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[TKR] 2 year post TKA-Need a revision :(

Discussion in 'Knee Replacement Recovery Area' started by AuntB3, Sep 24, 2017.

  1. AuntB3

    AuntB3 new member
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    This is my first post, so a little background.

    I am a 49 yo RN. In 2014 I started having right knee pain, but working in a busy emergency room at the time, just figured it went with the job. When quickly wheeling a patient around a corner, my knee "popped" and from then on, pain was constant. Found out I had torn a meniscus and had repair in Feb 2015.

    Dr allowed me to go back to work after 2 weeks at light duty (ask any nurse, no such thing as "light duty") and after about two weeks, I knew something was wrong. Of course Dr/PA told me surgery went great and its just "slow to heal".

    Because of the constant limping for a year, I started having hip and leg pain on my LEFT side that didn't go away with multiple treatment options, and I began to have numbness in left foot. MRI showed total L3-4 disc herniation/rupture that required surgery. So in Aug of same year I had back surgery. Back never seemed to heal all of the way and my neurologist kept insisting that it was because of the limp from my painful right knee and sent me back to OS. This went back and forth until eventually my neurologist ordered a knee MRI himself and of course I had shredded my meniscus and had severe arthritis in my knee.

    Then I went through multiple injections, etc until OS finally said it had to be replaced. I had right TKR in Feb 2017. My ROM was perfect before surgery, just painful and constant pain when walking, etc. But it was nothing compared to this recovery. My quadriceps were "paralyzed" for two weeks post op, so that put my recovery behind. I was a perfect PT patient.

    Dr just blamed problem at 2 months for being 50lbs overweight. Well, its 7 months now and the pain is so much worse. I can't get out of bed or up from sitting without looking like an 85yo arthritic lady; takes me 2-3 minutes to be able to walk and is so painful. It still have "heat" in knee and swelling constantly. PT thinks something else may be wrong, but OS disagrees and says it just will take time because I am overweight.

    SOOOOO..... my questions:
    1. Should I still be in daily constant pain that Aleve and Tylenol won't help?
    2. Why am I "arthritic" with such joint pain when I get up from sitting or lying?
    3. Is something else possibly going on or does it really take this long?

    So many other ?s that I can't think of. BTW my back/LEFT hip, leg and foot are all flared up again because of limping so I am stuck in the same cycle. I have not worked at the hospital since my surgery in Feb. There is no way I could do it. I wish I would have never done this. I was truly much better before surgery. ROM was great now my best with PT manipulation is 113, Pain is worse and mobility is worse.

    I am so upset and don't know what to do or who to believe.
    Thank You!!!
     
  2. Jockette

    Jockette FORUM ADVISOR Forum Advisor

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    I am so sorry that at 7 months you are still in so much pain! Others will come along to advise you, I just wanted to say hi and welcome.

    I am 6 month post op and coming along slower than others, but I don't have the pain you do, but I do have quite a bit of discomfort and I truly believe for me, is within normal range of recovery. We hesitate to use the word "normal" here as each of our knees has its own recovery timetable and to be honest I have to be continually reminded about that!

    ( I'm still sorry I had this surgery as I only qualified for a partial, and compared to recovery pain/discomfort I wish I'd known how "good" I did feel before and I had less limitations then than I do now in recovery. Next summer I'll know if I made a good decision or if I should have waited.)

    You made a great decision to join us here, we care and the staff is awesome and they really want to help.

    Sending a hug.
     
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  3. Pumpkln

    Pumpkln FORUM ADVISOR Forum Advisor

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    @AuntB3 ,
    Welcome to BoneSmart, glad you joined us!
    Sorry to hear you are still having pain and swelling after 7 months, with no real answers.

    Recommend you seek a second opinion for your TKR, from a surgeon specializing in Revisions, they have the education and background to determine what is happening with troubled knees. Look for a surgeon specializing in complex joint reconstruction or revisions. They should have no relationship with your present OS, not even golf buddies.

    Suspect you have been doing too much too soon and your soft tissues have not been given a chance to heal.
    Suggest you stop PT and exercises and Rest, Ice, Elevate, and Medicate on schedule as prescribed, give your soft tissues a chance to heal.
    You should be using an assistive device to take stress off your knee, back, and hip.

    I am going to tag @Josephine our forum nurse with 50 years of orthopedic experience to help you find some answers.
     
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  4. Pumpkln

    Pumpkln FORUM ADVISOR Forum Advisor

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    Here is your copy of our recovery guidelines, the articles are short and will not take long to read.

    Please post your exact surgery date, a moderator will add it to your signature for you. Having the exact date will help us properly advise you, Thanks!

    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
    elevate
    ice
    take your pain meds by prescription schedule (not when pain starts!)
    don't overwork.
    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. At week 4 and after you should follow this

    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 a 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 history before providing advice.
     
  5. AuntB3

    AuntB3 new member
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    My Meniscus repair 2/25/15
    Back Surgery 8/20/15
    TKR 3/7/15

    Thanks for all of your advise! I will look into finding a 2nd opinion!
     
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  6. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    Before you do, how about letting me offer you some structured advice. To that I also need to ask you some questions - I usually ask first but on this occasion, I'm sure you won't mind ...

    However, I'm going to make it a bit complicated for you as I need you to answer them twice. The first set of answers, 1 through to 8, to be from when you first had your TKR done which would be the first 6 weeks.

    The second set, 1 through to 8, will be how things are now, okay?

    It would be very helpful if you would answer each one individually - numbered as I have done - in as much detail as you can then I'll come back as see where you are ....

    1. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine. And don't forget to factor in other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness).

    2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?

    3. how swollen is your leg compared to these?
    ai63.tinypic.com_eta39s.jpg

    4. what is your ROM - that's flexion (bend) and extension (straightness)

    5. are you icing your knee at all? If so, how often and for how long?

    6. are you elevating your leg. If so how often and for how long?

    7. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and

    8. are you doing any exercises at home? If so what and how often?
    This is the most crucial question so please help me by using the format I have left as an example
    (which means please make a list and not an essay!)

    Exercises done at home
    - how many sessions you do each day
    - enter exercise by name then number of repetitions of each
    etc., etc.

    Anything done at PT
    - how many times a week
    - enter exercise by name then number of repetitions of each
    etc., etc.
     
  7. AuntB3

    AuntB3 new member
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    Thanks Josephine!

    FIRST 6 WEEKS

    1. During the first 2 weeks pain was steady 8-9, even though I could not move my leg; which I found odd. Anytime I would touch it or it would fall or was bumped; the pain was through the roof. There were a lot of tears those first two weeks and an occasional threat to jump off a bridge... It decrease to a steady 6 after I regained control of my leg and slowly decreased throughout the first 6 weeks. However I was on medications the whole time. (When I say can't move, I meant from any position other than standing. When I was standing, I was able to use hip flexors, etc to walk and could stand weight bearing. But could not lift leg at all, however, I could slide it around bed, again using hip muscles. To do any kind of lifting, I had to use my hands.). ALL IS WITH MEDICATIONS

    2. Hydromorphone 2mg q4-6hrs; I added Ibuprofen 800mg q6hrs myself for 2 weeks, then Hydrocodone 5/325mg q4-6hrs. Again I add Ibuprofen 800mg q6hrs.

    3. Huge to moderate

    4. Best Flexion was 113 (Was 138 pre-op), Extension -5

    5. OS recommended icing 4 times a day, but I used my polar pack every hour because I felt I needed it. I continued icing at least 4 times a day, even though PT and OS said I didn't need to.

    6. I elevated overtime I iced. I also elevated as much as possible at other times.

    7. First two weeks activity was minimal to basic personal care. After two weeks began to do minimal housework, simple cooking, dishes, etc. Trips out of home were limited to PT. Began to drive at 5 weeks.

    8. Home:
    Week 1-heel pumps every hour x10,
    Three times a day using a towel all x10 : Leg lifts, Short arch, Long Arch, heel stretch, sitting slides, knee
    dangling, and a few more I just can't remember.
    I also was prescribed a quad muscles stim brace that I used 4 times a day.

    PT began week two- three times a week
    Same exercises as above; added many more reps.
    After regaining ability to lift leg, began stair work and balance work.
    Front steps x10; three sets
    back steps x10; three sets
    Balance work on sponge 30sec x 8-10 reps
    leg presses to gravity x10
    mini-squats x10, three sets
    I did at least an hour of exercises at each session. My OS dc'ed PT after 6 weeks. Although my leg got stronger, I really didn't see much muscle development in quad right above my knee at my stitch area where there was so much atrophy.

    CURRENTLY- 7months

    1. Pain 3-6 most days. Worse when I've been on leg for long; walking or standing for more that 45-60min at a time. This is with meds. Nighttime waking 3 or more times due to pain, have to reposition leg. (side sleep with pillow between legs) Most pain is lower medial area of knee; PT said I have bursitis, but OS says that I can't have cortisone injection due to increased risk of infection. If I've been doing a lot of walking, I get a good bit of pain posteriorly also, mostly laterally. I had a very large Bakers cyst before surgery and it feels similar to that. I would say pain is mostly aching, but I have burning often as pain progresses.

    2. Naproxen 220mg bid, Tylenol 500mg q4-6hrs, Ibuprofen 800mg PRN; OS dc'ed pain meds at 6 weeks

    3. More than slight; there is notable conturing now, but still warm to touch

    4. same as far as I can tell; have not had it measured

    5. Usually at night and sometimes during the day after I exercise. Not very consistent with it honestly though because the PT told me that it will decrease ROM. (not sure I agree, but don't really know at this point)

    6. I still elevate every evening and two or three times a day for 15-20 minutes.

    7. I am able to do everything as before surgery, but I have difficulty with moping, vacuuming, on anything that requires me to bend or squat. I can't do any shopping, events, etc for longer than an hour without significant pain.

    8. Up until August, I did all of the above PT exercise 4-5 times a week in my pool. Additionally, I would swim with kick board 20 min.Then in Aug, I stared a temporary school Nurse position. I was completely exhausted and in so much pain everyday after work, I was unable to do anything but ice/elevate and stretching exercises.
    I completed the job two weeks ago, and started back to home exercises as above last week. I am able to go up stairs with minimal difficulty, but I must use assistance(handrail) going down.
    I have a recumbent bike that I ride 10-20 minutes 3 times a week just to try to keep the joint moving, but it hurts to do it. My OS and PT both give me different advise, so I don't really know what to do about that.

    I still walk with a limp; not sure if that is normal at 7 months. The most continuous walking I do is 30 min at a time. However that gives me a lot of left hip pain, so I do not walk anymore than that.

    Hope this doesn't confuse you too much! Thank you :)
     
  8. sistersinhim

    sistersinhim FORUM ADVISOR Forum Advisor

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    Welcome @AuntB3. I sure hope you can find an OS specialist really soon. You need to find out what's going on with that poor knee of yours.
     
  9. BamaBelle

    BamaBelle junior member

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    Hugs and prayers AuntB3
     
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  10. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    That is very high for almost 7½ months.
    Hee hee - can tell you're a nurse! First thing I notice is that you are taking two kinds of NSAID which is very unwise. Quite apart from the fact that NSAIDs are pretty rubbish as pain killers and have some pretty dire side effects. Medications: acetaminophen (Tylenol, paracetamol) and NSAIDs, differences and dangers So I suggest you stop taking them.
    As for the Tylenol, 500mg is not the effective working dose. That is 1,000mgs which can be taken 4 times a day at 6hrly intervals. Tylenol is actually a lot safer than NSAIDs as long as you don't take more than the recommended 24hr maximum which is 4,000mg. I think you will find that much more effect in controlling you pain.
    hmmm ....
    Same as this?
    I suggest you get it measure again and I can do the flexion for you if you send me a photograph of your knee including foot and hip - preferably with shorts on! Like one of these poses

    goniometry-horz.jpg

    As for the extension read this Extension: how to estimate it
    This question was about icing. I assume that's what you meant to say! But I don't agree with the PT that it decreases ROM. What it does is decrease swelling which will enable it. If it's still warm and swollen, then I suggest you do ice some though not as rigorously as you did at the start.
    Okay but you accomplish little or nothing in 15-20 minutes. Ice and elevate for at least 40-60mins and more than 4 times a day.
    Oh dear!
    I'm not in the least surprised you are now having problems. All this was far too much and for far too long because 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 was 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.
    That means you shouldn't be doing it! It's only making a bad situation worse.
    Not it is not! What you now have is chronic swelling, stiffness and pain actually caused by all the exercises you've been doing all these months!

    If you stop it all right now, you might have a chance of it recouping and regaining a bit of movement but only time will tell. But you must stop it.

    I don't often share this article which is in the library but it gives you a picture of the worst that overdoing exercises can do. You're nowhere near this yet but I just want to impress on you the importance of stopping now while you have a chance to get better. PT: the seriously grave consequences of doing too much of it

    Don't forget to send me the photo of you leg as I suggested above and also to estimate your extension.

    Keep in touch
     
  11. 2happy

    2happy member

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    I am also RN, I was injured at work in 2014 and have had 3 surgeries with PKR in November 2016. I am worse now then before PKR. I truly believe too much PT early on was the culprit. I am on gabapentin for nerve damage.
    I wish you the best recovery. Do as they say here on BoneSmart


    Sent from my iPhone using BoneSmart Forum
     
  12. AuntB3

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    BamaBelle, THANK YOU!!
     
  13. AuntB3

    AuntB3 new member
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    Jockette, thank you!!
     
  14. AuntB3

    AuntB3 new member
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    2happy, thank you for the support! I think our job is a big factor... They expect too much from one person now:gaah:

    I am going to do what they suggest here! My Dr just seems dumbfounded that one of his patients can possibly have a less than perfect outcome. Good Luck to you as well.
     
  15. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    I think you'll find them pretty resistant to that! Generally PTs and Drs just hate getting advice from the internet!

    AuntB3, it's unnecessary to quote a post just to reply to it. Just scoot on down to the bottom of the page and start typing! Unless there is some specific phrase you want to address, of course - like I just did! Then do it like this How to quote a post.

    Thanks for understanding! :)
     
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  16. AuntB3

    AuntB3 new member
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    I had a R-TKA March 2017 and have been having pain and complications since the procedure. Have been through many different treatments with no relief. Had a Genicular Block & Ablation, multiple rounds of treatment for back issues (PT, Injections, etc) which Dr said was cause of knee pain. Even after all of that, I still heard "the knee is fine-Xray looks great". After a 3rd opinion, a bone scan was done which shows loosening of both tibial and femoral components. My new Dr also explained that he has had patients with the Depuy Attune knee that had loosening and does not suggest anything except for continuing as is (I am a Nurse and have been unable to work due to pain/popping/locking since I had TKR) or have a revision.
    I am very scared to go through this again as I have done everything as advised and it was unsuccessful... However I can't imagine that at age 50 I will no longer do a job I love or even go for a walk with my family without pain.
    Wondering if anyone can give any advise on 2 year post TKA revision...
    Also, has anyone had complications with loosening in a Depuy Attune knee?
     
  17. Pumpkln

    Pumpkln FORUM ADVISOR Forum Advisor

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    @AuntB3 ,
    Welcome back to BoneSmart, wish it was under better circumstances.

    You'll notice that I have merged your newest thread with your original recovery thread. For several reasons, we prefer that you only have one recovery thread:
    • That way, we have all your information in one place. This makes it easier to go back and review your history before providing advice.
    • If you keep starting new threads, you miss the posts and advice others have left for you in the old threads, and some information may be unnecessarily repeated
    • Having only one thread will act as a diary of your progress that you can look back on.
    So please post any updates, questions or concerns about your recovery here. If you prefer a different thread title, just post what you want and we'll get it changed for you.
    If you need an urgent response to a question, just tag a member of staff.
    How to tag another member; how to answer when someone tags you

    Here are the instructions on finding your thread, How can I find my threads and posts? . Many members bookmark their thread, so they can find it when they log on.
     
  18. Pumpkln

    Pumpkln FORUM ADVISOR Forum Advisor

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    AuntB3,
    Continuing as it is is only going to get worse, and cause more damage with a loose implant.
    Suggest you find yourself an OS specializing in Revisions, when you find someone you are comfortable with, proceed with a revision.

    I had a revision 2+ years post op, life is so much better, the 24/7 pain is gone, and I have my life back.

    Click on a yellow revision prefix in the knee recovery forums, a list of members with revisions will pop up. Here is a link: https://bonesmart.org/forum/view/knee-replacement-recovery-area.9/?prefix_id=13
     
  19. Jockette

    Jockette FORUM ADVISOR Forum Advisor

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    I had a partial one week after you and I am also still having problems. Like you, my X-ray looks great, “so there is no problem.”

    At least you finally got a bone scan and an answer. I feel I have symptoms of a loose implant but I’ve had 2 second opinions and not one of them will look past my great X-ray to order a bone scan for me.

    It is very frustrating for those of us who don’t have text book recoveries.

    Best wishes as you make your decisions.
     
  20. Cjackso21

    Cjackso21 junior member

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    Hello,
    After many revisions from my original TKR in 2012, after a blood rest that was not covered by insurance, I paid $600 to find out that I was highly allergic to Nickel. OS went back to xrays and realized I had loosening of my top component. Seems like this may not be the issue as bottom component should be titanium. My top component was replaced with titanium almost 2 years ago. The problems I had before that are gone. A few new problems have arisen but they are tolerable for the most part. Hope this helps. Good luck. Will pray for you.
     

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