TKR 6 mos: Great knee, bad quad

[tiredwife]

@Anne27 Hubby had lower back pain before TKRs because of the way he was walking and his job. He still has lower back pain once in a while.

 

[Anne27]

My husband is doing well at almost 4 mos post LTKR. He has physical therapy twice a week and that has been very helpful. Yesterday he noticed some swelling in his right ankle - non operated side. I see it too - the area around the ankle bone is especially swollen, looks almost like a sprain, but he has no pain or discomfort at all. Something related to physical therapy?

 

[Anne27]

My husband will soon be five months post LTKR. He went into the surgery with some left quad weakness and atrophy due to nerve damage from an injury, a herniated disc three years ago. His knee replacement went well, surgeon viewed recent xrays and said it was "perfect; physical therapist is extremely pleased with his progress...but my husband won't walk. He says the quad weakness and "pulling sensation" prevent him from walking very far. Everyone says he must walk ("to the point of exhaustion' his surgeon said) but he won't. He has it in his mind that he is completely different from all other knee replacement patients because of his prior quad nerve damage and he feels his recovery could never be as good. He was seeing a psychologist for a while...I think that doctor made things worse by telling him that "some people who sustain injuries take a very long time to accept that things are different." My son and I are so disappointed because my husband barely leaves the house. He makes no future plans. In addition, I've been doing every chore for the last two and half year and looks like there is no end in sight. Some days I'm so tired. I wonder what happened to our happy life. How could a recovery that all the professionals tell me is going so well...really be going so wrong?

 

[kneeper]

Maybe he's getting too concerned with the "pulling" feeling. I think the walking stuff is a "practice makes perfect" kind of situation. Even if he can add a few more minutes each week, he may find improvement. His knee might not feel like it did at age 20 but it still can be good.

 

[Campervan]

@Anne27 I can relate to your husband so I'll pass on my story to you. And I know very well the pulling sensation he is talking about.

I didn't have nerve damage pre op but I got femoral nerve damage from the nerve block post op so effectively the same end result. I would try to do straight leg raises and my leg would lag/droop from the knee by about 30 degrees. At 3 years post op the lag has improved to around 5 degrees. My quads wouldn't work because of the nerve damage. My knee would buckle under me but I never fell, it just gave way and made me jolt. No amount of exercise, electrical stimulation by physio, etc helped improve things for the first two years. Towards the end of the second year I had an EMG and nerve conduction tests and proved that I had nerve damage. At that stage the lag was still close to 20 degrees. I then went back to physio, a different one, and she explained how nerves regenerate and the rate they regenerate. She tried her really strong electrical stimulation machine and could hardly get a flutter from the quads. She got me onto very specific, targeted exercises and within 3 months we were getting a very small contraction of the quad. One year later and there is a nice quad contraction without the electrical stimulation.

I was walking post op though but it felt weird. And it is weird because the knee cap isn't being pulled up straight because the quads can't do it. So that causes tightness all across the front of the knee. And because of not being able to walk correctly it would strain other areas of the knee and leg, such as the fibula head which would lock up. I had that mobilised maybe monthly for a year or so. As the nerves started to regenerate this slowly improved. Up and down stairs took over a year before I was confident to attempt them without a handrail and even now I still feel the tightness and pulling across the front of the knee. I still have physio massages and mobilisations about once every couple of months and that does keep me more comfortable.

And here's the point to pass on to your husband - I start walking, going up or down stairs or hills and I feel the pain and pulling BUT the longer I go for the easier it is. So that's the key - get out there and do it and see what happens. Use tramping poles initially as then you don't feel an invalid with crutches.

Swimming and water walking in a deep pool didn't help but didn't hurt to do it so I felt I was getting some exercise.

I wish you both well.

 

[vinny]

@Anne27 ...was your husband in a great deal of pain prior to surgery....seems like he may be suffering from depression due to a slower recovery? I hope he improves for his sake and yours.....not easy..

Vinny

 

[Jamie]

@Anne27 .....how are things going now? I am concerned about you as the caregiver for your husband! I hope things are better now, but if they aren't and he's still not moving about much, I think it would be a good idea to discuss this situation with your GP. It does sound like he may have some depression going on that could be treated. There is no reason for him not to start an exercise program to regain his muscle tone and strength.

 

[Anne27]

My husband had dealt with limited mobility for about 3 years prior to his knee replacement as a result of the nerve problem. The pain was never really a big issue - more a feeling of weakness. The new knee, six months out, is great...very successful surgery...but he can't walk very far because of the "pulling sensation" and weak feeling in the quad. Spoke to his surgeon's nurse today. They want to see progress notes from his physical therapist to determine if what's going on is normal for someone with his history. He had always been told that his recovery would take longer. Thanks to you both for your replies.

 

[Anne27]

My husband's nerve damage occurred three and a half years ago. We have been to neurologists who said there is some femoral nerve damage but it's "not severe." Camper, I do feel that at this point he has more nerve function than you did early on. He can do leg raises and almost all the exercises his physical therapist gives him except for walking very far- he says the pulling sensation stops him and doesn't improve the more he walks - and walking up stairs. He still cannot do stairs without a handrail, he really needs two handrails. The pulling, for him, starts higher up, in the quad.

The knee surgery itself was very successful. He has recovered well from that. I'm thinking that a healthy knee is now making demands on muscles that are not working right and/or haven't been called on to perform in a long time. Nevertheless, I feel it is time to address this quad issue, even it means returning to the surgeon for his advice on what to do next. My husband has an excellent physical therapist who is aware of this pulling problem and says regardless of the cause, he needs to strengthen the muscles.

I'm glad that your recovery, although it had taken a detour, is progressing. You seem to have a good attitude even with the nerve block complication. (With my husband's history, they opted not to do one since he already had the nerve damage.) We both wish you well and will give you updates, especially if they could benefit others in any way. Best regards.

 

[Josephine]

My husband will soon be five months post LTKR. Everyone says he must walk ("to the point of exhaustion' his surgeon said) but he won't

I'm curious to know what kind of exercising he is doing.

 

[Anne27]

@Josephine Physical therapy twice weekly consisting of recumbent bike, treadmill, stairclimber, machine on which he lies down and pushes with his legs, straight leg raises with weights, sitting on edge of table and raising legs with weights, walking, side slides. The therapist also does a lot of manipulation and massage of the leg and knee area - sometimes the manipulation is quite painful. No TENS or ultrasound. Sessions last about two hours. Been doing this for about three months. My husband also does daily exercises at home.

 

[Orthodoc]

Was the femoral nerve injury from a regional block?

Orthodoc

 

[Anne27]

@Orthodoc No, the femoral nerve damage was the result of a herniated disc at L2-L3 three years ago. He had a microdiscectomy four months later - surgeon said the nerve was "pretty beat up but it sprung right back." He predicted an 85% recovery of function. The knee deteriorated after a while and prevented him from walking, so it's hard to tell how much the nerve has recovered. Today his therapist set up a 15 week walking program for my husband. The therapist has never waivered from his belief that my husband is recovering well and although this nerve injury will "always be with him" walking is his best exercise at this point.

 

[Josephine]

consisting of recumbent bike, treadmill, stairclimber, machine on which he lies down and pushes with his legs, straight leg raises with weights, sitting on edge of table and raising legs with weights, walking, side slides.

How much of each though? It sounds a lot.

The therapist also does a lot of manipulation and massage of the leg and knee area - sometimes the manipulation is quite painful.

That should stop. It could not be helping his motivation.

My husband also does daily exercises at home.

Well this is what I wanted to know about. How many reps, sets and session.

If you're not familiar with this, it goes like so:
1 lift of your leg = 1 rep (repetition)
5 reps and then a brief rest = 1 set
5 sets and finishing = 1 session.

 

[Clipless]

I wonder if the wicked trio- weakness, pain and inflammation- is getting your husband down? Sometimes, for some of us, pain doesn't register properly. Maybe his "pulling" feeling is really pain. If so, he needs to treat it.

Maybe there's an activity to motivate your husband. Would he, for example, enjoy going to the gym with you? There's lots for leg work at a nice gym- machines, jacuzzi, pool, classes. Gold's Gym, if there's one near you, is offering a free 7-day trial membership through the end of March.

 

[Anne27]

@Orthodoc

No, the femoral nerve damage was the result of a herniated disc at L2-L3 three years ago. He had a microdiscectomy four months later - surgeon said the nerve was "pretty beat up but it sprung right back." He predicted an 85% recovery of function. The knee deteriorated after a while and prevented him from walking, so it's hard to tell how much the nerve has recovered. Today his therapist set up a 15 week walking program for my husband. The therapist has never waivered from his belief that my husband is recovering well and although this nerve injury will "always be with him" walking is his best exercise at this point.

Your thoughts would be greatly appreciated.

 

[Orthodoc]

This is a difficult problem. Frequently nerve damage can take a very long time to recover; however, 3 years seems to an adequate enough time. If the ongoing weakness is related to the HNP, thus effecting the femoral nerve, then it is possible that the weakness could be permanent. Your back surgeon would know best for this.

Orthodoc

 

[Anne27]

@Orthodoc Thank you.