Type 1 Knee Replacement and Healing Process

I’ve been a Type 1 for 42 years and have never had a surgery. Last year I was gardening that caused knee discomfort and had it checked out and found out that both my knees are in “bone on bone” condition. Orthopedic surgeon has placed me in a queue for knee surgery and awaiting my call when I’m ready. When I mentioned to the surgeon of my diabetes condition, he responded that he has done many knee replacements on diabetics and that my healing process may take longer than a nondiabetic. He also mentioned my A1c is fine. Endo stated that my A1c is fine so surgery should be fine. I would love to hear from any long term Type 1s that has had a knee replacement or any other invasive surgery and what I can expect during the healing process. I feel so alone in this predicament.

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Well, I’m T2, but for 38 years and on a pump for the past 20. Had both knees replaced in 2018 (one at a time) and had excellent recovery. My surgeon used Makoplasty, which is robotic assisted surgery, and I had very little swelling. Was walking without a cane in the house within about 8 days, and totally got rid of the cane within 3 weeks.

It hurts like hell the first week, but the pain was totally gone by the end of week 3. The more you push with p.t., the better your recovery will be.

Also, my pcp went into the hospital and wrote in my chart, “patient is to monitor her own blood sugar and titrate her own doses with pump” so I had no problems in that regard.

I will say that the surgery was the best thing I ever did and I just wish I hadn’t waited quite so long to have it. Total bone on bone in both knees, and lots of bone fragments had to be removed.

If you have any more specific questions, I’ll be happy to try to answer them.

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I’m a Type 1 for 20 years. High blood sugars slow down healing, which is why they are saying since your A1c is fine, you should be fine. I guess though, how well you heal kind of still depends on the how fine your A1c is and how you get to it.

But if you heal fine in general, it should be fine.

6 years ago I had a short surgery followed a week later by a major longer shoulder surgery and I healed great and I did my PT just fine. No issues at all. Other than being scared to death of surgery in the first place and my blood sugars during etc.

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Are you sure you are at the point where you need it? I injured my knee after spraining my ankle and they told me one knee is bone to bone or close. But I did PT for the injury and eventually it got better. I have had problems with both my knees ever since I tiled a floor and did the grout without kneepads years ago. But the right one is worse. Lately I’ve been walking every day and I’m starting to do some stairstepping again and I think it’s strengthening everything. My muscles wasted leading into DKA and I have never really recovered fully from that yet.

No one mentioned knee replacement yet so I think it depends on your functionality.
They said the reason I’m getting this condition is because of the bone structure- my knees turn inward and that causes the cartilage to break down when you walk. One of the doctors who retired mentioned an injection into the joint, of your own platelets, but it can cause blood clots so I did not pursue that.

Thank you for your response. I’m so glad you had successful outcomes! May I ask you what made you decide to get the knee replacement? How did you find your doctor who does minimally invasive knee replacement? How long were you in the hospital? The physical therapist I saw for my knees mentioned my surgeon’s name. The surgeon didn’t say too much as to how he would do the surgery. He stated that based upon his physical examination of my knees and movement, it deviated from what can be seen on my x-rays. His nurse practitioner cautioned me that it was necessary to continue to exercise the leg muscles, etc., but to be aware that I may be wearing out the existing knee joint to the point of complete separation. If this should occur, I will fall to the ground and be unable to get up and a knee replacement may not be possible due to insufficient bone to attach a new joint. Needless to say when I heard the NP say this, I couldn’t think clearly to question the surgeon.

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Thank you for your response. I’m glad to see that your shoulder surgery was successful. Did your shoulder surgery heal as quickly as a nondiabetic or did it take longer? I have difficulty accepting an A1c as a sole test method to determine one’s surgical/medical outcome. Does the control of blood sugars not matter the previous diabetic years prior to a surgery? It appears that a current A1c result puts everything in motion and one’s past diabetic control doesn’t make a difference.

I’ve had T1 diabetes since ‘88 and almost always had solid control. I can at least write that I’ve never had to be hospitalize for dangerously low or high BG levels since being diagnosed in grade school.

I didn’t have a major surgery until 2017 when I had to have a torn labrum in my right should repaired — an injury from my years coaching volleyball.

The thing is that I’ve noticed smaller things take longer to heal as far back as 1997. So, yes, things took longer to heal. I cannot say how much longer. I imagine the slowed rate depends on innumerable other factors. It was totally worth it though.

(Also, don’t rely on just your A1C. I learned at my most recent Endo appointment, there are now other data trends they are using in addition to A1C to draw conclusions for treatment.)

While I still do not have complete range of motion (that is normal for the kind of surgery I had and was warned about it in advance), I have enough range (about 90-95%) to do pretty much everything. Also, I no longer have the INTENSE pain and weakness.

Even when it takes longer, and it will take longer, it is the PT (and doing the PT homework) that while jumpstart the healing. The more you move and increase blood flow, the faster it will heal positively. Wihile you working to be cleared by a physical therapist, do research on body weight strength training and yoga to continue improvement after you “graduate” PT. You can strengthen the rest of your body while you manage the PT for your knees and will eventually be able to focus on larger combinations of body movements.

In fact, due to the Covid shut down beginning in March 2020, I had very limited access to exercise. During that time, I think I finally developed a similar condition in my left shoulder. I started to PT exercises around May 2021 and have increased intensity since then. I’ve been able to put off having to consider surgery. I still have moments when the left shoulder hurts, but it’s never gotten close the level of pain in my right shoulder. I think that is because of building strength and increasing movement over the last 15 months.

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I healed really fast and had started to heal before I went into surgery. In my case someone accidentally tugged on a vacuum cord while I was stepping over it and I went flying and the very tip of my shoulder hit the corner of a metal shelf fracturing it. And immediately I couldn’t lift my arm past my waist. They actually flew in a specialist because it was going to be a very tiny screw to hold the tip of a very tiny area of the bone into place. But it already had started to mend by the 10 days after, so they didn’t want to touch that once they got in there, so no screw was used. But they completely opened my shoulder and cleaned out the socket from a previous tendon tear and damage and re-positioned my arm in the socket. It still turned out to be a long surgery.

Huge 10 inch scar that there is almost no signs of it now and no signs of any issues. Even though when I came out of surgery the first thing I was told was I would need shoulder replacement surgery. I did PT and I was bugging them to start it as they were backlogged. I had a chiro friend give me some exercises to start while waiting. But I healed as fast as anyone and towards the faster side. Part of that was starting some PT as soon as I could to keep it moving and stop it freezing up. I did all the exercises religiously. I wanted it to be 100% as soon as possible. I also used argan oil and an oil blend to get rid of the thick deep layer of scar tissue I had after it healed.

High blood sugars can cause damage over time, but it also thickens the blood, which inhibits circulation and inhibits healing. I think if a more normal level of blood sugars are maintained, the healing process has a chance at being normal. While my A1c is lower now, at the time it was in the low 6’s because I was working and couldn’t spend as much focus on it as I do now. But I get a sore on a toe and it heals up quick. I know that because I snorkel and if I snorkel too much the fins take off several layers of skin from rubbing on my toes!

I have been a type 1 for 20 years. I have never shown any signs of healing slower. I would pay attention to what your healing time is. That should give you an idea more of what to expect in healing time. With a note that knee surgery recovery is work in the first place.

I had been having trouble with my knees for tears. My rheumatologist was giving me cortisone shots in one knee or the other. At first, the shots8 would relieve the pain for up to a year, then only six months, then they stopped working altogether. So then we tried synvisc, which is supposed to mimic and replace the hyarolonic(sp?) fluid in the knee. When that didn’t work. I went back to the orthopedic surgeon who had said, about 10-12 years earlier, “wait to have surgery until everything else stops working.” She is an expert on makoplasty, which is robotic-assisted. It allow for mor9e precision and causes much less swelling. She sent me for PT for several weeks before the surgery to strengthen my legs. I had the surgery on a Monday, and was sent home on Thursday. I could have gone home on Wednesday, but because of being diabetic, she kept me in for an extra day.

A friend stayed with me for the first 5 days, until I could manage by myself. I had in-home PT 5 days for the first week, 4 days the second week, 3 days the third week, and 2 days the 4th week.

They actually start you on a walker in the hospital on the first day after surgery. And, let me tell you, the first week is a real b**ch, even with really good pain med routine. But, I was told that the harder you work the PT, the better the recovery, and it’s true. By week 2, the pain isn’t that bad, by week 3, I was off all pain meds, and by week 4, I had almost zero pain.

I don’t know where you live, but if you’re in the greater Boston area, I’d highly recommend my orthopedic surgeon. I had surgery in my local community hospital, and she is the only doctor in a community hospital that made the Boston Magazine’s yearly list of 100 best doctors!

Otherwise, do a search for orthopedic surgeons in your area who use makoplasty, and make an appointment for a second opinion.

Also, you’re probably not going to “fall to the ground” in the near future. I think you have time to do some research and find a surgeon who uses makoplasty and who’s NP doesn’t use scare tactics.

Good luck with this and keep me posted. And definitely ask whomever you choose to do the surgery about pre-surgery PT. It’s super important.

Ruth

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Two non-D friends have had knee repacement and were pretty loopy on the pain meds the first 1-2 weeks. Did you need help managing insulin dosing during this part of your recovery? Were you able to respond to CGM alarms? I can imagine being sufficiently “out of it” not to hear low alarms.

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I don’t have a CGM, but I am on a pump. I was never too loopy to test and manage my bonuses, except for maybe an hour or two immediately after the surgery.

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I had 3 !/2 hours of neurosugury on my back last November and after 6 months of PT 3x a week this 83 year old is back to playing tennis. The one caveat is that if there is te need for steoid, (there was in my case) it plays havoc with the BGs. Otherwse I didn’t see any difference in healing time, in fact everyone is astounded that I can do what I do You’ll be fine.

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My father always said that, when you call any surgeons to ask for an appointment to see if you need surgery, they will always say you need surgery immediately, if not sooner. He said to always go with the minimally invasive procedure.
My orthopaedic doctor said to try glucosamine first, and it worked. He’s on salary, so he tries not to recommend surgery unless it is absolutely necessary. And the glucosamine fixed my knee problems without surgery.

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Thank you for your detailed explanation. I’m also in the Boston area. When I first caused the injury to my knees, I felt severe pain getting out of a vehicle to stand up or getting up from a seated position. After the first minute or two, to stand and stretch legs out, the knees were okay to walk. The PT exercises which I’ve been doing since last August has pretty much alleviated the pain.

I still have difficulty getting into a kneeling position to complete my PT exercises and I no longer jump up from a seated position. I’ve also noticed my knees don’t feel tight, like there’s unusual micromovement taking place in the knee area. In addition, I’ve noticed my legs feel weaker like there’s some resistance taking place. The latter symptom was noticed when I was in my early 50’s and I was checked out by a rheumatoid physician and no issues were raised.

I’m now 66. If my current knee condition remained unchanged, I could continue as is without surgery. However my concern is there may be further knee bone damage taking place without me noticing it. I think your response got me thinking more clearly that I should get 1 or 2 additional orthopedic doc consults to hear exactly what I’m dealing with.

Well, as I think I inferred in one of my previous posts, my orthopedic surgeon is not one who pushes surgery if you don’t really need it. Her name is Susan Chabot, and her office is on Route 1 in Norwood. It might be worth it for you to make an appointment with her for a second opinion

I don’t know if this will be helpful or not. My husband is 73 and doesn’t have diabetes. His knees have been painful for years. He saw an orthopedic surgeon several months ago. After looking at my husband’s X-rays, he told my husband that his arthritis isn’t that bad yet, and gave him a prescription for PT. My husband very faithfully does the exercises, but is in more pain than ever. He is going to make another appointment to see about cortisone injections.

This surgeon was in no hurry to do surgery, but my husband is in pain. He wears knee supports and takes very good care of his knees. He also can tolerate a lot of pain before complaining.

I am 71 and have been a type 1 for 63 yrs. My knees aren’t in good shape, but are not painful enough to get them checked out. They both make an abundance of noise when I go up and down stairs and I haven’t been able to get into a kneeling position in years when gardening. I can still get off the ground from a sitting position but it is very difficult. It is beginning to hurt when I stand from a sitting position in a chair. My left knee is also extremely noisy when I rise.

I suppose I should see someone especially since I have read about your knee problems, but I guess I am waiting until my knees hurt a lot more. I should start PT though.

I know that my husband’s GP told my husband to do whatever he can do to postpone surgery.

I think that getting a second opinion about your knees is very wise.

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I’m 66, A1c always good, work out 3 to 4 times a week, type 1 since 1970. Have had other major surgeries in past and i do take slightly longer to recover, but still within reason.

Had knee replacement nearly 8 weeks ago with highly recommended orthopaedic surgeon. Was NOT robotic/Mako. Totally regret surgery.

In far more pain today than before. Still stiff, in pain, using walker, swelling doesn’t go down. Should have about 110° of bend by now, instead have 80° but with pain to bend that far. Wake up several times a night in extreme discomfort. Have done nearly everything asked, do daily exercises, go to PT 3 days a week. Probably too much scar tissue has formed, so surgeon wants to put me under anesthesia and force knee to bend/break up scar tissue. Not sure what i’ll do, but current status is untenable.

I would not discourage anyone else from doing joint replacement. My outcome seems to be exception. Still, be prepared for any outcome. Ask a LOT of questions of surgeon and PT staff before proceeding. You may be asked to do leg exercises prior to surgery. Work on upper body and arm strength too in case you stay on walker for a longer time. Have help available for getting around, cooking, etc for several weeks, but hope you won’t need that. Look for YouTube videos that address knee therapy now so you are fully prepared for any outcome. I did not get any infections, but if you do insist it be cultured so correct antibiotic(s) are given. That is critical!

Best of luck!

Type 1 for 50 years. Had a six hour spine operation 12 years ago fusion of L3-4. I was on a pump but no CGM at the time. Also had a total abdominal hysterectomy 8 years ago. By that time I had a dexcom. I recovered quickly and healed faster from both procedures than some folks I know without diabetes. I did need steroids during the spine surgery and so the first 24 hours after my sugars were in the 300s and that did not affect my healing. I had Dilaudid in my pain pump which, much to my surprise as a nurse and CDCES, did render me too sedated to stay awake long enough to check my own blood sugars and I did not want to depend on busy staff nurses to keep from being hypoglycemic so I recruited family and friends to stay and do it
for me the first 24 hrs. With a CGM that worry would be taken away.

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Gezunt…you reminded me that I did have one problem after the surgery on the right knee. Developed some scar tissue in the back of the knee that kept getting caught in the new knee appliance, and had to have another surgery to remove the scar tissue. But, no big deal and SUPER quick recovery from that.

Thanks for that info, Ruth! After reading this thread i scheduled an appointment. Doc had cancellation so i see him tomorrow. My A1c is 6.2 sugar isn’t issue. Perhaps additional imaging is needed or additional therapies can be done to push this along. I suspect scar tissue built up too quickly. It does not help that I’m allergic to most pain meds. Very frustrating. But this forum is helpful!