


Driving gradually became uncomfortable for me because it was my right knee that I held on the gas pedal and braked with. Driving long distances was especially trying and I would use cruise control as much as possible so that I could bend and straighten my knee from time to time.

On long drives my knee would get stiff and sore so I made frequent stops to get out of the car and loosen my knee with a short walk. Getting in and out of cars was an issue especially if they were low profile models.

My wife and I bought a low profile Camaro for our 25th anniversary and it soon became “her” car, as it was too much trouble for me to exit. I had a full-size pickup with a bench seat. It was much easier to get in and out of the truck plus I could drive left footed and stretch my right leg out on the bench seat during long drives.

I encountered the same problem driving a golf cart with frequent stops and starts and setting the foot brake. For this reason I always asked my playing partner to take the wheel.


Sitting in theaters, at concert venues and sporting events became a problem especially if I couldn’t straighten my leg from time to time. I began to insist on an aisle seat so that I could bend and straighten my leg periodically.

I have a daughter in Australia and we visit her family once a year.

Sitting in an airline seat for 14 hours is a challenge. I seldom am ever able to sleep. I always sit in an aisle seat and I make frequent trips to the bathroom and kitchen area where I do simple stretching exercises with my leg.

The other option has been to buy a business class ticket where I can stretch out and get some sleep. Expensive but it makes a huge difference.

Related: Beginner Exercises for Knee Replacement Preparation


Bathing began to get harder as well. Washing each foot in the shower and having to balance on one foot got harder and harder. Our new home has a built-in bench where I can sit down and wash my feet.

When I swim in our community pool I always use the handicap shower and take advantage of the attached seat and handrails.

Believe it or not, getting up from the toilet even takes a bit of finesse.

Hiking presented challenges.

I’ve hiked with a group once or twice a week for the past 15 years. Most of the hikes range from 6 to 12 miles. In the beginning I had no real discomfort.

As time went by I began to take an ibuprofen before and after hikes. Later, I began using hiking poles. I began to notice that hikes with elevation gain and loss were harder on my knee.

Going downhill for long periods, having my muscles constantly catching wore out my knee and caused swelling. Loose gravel trails with downhill and boulder hopping were no longer possible for me.

Related: Best Walking and Hiking Poles for Knee Replacement

Getting in and out of pools

Swimming is part of my regular exercise routine. If I was unable to dive into the pool I had to enter on the steps. I had difficulty using the ladders particularly getting out of the pool.

Most spas have a handrail and steps that make it much easier to enter and exit. The use of kickboards and fins caused a great deal of pain and were not a part of my swim workout.


Gardening has always been a passion for me. Bending over and squatting while planting seeds or pulling weeds became impossible. Eventually I was using a foam pad to kneel on.

Standing up from a kneeling position was difficult until I discovered a garden kneeling pad with two side handles to push yourself up.

Household Chores

Chores involving a ladder became more difficult. Just going up and down ladders caused pain. If I was painting and had to balance on the ladder for long periods of time I had to take breaks and rest my knee periodically.

Playing with kids

Playing with children and grandchildren is great fun. However, I had to be careful in the backyard when kicking a soccer ball around. I always tried to kick with my left foot.

Kicking or punting a football was something I no longer did when playing catch with the football. When playing catch with the baseball sometimes the grandkids wanted to be pitchers and they needed a catcher to squat.

I utilized an old three-legged stool to receive their pitches and take the strain off my knee.


Get three different colored highlighters out after you have read over the examples I shared above.

  • If the activity causes you no pain, highlight it one color.
  • If the activity listed above causes mild to moderate pain highlight it another color.
  • If the activity causes you severe pain highlight it a third color.

When you visit your doctor share the self-assessment with him or her. The information may help the doctor as well as yourself decide whether TKR should be considered.

Related: How to Prepare Your Home for Knee Replacement Surgery


In this article I shared many everyday activities and many of my favorite activities that gradually caused me pain and discomfort. Years ago the discomfort was minimal and I continued to do things ignoring and enduring any pain in my knee.

As time went by some simple things and some activities that I enjoyed began to cause me more moderate and severe pain. This caused me to change the way I did things and to change my lifestyle and even eliminate some of my favorite activities.

With some activities that caused slight pain I was able to make adjustments and use aids that allowed me to continue to enjoy those activities. I hope you were able to relate to the examples that I shared and that you were able to take the self-assessment to determine if you are experiencing some of the same problems with your knee.

Share the assessment with your doctor on your next visit and get his or her opinion. Good Luck and I hope you keep reading my blog.

3 thoughts on “TKR Red Flags and Self Assessment | My Knee Replacement Recovery”

  1. Ken,
    I have been reading as many of your posts as I can find. I am tentatively scheduled for TKR on my right knee this summer. (In fact, my Ortho doctor was ready to set it up right then, my knee has gotten so bad!)
    Your posts have been so helpful with what to expect, how to manage, what I need that I have considered., And on and on. I did this assessment and I must admit most of them wound up in the second or third category, mostly the third.

    Thank you so much for sharing your story. There is much the medicos don’t share most likely because they don’t live it. This has helped

    • Glad I could be of help. Wise decision to give yourself some time to prepare. Go into surgery in the best shape possible and be prepared to work hard during the first few months. Good luck!

  2. I had a TKR 8 months ago. Still cannot get the swelling down. Lots of pain. Had MRI and scans bloods tests done. All clear of infection and inflamation. Please help. Still use ice when will I be pain free to walk and the swelling to go down

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