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[PARTIAL KR] 8 months post op.... HELP... Ideas?

Discussion in 'Knee Replacement Recovery Area' started by ronn, Dec 27, 2011.

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  1. ronn

    ronn New Member

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    My husband had a partial knee (Makoplasty) in April of this year. He was very compliant with PT but still had to go back in for manual manipulation. He has a great "bend" in his knee, but he walks very stiff legged and complains of the "tight band around his knee." his major pain is on the outside of his knee (not where the scar is, and not where the joint was replaced- medial side). The joint looks good on an xray, but appears to be more of a scar tissue or soft tissue issue some say.
    We have tried everything... deep tissue massage, ART, stretch therapy (he has a lot of muscle and not a lot of flexibility), yoga, chirpractor work, and multiple PT's. The Dr says to wait a year and see where things are, but the frustration level is so high. I read on a lot of threads about this feeling being common but I do not hear of a lot of solutions that are working for people. Any suggestions on where to go from here would be so greatly appreciated. Do you suffer from this? Did it go away or what did you do to remedy the issue? problems walking stiff legged? ETC. Thanks again!!
     
  2. Jaycey

    Jaycey Moderator

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    Hello ronn, welcome to BoneSmart. So sorry your husband is still suffering post-op but as you say it is not uncommon. Mobility and ROM take awhile to come back.

    Is your husband using ice on the knee? Sounds like there is still swelling there. Getting control of the swelling can help increase ROM.

    Also, is he taking any medication for the pain?

    I'll tag Jo our forum nurse so she can give you the expert advice. @Josephine: Meanwhile I hope you will keep us updated.
     
  3. Tykey

    Tykey Forum Advisor

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    If he's had manual manipulation, that drives recovery back almost to the beginning, and the clock almosts starts again. So his progress at eight months might still be reasonable.
    When was the manipulation?

    Also, a surfeit of aggressive PT (sadly a common thing we see in the USA!!!) also delays recovery. Almost everyone who does virtually NO PT makes a quicker recovery. What PT has he been doing, and what is he still doing?

    In this game, the harder you try the worse the recovery:thumb:
     
  4. maryo52

    maryo52 Sr Bonesmartie

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    You know, when things don't work as expected, we try harder. Isn't that what our parents taught? So it's counter-intuitive to do LESS when the knee doesn't go as planned. Tykey is so right. And he tried to tell me the same thing when I was in the dumps. But we live in a country where everyone and their cousin thinks it's their job to say, when things aren't going well, "Are you doing your PT?" It's like a national mandate!!

    Your husband had scar tissue grow inside, and the manipulation broke the bands. You already know there's scar tissue in there still, and that's not a problem. But knees that scar are very very sensitive to PT. I think the goal ought to be "minimalist PT."

    At my annual knee checkup in November my knee (which needed surgical removal of scar tissue after manipulation gains didn't last) was straightening great and bending well but it was very stiff. This is from effusion in the joint (extra fluid). The effusion pushes against the soft tissues coming into the knee thus giving the feeling of tightness, fullness, or discomfort at various points around the knee. My ortho explained that the effusion was caused by thickening of the synovium which happens because of the scarring (arthrofibrosis). At that point I had experienced little improvement in six months and so got referred to a rheumatologist, but you know what? Just two weeks later the effusion had decided to ease up. So FINALLY after more than a year I can go from morning to night without thinking about my knee.

    My advice: stop most PT efforts and let the knee just be. A little biking is good for muscle tone and mobility but nothing more is needed. Sometimes surgical knees need to kick back and take a day at the beach with a nice margarita!!

    With rest and a little time, the knee will calm down, the effusion will decrease, and the odd feelings in the knee will subside. As someone else put it, "The knee's the boss!"
     
  5. Josephine

    Josephine Forum Admin and Mother Hen Administrator

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    Wise words, both of you.

    And they are perfectly correct, ronn. Trying too hard to get that flexion actually makes the situation worse as it increases swelling (as does the MUA) and swelling is painful. Both of these hinder recovery big time so you'll forgive me if I say his present situation may be largely self-inflicted.

    I'm going to give you some articles from the Library to read all of which I think will be pertinent to your husband's present situation ....
    The importance of managing pain after a TKR and the pain chart
    How Long Does Healing Take ......
    Chart representation of TKR recovery
    Energy drain for TKRs
    Elevating your leg to control swelling and pain
    Using ice

    Why Do I Have That "Tight Band" Feeling Across The Front Of My Knee?
    Work “Smarter” and not “Harder”
    About recovering a knee - from one who knows!
    Some suggestions for home physio (PT) and activity progress
    It's never too late to get more ROM!
    It's Worth the Wait for ROM
     
  6. Tykey

    Tykey Forum Advisor

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    |It does seem odd doesn't it, that our advice seems to go against what these physiotherapists (and some doctors) tell us. After all they are the experts aren't they:hysterical:
    Our advice is strongly supported by many friends on here, but also by the fact that the "British Way" doesn't ever include any PT, other than gentle bending, and lifting exercises. We just recover gently and speedily, so there is real proof of it's success.
     
  7. Jamie

    Jamie Administrator

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    HI, ronn....welcome to BoneSmart.

    I'm hoping that things have improved a little in these past few days for your husband. How is he doing? Did you get a chance to read the links Jo provided???
     
  8. ronn

    ronn New Member

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    Thank you ALL for your thoughts, advice, ideas, and support. My husband's manual manipulation was only about 8 weeks post surgery. So, it has been about 7 months ago since that took place. He did do aggressive PT for several months and when that wasn't helping, his surgeon sent him to another PT for more :) He has been told by PT he has adhesions that need to be "broken up", so your library articles are informative and helpful. I will tell him to be patient. I know I am partially to blame as I have tried to encourage him to revisit PT and really work on his gait. His walking I fear is causing damage to other ligaments, etc. So, same advice? Just don't worry about the walking right now. It is strange because when he sits or lays he has GREAT flexion. But when he walks he complains of the tight band feeling so he stiff legs it more. Thanks again. All of your personal testimonials are priceless and much appreciated!
     
  9. aretha

    aretha Sr Bonesmartie

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    I can relate to your husband too Ronn, only today I was complaining that the stiffness band in my knee at 15 months is still there, and reminds me every day how slow this recovery can be, but after reading and chatting to all the Bonemarties on here, am I worried about it ............ not at all now that I realise that I am just taking a bit longer than some others, and class myself as very fortunate that I have no pain, very reasonable ROM and good flexion, just this tight band feeling, and if I have to suffer that for a while longer then thats fine. I am convinved that it will eventually disappear, so I can wait a while longer.

    Keep us posted as to the rest of his recovery, its always great to hear from other guys how their recovery is going, and it all seems to make sense when you realise the trauma your knee has been through.

    Take care .............:friends:
     
  10. Josephine

    Josephine Forum Admin and Mother Hen Administrator

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    8 weeks would seem a tad early. There is plenty of evidence that such early MUAs don't produce lasting improvements as the wounds are still too early and the MUA only causes a backlash of pain and swelling. Therefore, the wonderful flexion the surgeon obtained whilst the patient was asleep is quickly lost when the knee swells up hours later. Is that how it has been for him?
     
  11. ronn

    ronn New Member

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    Swelling, at least visible swelling, was not the problem ever. So post MUA, I can't see he had more noticeable swelling. He can get to 130 ROM and bends it fine while sitting, it's what happens when he feels that tight band that seems to inhibit is desire or ability to bend it. He was quite sore post MUA but since it has been 8 months post surgery and 6 months post MUA, the problem is just the "tight band" but it doesnt correlate with swelling... or at least not that we can see.
     
  12. jerseychick

    jerseychick Forum Advisor

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  13. aretha

    aretha Sr Bonesmartie

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    Don't worry Ronn, its perfectly normal this "tight band feeling". I've had it for months, at varying degrees, and it causes no pain and no restriction to my bending or walking, but comes mostly when sitting and doing nothing. I still get it, some evenings when sitting more than others, but I have read Jo's theory and am sure that I am just taking longer than some BS'ers to "knit" together, and am ready to wait it out to see if it does gradually disapear, and I am sure that it will.

    Please tell your hubby to be patient and it does not seem to harm the bending, just feels as though it does.

    Keep us posted as to the rest of his recovery, following this thread helps me too!:thumb:
     
  14. ronn

    ronn New Member

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    I did read that article but it is a great reminder as to the "why" Aretha, my husband's tight band is always when he is walking and is painful. Not sure if it is still the same thing with varying degrees of symptoms. He does have it some days more than others as well, but says it is always there when walking. Regardless, I will tell him to be patient and will keep you posted. Thanks again.
     
  15. Josephine

    Josephine Forum Admin and Mother Hen Administrator

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    Oh for sure it's the same thing - nothing stays the same, y'know. It's a real roller coaster ride! :snork:
     
  16. ronn

    ronn New Member

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    Hi all,
    Just checking in.. my husband is 11 months post partial knee now with NO improvement since I spoke with you all last. He can move around fine, but he still has that "tight band" feeling although no swelling. It keeps him walking pretty stiff legged, and for some reason his walking and pain is less in flip flops but greater barefoot or in shoes. Does that make any sense? We have his 1 year post op apt in a few weeks, and he is very frustrated. Not sure if having them scope the knee to make sure everything looks ok is something we should pursue but the negative impact this has had on his quality of life is so frustrating and sad.
    Thanks for listening!
     
  17. aretha

    aretha Sr Bonesmartie

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    Hi Ronn

    I spotted your post, and just wanted to say that I am still almost the same. I am now 18 months post op and still have a tightness in my knee, mostly to the outside of the kneecap and it can still be tender, but it in no way inhibits my walking/stretching or any other exercise. I do feel like its "normal" when I am in the water doing aqua exercises, and have come to the conclusion that it just needs more time! I know its frustrating, but to be honest I am so much better off now with this knee than the "old" one that I just think to myself, life is for living, so get on with it!!:dancy:

    I do not have pain though, so if he does, then perhaps it is not the same.
    Take care and hope it improves with time and patience. :friends:
     
  18. Roy Gardiner

    Roy Gardiner Forum Advisor

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    Ronn, what is your husband doing by way of stretching and exercise?
     
  19. PhoenixS

    PhoenixS Forum Advisor

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    I am so sorry for what your husband is going through.
    This recovery is long, painful and frustrating at times.
    I have no great pearls of wisdom, but I have been through the wringer with my original TKR. I am now 5 weeks out from my revision.
    I do feel however, that the milestone of 1 year is when most OS's start to hear those of us with issues. My revision was 2 years almost to the day from my TKR.
    Keep up the good fight, and be persistant.
     
  20. Jamie

    Jamie Administrator

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    Ronn.....since nothing has changed in all this time, you may need to get another opinion as to what is going on. It would be best to see a revision specialist that is in no way connected with the original surgeon (not in the same clinic, not practicing at the same hospital). I would certainly do this before attempting any surgery on the knee.
     
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