Bilateral TKR Update-Bilateral TKRs 2.5 years later

[Moka]

Very thankful for this site and all who contribute their support and insights. I had extreme swelling for several months after my surgery (May 2020), hence very limited ROM. My surgeon said I had to do "brow-sweating PT". So I pushed through heel slides and all my PT exercises and finally got to about 110 degrees flexion by month 3. However, by that time, I developed pain and weakness behind my knee which greatly limited any tolerance for exercise or walking more than a 1/2 mile. I stopped everything as advised and for the last 2 months have just done daily activities for exercise and a little walking every day. This pain behind the knee has not lessened...it grabs back there...feels like an unhappy tendon..have to lift my leg when I get into the car. Would really appreciate any insights as to how to go forward. Thanks so much!

 

[Pumpkin]

@Moka
Welcome to BoneSmart, glad you joined us!

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

Have you been icing the back of your knee? Your nerves and blood vessels are back there and ice may help with your current pain, it may only give you temporary relief.
Your current pain may be caused by a Baker's cysts and other knee bursae , there is also a small bone the fabella in the back of your knee that can cause problems, or you may have tendonitis in one of your hamstring tendons. Tendinitis - an explanation

Here is some information about the fabella;
"Impingement of the popliteus tendon
The popliteus tendon syndrome is difficult to diagnose and can be the cause of considerable discomfort after TKR. It can be treated effectively by arthroscopic release of the tendon from its femoral insertion.

Fabellar impingement (fabella - a small sesamoid bone - sesamoid as in sesame seed because they are often similarly shaped!)

This should be considered in patients with discrete posterolateral pain after TKR and with a large fabella seen on radiographs. Pain is usually activity-related and is due to impingement of the fabella on the femoral or tibial component. The diagnosis can be further confirmed by dynamic ultrasonography. The patients generally respond well to excision of the fabella."

Since your surgeon is unable to give you any answers. Recommend you seek a second opinion for your painful 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.

 

[longisland]

that was very interesting information about behind the knee pain, pumpkin... the most info I have seen. I thought I was alone in the dark about impingement pain behind knee. thanks for posting

 

[Pumpkin]

Glad you found the information useful, hope you are able to find some answers soon.

 

[Moka]

Thank you Pumpkin for your informative response. I sure do hope it is just tendinitis. My surgery date was May 19, 2020. What does the "signature" involve or mean? Thanks you.

 

[sistersinhim]

When people look down at the information in your signature they can see when your surgery was and what kind you had. It is so much easier to be able to help and relate to those who have had the same surgery and you have. It also helps us to be able to advise you better.

If you look down at my signature and add everything up you'll see that I have had two kneecap removals, numerous scopes, and a right tkr, for a total of 12 surgeries.

 

[Moka]

TRKR on May 19, 2020. thanks.
Wrote this before but do not see it added yet

 

[Moka]

So, how do i get into the recovery club?

 

[Celle]

What does the "signature" involve or mean?

The signature is where we put your surgeries and their dates.
It appears at the bottom of every post you make, for handy reference, so w don't have to keep going back to your first few posts, to see when you had surgery and what you had done.

So, how do i get into the recovery club?

I have added your name to the May Marvels surgery list. That makes you a member of the recovery club for May 2020.

Please remember that the surgery team recovery list is primarily to allow you to see who has had surgery the same month as you. Discussion of issues, comments, and questions regarding recovery must be kept in your individual recovery threads.
You see who had surgery close to your time and you correspond with those people on their own recovery threads and in yours, but not on the thread where the dates are listed.

 

[Moka]

Hi,
I am back. I am now 9 months post op from my TKR. My original post was last October but I had my TKR back in May 2020.
When I posted 4-5 months out from my surgery I was concerned about the back of my knee being very tight with concerns of impingement. I still have some of that but it has improved. And for months, my knee swelled with very limited exercise. At this point, I still have leg stiffness and my ROM has not budged since my 3rd month post op and remains at 110. My issue is now centered more on the front of my knee which still gets tight and full feeling with repeatitive bending. I can walk about 3/4 of a mile before it really stiffens up and can only do that a couple of times a week. And if I try to bicycle on a recumbent bike for even 4 minutes (backpedaling with no resistance), not even putting much of a bend in my knee, the front of my knee feels full, tight and warm. I don't have visible swelling until I do sustained repeatitive bending. I am wondering if this is arthrofibrosis as it has took months for my knee swelling to dissipate. And if so, if anyone has had successful arthroscopic surgery to cut some of it away. I am healing but at a snail's pace. I am okay with that but I do wonder why this is happening. I also wonder about IT band involvement since I am knockkneed. My surgeon just keeps saying give it more time but I would think it would have changed more by now. I even have a Conformis impant. Would appreciate any feedback. Thank you Bone Smart!

 

[RIT387]

Hi. I will be following for responses from those with more experience, but I am curious about your ROM not budgeing as I wonder about this for myself although it is still early in my recovery. Does a 110 ROM inhibit other daily activities beyond the recumbent bike?

 

[Celle]

A flexion of 110 degrees allows you to do almost everything you need to do.

At 8 months post-op, you are still only two thirds of the way through this year-long recovery, so you still have plenty of time for improvement. ROM can continue to improve for a year, or even much longer.
Where you are now is not where you're going to end up.

I suggest you and your advisers stop worrying about your Range of Motion (ROM) and take some pressure off yourself and off your knee. Try to forget about the numbers.
Stop doing anything to try and increase your flexion - and that includes using the recumbent bike and trying to take walks of a measured length.

By swelling again so easily, your knee is telling you it doesn't like all the exercising. It needs to be allowed to recover at its own speed, not some one-size-fits-all, artificial schedule.
It's swelling that is stopping your knee from bending more, not arthrofibrosis.

Instead of exercising, spend more time resting, icing and elevating your knee, to try to help it calm down. Don't do any formal exercises, but just use your knee normally, during the course of your activities of daily living - doing that is exercise, too.

You've faithfully followed one course of action and it isn't working for your knee, so you have nothing to lose by trying something different.
Knee recovery - Lose the Work Ethic!!

My surgeon never wants to know ROM numbers. He looks at my knees and says "Show me what you can do." That's because function is more important than the numbers.

A flexion of 110 degrees isn't marvellous, but it's acceptable at 8 months post-op, and there is still time for it to improve.

These are the approximate degrees needed for certain everyday activities:

• 65° to walk properly
• 70° pick an object off the ground
• 85° to climb up stairs
• 95° to stand from a sitting position
• 105° to tie shoelaces
• 115° (or greater) to squat or sit cross-legged
• 125°+ covers most activities. However, squatting or sitting on your heel may always prove challenging.

 

[Moka]

Oh my, .....here goes....I followed the last recommendations you gave me in March but in April, because I was doing so much better, I tried to advance. So, at 11 months post op of my R knee replacement, I finally was coming around....meaning i reached a new level of exercise tolerance....so I thought.

I walked up to a couple of miles in a 2 week period and got back on the recumbent bike several times in a two week period (which I was never able to do before as my knee never liked the bike even for 4 minutes). I seemed to be able to cycle forward for 10-15 minutes and even with a little resistance. I was so happy to finally be healing but then I woke up one day and my knee was stiff and tight making it difficult to walk.... back to the knee not liking repetitive bending.

So for the last 2-3 weeks, I have been extremely limited and can hardly walk much. I am keeping my leg elevated a lot and applying ice throughout the day.

I cannot help but feel that I pedaled too fast and with the added resistance, I caused tendonitis. I think that has been my problem all along...that at 3months I had worked my leg too much and pushed through too much pain causing tendonitis at that point and it taking 8 months to heal and then I went a little too much too fast for proper healing.

But now I am scheduled for surgery on my other knee in 3 days! I feel I have to go forward with this because the steroid shot is wearing off and now I am having trouble bearing weight on that knee. And as I was preparing for this next surgery, I was progressing and doing much better.

Either way, surgery or no surgery, my left leg is barely functional so I am going forward with it. So, I am seeking counsel from you wonderful Bone Smarties...am I taking the right approach with my 12 month post op leg? And going forward with this next surgery on the other leg, my take is to go slow, no pushing into extreme pain and by going slow and easy, I still should have a better recovery? I so appreciate all of you!

 

[sistersinhim]

my take is to go slow, no pushing into extreme pain and by going slow and easy, I still should have a better recovery?

I agree that you should rest your tkr knee and hopefully, it will improve. As you rest from your new tkr, your old knee should benefit from that. Lots of icing and elevating should be helpful in your preparation for the new knee.

 

[Moka]

Thank you!
That was quick

 

[Sisterpat]

Blessings on your upcoming surgery! I totally agree with sistersinhim! Your having to baby your new knee post-op will definitely help your other, older knee. Go slow and be patient. It will all fall into place, especially if you follow the BoneSmart guidelines.

 

[Grammy4b2g]

I hope you surgery went well. I am sure all the resting will also help your other knee. Please let us know how everything went.

 

[Moka]

Well, I have not posted since my last L TKR surgery on May 11, 2021. I have been to this site multiple times however over the last few months as it settles my nerves and gives me perspective! I am so grateful to this site and all of you who contribute your knowledge, experience and support!

My R TKR was done in May 2020 by one surgeon with a Conformis implant. My L TKR was done in May 2021 by a different surgeon with a Stryker implant. As can be seen from my prior posts, my R knee did not heal well (except I had a 2 week window in April where I was really making progress and had increased my activity without stiffness or pain, then things went South) and I continue to wear a knee brace on it every day as it remains stiff and easily swells with standing and walking after about 15 minutes. I did have an MRI done on it in June and another X-ray which my new surgeon evaluated. It was inconclusive but suggested possible loosening, metal allergy, and showed a small effusion... and the OS did not like the looks and fit of the Conformis implant. He wants to reevaluate it in October. Because I am now focused on healing my new left knee, and I am having to take care of my partner who is having bilateral partial knee replacements tomorrow, I cannot worry about my right knee and even think about a possible revision in the near future...UGH!

So, back to my new L TKR which is now 11 weeks old. I have had more pain with this and less exercise tolerance but I have much better ROM....I got to 120 within 6 weeks and if I push it, which I don't, I can get to 130. I only did PT for about 1 month and refused to do a lot of the things they wanted me to do I am listening to my body and using Bonesmart sensibilities as I guide this knee doing just ADL's for activity. Despite the fairly good ROM, I continue to have a very stiff knee
which still gets visibly swollen. I do ice and elevate several times/day. I can be up on my feet for about 30-60 minutes before it feels yucky and I can stroll around a grocery store for about 30 minutes. Otherwise, walking has been very limited for this new knee not to mention my other knee holding me back. I still have to take 1,000mg of Tylenol 3/day.

So, I share my updated story to add to the Bonesmart archives. Somedays I accept that I am not healing faster and better and other days I really miss my former self of 18 months ago who was hiking/walking 2-3 miles at a clip, biking and working out at the gym 3 times/wk. At 68 I feel and live more like 88! Thanks to Bonesmart I realize there are setbacks and plateaus and others who recover better and worse than myself. I feel compassion for the whole lot of us!! I'll be checking back...Thank you!

 

[Celle]

Somedays I accept that I am not healing faster and better and other days I really miss my former self of 18 months ago who was hiking/walking 2-3 miles at a clip, biking and working out at the gym 3 times/wk. At 68 I feel and live more like 88!

I think it's very understandable that you feel that way at this stage of your recovery. You've been through two major surgeries, only just a year apart. That's quite a knock to your whole body and it will still take more time for you to recover completely.

Can you try to be patient and give your body and your knees more time? How you are now is not how you're going to end up. There's still plenty of time for improvement.

 

[Ghostpipe]

Your left sounds as though it’s right on course for 11 weeks, hope so much for you that this continues so that you can get the other one sorted out. Has the right improved at all with the lack of activity?
I really feel your frustration. I had an exercise schedule almost identical to yours pre op, and just want to get back there too. One day....fingers crossed. It’s mentally exhausting, all this trying to be patient, and you have been living with it for a long time, bless you.