TKR Robert Johnson's hybrid recovery'

Ten days prior to surgery I had iovera cryoneurolysis treatment at my OS's office (I wrote about it in the pre-op forum). At the time I asked him if there would be any numbing of the surface (if I leaned against something hot would I feel it?). He said no, you should only get relief from pain in the knee capsule, mostly.

Well, he was wrong. The whole right (lateral) side of my knee was totally numb at the surface within days of the treatment. When I mentioned that the day of surgery he sluffed it off saying it was all temporary, don't worry about it.

When I saw him at both my 2 week and 8 week appointments he asked me if I thought iovera did any good. I told him it was hard to say for sure. It certainly didn't kill bone pain in the immediate weeks after surgery, but it was hard for me to compare the overall amount of pain with what I experienced in 2010. In general this seemed easier to me, but to say it was from the iovera treatment would be a total guess.

I told @maryo52 I would get back to her about it, so I do want to give you some insights.

Over the last week or so I started to notice feeling in the numb area, starting about 2" above the knee on the outside. Based on the info at their website it should last 3 to 5 months, which is exactly where I am. At first it felt super itchy and then I had an intense burning sensation for a couple of days, and was awakened by pain in the knee if I slept on that side, something I've been doing since day 1. At this point at least half, if not more, of the numb area has been restored to semi-normal feeling. I still have a much smaller numb area but I suspect that's from the actual operation and is something I couldn't separate out from the iovera numbness.

So, did iovera help? I would say yes, judging by how much more aware of my knee capsule area I am now. My knee bothers me now in ways it never did since the first week. I'm not in a lot of pain, so I think the difference is subtle, but if I had to do it over again, I think I would do the iovera treatment again.
 
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I was looking through my night stand and I came across my discharge papers. There's something I hadn't noticed before and I was wondering if anyone knows what it means. There's a section called "PROCEDURES" with two entries:

=========================
PROCEDURES:

Procedure (Laterality)
Right Total Knee Replacement (Right)
==========================

Anyone know what a "Laterality" procedure is?

I tried Google but couldn't quite zero in on it. I have a guess, though.
 
I think it just means he approached your knee from one side, rather than from the middle.
 
Oh that's interesting. Sounds logical.

When I googled it, I kept coming up with articles about mistakes that were made during TKR where they put a right femoral component in a LTKR (or vice versa). There are even xrays showing it. I found one article describing 3 such mistakes. One of them they asked the patient whether or not he wanted them to immediately operate again to fix it and he said yes.

So, I was guessing it was a quality control procedure that was put in place where they go through some kind of procedure to double check all the parts.
 
Update at 4 months post op (July 8th is 4 months) - WOO HOO!: :wow:

Swelling: My swelling is almost completely gone. My two knees measure less than 1cm difference around the knee. From 5 weeks PO to 12 weeks it was consistently 2cm difference. I can still see a tiny amount of swelling, but the big difference now is that nothing I do seems to give me the feeling that I have to ice. I don't notice that internal kind of swelling anymore. If I do something kind of hard, either around the yard or a really long walk, I'm just as likely to be bothered by my left knee as my right, and that's because I still have a human left patella. The last time I saw him, my surgeon conceded that a certain percentage of patients are never comfortable with human cartilage sliding on a titanium groove (now he tells me). I'm one of them.

Knee Pain: If I take Tylenol 3 times a day, I have virtually no pain in my knee. That's been true for at least a month. Twice though, I woke up in the middle of the night and was intensely aware of knee pain deep in my knee. So much so that I had to get up to see if it hurt while standing or sitting. It didn't, it just hurt leaning against the bed. Both times I had been attempting to cut back on the amount of Tylenol I take. Both times after taking 1 or 2 extra strength Tylenol and 1 Zanaflex, I was able to go back to sleep for the rest of the night.

Sleep: Since day 1 PO, I've always slept the way I've been sleeping for decades: on my side using a pillow to rest one knee on, depending on which side I'm on. I've never elevated at night or purposely slept on my back, although I wake up on my back a lot. I rarely sleep more than 2 hours in a row, although occasionally one of these events I'm describing results in me sleeping for 4 hours or so after it.

Icing: I rarely ice, but after these pain events I have returned to icing once or twice a day for a couple of days. On long days I'll ice once at the end of the day.

Other pains: Beyond any doubt my biggest problem since I started walking in my neighborhood (~4wks PO) has been hamstring tightness. At times it's been almost debilitating. A couple of weeks ago, I took a week off walking and that seems to have made an enormous difference. Monday I had my first post op acupuncture treatment and she did Gua Sha on my hamstrings and that seems to have worked miracles. I may finally have it under control. :)

Exercise: Besides life itself, my main exercise is walking, although my acupuncturist reminded me that bike riding played an huge role in my recovery and recommended that I get back to it. I tried 15 minutes on the bike the other night and I'd have to say the jury is still out as to whether or not that's a good idea. My knees were bothering me the next day, but after icing once they were ok again. Maybe if I rode more consistently it would be better. Not sure what to make of it.

I bought a pedometer in May and since then I average 1.3 miles (2840 steps) a day (56 miles in 43 days). I walk up and down steps normally. It's never really been much of an issue except I can tell I'm still not strong as I could be going up. If it's a high step (>7in) going down hurts a little. For 6 or 5 inch steps I don't notice anything.

All in all things are going well, although I look forward to the time when I sleep like a normal person. :bored:

One other thing. As far as ROM goes, I haven't measured it in months and I assume it's still what it was. The only thing I've ever noticed is if I sit down in a really low chair, like a lawn chair, if I'm not careful I'll notice some strain on my right knee like flexion isn't quite far enough to handle that, although I did sit down ok. I imagine that will go away in time.
 
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Update at 6 months post op on Sep 8th.

Things have been going well. My sleep is gradually returning to normal, and walking has become a ritual. Since May 27th I average walking 1 3/4 miles a day. I walked over 3 miles on a few occasions. As far as my knee is concerned, my life is pretty much back to what it was before I started using a cane. Even my hamstring tightness is "almost" completely gone. I am very happy about the outcome. In my wildest dreams, I never imagined it going quite like it has.

On the negative side, I still have a couple of pains in my knee that, as far as I can remember, go back to the very first week post op. They're not serious pains, but because they never seem to go away one can't help wondering if they'll ever go away.

One pain is when I attempt to flex my knee as far as it will go (without assist) while laying on my side. It's a pretty severe pain and like I said, I first noticed it week 1. It doesn't affect daily activities, because I still have roughly 125 to 128 flexion, but when it happens (say while stretching when waking up) it's startling. It's a deep throbbing pain in the bend of the knee that feels like the pain from doing a full rotation on the bike in the early days before you're ready for it (happened once to me),

Another one is while walking long distances, or if I overdo the bike, I get a sublte pain in the medial condolye of the femoral component. Sometimes that pain is there for days upon days in a row. Not enough to stop me from doing anything, but just enough to remind me that the first time I noticed it was back in April. So again, I worry why isn't that going away. I believe it has to be bone pain where the bone adheres to the femoral component. Subtle bone pain, not excrutiating bone pain.

Is it normal to have some pains that last this long, that never seem to go away and that will ultimately go away over the full year or more?

I would be very interested in hearing what @Celle or @Jockette or @Jamie (or anyone else who cares to comment) thinks about that, and/or about these two types of pain in particular.

I wish you all well, and many thanks to everyone who contributes their experiences here. Any chance I get, I tell people about this website, which is quite often seeing as how many old people there are around here with knee problems. :loll:

Robert
 
I’m now 2.5 years post op. In spite of my less than stellar outcome, during the second year I felt my whole leg relax more which, in my case, increased my ROM quite a bit, and that has continued into my third year.

At “only” six months post op, where you are now is not where you will end up. You still have healing to do.

You are doing really well for only 6 months in this year long, on average, recovery!
 
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Please know that you can have lingering pains like you describe for a long period of time. They may even come and go forever. The key is they come and go and they are not debilitating. What you may not remember is that you may have had odd pains with your natural knee too. You just didn't focus on them like you're doing with your knee now. Eventually they will either stop or you'll become so familiar with them that it just won't be an issue. The only time for concern would be if you had pain that affected your ability to stand or walk or pain that did not go away.

It sounds like you're doing just great. Six months is still a new new knee so you'll continue to see more improvement.
 
What you may not remember is that you may have had odd pains with your natural knee too.
Jamie, that's a really good point. Who knows? You're right, any number of things could have been going on back during the cane-walking days or even before. I have to admit, there's no way I would remember.

The only time for concern would be if you had pain that affected your ability to stand or walk or pain that did not go away.
I like these guidelines. That's definitely something I can work with. Thank you.
 
I had that lying on your side and straightening your leg pain for a while after my first tkr. Sort of like a catch but not quite. It gradually diminished. I don't know what it was about.
 
When I was at my 8 wk checkup, the doctor only checked 3 things while I was sitting on a chair in front of him sitting on a stool facing me:
  • He told me to flex as far as I could. He was visibly satisfied with what he saw.
  • He told me to straighten my leg, and again he was visibly satisfied.
  • He told me to put my feet flat on the floor, legs bent at 90, and with his index finger pointing to his left (while facing me) he put it under the bend of my knee a pressed upward as he told me to bend my knee as far as it would go. Again, he was visibly satisfied.
The mistake I made was not asking him what the significance of that last test was. He was obviously feeling for something that was important to him. Maybe something that could go wrong at times. But I didn't think fast enough to ask him what it meant.

At the 2 wk checkup and stitch removal, I mentioned to him that I had a significant pain in the bend of my knee right around the tip of the fibula that I noticed the first time I got out of the bed at the hospital. He just looked at me with a sort of crooked smile and said something like 'well yeah now' or something as if to say 'no kidding you have pain 8 days after a TKR, wow there's a newsflash.'

So maybe I was a little less inclined to ask him again at 8 weeks.
 
I had somewhat of a setback, at least are far as my normal routine goes. But let me backup a little. Sorry if this gets a little long.

Things had been going really well. My knee is doing great, no problem with it worth mentioning.

On October 14, I happened to be at the Olympia Port with my wife, taking a walk by the dock. There's a tower there that's used for sightseeing. It's 6 flights of 6 steps each. I decided to walk up to the top, foot over foot, took some pictures and then back down foot over foot.

The next day or two I assessed my knee and decided it felt fine, so over the next two weeks I started doing steps at least 4 times a week. Sometimes I would go to the Capitol Building a go up and down a couple of times. My knee was feeling better and better each day. I was really loving my new activities. Not quite Rocky, but you get the idea. Meanwhile I walked on average about 1 and 3/4 miles per day on average.

On Nov 4th, I did a pruning job in my backyard that involved a significant amount of bending. It was cold and wet that day.

Two days later when I started out on my walk. By time I got about 50 yards from the house I noticed I had a pain in my left leg/hip area. I tried to ignore it for awhile, but no good as I was developing a serious limp. I hobbled back to the house.

My first thought was that I pulled a quad muscle, so I spent a good deal of time icing, resting and Ace wrapping. After a week or so I thought it was feeling better, so I ventured out for a walk.

No good. Again, I hobbled back to the house. I finally got in to see Dr. Snow, the surgeon who did my two knees, yesterday. They took X-rays and examined me and told me it was trochanteric bursitis. He gave me a cortisone shot, loaded with lidocaine and asked me to try to make the pain happen but I couldn't. Apparently, he hit the right spot.

He gave a prescription for PT, and I'll try to get in next week. Once the lidocaine wore off, the pain is back if I take a full stride. If I walk slowly or use a tiny assist with a cane, I can do it without pain. I called the triage nurse today and she said it could a couple of weeks for the cortisone shot to take it's full effect.

So that's where I at now. When I told my wife I probably overdid the steps, she said, "No kidding, you think?" (After 43 years, you can't fool her.)

Does anyone have an opinion about whether or not rest alone, light walking with a cane and enough time might allow it to heal? Or is physical therapy essential for something like this?
 
Just my opinion but I would not do any PT for bursitis. You got this because you did too much. How could more activity improve the situation. Rest, ice and elevate and use a cane if needed. Here's an article from our Library.
 
Jaycey is right, exercise won’t help trochanteric bursitis. A PT can help by teaching you a few gentle stretches you can do at home for your trochanteric bursitis.
 
Thank you @Jaycey and @Pumpkln , that's exactly what I was wondering. And thanks for the article which I just read.

Can you tell me though, what constitutes "elevating" when the area you're trying to elevate is the side of your upper thigh/hip?

I think what I'll do is contact the PT I worked with for my TKR using the patient portal on the website, tell him the situation, and ask him if I can get one visit with him to see what he recommends. He knows how I feel about things and knows my history.

If I call the front desk and say I have a prescription for up to 8 visits for bursitis they're more likely to be on automatic pilot, assign me a PT and assistant, and put me in a situation I don't want to be in.

So, now that I'm forewarned by Jaycey and Pumpkin, I think I know how to approach this.

Thanks again.
Robert
 
Glad you have a plan to work with the PT you trust.
Elevating is the same as for your TKR, having your legs elevated makes it easier for swelling to move out of your hip area. Cold packs will also help.
 
@Pumpkln something else occurred to me. In my reading over the last week or so, I think at the Mayo Clinic, I came across another possible cause of bursitis: An injury from a blow or accident.

When I walk by the island in my kitchen, the corner of it is exactly at the right location where the painful bursa is. It is quite possible that I bumped into that one night and forgot about it. It wouldn't be the first time. It's in the path of going from the fridge to the stove, etc.

Does it matter if I got bursitis by bumping into something rather than as an overuse injury, or is that pretty much irrelevant to what I do now that I have it?
 
It's been 9 months now since surgery and I have good news and bad news.

The bad news is my hip still hurts when I walk. Actually, I don't really think it's my hip. The cortisone shot seemed to work to a certain extent in that I can put all my weight on my left leg now. But when I try to walk normally with a full stride, I still have the same very bad pain at the top of my leg. I'm back to thinking it's a strain/tear/whatever in one of my hip muscles (or quad or connective tissue) from the day working in my yard. If I walk softly with short steps and a tiny assist from a cane I don't feel any pain. But I forgot for a second while walking in Rite Aid the other day and I almost fell to one knee in pain.

I have an appointment next week to see if I can get pre-approval for a MRI. Who knows how long that will take. My guess is early Jan. I don't see how they can refuse it though, now that we tried a cortisone shot first.

The good news is a different pain went away. One I had since PO Day 1 (actually Hour 1). My leg always hurt below the joint when I flexed it unassisted as far as it would go. I may have mentioned it here before. I found it to be very concerning how it lingered from day 1 up until a week or so ago when I suddenly became aware that it didn't hurt anymore. That's amazing that something would go away in 9 months. I was very happy about that.

I hope that's encouraging to those early in their recovery who feel like they have a pain lingering on for months.
 

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