Revision TKR TKR Revision gone wrong

[HipRev2]

Hi, My situation seems unique, but surely it isn't. I am here to learn, to get support so I don't feel so alone, and sometimes confused.I had a TKR revision on Valentine's Day- 2022.(Can I be on the Valentine list please? Amazing what I can get a dart of pleasure from these days) ...All kidding aside, my old prosthetic was only 9 years old, but it was loose. I have osteoarthritis and I am hyper-mobile, so those are contributing factors. This was my 6th joint replacement or revision (hips, shoulder, knee). Apparently, my femur and tibia fractured because my old prosthetic was "junk", according to surgeon. After that, when new one was being inserted, my MCL tore away from the bone.So I came home with a full leg brace and I may not bend my knee or remove the brace for 6 weeks and then "we'll see." As an extra parting gift, I left the hospital with "foot drop", which no one addressed, except to say I'd be fine in a day or so.
Not true. The peroneal nerve was compressed or poked with an anesthesia needle, and I was later told it would heal in 3-9 months. WHAT???!!! So I'm literally dragging my foot around.
It could always be worse- I know this. But if anyone out there has had to keep leg straight and not do the PT right away, or had foot drop, I would really appreciate hearing about other people's outcomes.

 

[sistersinhim]

Hello @HipRev2 Welcome to the Bonesmart knee recovery forum. I requested that you be added to the February team thread. You'll find all those that had a TKR in February listed there and you can share information with those recovering from this surgery at the same time you are.

Each person is different as is their recovery. Most find that the Bonesmart approach works best for them, but others find that a more aggressive therapy helps them more. It's your recovery and your choice on how you recover. As you read more on other members' recovery threads, you’ll get a better perspective of what to expect. The following are our basic guidelines and should help get you started.

Knee Recovery: The Guidelines

1. Don’t worry: Your body will heal all by itself. Relax and let it. Don't try and hurry it, don’t worry about any symptoms now; they are almost certainly only temporary.
2. Control discomfort:

rest​

elevate​

ice​

take your pain meds by prescription schedule (not when the pain starts!)​

don't overwork.​

3. Do what you want to do BUT...
a. If it hurts, don't do it, and don't allow anyone to hurt you.
b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again for a few weeks.
4. PT or exercise can be useful BUT take note of these

the BoneSmart view on exercise​

BoneSmart philosophy for sensible post op therapy​

5. Here is a week-by-week guide for Activity progression for TKRs


The Recovery articles:
The importance of managing pain after a TKR and the pain chart
Swollen and stiff knee: what causes it?
Energy drain for TKRs
Elevation is the key
Ice to control pain and swelling
Heel slides and how to do them properly
Chart representation of TKR recovery
Healing: how long does it take?

Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

There are also some cautionary articles here
Myth busting: no pain, no gain
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds

We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery.

While members may create as many threads as they like in a majority of BoneSmart's forums, we ask that each member have only one recovery thread. This policy makes it easier to go back and review history before providing advice.

Try out our great new opportunity to improve your gait. It's OneStep. It's free and you will find it to be a huge help to you. Click here: OneStep

 

[sistersinhim]

I know very little about foot drop following this surgery. I will leave a note about it in the staff area and see if anyone can help you.

 

[Jamie]

@HipRev2 .... hi and welcome to the forum. You'll find lots of friendly BoneSmarties to chat with here. Even if they aren't experiencing exactly what you are in recovery, the support will still be there so that you know you're not alone.

Am I understanding correctly that during your knee revision surgery, your MCL was damaged and repaired in addition to the new hardware being placed? If this is the case, it's a very rare complication, but one that at least one study I found showed that patients can recover from the repair with no loss of stability in the knee.

The 6 weeks of non-mobility is typical for this type of repair. When a ligament becomes detached and must be reattached, it takes that long for things to grow together and be able to take all the pressure put on your knee. It is critical that you adhere to your surgeon's advice about any weight bearing and the use of the brace. You do want this to heal correctly. Don't worry about the "no bending" rule. You will have plenty of time once the brace is removed to establish Range of Motion (ROM) in your knee. Your goal right now is for things to heal.

While I don't recall a member who has had exactly this happen, there have been several people who needed to wear a brace for 6 weeks right after surgery. Other than the obvious discomfort of the brace, they did just fine.

As for the drop foot, I'm sorry that's happened to you. It can take quite a while to repair itself, as nerves grow very, very slowly. If you have any concerns about how it's progressing, don't hesitate to contact your surgeon's office and even go in for a consultation with him or with a nerve specialist so that you stay on top of it.

Here is a list of threads that have to do with foot drop you can read. If an questions come to mind, please don't hesitate to ask.

 

[Pumpkin]

HipRev2,
Ask if an Ankle Foot Orthosis is appropriate to address your foot drop.
With all the work of dealing with foot drop, you are getting plenty of exercise and activity for your recovery.

Swelling blocks ROM for most of us, as your knee heals even in a brace you ROM most likelywill be there for you when you come out of the brace. You may have to do some gentle heel slides to promote ROM.
There is an article in our Knee Recovery Guidelines that shows how to do heel slides, take a look when you have a chance.

 

[Magsmom]

Hi
I’ve had nerve issues associated with my left TKR done 2.5 yrs ago in Oct 2019.
I’ve had pain (def nerve pain) on the outside of my leg right near the fibular head since the day I got out of the OR.
Now that my hip project has concluded (both replaced in late 2021), it’s time to really address this and fix it.
The imaging shows my peroneal nerve is compressed against the fibula and fibular head. The fibular tunnel is pretty small with not a lot of room. I haven’t experienced foot drop though I have tripped a few times and my gait gets a little off when I’m tired. Almost as if my foot is slapping the ground.
Apparently The peroneal nerve can be released - very similar to carpal tunnel release. I will be having it done but have chosen to wait until late Summer. If I did it in May, the recovery would take me too much into the summer. I need my season at the beach where we just relocated last year. Plus I just need a break from all these surgeries. I’ve had 5 in 2.5 years and 10 in the last 4+ years. Im sick of being a patient, sick of pain killers, sick of not sleeping well or being able to work out like I used to. I’m sick of anesthesia and how I feel lousy after it. But I’m expecting they’ll name a wing for me at the hospital soon! But for now my plan is to white knuckle it till late august. Gabapentin does help it on particularly bad days.

 

[eaglemom]

This sounds like a very reasonable plan. Take a break & enjoy yourself. Personally the beach is my happy place. Enjoy & relax and you can tackle this surgery later in the year. I like you comment about naming a wing of the hospital - sometimes if simply feels that way.

 

[HipRev2]

Thank you to the moderators and other women who’ve responded. I really appreciate it so much! I’m not proficient at navigating around this site, so I hope this goes out to the right people!
@sistersinhim Thank you for the TKR recovery reminders. Though this is not my first rodeo (haha) it is good to be reminded of these important guidelines because the overarching message seems to be “Be gentle with yourself. Be patient.”
@Pumpkin My surgeon doesn’t want me in the Ankle Foot Arthosis while I’m wearing the full leg brace. The MCL pulling away and the femoral fracture need to heal first

@Magsmom What kind of imaging did you have done that revealed that your peroneal nerve compressed?
——
I fell yesterday for the second time since my surgery, because of the foot drop. I have to be so mindful and go super slow. Apparently doc had to do a cable tower to hold it together and falling could be a disaster.
My first folllowup with the surgeon is this coming Tuesday-5 weeks out. I hope I will graduate to being allowed to go to PT!

After my other 5 surgeries, PT gave me momentum, a reason to keep going forward; being in the brace being sedentary is not good for my head. I worked so hard at PreOp- walking, exercising and Aqua Aerobics, I see the scale whooshing upward and muscle tone leaving. Just sayin’ Thanks for listening.

 

[HipRev2]

ANDDDD...I have a question...
I apologize for repeating myself but this is a domino effect situation...I'm not allowed to bend the TKRR knee that's in a brace, so I haven't been to PT yet. I'm hopeful that I'll get the go-ahead to start PT at 6 weeks (next week). My gentle PT has never hurt me after the other replacement surgeries. My leg brace is set at 30 degrees. Surgeon wants my PT to increase brace by 10 more degrees every week.

But right after the surgery, he told me he plans to do an MUA at the 10 to 12 week mark. From what I've read on here, that is sort of early?

 

[Magsmom]

Hi @HipRev2

First-I went back to the specialist who did my carpal tunnel release. He’s listed as a hand/arm surgeon but in reality he’s a nerve specialist. I’ve known him for a few years and really like and trust him. So my first comment for the peroneal nerve topic is get yourself to the right doctor. An ortho surgeon may not be as persistent in trying to figure out the issue.

Imaging and tests I had done:
1) EMG : measures muscle response or electrical activity in response to a nerve's stimulation of the muscle. In this case it was “unremarkable” and just didn’t show much.

2) next was an MRI but a specific kind that was focused on the nerve, possible lesions, tumors etc. That too was “unremarkable”.

By this time I was really frustrated - and my dr was too. His physical exam clearly indicated there was something amiss. So…on we went to ….

3) an ultrasound of that area of my leg (plus some images from the other leg for comparison. Finally, this showed the irritation/inflammation and the nerve being crowded out (my term, not theirs) from leftover scar tissue and thick fascia.

I think I mentioned that I haven’t experienced foot drop though am on the lookout for it. I walk very carefully and almost exaggerate lifting my left foot up to ensure I don’t trip and end up on the ground!

I’m sure I’ve said this but it bears repeating- gabapentin is the only thing I’ve found that helps the nerve pain and is not a narcotic. I don’t seem to experience side effects from it.

Good luck w your appt this week!

 

[Pumpkin]

MUA at the 10 to 12 week mark

After a TKR 12 weeks is OK. I would be cautious with your fractures and torn MCL.
Hopefully your ROM will increase during the 6 weeks of PT, and you will not need a MUA. Most surgeons won't do a MUA if you have 90 º of flexion.

With your fractures torn MCL, slow but sure healing may be your best option.
Sounds like you PT is very gentle and can help guide you through healing and rehabilitation for the best outcome.

 

[Magsmom]

Hi @HipRev2
just saw your question Re MUA timing. My TKA leg was like a total block of cement. I had my first MUA at about 10 weeks. There’s lots of discussion about it and varying views - but I’m told that generally an MUA done around 10-12 weeks post op has a higher rate of success than doing it later. Here’s a report from NIH about it (forgive me, I’m kind of a nerd about this stuff!)

Timing of manipulation under anaesthesia for stiffness after total knee arthroplasty

Stiffness following total knee arthroplasty (TKA) is a debilitating condition for the patient with limitation of functional outcome. There are various causes of stiffness, which can be classified as pre-operative, per-operative and post-operative. Arthrofibrosis ...

www.ncbi.nlm.nih.gov

My second MUA and arthroscopic arthrolysis (cleaning out the scar tissue) was done at around 16-18 weeks. Definitely get better results from that one. I can flex to around 110 but had a long lasting extension deficit where I was stuck at about 11 degrees. When my hips were done late last year, I got the extension to about 6. Good enough for me.

 

[HipRev2]

Yesterday, in the surgeon’s waiting room, a total stranger saw the state of my foot drop and started lecturing me on “looking ahead and not looking back”. And I hadn’t complained to her. Or said a word, for that matter. Well, if she saw me today, perhaps I would earn her unhelpful comments because my mood is not good today.

I confess, I was excited to track along with others who had TKR or TKRR around the same time that I did. (My surgery was 2/14/22).

Instead, I am close to tears, because I just read accounts of those who had surgery the same time that I did, and they are moving on. I am doing that stupid thing of comparing myself to people with uncomplicated outcomes.

Metaphorically, I have to accept that I am on a different long distance run than they are. I can be happy for them as I read their successes on their run with the others who are beside or around them.
….But that USED TO BE ME with the other 5 joint replacements. I could run alongside others. Now I am on a different path altogether. Self-pity? Just a little. But mostly just sad because I’m still shocked by the 2 unexpected outcomes. And I feel very much alone. Isolated.

As I mentioned before, coming out of surgery, I was assigned to 6 weeks of inactivity so MCL/ fracture, and other complications could heal. So, no PT. No nothing. And that was even before anyone know about the foot drop. I move from my bed to the recliner to the bed. Thank God I am able to spend more and more time in the recliner. Could not sit there at all at first. I try to walk around some, but it’s not advised.

BUT! I had my 5 week follow up yesterday with the surgeon: Good news! I get to start PT today! I also get to have 10 extra degrees per week in the brace. (They set the brace so your knee can bend no further than the setting.)

I have to stay in the brace 6 additional weeks, but I GET TO TAKE THE BRACE OFF AT NIGHT! YAY!

So that is the good news.

The bad news is that the foot drop is a real inhibitor as far as getting around. I will still be using a walker for a while. I just got a wheelchair so I can leave my house..( WHAT??? a WHEELCHAIR?!?). Yes, I know it could be worse, and I am thankful for the wheelchair. I just never dreamed…

I am used to being like the other folks on this “long distance run”, rapidly moving from walker to cane, to no assistance at all, gaining flexion and strength, and congratulating one another at PT as we all move ahead. I’ve met dozens of post joint replacement people at PT in the past, and we encouraged each other to press on. I am not in that “normal” pack this time.

The bad news yesterday was that the foot drop is pretty bad and he guessed it would be 9 months to one-and-a-half YEARS, until it goes away. My first reaction was joy, that it isn’t permanent! Also, he owned it. Peroneal nerve either got bumped by anesthesia needle or saturated with anesthetic. What a difference it makes when someone is honest with you!

As soon as the leg brace comes off, I go into an orthotic for the foot drop- WITH A LIMP. The orthotic does not help to heal foot drop…it’s just a tool to assist.

I just had 3 rounds of Prolotherapy (expensive, not covered by insurance, but oh so worth it!) before the TKRR to stabilize my wonky, painful SI joint, and I fear that messing with my gait - limping with foot drop- is going to mess up my SI.

Just prior to TKRR surgery, I was fit, strong, and more stable than I’ve been in years. My knee didn’t hurt at all, but the prosthesis was falling apart and causing damage. It had to be done. Now I am asking God to please heal peroneal nerve sooner.

If you actually read this whole post, thank you so much!

 

[Layla]

I’m sorry you’re dealing with this and while we’re always cautioned not to compare our recoveries with others…it’s a big ask! I understand your frustration and admire your ability to see the bright side. Wishing you comfort, brighter days and perfect healing.
@HipRev2

 

[Jockette]

It is so easy to get upset when we have a tougher road than others.

 

[Jockette]

Oops, I accidentally hit reply before I was ready!

Keep posting here, vent away, we understand. We are here for you.

 

[sistersinhim]

We are here for you. Come and vent whenever you feel like it. But, also come here so we can celebrate your successes!

We had a lady at church who had drop foot that went away after about 6 months. Let's step out in faith that yours won't last even that long!

 

[Susie-Q]

@HipRev2 , keep us posted so we can cheer on your successes! I'm sorry this time has been a rougher road, I admire your persistence and tenacity!

 

[MSN58]

So very sorry for your challenges. Mental health issues are real with this surgery without the added foot drop. The glass is half full because your past experiences are on your side. I started a journal in Week 4 because I was frustrated and spiraling downward. Every little task is a positive milestone, even a backward slip because I learned something. You will be successful.

 

[Magsmom]

Oh God @HipRev2 , I’m so familiar with what you’re going through, how you’re feeling and the pity party trap we all fall into. I think it would be unusual to NOT feel bummed, depressed etc. I’ve had 10 various orthopedic surgeries in the last 4 years incl cervical spine, both shoulders, TKR plus 2 MUAs on that and most recently, THR on both hips.

I have been athletic (and competitive) all my life and up until 10 mos ago had been going to CrossFit 5 days a week. My recoveries have run the gamut from easy and straightforward to downright torture. Comparing ourselves to others and even to our own other surgery recoveries is a pretty natural thing to do. I think it would be unusual if we didn’t do it. But it also throws a bucket of cold water in our faces. The biggest lesson for me (well, one of them anyway) is that I’m not bulletproof. Surprise! We’re human and this stuff happens. That all makes logical and rational sense - but it doesn’t mean you don’t still feel like you’re doing something wrong or have terrible days. For me, it seems to be the old 2 steps forward, one back. Eventually you make the progress- just not in the way you hoped or expected. Or as fast as you want.

This is a favorite of mine ….

I don’t know where you live but Is the weather cooperative? Can you get outside? I live at the beach in the northeast US and even when I couldn’t walk very far, my husband would drive me over and we’d sit on a bench just to get some air, watch the fishing boats etc.
I’ve also come to love podcasts as a way to kill time. The bite sized pieces are easy to digest.

So great to hear you got the ok to start PT. I found a good one who’s been so helpful. He’s actually working on both hips and also helped with a back issue. I’ve had to shop around and do my own due diligence to find the right place/person. But I did and feel good about going. Hopefully this will give you a little much needed shot in the arm.

If after some period of time your peroneal nerve issue continues to be trouble, I’d seek out a nerve specialist to get a consult with. I finally got to the right person and after all the tests and imaging, confirmed it’s compressed along the fibula/fibular head. I’m sure I mentioned this but I’m getting it “released” but not until September. I need a break from surgeries. I want to enjoy Summer in our new house. Last Summer was a mess between moving, unpacking, our car getting totaled and some issues with one of our kids. So much drama. I’m determined to enjoy this Summer then go back in early Sept to repair this.

Please hang on and hang in. It may not feel it right at this minute, but you WILL get better. And until then you have lots of ears here so vent away!!