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Revision TKR 11 wks LTKR revision. Possible stretched ligaments?

CUFlygirl

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I had first LTKR 3/19. My recovery was slow to non-existent. To keep this short, went for a second opinion to two doctors. Implant checked by 3 surgeons, found to be in solid. Found a revisionist surgeon who was positive my pain was due to unstable knee due to thin spacer. Revision surgery was 11/19. Knee felt good, recovering well EXCEPT I still had this rolling tendon feeling in outer side of knee. It felt like when I took a step a tendon or ligament slid across the side of the knee. Fast forward to 9 weeks PO, I was getting out of the car and my knee kind of popped on the lower left side where it felt like a breadstick breaking. Since then my knee is becoming slightly unstable again (OS today noticed it) I have targeted pain where pop occurred. I have had days I couldn't put weight on that spot, then after rest it would be okay. Doc seems to think everything is fine and I should just keep exercising. At almost 12 weeks I think he's full of it. Pain has increased a LOT since that pop. I should not be in this kind of pain at this point.
 
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CUFlygirl

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Sorry, not sure how to edit original post. I also am having difficulty walking, where I feel as if there is a wedge of hard whatever in the outer side of the knee and I'm trying to walk over it (hard to explain). Pain has been radiating across the knee cap and down into the shin. I can't stay on my feet long. Additionally, I have experienced a painful locking also.
 

Celle

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Hello @CUFlygirl - and :welome:

Please will you tell us the full date of your knee replacements (day as well as month and year), so we can make a signature for you? Thank you.:flwrysmile:

It does sound as if you have sustained some tendon damage.
Rather than continuing your exercises, I think it would be better if you stop doing them and only use your knee in your activities of daily living.

Spend some extra time resting, icing and elevating your leg. Pay particular attention to icing the part where you knee is most sore.

If you don't notice any improvement after about a month, you should go back to your surgeon.
Maybe another second opinion would be a good idea?

Here are the recovery guidelines we give to everyone with a new knee:
Knee Recovery: The Guidelines
1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now, they are almost certainly temporary
2. Control discomfort:
rest
ice
take your pain meds by prescription schedule (not when pain starts!)​

3. Do what you want to do BUT
a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you​
b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.​

4. PT or exercise can be useful BUT take note of these

5. It's best to follow this advice

6. Access to these pages on the website

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 the 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 the member’s history before providing advice, so please post any updates or questions you have right here in this thread.
 

Helizabug

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I wish doctors would explain why they are so confident that everything is fine and we should stay the course. It can be so demoralizing when they leave us in the dark to simply trust them. It leaves us without any control. Still, I hope your doctor is correct, and that the pain and debilitation will ease up with normal care.
 

sistersinhim

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Welcome to Bonesmart!

I had that lateral, (outside) popping feel in my early recovery, too. The skin on that area has been numb for years, so no pain on the outside. But, to push on it, it is still tender. I agree that you should stop exercising and just use your knee in your daily activities. If it is a tendon that's angry, exercising it will just continue to anger it. It could be that when you felt that strong pop, that the tendon was strained. Rest and ice is the best thing for it.
 
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CUFlygirl

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Hi thank you for your reply. Original LTKR 3/7/19, revision 11/11/19. Left knee Arthroscopy 10/18/2018. I did go to another doctor BEFORE the revision for an opinion and was given the "we won't touch you until a year is out" speech after waiting 45 days for an appointment. Was THAT devastating.

I am making arrangements to get an opinion at Mayo. The sorry, sad thing there is I live in the Chicago area and have access to excellent hospitals: Rush Medical Center, Northwestern, University of Chicago, Loyola. The orthopedics in our area were all educated at these fine institutions and I shouldn't *have* to go outside of here wouldn't you think? My doctors however (and my PCP), have adopted the 'it takes a year to heal, just give it time' approach after a 15 minute visit where my xrays are reviewed and hands on exam.

I can report that I can stand on my leg, my ROM is excellent 135/0. I CAN walk, but it isn't without a lot of pain and again, prior to that 'pop' on 1/13/20 I felt I was on a path to recovery. I had this ropey-tendon moving over the knee feeling since the first surgery and while uncomfortable it didn't cause pain. NOW I'm having serious pain. It moves around, but the epicenter is the area with the pop. and the ropey-tendon area. What a mess.
 

sistersinhim

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Wow, your ROM is really good. You are already reached where you need to be. Now, is the time to rest and ice that area.
 

Jockette

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The sorry, sad thing there is I live in the Chicago area and have access to excellent hospitals
The orthopedics in our area were all educated at these fine institutions and I shouldn't *have* to go outside of here wouldn't you think?
I understand your frustration. It will be 3 years in March since my Patellofemoral partial, which has never felt right. I had my surgery in Delaware, one of the tiniest states, I mistakenly trusted the first doctor I saw who said I needed a partial. I didn’t know enough to get a second opinion before going ahead with the surgery.

I’ve had 2 second opinions, one in Philadelphia at 15 months and one in Baltimore at 23 months. My X-ray looks fine, end of story. My knee is far from fine.

I am managing, but I have more limitations and discomfort since the surgery than I did before with the arthritis. I’m very sorry I had the surgery. I am now convinced it was way too early. Yes, my knee hurt, and I thought it was limiting my activities. Now I realize I didn’t know how good I had it. Too bad I can’t return it, like we can with many other products we buy.
 
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Thank you Jockette for sharing your personal story and insights which help so many.

Yes, it is so crucial to take time, review and seek multiple opinions before surgery -- any surgery that you have the time to plan for and apprehend details.

I saw/ carefully reviewed three surgeons before choosing the one I went with. Asked 50 million questions (smile), as I learned more about TKR's and osteoarthritis over the span of about a year and half.

It would have additionally, help me to have known of this site prior to surgery. Thanks again.
 
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Thank you for sharing your story CFgirl. I worry about the next few months weaning off of being at home recovering. Back to full time work and wary of any 'pops' that may be ahead signaling that something may not be right.

It will be interesting to see what the MAYO people say... Hoping it is not too serious. Please let us know...:console2:
NOW I'm having serious pain. It moves around, but the epicenter is the area with the pop. and the ropey-tendon area. What a mess.
 
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Celle

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The sorry, sad thing there is I live in the Chicago area and have access to excellent hospitals: Rush Medical Center, Northwestern, University of Chicago, Loyola. The orthopedics in our area were all educated at these fine institutions and I shouldn't *have* to go outside of here wouldn't you think? My doctors however (and my PCP), have adopted the 'it takes a year to heal, just give it time' approach after a 15 minute visit where my xrays are reviewed and hands on exam.
One very good reason for going out of your area is so you can get a completely independent opinion, from someone who won't be influenced by your current doctors. In the same area, even if the surgeons don't work together, they could be golf buddies. Your second opinion needs to come from a surgeon who has no contact, either professional or social, with your current surgeons.

It's not just in Chicago - the reluctance to do anything before a year is up is very common. You might met it at the Mayo, too. It's based on sound principles. Very often, problems do cure themselves with time, so waiting for a year (which is the normal time for complete recovery) can stop you from having unnecessary surgery.

The other reason is professional courtesy. No surgeon wants to be perceived to be "stealing" another surgeon's patient, so they tend to wait until a year post-op, by which time many problems have sorted themselves out.

I can report that I can stand on my leg, my ROM is excellent 135/0. I CAN walk, but it isn't without a lot of pain and again, prior to that 'pop' on 1/13/20 I felt I was on a path to recovery. I had this ropey-tendon moving over the knee feeling since the first surgery and while uncomfortable it didn't cause pain. NOW I'm having serious pain. It moves around, but the epicenter is the area with the pop. and the ropey-tendon area. What a mess.
I also had that feeling of a tendon passing over my knee with my first surgery. As time passed, it gradually went away. I think it happened because the surgery corrected a degree of varus that I had and the ligament had to alter its length to accommodate that. As time passed, the ligament adjusted, and I no longer felt it.

What might have happened to you is that putting a thicker spacer in your knee could have made it so that the ligaments needed to stretch a little bit more and before they'd had time to adjust to that, one of them tore a little bit.

If that is what happened, it may be that the ligament will heal, given time. If it doesn't, it may need to be repaired.

If you do find a surgeon who will give you a second opinion, it might be a good idea to ask for an MRI, to establish the condition of your tendons and ligaments, before getting involved in more surgery.
 

Ceegee

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I can tell you that I am almost two years post-TKR and still have occasional problems with tendons and ligaments. My old, arthritic knee was permanently bent for many years, and when the new, straight, artificial knee was installed, everything around it had to adjust. It was (is) a very long process. I have had a succession of strained tendons and ligaments (causing the type of pain and "breadstick" sensation you describe), as well as problems with both ankles and the hip and knee on my non-TKR side, all of which resolved over time. I'm a very active person and it's been a bit frustrating. The worst problems have been with the tendons and ligaments around the artificial knee, which have had to expand or contract and settle into their new role. They were particularly bad in the first six months after the operation, and have flared periodically since. I get through with a combination of rest, strapping, ice and gentle stretches.

I, too, thought I'd be up and running (literally) after three months, but it wasn't the case. It was a long time before I was pain-free - many months - and while I was active from the outset, I'm still gaining in mobility and strength.

As an aside, I'm somewhat jealous of your range of movement (0-135). I've never been able to get more than about 0-120. But it's enough to do everything I want in life, including yard work, running agility courses with my dog, hiking, and taking long daily walks. Every recovery is different, but the one thing I've learned is that they all take time - a lot more time than we're led to believe.

Best of luck, hope things resolve for you.
 

marieltha

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IMy soft tissues recovery is more challenging than the PKRs. Sigh. I empathize. With you @Ceegee as well. Very similar experiences.
 

lionsm13

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@Celle
I have had two OS opinions on what I should do regarding my situation.
One said that I need to do a revision.

The original OS said to just leave it alone and try to live with it as I will probably not be much better off in the long run even if I had a revision.

I am scheduled to see another OS in the 1st ones network, (in 9 days) but not in the same city.
45 minutes away. I haven't made up my mind yet as to whether or not I want to do this.

I would really like to go out of the two networks that are available to me however I have to go @ a minimum of 5 hours or more to find a physician who specializes in just "revsion surgery"?
It is also winter here.

While they might be out "there"in my area they are a few who do revisions but finding one who does revisions exclusively and nothing else might be thin at best.
The OS I saw two weeks ago said that he did "50" Knee revisions last year.
He also does regular hips and knee replacements.

My original said that he did 40 revisions last year.

Even if one were to find one whose focus was more on revisions how could one get there and then return home?
Taking an air ambulance might be/probably be impractical, not too mention the cost which would probably about as much or more than the revision itself.
It would not be easy.

@CUFlygirl
Did not mean to hijack your thread.
Just wanted to give you some perspective.
 

Jockette

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@lionsm13 I don’t see your post as derailing. You are responding to the topic of revision and going out of our area for second opinions, just like I did.
 
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CUFlygirl

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Thank You all for your replies. Today is Monday. February 3rd and the pain has increased dramatically. Yesterday I could not make one loop through the grocery store. Something is very wrong here, I don't mean to sound dramatic but in 3 weeks I have gone from shopping in 3 stores and cooking dinner (rests in between) to staying in bed as much as possible. Can't believe this.
 
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CUFlygirl

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Update: Physiatrist said it's IT band. Two orthopedics, chiropractor, PT and massage therapist said it's not the IT band. Had a CT scan which shows hardware in place. Went to a new orthopedic (recommended by my PCP, his resume shows he did residency at Johns Hopkins and fellowship at Mayo). Saw his PA, and the PA thinks one, or a combination of the following: 1) possible incorrect size of hardware, 2) spacer that was put in by 2nd OS may be too large which may have caused 3) the IT band to "tear". He is sending me for a MARS MRI tomorrow night. Follow up with the Doctor on Tuesday. PA said it is possible a revision might be necessary because starting from scratch may be the only answer (but they try to avoid that). I'm positive some type of surgery is necessary.
 

Celle

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I'm glad you're getting the MRI, @CUFlygirl . That may help to clarify what's happening.

@lionsm13 - I think a surgeon who does 40-50 revision a year would have sufficient experience in doing them.
 
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CUFlygirl

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Update 2/19/20: I saw the 3rd OS (which is technically the 2nd opinion post spacer revision). For the record his resume includes MD, Phd, residency at Johns Hopkins, fellowship at Mayo. Good credentials. I think I'm going to have to stop at him for a while as these docs are going to think I'm out of my mind. I Had a conversation with him where he told me the MRI shows nothing wrong (ugh). He also said knees don't like to be worked on too much; they tend to get 'mad'. ( I wonder if that's why the OS's seem to blow you off.)

*He (like the other two OS's) keeps focusing on the implant/hardware. The CT showed no loosening, the MRI doesn't show anything, so he wants me to do a bone scan next.

*The problem with the above is...I just don't think the hardware has anything to do with anything. I think whatever "popped" is what has caused the loose feeling (just like before the spacer revision) and all of the pain. Can a ligament or tendon pop out of place and cause this kind of pain?

*He gave me some kind of nerve block shot in the knee which he said would last about 4 hours. I think he was looking to see if it gave me relief and if so, would show that an ablation might be the way to go for relief (spoiler...it didn't work).

*Doctor ordered bloodwork looking for infection (so far no infection and I've had blood AND fluid from the knee drawn)

I spoke with his assistant today, she told me he is a VERY smart man and they're used to people like me who are beyond flustered and frustrated with pain. I kind of apologized for crying in the office and she told me not to feel bad about feeling bad.
 

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