Revision TKR Here I go again!<<.

1-Pain levels 1 at rest, 5 when walking. Stiffness and throbbing while walking
I get stiffness and throbbing but how does it apply in your pain score? I would imagine it means your score should be more than 5. More like a 6.
2-taking Tramadol (50 mg) as needed. 1000 mg Tylenol twice a day
Given your pain levels, I would suggest you take the Tylenol 4 times a day and the Tramadol an extra once or twice as well.
3-Swelling is still moderate but not squishy really hard especially around the knee, Knee shaped like a bowling ball.
Well that should also figure in your pain
score. Maybe even and extra point or two. Which makes your total active pain score 6-8
4-Range of motion, 70/75 flex and 5 extension
Is that 5 a plus or a minus? And gosh that's low for 10 months.
5-Icing and elevation rarely. Icing and elevating about an hour when active
If you have moderate swelling then you need to ice and elevated daily and more than once a day.
7-Activity level-work 40 hours a week, housework, shopping ,cooking three times a week
OKay
8- No exercises at home, Deep tissue massage is once a week for 30 minutes. No more PT
Okay. I am officially puzzled and have no advice to offer you. So sorry.
 
Well I had my 4th opinion about my knee and I’ve just decided to stop actively searching for answers. He confirmed what the other surgeons said- there’s nothing to do about it. He even advised against more surgery to clean up scar tissue. He said that its not a knee issue it’s a soft tissue issue and the risks greatly outweigh the rewards of another surgery. I’m bummed! My muscles, tendons, and ligaments are so tight that reversal is little to non existent. At least no more lies and leading me on! Suggested that I have a pain block to help with pain but I’m stuck with the stiffness.
I appreciate everyone’s kind words and this forum but I feel like I need to bow out!
Thanks so much!
 
Jordon6,
At least your 4th opinion was straightforward with you.
Wishing you well, remember you are welcome here anytime.
Chris
 
:console2: I’m so sorry you didn’t get the answer you wanted.

Did they give you any hope that in time your soft tissues would settle down and heal further? Any hope that where you are now is not where you will end up?

I pray that in spite of all your poor knee has been through in the last few years that things will improve.
 
Your knee can still do a lot of healing. It's not even a year old yet and is not uncommon for a revision to take longer to heal than a first time tkr. We are here for you and would like to continue to hear from you.
 
Ok... I'm back! Still struggling with pain and stiffness after a year post revision. Referred to a pain specialist from, yet another opinion from an orthopedic surgeon, after he advised me to leave the knee alone. Saw the pain doc today and he believes that I have complex regional pain syndrome @Josephine i read your article regarding and it was very informative.

The plan now is---
1-take 100 mg Tramadol ( I was taking 50 every now and then)
2-take 300 mg gabepentin 3 times a day (previously only taking 300 mg at night)
3-physical therapy

If this shows no improvement in a month, I will be referred to have neurostimulatiom therapy.

This has been a tough 3 years! I would appreciate any advice or imput!

Advisors please change my title thread to -" Ouch...CRPS!"
 
When my knee was stiff, I had a lot of pain. Lots. It's a law of physics that challenging a stiff knee (e.g., physical therapy) creates pain. The PT inevitably gives you home exercises and those also challenge the stiff knee and perpetuate the pain. My pain did not let up until I got the scar tissue out (it was arthroscopically removed). I don't know your whole history but I'm very sorry for what you're going through. You see so many people say how much they love their knee. I had a friend do a 125 mile two day bike trek about two months after both his knees got done. Simply put, it's not fair!! But the lesson is my friend went to the best surgeon in the state and I went to the local guy for convenience.
 
@maryo52 it certainly is not fair! I have so many things that has caused my stiffness. Multiple surgeries, MS, and now maybe CRPS! It's been very challenging for me. I eat and sleep this! Some days I can forget and enjoy my life but other days it consumes me. To go from walking 3 years ago to almost being immobile is tough to swallow!
 
Jordon6,
Be sure the PT you are referred to has a background in pain science and can educate you about how your brain processes the signals from your body.
Pain makes it difficult to deal with life's challenges when your brain is at a pain meeting, as you say you are consumed.
You can heal with time, and the right people, it may not be 100%, but it will be much better than it is now.
There is hope,
 
@Pumpkln your words are what I needed today! I have been down today and I'm trying hard to pick myself up- thanks so much!
 
I am so sorry to hear that you are facing this now. I pray you can get much relief!
 
Well you're on gabapentin, that's the first step. But listen to Pumpkln - she knows, y'know!
 
Well turns out that I didn’t have CRPS. I have been suffering from adhesions/ arthrofibrosis! I had open surgery two days ago (Tuesday) to remove it. Surgery was supposed to be outpatient but I ended up spending a night in the hospital. The surgeon said that it was so much scar tissue on top of and underneath my knee cap that it he probably removed an inch thick. He had to shave some bone because it was growing together because of the scarring. At home but in a lot of pain! The first night it was much looser but today it’s so much tighter maybe from swelling. I’m trying to stay elevated and iced!

Doc said that I’m one of those people who scar a lot and this will be a year ( or two) year journey. He gave me a month of prednisone to keep scarring at a slow pace! Supposed to start PT but I’m nervous about creating inflammation but I do want to keep it moving!

I’m at a lost of what to do!

Administration-Please change my header to-Here I go again! And add open lysis of adhesion to my history 11/13/18
 
Hi, Jordon, I really hope this helps once you heal from this new surgery. I think it makes sense that if the doctor had to cut a lot out that it would cause a lot of pain and swelling. :console2:

@Josephine is offline for a few days, but she’ll come talk to you when she gets back here.
 
Last edited:
Jordon6,
Your title and signature have been updated.

@skigirl had open lysis and a space exchange, she did nothing but rest the first 3 weeks or so. Inflammation causes arthrofibrosis, you want to be very gentle so your knee can heal.
Skigirl will be along with she sees the tag.
 
Hi there, I have been on the trip you're on. Back in 2010/11. I had the scar tissue removed arthroscopically. The doctor showed me a photo later of what he removed. One component looked like a ligament, 1/4" thick band tethering the muscle to bone. After the scar tissue came out, I was at 85 degrees, which was the number I could never get beyond. I went and got a second opinion, and that guy just gave me a sad face and had nothing to offer. But every day I did my own scar-dodging PT, which was very slow bends to gain flexion, and these I held for a minute or two. And I used a CPM, which has been proven to not change the incidence of adhesions but which I believe in my case made a difference. I set it on a slow speed and held the stretches for a minute or two. Once I hit 110 I was satisfied.

So now I'm 120 but my knee was never that good, and now the components have come loose. So I'm facing revision and I'm pretty certain that my body is going to want to quickly lay down scar tissue. I will go back to my routine of sitting on an exercise ball with my feet planted and slowly rolling forward to flex my knee. Slow and gentle, with lots of icing in between. That's what worked for me before.

You WILL get flexion. I will tell you that it was a month after the scar tissue was removed before I passed 90 degrees. At some point it just came despite all the angst. My extension was at 10 and I put a pillow under my knee and had my husband push very very gently because, Man! did that hurt. You have to challenge your knee but without so much pain you grimace.

Your physician seems to have been down this road before. Lots just throw up their hands and have nothing to offer. The prednisone may be a bit of throwing something at the wall to see if it sticks, but again, your doctor is taking measure to help, and there's still so much that is not known about arthrofibrosis. This much I do know. It's a nightmare.
 
@maryo52 thanks for your response. They told me too that I would only get 85! After reading your post I messaged my doc asking for a CPM. I used it with my revision and couldn’t decide how much it helped- but it didn’t hurt either! He’s not a big fan, I, too, have read the research but I’m open to trying anything cause the alternative is awful!

I’m trying to find the right balance stretches and exercises. I’ve been relentless about using ice trying to keep the inflammation down.

But it’s really painful! I’m on pain meds and it takes the edge off but not much help! This has been a bear to deal with!!
 
I also had unbearable pain that made any PT challenging. I ended up deciding that muscle strengthening was not important, just keeping things moving. The only thing I did was stretch. But there are ways to strengthen the quad, which is important, without aggravating your knees, e.g. straight leg raises (with light ankle weights), and just sitting with straight legs and trying to push the back of the knee into the floor. The other stuff can wait until the battle of the bend is won! This is a good topic for me because I will need to stay ahead of the arthrofibrosis when I have revision Jan. 9th.
 
Bless you @maryo52! I will be praying for you! Praying that we both recover and finally see that light at the end of this loooong tunnel!

My revision was, honestly, a cake walk after all I had been through! You’ll do fine. Try to keep your strength up especially in your quads. Mine really suffered and still not back! Keep me posted!
 

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