20 days post-op and hoping things get better

[btilelli]

I had surgery in Chicago on New Year's and came back to Minnesota a few days later. Had alot of trouble keeping down oral narcotics and feel my rehab is not optimal because I'm having difficulty controlling pain. Will be trying a fentanyl patch tomorrow. My flexion is just 90 degrees and I'm worried about forming scar tissue. Any suggestions?

btilelli from MN

 

[Jamie]

Are you in PT? Hopefully you are and I think you should discuss your concerns with your therapist. Find out what their plan is for you. And if you don't get answers, talk with your surgeon. At 20 days, you are still very new to the recovery process and you have time to improve. ROM can be impacted by swelling....are you having swelling problems? Are you icing a LOT and elevatinig your knee above your heart? That will help reduce the swelling and possibly "free up" your knee to obtain better ROM. Also, a lot seems to depend on the state of your knee prior to surgery. Did you have limited ROM before? If so, then you have to really push past that and it may take longer. Sorry to throw so many questions at you, but progress depends on a lot of factors. Another really important one, as you've figured out, is pain control. It is much more difficult to have good PT sessions when you are in pain. I hope you can get that worked out! Keep pushing, though....it will get better!!!

 

[Josephine]

Jamie, you rock! You've not left out a thing!

btlelli, that's a great shame about your problems with the meds. I hope your doctor is working with you to come up with a solution.

 

[Jamie]

Thanks, Jo...Da chick do know stuff she learned from da Momma Hen. : )

 

[btilelli]

Thanks so much for the info. I am going back to P.T. today and have a new fentanyl patch they are trying for pain. I've been able to keep some food down today so I'm hoping my session will go pretty well. I had some limited ROM pre-op due to a large Baker's cyst behind my knee. My incision is healing well but I still have a fair amt.of swelling so I am icing and elevating. I also have a CPM machine at home that I use 4-6hrs./day. My daughter's big sweet 16 party this weekend so I'm hoping I can enjoy some of the evening with her and at least 40 of her invited friends. I remain hopeful and thanks again for your input.
Bridget (btilelli)

 

[Jamie]

Hey, Bridget!!! Sounds like a plan! You are working hard....hang in there and things will get better. But I won't lie to you.....it's LOTS of work to recover from this surgery. Post any time and your friends here will support you every step of the way. We love hearing of your successes and milestones met, no matter how small. And on those days when you feel less that spunky, the forum can help too!

 

[Weezy]

But I won't lie to you.....it's LOTS of work to recover from this surgery.

Whew! Ain't that the truth! And the reality is that most people really don't understand the pain and length of recovery from this surgery. I had friends equate it to a broken leg and wondered why, after flying across country with two transfers, I didn't want to spend all afternoon/evening walking around up and down hills. After all, it had been almost four months at the time and they just couldn't wrap their heads around a recovery taking even that long.

Jamie said it all...the hard work DOES pay off, and the relief from that joint pain is the most incredible feeling--and you WILL get there! I remember feeling amazed the first time I realized I was walking and my left knee didn't hurt deep in the joint. Wow. BUT it takes longer than any of us really want...patience pays off, but its really hard to remember that sometimes.

Weezy

 

[Josephine]

Just as a matter of interest, Bridget, did they deal with the Baker's cyst during the op?

 

[btilelli]

They said they drained the cyst during surgery but we were under the impression (from my pre-op complaint) that this would become a "non-issue" with a new knee. They have since told us it may take months for the cyst to go away and some just never do--not what we were expecting to hear at all. Any thoughts on this? Let me know. thanks.
Bridget

 

[btilelli]

The fentanyl patch helped with the pain today and I made it through P.T. OK. I was just happy that I wasn't vomiting and could get some pain relief. I'm still worried about "getting from here to there" as in returning to work by April 1st. It seems like such a leap from where I am today but I guess I just need to take one day at a time. Thanks for listening.
Bridget

 

[Josephine]

Hmm - back to work in 9 weeks? Could be doable but is a tad ambitious in my opinion. Depends what your job is. And if you work fulltime then you should negotiate a phased return to work over the first 4 weeks. Previously I've suggested this as a starting point but whatever you feel is appropriate for your circumstances. Just don't try to be a hero over it as your boss and co-workers are likely to think that because you're back, it's all over and done with!

week 1: Tues, Thurs ~ 10-4
week 2: Mon, Wed Fri ~ 10-4
week 3: Tues, Thurs ~ full day
week 4: Mon, Wed, Fri ~ full day
week 5: normal duties



As for the Bakers (or popliteal) cyst, well it being a non-issue is correct in theory. Actually the 'bag' that is the cyst is a normal part of the knee's anatomy gone a bit wrong!

In the first image you can see where the natural 'sac' of the joint capsule goes up behind the femoral condyles at the back of the knee - I've marked it in red. All the capsule is lined with a membrane called synovium whose job it is to produce the fluid (synovial fluid) that lubricates the joint. This a viscous fluid that circulates round the joint as it moves, much like the oil in your car engine!

Well, sometimes when there is inflammation in the joint (i.e. inflammation of the synovium amongst other things) the whole situation causes the membrane to become thickened and over productive of s. fluid that can be more viscous than usual. That area behind the knee that I've marked on image 1, can stick to itself, closing off the upper area. The synovium in there goes on producing the fluid but as it has nowhere to go, it just gathers and accumulates, making a balloon behind your knee which is all a cyst is. As you can see in image 2, the cyst can get so inflated it can be readily felt, even seen and in advanced cases, protrude through the muscles. And this is also why such a cyst seems to come and go as the fluid builds up, some maybe finds its way into the main part of the joint or just get reabsorbed and down it goes again!

So once the diseased bone is removed then yes, as the surgeon said, it should then become a non-issue as the production of synovial fluid will return to normal. The contents of the cyst should get reabsorbed so the sac deflates and disappears. Sometimes there will always be a residue of fluid in there, sometimes the cyst becomes fibrosed and hard then with or without a fluid content it will always be palpable when you touch that area. But it shouldn't be painful.

Hope this helps.

 

[aussie]

Thanks for the diagrams Jo, I've had a couple of those before OUCH, didn't really understand what they were until now.

Chris