TKR 16+ weeks out and ROM of 90 degrees!

[kneeper]

My guess is along the lines Roy says. I would guess this lack of extension is doing a number on your back. I hope you can find a second opinion and some help.

 

[sparkie]

Hi,
After the MUA I took the Bonesmart mantra way and just iced and elevated (properly elevated, not just feet up on a foot stool which is where I went wrong in the beginning as elevation had not been explained to me!). I did gentle bends/heel slides and a little peddling. I only had 2 weeks of this as I had to return to work.

Since having my knee replaced (April 2013) I had been paying a private osteopath as he was helping with the bending and stretching. My bend was only 90 deg at best, but he did get it straight to around 5 deg . However, since the MUA the bend is 120 deg and the straightening is about 15 deg! My knee "gives way" so I look like I'm doing a courtesy, every so often especially if the ground is sloping downwards and this is also why I have difficulty walking downstairs one at a time. I can' trust my knee not to just give way on me.

I consulted a so called "Specialist" PT who was meant to be highly experienced in walking rehabilitation, but she always seemed so unorganised and pre-occupied that half the session was waiting for her to find my notes! She said "we have to get that leg stronger". I knew that. She also asked me to do leg lifts. I can't, that's why I was there! She got me doing them by putting a ball under my knee and then pulling on a strap around my foot. It hurt like hell and I'm not sure if this is what started my back pain, as all the pulling was coming from my butt muscle and not my leg.

This is my case now:- when I walk I can feel the back of my thigh, butt muscle and back tighten up. I stop and stretch my leg by standing on a kerb or step and dropping my heel or bend forward to stretch my back. It depends which bit aches most. I probably look like a weirdo, but I don't care. This did not happen before the MUA.

If I do manage to do a reasonable amount of walking, the sides of my upper thigh (hips?) ache like hell when I stop. Carrying any weight, like a shopping bag makes it worse.

My doctor recently gave me diazepam for my back spasm and to tell the truth, it has done more for my stiff knee than all the pain killers. I am being whined off the Tramadol now (my choice) as I don't believe it makes any difference anymore. But I don't want to just replace it with another drug.

I think there has been serious nerve damage and that's why I can't do a leg lift? I don't know why my lower leg as wasted like it has? Probably because I can't yet do stairs properly.

If anyone has any suggestions I would sure like to hear them. I would go back to the OS but I might just give him a kick in his knee so he has a clue to how I feel about this!

 

[bottomshollow]

@sparkie, I am tagging @Josephine to respond to your concerns.

 

[Josephine]

I only had 2 weeks of this as I had to return to work.

However, since the MUA the bend is 120 deg and the straightening is about 15 deg! My knee "gives way" so I look like I'm doing a courtesy

You mean you've lost extension from the MUA? And if you have 15 degrees of extension, then of course your knee will give way as it's always bent!

This is my case now:- when I walk I can feel the back of my thigh, butt muscle and back tighten up. I stop and stretch my leg by standing on a kerb or step and dropping my heel or bend forward to stretch my back. It depends which bit aches most.

You are walking with a bent knee and that also means your gait is bad. This is going to throw your entire body off kilter and cause all kinds of problems from you head down to your toes. It's inevitable.

I am being whined off the Tramadol now (my choice) as I don't believe it makes any difference anymore. But I don't want to just replace it with another drug.

I think your mean 'weaned', don't you?
Tell me how much Tramadol you were taking and how often.
You could also try using 2 paracetamol 4 times a day.

Since having my knee replaced (April 2013) I had been paying a private osteopath as he was helping with the bending and stretching.

I think you would be much better off going to a chiropractor than an osteopath as they are mor pro-active in body alignment which is what you need. Neither a physiotherapist (even a 'specialist' one!) nor an osteopath will do this. Have a look here to see what Chiropractic as all about

 

[Jozilla]

I am not a medical professional so I can just advise what I would do. If I thought there was any chance of nerve damage or nerve problems I would see a neurologist. They can do a simple EMG nerve study test right in their office. You would also know the results right away. The chiropractor also sounds like a logical choice. Good luck and I do hope you find a solution. Let us know how you make out!

 

[sparkie]

Hi Josephine, thanks for the replies - yes my leg gives way because it is always bent, which is why I am still not good with stairs, especially going down them!

I looked at the Chiropractor information and to honest my osteopath does pretty much the same manoeuvres and massage? He was great at getting my leg straight but most of this was lost post MUA.
I am taking 3 to 4 Tramadol along with 2 paracetamol each day. (Yes I meant weaned off, sorry!)
Always 1 lot in the morning to get me moving and 1 lot at night as I not get painful hips and pain in my other knee at night now! I take 1 or 2 lots during the day depending on what I am doing and if it hurts.

The thing is, my GP gave me diazepam for my back a few weeks ago - half a tablet 3 times a day and it has helped my back, but my knee also feels like it is working more "freely" and is not so stiff. If I don't take anything at all, it takes me a few minutes to get up and walk away. I get so upset at this as I am only 52 for goodness sake and used to be so fit. The hole point of getting my knee done was to be able to get back to fitness, but it just has not happened for me.

Honestly Josephine, I feel that if I was a dog I would have been put out of my misery by now! In saying that, I am just trying to get on with my life and not think about it, hence the long breaks in my blogs.

I am due to see my GP for my bi-monthly B12 jab (pernicious anaemia - whole other story) on Tuesday and will ask him about seeing a neurologist to find out why I can't do a leg raise. My whole leg just feels so weak and is more wasted than it was pre TKR. I waited 7 years for the TKR. I was told I had to be over 50, so my leg was pretty wasted anyway. Always trousers for me, never skirts or dresses.
Anyway, enough of my person story.
Thanks again xxxxxx

 

[Jozilla]

Hi Sparkie. I just reread your thread. The neurologist will help with nerve pain but After re-reading I would suggest a second opinion with a OS that does revisions. Josephine is definitely the person that can suggest who could help you. Your rom is ok but your extension is -15? A good idea to have that checked out! Valium is an excellent muscle relaxer so that is probably why you have improvement when you take it! Good luck and I am interested in how you make out!

 

[Josephine]

I looked at the Chiropractor information and to honest my osteopath does pretty much the same manoeuvres and massage?

Yes, some osteopaths will use chiropractic techniques which is fine. I had a such osteopath myself many years ago.

I think you would be well advised to get a second opinion. If you tell me whereabouts you live, I can suggest someone for you. It would also help me to know which surgeon has been treating you and at which hospital.

 

[sparkie]

HI,

I had my knee replacement done at the Benenden Hospital in Kent, under Mr Richard Goddard. I had a "Signature" knee.
However, I live in Bedfordshire and the Benenden is a 200 mile round trip for me.

My initial op' was in April 2013 and as I was first referred in February 2013, I was removed from Benenden's care in February 2014. I have not seen anyone except my Osteopath, about my knee since October 2013 when I had the MUA, again this was at Benenden.

I am seeing my GP tomorrow and will go through this with him again. My back has improved a bit with some rest, but both of my hips are giving me pain now, especially at night.

Would a digital biometric gait assessment help? If 1 leg is now longer that other, perhaps I need special insoles in my shoes?

I would trade all this for the old pain in my duff knee if I could turn the clocks back!

Thanks so much for bearing with me on this.xx

 

[Josephine]

What on earth did you go to Benenden for? You have any number of excellent knee surgeons almost on your back door step! There's the RNOH at Stanmore Middlesex, one of the top 10 knee surgeons in the UK at Harlow and an excellent knee unit at Oxford.

But I can recommend the surgeon at Harlow. I worked with him and he's ace! His name is Paul Allen and he works at the Princess Alexandra Hospital.

 

[sparkie]

Hi,
I went to Benenden because of their excellent hygiene record (my local hospital is rife with C.diff and MRSA)
I had also read an article about Richard Goddard being at the forefront of fitting "Signature" knees and how a lady he had helped by doing a revision on an nhs knee and was boasting how she salsa dances and her knee is much more "bendy" than before, that this would be the best way to go for me and the best possible outcome! My GP had already sent me to the local hospital where I as told that they would fit an "off the shelf" knee that may be slightly too big or small but would "do the job"! The pre-op' check up nurse was horrible and they still use mixed sex wards.
I spoke to my again GP just on Tuesday and like me, he has no idea where to go from here. I do not want further surgery and it seems nothing helps with the stiffness. I am now coming off the tramadol and will just have to put up with it. I feel like an 80 year old not a 52 year old. I'm putting on weight and am pig sick of it! My ethos now is to just get on with it and accept that I will always be useless on stairs and will always have 2 very different sized legs as my leg is even more wasted than it was before the op' despite the exercises. Basically, I give up. I was in pain for 7 years before the op, I guess I will be in pain forever, only before it was just my knee and now it is my back and hips as well!
I will ask my GP about Mr Allen, but I don't understand what he could do for me now?
Thanks
all the best

 

[patient 99]

Basically, I give up.

Hi Sparkie
Really sorry to hear what you are going through. If your knee keeps giving way you can't give up. You are only 52. If you ask your GP if you can be referred to Mr Allen in a way that sounds like you don't care, you will reduce your chances of getting a speedy referral.

You don't think he can help. But you don't know, and with so much at stake you have to leave no stone unturned. I know only what I've picked up on BS, but I know orthodoc shoes help some people; more extreme there are braces. But this is all cart before horse. Find out what is wrong then assess your options. You might be surprised. There may be no need for further surgery. But let's say that is your only option, it may be less intrusive than you think eg, it may not require a full revision. But again let say that it does. Its better to be in a position to make good choices than soldier on in the dark like you are now.

My very best wishes. Carol

 

[Pumpkin]

Hi, Sparkie,
Mr. Allen is a specialist in troubled knees and will be able to assess what is going on with your replacment. He is well educated in problem knee repalcements and will know what to look for. He will determine what additional imaging will help reveal what is going on with your knees. He will make recommendations for you after his examination, and only then will you be able to make a decision as to what direction to go in.
I went to a top revision specialist, he identified my problem in a one examination. I have had my revison, and yes it is not easy, but after 4 months I am finally turning the corner, and am hopeful for a full recovery in the future.
I agree with Carol, invest some time seeing Mr. Allen, you have nothing to lose, and whole a lot to gain with a consultation.

 

[StillShortie]

Hi @sparkie your story sounds a bit like mine, I had my original TKR in March 2013 and initially seemed to be recovering according to plan but then the ROM stopped and started going backwards (I think I achieved 100 once but was mostly @ 90 at best and then reduced to 70 and the pain kept on increasing until I could cope no more. My original OS had retired and the team I had been placed under didn't seem to have any idea as to what was happening.

I finally got referred for a second opinion to a lovely OS who quickly and efficiently did extra tests including an arthroscopy to rule out infection during which he did an MUA which only go the bend to 90. Although there was no definite reason for the problems he said he could try a revision all the time he was very up front and said there was a chance it could make it worse, a chance it would be no different but there was a bigger chance it would make it better and although I am only 10 days post op I already no longer have the pains I was having (don't get me wrong I do have pain from the surgery but I'm hopeful that this is temporary, I already have more bend than I have had for months and am sleeping better than I have for a year!

It has been / it is a long hard slog but I really believe mostly because if the truly inspiration stories of others on BoneSmart that although "this road is bloomin long" (my thread title) I don't have to accept pain and reduced ROM without trying lots and lots of things first and that trying all of these things there is a very very good chance I will end up with a good outcome and although the journey is much much longer than I had ever hoped for it will be worth it in the end, especially with all the lovely Bonesmarties who accompany me (and you) on the way.

Sorry to waffle on but I just wanted to say don't give up I know exactly what you mean about being young but feeling like a 80 year old and it does take over your life but there is hope grab that hope, take strength from the fabulous stories on here and get another opinion good outcomes are possible!

Shortie x

 

[Josephine]

I had also read an article about Richard Goddard being at the forefront of fitting "Signature" knees and how a lady he had helped by doing a revision on an nhs knee and was boasting how she salsa dances and her knee is much more "bendy" than before, that this would be the best way to go for me and the best possible outcome!

Which goes to prove that everyone's experience is unique to them! Just because she was dancing the salsa, doesn't mean that all his other patients are doing the same! Never ever judge by what you've seen one person do.

I do not want further surgery and it seems nothing helps with the stiffness.

If you want it fixed, there may be no other option.

I will ask my GP about Mr Allen, but I don't understand what he could do for me now?

If you knew that, then you'd be the surgeon! You lose nothing by going to see.