Revision TKR 2 failed revisions & a stress fracture, all in 14 months

[Ilovecruising]

@Josephine, I do 20 repetitions of the exercises mentioned at rehab twice a week. One session per visit.

Cone exercise is where there are (6) cones about 6” high lined up several feet apart on the floor. I stand right below cones then I start walking picking up my surgical leg above the cone to clear it as I walk over each cone (without hitting it or knocking it over as i go) I do (2) complete cycles going one way and then turning around and going back the other way. and then do the same thing with my right leg.

Next one, I’m hooked up to the NMES machine with probes that are placed on my knee. The machine is turned on to fire sporadically (running little electrical currents to my knee to fire up quad muscles) and stay on for a few seconds and then go off and then repeat. I am lying with a rolled pillow beneath my knee. When the electrical current starts, I also push the back of my knee hard against the rolled pillow to contract the quad muscle. I push until the current stops and then I relax the muscle. I repeat with each electrical current, usually 10 or 15 repetitions

 

[Josephine]

Thank you!

1. Pain level at the moment is 3 but varies considerably as this time. Last night I would have given it a 9

You do know that moderate swelling adds a factor of 4 to your pain score which makes it 7 and 13!

2. I am prescribed Oxycodone 5mg every 12 hours. Also Tramadol 50 mg x4 6 hours, however I usually only take 1.
Oxycodone at bedtime.
If I continue to have pain I will take another Oxycodone or Tramadol in 4 hours. I hardly ever take one during the day. The max that I have been taking in a 24 hour period is 3 pills a combination of the two. (usually 2 Oxycodones and 1 Tramadol.

I suggest that instead of the oxycodone you take Tramadol 50 or 100mg 4 times a day and Tylenol 1,000mg at the same time. I used this schedule for both my knees and found it very effective. And Tramadol doesn't have quite the same side-effects as oxycodone.

3. Moderate swelling

mentioned above

4. Flexion 112, extension 2

That's actually jolly good for only only 5 weeks out!

5. Usually I ice only once a day for 30 -45 minutes

With moderate swelling, I do recommend that you ice for at least 40-60mins and more than 4 times a day.

6. Yes, I elevate a lot. I would say at least 6 to 8 hours a day. Elevate in my recliner.

And I trust you elevate at least 4 times a day for the same amount of time? If not, you should be.

7. My activity level is fairly low. I make myself a simple breakfast and assist my helper with dinner prep. I get up to go to restroom, to get myself a snack, to let dog outside, make my bed and sometime do laundry. I drive myself to therapy twice a week.

That's good


Exercises at home 5 days a week 2 sessions per day - I suggest one session a day and none at all at the weekend!
Straight leg raises x10 - tip - once you can do a SLR, you don't have to do them any more
Pressing knee on pillow x10 - such exercises are questionable plus they are for extension
Knee lifts x5 - the same as above

Out-patient therapy twice a week, 1 session
Stationary bike 10 minutes - okay
Press ball between knees 25 repetitions - this is not a good exercise
Tie band above knees and stretch knees apart x25 - never, ever use bands. Worst thing ever
Standing and holding onto bar 20 repetitions each of following - again, a questionable exercise
Marching left then right leg x20 - never do marching, very bad
Mild squats x20 - marginally okay
Heel raises x20 - these are questionable also - read this Heel slides and how to do them properly
Stand on right leg, swing left to side stand on right leg, kick left backwards x10 - Poor exercise
Stand on left leg, swing right out to side x20 - another poor exercise
Walk over 6 cones one at a time - an extremely poor exercise!
Climb steps x10 - if these are what you have to do, then it's okay
Straight leg raises, raise when comes on, hold and lower x20 - as I said before, you don't need to do SLRs once you've mastered them
Place knee on rolled pillow, press knee into pillow when firing starts, hold until stops x20 - another bad exercise
With leg on rolled pillow, toes pointed facing me, raise and lower leg when firing starts and stops x20 - another poor exercise
Put my feet on huge ball and raise my hips off of table s10 - also no recommended: don't use balls!

In Summary:
1. adjust your pain meds as suggested
2. cut your exercises as suggested as per this recommendation

It's not the exercising that gets you your ROM, it's time. Time to recover, time for swelling and pain to settle and time to heal. One thing that seems to be missing from all the PT's protocols is that all your ROM is there right from the start, just waiting for all that to happen so it can show itself. In the general run of things, it doesn't need to be fought for, worked hard for or worried about. It will happen. Exercise as in strength training is counter-productive and in the early weeks does more harm than good. Normal activity is the key to success.​

3. increase the amount of icing and elevating
4. Read this Bone grafts and hip replacements
5. and this: If you are concerned about refusing to do therapy, you need to read this Saying no to therapy - am I allowed to?

 

[Ilovecruising]

@ Josephine, as I explained in my post I haven’t been able to do the straight leg raises or knee raises while sitting in a chair so I have not mastered these two at all. It’s like I am telling the leg or knee to pick up but it just sits there and will not cooperate. So what exercise do you recommend for these? General census is that my knee instability is from poor quad muscles. So what is your suggestion for strengthening?

Just curious if you can explain to me why you feel like most exercises that I do are wrong? Like the stepping over cones for instance, what would be wrong with that? And the NMES, are you against those entirely or just when combining with other exercises simultaneously that you feel is wrong?
I value your knowledge greatly and I’m certainly not questioning your expertise, I’d just like to know why you feel like these are so wrong.

And as far as extension, I’m not quite there yet with a 2. I still have a pretty bad limp so I was hoping by getting leg completely straight, it will help resolve the issue. What tactics do you suggest to improve the limp?

I will get on the Tramadol and Tylenol Schedule that you suggested to see if that will control pain more efficiently.

And yes, I definitely do enough elevating every day. But you are correct that I don’t do enough icing. So beginning today, I will get on a better schedule for that. Just a question, from your experience do you think that since I have had swelling in my knee for almost 30 years, that it can be helped with a strict regimen of icing and elevating?

Thank you, thank you, thank you for this forum! I am so happy to read other people’s stories and see that I’m not the only one these things have happened to and most of the issues will resolve over time. Gives me hope and encouragement!

 

[Josephine]

@ Josephine

Honey, if you want to tag someone, you have got to ensure that the @ sits close by the name. Also, that when you've posted your post, that the name goes blue and becomes a hyperlink. How to use the quote feature

as I explained in my post I haven’t been able to do the straight leg raises or knee raises while sitting in a chair so I have not mastered these two at all.

I apologies, I didn't notice. But that's not uncommon and can take a while to resolve. Quite contrary to what I said (though that is also true) you should go on with the SLRs until your quads respond which they will eventually. Don't let it get you down though. It will resolve.

General census is that my knee instability is from poor quad muscles.

In whose opinion? Doctor, PT?

Just curious if you can explain to me why you feel like most exercises that I do are wrong?

It's not just you, honey. If you read around the forum, you will notice that I think most of the exercises everyone does are wrong! Read this to see why BoneSmart philosophy for sensible post op therapy

Like the stepping over cones for instance, what would be wrong with that?

Because it over stresses your legs and increases pain and swelling. And I've never heard of them before! I don't subscribe to any exercises!

I still have a pretty bad limp so I was hoping by getting leg completely straight, it will help resolve the issue. What tactics do you suggest to improve the limp?

Walking is the best remedy but only in moderation.

Just a question, from your experience do you think that since I have had swelling in my knee for almost 30 years, that it can be helped with a strict regimen of icing and elevating?

Can't hurt to try!

 

[Ilovecruising]

@Josephine thank you for your reply.

 

[Ilovecruising]

I would like to share my experience with Physical therapy. After my car accident in 1990, I had a left crushed knee and femur, a R broken femur and a L crushed arm and elbow. The pain with PT on my arm was excruciating as PT did try to manipulate it to get movement. I end up crying all the time and finally refused to do it. The PT told the arm surgeon whom came in and talked to me about the importance of persevering and pushing through the pain in order to get good results. But I just could not (would not) worry about my arm with all the other problems I had with my legs, dealing with unimaginable pain and learning to walk again. So I refused any exercise on my arm that caused pain. The elbow never did straighten and my flexion is poor. I don’t know my numbers but I cannot get enough bend to eat with my left hand nor cannot straighten the elbow enough to make transactions when going through drive in windows. I have to open the door and slide part of my body out in order to reach the window.

I don’t know if this would be the same as a knee joint or not, and of course the elbow was not a joint replacement, but I do have a plate and 23 (I think) screws that run from mid-forearm to mid upper arm.

When I did the TKR of the L knee June, 2018 , I was not yet a member of BoneSmart and I very much believed in the motto of no pain, no gain. But after I started reading through BoneSmart, I did somewhat change my perspective in time for my revision in January 2019. I had a talk with my therapist (same one as last year) where I explained to her that I would go to the point of feeling pain but then I wanted to back off on that particular exercise. I told her I want to take things slowly because there is no reason for me to try to rush through it. I have refused several of the exercises that I did last year. I feel like maybe going slower and not pushing any exercise, will hopefully give my knee a chance to heal stronger this time. I’ve been back with her for 4 weeks now and I am entirely calling the shots. And she is very much accommodating.

I do not, however, believe that having no PT is right for everyone. We are all different individuals with different circumstances and different bodies. We all have our own extenuating circumstances which calls for individual approaches to physical therapy. At least that is my belief. Thank you for listening.

 

[sistersinhim]

I do not, however, believe that having no PT is right for everyone. We are all different individuals with different circumstances and different bodies. We all have our own extenuating circumstances which calls for individual approaches to physical therapy. At least that is my belief.

I completely agree with you. We have never said to not have PT. What we say is that painful PT that causes swelling and inflammation is bad for a new tkr. The new knee needs to heal more before subjected to strenuous exercises. Also, we stress to not just sit around and do nothing, but to do all the daily activities you can without increasing pain and swelling. Each week of healing means being that much closer to being healed. Each week the healing is slowed down is that much longer it's going to take to recover.

 

[kneeper]

If you have a good PT and use your common sense, PT can be useful for you. There were times I simply said to my PT "not yet" or I would ask for a different exercise that might accomplish the same goal, or I would know when I had done enough for the day and say so. The next time I might be able to do more.
I do believe that each injury/surgery is different as well.

 

[Ilovecruising]

@kneeper Thank you so much for your message. I do have a very good PT whom I have a lot of respect for. After reading numerous threads here, I am very much surprised by the actions of some of the PT’s that some people have encountered. So I, too, have become very vocal on exercises that I will or will not try in rehab. My PT never gives me any resistance, respects my feedback and seems happy to honor my requests. I appreciate all the valuable information that I have learned reading this forum about therapy, otherwise I would probably be following my (PT’s) guidelines instead of my own body.

 

[Ilovecruising]

I am 6 week post op for my knee revision and sometime feel like I am doing pretty well and other times I don’t! Like others have mentioned, it sometimes feels like it’s one step forward and two steps back.

My latest flexion was 112 and extension was 2.
The flexion was measured with me lying on a table and actively bending my knee. I pulled it back as far as I could and she measured and then ask me if it would go any further. I then took my hand and passively pulled it until the pain began and then stopped. She said it measured 106 initially and then increased to 112 after I manually pulled it further. I’m just wondering if all measurements are done the same way. And which measurement is more important, active or passive?

After my initial TKR my measurement at 4 months was 126.5 and 0. So I am hoping to get back to those numbers. But It saddens me to read on several threads that their numbers started to regress after a few weeks and that’s kinda scary.

I have several concerns and questions but going to ask them in different post so hopefully it will be easier to follow and not get all jumbled up in one.

Thanks for reading and giving me feedback from your own experiences that might help.

 

[Lindylee]

My flexion was measured in hospital sitting on a chair with my foot on the floor. At PT it was measured sitting on the end of a bench with me bending my leg back under the bench. I achieve far less flexion when lying down so it's very difficult to compare with others if we weren't all measured in the same way.

It's natural to take backward steps. Mine was between 4 & 5 weeks, but I've noticed a definite improvement since week 6 and again this week. We tend to lose flexion if we gain swelling. It's a balance between gaining strength and not causing too much swelling that then impedes movement. Hang on in there and I'm sure you'll get there in the end.

 

[Jockette]

I agree with everything @Lindylee said.

I also get a much better bend when I’m sitting on a chair. It’s drastically different when I’m laying down, even now, 2 years later.

Don’t worry about the number fluctuating, you are still in very early days in this recovery.

The important number is what you can do yourself without help. Pulling your leg further towards you is not a good idea as it stresses your knee unnecessarily. I guess it’s really only good for showing you the potential of what you will be able to do later.

I had excellent numbers early on, but they were always with a PT or my surgeon putting my leg in a painful place. My records show a great recovery but it is not true as I didn’t have any of the function those numbers implied.

 

[Ilovecruising]

@Lindylee thanks so much for your encouragement. I just hit my 6 week mark Tuesday so hopefully everything will take a shift in the right direction. Good luck with your recovery also.

 

[Ilovecruising]

@Jockette thank you so much for your reply. I agree with you on the purpose of measuring the knee when pulling on it. That number doesn’t mean a whole lot. It’s the number that I can do actively that really counts.so I’m not going to be too concerned about the numbers as long as they continue to increase, even if it’s slightly. After my TKA last June, I was able to get flexion to 126. At about 4 months. I would be more than happy with that outcome this time.

I have read bits and pieces on your problems you have endured since your surgery. I am truly sorry that you have had all these issues and hope things improve for you. Is it possible for you to tell me how to find your recovery thread as I would be interested in reading the entire thread. I haven’t quite mastered the art of moving around freely on BoneSmart yet.

 

[Ilovecruising]

I am having issues achieving a normal gait and it really is weighing heavy on my mind. It’s been 6 weeks and I still walk with a cane. Without cane I have a very pronounced limp. And even with the cane I still limp. I’m just wondering if it will ever be normal again.

Prior to my initial TKR, I had a pretty bad Valgus knee. I’m not sure the exact degree as it was never measured but I’m guessing it was probably about 20 degree. With that I did have an unusual gait as my leg kind of slung outward. But it wasn’t a penguin waddle like it is now.

After reading a lot of recovery threads on here, I am happy to see that so many of you are walking without any assistive devices and with a normal gait in just a few short weeks. I know I shouldn’t compare myself but it’s hard not too.
It’s just so depressing that after two surgeries to “fix” my knee, it seems I have more problems now than I had before my first surgery.

If anyone can give me encouragement or share your experience on things you did to improve your gait, I would be most appreciative.

 

[Lindylee]

My knee was a valgus knee too, but maybe not as pronounced as yours. I don't know what the degree was. I had to have a special prosthesis though. One thing the surgeon commented on was that my tendons and ligaments were strong. If yours were weakened it might take longer plus you had previous surgery. I had cartilage repair on that knee nearly 20 years ago after an accident, but nothing else.
I was advised to use my cane until I could walk without limping so I wouldn't give yours up yet. I still use mine if I'm out, as my leg tires and then I might limp. Try to concentrate on gradually increasing the length of your stride, putting your heel down first and working through the whole foot before lifting the heel. Do it slowly until you've perfected it. 6 weeks is still early so try not to be disheartened. It's not a race.

 

[Zommom]

I see we had our procedures done on the same date so happy 6 week anniversary to us! I know it’s hard not to compare our recovery with others - that’s just human nature as well as a little competition sprinkled in, we all want that miraculous recovery but alas no one gets that everyone has those bumps - mine is flexation some are extension and others a whole array of other issues. I was born with bowed legs and hence my gait was never correct those knees wore down over time. My poor grandmother lived 90 some years with painful bowed arthritic knees without being able to get surgery. So I am very grateful to have this option. Before I could have surgery I had a stroke that put me back about 6 months before I could fix my knee -during that time I could not bend and would only walk with a walker - those muscles and ligaments now need more time to learn what to do with my new knee. I went into it with a walker and 6 weeks later graduated to walking with occasionally using a cane. This morning I got out of bed and was so stiff I had to grab my walker until I loosened up so try not to get down we are still so early in this recovery. I try to stay positive and thankful for being able to walk knowing it will get better as the alternative (in mobility and using a wheelchair) is behind me.

 

[Jockette]

@Ilovecruising Thank you for your kind thoughts about my recovery. It’s been a tough 2 years.

I have a link to my recovery in my signature, but I see that you already found it, as you “liked” a post in my thread. Make sure you are comfortable with snacks and your favorite beverage as my thread is quite long, I write long posts!

Here is a link explaining how to find another member’s threads and posts:
https://bonesmart.org/forum/threads/finding-another-members-threads-and-posts.15316/

 

[Ilovecruising]

Well, tonight I am in pain and frustrated to the point I’m in tears. Tuesday will be post op week 8 for my revision surgery. I was very concerned about my limp and mentioned it to my therapist last week. She said from watching me walk she felt like the limp was actually coming from the hip on side of the affected knee but not the knee itself.

Last year after I had my TKR, I noticed that I had a popping sound in my hip when I walked. I could put my hand on it and feel the popping sensation. I told my surgeon about it and he said that shouldn’t have anything to do with my knee surgery. WHAT! But keep in mind this is the same surgeon that said all my post op x rays looked good even though I had to have surgery for revision due to instability a few months later. Also one that told me I needed a hinged knee implant the 2nd time around because he was positive my ligaments were weak and could not hold the initial implant in place. However when he got in there for second surgery, the ligaments were fine and he replaced the femoral and spacer components with larger ones. I still have instability so not sure that’s going to work either.

And now, just today, I started having significant pain in my left hip. Just whole I was sitting and now while resting in bed. I have noticed a little ache type pain in the hip previously but these pains are more throbbing or stabbing and just comes out of nowhere.

Any thoughts or experience on this from any of you BoneSmart peeps out there

 

[Ilovecruising]

@Lindylee thank you so much for your encouragement. I’ve been trying to practice my walk with longer strides and heel to toe. My PT told me last week that she thinks my limp is coming from my hip instead if my knee. And now my hip has been hurting significantly since yesterday. I have an appointment with my OS next Monday but I hate to say it but I don’t expect to find out much from him.

I’ve been trying to stay positive but it gets harder and harder to do as something new keeps popping up.