MUA 11 week post RTKR

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1. My pain is typically a 6 but when I take pain meds regularly, it goes down to about a 4… when I walk, the pain goes back up to a 6.
2. The majority of my pain is behind my knee, hamstring, calf and ankle (where it is all very tight)
3. Occasionally, I have a very sharp stabbing pain along my incision. I imagine that may be scar tissue hitting the nerve. Luckily, it only lasts a split second to a few seconds but when I feel it, it is an 8.
4. I have pain on top of and the sides of my knee but it is very manageable around a 1
5. I have trouble walking, this is most frustrating. The more I walk the more I hurt.
6. I have the most pain in the afternoons/evenings
7. It is tight to the touch behind my knee
8. Pain to my outer knee (if you drew a line from the spot I have the most pain behind my knee to the front of the knee)
All of these are caused by doing too much exercising as typified by "the more I walk the more I hurt"
I ice my knee daily, usually in the evenings after I get home from work
You never said how long you are icing for? For instance, you will accomplish little or nothing in 20 minutes. Ice and elevate for at least 40-60mins and more than 4 times a day when you can.

At home/work (at least 3 times/day – more if I can especially when sitting at my desk)
Heel slides x10
Straight leg raises x10
Lunges (a few times per day)
I suggest you do NO exercising on work days. Work alone is sufficient.
At the Gym twice/week
(I just started this and am trying to fit this into my regular schedule. My goal is to do this 4xweek):
Recumbent bike 15 minutes
Treadmill 15 minutes
Leg press machine (no weight or very little weight) – in the seated position I let the sled lower where my knees are bent and I hold that position for 10 seconds. I do this for about 10 minutes.
I sit on the row machine with my feet firm on the floor and roll so that my knees are bent and repeat several times.
I suggest you do it 0 times a week! None of these are helpful to you, especially not the leg press which was one I have heard many knee surgeons caution against, especially since you knee is uncemented.
PT (twice/week)
Stepping over cones
Balancing on a foam pad (alternating weight) and throw/catch a ball
Wall squats or squat while tossing a ball
Balancing on half ball
Recumbent bike/ Nu Step/ Treadmill / Total Gym squats (I alternate these each session sometimes doing 2 per session)
None of these are exactly good for you either.

You're 16 weeks out which means you are still in recovery period. Your knee is not yet ready for boot camp! I'm only surprised you have so little pain!

You also don't need to be on hydrocodone at this stage. Much better if you started on a regimen of Tramadol 50mgs and Tylenol 1,000mg 4 times a day instead.

As regards your ROM, the reason you are having difficulties is because you are keeping all the muscles and ligaments in an inflamed and swollen state which blocks ROM very effectively. Perhaps you should read this to understand why Swollen and stiff knee: what causes it?. There really is no great mystery to this ROM thing - beat up on your knee with all that exercising and your loose it. Rest it and treat it kindly with ice and pain meds and after a few weeks you will find the ROM beginning to emerge. It's all there, you see, just waiting for you to ease up so it can show itself. And guess what? when it does, the pain will dissipate too! You have my word on it.

I also have something you should read as a cautionary tale - a story of a man who was doing all the stuff you are doing and what happened to him. Let it be a warning to you. PT: the seriously grave consequences of doing too much of it
 
Thank you @Josephine :) The "PT: the seriously grave consequences" piece was pretty scary! I really thought I had cut back from my normal (pre-op) routine..... before surgery, my knee was in pain and just got worse over the years... mind you, I'm only 42 years old. Some days I feel much older! In 2013, I worked my rear off (despite pain but never pushing myself to the point that pain was unbearable). I worked out at the gym 4-6 times per week, I was doing 5k's regularly (It hurt too much to run even then, so I walked). I walked a lot. After having meniscus surgery, I thought I would take a few days off and be back in the gym but I pushed myself too much too soon and knew better when I had this surgery. Unfortunately, the past year, I have had so much pain that I gained back a lot of my weight. I was still in the gym 4 days a week but I was mostly lifting weights and gave up on anything cardio-like that would put too much pressure on my knee. I know this recovery takes a long time and (per my PT) went back into the gym to do my own therapy - she said that I could do more on my own since I seem to be stagnant in their office. Still, I know that I am not ready to go back to the gym full time, in fact, I'm cutting back to give my leg a break for a while.... My goal was to go back in January but we will see how things go at that point.

You said you don't know why I'm not in more pain, honestly, I think it's because I take my pain medication regularly because if I don't take it and I'm active, it's nearly unbearable.

I had a long talk with the representative that fitted me for my brace last night. The goal for it is to help with gentle static stretching. There are times that it hurts pretty intensely so I'm just dialing it back so that the stretch isn't so intense. I have been wearing it 2-3 times per day (30 minutes) for 3 weeks now and am not seeing any improvements. He said that I should not ever wear it longer than 30 minutes at a time and it should never hurt. He said that it should feel like a "good stretch". He mentioned on the phone last night that I should be seeing some improvement at this point and it may still be a problem with my knee, the scar tissue, adhesions, the joint capsule, excessive swelling....etc.... So I'm taking everyone's advice and cutting back and not pushing myself too hard.

As for icing it, I keep it iced for about an hour in the evening (during the work week, I ice more on the weekends) and keep it elevated all evening when I get home from work and most of the weekend, I keep it propped/elevated on the couch. I have an icepack that I brought to work so I can use and even have a make-shift ottoman set up under my desk so that I can prop it up. Unfortunately, I can't get it above my heart but I prop it up which also helps to stretch a little.

Tomorrow, I meet with my surgeon to go over everything. My plan is to discontinue the PT with the therapist since it's not doing me any good and rest let my leg rest for a while (not returning to the gym) and just be patient (I've gotta admit, that's hard for me but I really want to walk like a normal person again.... so I've GOT to do it).

I want you all to know how much I appreciate you! :)
 
My plan is to discontinue the PT with the therapist since it's not doing me any good and rest let my leg rest for a while (not returning to the gym) and just be patient
:yes!: Atta girl!
I want you all to know how much I appreciate you!
Oh that's so sweet of you! For my part, I was beginning to fear you would start think of me as being a bit of shrill! :flwrysmile:
 
An update.... my OS isn't ready to go in and do surgery again so he wants me to continue stretching to see if I can improve my flexion. He wants my swelling to have a chance to go down and I will go back and see him in another 6 weeks.... so in the mean time, I'm following orders :)
 
@Lori1973
It isn't even 2 months yet since your MUA - much, much too early to even think about further surgery. :yikes:

Your surgeon is quite correct. It's most likely to be swelling that is inhibiting the bend in your knee. A knee that is full of swelling just can't bend properly. Think of a hosepipe filled with water.. It's stiff and doesn't bend easily. On the other hand, when the hose is empty, it's easy to bend it. That's what happens with your knee, too.

So, apart from doing a little, gentle exercise, concentrate on spending as much of your time as you can doing this:
rest, elevate, ice and take your pain meds by the clock.
 
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he wants me to continue stretching to see if I can improve my flexion. He wants my swelling to have a chance to go down
Celle said it.

Are you doing any exercises?
 
Yes, I'm doing daily exercises. I have since quit going to PT but I constantly stretch, ride the stationary bike and I have just started water aerobics twice a week. It's amazing how much easier exercising is in the water. Unfortunately, I'm still having issues with my ROM. I fell about 2 weeks ago but had an exray and all of my hardware is just fine. It is still very painful when I walk, especially when I get up. I am very unsteady and my husband says I look like the hunchback of notre-dam because I walk hunched over from the pain. After I have walked and I have had a chance to warm up and everything can stretch, it's a bit easier but I still have an awful lot of pain for being 5 months post-op.

Earlier, I read about a guy named Andy on here that had the exact same problems as I am having now (his post was from 2012) but the discussion has been closed and i wish I knew what came of his surgery to release the posterior capsule, change his spacer, remove adhesions and loosen his ligaments. I'll do some research and see what i can find :)

I meed with my OS again next month and I will see what he suggests. I just know I'm tired of walking with so much pain and feeling like a have a really tight rubber band keeping me from straightening my leg. :-/
 
I am very unsteady and my husband says I look like the hunchback of notre-dam because I walk hunched over from the pain.

I hope you were able to limp over and smack him.

Sorry you are having such a tough time. Wise voices will appear with great advice. It's hard to believe, but usually doing less get you further. Good luck.
 
Yes, I'm doing daily exercises. I have since quit going to PT but I constantly stretch, ride the stationary bike and I have just started water aerobics twice a week. It's amazing how much easier exercising is in the water. Unfortunately, I'm still having issues with my ROM.
Has it ever occurred to you that your issues with ROM are actually being caused by your exercises? If you've kept this up since surgery then you're fast getting to the state of chronic inflammation which will be very difficult to resolve. Fact is that neither your knee nor your leg is weak but injured and injuries benefit most from rest.
 
I agree with Josephine. My first thought was to drop the water aerobics and just stick to some light stretching and a few minutes on the bike to loosen up and that's it. Then see how it goes from there.
Water exercise is deceptive.
 
I agree with Josephine, too. I would definitely stop all the exercising, particularly the water aerobics. Because you feel cushioned and almost weightless in the water, it is so easy to overdo things without realising it.
 
Later this month will mark 6 months post TKR. I just wanted to update that I'm still having issues and I had an appointment yesterday and I have a revision surgery scheduled for January
 
He isn't sure if I am just rejecting this particular implant (it's a cementless implant) or that my scar tissue is so severe (he knows it is bad because I still can't extend my leg) that the scarring and adhesions are wrapped around my ligaments. He said that he will use a whole new implant this time.
 
I hope the revision works for you. Did you consider seeking a second opinion? I think it would be wise to do that.

Did you ever stop all the exercising? If so, did you notice any difference?

I don't think that whether or not your implant is cemented or cementless has any bearing on rejection. However, if you are rejecting the implant, it might be because you have an metal allergy, so please ask about being tested for that.
Metallosis: what is it?

I'm going to ask @Josephine for her opinion, too.
 
I did stop all of the exercise and PT and there is no difference than before. I just got my lab results back from last week and my C-Reactive Protein was pretty high. If I read it correctly, the standard range is 0-3.2 and mine is 14.6. I'm not sure if that is from swelling or if there is a possible infection.
As for my surgeon, he is one of the best (Dr Kirby Hitt) and he is specializes in revisions, so I have all the faith in him.
 
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